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Friday, February 5, 2016

My Best Asthma/ COPD Posts for 2015

The following was written by me and published at healthcentral.com/asthma on December 21, 2015

Looking to improve your repiratory health in the new year? As one of HealthCentral's health guides,  I was asked to write an article with a list of my best articles going forward into 2016, with an explanation of why I chose each one and why it’s important to respiratory health readers.

Here are my picks for the best respiratory health articles from 2015: 

1.  The Natural Progression of COPD. This is probably the most important article I’ve ever written, and I refer to it every time I’m encouraging my patients to quit smoking. I discuss the Fletcher-Peto Curve.  It’s a telling visual for anyone with COPD because it shows that smoking speeds up the progression of the disease, and that quitting smoking at any age slows the progression of the disease, thus prolonging life.  

2.  Smart Inhaler the Future of Asthma Control. This article is neat because it shows how far technology has come to helping people live better lives. Smart inhalers have special sensors that track when you use your inhaler and the quality of the air around you. Doctors can track this data on their computers and send you messages on your smartphone with tips to help you breathe better. The system can even send reminders to use your inhaler.  This is a very impressive system.

3.  What Are Asthma Subtypes And Groups?  Researchers learning so much about our disease (which is actually now called a syndrome) it’s simply amazing. Now they understand that asthma is a heterogenous disease, which means that all asthmatics are different, and should be treated different. By breaking asthma into different subtypes, researchers should be able to create guidelines specifically tailored to you to help you breathe easier.  This is compared with the old system where one set of guidelines were created that treated all asthmatics the same.  

4.  What is Severe Asthma? This is just one subtype, but an important one. Researchers observed that about 10 percent of asthmatics do not respond to conventional asthma medicines. Now they understand that this is because these asthmatics develop certain airway changes similar to patients with COPD. Now that this subtype is recognized, researchers are working overtime to learn more about it and to find treatment options to help these patients breathe easier and live better lives.  

5.  Do You Need Oxygen Therapy? and Understanding Oxygen and Oxygen Levels With COPD. Did you know that oxygen is the only drug proven to prolong life? It’s true. If your body is not getting the oxygen it needs, it causes your heart to work harder to pump blood through your body, and you become increasingly winded.  Inhaling a small amount of oxygen is sometimes all that’s needed to ease the work your heart has to do, thus making your breathing easier and prolonging your life.  

6.  Should You Join An Asthma Study?  Researchers are working overtime to learn more about asthma so they can come up with solutions to help us live better with it.  In order to make this work they need to study those of us who have it.  If you have time, it’s important for you to volunteer some of your time (and maybe some of your sputum) for the good of the cause. Future asthmatics are counting on you.

7.  Links Between Asthma and Genetics. I love writing articles explaining what researchers are learning about our disease, even if that means sifting through complex “law-like” material and spending hours and hours doing research.  Of course then I have to simplify it so it’s easy to read and understand. I do this because I’m passionate about understand my disease, and I love to share what I learn.  It’s fun, and as long as I can still breathe I’m going to continue writing posts like this.  

Tuesday, February 2, 2016

Your Daily Asthma Checklist

The following was originally published as a slideshow on healthcentral.com/asthma on April 8, 2015.

Your Daily Asthma Checklist

Asthma can be managed, allowing you to live a normal life, as long as you take the proper steps and maintain compliance. Here is a checklist to guide you through your day to help maintain asthma control.

1.  Take Your Asthma Controller Medicine.  They reduce airway inflammation and keep your airways open so your breathing stays normal. They also make it easier to treat and control asthma attacks when they do occur. Most are long acting, meaning you only need to take them once or twice a day. A good tip is to take them just prior to brushing your teeth in the moring and at night.

2.  Keep Rescue Medicine Nearby. Rescue medicine opens airways to quickly end an asthma attack. Its fast-acting medicine helps you catch your breath. Nebulizers and inhalers work great for home. Inhalers are small and compact, and ideal for when you’re on-the-go. They conveniently fit into pockets and purses, making them easy to take with you.

3.  Avoid and Control Asthma TriggersAsthma triggers are things that may cause your asthma to flare up. Triggers, such as animal dander and cigarette smoke, can easily be avoided. Triggers in the air, such as pollen and high humidity, may be difficult to avoid. However, these may be controlled by using air purifiers and air conditioners.

4.  Use Your Peak Flow Meter. A Peak Flow Meter is a small, hand-held device that measures how much air you can push out of your lungs in one exhalation. Your peak flow numbers can indicate your asthma is getting worse even before you feel symptoms. Swift action may help you stave off an impending asthma attack.

5.  Be Vigilant Early On. Early warning signs appear before an asthma attack starts. Examples include sneezing, coughing, and feeling tired. These are usually unique for each person. When you observe them, take swift action to prevent an asthma attack.

6.  Keep An Asthma Diary.  Record your daily peak flow readings and any asthma signs and symptoms. Keep track of anything new you might have been exposed to, such as an animal. Physicians can use your diary to help recognize potential asthma triggers and patterns, and can adjust medicines accordingly.

7.  Refer to your Asthma Action Plan. An Asthma Action Plan is a plan you create with your doctor to help decide what actions to take when you observe your early warning signs, or your peak flow numbers are trending downward. It should be in a very convenient location, such as on your refrigerator. Others can use it to help you if you are unable to help yourself.

8.  Exercise Daily.  Most asthma experts recommend asthmatics get some form of exercise, even if you have severe asthma. This is important because it helps to keep your heart and lungs strong. It may help prevent asthma, and may also make asthma attacks less severe. Of course, there are other benefits to exercise, such as boosting your energy and improving your mood.

Monday, February 1, 2016

What is a COPD Control Team?

The following was submitted to be published at healthcentral.com/copd.


So you’ve been diagnosed with COPD and now you want to live better with it.  The best next step to gaining control of your COPD is finding a doctor you feel comfortable working with and creating a partnership with that doctor.  In other words, the best way to control and live well with COPD is by creating a COPD Control Team. Here are eight things you and your doctor can accomplish as a team.


Learning COPD wisdom.  You expect your doctor to keep up on all the latest wisdom regarding COPD, such as a good understanding of COPD Guidelines.  Yet you’re not off the hook either, as you’ll need to educate yourself.  The best way to do this is to find a good book like COPD for Dummies or by hanging out on sites like ours.


Smoking cessation.  Your doctor will surely make you well aware that cigarette smoke is not the only cause of COPD, but it is the most common. You’ll learn that quitting smoking is the single most important thing you can do to slow down the progression of your disease.  You’ll learn about the various methods to help you quit.  It’s your job to decide on a plan of action to quitting smoking, and to stick with it.  


Finding the best medicine for you.  You expect your doctors to prescribe the best COPD medicine to help you breathe better.  It’s also their job to make sure you understand why taking your medicine is important, and to make sure you are using proper technique with your inhalers.  Your job is to follow their instructions and to take your medicines at the right times by using the right technique. Just remember that finding the best medicine will usually be a matter of trial and error and may take time.


Learning your COPD symptoms. Your doctor will help you learn about COPD symptom, such as worsening shortness of breath, feeling winded, chest pain or tightness, edema of the ankles, abnormal sounds coming from your airway (such as wheezes), increase in sputum production, and colorful sputum (green or brown). Your job is to pay attention to your body, learn what symptoms are unique to you, and seek help when you observe them.  You’ll also want to take notes and communicate what you learn with your doctor.  


Learning your COPD Triggers. Your doctor will help you recognize what might trigger your flare-ups, or make your COPD worse.  Possible triggers include strong smells, allergens (dust mites, pollen, animal dander, mold, fungus and air pollution), cigarette smoke, fumes, cold air, high humidity, over eating, and overexertion.  By learning your triggers and taking notes, you will be able to work with your doctor on developing a plan of action to control them.


Creating a COPD Action Plan.  Your doctor will work with you in creating a written plan to help you decide what to do if you feel symptoms.  You should keep your plan in a convenient location (such as on the refrigerator) so it’s easy to find by you or anyone trying to help you. You should also bring it to each appointment so you and your doctor can tweak it as needed.


Learning to take quick action.  Certainly you’ll expect doctors to take quick action to help you feel better when you are having a flare-up.  Your part will be to recognize your symptoms right away and refer to your COPD Action Plan so you can take immediate action on your own.  You should call your doctor immediately when your symptoms start to get worse, as opposed to waiting.  In other words, the sooner you seek help, the easier it will be for doctors to help you.


Keeping your appointments.  Your doctor may request you be seen frequently until your COPD is under control.  Your doctor will be at the appointment and be prepared.  You will also be expected to make your appointments and come prepared. Come with questions and any new wisdom you have regarding your symptoms and triggers, preferably written down.  Bring your COPD Action plan, as it should be reviewed with each visit. You should also bring your inhalers so your doctor can make sure you are still using them properly.

Living well with COPD.  Your doctor works with you, and you work with your doctor. Together you are a COPD control team.
This is the first step on your quest to gaining control of your COPD and living well and long with it.

Tuesday, January 26, 2016

Learning your asthma signs and symptoms

The following was originally published as a slideshow on healthcentral.com on February 19, 2015.

Learning your asthma signs and symptoms

One positive thing about asthma is your body lets you know how things are going inside through symptoms and signs. A symptom is something only you can feel. A sign is something others may observe. Here are nine of the most common symptoms and signs of asthma.

1.  Itchy Chin or Throat:  This is a symptom that may appear before you have an asthma attack, but it may also be present during the attack. While many asthmatics observe this, scientists do not understand why it occurs. 

2.  Allergy Symptoms. Allergies are an abnormal response to substances that are harmless to most people, such as dust mites, pollen, and mold. Once you observe a stuffy and runny nose, itchy and watery eyes, sneezing and coughing, you know it’s time to remove yourself from whatever it is you have exposed yourself to.

3.  Cold Symptoms.  One of the most common causes of asthma are viral infections. Inside your lungs they may trigger the asthma response. So once you feel the symptoms — itchy or sore throat, stuffy and runny nose, coughing and sneezing, fatigue — action may be necessary to prevent asthma, such as calling your physician.

4.  Chest Tightness or Pain.  As the disease gains a grip on your lungs, this forces you to use youraccessory muscles to breathe. Accessory muscles are not normally used for breathing in healthy lungs. So, sort of like how your muscles ache after a hard workout, your accessory muscles may ache once you are using them to breathe. 

5.  Coughing.  A part of the asthma response is your body creating excessive amounts of secretions. As these build up, your body will create a cough to remove the sputum. Usually asthma sputum is white; although, if you have a cold caused by a virus, it may be light yellow. If you have bacteria in your lungs it may be dark yellow, green, or brown. 

6.  Shortness of Breath. Despite contrary belief, difficulty breathing is not always the first symptom you feel. Still, it is the tell-tale symptom of asthma. It’s caused by air passages that are narrowed when the muscles wrap around them to spasm and squeeze the airways. Excessive mucus production may also block airways. 

7.  Hunched Shoulders and Difficulty Speaking. In order to make more room for air in your lungs, a natural mechanism causes you to raise your shoulders as high as you can. As your asthma attack becomes more severe, this may require you to lean on things to breathe. Speaking may be difficult, so you speak in short, choppy sentences. When you observe these symptoms your asthma attack is severe and it’s time to take immediate action. 

8.  Paradoxical Breathing. Normal breathing results in little chest movement. Normally your stomach goes out on inspiration and in on expiration. You don’t have to think much about it, it just happens. During an asthma attack, a natural tendency is to suck in your stomach to push up your diaphragm to force air into your lungs. This is a symptom and sign of a severe asthma attack and immediate action is needed.

Be Vigilant. The simplest way to prevent and treat asthma is by paying close attention to what your body is saying. Your physician may help you understand your signs and symptoms and what to do when you observe them.

Tuesday, January 19, 2016

Introducing the new smart inhaler

The following was originally published on August 1, 2015, at healthcentral.com/asthma.

Smart Inhalers the Future of Asthma Control

Smartphones, smart TVs, and now smart inhalers? It appears this is already happening, thanks to new technology developed by Propeller Health. This may be the revolutionary breakthrough the asthma community has been yearning for to obtain ideal asthma control.

You actually turn your own inhaler into a smart inhaler. To begin all you need is a prescription for an inhaler from your doctor as normal, and also a prescription for an inhaler sensor. Then you download an app and sign in. After picking up the inhaler you simply snap the sensor onto it. The sensor then wirelessly syncs with your smartphone using Bluetooth.

When you use the inhaler, the sensor picks up the signal and collects data regarding any potential asthma triggers in your area. You can then track when and where you use your inhalers, and what symptoms you felt. You can even set reminders.

The data is then collected both on your smartphone and on the company’s server. The system automatically keeps a record of your trends including time, date and location of when you use your inhaled medications, along with whatever data you enter into the system.

If the system determines that your asthma is well-controlled, you may receive prompts, such as: “Congrats! We hope you are feeling fantastic and are spending your time doing all of the things that you enjoy!”

However, if it determines your asthma is not well-controlled or poorly controlled, you may receive notifications such as:
  • Are you taking your controller daily? If not, it’s time to start taking your controller DAILY as directed.
  • Know your triggers and start avoiding them; if they are not always avoidable use your rescue inhaler before being exposed to them or directly after being exposed.
  • See your doctor if you are not lasting four hours between rescue inhaler doses and bring the information from your Propeller account that shows how often you are taking your rescue inhaler with the signs and symptoms you note, and the trends that all your information has formed regarding your asthma. This record helps you have good, honest conversations about your asthma with your doctor and so, together, you can build strategies to control it better.
The goal of this new technology is to help...

1. YOU. No longer will you have to rely on memory when reporting on your asthma since your last physician’s visit. No longer will you have to keep an asthma journal, which most studies show aren’t reliable anyway. By reviewing the data on your smartphone your doctor will have access to all the same data you do.

2. Doctors. They will receive emails every morning to help them better manage their days. They can make sure they see patients who need help, and not bother those who are doing fine. For instance, if your status changes from well controlled to poorly controlled, your doctor will be alerted. This way your doctor can make sure you get the help you need when you need it. Your physician may have a nurse call you with advice, or may suggest you come in for a visit.

3. Community Health Leaders. They will be able to track where and when asthmatics use their inhalers. For instance, if the data reveals that one spot in your neighborhood is a hotspot for inhaler usage, this may indicate something in that area is acting as an asthma trigger and should be avoided by asthmatics. You and your doctor will also have access to this data.

The company promises that the only name you will see is your own name. All other names will not be shown on the app, only when and where inhalers are used, along with potential triggers and symptoms reported.

This is a novel idea and it’s still in the early stages. However, the FDA seems to like it, having cleared the way in 2012 for it to be marketed for any metered dose inhaler (MDI), including albuterol, xopenex, Qvar, Flovent, Dulera, and Advair.

Just recently, the FDA cleared the way for it to be marketed for any medicine delivered by the GlaxoSmithKline Discus and the Boehringer Ingelheim’s Respimat device, including Flovent, Advair, Spiriva, and Combivent.

We’re not endorsing any product here, just letting you know that this might be the wave of the future as far as asthma inhalers go. Other companies will probably enter this market, and the increased competition will only make smart inhalers smarter.

There are many asthmatics, both adults and children alike, who struggle to gain control of their asthma, and this may be an ideal tool for helping them gain optimal asthma control.

Further reading and references:

Saturday, January 16, 2016

Friday, January 15, 2016

Bronchodilatoracholics: Frequently Using their Quick-Relief Asthma Inhalers

These are asthmatics who use their bronchodilators frequently, perhaps too frequently. It's usually an indication that their asthma is not controlled.

A bronchdodilator is a quick-relief asthma medicine that relaxes the airways in the lungs so it's easier to breathe. They are often prescribed in conjunction with anti-inflammatory asthma medicines.

Some bronchodilatoraholics are hard-luck asthmatics who just need help breathing very often. While others are regular asthmatics whose asthma is out of control.

But some bronchodilatoraholics are abusers, taking their asthma medicine more out of habit than necessity. They may also ignore the directions given to them by their doctor. Abusers don't work with their doctors on an asthma action plan and they may not bother withcontroller, anti-inflammatory medications. For them, puffing away is like a bad habit -- like biting your fingernails. In contrast, some hard-luck asthmatics may just need their bronchodilator frequently -- many times a day, every day.

Asthma Attitude: "Just one more puff, and I'll be fine."

Asthma Strengths: They know not to wait until they have severe breathing trouble to take their bronchodilator.

Asthma Weaknesses: A bronchodilator is not made to control asthma, but to relieve and prevent symptoms. Bronchodilatoraholics are not treating the underlying cause of their asthma symptoms -- inflammation in their lungs.

Lessons to Live By: The first step is to admit you have a problem. If you use your bronchodilator too frequently, then you need help controlling your asthma. The bronchodilator isn't going to solve the problem.