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  AH! (Asthma Health)
Quality Network Newsletter

June, 2008

Table of Contents

Program Update       
Asthma News      
Clinical Update    
Asthma Tools and Resources

Program Update

Welcome Dr. Vance Brown
MaineHealth welcomed Dr. Vance Brown as the new Chief Medical Officer on April 1, 2008.  Previously, he was the Chair of the Department of Family Medicine, Research Director of the Division of Regional Medical Practice, and Medical Director, Cleveland Clinic Foundation Strongsville/Brunswick Family Health Centers.  At the Cleveland Clinic, Dr. Brown also lead the quality improvement efforts for the Department.  He completed residencies at University of North Carolina Hospitals, UCLA Medical Center and Yale-New Haven Medical Center.  He received his BS at Stanford University in 1980 and his MD at Yale University School of Medicine in 1985. 

AH! Asthma Annals
Click here for the latest edition which features the results of a recent patient survey of the value of asthma education and a handy FAX referral form.

Asthma Education goes Regional 
If you don't currently have an asthma educator on site, you may be interested in referring to an asthma educator in the region who can work with your patients. Asthma educators are just a click away.  Use this FAX referral form  to connect your patient to an asthma educator near you.

Asthma News

Xopenex HFA Update
Recently the manufacturer of Xopenex HFA, Sepracor, informed the state of Maine that it would not honor the remainder of its multi-year contract, terminating it effective June 30, 2008.  Their stated reason was that they were not making enough money.  This means that the State needs to enter into contracts with the other manufacturers of albuterol HFA. The State has made arrangement for ProAir, Ventolin HFA, and Proventil HFA to be preferred and available without prior authorization to MaineCare members effective July 1, 2008.
The Phoenix Event
On Friday, May 30, 58 people gathered for the Asthma Phoenix Event at the Elks Club in Waterville to reinvigorate the community working with issues related to asthma in Maine, to share information and to offer some ideas to move forward with the development of a statewide asthma plan with working partners.  David Callahan, MD, Director of the Asthma Research Team at CDC spoke about the national perspective; Laurie Stillman, Director of the Asthma Regional Council of New England gave the regional perspective; Katie Meyers, Maine Asthma Program Epidemiologist, the state perspective and Ed Miller from the American Lung Association of New England gave an overview of the Asthma Policy Project. Attendees pooled experience and knowledge gained during the day to begin to develop statewide direction for asthma in Maine. The event also included a report on the recently released document, The Burden of Asthma in Maine 2008 produced by the Maine Center for Disease Control and Prevention.  For a copy of this document, email

Save the Dates
The American College of Chest Physicians (ACCP) - announces the Tenth Annual Community Asthma and COPD Coalitions Symposium in Philadelphia, PA on Wed. and Thurs. October 29-30, 2008.  This symposium is part of CHEST 2008, the annual international scientific assembly of the ACCP.  For more details, go to and then in the left hand toolbar select asthma coalition. 

The American College of Allergy, Asthma and Immunology (ACAAI) Annual Meeting will be held November 6 - 11, 2008 in Seattle Washington.  Click here for a brochure and registration information.   

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Clinical Update

Eliminating Chlorofluorocarbons (CFC) -Albuterol.
In the modern history of medicine, therapeutic agents have been recalled, removed or banned for many reasons. A very atypical withdrawal becomes final on December 31, 2008, which will be the last day of sale, transfer or even gifting of CFC-containing albuterol MDIs. According to the Director of Respiratory Division of the FDA, Dr. Badrul Chowdhury1, this is the first time that an effective medication has been removed from the market in the USA for an environmental issue. Clearly the Montreal Protocol with its 191 signatory nations has made clear that these benefits accrued by stopping chemicals that deplete the ozone layer outweighs the many problems and inconveniences and costs of changing the propellants to non-CFC products. 

The first HFA albuterol product was introduced in 1996, and since then two additional racemic albuterol MDIs using HFA as a propellant have been brought to market. A separate product L (or lev)-albuterol was also introduced two years ago. In the past three years there have been at least three albuterol HFA products available, for large populations to use. The original requirements for post marketing surveillance and adequate supplies have been met, and so the transition has been progressing. A recent EPA estimate is that 60% of the patients who use albuterol MDIs have made the transition to an HFA product.

However, the products available are not identical and each has specific differences. These differences need to be noted and taken into consideration when they are prescribed. Since there are only branded products available, prescriptions and patient instructions should be appropriate to each product. It is important to note that the propelled spray (plume) is softer than CFC propellants and patients need to be reassured that they will be receiving the correct dose of active ingredient. There are also differences in excipients and taste. Cleaning instructions are important as well as priming. Also, there may be price differences among the branded HFA products, which cost more than the soon to be discontinued CFC products, since generics were available. Physicians should monitor patients making the transition to HFA albuterol to be sure they understand the differences in the use and care of the newer products.

Click here to see Table 1 HFA - Albuterol Products

Hugh A. Sampson, M.D., FAAAAI
AAAAI President
Jay M. Portnoy, M.D., FAACI
ACAAI President
American Academy of Allergy, Asthma & Immunology
555 E. Wells Street
Suite 1100
Milwaukee, WI 53202-3823

Note:   Click here for a copy of Inhaled Asthma Medications - quick-relief on one side and controller on the other.  It provides information on priming the medications.

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Asthma Tools and Resources

NHLBI Clinical Guidelines
The (NHLBI) National Heart, Lung and Blood Institutes' updated Asthma Guidelines will soon be available.  The AH! Program has been working to develop this 480+ page document into an easy-to-use flipchart format.  Look for the new flipchart on J.S. McCarthy website in early August:

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Health Information
AH! Asthma Camp
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