2/21/02
http://www.boehringer-ingelheim.com/corporate/products/prod_prescr_copd.htm

http://www.boehringer-ingelheim.com/corporate/asp/archive/adetail.asp?ID=145

2/26/02
Dear Friends and Fellow EFFORTS Members, It has been exactly one week since last Wednesday, February 20, 2002 that I was first given SPIRIVA by my pulmonologist. And the results are the following:

Firstly, I have not use any supplementary medications such as my MDI's (Atrovent, Berodual), I have not nebulized since last week, I have not taken any Foradil, nor Flixotide, I have of course due to contraindications to my heart conditions not taken any Theo-Dur or Theophylline, and since my last slight exacerbation not taken any Prednisone either.  So it has solely been SPIRIVA with my Oxygen supplement nightly of one lpm for around 10 to 12 hours. I have no new FEV1's to report and am still waiting for the exact figures from my pulmonologist, as I first mentioned that my last FEV1 was 62%, but this might be misleading cause I found out later that this was my PaO2 figures, which only showed after my last ABG that I could travel by air on a borderline level of not more than four hours without oxygen, so my pulmo strongly suggests that I fly with supplementary O2 if I were to travel for more than four hours on an airplane.

Secondly , going back to SPIRIVA, I have noticed that since it is the only medication that I am taking for my COPD/Emphysema, of course it will cut down on my medicinal expenses, since I don't have to buy all those other meds unless I get infected with a virus and may need a burst of Prednisone, some nebulizer treatments to suppress any cough, etc. But for now, the past week has been a normal week for me, I did some driving to pick up my kids in their respective schools last Friday. Attended my daughters Grade Two Family Day without any problems, and without O2. I do twice a week of physical therapy, quite hectic for my heart and lungs ,with one lpm of oxygen just for safety measure as my sats do drop when I am physically active. I use an oximeter to monitor my Sats and notice that after brisk walking my sats do drop still down to 89% but after a few minutes rest and purse lip breathing my sats go back up to 92% to 93% without O2. With O2 of course my sats are up to 97% to 98%. So there is no problem there. And if you remember I mentioned in day three or four that I noticed that my inhalation seems to be longer and deeper as well.

With the SPIRIVA, I still get SOB sometimes after bending and reaching down for objects which squeezes my diaphragm or when I get stressed with some home or office problems, this always seems to trigger a little SOB in me, but PLB solves the problem right away. So far, for the past seven days life seems a little bit better than taking all those other medications, and for a medicine that is suppose to last 24 hrs, I must say that it is doing a pretty good job, my pulmo has also advised me that I can take a capsule of Foradil through its aerolizer late in the day if I feel that there is a need, but so far I have not found the reason to, I have stuck to the one Handihaler shot of one capsule of SPIRIVA a day and so far so good.

I have noticed though that I have developed a little phlegm and need to cough it out, this happened only last night and only when I am lying down, I hope that this does not develop into a heavy mucous and cough, if not I will immediately report this to my pulmo and I know she will tell me to take Fluimicil, which is a mucolytic in 600mg effervescent tablets (acetylcysteine) to be diluted in about 50 cc's of water for ten days at one tablet every evening.

Well, knock on wood, everything seems to be going as well as expected except for the slight cough to expel some viscous secretions.

Keep your fingers crossed that this SPIRIVA will continue with the expectations that we all read in the Roy Giddens Spiriva Trials submitted to us by our good friend, Gary Leach sometime ago, and that this will also be the only medication we will need in our everyday life so as to reduce our costs and number of meds we need.  (I hope that this will soon be released here commercially before I run out of my 60 day supply!!!)  With the exception of when we exacerbate or get a virus or flu. For now this is all I can report, I will send my actual FEV1 as soon as I get them so that you may compare them with yours. My warmest regards to you and yours, and may all be well with all of you, Breathe easy and take care.  Cheers, Victor in Manila, Philippines

3/6/02
Dear Co Members, On my 16th day of being on Spiriva and everything is so far so good, It is the only med I have used for my COPD/Emphysema since February 20,2002. I have developed a cough with no phlegm due to exposure to a cold night and strong winds last March 02,2002 and I was immediately given 600 mg. effervescent tablets of Acetycysteine (Fluimucil), to be diluted in 50 cc of water and taken once nightly before sleeping. This is a mucolytic for me to develop a productive cough instead of a dry constant cough which caused me to get really short of breath which in turn dropped my O2 sats to 89% due to the constant coughing and efforts to spit out nothing that was irritating my throat due to the cold that I had developed. The cold is now gone but a slight cough remains as I am only on my fourth day of the mucolytic which I take only once a day.

It was only in my panic about three days ago when I felt I could no longer inhale any air that I succumbed to using an MDI which was Berodual (a fenoterol Ipratropium) to ease my breathing for that very moment. I was instantly relieved and thought to myself that maybe had I just Pursed Lip Breathed I would have passed that stage without any supplemental medication but the mind in panic reached out for the metered dose inhaler and I took two quick puffs. Since then I have not succumbed to anymore supplemental meds, and have stayed on track with just using Spiriva, one inhalation in the morning, then take my mucolytic before bedtime and as always my O2 of 1lpm which I start normally around 6:00pm up to 6:am the following morning.

The sad news is I have been informed by Boehringer-Ingelheim/Pfizer Philippines medical representatives that the release of SPIRIVA in the market was postponed to May of this year instead of April due to some importation glitches, this will mean that the 60 capsules which my pulmonologist gave me for trial may not last till May, or whenever the actual date of commercial release here in the Philippines will be.

This will probably mean that if none is available commercially I will have to discuss this with my pulmonologist and most probably go back temporarily to Foradil which is to be inhaled twice a day, and with metered dose supplements, unlike the Spiriva which was the sole medication I have been taking. This will also mean going back to added medicinal expenses for the meantime although I don't have any idea as to how much the Spiriva will cost as against the Foradil which is quite cheap.

Well, as I said, so far so good, and hopefully nothing more serious develops, I have controlled my cough with the mucolytic and I am back to my routine of having Respiratory therapy twice a week, do weights, stationary biking , a lot of stretching and trying to get in daily walking of around 30 to 45 minutes( which I don't do regularly but with constant prodding from Carolyn Hull, and motivation From Gary Leach and Karen Hodge) I try to exercise as much as I can in order to be more physically fit and to lose a little weight as suggested by my cardiologist and endocronologist to allow my heart to work better and for my diabetes to go down further, in conjunction with my pulmonologist to push as much as I can within my limits to get the benefits of exercise which is quite important for all of us.

So until next week, when I will be on my third week of Spiriva, more letter writing my co-efforts members, let us not let our President down. More power to you all and my best regards!!  Victor in Manila, Philippines

And to tell you the truth, aside from getting obviously short of breath from the many activities that I have attended over the past week since last reporting, things are still fine and I am still only on my Spiriva without any other supplements except for the reported panic incident I had a week or so ago, wherein I unconsciously reached from by MDI Broncodilator  "Berodual" and took two quick puffs after getting so out breath after a fit of coughing. If you had remembered that I did develop a dry cough which was none productive a few days after my starting Spiriva last February 20,2002. I was asked to take "Fluimucil" a mucolytic which started to take effect a few days later and caused my cough to be productive and a even before I finished the prescribe ten daily doses of 600mgs. my cough had ceased as well as my wheezing.

Now 23 days later, I feel fine, no cough, take deeper breaths and still get along without any other supplementary bronchodilators or nebulizers, I did go on a short prednisone burst of four days, before I forget, started with 20mgs, the first day tapering off to 15mgs, the second day, 10 mgs on the third and 5mg on the last and fourth day just to clear the lungs of the cold and cough. Now have been off prednisone since Thursday and I feel normal.

I still do get short of breath on long walks, and on exercise with my RPT which lasts about an hour, three times a week, this consists on stationary biking at an average speed of about 6 kilometers an hour for about 10 to 12 minutes, a lot of stretching, and lifting of dumbells ranging from 4 lbs. to 8lbs,  for the rest of the session,  legs raises,  pelvic raises,  diaphragmatic breathing exercises, etc.

Occasionally I use O2 at 1lpm, on rare occasions after bicycling, but normally just purse lip breath throughout the session. My Blood Pressure starts off at 120/70 and ends up at 130/80. My O2 sats start at around 94% and goes down to 90% but with pursed lip breathing climbs back up to 92% for the duration.

So fortunately I have reduced my med intake to one which is Spiriva, (or tiotropium) aside from the fluimucil and short prednisone burst, and my usual 1 lpm at night of O2.

I am worried that my supply may not last until they release commercially since they first said in March, then again on April, but I still have the Foradil to lean onto to just in case and It had worked well with me as well for over a year that I had been using it, the only difference is that I had to take it twice a days and occasionally get a puff of my bronchodilators when planning to go out and do some activities out of the house.

I am therefore happy to let you all know that Spiriva may not yet be the total relief cure we have been waiting for but it is certainly the best that has come in a long time after Foradil. It will not reverse our illness but it will certainly alleviate the worries of staying out of the house too long in order to get nebulized, or take other meds which are too uncomfortable to bring along with you out of the house. Spiriva gives you the freedom for more than sufficient time to go about what you have to do without worrying when your next fix is, sort to say!!!

Hopefully it will be released worldwide soon and that we can all give it try and benefit by it, for those who are on Foradil, it is just as good and will keep you breathing well but not for the time frame Spiriva has been doing for me.

Till my next update, enjoy the coming weekend....................breathe easy!  VICTOR

3/22/02
Dear Friends, I have just completed 30 days of using only Spiriva as my sole medicine for my daily use as against the old ways of using Foradil, Atrovent, Combivent, Flixotide, and Berodual -nebullizing or MDI's. In those 30 days I reached for my MDI Berodual during one panic attack of SOB but after that never reached for it again since I decided to ride it out with just purse lip breathing. I have been going to my Respiratory Physical Therapist twice a week and we do an hour and a half of strenuous exercises which include stationary bicycling, lifting weights, and leg exercises with added weights, I do this with supplementary O2 of 1 to 2 lpm as I do get tired and a little SOB, but other than that and the compulsory O2 every night at 1 lpm for 10 to 12 hours a night, I have not had any use for any other supplementary medicine except at the start when I developed a cough which was dry and was put on Fluimucil, a type of mucolytic, and a short three day burst of prednisone starting at 20mgs a day for the first day, 10mgs on the second day and to 5mgs on the third day after which prednisone was stopped, I think this was just to clear the cough after the mucolytic took effect. I am happy to say that to this day I am feeling fine, no cough, no wheezing, yes sometimes short of breath when I guess I overexert myself doing some walking and malling, but can drive with no difficulty nor O2, I guess I also must have save a little sum since I am not buying any other kids of meds or replenishing any either. I still have another 30 days supply of Spiriva, and hopefully it will be out in our market by mid-April as they said, cause if not then I'll be back to Foradil and my other supplementary meds during the day.