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Post by dreamboatcruise on Sept 12, 2016 11:48:00 GMT -5
It is great we have a window of opportunity to inhale; however, my follow up question would be..."How quickly do people recognize that they are having a severe attack?" I know people with severe allergies that observe the symptoms mentioned in the window above that attribute these symptoms to being "no big deal" and that it will pass. No one wants to inject themselves immediately without assessing the situation for several minutes. I doubt anyone would take a dose of epinephrine within the first 10 minutes and even more so if they have never experienced an attack before. Thoughts? I would think a factor would be what side effects taking epi has. Replacing injection with inhalation would likely lower barrier for the decision to dose, assuming epi side effects and risk are low.
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Post by boomboom on Sept 12, 2016 11:48:25 GMT -5
Peppy, so when the airway is obstructed so severely, wouldnt this mean we are in the severe respiratory zone or the shortness of breath zone? Will someone with shortness of breath immediately administer epinephrine? The obvious answer sounds like yes but because I have never experienced this I have to ask. Sorry I am just not familiar enough to speak too competently about this subject.Just making observations from the chart. Loving the education here.
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Post by boomboom on Sept 12, 2016 11:52:01 GMT -5
DBC, I also was thinking the same way and also do not know the repercussions of taking an epi dose. what is the outcome if you are not experiencing an attack but think you are and still take an epi dose. can it be lethal or did you just "waste" a dose and now you have to buy another one?
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Post by derek2 on Sept 12, 2016 11:52:05 GMT -5
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Post by goyocafe on Sept 12, 2016 11:57:00 GMT -5
imagine if they'd filed in Jan 2016
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Post by saxcmann on Sept 12, 2016 11:58:42 GMT -5
It is great we have a window of opportunity to inhale; however, my follow up question would be..."How quickly do people recognize that they are having a severe attack?" I know people with severe allergies that observe the symptoms mentioned in the window above that attribute these symptoms to being "no big deal" and that it will pass. No one wants to inject themselves immediately without assessing the situation for several minutes. I doubt anyone would take a dose of epinephrine within the first 10 minutes and even more so if they have never experienced an attack before. Thoughts? Pfeffer said MannKind is aware of that issue, but that since respiratory symptoms typically don’t start until several minutes into an anaphylactic attack, there would be time to use an inhaler before symptoms become life-threatening. “Most people want to be pretty sure before they stab themselves in the leg with a big needle,” he said. “That’s often why people wait too long. We thought we could put epinephrine into a form that’s not as intimidating to people so that people would use it sooner in the process with less hesitation.” Read more: mnkd.proboards.com/thread/6034/epi-pen-pricing-rising#ixzz4JgkFbc00
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Post by sophie on Sept 12, 2016 12:04:36 GMT -5
It is great we have a window of opportunity to inhale; however, my follow up question would be..."How quickly do people recognize that they are having a severe attack?" I know people with severe allergies that observe the symptoms mentioned in the window above that attribute these symptoms to being "no big deal" and that it will pass. No one wants to inject themselves immediately without assessing the situation for several minutes. I doubt anyone would take a dose of epinephrine within the first 10 minutes and even more so if they have never experienced an attack before. Thoughts? I would think a factor would be what side effects taking epi has. Replacing injection with inhalation would likely lower barrier for the decision to dose, assuming epi side effects and risk are low. If MNKD is going to use that as an advertising point, they'd better make sure the cost stays fairly low. You don't want people dying from not administering the medication because they don't want to spend money on the next dose.
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Post by centralcoastinvestor on Sept 12, 2016 12:05:05 GMT -5
imagine if they'd filed in Jan 2016
Got to love Sanofi, don't ya.
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Post by audiomr on Sept 12, 2016 12:07:03 GMT -5
Epi, time tables Doesn't that slide suggest that an inhaled drug would be inappropriate? "Wheezing, shortness of breath, swelling of...pharynx"? No. The drug can be administered as long as the patient can still inhale, so there's a reasonable amount of time. And a Cricket will be a lot easier to carry around than an epi-pen.
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Post by audiomr on Sept 12, 2016 12:10:14 GMT -5
Doesn't that slide suggest that an inhaled drug would be inappropriate? "Wheezing, shortness of breath, swelling of...pharynx"? Those are the symptoms: Wheezing, shortness of breath, swelling of...pharynx. The symptoms tell you, I need intervention.
Afrezza epi, is the intervention. Quick as can be. delivered to the site. stopping the spasm. allowing relaxation. allowing breathe.
Couldn't be a better set up.
Not delivered to the site, delivered to the lungs where the epinephrine can be absorbed into the bloodstream. Anaphylaxis is a systemic reaction. Local responses such as swelling of the pharynx are just symptoms. The windpipe is not the target.
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Post by audiomr on Sept 12, 2016 12:15:33 GMT -5
It is great we have a window of opportunity to inhale; however, my follow up question would be..."How quickly do people recognize that they are having a severe attack?" I know people with severe allergies that observe the symptoms mentioned in the window above that attribute these symptoms to being "no big deal" and that it will pass. No one wants to inject themselves immediately without assessing the situation for several minutes. I doubt anyone would take a dose of epinephrine within the first 10 minutes and even more so if they have never experienced an attack before. Thoughts? But we're not talking about an injection. People are a lot more likely to inhale promptly than they are to inject promptly. You know you're having a severe attack if the symptoms continue to worsen, and for folks with really bad allergies (nut allergies seem to be among the worst in this regard), all attacks are severe.
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Post by babaoriley on Sept 12, 2016 12:18:40 GMT -5
From a legal perspective, I think the individual still needs be told to carry an epipen around with them, just in case. And they would use that pen when their allergic reaction prevented them from inhaling with sufficient force. I don't know if people's symptoms always are the same; if they are, then those who have never experiences severe shortness of breath as an early symptom would be fine, and those that do, would be told to make sure they have a pen available (or not use it at all, kinda like smokers and Afrezza).
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Post by audiomr on Sept 12, 2016 12:20:30 GMT -5
DBC, I also was thinking the same way and also do not know the repercussions of taking an epi dose. what is the outcome if you are not experiencing an attack but think you are and still take an epi dose. can it be lethal or did you just "waste" a dose and now you have to buy another one? Not lethal but possibly annoying -- agitation, sweating, dizziness, nausea, headache, racing heartbeat are all possible side effects. But the chances of someone taking epi when he doesn't need it are small. If you're carrying it around, you're going to be pretty darn sure when you actually need it.
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Post by audiomr on Sept 12, 2016 12:23:06 GMT -5
From a legal perspective, I think the individual still needs be told to carry an epipen around with them, just in case. And they would use that pen when their allergic reaction prevented them from inhaling with sufficient force. I don't know if people's symptoms always are the same; if they are, then those who have never experiences severe shortness of breath as an early symptom would be fine, and those that do, would be told to make sure they have a pen available (or not use it at all, kinda like smokers and Afrezza). You're still going to want epi-pens in school nurse stations and emergency rooms for use on patients who are unconscious. But if you have an epi-Cricket with you, you shouldn't need to have an epi-pen on your person as well.
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Post by peppy on Sept 12, 2016 12:25:34 GMT -5
Do you administer epinephrine after that 30 seconds? Asthma Care Quick Reference DIAGNOSING AND MANAGING ASTHMA www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf
Select medication and delivery devices that meet patient’s needs and circumstances. Use stepwise approach to identify appropriate treatment options (see page 7). Inhaled corticosteroids (ICSs) are the most effective long-term control therapy. When choosing treatment, consider domain of relevance to the patient (risk, impairment, or both), patient’s history of response to the medication, and willingness and ability to use the medication.
Immediate Hypersensitivity Reactions Treatment & Management emedicine.medscape.com/article/136217-treatment Treatment is as follows:
• Administer epinephrine immediately (see Medication). This is the most important medication and the only medication that has been shown to decrease mortality due to anaphylaxis.
• Start intravenous fluids; these should be administered rapidly and as blood pressure and overall fluid status warrant. • Consider other vasopressors (eg, dopamine) if hypotension does not respond to the above measures. Norepinephrine may be used if dopamine is not effective. Importantly, isoproterenol should not be used because it is a peripheral vasodilator. Patients with beta-adrenergic blockade may be particularly difficult to treat. They have both chronotropic and inotropic cardiac suppression and may not respond to the above treatments. Glucagon has positive inotropic and chronotropic effects and is the drug of choice in these cases. Atropine can also be used but will only be effective in treating bradycardia. • H1- and H2-receptor blockers can be helpful in alleviating hypotension, pruritus, urticaria, rhinorrhea, and other symptoms. Cimetidine, when combined with any of several H1 antihistamines, has been demonstrated to block histamine-induced hypotension. Other H2 blockers have not been studied in this context. • Use albuterol nebulizers if needed. • Administer a corticosteroid, which is believed to help prevent or control the late-phase reaction. • Transfer the patient to the hospital for further observation and care. • Late phase reactions can occur 4-6 hours after the initial reaction and can be as severe as or worse than the original reaction. In some cases, late phase reactions can occur up to 72 hours later. Education of the patient and observation is, therefore, important.
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