Our goal with Advanced Pulmonary Care Program is to provide cutting edge latest drug therapy and disease management on an out patient bases to continuously improve upon quality care and in a cost effective way. Simultaneously reduce hospital readmission. Helping our patients step on the healing path to feel better. Following are few of the drugs and protocols we deliver under our Advanced Pulmonary Care Program.
Nacala is a Monoclonal Antibody given to patients with Moderate to Severe persistent Asthma needing Steroids with Eosinophils greater than 150 to 300 and recurrent admissions to the hospital.
Patients should either have had Herpes zoster vaccine or have a history of chicken pox. Parasitic infection should not be present or suspected.
This drug should not be shaken when reconstituted.
We make sure crash cart is available with Benadryl, Solumedrol and Epinephrine.
We make sure that we are transfer to hospital ready.
Informed consent is needed.
The anti-IgE agent omalizumab (Xolair) is approved by the US Food and Drug Administration in the United States for use in patients age 6 and above with moderate-to-severe persistent allergic asthma, an IgE level of 30 to 700 IU/mL, positive allergen skin or specific IgE tests to a perennial allergen, and incomplete symptom control with inhaled glucocorticoid treatment.
Omalizumab is administered by subcutaneous injection every two to four weeks in a dose that is determined by body weight and the levels of serum IgE (0.016 mg/kg per IU/mL of IgE per month). A dose of 150 to 375 mg is injected subcutaneously every two to four weeks to achieve the monthly target. No more than 150 mg is administered at a single injection site, to prevent local reactions.
We typically use a three to six month trial before concluding benefit or lack thereof.
Hizentra is a Sub cutaneous immunoglobulin given to immune deficient patients.
Consent is needed and should also discuss possible adverse effects, which include headache, infusion reactions, renal complications, hemolytic anemia, neutropenia, thromboembolic events, rare but serious allergic reactions, and the small but theoretic risk of transmission of blood borne diseases.
Initial Blood work is needed for HIV, hepatitis B and C, CBC, BMP and LFTs. Direct Coomb test is done, if anemia, to detect hemolysis. Antibodies to IgA are checked, if IgA levels are low.
Periodic BMP and CMP every 6 months
A standard initial dose of IVIG for the treatment of antibody-deficient patients is 400 mg/kg (with a range of 400 to 600 mg/kg) every three to four weeks. Standard starting doses for SCIG are in the range of 100 to 200 mg/kg per week. For patients starting on fSCIG, the IVIG monthly dosing considerations apply.
Blood trough level of the drug is drawn after 3 months.There is no single target trough level that correlates to protection from infection in all patients. One set of guidelines in the United States recommends 500 mg/dL as a minimally acceptable trough level.
The dose, brand, lot number, and expiration date of the immune globulin product infused into any patient is recorded in the medical record, as is done for blood products.
We consider pre medications with Tylenol, Ibuprofen, Benadryl and Prednisone in certain patients with allergic tendencies. We consider boius of Normal Saline due to hyper hyperviscosity of the product.