Oct 31, 2011

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Is this the real life? Is this just fantasy? Caught in a landslide. No escape from reality. Open your eyes, look up to the skies and see. I'm just a poor boy. I need no sympathy. Because I'm easy come, easy go. Little high, little low. Any way the wind blows doesn't really matter to me. Now that was at least as good as William Shatner. Yes, Captain Kirk has put out a new album called Seeking Major Tom on which he covers the Queen classic. Even my tone deaf ears say this is not a good version of the song. The first version of Bohemian Rhapsody I ever heard was by a bar band in Winnipeg. We had snuck into the bar underage after a hockey game because a friend of mine really wanted to see this band. Since then, Ive heard the original by Queen, many times. My favorite version of Bohemian Rhapsody is off of the movie Waynes World. Shatner doesnt hold a candle to any of these.


Now Im not saying Zenhale is a William Shatner version of an inhaler. But it is another me-too drug. Zenhale is a combination inhaler that contains mometasone and formoterol. Mometasone is a steroid that reduces inflammation inside the lungs. Formoterol is a long acting beta-agonist. That means it opens up airways in the lungs. We already have two combination steroid/long acting beta agonist inhalers on the market. Advair has the steroid fluticasone and the long acting beta-agonist salmeterol in it. Symbicort has the steroid budesonide and the long acting beta-agonist formoterol in it. Yes that is the same long acting beta-agonist as in Zenhale.


Why would a patient use one of these combination inhalers? Well they are convenient, but they shouldnt be used first line in asthma treatment. An asthma patient should always be started on a steroid inhaler alone like fluticasone or budesonide to reduce the inflammation in their lungs and a fast acting beta-agonist like salbutamol or ventolin for when they cough or wheeze. If we cant control the patients asthma with the single steroid plus salbutamol, then the doctor can consider adding a combination inhaler. Combination inhalers are generally only used in patients 12 years old and older.


How is Zenhale used? The dosage of Zenhale is two puffs twice a day. Like the other combination inhalers, a patient should rinse their mouth out with water after using Zenhale to prevent thrush. Other possible side effects from Zenhale include dry mouth and throat pain from the steroid and a racing heart from the beta-agonist. These again are similar to the other combination inhalers.


One of the differences between Zenhale, Symbicort and Advair is the devices they come in. Symbicort just comes in a turbuhaler. A turbuhaler delivers a small amount of dry powdered medication to the lungs when a patient inhales. I think the turbuhaler is one of the best and easiest of the asthma devices to use. Advair comes in a diskus and a metered dose inhaler. The diskus is another device that delivers powdered drug into the lungs, but I dont think it is quite as nice as the turbuhaler. A metered dose inhaler is what everyone thinks of when I say a puffer. A metered dose inhaler or MDI has a spray paint like canister under pressure that puffs out medication when someone pushes on it. Although most asthmatics are familiar with the MDI, they are my least favorite asthma device because they are so often used incorrectly. It is surprisingly difficult to coordinate spraying medication out of an MDI and inhaling into your lungs. Zenhale only comes in an MDI. So while asthmatics will be familiar with the device, again it is difficult to use properly.


One of the interesting possible problems with Zenhale is its color. It is blue. Asthmatic patients often refer to their inhalers by color. Their orange inhaler is fluticasone. Their white inhaler is symbicort. Their purple inhaler is advair. Most importantly their blue inhaler is salbutamol. The blue inhaler is very important because the salbutamol is what is called a rescue inhaler. The salbutamol is what the asthmatic should reach for when they are having a coughing or wheezing attack. The blue salbutamol will help them breath better quickly, within minutes. Zenhale is not a rescue inhaler. Asthmatics will have to be careful to reach for their proper blue rescue inhaler, not their Zenhale when they are having a coughing or wheezing attack.


Zenhale is a me-too inhaler. It really doesnt offer anything new that Symbicort and Advair dont offer. It is even priced about the same. But Im not going to complain about another tool in the asthma tool box. Maybe some asthmatics will prefer Zenhale over the other two combination medications for some reason I havent thought of. Zenhale isnt a new exciting treatment for asthma, but it isnt a William Shatner cover of the other inhalers either.


Okay, like everyone else, I make fun of Shatner. But I really did like him in the original Star Trek. I love him in Boston Legal. I even liked him in T.J. Hooker. But his singing is worse than mine. And that is a feat. He really shouldnt have four studio albums to his credit. Beelzebub may have a devil put aside for me, but he better have one put aside for Shatner as well.


The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca


Shatner does Bohemian Rhapsody : http://www.youtube.com/watch?v=cKo4FMzt_hM


Mike Meyers (Waynes World) does Bohemian Rhapsody: http://www.youtube.com/watch?v=VzUU7SRRsGo


Queen the originals: http://www.youtube.com/watch?v=oozJH6jSr2U



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