image066Ask Mark …

Cindy is concerned about when to take Brovana, Spiriva and Symbicort.

Mark advises, You do not need to wait between treatments when it comes to taking Brovana and Spiriva or Symbicort and Spiriva. You should not be taking both Brovana and Symbicort on a regular schedule. They are both long-acting beta agonists and if both taken over a long period of time can cause issues with your breathing, heart and possibly your blood pressure. Please check with your physician to review the medications that you are taking.




Jane wants to know if there is a differ­ ence between the oxygen that a concentrator delivers and that delivered from a tank.

Mark says, Medical grade com- pressed gas oxygen in tanks is 99.9998% pure, as is oxygen in liquid form that is distilled to medical grade purity.

Home concentrators make oxygen that is generally between 92 percent and 96 percent pure when they are working at their optimum levels. Concentrator systems that fill compressed gas cylinders fill those cylinders with the same purity of gas the concentrators are producing for home use. There is no decrease in purity for the gas being sent to the portable cylinders.


Betty from EFFORTS takes Advair, Spiriva and albuterol regularly and comments her heart feels like it is racing and wonders if this is normal.

If you are experiencing a racing heart, it is most likely because you are taking too much beta agonist medication. The beta agonists are one of the components of albuterol and Advair. The albuterol will make you shaky and your heart pound or race, more so than the Advair will. The albuterol should be only for rescue, not as a regular or maintenance medication.




Susan asks Mark if it is okay to use a rescue albuterol inhaler and then four hours later take a nebulizer treatment, also with albuterol. 

Mark replies, Three to four hours is an acceptable time frame between these two doses of albuterol. You may experience the side effects of shakiness, trembling or a racing or pounding heartbeat. I caution to keep in communication with one’s doctor if symptoms escalate or remain significant enough that treatments are needed as often as every three hours. If you are also taking long-acting medications such as Symbicort and/or Spiriva and are still symptomatic enough to require more than one or two treatments each day, suggests a problem and the possibility that you are having an exacerbation.

If you take the albuterol inhaler or nebulizer treatment, be sure to wait at least two hours before taking the Symbicort. If you take a nebulizer with ipratropium bromide in it, then wait two hours to take Spiriva, as well. Any sooner may interfere with the effectiveness of those medications. It is important that you know and fully understand the medications you take – why you take the ones you do and what each is supposed to do for you.

For those who require supplemental oxygen, using their inhalers will not increase or appreciably alter their oxygenation or their saturation level. Hypoxia is the result of lack of ability to get oxygen molecules through the membrane between the alveoli and the capillaries that serve them. Inhaled medications do not affect diffusion.


How Exactly Do My Inhalant Drugs Help Me?

Albuterol is a short-acting bronchodilator that relaxes muscles in the airways and increases air flow to the lungs.

Advair contains fluticasone, a steroid to decrease inflammation and salmeterol, a long acting bronchodilator that relaxes muscles in the airways to improve breathing.

Brovana (arformoterol tartrate) is a long-acting bronchodilator that helps you to breathe better for up to 12 hours at a time.

Spiriva (tiotropium bromide) is also a once-daily, long acting bronchodilator for COPD.

Symbicort contains a combination of the steroid budesonide and formoterol, a long-acting bronchodilator.