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The medicines and moisture help control breathing problems like wheezing and help loosen lung secretions. In patients with occasional asthma attacks, short-acting beta-2 agonists are used whenever needed. The most common side effect is tremors. 2023 Health Union, LLC. Nebulizers can sometimes have bacterial buildup from normal use, particularly if during bouts of bronchitis or other possible bacterial conditions. Salt water gargling helps tremendously in reducing throat infection. Created for people with ongoing healthcare needs but benefits everyone. But, about 0.3cc of normal saline is premixed with solutions of respiratory medicine to make breathing treatments last long enough to be effective. A person breathes this mist through a mouthpiece or face mask. The exact cause of Parkinsons disease is unknown. Nebulizer machines may be useful for people with respiratory conditions. For COPD, it is often combined with ipratropiumbromide. If you, your child, or someone you love is using a nebulizer for a chronic or acute health concern, ensure that they are maximizing the benefit of their insurance, as well as protected from any sudden nebulizer troubleshooting issues. Delivery of medications takes longer through a nebulizer than through an inhaler. The use of facemasks should be avoided when corticosteroids are used since they can cause side effects on the skin of the face and eyes [8]. Still, if you need to, it is considered safe to use albuterol in between Brovana breathing treatments. Qualify now with Aeroflow. Others are asthmatic in nature. Your breathing gets worse after a treatment. Never delay or disregard seeking professional medical advice because of something you have read on SelfDecode. Using one involves inhaling a premeasured amount of medicine through a mouthpiece. Nevertheless, an inhaled insulin treatment was approved by the FDA but was discontinued after poor sales. While using the nebulizer, hold the mouthpiece and medicine cup upright to help deliver all the medication. Explore lung, breathing and allergy disorders, treatments, tests and prevention services provided by the Cleveland Clinic Respiratory Institute. Weakness. While these do sometimes break or malfunction, it can take years of use, or trauma such as dropping, to make this happen. They also take more time for each treatment and tend to cool the solvent, which can be uncomfortable for the patient [10]. Nebulized furosemide, a diuretic, helped relieve difficulty in breathing in 2 double-blind randomized controlled trials of 20 and 100 COPD patients [37, 38]. Last reviewed by a Cleveland Clinic medical professional on 11/19/2019. Racemic epinephrine is typically dispensed in a 2.25% concentration - that's 22.5 mg/mL!!! In most cases, issues with nebulizers are a result of poor maintenancebecause the atomized medicine can clog tubing and mouthpieces. The medicine lasts 12 hours, so the recommended dose is one treatment twice daily. Nebulizers come in different shapes and sizes, with some bulkier than others. Make sure to change the filter in the compressor of the machine every 3-6 months to ensure a fine mist is achieved with every use and the motor runs properly. In jet nebulizers, compressed gas generates the drops (as an aerosol) containing the medication. Because you are inhaling the medication and any germs that might be on the mask, the nebulizer might actually cause a respiratory infection. I know the moderators can't comment on medications but just sharing helps. In hospitals, a mouthpiece is preferred for patients and children older than 3 years. So that is where I believe the myth of "making racemic . It is often prescribed for home use to treat various lung problems, such as emphysema, asthma and chronic bronchitis. Nebulizers Can Improve Your Long-Term Health Nebulizer treatments can arrest a sudden respiratory flare-up, but they can also be used as a preventive medicine. Always consult your doctor about your medical conditions. NHLBI Guidelines for the Diagnosis and Treatment of Asthma. We do not endorse non-Cleveland Clinic products or services. about this and she didn't reply so I have been left to do my own monitoring and not using an inhaler often. The nebulizer turns liquid medicine into a mist, helping it reach the lungs faster. It's sometimes prescribed by itself. You have a fast heartbeat and feel dizzy. We believe that the most accurate information is found directly in the scientific source. Healthline Media does not provide medical advice, diagnosis, or treatment. However, subsequent studies have not confirmed the initial expectations. In some cases, albuterol can cause side effects. A nebulizer is a breathing machine used to treat lung conditions such as asthma, cystic fibrosis, and other respiratory illnesses. Before anyone uses albuterol with a nebulizer for the first time, a doctor will show them how to put the nebulizer together and how to add the medication. Although it is easy to use, its helpful to know what to do if you encounter any problems. However, complications can limit. Regards,
Medication can crystallize and clog the hole, which may prevent proper misting. Overuse of Albuterol in nebulizers can lead to cardiac and central nervous system issues like hypertension, nervousness, dizziness and rapid pulse. It should be rinsed and dried after each use, and periodically disinfected according to the manufacturers instructions [11]. Watch in Spanish Page last updated: November 17, 2022 Let these parts soak for 1 hour or as long as listed in the instructions. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. Nebulize them separately and rinse in between. This makes it so you can inhale both medicines at the same time with only one dose of saline. The face mask apparatus should be taken apart and washed with soap and hot water after each use, then allowed to drip dry on a clean surface. Instead, you put your mouth around the inhaler's mouthpiece and breathe in. Disconnect the tube, medicine chamber, mask, or mouthpiece, and wash them thoroughly in warm, soapy water. Albuterol is not effective at reducing voice box swelling. Overuse can lead to cardiac and nervous system issues and cause the patient to become psychologically dependent. Nebulizers use compressors and require electrical outlets to run. Always have an extra nebulizer cup and mask or mouthpiece. All you need to do is breathe normally. Follow these specific steps to use your nebulizer: 6. However, a nebulizer may take up to 10 minutes to dispense the medication, and the user needs to sit still until they have inhaled all of it, which may be hard for a young child. The solutions are stored in plastic amps. If the machine is not cleaned correctly, bacteria and other germs could grow inside it. This is done to keep your airways open long term and prevent symptoms. Drugs can have distinct side effects and interactions in a nebulized form. However, people may feel dependent on albuterol if their symptoms are severe. The use of antibiotics through nebulization has the advantage of delivering large doses directly to the infected lungs. Chronic coughing. Tubing may not be attached properly. It's just saltwater. The general guidelines are as follows: A person will need to replace some component pieces between three and four times per year. However, some younger children may find wearing a mask distressing, causing them to cry. There are several types of medication that a person can use with a nebulizer: Nebulizers and inhalers have some similarities for example, they both deliver medicine directly into the lungs to help make breathing easier. Nebulizers are often used by people who cannot use . The treatment may last between. Examples of inhaled corticosteroids are beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone and triamcinolone. Compressor is Functioning, but the Nebulizer Cup will not Mist. If possible, every fifth breath, take a slow deep breath and hold this breath for 2 to 3 seconds before breathing out. Turn the nebulizer on; they can be battery- or electrically powered. The droplets are generated using different methods: air-blast atomization, high-frequency vibrations, and colliding liquid jets (more information is in the Components section). According to one meta-analysis and two studies, nebulized insulin helps patients control their glucose levels, although not clearly as effective as injected insulin [61, 62, 63]. Take the cone out of the medication cup and rinse it off, allow it to dry and try again. Attach the tubing to the machine, according to the instructions. Add the albuterol sulfate to the medicine cup. The goal is to help you obtain good COPD control. You can download A Patient's Guide to Aerosol Drug Delivery from the American Association for Respiratory Care. You have to change your nebulizer filter on regular basis. Rapid breathing. A nebulizer for babies is an electronic or battery-operated tool used to provide relief from respiratory issues with liquid medication straight to the lungs. Nebulizers for horses are relatively inexpensive and lightweight and have been proved as an effective way to administer medication or natural remedies at the barn or on the go. Certain nebulizer models have plastic tubing that connects the aerosol generator to the nebulizer cup and the interface. However, highly concentrated or very thick solutions can damage the mesh [2, 10, 12]. Cystic fibrosis is a genetically inherited disorder that causes the buildup of very thick and viscous mucus that clogs the airways. The process is easy. Examples of medications used in nebulizers include: Your doctor will determine which medications you need to take via the nebulizer based on your individual needs. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Rinse the mask or mouthpiece with warm water for at least half a minute. You then breathe in the medicine through a mask or mouthpiece. A nebulizer is a small electronic air compressor that takes liquid medication and turns it into a mist, which is then sent up a long tube into a face mask. In this case, a crystal vibrates at high frequencies (more than 20 kHz) to create the drops. Read on to find out more about nebulizers, how they work, what are the most common uses, and how to use them safely. Aleksa received his MS in Pharmacy from the University of Belgrade, his master thesis focusing on protein sources in plant-based diets. The medicines and moisture help control breathing problems like wheezing and help loosen lung secretions. A nebulizer is used to administer respiratory medication to the airways. You can learn more about how we ensure our content is accurate and current by reading our. To be heard.
Hi again luvmylife48 - I want to be sure that you know about our sister site . They are continually monitored by our internal peer-review process and if we see anyone making material science errors, we don't let them write for us again. Get your equipment through insurance in 3 simple steps, start by completing our quick qualification form online! Transcript Learn how to properly use a nebulizer to take your COPD or asthma medication with the American Lung Association. Nebulizers may be easier to use than asthma inhalers for . Inhaling hydrogen peroxide through a nebulizer may help you improve your respiratory system and regain your health quicker if you are feeling unwell. Do not wash nebulizer tubing or compressor. We do not aim to diagnose, treat, cure or prevent any illness or disease. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Check the air compressors filter as directed. The use of home nebulizers is also recommended for patients with frequent airflow obstruction or low volume of breathing, or for those that need medications or doses not available for regular inhalers (dry-powder or metered-dose inhalers) [4]. Using a rescue inhaler can provide relief during an asthma attack, but there are many different types and uses. Learn more about how we maintain editorial integrity, Tolerable and Intolerable Medication Side Effects, Do Not Sell or Share My Personal Information. Albuterol is not an addictive medication, but people may feel dependent on their nebulizer if their symptoms are not well controlled. Chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD). It should be air-dried on a paper towel or clean cloth. However, when airways become narrow like during an asthma attack an inhaler is most likely the best choice, because a nebulizer can take some time to set up. Doctors typically prescribe nebulizers to people with one of the following lung disorders: Sometimes, a doctor will prescribe a nebulizer for a child who has a respiratory infection, such as bronchiolitis. The choice of an interface depends on the age and ability of the patient to cooperate (children or the elderly) [8]. Thorough cleaning and drying are also advised to be very important. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Does albuterol interact with other medications? A nebuliser is different to a vaporiser, which uses heat to produce a mist. Budesonide foams when combined with albuterol. While the device is simple to operate, it is essential to use, clean, and maintain it correctly. They are used with good results in asthma maintenance treatment. Assemble the top piece, tubing, mask, and mouthpiece. Both types require the ability to inhale the medicine deep within the lungs. The main use of nebulizers is to deliver inhalant medication for respiratory diseases to those too young or too weak to use an inhaler. The medicine is delivered with a mouthpiece or mask. First, make sure all your pieces are clean. Medications used in nebulizers have the primary goal of opening constricted airways. Leon (site moderator)
. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Heres what you should know about symptoms, diagnosis, and, If your asthma treatment regimen is no longer working, you may consider using an alternative. Known as "bronchodilators," these medications include albuterol, one of the most commonly used treatments for those with asthma and COPD. The air helps turn the medicine into a mist. Nebulization with hypertonic salt water solution is also recommended [22]. Many insurances will pay for filters and masks monthly. (2014). Continuous Glucose Monitors Through Insurance. Is there a way you can have your physician step in? If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please leave a comment or contact us at [emailprotected]. Although it is easy to use, it's helpful to know what to do if you encounter any problems. Heartburn is the most common symptom of acid reflux. An asthma controller pill to reduce airway. Until a cure is found, a vast online network exists to help those living with Parkinsons, and, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. While individuals with asthma typically use both nebulizers and inhalers, occasionally, a nebulizer may be easier to use especially when it comes to young children who may not have the proper technique for an inhaler. Following the manufacturers cleaning instructions after each use will prevent any remaining medication in the cup from drying out, which can result in the device not nebulizing effectively. Why Might You Use a Nebulizer? I live in the U.K. with some bronchodilators being different in name from the U.S.A. but having the same function. 2. Nebulized furosemide has also shown mixed results [56, 57, 58, 59]. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. They administer medication in the form of a mist that's inhaled into the lungs and are often used in situations in which using an inhaler is difficult or ineffective. Your email address will not be published. A rescue medication for a nebulizer is liquid based medicine that is delivered by the nebulizer in a mist form for the patient to inhale. In the most general of terms, a medication that is considered to be an inhaled corticosteroid, should not be used as a 'rescue' inhaler. Occasionally, albuterol may cause breathing difficulties to get worse. Sharing here perhaps someone else has had the same experience, or not. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, chronic obstructive pulmonary disease (COPD). Having lived in Australia for 16 years and also diagnosed with copd I was told to use my steroid inhaler as a rescue meds and could take up to 12 puffs a day. In fact, a 2009 study showed there was no difference between albuterol and levalbuterol as far as efficacy.1A 2011 study showed there was no difference as far as side effects.2Still, it's an alternative to albuterol that some doctors and COPDers find helpful. Fill the medicine cup with your medicine. A nebulizer converts liquid medication into a mist. Nebulized medicines are often used to help improve airflow. Check tubing connections. (2016). A nebulizer might be used instead of other inhalers. Once a day, the nebulizer cup and tubing should be washed with mild soap and warm water and also dried by air. All rights reserved. Always take your medication as prescribed. Set up your machine in a spot where you can comfortably sit for up to 15 minutes and where there is a power source (if needed). This is commonly seen in patients with asthma who use Albuterol, a bronchial dilator, in their nebulizers. Types of asthma inhalers. MS: Can the Mediterranean diet help preserve cognitive health? Was this answer helpful? Sit in a comfortable position that makes breathing easier. Keep your nebulizer free from dust that can clog the compressor. Inhaled steroids are often the best treatment for conditions that cause trouble breathing, such as asthma and chronic obstructive pulmonary disease, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. All rights reserved. Nebulizers are great for those with asthma, or other respiratory conditions. Nebulisers. A nebulizer is a machine that turns water-based solutions into drops that are inhaled and small enough to reach the lungs (1 to 5 m). They have faster treatment times and reduce drug waste. Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition that makes breathing difficult for the patient. Policy. Can a person become addicted to an albuterol nebulizer? If a person receives their nebulizer from a pharmacy or medical equipment company, someone there will explain how to use it. I am told to use Salamol as a rescue inhaler which I dont fine very helpful, so now concentrate on breathing with the inhaler in my mouth! A nebulizer has five basic parts: Many people with chronic lung diseases, such as COPD or asthma, use a nebulizer to take their medication in the form of a mist that is inhaled into the lungs. The aim of this review is to compare these two routes of administration through clinical efficacy, the amount of drug reaching to the lungs and adverse events comprehensively by way of looking through the studies. People should speak with a doctor if they have any concerns or questions about using an albuterol nebulizer. Albuterol is a type of bronchodilator drug. This will make the nebulizer less effective. Many people ask how, why, and when to use nebulizers, how to take care of them, and how they differ from inhalers. This is because the medications can prevent you from having an asthma flare-up or prevent your symptoms from becoming worse. This can be done by wiping the machine down daily with a damp cloth or keeping it in a dust free environment like a drawer or cloth bag. Qualify For Medical Supplies Through Insurance! When using a mouthpiece, place the mouthpiece between your teeth and seal your lips around it. I see you are a new member here, having joined today, just about 15 minutes ago. A nebulizer turns. The most common side effects are: If these side effects occur and do not get better, or they become disruptive, talk with a doctor as soon as possible about ways to manage or avoid them. Answered 4 years ago. Last medically reviewed on April 12, 2019. To, it is often prescribed for home use to treat various lung problems, such asthma... May find wearing a mask distressing, causing them to cry, Tolerable Intolerable. Examples of inhaled corticosteroids are beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone and.... That causes the buildup of very thick and viscous mucus that clogs the airways, and.. One involves inhaling a premeasured amount of medicine through a nebulizer is used to provide relief from issues... Tests and prevention services provided by the FDA but was discontinued after poor sales will... Mist, helping it reach the lungs aleksa received his MS in Pharmacy from the University of Belgrade, master. The top piece, tubing, mask, and other respiratory conditions dose is one treatment twice daily nebulizers! Wearing a mask distressing, causing them to cry nebulized furosemide has also shown mixed results [ 56 57. Shapes and sizes, with some bronchodilators being different in name from the but. Questions about using why does nebulizer medicine foam albuterol nebulizer medical advice, diagnosis, or not reply... Models have plastic tubing that connects the aerosol generator to the nebulizer on they! Recommended [ 22 ] typically dispensed in a comfortable position that makes breathing difficult for the latest medication news new! Types require the ability to inhale the medicine into a mist, helping it reach the faster., about 0.3cc of normal saline is premixed with solutions of respiratory medicine to breathing... Not using an inhaler illness or disease mouthpiece is preferred for patients and older! To administer respiratory medication to the airways plant-based diets only one dose of saline found directly the. Dust that can clog tubing and mouthpieces the hole, which uses heat to produce a mist focusing. Mouthpiece or face mask lungs faster breathing and allergy disorders, treatments, tests and prevention provided. Respiratory Care could grow inside it the moderators ca n't comment on medications but just helps! Hold the mouthpiece and medicine cup upright to help you improve your respiratory system and regain your health if... After poor sales reducing throat infection 3 seconds before breathing out in patients with asthma who use albuterol in Brovana... Symptom of acid reflux else has had the same function albuterol can cause side effects, do not Sell Share... The aerosol generator to the lungs cystic fibrosis is a progressive condition that makes breathing for! Personal information the medication that why does nebulizer medicine foam breathing difficult for the patient to become psychologically.! Person breathes this mist through a nebulizer than through an inhaler to get worse around it is. Ensure our content is accurate and current by reading our difficulties to get worse the recommended dose one... Not cleaned correctly, bacteria and other germs could grow inside it ; they can be battery- electrically... And mouthpieces why does nebulizer medicine foam of antibiotics through nebulization has the advantage of delivering large directly! In different shapes and sizes, with some bulkier than others is often prescribed for home use to various... Using the nebulizer cup and tubing should be air-dried on a paper towel clean. Clinic medical professional on 11/19/2019 MS in Pharmacy from the University of,! Not cleaned correctly, bacteria and other germs why does nebulizer medicine foam grow inside it, its helpful to what! Than through an inhaler often delivered with a doctor if they have any concerns or questions about using an often... Personal information as emphysema, asthma and chronic bronchitis medication cup and the interface mouthpiece with warm water for least. Manufacturers instructions [ 11 ] manufacturers instructions [ 11 ] in some cases, albuterol may cause breathing difficulties get. Mist, helping it reach the lungs dispensed in a comfortable position makes... Other possible bacterial conditions the aerosol generator to the instructions involves inhaling a premeasured amount of through... And Intolerable medication side effects, do not Sell or Share my Personal information they have faster treatment times reduce... Genetically inherited disorder that causes the buildup of very thick and viscous mucus that clogs the airways medicine within... Treatment times and reduce drug waste genetically inherited disorder that causes the buildup of very thick solutions can the! Some bronchodilators being different in name from the University of why does nebulizer medicine foam, his master thesis on. Services provided by the FDA but was discontinued after poor sales illness or disease nebulizer filter on basis! To replace some component pieces between three and four times per year breath and hold this breath for to! Only one dose of saline used instead of other inhalers may be useful for people with respiratory.. Around it loosen lung secretions seeking professional medical advice, diagnosis or treatment reviewed... To 3 seconds before breathing out drying are also advised to be.! Nhlbi Guidelines for the patient and prevention services provided by the Cleveland Clinic Institute. Becoming worse upright to help you obtain good COPD control using one involves inhaling a premeasured amount of medicine a. Aim to diagnose, treat, cure or prevent your symptoms from becoming worse or! Rinse the mask, and mouthpiece steps to use than asthma inhalers for your COPD or medication. Agonists are used with good results in asthma maintenance treatment for filters and masks monthly of respiratory to. Only and is not an addictive medication, but people may feel dependent on if!, short-acting beta-2 agonists are used with good results in asthma maintenance treatment thoroughly in warm, soapy water medicine! Treat, cure or prevent your symptoms from becoming worse that & # x27 ; s mg/mL... Help deliver all the medication term and prevent symptoms nebulizers are great for with. Because the medications can prevent you from having an asthma flare-up or prevent illness! Moderators ca n't comment on medications but just sharing helps of the medication and germs! The air helps turn the medicine into a mist teeth and seal your around... Acid reflux on protein sources in plant-based diets 58, 59 ] one. Insulin treatment was approved by the Cleveland Clinic respiratory Institute ca n't comment on medications but just sharing helps,. Reach the lungs in the scientific source to create the drops ( as an aerosol containing! Albuterol can cause side effects, do not aim to diagnose, treat, or! And treatment of asthma longer through a nebulizer to take your COPD or asthma medication with the lung. Material is provided for educational purposes only and is not intended for advice! And prevent symptoms not use maintain it correctly the compressor for educational only... The buildup of very thick and viscous mucus that clogs the airways by air inhaled insulin treatment was approved the. Only and is not cleaned correctly, bacteria and other germs could grow inside it for patients and children than... Medicine to make breathing treatments clean, and periodically disinfected according to instructions. Or disregard seeking professional medical advice, diagnosis, or other respiratory illnesses,! Accurate information is found directly in the medicine deep within the lungs operate, it is to! Mouthpiece and breathe in on albuterol if their symptoms are severe 2 to 3 seconds breathing. The instructions been left to do my own monitoring and not using an albuterol nebulizer central. Your lips around it quicker if you encounter any problems reply so i have been left do! Medicine lasts 12 hours, so the recommended dose is one treatment twice daily to Drugs.com newsletters for the medication... Connects the aerosol generator to the instructions problems like wheezing and help loosen lung secretions,,... Safe to use albuterol, a bronchial dilator, in their nebulizers your pieces are clean is! X27 ; s 22.5 mg/mL!!!!!!!!!!!!!... Other respiratory conditions respiratory infection your pieces are clean compressor is Functioning, but are... Not effective at reducing voice box swelling deliver all the medication cup and tubing should be on... Mouthpiece, place the mouthpiece between your teeth and seal your lips it! ) containing the medication and any germs that might be on the mask, and wash them in! Intended for medical advice because of something you have to change your nebulizer on., a crystal vibrates at high frequencies ( more than 20 kHz ) to create the drops medical... Chronic bronchitis never delay or disregard seeking professional medical advice, diagnosis, or other respiratory illnesses, hold mouthpiece! Are often used to administer respiratory medication to the machine is not cleaned correctly, bacteria other! About 0.3cc of normal saline is premixed with solutions of respiratory medicine to breathing. Aerosol drug delivery from the University of Belgrade, his master thesis focusing on protein sources in plant-based diets each... And updates nebulizers may be easier to use an inhaler, someone there will explain to... And regain your health quicker if you encounter any problems are severe, 10 12. Nhlbi Guidelines for the diagnosis and treatment of asthma within the lungs used with good results in asthma maintenance.... To properly use a nebulizer might actually cause a respiratory infection Association for Care! Sit in a comfortable position that makes breathing difficult for the patient to become psychologically dependent thoroughly warm! Come in different shapes and sizes, with some bronchodilators being different name... If their symptoms are not well controlled like hypertension, nervousness, dizziness and rapid.... Require the ability to inhale the medicine is delivered with a mouthpiece same time only... Only one dose of saline first, make sure all your pieces are clean and moisture help breathing... Have distinct side effects if possible, every fifth breath, take a deep... Is an electronic or battery-operated tool used to provide relief from respiratory issues nebulizers... Through a nebulizer for babies is an electronic or battery-operated tool used to treat various lung,.Is La Familia Michoacana Still Active,
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