Monday, December 22, 2014

Is Symbicort safe?

Your Question:  I'm an asthmatic and have been taking Symbicort for three days, one puff twice a day.  Should I keep using it or stop?  From what I've read, I am afraid about side its side effects and that it may cause asthma-related death. 

My answer:  Your physicians prescribed this medicine because he believes the benefits outweigh the risks. It is a very good medicine for controlling and preventing asthma, and  is a top line asthma medicine. 
and, so long as it is used as prescribed, is considered safe. I wrote an article about just this topic a few years ago, and I will link to it here for you to review. If you have further questions please feel free to ask.

Saturday, December 20, 2014

2000-539 B.C.: Babylonians describe first lung diseases

Ancient Babylonian texts describe both diseases of the lungs and heart, and they even describe diseases such a`s chronic bronchitis and pneumonia. These respiratory diseases were more frequent than in ancient Egypt, and the reason may be due to the climate of Mesopotamia which can result in scorching hot days as hot as 120 degrees, and very cold nights. (Sigerist, page 381)

Generally, what is described are the symptoms, which was generally how it was in the ancient world  These ailments that caused you to become short of breath, or to develop a cough, were caused by demons sent by the gods. The gods made you get inured or sick because either you or your ancestors had sinned.  Another way you might get sick or injured was when dark magic was used by other people, either in the form of words or poisons. (Garrison, page 420)

If, for example, a demon possessed your lungs or heart, this resulted in shortness of breath, chest pain, increased sputum, wheezing, and similar symptoms.  Other diseases described were rumination, acid stomach, nerualgia, and various diseases of the eyes. They also knew about epilepsy and contagion, which was epilepsy caused by demons.  (Garrison, page 56)

They new that some diseases were hereditary, and this was probably caused by a sin of your ancestors.  They also observed some diseases were contagious, and this was probably due to demons possessing anyone who comes into contact with the diseases.  It was probably for this reason people with diseases like leprosy or syphilis were forced to live in exile, and people were discouraged from coming into contact with them. They were also struck by various plagues, and of course these were during times when the gods were exceptionally irritated. (Garrison, page 426)

Many of their remedies, especially exorcism and herbal, were picked up by later societies, including the Egyptians, Hindu, Chinese, Islam, and Medieval Christians.  So what was learned by one society greatly impacted future societies. (Garrison, page 56)

If you were sick or injured, if you were short of breath, you had a variety of options.  You could grin and bear it.  You could treat yourself with your own incantations, prayers and herbal remedies.  You could go to a smaller temples and perform a ritual for health and healing.  You could rely on the priests to perform such rituals at the larger temples.  You could lie in the streets.  You could call for a priest/ physician.

Primitive indeed the options were, you did have options for health and healing in ancient Babylonia.  Around 700 B.C. the Babylonians were defeated by the Assyrians, and sometime around 612 B.C. they conquered the Assyrians and there was a resurgence of sorts, with the capital city of Babylon reaching the peak of its glory.

However, Babylonian civilization grew weak, and was conquered by the Persians and Medes in 539 B.C. The Persian Empire rose to glory, becoming the preeminent civilization of the Near East, and in itself helped to advance medicine.

However, while knowledge was growing in ancient Greece and Rome, the Near East, Mesopotamia included, went into a dark ages of sorts, meaning knowledge was stalled, even regressed.
References:  See post "2000 B.C.:  Assyrian physicians will treat your dyspnea"

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Friday, December 19, 2014

2500-539 B.C.: Chaldeans create system of medicine

Originating with the Chaldeans was the Zend Avista, or the Living Word.  This was a compilation of all the Chaldean knowledge accumulated around 2500 B.C. by Zarathustria (Zerdutscht Zoroaster), who was a "priestly lawgiver who lived around 2500 B.C.  

As the most educated Chaldean, he was probably a member of the priesthood. His writings were lost to time, although they were ultimately rewritten into a book consisting of: (Baas, page 25)
  • Yanza -- A liturgy
  • Vispered -- Prayers (this would include the medical portions)
  • Jesch -- History of Chaldeans
  • Bundehesch -- Cosmology
Priests were educated at the world's first universities, some of which were created amid the Sumerians, and included locations in Urikh (Erech), Akkad, Nipur, Kutha, Larsa, and Borsippa.  The various branches of learning were not separated as they are today, so if you attended one of these universities you were pretty much educated in all wisdom, which included literature, writing, mythology, religion, medicine, science, mathematics, astronomy, cosmology, weights and measures, magic lore, divination, and astrology. (wiley, page 20)(Garrison, page 54)

Although, the priesthood was ultimately broken down by the Jews/ Hebrews as follows: (Garrison, page 58)
  • Priest: Used words to create heal and prevent sickness and injuries. Hebrew priest were the "hygiene police" There is no mention of Biblical priests acting as physicians. (Garrison, page 57)
  • Prophets: Had the ability to heal using knowledge they obtained at the universities.  Both Elijah and Elisha had the ability to cure and raise people from the dead. There are various references to them "making medicine" in the bible. 
  • Physicians:  Used various herbal remedies and surgeries to heal
  • Pharmacists: Created various herbal remedies and poisons to be used in healing
So most of the medicine was contained in the vispered, and it was all theurgic in character, meaning that it was based on mythology and divination.  These priestly magicians were the most excellent physicians, and they cured by their words, and thus they were: (Baas, page 26)
  • Word doctors: They healed with their charms, incantations, and prayers. 
  • Herb doctors: They healed with their potions
  • Knife doctors: They performed surgery, which mainly consisted of blistering, bleeding, or operating on eyes, castration, etc. It rarely consisted of internal surgery.
According to Wiley, they were familiar with the following: (Wiley, page 20)
  • Astrology:  Mainly consisted of using astronomy, the alignment of stars, planets, comets, etc. to determine the words of the gods to predict the future. (Wiley, page 20)
  • Divination: Mainly consisted of determining the words of the gods by reading the alignment of internal organs, mainly the liver (called hepatoscopy). Garrison notes that the liver was important because it was the source of blood and the seat of the soul.  He says, "to inspect the liver was to see into the soul of the sacrificed animal, and the mind of the gods." (Garrison, page 55) This also involved palmistry (reading palms) and astrology (reading stars, planets, comets, etc.)
  • Herbs: They had poisonous and healing properties, and worked by powers invested in them by gods. Herbal recipes were used as medicine, both internal and external (Wiley, page 20)
  • Words: Included magical incantations, conjurations, spells and charms that were disgusting to evil spirits and demons, and remedied and cured ailments 
  • Amulets: Their magical powers were able to suck out demons and spirits to cure ailments
  • Talisman: Warded off evil demons and spirits
  • Pharmacy: Medicine kept in vases and jars (Wiley, page 20)(Recipe page 21)
Garrison said priests or physicians would use one or more of the above in the following fashion: (Garrison, page 54-57 )
  • Aetiology: Blaming demons (similar to modern physicians blaming germs)
  • Diagnosis:  Based on inspection of patient
  • Prognosis: Based on the following: 
    • Divination or augury from liver of sacrificed animals:
      • Abnormally large organ: token of future power and success
      • Abnormality on right side of organ: token of future power or success
      • Abnormally small organ: token of weakness or failure
      • Abnormality on left side: token of weakness or failure
    • Divination of astrological signs
    • Birth omens, which determined whether person was going to be a super power or a failure.  These were based on augury of liver of sacrificed animals, astrology and palmistry.  They also studied fetal abnormalities.
    • Disease omens:  Inspection of the body, abnormalities, studying liver of sacrificed animals, astrology, and palmistry. 
    • Palmistry:  foretelling future through study of palms
  • Therapy:  The goal of various remedies was to "disgust demons inside the body." (Garrison, page 56)
    • Exorcisms by special ritual.  May be performed by the sick at home or at one of the smaller temples, or by the priests at your home, or as part of the regular rituals held at the larger temples. 
    • Herbal remedies 
    • Words: incantations, charms, spells, prayers, or conjurations
  • Prophylaxis:  Prevention
    • Incantation
    • Talisman
    • Charms (may place seal of gods on both sides of door of invalid) (Garrison, page 56)
    • Good behavior
    • Good hygiene (this was later perfected by Egyptians and Hebrews, although there is evidence of Babylonian drains, indicating they made the link between feces and disease) The Babylonians did wash their hands before meals, however, mainly because they ate with their fingers. They usually only washed the rest of their bodies only once a week. It was a sin to urinate in canals. (Sigerist, page 402)
In this way, it was the Chaldeans who created the first system of medicine. After the fall of Sumeria in 2000 B.C., their medical wisdom would be assimilated into Babylonian culture. 

References:  See post "2000 B.C.:  Assyrian physicians will treat your dyspnea"

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RT Cave listed among best COPD blogs

So I am up late, and to kill the time I'm surfing the net.  I'm looking for a book that covers the basics of COPD in order so I can stay up to date on COPD wisdom, with the ultimate goal of coming up with ideas to write for and this site.

As I'm doing this I come across a slide show called 14 Best COPD Blogs. I decide to flip through the show to see if there are COPD blogs that might be of interest, when I come to #10 on the list, which is Respiratory Therapy Cave.

This is what they said about the Cave:
Being diagnosed with COPD doesn’t mean you can’t enjoy the humorous side of life. Respiratory Therapy Cave was created with the mission to cause you to lose your breath—from laughing too hard. The blog provides accurate information about respiratory therapy and related topics with unrivaled wit.
Topics include inhalers, mesothelioma, and the understated consequences of smoking. And each day carries a specific theme. For example, Mondays are dedicated to answering community questions on respiratory therapy.
That's a pretty good endorsement, and one I wasn't expecting.  So, in return for the favor, I'm providing the link above, and here, to

By the way, they have featured my blog before as one of the best asthma blogs. So I'm taking this as a nice compliment, and an honor.

Thursday, December 18, 2014

2000 B.C.: Chaldeans introduce physicians to Babylon

Various groups of people continued to emigrate into Mesopotamia even as the Sumerian civilization was fading. Among these were the Syrians, Babylonians, Hebrews, Phoenicians, Akkadians and Arabs. Some of these matured to form villages, towns, cities, empires and even civilizations. Yet it was another group of people who had the greatest impact on medicine: the Chaldeans (Chaldees). (Baas page 25)

No one knows when they emigrated into the area, although many speculate they came from the north. The Hebrew Bible says they came from the "extremities of the earth," which may be Armenia, Cephenin, and Arrapachitis. Job mentions gold, and Jeremiah the iron of the north. It's also believed they left their homeland (and nobody knows why) over a century before they landed in Babylonia and Persia, or "before they besieged Jerusalem." (Asiatic Journal, page 36-37)

As time went by they were assimilated into Babylonian and Persian society to the point that they were often referred to as Babylonians and Persians, as opposed to Chaldeans. (Asiatic Journal, page 36-37) 

The dominant element of their way of life "consisted of servants to the deity," (Baas, page 25) and they are even referred to in the Bible as the "Magi" or the "Wise men," or "haruspices."  (Asiatic Journal, page 37)(Baas, page 25)

Magi or wise men were magicians, priests who were proficient in all the knowledge of the universe.  They specialized in mythology, religion, and medicine.  They were, perhaps, the most well educated people among society, and they were, in essence, magicians.

Haruspices, according to, refers to the study of organs, such as the liver, and astronomical phenomenon, such as thunderstorms, lightning, alignment of stars, planets, comets, etc.  This was all done for the purpose of divination, or predicting the future.

The Chaldeans were known for their knowledge of mathematics, astronomy, astrology, interpretations of dreams, and medicine. Some referred to them simply as "skygazers."

Perhaps by gazing at the stars they developed the first calendars based on the phases of the moon.  Perhaps they are the ones who introduced Babylonians and Persians to a numerical system based on the number 60.  This system included the 360 degree circle, 60 seconds in a minute, 60 minutes in an hour, and so forth. They are also sometimes credited as helping the Babylonians advance mathematics, astronomy, astrology and medicine. 

Henry Sigerist, in his 1922 history of medicine, said that ancient societies did not study the sky because they were interested in the alignment of the planets, stars, comets, etc. What they were interested in was interpreting the words of the gods, and this alignment, so they thought, was how the gods communicated. It was the job of the Chaldean priests, and later the Babylonian priests, to interpret astrological signs. (Sigerist, page 392)

Or, as William Osler wrote in his history of medicine:
A belief that the stars in their courses fought for or against him arose early in their civilizations, and directly out of their studies on astrology and mathematics. The Macrocosm, the heavens that “declare the glory of God,” reflect, as in a mirror, the Microcosm, the daily life of man on earth. (Osler, page 24)
As they themselves were, their knowledge and culture were assimilated into Babylonian culture, and this is how medicine evolved into a science of divination through astrology and hepatoscopy in ancient Babylonia, or so it is believed. (Baas, page 25)(Sigerist, 392)

Actually, not only were the Chaldean Priest known for their astrology and hepatoscopy, they were also known for their herbal remedies and incantations. In fact, it was probably due to the Chaldean Priests that the Babylonians became well known for their poisons. (Baas, ?)

Babylonian medicine was initially referred to as poison because it was used for its poisonous effects, which sometimes included killing people who were not wanted.  It was this effect, some believe, that gave Babylonian medicine, at least initially, a bad name.  Perhaps for this reason most physicians were seen as bad people, and for this reason they worked behind the scenes.

Perhaps this was among the reasons that when the Greek historian Herodotus traveled through Mesopotamia, he wrote that "they have no physicians."  Various historians have noted ample evidence that there were, especially after the assimilation of the Chaldeans.

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Wednesday, December 17, 2014

Asthma/ COPD medications over-prescribed?

According to, asthma is the 7th most common diagnosis, with COPD falling to #37.  However, according to the Detroit Free Press, based on the amount of asthma and COPD medicine prescribed, asthma and COPD are the 4th most commonly diagnosed diseases.  

The evidence seems to suggest that there are a lot of people being prescribed asthma and COPD medications -- i.e. albuterol -- who have not been diagnosed with either asthma or COPD. 

Many respiratory therapists observed this as a common truth years ago, as it is quite obvious that many of the people prescribed aerosolized albuterol, Duoneb, and Pulmicort do not need these medicines.  

However, there was a study done a while back that proved the placebo effect of albuterol, whereby 50% of patients who were given albuterol noted that they felt better after the treatment, and 50% of those given the placebo noted that they felt better after the treatment.  

Tuesday, December 16, 2014

COPD Combination Therapy

The Breo Elipta is the most recent
COPD combination inhaler
to be approved by the FDA
The following was originally published at on October 29, 2014

Quite a few years ago now asthma experts realized asthma was much better controlled when a combination of medicines were used, as compared to just one. Recent evidence seems to suggest the same might be true regarding the treatment of COPD.

Combination therapy generally refers to the use of both an inhaled corticosteroid and a long acting beta adrenergic (LABA). The steroids help to reduce inflammation in air passages, while the LABA works to relax muscles that surround the air passages in order to keep air passages dilated long term.
Together these work to improve lung function, thus reducing the need for rescue medicine, and reducing the risk for COPD flare-ups.

While these medicines can be taken as separate inhalers, they can usually be taken together by using one of the following convenient and easy to use combination inhalers:

1. Advair. It includes the steroid furosimide and LABA salmeterol. It comes as as an Advair Discus, and requires two puffs twice a day

2. Symbicort. It includes the steroid budesonide and LABA formoterol. It's an inhaler that requires two puffs twice a day.

3. Dulera. It includes the steroid mometasone furoate and LABA formoterol. It's an inhaler that requires two puffs twice a day.

4. Breo. It includes the steroid fluticasone furoate and LABA vilanterol. It comes as the Breo elipta and requires only one puff once a day.

Which one of these inhalers works best for you is generally a manner of trial and error. Some doctors are willing to give out free samples so that you can use one for a while to see how it works. If it works, great. If you have problems with it, or if it doesn't work, then you can try another.

Another option that is available for COPD patients is to take simlar medicines via a nebulizer. This is a nice option especially for those patients with severe airflow limitation, or patients who cannot create enough flow to activate the inhalers (patients in the end stages of the disease).

If this is the desired option, then two medicines will have to be combined in a twice a day breathing treatment. These medicines are:

5. Budesonide (Pulmicort) and Arformoterol (Brovana)

These may be combined in a single nebulizer treatment, and it usually lasts anywhere from five to ten minutes. Still, the nice thing about it is it only needs to be done twice a day.

The key here is that your doctor can only prescribe one of the above five options. It is very important that you never take a LABA more than recommended. Otherwise, if used as prescribed, they are safe, and have proven very effective for improving lung function.

A frequently asked questoin is: If I'm taking a LABA, can I still use my rescue medicine? Yes you can. It is absolutely safe to use your rescue medicine, as prescribed, between doses of LABA (or combination inhaler). However, there are three things you must consider here:

1. The LABA in Symbicort and Dulera is fast acting, so if you just used it you shouldn't need to use your rescue inhaler. The same is true for Brovana. So don't use your rescue inhaler if you just used these medicines, you shouldn't need to.

2. While the LABA in Advair and Beo is slower acting, it may be wise to wait 15 minutes after using it to see if your breathing improves. If it doesn't improve, feel free to use your rescue inhaler or revert to your COPD action plan.

3. Ideally, however, the use of combination therapy should reduce, and possibly eliminate altogether, your need to use your rescue medicine. Still, you should always have your rescue medicine nearby just in case you need it.

There. Any questions? That's pretty much all you need to know about COPD combination therapy. Studies seem to show it works pretty well, and the patients I've seen using it seem to feel that it works well for them.

So, if you're not doing so already, and your COPD is not as controlled as you'd like, combination therapy might be something to discuss with your COPD physician.