I lie and so do you

I was in my doctor’s office today (yes, I go to the doctor as well) and she asked me if I was taking my #medications.  Of course, I said “yes, the ones that are in my chart”, not really having that photogenic list in my head.  As we talked, I realized my confession of what my doctor wanted to hear got the priority over what I was really doing. Busted for lying, but not intentional.

I wish it wasn’t so difficult to take care of our bodies.  I always overestimate how much I #exercise and how little I eat.  Scales don’t lie, so I just don’t weigh myself.  Isn’t it a good thing I only see my dentist every 6 months? I only have to lie about flossing twice a year!

We all do this everyday--just kidding!
We all do this everyday–just kidding!

#Asthma, however, is no laughing matter. Your asthma control and cost of keeping you out of the hospital depends on how often you take the medications prescribed to CONTROL your asthma not just treat it. The solution is simple, yet very difficult to actually perform correctly.  Here’s the issue with asthma–which inhaler do I use when it’s prescribed by my asthma doctor?  I’ll bet you confuse the use of controller medications with reliever medications and now that more new inhalers are on the market it’s even more difficult to do the right thing.

Let’s start at square one with asthma management.  Asthma is a condition of swelling and inflammation in the  lungs.  When you cut your skin, a temporary scar is formed and eventually your skin heals.  Your lungs can also get injured by a virus or allergy. In the lungs, however, your body tries to heal itself with the same scar formation, but the scar can’t resolve in the lungs and you’re left with “stiff lungs” and more trouble with your asthma.  This process is called inflammation and it can be treated but you have to use medication formulated for this purpose. Caretakers of asthma soon learned that there are two types of medications for treatment of asthma:

  • Relievers.  This type of medication takes care of your #wheezing and asthma attacks, but doesn’t prevent the wheezing from happening over & over again.  Examples of reliever medications include albuterol, ProAir Respiclick, Ventolin, Proventil, and your breathing machine (nebulizer). If you’re having an asthma attack, nothing works better than relievers, but you’re not using your inhalers correctly if you are only using this category of medication. Something else is needed, and that’s where the controller medication comes in.
  • Controllers.  Although this type of inhaler is the most effective for treatment of asthma, it’s the most difficult to use on a consistent basis.  Controller medications reduce the damage in the lungs due to inflammation from all of the insults life brings: viral infections, allergy, exercise, and reflux. Examples of this type of medication include Asmanex, Flovent, QVAR, and Aerospan to name a few. Because you can’t perceive the beneficial effect of controller medications for several weeks, it’s very difficult to use these medications on a consistent basis. Remember the dental floss?

Now that I know which inhaler to use everyday and which inhaler to use for asthma attacks, using my medication in the most efficient way possible should be easy.  Not so fast.

As Kristen Mattei writes in her blog in 2012, fifty percent of adults and children fail to use metered-dose and dry-powder inhalers properly. (with compliance rates as low as 30%). http://www.clinicalcorrelations.org/?p=5129Many have trouble timing inhalation with medication release, and spacers are bulky and inconvenient. Patients should be asked to demonstrate inhaler use at each visit and instructed on proper technique, but this doesn’t happen very often because of time constraints with a short office visit anyway. Not very encouraging is the fact that after instruction, 50% of adults continue to use inhalers improperly.

Buston and Wood found, in a 2000 study that asked adolescents to describe their reasons for non-compliance, that 50% of those questioned attributed their non-compliance to forgetfulness. They reported that changes in daily routines, such as vacations, holidays, and weekends made them less likely to remember to take their daily medication.

Adults are just as likely as children to misunderstand or forget their disease management: they hold similar fears of medication side effects and dependence, and they are often unable to properly take their medications. Even those with severe illness misuse their medications. Only 50% of patients on nebulizer or oxygen therapy properly follow their treatment plans.

I would agree with Dr. Mattei that the proper management of chronic diseases requires an honest partnership between the doctor and patient, but patients are reluctant to disclose their non-compliant behaviors and doctors have a difficult time exposing improper medication use. (like anyone who wants approval, confrontation is often avoided) A good doctor-patient relationship begins with rapport building and probably better medications.  We also know that the more medications you take, the less likely you will be to take any of them properly.

Introducing the once daily inhalers for asthma!  I can remember the days when asthma inhalers needed to be used 3-4 times per day just to get through a day with exercise or the common cold.  As you can imagine, not many used their medications as they were prescribed.  With the introduction of twice daily inhalers, our prescriptions have forever changed. (Advair, Dulera, Symbicort)  We don’t floss twice a day, so why do I have to take my asthma inhaler more than once?   While a discussion on when to use Breo, Stiolto, or Anoro is way beyond this article, I’ll introduce you to these long acting medications and remind you that the age of “once daily” inhalers for asthma and COPD is upon us. Talk to your doctor about this new generation of asthma medication and if any of them would be the right one for you.  Perhaps you won’t have to tell any more little white lies about your asthma, even if you still don’t floss!

The new BREO
The new BREO

This is Anoro–

The new Anoro Ellipta
The new Anoro Ellipta

Stiolto web page–

stiolto

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