Category Archives: Asthma

Dealing with Problems by Self-Medicating

lynnawiensmd:

Couldn’t say it better for allergy & asthma meds!

Originally posted on 123MyMD:

Dealing with Problems by Self-Medicating

How many of us try to self-medicate ourselves. We might do it with alcohol; we might do it with drugs; we may do it with over-the-counter medications; we may do it with caffeine. All sorts of things are used to self-medicate. What you have to look at is what problem are you dealing with, and how are you trying to handle it? Self-medication is not a bad thing if you’re taking a cough medicine for a cold. But if you’re trying to grapple with something that’s beyond your skill, you need to get help. That’s why it’s important to see a doctor and get that advice.

For more information, please go to http://www.123MyMD.com.

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Running with asthma

lynnawiensmd:

Keep up the good work! No excuse for not exercising.

Originally posted on lissyruns:

I’ve had asthma for as long as I can remember. I can also remember as a child being told that it was likely that I’d just ‘grow out of it’. But I got older and older, and now here I am at 26, still an asthmatic.

Like most people, I have certain triggers that make asthma worse. The biggest trigger I have is cold weather. Asthma is a major problem for me in winter – the cold air coupled with spending more time indoors with central heating on full blast plays havoc with my ability to breathe comfortably. 

It makes training so much harder – the running in general is harder, with inhaler breaks mid run. Harder runs in turn lead to dreading runs, which in turn leads to missed runs. It’s a vicious cycle.

I remember once being at a BBQ, and getting out and using my inhaler. Bemused…

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Is it legal to buy drugs online or import them from another country?

lynnawiensmd:

Many asthma patients will inquire about this for cheaper inhalers. Good article.

Originally posted on PharmacistAnswers:

Is It Legal To Buy Drugs Online Or From Outside Of The United States?

     ​Consumers always want to find the best price to purchase their goods and medications are no different. The drugs that treat our many illnesses and disease states can help us lead healthier and better lives, but they can also come at an enormous cost. We now live in a digital age, where many of our purchases that once took place in brick and mortar stores, now take place online. There has always been a sort of stigma regarding online pharmacies. Are their prices too good to be true? Are they safe? Will you get the same medication online as the medication that is at your CVS down the street? The big questions though are those concerned with the legality of it all. There are two legal questions that people always want answered. The first is if it is even legal to buy drugs online. The second is, if it is legal to buy drugs online, can…

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Asthma Triggers!

lynnawiensmd:

Ah yes! Triggers are what make asthma so unpredictable.

Originally posted on More Than A Mom:

If you have asthma, certain things can cause you to have an asthma attack. These triggers include things like cigarette smoke, pollen or air pollution, cold air, mold, animals, and dust. To help control your asthma, stay clear of these triggers.

Also, learn how to spot the early signs of an asthma attack. When you know the signs, you can stay in control. Early signs can be different for each person, but here are common ones:
A long lasting cough
Chest tightness or discomfort
Becoming out of breath more easily than usual
Coughing
Frequent clearing of the throat
Wheezing
Stuffy nose

A written asthma action plan spells out how to use your drugs. If you don’t have a written asthma action plan, ask your doctor for one.

Remember: If you don’t have a written asthma action plan, ask your doctor for one.

If you have a certain topic or question…

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Bronchial thermoplasty: Long-term safety and effectiveness in patients with severe persistent asthma

The research is now there for use of bronchial thermoplasty.  What is this procedure?

We have this procedure available here in Tulsa at St Francis hospital.  Do patients like it?

For the study in this month’s JACI that summarizes the beneficial effects of bronchial thermoplasty, click on the link below:

Bronchial thermoplasty: Long-term safety and effectiveness in patients with severe persistent asthma.

Health: Asthma Misdiagnosis Is Common

lynnawiensmd:

Don’t think you have asthma….try the following:
1. Reflux can mimic symptoms of asthma with cough & wheeze
2. You might need a Aridol challenge test to be sure.
3. Don’t forget about sinus infection which can mimic coughing.
4. Make sure you’ve performed lung function! (PFTs)
5. Vocal Cord Dysfunction can sneak in as a cause of cough & wheeze.

Originally posted on CBS Philly:

[worldnow id=9641386 width=400 height=300 type=video]

By Stephanie Stahl

PHILADELPHIA (CBS) — One in 12 people have been diagnosed with a breathing disorder and the numbers are growing every year.  But experts say many people are being misdiagnosed, and in some cases, the drugs they’re prescribed are doing more harm than good.  3 On Your Side Health Reporter Stephanie Stahl explains.

More than 25 million Americans have been diagnosed with asthma.  But experts say not all of those people actually have it.

“Patients are often misdiagnosed with asthma, much more often than anyone typically realized,” said Dr. Sally Wenzel, a Pulmonologist.  She says studies have shown 25 to 30 percent of asthma patients are misdiagnosed.

When Deb Bushe came to Dr. Wenzel for help with her asthma she learned she didn’t have it.

“I was very surprised when I was told I didn’t have asthma,” said Deb.  For 15 years Deb…

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Oklahoma Drivers…Shut ‘em Down.

Without a doubt, driving on ice and snow should be reserved for the experienced drivers only.  We don’t need more wrecks on Hwy 169 that what we already have to endure.  But when the forecast for a winter storm brings on a run for bread and milk, we may have gone a bit too far.  We have our own version of Black Friday…it’s called snow storm panic!  Here I was shopping at Target to get a few items I really did need.  Usually, my wait at the pharmacy is very short, but last night I guess EVERYONE thought it was important to get their medications filled before the storm arrived in case medications would no longer be available.  Come on, pharmacies stay open even in Minnesota.  Did you happen to go down the bread aisle?  Nothing left and not a snowflake on the ground.  No wonder you can’t yell fire in a theatre.  The most shocking behavior, however,  found in Oklahoma in preparation for a winter storm is to cancel school before it even starts to snow.  Will you catch us off guard and unprepared?  Not a chance.  No wonder our kids have never seen snow or had a chance to make those lovely snow angels.  They’re never in it.  All joking aside, we did have a pretty nasty snowstorm 2 years ago with almost 20 inches in one night.  That amount of snow shut the city of Tulsa down for a week!  Could it happen again?  Sure could, but the video below is enough for me:

Now, you’re probably wondering if I always pontificate about a totally irrelevant topic such as how Tulsans prepare for snow storms.  Fortunately, this can have some relevance to cold weather illness:

  1. Asthma can be a real problem during the cold weather.  Inhaling cold air causes drying of the airway wall and more severe bronchospasm that moderate temperatures.  Don’t think that coughing and shortness of breath is just cold air; it may be your asthma getting out of control.  Learn how to cover your nose and mouth with a scarf or mask, even if you’re outside for a short period of time.  And most of all, use your regular inhaler (controller) during the winter  months if cold air or upper respiratory infections are triggers for your asthma.
  2. Another problem with the winter season is trying to figure out if I have a cold, flu, sinus, or allergy problems.  Let me make this much easier for you.  Most ragweed is done pollinating by the end of October, so without much pollen in the air, your sneezing and coughing is probably not due to allergy (no exposure). A cold usually lasts < 1 week and any congestion or runny nose that doesn’t resolve from one Saturday to the next is probably a sinus infection.  Why does this matter?  Sinus infections should be treated with the “all or nothing” approach as any infection left in the sinuses will only result in more infection.  Catching the flu makes you feel terrible and you’re already coughing.  What could be worse?  Add a fever with muscle aches and your diagnosis is most likely some type of influenza.  Good motivation to get your flu shot!
  3. Am I Allergic to the Cold?   I’m glad you asked.  Cold-induced hives stays hidden for most of the year and comes out with a vengeance during cold weather.  Some instances can be life-threatening and this condition is nothing to take lightly.  Cold-induced urticaria of course, responds best to a vacation at Key West, but if you don’t have the luxury or flexibility to do that, antihistamines are still the backbone of treatment.  Be careful when shoveling snow as shortness of breath and chest tightness may be associated with hives and a cold-induced reaction.

Although you must be careful with cold weather illness, you have to do something outside or you’ll get cabin fever.  The link below is from AAAAI on how to control your asthma and still participate in winter activities.  It’s a good read in front of the fireplace with a cup of hot chocolate.  In the meantime, I’m heading for the slopes!

Asthma and Winter Sports.

Health Care Changes Will Affect Your Asthma Regimen

 

Europe and the United States differ on many things including how we look at war and how often we pick our noses…yes it’s true about rhinotillexomania (nose picking).  Perhaps this is why Europeans will reach for a nose spray FIRST to treat allergies and then go for antihistamines.  Yes, there’s even a Dr Oz video on the subject: http://www.oprah.com/oprahshow/Dr-Oz-on-Health-and-Hygiene

So what is the point of all this nonsense?  Treatment of asthma also differs between the United States and Europe.

The Misuse of Asthma Drugs

Gene L Colice Expert Rev Resp Med. 2013;7(3):307-320. 

There are three major problems with asthma care in the USA today and misuse of asthma drugs contributes to each.

This is where the information comes from!
This is where the information comes from!

First, multiple sources document that symptom control of most Americans with asthma in the general population does not meet standards established in the National Asthma Education and Prevention Program Expert Panel Report III (EPR3). In the CHOICE survey, 1000 patients with asthma randomly chosen across the USA were asked about their care and burden of disease.  Almost half of these patients (49%) reported that they did not use asthma controller medications, although 79% had evidence of persistent disease. Of the 51% of the patients reporting the use of asthma controller medications in this survey, 85.7% had not well controlled or very poorly controlled disease. Numerous previous surveys of asthma patients in the USA and Europe, using either telephone interviews or questionnaires, have reported similarly high levels of uncontrolled disease. In the Exercise-Induced Bronchospasm Landmark Survey, 78.8% of the children with asthma and 83% of adults with asthma described respiratory symptoms with exercise. Children and adults with asthma commonly described being limited in their ability to perform sports and outdoor activities by their disease in this survey. 

I know most patients would like to stop their asthma medications ASAP, but it comes at the cost of losing asthma control.  I’ve previously discussed when to stop asthma medications…I’d like to know what you think?  Are doctors prescribing unneccesary medications?

 Second, in addition to difficulties with symptom control on a daily basis, patients with asthma in the USA frequently suffer exacerbations.

Grandpa can't breathe! --that's what exacerbation means
Grandpa can’t breathe! –that’s what exacerbation means

In the CHOICE survey, 5% of the patients reported being hospitalized and 14.4% described either an emergency department (ED) or urgent outpatient visit for an asthma exacerbation in the past year. Patients interviewed in this survey with more severe, persistent or uncontrolled asthma were more likely to have suffered asthma exacerbations. Previous surveys have reported similarly high rates of asthma exacerbations resulting in ED visits and hospitalizations. Data from the US CDC confirm that nationwide rates of ED visits and hospitalizations for asthma exacerbations remain unacceptably high.

So what are parents to do?  The choice between giving your child steroids and having to rush to the emergency room for an asthma flare can be a “no win” proposition. 

 Third, asthma is an expensive disease.

If only!
If only!

The CDC has recently estimated that asthma costs the US economy approximately US$56 billion annually. On average, an asthma patient has been calculated to generate approximately US$2000–$4000 more in healthcare costs per year than a nonasthma control patient. Indirect costs due to work loss, school absenteeism, reduced productivity and so on, further contribute to the economic impact of asthma. Healthcare costs of asthma increase in patients with more severe disease. In patients with moderate and severe persistent asthma, exacerbations will further substantially increase healthcare costs.

I know the most common reason that patients stop their medication is simple: medications are too expensive.  Here are some tips to reduce the cost of your prescribed medications for asthma:

  1. Make sure the medications you are picking up at your pharmacy are needed year round.  Some patients need asthma inhalers only during the cold winter months.
  2. Educate yourself…know your triggers for asthma attacks to keep you out of the ER and better yet to use inhalers as prevention! (I have links to the American College of Allergy and the American Academy of Allergy, Asthma, and Immunology)
  3. Monitor your symptoms with a peak flow meter and pay attention to how much exercise you can do, and how well you sleep.  Both of these indicators will tell you several days in advance if your asthma is flaring.
  4. Use coupons for your inhalers.  In years past, pharmacy reps would leave samples for us to hand out to get patients started on asthma prevention.  This is no longer the case because of health care reform.  But….coupons are available for a similar value.  Just don’t forget to take the coupon in to your pharmacist when you pick up your inhaler. 

  In summary, having reviewed the data, the EPR3 predisposes to under treatment of asthma. The tendency is for healthcare providers to underestimate asthma severity and to correspondingly undertreat the disease. In most asthma patients, the result will be persistent asthma symptoms. In important subsets of asthma patients, particularly smokers, the efficacy of ICS seems impaired. For a given categorization of asthma severity (even if accurately calculated by the healthcare provider), the corresponding recommended treatment with ICS in the EPR3 might be insufficient in smoking and obese asthma patients. Again, the consequence will be persistent asthma symptoms.  Asthma tragedies occur all the time…let’s make sure it doesn’t happen to someone you know!

Why Does Vitamin D work?

Asthma sufferers may benefit more from inhaling vitamin D than the steroids usually prescribed for the condition.  And besides, aren’t we all concerned with side effects from steroids? A new study from the U.K. identifies a mechanism through which the vitamin can significantly reduce asthma symptoms and suggests it may offer a new method of treatment. Continue reading Why Does Vitamin D work?

You’ll Be the Hit of the Party!

Oh, if I only knew of a more interesting subject for MY next cocktail party.  When kids’ drama, and the latest neighborhood gossip just won’t do, try your luck at the newest asthma mediation! 

A special thanks to Reuters for their excellent reporting…my comments will be in RED.

Medscape Medical News from the American Thoracic Society (ATS) 2013 International Conference

Regeneron, Sanofi Asthma Drug Seen as Potential Game Changer

By Ransdell Pierson

(Reuters) – A new type of asthma drug meant to attack the underlying causes of the respiratory disease slashed episodes by 87% in a mid-stage trial, making it a potential game changer for patients with moderate to severe disease, researchers said on Tuesday.

Slashing episodes by 50% is pretty dramatic, much less results of 87%.  Too good to be true always lurks in the background with medical studies.  Am I cynical?  Unfortunately, I’ve been burned by too many drugs, gadgets, and the next best nutritional supplement to accept this news without a grain of salt.

“Overall, these are the most exciting data we’ve seen in asthma in 20 years,” said Dr. Sally Wenzel, lead investigator for the 104-patient study of dupilumab, an injectable treatment being developed by Regeneron Pharmaceuticals Inc and French drugmaker Sanofi.

The drug also met all its secondary goals, such as improving symptoms and lung function and reducing the need for standard drugs called beta agonists.

Although far larger trials will be needed to confirm findings from the “proof of concept” study, researchers expressed optimism. They noted that dupilumab has also shown the ability to tame atopic dermatitis or severe eczema.

The medicine, if approved, could hold promise for patients with moderate to severe persistent asthma that is not well controlled by standard drugs.

“We have been treating asthma with sort of Band-Aid therapies that didn’t get at the underlying causes,” Dr. Wenzel said in an interview, adding that dupilumab could be an important step in going to the root of the problem. 

The Holy Grail in more ways than one!
The Holy Grail in more ways than one!

The drug works by simultaneously blocking proteins that have been linked to inflammation, interleukin-4 (IL-4) and interleukin-13 (IL-13).

Dr. Wenzel, director of the Asthma Institute at the University of Pittsburgh, said other drugmakers have tested medicines that block one or both of the proteins, but without success.

The trial recruited patients with high levels of eosinophils. Such patients were deemed likely to benefit from treatment.

This new form of medication, called monoclonal antibodies, targets single molecules to avoid the side effects of steroids.  Our prototype for asthma is Omalizumab or Xolair which just celebrated its 10th year out in the market.  Other than Xolair, I’m limited to using steroids for severe asthma.  :(

All patients initially stayed on their standard asthma treatments, meaning medium-to-high doses of inhaled glucocorticoids, as well as long-acting beta agonists. But patients gradually tapered off on those drugs and were no longer taking either of them after nine weeks.

Throughout the Phase IIa trial, half the patients also received weekly injections of dupilumab, while half received placebo injections.

After the ninth week, about 25% of those on placebos had experienced exacerbations, i.e., the need to take a beta agonist, a decrease in lung function, the need for an oral or inhaled corticosteroid, or admission to the hospital or emergency room for worsening asthma.

“By end of the trial, after 12 weeks, 44% of those in the placebo group had exacerbations, compared with 5% of those on dupilumab,” Dr. Wenzel said.

That represented an overall 87% reduction in exacerbations, which Dr. Wenzel said was highly statistically significant.

She said dupilumab was well tolerated, with side effects similar to placebo. But she cautioned that longer trials are needed to fully assess the drug.

Regeneron and Sanofi said standard drugs are unable to control asthma well in 10% to 20% of patients. They estimate that inflammation caused by Th2 cells – the type of inflammation among patients they tested – plays a role in half of those moderate to severe cases and affects as many as 2.5 million people in the United States and up to 30 million worldwide.

Dupilumab has also shown strong hints of safety and effectiveness in two early-stage trials that involved 67 patients with atopic dermatitis. Larger studies are slated to begin later this year.

Atopic dermatitis is inherited and involves patches of highly itchy skin on any part of the body. Patients, many of whom also have asthma and hay fever, have compared the sensation to having unending poison ivy.

“This asthma data and the data we already have in atopic dermatitis really raises the possibility the scientific community has finally hit upon the key pathway across all these allergic diseases,” George Yancopoulos, Regeneron’s research chief, said in an interview.

And there you have it….next time don’t be stuck with boring conversation about the weather, talk about Dupilumab!