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sslei
Member

73 Posts

Posted - Jun 26 2017 :  2:21:14 PM  Show Profile  Reply with Quote
Please do not post links to this chart. My medical school team disagrees with Mark's basis for the chart. One time I asked them about this specific information, and the doctor laughed at it. The receptors can take multiple medications.

MDC
Member

344 Posts

Posted - Jul 01 2017 :  09:34:28 AM  Show Profile  Reply with Quote
Odd my medical team made copies to hand out to patients. They said it was so obvious that a busy receptor is not as receptive as one that is not busy. It has worked wonders for me.

"I don't know what the future holds, but I KNOW WHO holds my future"

Edited by - MDC on Jul 01 2017 09:35:57 AM
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jmrommes
Contributing Member

1685 Posts

Posted - Jul 01 2017 :  09:51:06 AM  Show Profile  Reply with Quote
The chart is simply a chart. I think this exchange demonstrated just how we can use it by taking it to our docs and letting them see it. If your docs absolutely think it's bunk and you trust them, do what they say. If they think it's gospel and want to spread it, so be it. It's clear that this is an on-going discussion among the professionals and that there isn't one agreed upon answer. Clearly no one know what best practice is here. It's an interesting topic and would make a good research project. I know some people to suggest it to for a comparative effectiveness study.

Just because your docs don't buy in doesn't mean the information may not be useful to others.

Exercise not only lets me live, it enables me to have a life.
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tsainta
Contributing Member

USA
1665 Posts

Posted - Jul 01 2017 :  1:13:27 PM  Show Profile  Reply with Quote
What are you guys talking about? What chart?

Tony-CA

50% of dealing with COPD is common sense.
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Sam-Tx
Senior Member

596 Posts

Posted - Jul 01 2017 :  1:32:49 PM  Show Profile  Reply with Quote
Thanks for asking, Tony! I want to know, too, but I didn't want to ask and let everybody know I was that dumb!
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jmrommes
Contributing Member

1685 Posts

Posted - Jul 01 2017 :  4:57:31 PM  Show Profile  Reply with Quote
They're talking about a chart that Mark Mangus, an RT who posts on EFFORTS and several other places, put together describing each med, the receptors they target and his preferred/suggested sequence of taking meds. It's been the topic of a lot of controversy on this board and many others. Some love it and think it's the next best thing since pancakes and others who believe it's so much hooey. It's just a chart. Do with it what you will. I think the first two exchanges are pretty representative of the two different points of view. One person's docs think it's hooey and the other's is copying it for all their patients. Go figure.......

Exercise not only lets me live, it enables me to have a life.
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tsainta
Contributing Member

USA
1665 Posts

Posted - Jul 01 2017 :  7:23:40 PM  Show Profile  Reply with Quote
Thanks Jean. I'm very familiar with the many years of running discussions and of Mangus's strong assertion that his way is THE way.

Tony-CA

50% of dealing with COPD is common sense.
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sslei
Member

73 Posts

Posted - Jul 02 2017 :  1:27:33 PM  Show Profile  Reply with Quote
I posted the address for Sandyspen not knowing Dave would remove it , but it sure looks like a lot of people interested.
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SEW4no
Member

137 Posts

Posted - Jul 02 2017 :  2:06:48 PM  Show Profile  Reply with Quote
tsainta - Mark has stated quite clearly on his chart that it is a "SUGGESTED' sequence - he has NEVER said that his way is The Way....
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tsainta
Contributing Member

USA
1665 Posts

Posted - Jul 02 2017 :  2:15:32 PM  Show Profile  Reply with Quote
SEW4no, sorry. Wrong recollection, I guess.

Tony-CA

50% of dealing with COPD is common sense.
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Dave-OH
Administrator

USA
3950 Posts

Posted - Jul 02 2017 :  6:53:35 PM  Show Profile  Reply with Quote
Mark has said his science has backed it up, but he has done published clinical trials to test his theory. It would not be real difficult for an RT in a medical practice to arrange a small scale trial with volunteers. The problem is such trials require supervision. He could probably do one privately, using spirometry at set intervals to test his theory. Probably a dozen of each way to do it. Then we would see if his receptor theory, versus opening the airways short term followed by long term meds is the best way.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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MDC
Member

344 Posts

Posted - Jul 02 2017 :  7:29:21 PM  Show Profile  Reply with Quote
Just for clarity this is Mark's response to how he derived his hypothesis. Pretty interesting and goes to show that what works for one will not work for all, but describes in detail his and the Doctors points of view on the subject and that this was just based on his experiences and other professionals in the field. But please note that in some patients that wake up early sob might not need to follow the sequence outlined but just allow the time to free receptors. This just basically tells how the chart came about and the reasoning behind it so people know that it is not set in concrete and everyone is different.

I have again removed it.

Mike


"I don't know what the future holds, but I KNOW WHO holds my future"

Edited by - MDC on Jul 04 2017 09:57:14 AM
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SEW4no
Member

137 Posts

Posted - Jul 03 2017 :  11:49:11 AM  Show Profile  Reply with Quote
Mike - when I clicked the link at end of above article, Mark's original sequence chart flashed but was quickly replaced with the 2016 chart that he and Noah Greenspan put together.....which I do not like. The new one advocates an A-B-C column approach to make it easier for patients. This means putting the anticholinergic first, B-agonist second, then steroid. Mark's original charge has the A & B reversed and a separate box for all the short acting drugs.
Do you have a date and source, especially date, that the article appeared?
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MDC
Member

344 Posts

Posted - Jul 03 2017 :  4:25:03 PM  Show Profile  Reply with Quote
SEW4no,

No I sure don't just found it with a google search. When I look at the source info from my browser it shows 2011 as revised date. IDK what that means for sure. Sorry.
Mike

"I don't know what the future holds, but I KNOW WHO holds my future"
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Dave-OH
Administrator

USA
3950 Posts

Posted - Jul 03 2017 :  7:09:26 PM  Show Profile  Reply with Quote
Please stop lining to Mark. This is fake science.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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tsainta
Contributing Member

USA
1665 Posts

Posted - Jul 03 2017 :  7:48:12 PM  Show Profile  Reply with Quote
My common sense tells me that I should take first whatever opens the airways quickly so any other inhalers, which do not quickly open airways, can penetrate deeper. In 22 years of reading and listening to arguments to the contrary, I have never found one to be convincing.

So I take my short-term beta agonist (levalbuterol), then my long-term beta agonist (Breo with Vilanterol [and fluticasone furoate]), and then anything else in any order. And I take them at a leisurely rate.

Tony-CA

50% of dealing with COPD is common sense.
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Dave-OH
Administrator

USA
3950 Posts

Posted - Jul 04 2017 :  08:27:44 AM  Show Profile  Reply with Quote
Tony we agree

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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Sokcap48
Senior Member

USA
804 Posts

Posted - Jul 04 2017 :  2:01:51 PM  Show Profile  Reply with Quote
Before my surgery I had three different Pulmonary doctors and they all said take fast acting first and progress from there.

Paul-Ut
The Journey Continues.
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MDC
Member

344 Posts

Posted - Jul 04 2017 :  3:21:18 PM  Show Profile  Reply with Quote
Dave Respectively what you call Fake Science might help someone. Especially since you have no more than your Dr's opinion and I have my Dr's opinion. But I will honor your request as this is your Board

I am sure this will be removed and I will be banned but I love and pray for you all! Good Luck!!
Mike

"I don't know what the future holds, but I KNOW WHO holds my future"

Edited by - MDC on Jul 04 2017 4:12:51 PM
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tsainta
Contributing Member

USA
1665 Posts

Posted - Jul 04 2017 :  3:29:16 PM  Show Profile  Reply with Quote
I can't imagine why you would be banned, but throwing out the term "fake science" is terribly disrespectful of other peoples' views. I will be careful to not disagree with you in the future.

Tony-CA

50% of dealing with COPD is common sense.
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tsainta
Contributing Member

USA
1665 Posts

Posted - Jul 04 2017 :  4:10:24 PM  Show Profile  Reply with Quote
Gotcha. Thanks.

Tony-CA

50% of dealing with COPD is common sense.
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MDC
Member

344 Posts

Posted - Jul 04 2017 :  4:14:13 PM  Show Profile  Reply with Quote
quote:
Originally posted by tsainta

Gotcha. Thanks.



Thank you so much Tony. You are an inspiration to us all!!!!!!!!!!

Mike

"I don't know what the future holds, but I KNOW WHO holds my future"
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Dave-OH
Administrator

USA
3950 Posts

Posted - Jul 04 2017 :  8:45:26 PM  Show Profile  Reply with Quote
If you or I as lay people share our views, that is peer support. When a medical professional makes a strong statement that this is science and the common regime that doctors support is wrong based on a scientific supposition without any type of clinical trial, that is fake science.

It would be OK for him to say that an alternative to conventional wisdom has worked for some, and if your medications are not working for you, discuss this alternative with your medical team.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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MDC
Member

344 Posts

Posted - Jul 04 2017 :  9:30:06 PM  Show Profile  Reply with Quote
As you stated there are no clinical trials showing the evidence that what your Dr's are stating is right, and none that makes Mark's or my Dr's right. Even the drug companies cannot agree or will not go on record regarding the "SUGGESTED SEQUENCE" or in your term "conventional wisdom" based on no trials, not science, so in reality you have to find what works for you. Just as the chart says.

And since your Dr disagrees with mine, Looks like a judgement call to me, not fake science, any Dr, yours or mine is practising fake science due the lack of available data by making a judgement call with no ammo.

Anyway lets just agree to disagree and I will not touch the subject again as neither of us are Doctors.

Edited by - MDC on Jul 04 2017 10:36:12 PM
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Dave-OH
Administrator

USA
3950 Posts

Posted - Jul 04 2017 :  10:40:14 PM  Show Profile  Reply with Quote
We can debate what works for us, I am just not wiling to support Mark'S reasoning. Now what I do is check my peal flow before and after my SABA. I am not currently on a LABA, but use Spiriva. I can tell you that my ability to move air increases after albuterol.

I am out of town but I will look for research on the topic later this week.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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MDC
Member

344 Posts

Posted - Jul 04 2017 :  11:25:07 PM  Show Profile  Reply with Quote
I am not questioning your beliefs and results.I am sure you know what works for you. As well as I know what works for me.

Lets just drop it my friend and keep on keeping on. I guess my biggest hangup is Marks Suggested Sequence works for some of us and is not "Fake Science" because it does not work for you. No evidence for and none against any sequence.

Hope you have a good trip Dave.

God Bless

"I don't know what the future holds, but I KNOW WHO holds my future"
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Dave-OH
Administrator

USA
3950 Posts

Posted - Jul 05 2017 :  08:19:00 AM  Show Profile  Reply with Quote
The question is not does it work, but his theory is untested. We know that albuterol opens the airways. And after my post I read both CF and asthma sites on order, as well as COPD Foundation and did not find one supporting his view.

That said, most COPD patients or asthma patients do not take albuterol on a daily basis. It is a rescue medication for most. My suggestion for you to test objectively is to get a peak flow meter and try both sequences to see if it makes a difference. Wait between medication, and measure you flow at different intervals.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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MDC
Member

344 Posts

Posted - Jul 05 2017 :  10:14:06 AM  Show Profile  Reply with Quote
OK thanks! have a great day!!

Mike

"I don't know what the future holds, but I KNOW WHO holds my future"
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Sandy9s
Member

USA
298 Posts

Posted - Jul 14 2017 :  5:26:12 PM  Show Profile  Reply with Quote
I just want to weigh in here that I, too, take the fast-acting combivent before I take the advair. And then about an hour later, I take the Incruse Ellipta. The Pulm. never told me what order to take these drugs........just my own silly common sense which says to "Get those tubes opened up 1st." Then when they are opened up (which they do with the Combivent), I do the Advair. I do these both while sitting on the toilet in the morning (but this is probably TMI (too much information).

Then after getting dressed, I do the Incruse Ellipta.........seems like common sense to give my bronchials another boost about an hour after the 1st two boosts!

Then about 4 hours after the Combivent, I do another Combivent......but only 1 inhaling. (If I'm bad that day, I'll give it 2 inhales....the normal dose).

If I'm having a worse day, I'll throw in the Duo Nebs nebulizer == starting it if the other things are not working too well. That shows me it's a bad day -- and I'll do the DuoNebs nebulizer every 6 hours -- but I watch my blood pressure inbetween because all of these meds will start raising it pretty darned high! If that happens, I slacken off the DuoNebs, and start spacing out the other things too.

When even worse, I'll start a prednisone regimen.........also checking my blood pressure off and on during the day. If that b.p. starts sitting around 180/100, I again slack off and space out everything.......and try to relax.

This is my own silly common sense -- but it works for me!

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Sandyspen
Member

USA
261 Posts

Posted - Jul 28 2017 :  08:43:44 AM  Show Profile  Reply with Quote
Good morning,
I've been so busy haven't been back since my search for that little chart. Wow! I'm glad to hear each and every opinion.

I've used the chart for many years but did ask my doc about it. Like some others, he told me it made no difference at all.

I smiled, went home, and use my chart. It just feels better to me, I think.

~ Sandy
"Happiness" is not a destination--it's the trip!
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