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Monday, July 13, 2009

Tons of new meds at the asthma hosital

(Note: This is part VII of my story growing up with hardluck asthma. To view Parts I through VI you can click here and follow the links.).

Perhaps I'm submitting this list of medicine to amaze myself, but these are all the medicines I was on shortly after being admitted to NJH/NAC back in 1985.

  • Theodur 400 mg: 6 a.m. and 6 p.m.
  • Prednisone 60 mg: 6a.m.
  • Nasal irrigations: 6 a.m., 12 noon and 6 p.m.
  • Nalalide 2 squirts: 6 a.m., 12 noon and 6 p.m.
  • Afrin 2 squirts: 6 a.m., 12 noon and 6 p.m.
  • Tinactin Cream: 6 a.m. and 10 p.m.
  • Tinactin powder: 6 a.m.
  • Cromolyn: 6 a.m. 12 noon 6 p.m. midnight
  • Vanceril 4 puffs 6 a.m. 12 noon 6 p.m. midnight
  • Theodur 6 a.m., 2 p.m., 10 p.m.
  • Blood Pressure 6 a.m, 6 p.m.
  • Drixorol 6 a.m., 8 p.m.
  • Amoxicillin 6 a.m. 2 p.m. 6 p.m.


  • Alupent: 0.5cc at 6 a.m., 12 noon, 6 p.m., and midnight
  • Atrovent: 4mg (.63cc) 6 a.m., 12 noon, 6 p.m., and midnight
  • Terbutaline 4 mg at 9 a.m., 3 p.m., and 9 p.m.
  • Spirometry: 6 a.m., 12 noon, 6 p.m., midnight
  • Peak flows: 6 a.m. and 6 p.m.
  • Postural drainage: 6 a.m., 3 p.m., 6 p.m., midnight

Initially when I was admitted my asthma was severely uncontrolled, so my doctor basically put me on all the asthma medicines and therapies she knew of at that time. The goal, I believe, was to start me on everything and slowly eliminate.

At that time terbutaline was still a commonly used bronchodilator (it is still available but rarely used in the U.S. I think we still have a vial in our med drawer, although I'm sure it is long since expired) even though it had a tendency to cause some side effects similar to adrenaline (epinepherine, susphrine). And I think it was for this reason I had to have twice daily blood pressure checks.

I think after I was there about 30 days or so (and after I was released from PSC after 3 days)that my doctor told me my asthma was finally stable enough so I could stop taking Terbulatine, and thus Q3 breathing treatments. That was a major day of celebration for me, as it was a major pain leave school every few hours for a treatment and meds.

Postural drainage was initiated on me thinking I was having trouble expectorating, but it was discontinued when Terbutaline was. There were some kids who still got PD, but not me. Although I received some experience performing it on some of the other kids, and them on me. this, in a sense, prepared me for RT school. In fact, all of this prepared me for RT School.

Today PD is no longer recommended for asthma as it is thought that it might loosen up a mucus plug (common with severe asthmatics) and cause even worse asthma.

I think one of the main reasons I wanted to post this list is to show how many medicines asthmatics with allergies had to take to control their asthma. In fact, it should be known that asthmatics with allergies are more likely to develop severe persistent asthma, if not controlled. Likewise, smoking too can speed up the severity of asthma. Thankfully I did not smoke, and only had the allergies to worry about (in case you're wondering, I had allergy testing done three times in my life, once before NJH, once during, and once after. Each time I had a possitive reaction for nearly everything outdoors).

While I was in the asthma hospital I had nothing else to think about, yet when I was discharged to home it became difficult to live a normal life (as they say we should be able to with asthma) and take all our meds as prescribed.

So, for the first three months I was at NJH/NAC I was basically on the meds as listed above. The red were eliminated when the terbutaline was eliminated, and the meds listed in orannge were added. I imagine some of the others were temporary too, but since I didn't cross them out I imagine I was on them a while too.

I have no idea why I was on Tinactin. The Nasal irrigations and nasalide and Drixoral were the only means of treating allergies. While I was in the hospital I wasn't exposed to my asthma triggers anyway, so I don't thing I even needed them while there (the nasal washes were a pain in the arse to do). Yet I imagine my sinus passages were swelled up big time when I was admitted.

I had a major case of sinusitis (common among child asthmatics), so that explains the amoxicillin. The chromolyn was a new medicine available, and it was the first dry powder inhaler (DPI) ever made (I think). You took it with a spinhaler (see picture) which crushed the capsule and you inhaled the powder. It was worse than the new DPIs in that it often caused asthmatics to cough and go into bronchospasm. I had this happen a few times.

The Spirometry was actually fun to do. It let me know how much my asthma was improving not just before and after treatments, but overall. Later on I will publish one of my Spirometry flow sheets. Peak flows were no different back then than today, as every doctor and RT recommended you use one. Although pre-NJH I was not very compliant with mine.

The Vanceril was the common corticosteroid at that time. I think before I left NJH/NAC I was switched to the new Azmacort. Neither were as effective as the newer corticosteroids available today, which is why we had to take so many puffs so often. And yes, it was a pain to remember all the puffs and doses. When I was discharged to home, it was hard to remian compliant with this regime.

Alupent (recently discontinued) was the bronchodilator with the least side effects back then, although it did leave me with a palpable thump-thump-thumping in my chest after each use, but not as bad as the Terbutaline. Atropine was the equivelent to the Atrovent and Spiriva we use now adays, although this line of back door bronchodilators is no longer recommended for the treatment except for when other meds don't work (as in Hardluck asthma).

Asthma Action Plans did exist back then, and before I went home I was given an oxygen tank, a box of epinipherine amps, syringes, and I was instructed how to give myself it. I was told only to go to the ER if the Epi didn't work. I digress though. That's for a later discussion.

There was an incentive to get your pills at the nurses station on time, and to take your treatments on time, and that was a points system. We had to carry a points sheet with us throughout the day and have each of our teachers sign it to prove we attended class. We had to have whomever we had appointments sign for the same reason. Of course if we were bad in class, the teacher (Mr. Rose) would threaten to take away points.

Likewise, every time we left the floor (and returned) we had to sign in and out on a recording sheet. If we forgot, we didn't get those points. The more points we earned in a week the greater likelihood we moved up to the next level. Actually, you moved up levels as you proved you were responsible with your meds and rules. Moving up levels wasn't really too hard on 7-Goodman.

If I remember right, the levels were 1 (poor behavior) 2, 3 and Honors. There was a bulleton board behind the nurses station that monitored our progress.

With each level you get new resonsibility. Such, if you are on level one you cannot leave the floor except for school and appointments. On level 2 you got to participate in anything, but you could not leave the floor without a nurse, a counselor, P.E. instructor, etc. Level 2 is where all new patient's start. Also on level 2 you have to have a nurse supervise when you are mixing your nebs.

On level three you are now able to draw up your own meds unsupervised as you have proven that you are capable and responsible. You can also leave 7-Goodman without an adult escort so long as you are with someone on Honors.

The same is true when we went on excursions to the mall, movies, mountains, etc. If you are on level 2 you can go, but you have to stay with the adult escort the entire trip. If you are on level 3 you can go alone if you have an Honors escort, and if you are on Honors you can do whatever you want so long as you return to the designated meeting area at the designated time. If you prove not to be resonsible enough to hold up the responsibilities provided to you, you had points taken away and risks moving down a level

I guess I'd have to say that my brother David was right in that it was like a camp in a way. They kept us so busy we barely had time to sit around and be bored. However it did happen. And in the initial days it was hard not to feel homesick -- especially the first several weeks.

As far as my treatments were concerned, the nurses initially drew up my meds and watched me take a treatment, but eventually (as I moved up levels) it was my responsibility to draw up my own meds, but I had to find a nurse to watch me. Eventually, though, I earned the right to take my treatments unsupervised (which occured on level 3). On 7-Goodman no patients were allowed to have their own pills in their rooms.

As I wrote before, there were basically 2 air compressors set on a table in the lobby of 7-Goodman and we had to take turns using it, so I usually tried to be the first one considering I was usually tight and wheezing and didn't want to wait for relief (of course I wasn't the only one who was tight, so with only 2 machines one of us had to wait).

Within days after I was admitted I had to attend classes so I could learn about asthma and asthma meds. Back then asthma was basically treated as a disease of airflow obstruction secondary to bronchospasm. In class, we were taught about the acronym ROAD, which stood for Reversible Obstructive Airway Disease. The main treatment for the disease was to control bronchoconstriction.

Today, airway obstruction is considered a component of asthma, but is mainly considered as a marker for airway hyperresponsiveness due to inflammation. If your inflammation is uncontrolled, your airways are more resonsive to your asthma irritants. Thus, asthma today is considered more a disease of chronic inflammation, and the efforts of treatment are mostly aimed at treating this underlying inflammation. Once controlled, your airways become less hyperresponsive, and you'll have acute episodes of acute bronchospasm less often.

Back then, however, we were taught about ROAD. In fact, when I entered RT School I asked about ROAD, and my teachers had never heard of it. So by the time they had become RTs that old acronym had expired in favor of new wisdom. However, to be considered asthma, the bronchospasm component has to have some degree of reversibility, which is why all asthmatics must always have a rescue inhaler handy. (Perhaps ROAD is still in use, as I've found it here and here.)

You have to realize here that the goal was to teach us asthmatics to be gallant asthmatics, and this was the method the asthma hospital used at this time. Since most doctors back then were not privy to the asthma wisdom of NJH back in the 1980s, if you had severe asthma NJH/NAC was the best place for you.

However, the good news is that in the late 1990s several doctors got together and decided something had to be done to improve the way asthma was treated by regional doctors (like mine back home), and the asthma guidelines were created. With the new asthma guidelines, new asthma wisdom, and new medicines, it became easier for local doctors to treat asthma.

In fact, even better for good asthma control, new asthma meds like Adviar and Symbicort allow for puffs to be needed only twice a day. This greatly helps in the comliance department. With greater compliance comes greater asthma control.

In fact, I recently talked with a person in charge of public affairs at National Jewish Health (that's the new name) and she said that 7-Goodman no longer exists because local doctors do such a great job now of managing asthma.

She said one of the reasons it was able to close was because of the asthma guidelines, and another reason is the fact that NJH sends doctors to regional areas to make sure that all doctors are aware of the latest asthma wisdom of how to care for asthmatics. And the Internet I'm sure is also a factor in improved asthma wisdom among both doctors and patients alike.

(I will try to have part VIII of my asthma story up on Sunday, July 19, 2009)

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