Category Archives: Cough

Four reasons I still practice Allergy in the Information Age

Ever notice how everyone has #allergies these days?  I kid you not, almost everyday, a patient will tell me that #Tulsa (where I practice) has more allergies than any other place in the country.  The irony of it all, is so did patients in Kansas, and patients say the same thing in Virginia and Texas.  You get my point–we all love to be known as the Allergy Capital of the World! Maybe it’s because allergies make us feel so miserable, and we love to hear stories about how to deal with the nemesis.  Or maybe we want some “inside information” to share with our friends & family who also suffer from allergy. Whatever the reason for our obsession with allergy, you can’t argue with the fact that good allergy advise is not only helpful for better quality of life, but it’s crucial in making sure that allergy sufferers avoid heeding the WRONG advice for treating #hay fever. This is the passion I experienced in order to complete a fellowship training in allergy– I wanted to be able to interact with patients about their #allergic symptoms on their journey to good health. But wait, why practice a specialty that has so much incorrect information on-line and no doubt, “everyone’s an expert in allergy” when you could be doing real medicine to treat someone’s heart attack? Here are four reasons I still practice allergy for your consideration: Continue reading Four reasons I still practice Allergy in the Information Age

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Drug Reps Will Give You Asthma

I know you’ve been there before….waiting in the doctor’s office for your appointment and some smartly dressed man or woman barely has to say hello to the receptionist and walks right by your seat, straight to the doctor’s office. “Hey, that’s not fair,” you say to yourself as you dig your nose into that outdated magazine trying to mask the irritation.  “My time is just as valuable as theirs is, put me to the front of the line!”  As a patient, my frustration with the #health care system only percolates at the injustice.  Isn’t the cost of #medication so high in America because of all the drug companies?  If there were no drug reps, wouldn’t my doctor have a better and certainly more unbiased selection of medications?  Granted, the goal of any #pharmaceutical company (employer of drug reps) is to make profit, but they can’t do that unless a product (medication) works well and is taken as directed.  In the end, drug companies want you to be adherent to medications prescribed so they’ll work, you get better, all of which is good for the bottom line.  Almost sounds too good to be true when everybody wins, but hang on and I’ll show you how this is possible. Continue reading Drug Reps Will Give You Asthma

First new dry powder inhaler for quick relief!

At first glance, I thought to myself, do we really need another quick acting inhaler?  As I thought about inhaler technique and how we use our Ventolin MDI’s, most of use suck on the end of the inhaler which is the wrong technique to use.  (all of the medication deposits on the back of the throat)  Why not use the appropriate inhaler that’s meant to actuate with your breath anyway?  ie, sucking on the inhaler is what you’re supposed to do!

Give the dry powder a try!
Give the dry powder a try!

Here’s the link to the article if interested–http://www.pharmatimes.com/Article/15-04-01/FDA_OK_for_Teva_s_acute_asthma_inhaler.aspx

Asthma Triggers!

Ah yes! Triggers are what make asthma so unpredictable.

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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My Sinuses Suck!

Allergy or Irritant--that is the question!
Allergy or Irritant–that is the question!

Sinus pressure can be a real problem during the cold, winter months.  Do I take decongestants or antihistamines?  Sudafed or Zyrtec?  Are my allergies acting up?

Here are some pointers on dealing with sinus infections and sinus pressure with some really cool slides at the end:

  1. Most allergens are gone in December-January, so the statement “my allergies are bothering me” is actually misplaced.  You are meaning to say that sinus pressure is causing congestion and runny nose.  Inflammation and swelling definitely exist in your sinuses, it’s just that your symptoms during the winter are not caused by allergy, but rather sinus infection.
  2. Treatment of a sinus infection is “all or nothing”.  In other words, if you only remove 50% of the infection, it is likely your symptoms will quickly recur.  Your body requires a mucociliary blanket in the sinuses to gradually remove bacteria and excessive snot.  This protective blanket is destroyed during any infection, and won’t grow back until the inflammation subsides.  Often it takes 30 days of antibiotics and prednisone to restore the sinuses back to their original condition. 
  3. One of the pictures in your slide set (slide 3 of 15) shows what normal mucociliary blanket looks like under the microscope.  If this giant vacuum sweeper was operating normally all of the time, you wouldn’t have to use all your medication. 

Here are some suggestions on how to treat your sinuses better:

  1. Make sure you eliminate nasal congestion.  For the short term, use Afrin or similar equivalent (OTC) if you limit to < 1 week per month.  This allows the nasal airflow to drive away the excessive mucous in your nose which would otherwise become a great meal for hungry bacteria.  Sick but true!
  2. Find out if you have allergy!  The winter season gives you a reprieve from outdoor allergens, but during the spring, summer, and fall, tree pollen, Bermuda grass, and ragweed are more than willing to invade your sinuses and cause irreparable damage to your mucous membranes and make you always sick. 
  3. Use your prescribed nasal spray EVERYDAY as prescribed by your doctor.  I know, Americans hate to put anything in their nose (except your finger), but regular use of nasal steroids and antihistamines will reduce the swelling in your sinuses and guess what?  You got it, fewer infections. 
  4. Get smart!  Go through the slides below, and if you don’t learn anything new, I’ll buy your favorite drink at Starbucks. 

http://www.medicinenet.com/sinusitis_pictures_slideshow/article.htm

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!

A Cultural and Historical Examination of the Cough Drop

What’s medicine and what’s just candy!  Read on to find out.  My own personal thought is many patients with vocal cord dysfunction (VCD) respond to vocal hydration which can occur while sucking on a cough drop/candy.  Maybe we’ve been treating VCD all along with HALLs!  Stranger things have happened.

A Cultural and Historical Examination of the Cough Drop.

To Use or Not To Use FeNO (exhaled nitric oxide)

 

Whether exhaled NO helps to identify a specific phenotype of asthmatic patients remains debated. Not everyone would agree with Dr. Boggs in this video–what do you think?

In conclusion, FENO0.05 is independently linked to two pathophysiological characteristics of asthma (ICS-dependant inflammation and bronchomotor tone) but does not help to identify a clinically relevant phenotype of asthmatic children.

For the Usefulness of FeNO complete study click here:  (let me know if you need a password)

I’m Worried about Whooping Cough

Grandparents eager to hold the new baby in the family this holiday season should add vaccines to their shopping list.

  • The whooping cough vaccine given to babies and toddlers loses much of its effectiveness after just three years, a lot faster than doctors believed, and that could help explain a recent series of outbreaks in the U.S. among children who are fully vaccinated.The whooping cough vaccine given to babies and toddlers loses much of its effectiveness after just three years, a lot faster than doctors believed, and that could help explain a recent series of outbreaks in the U.S. among children who are fully vaccinated. 
By Rich Pedroncelli, AP
 
  • Anyone who comes into close contact with infants is now urged to get vaccinated against whooping cough, or pertussis. Getting the vaccine now will provide enough time for it to start working by Christmas weekend, but cost could be a barrier for many people.

Last year (2010), the whooping cough epidemic hit hard in Oklahoma, resulting in several infant deaths from an apparent “benign” disease.  (review News on 6 report)

How do you protect your babies against whooping cough?

Being a “pit bull” for your baby is the right thing to do, according to Dr. Eric Scott Palmer, a Nashville neonatologist .  “Not only is there pertussis or whooping cough, but we are entering the influenza and respiratory syncytial virus seasons,” Palmer said. “These are some viral illnesses and bacterial illnesses, such as whooping cough, that can and do kill infants, particularly former premature infants. At family gatherings, while everyone loves babies, the infection control during those times is of critical importance — particularly as it relates to hand-washing.”

Many adults mistakenly believe they are protected against pertussis because they’ve had whooping cough before, while others walk around with the virus without realizing it, said Dr. Kelly Moore, who directs immunization programs for the Tennessee Department of Health. Also, the vaccine wears off over time, so a booster shot is needed about every 10 years.

“People may assume it’s like measles, where you get it once and you never get it again,” Moore said. “Unfortunately, this is something you can get many times. The problem is the symptoms aren’t as classic as measles or chicken pox. People might not even realize they have it because it is not as obvious.”

  • Doctors start vaccinating infants for pertussis at two months old, but protection requires booster shots. Children need five doses of the vaccine, and three of those occur before the age of 1.
  • Another new recommendation from the CDC is that pregnant women get the shot after the 20th week of gestation if they have not been previously vaccinated.

“What is frightening is that people with an ordinary cough illness might not think they have pertussis and might expose a newborn or infant unknowingly,” Moore said. “Small infants or newborns can stop breathing when they have pertussis.”  Here’s what pertussis sounds like in small infants (watch the video)

“The vast majority of pertussis cases are never diagnosed or confirmed,” Moore said, noting that it takes a more sophisticated lab test than a blood check to detect the bacterium.

Protection is provided by the Tdap vaccine, available in your doctor’s office or at the local health department. Whooping cough is one of several winter illnesses that can cause serious complications for infants and people with compromised immune systems. While you’re getting the pertussis vaccine, get the flu shot while you’re already there! 

“The stoic family member who shows up sick at the family Christmas party is probably not doing anyone any favors,” Moore said.

The full article from USA Today is found here!