The Prescription for Wintertime Asthma Control

We haven’t had much of a winter in the Midwest, but the air is still dry enough to cause “winter” asthma.  Today I would like to discuss how clinicians can provide evidence-based care for their patients with asthma by advising them on how to control asthma during the cold winter months. Today’s discussion is based on the National Asthma Education and Prevention Program’s Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.

  • Extreme temperature changes during the winter can wreak havoc on patients with asthma. Inhaling cold air, especially during physical exertion, can cause drying of the airway and bronchospasm in patients with asthma. 
  • This can result in dangerous episodes of coughing and shortness of breath. Often symptoms occur minutes after exposure.

Patients may recognize that coughing and shortness of breath are a result of exposure to cold air. However, they may not understand that there are ways for them to reduce these adverse reactions to the cold.

Educate your patients about ways to deal with their asthma in cold weather.

  • Teach your patients to shield themselves from the cold air with a scarf, turtleneck, or jacket collar. Covering one’s mouth (and nose when possible) with a scarf will help to warm the inhaled air. Warming up before exercise and cooling down for at least 10 minutes after heavy exercise by walking or stretching can also help.
  • Every use one of these for outdoor activity when it’s cold?

    pearl izumi running mask--it works!

Most important, as their physician, explain the proper use of medication. All patients with persistent asthma (patients having any asthma-related nighttime awakenings or having daytime symptoms more than twice a week) should be on a controller medication, usually an inhaled corticosteroid. These should be taken daily, not just as needed.

The controller medication can be supplemented by the use of a short-acting beta-2 agonist inhaler before any outdoor activity in cold weather. It is better, however, to control the underlying airway inflammation and reactivity with a controller medication.

And remember: This is the time of year to give your patients a flu shot. It’s not too late even in March.  People with asthma are more likely to have serious health problems from getting the flu, yet most people with asthma don’t receive a flu shot every year. Flu vaccine is the first and most important step they can take to protect themselves from the flu.

Finally, the goal of good asthma care is for your patients to be able to enjoy life with as few symptoms as possible. Partnering with your patients through scheduled follow-up care can achieve that goal. Schedule regular follow-up visits. Assess control at each visit, beginning with a standardized questionnaire. Review the patient’s written Asthma Action Plan at each visit. Ask about asthma triggers and help your patients reduce or eliminate them. Review medications and be sure your patients understand how and when to use them.

#asthma, #conditions-and-diseases, #corticosteroid, #dyspnea, #health, #patient, #pharmaceutical-drug, #respiratory-disorders

New Year’s Resolution–Who Should start Controller Meds?

New Year’s resolution!

I don’t like New Year’s Resolutions–if I don’t do something everyday, how is a resolution going to change my priority?  Behold…I bring you good tidings of great joy…taking regular PREVENTATIVE medication works the same way! 

So what’s the issue at hand?  Patients with asthma often want to stop preventive medication for the cough & wheeze.  I often hear…I don’t need it, only to suffer from an asthma attack with their next cold.  What are some useful strategies to improve asthma care in this regard?

 From the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition: Abstract 14793. Presented October 14, 2011: 

American Academy of Pediatrics

  • Pediatricians strongly support the recommendation that emergency department (ED) physicians start asthma controller medications during an acute visit to the ED, according to research presented here at the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition.
  • Why in the emergency room?  It’s the best time to have that one-on-one discussion with asthma patients.  You have their attention.

National asthma guidelines recommend that ED physicians consider initiating long-term controller medications when children present with an acute asthma attack. We all (I mean physicians) follow the guidelines, right?  Think again!

  • Many ED doctors are reluctant to do so, lead author Esther Maria Sampayo, MD, MPH, from the University of Pennsylvania School of Medicine, Philadelphia, said in an oral abstract session.
  • “One AAP study noted that less than 20% of ED doctors actually do this,” Dr. Sampayo told Medscape Medical News. “When you ask them why, they say it’s not their role to be the pediatrician and they shouldn’t be providing long-term management.”

If you don’t know the answer….then let’s find out.  The researchers did a cross-sectional mail survey of a randomly selected national sample of pediatricians involved in providing primary care from the AAP.

  • Of the 527 pediatricians who responded to the survey, 83% reported that they feel it is appropriate for the ED physician to initiate controller medications.
  • Just 23% of pediatricians reported that their patients “almost always” follow-up within 1 month after an ED visit. Makes you wonder what else gets “missed!”
  • Half (51%) of those surveyed believe that having ED physicians prescribe controller meds in the ED will encourage patients to follow-up. 
  • The survey also asked the pediatricians what they consider to be the benefits of having ED physicians initiate asthma controller medications. Most (85%) feel that it is a “teachable moment” and represents an important opportunity to capture patients who are poorly controlled.  Strike it while the iron is hot!

    Strike When the Iron is Hot!

Noah Kondamudi, MD, an asthma specialist in the Pediatric Emergency Department of the University of Medicine & Dentistry of New Jersey in Newark, said that in his experience, more and more ED doctors are prescribing asthma controller medications when children present with acute asthma.

Here in Oklahoma, no data is available on prescribing habits of emergency room physicians for asthma controller meds or the opinion of local pediatricians.  Do I hear a study that needs to be done?

“In general, emergency room doctors would not want to add to or change the primary care doctor’s chronic disease plan. However, more and more data are showing that many asthmatic children are not on controller medication, so initiating controller therapy should make a big difference,” he said.

My thanks to Fran Lowry who is a freelance writer for Medscape.  She has disclosed no relevant financial relationships.

#american-academy-of-pediatrics, #asthma, #emergency-department, #pediatric, #pharmaceutical-drug, #physician, #united-states, #university-of-pennsylvania-school-of-medicine

After Thanksgiving Hangover!

Treating Acid Reflux Disease With Diet and Lifestyle Changes

 Need I say more?

Recipe for heartburn!

Do you often experience the pain of heartburn or other symptoms of acid reflux disease? Most patients despise yet another medication to treat reflux.  You might take comfort in knowing that making diet changes as well as other lifestyle changes may be all you need to do. Here’s how. (the above links to WebMD can be trusted)

What Kind of Diet Changes Can Help Acid Reflux?

One thing you can do to reduce your risk for heartburn and acid reflux disease is to eat low-fat, high-protein meals. Also, eat smaller meals more frequently; eat until you’re no longer hungry–avoid eating until you feel full.  You will always eat less if you eat slower; your mother was correct! 

Mother is usually right!

It may also help to avoid certain beverages and foods.

Avoid beverages that seem to trigger heartburn or make it worse, such as:

  • Coffee or tea (both regular and decaffeinated)
  • Other beverages that contain caffeine
  • Carbonated beverages
  • Alcohol

Avoid foods that seem to trigger your heartburn or make it worse, such as:

  • Citrus fruits, such as oranges and lemons
  • Tomatoes and products that contain tomatoes, such as tomato sauce and salsa
  • Chocolate
  • Mint or peppermint
  • Fatty or spicy foods, such as chili or curry
  • Onions and garlic

What Other Lifestyle Changes Can Treat Acid Reflux?

In addition to acid reflux diet changes, see which of the following lifestyle changes you can make.

  • Quit smoking . Smoking may increase your risk for heartburn and acid reflux disease in many ways. For example, it may increase the amount of acid secreted by your stomach and interfere with the function of muscles that help keep acid down.
  • Reduce reflux while sleeping.These steps will help reduce reflux when you sleep:
    • Put blocks under the head of your bed to raise it at least 4 to 6 inches. This helps keep your stomach’s contents down. However, it doesn’t work to simply use lots of extra pillows because this position may increase pressure on your abdomen.
    • Stop eating at least two or three hours before lying down.
    • Try sleeping in a chair for daytime naps.
  • Lessen the pressure.Often, extra pressure around your abdomen increases acid reflux. Try these steps:
    • Don’t wear tight clothes or tight belts.
    • If you’re overweight or obese, take steps to lose weight with exercise and diet changes.  Here again, WebMD has some great tips to get started.

Can Medication Help Heartburn?

Over-the-counter medications can help neutralize stomach acid. Be careful at this point.  Antacids and ranitidine (called Zantac™) are very weak–I would recommend starting with Prilosec™ or omeprazole. Use 20mg morning and evening until symptoms are well-controlled.  Antacids may give quick, short-term relief for many people, but it doesn’t take care of the “root” of the problem, that is oversecretion of acid from the stomach.  If you find you need to keep taking OTC meds  for more than two weeks, see your doctor or other health care provider.

Also, ask your doctor whether any medication could be triggering your heartburn or other symptoms of acid reflux disease. These are examples of medications that may trigger acid reflux:

  • Aspirin or NSAIDs, such as Motrin
  • Some muscle relaxants
  • Certain blood pressure drugs

Want more information on GERD or heartburn?  Look no further–AAAAI!

#carbonation, #conditions-and-diseases, #digestive-disorders, #esophagus, #gastroesophageal-reflux-disease, #health, #heartburn, #pharmaceutical-drug