HFA Inhalers Really Grind My Gears

I can remember it like yesterday, my last puff from my CFC MDI albuterol inhaler, it was that cold consistent blast of life my body so desperately needed. I’ve had severe asthma my entire life, so I can say that over the years I have learned what products work for me the best in preventing or stopping an asthma attack. However, the FDA stepped in and last year CFC MDI inhalers were banned in the United States because of the clean air act. Many people out there might be wondering, “What’s the big deal, there obviously is something else out there that’s just as effective and good for use if the government is stepping in and banning one product.” My answer is yes there is another product, how useful it is where I my gears get grinded.

For those who started reading this and are wondering what CFC MDI is its chloroflurocarbon metered-dose inhaler. Albuterol needs a carrier compound to help in delivering it to the lungs, so CFC was used for more than 50 years. The change of the CFC MDI comes after the Montreal Protocol on Substances That Deplete the Ozone Layer (MPSTDOL) met and decided that these inhalers are not environmentally friendly and can affect the ozone. However, the MPSTDOL looked at CFCs as a whole and not individually. CFCs were used in many other things like fire extinguishers, air conditioners, and industrial refrigerants besides just their medical use mention here. So CFCs were taken as a whole into consideration and decided upon the need to replace them with something more environmentally friendly…keywords: environmentally friendly.

HFAs (hydrofluoralkane) are the new kid in town that’s taking over CFCs. HFAs haven’t been around for very long but the FDA approved the cutting of CFCs in 2005 so testing of the HFAs hasn’t been going on for as long as the CFCs. This may not be a crucial part the changing over but in 2008 HFAs were only making up 5-10% of the albuterol sales. With doctors fully knowing that a change was coming, why wouldn’t they get their patients ready for the change? Now there isn’t any information on why doctors didn’t but it just seems odd to me that they didn’t inform or ready their patients for the change and I just wanted to point it out.

Now in the journal article “Final Count Down to HFA Albuterol Inhalers: Are We Ready as Yet?” there is a nice table that I can not find a way to place here that list which HFA or CFC is better at. When I look at this table it is pretty equal across the board on which is the better delivery method except for the fact that in the paper they consider the CFC inhalers and environmentally unfriendly due to the previous studies on the whole group of CFCs. That grinds my gears because it obviously gives the HFA an overall better look.

The HFA is considered a better steroid because it is smaller and can deliver the medicine deeper into the lungs unlike the bulky CFC. Now asthma attacks can occur at different levels in asthmatics lungs. For me I know that the majority of my asthma attacks start in my upper lungs and spread down to the smaller air sacs. Because of this the reaction my body receives from the HFA inhalers is delayed and I feel the need to keep puffing on my inhaler. Some may think that that’s not a problem but it definitely is when looking at the cost of the product.

HFA inhalers cost anywhere from $30-$60, while the CFC inhalers cost $5-$25. So now for me to feel like I’m protected against my asthma I spend more money, but I never seem to get my monies worth out of an inhaler because it doesn’t seem to last and insurance has to be considered here too. Insurance will only allow you to purchase one inhaler a month. Before with the CFC inhalers I could go three months without replacing my inhaler, and now with the HFA inhaler I can barely make it a month. For me this is frustrating since my asthma is in the severe category and I need to be carrying an inhaler with me at times even if the inhaler doesn’t seem to be working properly.

These new HFA inhalers need to be cleaned out weekly or steroid builds up and clogs the spray hole. I have been stuck before when I needed the inhaler badly and it hasn’t worked because I used it for two days and the spray hole was clogged. Now I haven’t seen any studies out there that have looked at the correlation between asthma deaths to those due to improper maintenance of inhaler but it would be interesting to see done. Now with the CFC I never had a problem with clogging. When the HFC clogs it limits the dose received. Its frustrating that I just now saw that it needs to be cleaned weekly. I was never told this and it was never apparent in the material given with the inhaler or made clear. I feel like that the cleaning of the inhaler so that it can be used properly would be very important to tell patients.

If all of that hasn’t grinded my gears enough I voiced my concerns of the new inhalers with my family doctor, who just so happens to be one of the people that gets to review all inhalers and their design and ease of use. It was refreshing that he felt the same about the new inhalers and is currently trying to get them reversed back to the CFC MDI albuterol inhalers. He provided me with some aggravating information on the CFC inhalers that they have been provided within his focus group. One plane flying from L.A. to NYC produces more harm to the environment and ozone than did all the CFC inhalers being used do in a complete year. That stat with the obvious problems that can occur and the cost of HFAs really grinds my gears!

1.Butt, Ahmed T et al. Final Count Down to HFA Albuterol Inhalers: Are We Ready as Yet?. Clinical Pediatrics. Vol 48. March 2009.
2. Evans, Jeff. Switch to HFA-propelled albuterol inhalers now, FDA advisory urges. Entrepreneur. August 2008.

Dave’s 800-1000 Word Dissertation on Beer...and Other Manly Insights

Man, four years flies by fast. It seems like just yesterday that my parents drove me to AU to attend college. My mom teared up as she imparted some of the most poorly chosen words of wisdom I’ve ever heard. She said to me, “David, college is a fountain of wisdom, and you’re here to drink”. After hugging my parents goodbye, and promptly ditching them to go have dinner with a cute girl that I had met mere minutes earlier, I set out to drink from that fountain. And drink I did.

A couple years later and here we are, learning how to communicate the concepts we've learned. During our Sr. Seminar course, Dr. Posner has given us some very useful advice on how to present data. My approach is to mix humor with factual information in an attempt to keep the material lively and engaging. I will probably always remember Dr. Posner saying that if the audience walks away with two take home messages, the presentation was a relative success. I’ve left college with two take home messages...and feel relatively successful.

Take Home Message #1: College is a collection of classrooms where you sit for roughly 1,500 hours trying to memorize things. The rest of the time is spent napping and trying to get dates. Therefore, avoid choosing a major that involves “known facts” or “right answers”. Philosophy is generally a good choice because from my understanding you sit in a room, decide that reality doesn’t exist, and then go to convo for lunch.

Take Home Message #2: The things you learn in college can be thrown into one of two categories. The first are things you need to know later in life. It will take about 2 hours of your college career to learn all of these. The other 1,498 hours are spent learning things you will not need later in life. These things typically end in –ics, -ology, istry, ect. The key here is to write the things you learn in these classes down in little examination books and then forget it. Those of you who fail to forget it will inevitably become university professors and be forced to stay in school the rest of your adult life.

But I digress. My undergraduate career in biology has taught me a few things I know with relative certainty. For instance, the hormone testosterone plays a key role in promoting muscle development, bone mass, and the inability to stop pressing the channel changer until Cops comes on. It’s also the reason men don’t ask for directions. This is why it takes several million male sperm cells to locate a female egg. Another thing that I’ve learned via my biology career is how to make beer. I like beer. I’ll enjoy a nice brew to celebrate occasions such as the fourth of July, my mom’s birthday, or that my fridge is still working. The beer making process has inspired me to read several papers on the purported benefits of occasionally enjoying a good brew.

For those of you who are completely oblivious to what exactly that golden nectar of the gods is, beer is a fermented beverage comprised of malted cereals and spiced with hops. The fermentation of sugars released in the brewing process results in an alcoholic beverage that is pleasing to drink, and scientifically complicated. Craft beer, much like wine, contains compounds that have been scientifically shown to improve heart health and other proliferative effects. A study conducted in 1999 by Miranda et. al. reported the cytotoxic effects of one such compound on human cancer cell lines. The flavinoid compound present in hops, called xanthohumol was shown to diminish the proliferative activity of human breast cancer, ovarian cancer, and colon cancer cells in vitro. The researchers treated the cancer cells with a dose dependant amount of the compound to study its effect on the cancer cells. After two days, the growth of the cancer cells was inhibited by 50% at the 13.3 um dose. A 3.47 um dose retarded cancer cell growth by 50% after 4 days. The compound was found to be extremely effective against a stain of ovarian cancer cells in which a 5.2 um dose completely retarded growth of the cells after 4 days (Miranda et. al., 1999). The compound has also proved to be a powerful antioxidant. The implication of this study is that the effective chemical can be refined and used to prevent cancer occurrences.

Figur 1: Xanthohumol Effects on Ovarian Cancer Cell Line



















However, the concentration of xanthohumol in most beer has recently been proven to be 0.002-0.628 mg/L-1 using sensitive HPLC quantification (Chen et. al., 2010). Unfortunately, this molecule is present in such minute quantities that one would need to consume nearly 1,300 12 ounce bottles a day for the amount of xanthohuol to be beneficial. Therefore I recommend that you consume 120 gallons of beer daily to reap the benefits.

If you need another reason to drink to your health, it’s been widely demonstrated that light consumption of alcoholic beverages ahs been associated with reduction in cardiovascular related mortality. Moderate alcohol intake has shown to improve lipoprotein metabolism as well (Kondo, 2004). The effects of antioxidants on atherosclerosis have been well documented. Figure 2 in the paper shows the effects of beer, water, and red wine on the antioxidant levels in the blood circulation of rats. The data suggests that the antioxidants in beer may be more easily absorbed than those in red wine.

Figure 2: Antioxidant Levels in Blood











So here’s to you guys. It’s been great getting to know everyone and good luck to you in all your future endeavors. Have a drink to your success thus far. Cheers!


Sources:

Miranda et. al. “Antiproliferative and Cytotoxic Effects of Prenylted Flavinoids from Hops (Humuls lupulus) in Human Cancer Cells”. Food and Chemical Toxicology. Vol 37, p. 271-285. 1999.

Chen et. al. “Determination of xanthohumol in beer based on cloud point extraction coupled with high performance liquid chromotrography”. Talanta. Vol 81, p. 692-697. 2010.

Kondo, Keiji. “Beer and health: Preventative effects of beer components on lifestyle-related disorders”. Biofactors. Vol 22, p. 303-310. 2004.

Sweet Dream or a Beautiful Nightmare

Just like Beyonce’s song, a night of sleep can end up as a “Sweet Dream or a Beautiful Nightmare,” well, in my experience nightmares are not beautiful, but she's the uber-famous recording artist, so I'll let it slide . But the real question is what causes us to have a sweet dream or a nightmare?

There are two types of sleep that we experience, Non-Rapid Eye Movement sleep (NREM) and Rapid-Eye Movement sleep (REM).

REM sleep is the time that we experience our most vivid dreams, 75% of sleep occurs NREM. Dreams during NREM sleep are very rare, muscles are not paralyzed and there is minimal eye movement. NREM is divided into 3 stages, each with distinctive brain wave patterns.

Stage 1 of NREM sleep is the beginning of sleep, the eyes are moving slowly, brain monitors show that alpha waves disappear and theta waves appear. In stage 1, sleepers often experience a hypnic jerk, which is an involuntary muscle twitch, resembling a “jump” made when a person is startled, a sensation of falling often occurs with a hypnic jerk. This happens to me all the time, I lay down and then see myself running in a field, only to fall in a whole and wake up “jumping” or trying to catch myself and break my fall.

Stage 2 of NREM sleep, there is no eye movement and the sleeper is a very light sleep. Stage 3 is characterized as a very deep sleep, known as slow-wave sleep. Dreaming is common in this stage, but not nearly as common as in REM sleep. Dreams in this stage tend to be less memorable and typically are not remembered as they are in REM sleep. Stage 3 is the stage that many people with sleeping disorders, such as sleep walking are in when they sleep walk.

To start, a dream or nightmare occurs during the REM or Rapid Eye Movement sleep, you guessed it, at this point in sleep, and the eyes are rapidly moving. This comprises roughly 20-25% of an adult’s sleep each night. During REM sleep, the activity of the brain is very similar to that when a person is awake, but the body is paralyzed, due to the relaxed state of the skeletal muscles at this time, because motor neurons are not being stimulated.

Types of dreams
When we are asleep, there are a number of different types of dreams that we can have. They include dreams, lucid dreams and nightmares. Dreams are classified as a grouping of images, thoughts, sounds and emotions that the mind experiences.
Lucid dreams are the type of dreams in which we are aware that we are dreaming, so we can actively participate in and change the events and locations that happen in the dream, how aware we are during the dream determines how realistic it is.

We’ve all probably had at least one nightmare in our lives, but for any of those lucky few who haven’t, a nightmare is typically classified as a dream that triggers a strong negative effect from the sleeper, such as fear. Nightmares typically contain situations of discomfort, pain, danger, psychological or physical distress. Often times a sleeper will wake up from the nightmare in a distressed state and may be unable to go back to sleep.

It is interesting to look at how nightmares are perceived by different cultures. Some cultures believe that nightmares are a sign that the dreamer is open to physical and spiritual harm, while in other cultures they are thought to contain messages from the spirits that can predict the future. To me though, Nightmares=Not fun.

Nightmares can have a number of causes both physical and emotional. Some physical causes are sleeping in uncomfortable positions, fever and eating too close to bedtime (this increases the body’s metabolism and brain activity, potentially triggering nightmares). Some emotional triggers of nightmares include depression, stress, anxiety, experiencing a traumatic incident, such as rape and post-traumatic stress disorder.1

The typical protocol for the treatment of reoccurring nightmares is to treat the underlying problem, or believed cause of the nightmare. Using this hypothesis for treatment, treating the cause/trigger, the nightmares should fade away.

For nightmares that persist after treating the believed underlying cause, a treatment known as Imagery Rehearsal Therapy can be used. In this type of treatment a person, while awake writes down or describes their nightmare, and then while still awake writes an alternate ending to the nightmare, so that it does not upset them. The person is then instructed to visualize and continually replay this rewritten nightmare (now a new dream) in their minds.

A study published in 2000 involved nearly 200 women who had been victims of sexual assault, who were plagued by nightmares. They were divided into two groups, one group which maintained their regular sleep routine, while the other group was given Imagery Rehearsal Therapy. At the end of treatment, the women in the Imagery Rehearsal Therapy group had a significant decrease in nightmares and disturbing dreams. 2

So the next time that you lay your head down to sleep, try your best to think happy thoughts and hopefully you will have a Sweet Dream or a Beautiful Nightmare.

Check out Rhytmn City's (a dance crew from the fourth season of ABDC) take on a Sweet Dream or a Beautiful Nightmare...



1Forbes, D. et al. (2001) Brief Report: Treatment of Combat-Related Nightmares Using Imagery Rehearsal: A Pilot Study, Journal of Traumatic Stress 14 (2): 433-442
2Johnston L, Krakow B, Melendrez D, Herlan M, Hollifield M, Chavez-Kennedy D. 2000. Treatment of nightmares and insomnia in crime victims. Sleep 23 (Suppl #2): A316.

The Squirrels of Ashland

This video shows the squirrels around Ashland University. Although often comical, the video offers some squirrel facts as well to the interested viewers. Really though, who wouldn't want to watch Blair and Pat chase squirrels?

I'll Have a McCancer With Fries Please

In the past few years’ comical documentaries with serious messages have been sweeping the nation targeting the health consequences that can arise from fast food consumption and obesity in general. Some recent films include those such as “Supersize Me” and “Fast Food Nation."

SUPERSIZE ME TRAILER

Obviously eating fast food is not the best thing for any individual provided most cheeseburgers and French fries come laden with high amounts of sodium, fat and calories. However, beyond knowing how eating this food can give you a bulging waist line, it can also lead to levels of obesity that can greatly increase one’s risk to develop breast, pancreatic, and gastrointestinal cancers. [1] One research project conducted focused on demonstrating the relationship between obesity and breast cancer. It has been estimated that for every 5kg of weight a woman gains, the risk of developing breast cancer is increased by 1.08%. Furthermore, just an increase of one point in BMI could increase the risk of developing breast cancer by 3%. The analysts also found that obese women have a 31% increased risk of developing breast cancer. As can be seen via analysis of BMI, overall weight gain, as well as hip and waist girth the risk of breast cancer was determined. However, all of those factors can also prevent proper diagnosis of breast cancer due to several factors. [1]

One factor that can help determine the relationship between obesity and cancer development is the discovery that hormones are not properly regulated in individuals with excess weight. Obese women have a 35 % higher concentration of estrogen and 130% higher concentration of estradiol compared to women who are of normal or healthy weight. An increase in these hormones promotes increased adiposity of cells, which could lead to tumor development. Concomitant hyperinsulinaemia is another hormone found in abundance in obese women, which may promote mammary carcinogenesis by increasing the levels of insulin-like growth factor leading to tumor development. Another hormone that can cause the development of cancer if not properly regulated is leptin, which is part of a family of hormones, produced by adipocytes and has been associated with carcinogenesis in the past.

Beyond the realm of hormones, researches discovered that individuals who are obese have a higher risk of developing problems associated with the tumors that arise when one contracts breast cancer. In obese individuals it has been found that the tumors are often larger once the breast cancer is discovered and the tumors often have markers of high cellular proliferation on them. [1]

Lastly, perhaps the most devastating effect of obesity on breast cancer is the hindrance obesity causes on the various treatment options. One option to treat breast cancer is surgery. Those who are obese and under go surgery are more likely to suffer complications both during and after the procedure then those who are of a more normal weight. Obesity can also alter the success of radiotherapy and chemotherapy provided the tumor and cancerous cells cannot be as easily found or attacked. As can be seen breast cancer can drastically affect one’s chance of developing cancer and how well it is treated, however obesity can also increase one’s chance of developing pancreatic cancer. [1]

The study to determine the relationship between obesity and pancreatic cancer determined that excess body weight both accelerates pancreatic cancer development along with increasing the progression of the disease. The researchers admit that they are unaware of the mechanisms behind such a finding, however obesity acts to disturb the functioning of the immune system one way or another. In the study researchers utilized six lean mice and six obese mice. The tumors that grew in the mice were analyzed and immunochemistry was utilized to see the impact on both T and B cells. [2]

At the conclusion of the study it was determined that in mice who were over weight, pancreatic cancer tumors grew larger, metastasized more and overall decreased the survival of obese mice. The mice with the tumors also had lower amounts of circulation T and B cells. Researchers found the lower amounts to be due to down regulation of B cells as well as immunoglobulin gene expression. It is believed that a down regulation in tumor infiltrating lymphocytes was responsible for the lower lymphocyte amounts provided in analyzed tumors from obese mice, there were fewer tumor infiltrating B cells. [2]

Thus the main findings of the study were that T cells, B cells, and macrophages are present in pancreatic cancer tumors of both obese and lean mice. However, in comparisons to the tumors analyzed in lean mice, those from obsess mice once again had the lower B cell amounts. So it was presumed that obesity lowers immune functioning to limit the number of lymphocytes produced to combat developing cancerous tumors. [2]

As can be seen from the studies focusing on determining the relationship between obesity and cancer development previously discussed, excess weight plays a role in both pancreatic as well as breast dancer development. Moreover, obesity also has a significant role in the development of gastrointestinal cancer. [3]

The study was based on the emerging evidence that an association lays between both excess weight and gastrointestinal cancer. To determine such a relationship researches conducted a study in which both epidemiological and pathophysiological studies were conducted. It was found that sex plays an important role in the development of gastrointestinal cancers. Furthermore, it was found that adipose tissue, especially that surrounding on the visceral surface of organ is metabolically active with the ability to exert a systemic endocrine effect due to alteration of the insulin growth like hormone. Obesity’s effect on adipocytokines is well as sex steroids also suggest having a vital role in cancer development. [3]

NEWS REPORT ON CANCER AND OBESITY CONNECTION

Thus as can be seen, as America’s waistlines continue to grow at an alarming rate, so does the risk for developing life-threatening cancers such as breast, pancreatic, and gastrointestinal strains. However, combating the epidemic of obesity is hindered by the genetic make-up of humans. In the more ancestral times, individuals craved foods high in both fat and sugar since they provide the body with a greater amount of energy. However, people do not generally utilize all the calories they intake, which ultimately adds to an accumulation of body fat. If action is not taken to reverse or at least remedy the obesity epidemic, individuals could soon face a cancer epidemic, with no cure to turn to. [3]. So the next time you crave a McDouble or a Whopper you may want to reconsider your options. Or when they ask if you want fries with that, listen to the reality of “Do you want lies with that?”

[1] Carmichael, AR. "Obesity as a risk factor for development and poor prognosis of breast cancer." An International Journal of Obstetrics and Gynaecology (2006).

[2] White, P., et al. "Pancreatic Cancer and Obesity: Do B cells play an important role?" Indiana University Medical School (2010).

[3] Donohoe, C., et al. "Obesity and gastrointestional cancer." British Journal of Surgery (2010).