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    gargoyle posted:
    I was born with asthma and now COPD/Emphysema. I was doing fine with my Combivent Inhaler. Then they stopped making it. They replaced it with Combivent Respimat spray mist. But, my insurance won't pay for it. I have a backup = Proair inhaler. But it doesn't help much. My doctor says her hands are tied. The insurance company won't pay for the new inhaler because it's not on their list of medicines they will pay for. So, I am using the Proair inhaler and struggling to breathe. Anyone have any advice for me? Thank you.
    amcate responded:
    I've run into a similar situation. The replacement for Combivent is very expensive. My allergist PA thought the less expensive way to replace it was Ventolin HFA 108 mcg/act aers and then a separate inhaler Atrovent HFA 17 mcg/act aers taken immediately after the Ventolin. I still have some Combivent left, so have not yet tried this to see if it works.

    I also have DuoNeb, which is the same medicine in Combivent, but it's delivered by nebulizer. It is thought the nebulized medicines get into the lungs better than the inhalers, and I know from years of experience it will work even when Combivent doesn't. So, if you don't have a nebulizer as a back up rescue medicine, you may want to ask about it.

    Best of luck.
    gargoyle replied to amcate's response:
    What is a nebulizer? Is it an inhaler? Or is it a liquid that you put into a nebulizer machine? I'm assuming your insurance covered the DuoNeb?
    amcate replied to gargoyle's response:
    A nebulizer is a machine that turns liquid medicine into a fine mist. The idea is that it gets into narrow airways easier than the meter dose inhaler since the particles are smaller. Since I had several documented instances of the meter dose inhaler failing to reverse the attack, my insurance at the time paid for both the nebulizer/air compressor and the medicine DuoNeb. Right now, the insurance I have will only pay for the medicine. Nebulizers and their compressors typically run around $100.

    Technically speaking, the nebulizer kit is the tubing and the cup. The air compressor is attached to the cup by the tubing and makes a lot of noise. DuoNeb is the liquid medicine I put in the cup. DuoNeb is not the nebulizer, but is the medicine I put in the nebulizer cup.

    I use the meter dose inhaler for run of the mill attacks, and if it fails, I use the nebulizer, which has never completely failed. I'm not good at writing, so bear with me.
    cwille replied to amcate's response:
    got my first nebulizer from walgreens, all i needed was a prescription from the doc. Now i have humana insurance also, and because of all the asthsma problems (which you know about) they put me on a special asthma program, i don't know about other insurance companies, but because i am on program they paid 100 percent for a batterie operated neb, so maybe you should check with your insurance company, i use my nebs quit a bit.
    amcate replied to cwille's response:
    Usually insurance companies I've had in the past pay for the air compressor and the nebulizer kit, but not the battery. Then, I just found (when it came time to replace mine since it had a crack) that my current insurance dropped covering nebulizer equipment completely...telling asthmatics to go to the ER for every nebulizer treatment. This makes no sense to me, as when I'm bad, I take them a lot, and the ER visits add up. So, I ended up having the get the replacement out of pocket.
    gargoyle replied to amcate's response:
    Thanks for the advice. My insurance won't pay for Ventolin. But I think it's the best inhaler out there now. I'm on Medi-Cal. Only Medicare will pay for Ventolin.

    I was in the hospital a month ago for breathing problems. The doctor gave me 60 vials of DuoNeb. I read your note before I went into the hospital; so I asked him for it and he said yes. Thank you so much, it works pretty good.
    amcate replied to gargoyle's response:
    Your welcome. I am pretty ignorant of the available forms of albuterol in a MDI (meter dose inhaler) form. You may want to see if there's another type other than Ventolin that your insurance company will pay for, then combine it will ipratropium bromide in an MDI form.

    DuoNeb works very well to get my lungs open, but the main drawback I have is it also has more side effects compared to the MDI (since more of it gets into the lungs, I guess). So, I normally use the MDI if possible, but use DuoNeb if the MDI won't work.

    Anyway, glad I could help and that you have a way to get your lungs open when you need it.

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