Did you have any doubts of being a RT while you were in college for it?
Yes I did have reservations about being an RT. In fact, other than doing breathing treatments, I didn't even know what the job entailed. While I did go to some career days and talk to RTs, I didn't have access to much information. Thankfully at least you have access to the Internet, so you should at least have an idea of what you will be doing as an RT, and what you will be getting into (at least to a certain extent).
(While the RT School I endorse is not on this website, you can still click here for an excellent article regarding the RT program.)
In fact, when I entered the RT program, I was shocked when I learned I would have to draw blood and manage ventilators, and suction, and run codes. It turns out those things I feared the most are the things I enjoy the most. It's those things that provide the greatest stress, but they also provide the greatest deal of satisfaction.
I guess any career you choose is a crap shoot. It seems kind of awkward that you have to choose what you are going to do the rest of your life before you even do it. I always thought it would be neat if you could be an apprentice for a year or so in whatever field you want to go in before you spend $30,000 or more to go to school for it. However, if you want, you can probably call your local RT department and see if you can follow an RT around for a day or two to see if you like it. I'm sure they,d let you. I would.
I'm sure you will enjoy being an RT But, even if you don't, you will learn so much about life, and people, and the medical field that this is the ideal job to gamble on. I say this because 1) you will have a recession proof job 2) you can be an RT anywhere in the world 3) you can use it as a stepping stone to just about any other profession 4) It provides a decent income and benefits 5) You can start working as one even as you are going to school.
I'll be honest about one other thing. When I was a student I was afraid about this field. I was afraid I'd do something stupid and wouldn't fit in. I was afraid of failure. But, after I got into the RT program and saw some of the other people who were in RT school, or who were already nurses and RTs, I said to myself: "If THAT person can do this job, so can I."
In fact, the whole time I was in RT school I kept repeating that to myself over and over. It was kind of my war cry, my "Remember the Alamo." And to make sure I didn't fail, I studied my butt off so when I got into a situation I'd know exactly what to do. And while I did fumble the first time I did everything, that RT wisdom and my war cry got me through it.
Here's another thing you should know. The RT program is hard. I know people who went through the RN program and the RT program, and all of them have told me the RT program was really hard, harder than the RN program. But it's kind of like going through boot camp in the military: when you get done with it you will be great RT. You will be an absolute expert, fully confident and competent in your wisdom and skills -- and that is a good thing.
It's funny, though, because I think because RTs come out of RT school so prepared some of us feel a little disappointed once we do the job for a while -- at least in some hospitals. I say this because some hospitals don't let us use all of our skills and wisdom, as you can see by some of my writings.
And I think all people in the medical field get frustrated with the politics of the medical field. As, for instance, one person sitting in an office in Washington D.C. decided that every person who is admitted with pneumonia needs to have breathing treatments every 6 hours to meet criteria for reimbursement.
Well, an person with half a brain knows breathing treatments don't even get down into the alveoli where the pneumonia is. Still, that's no reason not to become an RT. The hope is that some day soon someone will realize the flaw of this method.
Yet you also have to know this is still a maturing profession, and doctors are quickly realizing (or so we would hope) how great of an asset we RTs are to the team and giving us more and more responsibilities via RT Driven Protocols.
Now, there are a few other things that hold some RT departments back, such as criteria for reimbursement set by Insurance companies and the government (Medicaid). But that doesn't have anything to do with respect. We'll discuss that later.
So, yes, I did have reservations. But I think that's actually a good thing normal -- and wise.
Sunday, May 31, 2009
Saturday, May 30, 2009
The growth of the RT profession
While there is still room for growth, respect for respiratory therapists has grown immensely since the profession was first created in the 1940s.
In the 1940s and 1950s respiratory therapists were called inhalation therapists, and there job was to set up and manage oxygen, do intermittent positive pressure breathing (IPPB) treatments, do CPR when needed, and manage negative pressure ventilators when needed.
In the 1970s and throughout the 1980s EMTs and nursing assistants did many of the duties that respiratory therapy performs now. Other people were hired off the street, and were trained on the job (they were called OJTs). For the most part, they were button pusher. Doctors told them what needed to be done, and they did it no questions asked.
By 1969 the National Board of Respiratory Care was established to create schools and testing criteria for those interested in the profession of respiratory care. Yet, while there was increasing demand and few people interested in going to school, few in this profession were interested in becoming formally educated.
Yet this gradually changed, mainly due in part to the efforts of the NBRC. One of the methods of generating respect for this profession was to create better educated therapists who would do more than just push buttons. But this would be years in the making. The first step would be to encourage or provide incentives for OJTs to go to school.
Yet another challenge occurred in the late 1970s and early 1980s as positive pressure ventilators were invented and became popular. It was determined, more so than in the 1950s with negative pressure ventilators (iron lungs), specially trained people were needed to run this equipment and assist physicians. This caused an increase in demand, once again, for RTs.
This resulted in hospitals hiring in more people to fill these positions from the streets. While this was contrary to the wishes of the NBRC, more people who lacked any respiratory education were hired to become respiratory therapists.
Because many didn't want to go to school (mainly because they didn't need to), programs were set up where therapists could sit through day long classes for one or two days and when they were finished they qualified to take the test. If they passed they earned their CRTT certificates. The same process was continued on the way to earning an RRT.
So you can see that slowly but surely respiratory therapists became better and better educated. Eventually the field became saturated and requirements to becoming an RT were increased. To get a CRTT you had to go to school for one year. To get your RRT you had to finish a two year program.
Then, at the turn of the millennium, the requirements were increased once again so that you cannot even get a CRT (changed from CRTT) until you have finished two years of RT school. So, basically, the CRT program is pretty close to being all but phased out. Because as long as you've already finished your two years of schooling, you might as well just take the test and get your RRT.
So, as the requirements to become an RT have improved so has the educational level for RTs. Where I work, and in other hospitals in this region, hospitals will only hire RRTs.
Like nurses, we are put under the same level of educational stress. We are trained not just about respiratory, but about the entire body and how it relates to respiratory. We are not just trained about oxygen and respiratory equipment, we are trained to think along the same lines as physicians.
And, therefore, by the time we become full fledged RTs we are fully capable of working alongside with nurses and physicians rather than for them. We are fully capable of making recommendations and suggestions to improve patient outcomes. We are now the well educated profession the NBRC set out to create nearly 40 years ago.
Yet there is still room to grow. There are still old school nurses and physicians who still think of RTs as button pushers. They have trouble setting aside their pride and giving up the autonomy
necessary in trusting the wisdom of the new improved RTs. Instead they overrule us and order useless treatments anyway.
And, to be fair, there are still some RTs who are afraid to take on responsibility and prefer to be button pushers. While these RTs may be great people, they do nothing more than set this profession back. When old school doctors and nurses work with these RTs, their old notions about RTs are confirmed.
Likewise, you still have RT complainers who also do little to move this profession forward. Instead of working to improve respect and come up with ideas to make the job better for all, they complain. Now, to be honest, we all fall into this trap from time to time, but it accomplishes little.
Unlike the profession of nursing, respiratory therapy is still a maturing profession. If you refer to the 40s and 50s as the infancy of this profession, we are now entering adulthood.
This might be the best time to enter this profession, because the respect we earn, and the protocols we create, will set the way for all who walk in our shoes in the future.
So you can see there remain obstacles to the zenith of respect for the RT profession, but we have made great strides from the day of the OJT.
In the 1940s and 1950s respiratory therapists were called inhalation therapists, and there job was to set up and manage oxygen, do intermittent positive pressure breathing (IPPB) treatments, do CPR when needed, and manage negative pressure ventilators when needed.
In the 1970s and throughout the 1980s EMTs and nursing assistants did many of the duties that respiratory therapy performs now. Other people were hired off the street, and were trained on the job (they were called OJTs). For the most part, they were button pusher. Doctors told them what needed to be done, and they did it no questions asked.
By 1969 the National Board of Respiratory Care was established to create schools and testing criteria for those interested in the profession of respiratory care. Yet, while there was increasing demand and few people interested in going to school, few in this profession were interested in becoming formally educated.
Yet this gradually changed, mainly due in part to the efforts of the NBRC. One of the methods of generating respect for this profession was to create better educated therapists who would do more than just push buttons. But this would be years in the making. The first step would be to encourage or provide incentives for OJTs to go to school.
Yet another challenge occurred in the late 1970s and early 1980s as positive pressure ventilators were invented and became popular. It was determined, more so than in the 1950s with negative pressure ventilators (iron lungs), specially trained people were needed to run this equipment and assist physicians. This caused an increase in demand, once again, for RTs.
This resulted in hospitals hiring in more people to fill these positions from the streets. While this was contrary to the wishes of the NBRC, more people who lacked any respiratory education were hired to become respiratory therapists.
Because many didn't want to go to school (mainly because they didn't need to), programs were set up where therapists could sit through day long classes for one or two days and when they were finished they qualified to take the test. If they passed they earned their CRTT certificates. The same process was continued on the way to earning an RRT.
So you can see that slowly but surely respiratory therapists became better and better educated. Eventually the field became saturated and requirements to becoming an RT were increased. To get a CRTT you had to go to school for one year. To get your RRT you had to finish a two year program.
Then, at the turn of the millennium, the requirements were increased once again so that you cannot even get a CRT (changed from CRTT) until you have finished two years of RT school. So, basically, the CRT program is pretty close to being all but phased out. Because as long as you've already finished your two years of schooling, you might as well just take the test and get your RRT.
So, as the requirements to become an RT have improved so has the educational level for RTs. Where I work, and in other hospitals in this region, hospitals will only hire RRTs.
Like nurses, we are put under the same level of educational stress. We are trained not just about respiratory, but about the entire body and how it relates to respiratory. We are not just trained about oxygen and respiratory equipment, we are trained to think along the same lines as physicians.
And, therefore, by the time we become full fledged RTs we are fully capable of working alongside with nurses and physicians rather than for them. We are fully capable of making recommendations and suggestions to improve patient outcomes. We are now the well educated profession the NBRC set out to create nearly 40 years ago.
Yet there is still room to grow. There are still old school nurses and physicians who still think of RTs as button pushers. They have trouble setting aside their pride and giving up the autonomy
necessary in trusting the wisdom of the new improved RTs. Instead they overrule us and order useless treatments anyway.
And, to be fair, there are still some RTs who are afraid to take on responsibility and prefer to be button pushers. While these RTs may be great people, they do nothing more than set this profession back. When old school doctors and nurses work with these RTs, their old notions about RTs are confirmed.
Likewise, you still have RT complainers who also do little to move this profession forward. Instead of working to improve respect and come up with ideas to make the job better for all, they complain. Now, to be honest, we all fall into this trap from time to time, but it accomplishes little.
Unlike the profession of nursing, respiratory therapy is still a maturing profession. If you refer to the 40s and 50s as the infancy of this profession, we are now entering adulthood.
This might be the best time to enter this profession, because the respect we earn, and the protocols we create, will set the way for all who walk in our shoes in the future.
So you can see there remain obstacles to the zenith of respect for the RT profession, but we have made great strides from the day of the OJT.
Friday, May 29, 2009
Is it true respiratory therapists get no respect?
When I was in high school I really wanted to be an RT, but I was afraid to go that route because I failed chemistry in high school and thought for sure I'd fail it again in college.So I decided I wanted to be a teacher instead. To make sure I was making the right choice, I asked one of my teachers. He said, "Oh, you don't want to be a teacher. The pay is pathetic."
My confidence was shot. Here I had decided teaching would be the perfect career for me and now this teacher I respected grumbled and griped about his job. So I set out to ask another teacher I respected. And, to my dismay, he said just about the same thing: "The pay isn't good. This isn't the best career choice. You get no respect!"
I was crushed. Not only could I not be an RT, I now couldn't be a teacher either. So, when it came time to circling a career when I was applying for college, I circled journalism. It was a spur of the moment decision, and my heart wasn't in it.
After I received an associate's degree in journalism I had to choose another career path, so I chose Advertising. Two years later I graduated and got a job as a writer for a small newspaper in Lake County, Michigan.
I hated it. I hated snooping on people. I hated newspaper politics. I hated talking on the phone. I was miserable, depressed and, because of this, my writing was awful.
After only three short months, I was fired. A good friend of mine offered me a job as an advertising salesperson, but I turned him down. My confidence was chopped and crushed. I had wasted four years of my life pursuing this career path for nothing (or so I thought at the time).
I pitied myself for a year, and partied as often as I could with my friends, slowly squandering the money I had saved. That is until one day I was lying on the floor writing in my journal, trying to decide what to do with my life, when a sheen of sunlight filled the room, and a warm breeze wafted through the open window causing goose flesh and a tingling sensation to rush up my spine.
In a sense, it was as though God had touched me and said, "Follow your heart son: become an RT." And so I did just that. And it was the best decision I ever made. Finally, when I was 27 (in 1997) I was hired as an RT
Ironically, as though fate had guided me on the path I chose, once I started up my RT Cave blog, and later my Asthma blog, I was utilizing the skills I learned in obtaining my previously unused Bachelor's degree.
On top of that, I get to teach on this job too. I teach every time I have a patient, every time I have a student follow me, and on a daily basis right here on this blog.
Thus, in a sense, fate guided me to where I am today. While I initially swayed from my hearts desire because of what some burned out idiots told me, I ended up right where my heart initially wanted me to be -- only it took me ten years instead of two.
So, that in mind, this is what I initially thought of when I received the following question via email earlier today:
Question: I am thinking about becoming a RT ad i was reading some blogs on the Internet (which weren't as good as yours). And a couple said that RTs get no respect. Is that true?
My humble answer: I think one of the best pieces of advice I can give you when trying to decide what career path to follow is simply this: follow your heart. If you want to become an RT, become an RT. Don't not choose this profession because some of the most heard voices are cynical.
Where I work the RTs are very well respected. We are a part of the patient care team, and we are among the first people called upon when a patient is having trouble breathing, or is otherwise not looking quite right. It's our skills that often greatly improves the health, and quite often saves the life, of patients. And our expertise and opinion are well taken by nurses and doctors in making appropriate decisions in caring for these patients.
Now I'm not going to say everything is perfect in this field. There are many procedures, for example, that are ordered for reasons I think are frivolous or ridiculous, and when we RTs try to get these procedures cancelled we are told no. Yet one must also consider the politics of the matter, as many insurance companies and Medicaid require these procedures to be completed in order to meet reimbursement criteria.
Still, you must consider that this profession is relatively new compared to nursing, and still growing. While nursing has been around since the Civil War, respiratory therapy only started with the Polio Epidemic in the 1950s. One of the neat things about being an RT today is we are part of the RT revolution. While RTs used to be hired off the street as on the job trainers, we now have to endure two years of respiratory therapy school, and by the time we earn our degrees and certificates we know as much about the heart and lungs as the doctors do.
Slowly but surely doctors and nurses are realizing how great an asset we RTs are to the institution, and as this happens we RTs are earning respect, and also earning more responsibility. In many larger hospitals protocols allow RTs to assess and treat patients without an order even being written. In fact, in many states RTs have gained the same respect as nursing by requiring RTs to be licensed.
Where I work we are a little behind some of these hospitals, but we are slowly catching up. In fact, my fellow co-workers and I only recently worked with doctors in creating new protocols that allow us to do things we never could do before. The reason doctors gave us RTs these protocols is because we earned their respect by educating ourselves, working hard, and impressing doctors and nurses with our wisdom.
So there are good things and bad things about this profession as there are with any other. And, no matter where you work there will be complainers. Yet, in the end, a career is what you make of it.
My humble answer: I think one of the best pieces of advice I can give you when trying to decide what career path to follow is simply this: follow your heart. If you want to become an RT, become an RT. Don't not choose this profession because some of the most heard voices are cynical.
Where I work the RTs are very well respected. We are a part of the patient care team, and we are among the first people called upon when a patient is having trouble breathing, or is otherwise not looking quite right. It's our skills that often greatly improves the health, and quite often saves the life, of patients. And our expertise and opinion are well taken by nurses and doctors in making appropriate decisions in caring for these patients.
Now I'm not going to say everything is perfect in this field. There are many procedures, for example, that are ordered for reasons I think are frivolous or ridiculous, and when we RTs try to get these procedures cancelled we are told no. Yet one must also consider the politics of the matter, as many insurance companies and Medicaid require these procedures to be completed in order to meet reimbursement criteria.
Still, you must consider that this profession is relatively new compared to nursing, and still growing. While nursing has been around since the Civil War, respiratory therapy only started with the Polio Epidemic in the 1950s. One of the neat things about being an RT today is we are part of the RT revolution. While RTs used to be hired off the street as on the job trainers, we now have to endure two years of respiratory therapy school, and by the time we earn our degrees and certificates we know as much about the heart and lungs as the doctors do.
Slowly but surely doctors and nurses are realizing how great an asset we RTs are to the institution, and as this happens we RTs are earning respect, and also earning more responsibility. In many larger hospitals protocols allow RTs to assess and treat patients without an order even being written. In fact, in many states RTs have gained the same respect as nursing by requiring RTs to be licensed.
Where I work we are a little behind some of these hospitals, but we are slowly catching up. In fact, my fellow co-workers and I only recently worked with doctors in creating new protocols that allow us to do things we never could do before. The reason doctors gave us RTs these protocols is because we earned their respect by educating ourselves, working hard, and impressing doctors and nurses with our wisdom.
So there are good things and bad things about this profession as there are with any other. And, no matter where you work there will be complainers. Yet, in the end, a career is what you make of it.
Personally, I love helping people catch their breath, and I love teaching them how they can improve their lives. I also love the challenge of making this a better profession that is more respected by doctors, and I think we are doing just that.
Bottom line, this is a good profession that pays the bills. If you like taking care of people, if you like a challenge, then this may be the right career for you.
Bottom line, this is a good profession that pays the bills. If you like taking care of people, if you like a challenge, then this may be the right career for you.
Now, to be fair, I myself do criticize some of the things doctors have us RTs doing, but I try to do so in a fun and humorous way. Through my satire I like for doctors to see how goofy some of their doctor's orders are.
Yet, despite it all, I still love my job as an RT, and you might find you like this job too. However, whether you do or not is up to you. Because respect, my friend, is something that must be earned. You can earn it independently by working hard, and you can earn it by being part of a great team, like we have here at the RT Cave.
For the betterment of your wisdom, I have included with this post some links to humble (from the heart) posts I wrote about this profession. By reading them perhaps you will get a better feel of what being an RT is all about -- at least from my humble perspective.
The future of the RT profession is in our hands
Some things should not be the job of the RT
Contemplating large versus small hospital
Is the job of respiratory therapy a good career?
Is the job of respiratory therapy right for you?
Choosing a career: RN versus RT
A list of what I like about being an RT
RT bosses, admins think on different level as RTs
New Vent protocol bi product of teamwork
The greatest joy of being an RT
Some things should not be the job of the RT
Contemplating large versus small hospital
Is the job of respiratory therapy a good career?
Is the job of respiratory therapy right for you?
Choosing a career: RN versus RT
A list of what I like about being an RT
RT bosses, admins think on different level as RTs
New Vent protocol bi product of teamwork
The greatest joy of being an RT
Thursday, May 28, 2009
New drug combo may greatly benefit COPDers
I had an uncle with COPD call me about a year ago because he wanted to learn ways he could improve his lung function. Basically, I gave him three recommendations off the top of my head:1. Stop smoking
2. Stay as active as you possibly can
3. Take all your lung medicines exactly as prescribed
4. Talk to your doctor about Spiriva.
I told him I had read about studies that proved Spiriva improved lung function in COPD patients. He heeded my advice, but he passed away before I could talk to him about how it worked for him.
A new study released this past month shows not only does Spiriva improve lung function in COPD patients, if it is used in conjunction with Symbicort. According to an article at medicalnewstoday.com, the combination of Spiriva plus budesonide/formoterol combination (the contents of Symbicort):
- Reduced the rate of severe exacerbations by 62% (p<0.001)2
- Improved clinical lung function as measured by improvement in pre and post dose FEV1 (p<0.001,>
- Improved morning symptoms and activities (p<0.05)
- Improved health-related quality of life
- Was well tolerated
Typically, according to the above article, a combination of a long acting bronchodilator and corticosteroid and Spiriva is indicated in any COPD patient with a lung function (FEV1) of less than 50%.
So this is all the more reason to keep in touch with the latest research. If your doctor is unaware of this study, perhaps you'll want to nudge him.
However, keep in mind this is just one study, although one that showed significant improvements in lung function with those taking the trio of medications compared to those who received a placebo.
While there is no cure for COPD, the goal of therapy is to make sure all COPD patients are able to remain productive members of society. Aside from avoiding cigarette smoke and staying active, new medicines can help COPD patients accomplish the goal of maintaining a quality of life.
Wednesday, May 27, 2009
My answer to your queries
Each week I check my statcounter to see who's typing things into Google or Yahoo and being linked to my RT Cave blog. I provide this spot each week to make sure no query goes unanswered.
Today's focus is on random questions.
1. infants drinking albuterol for cold: Bad idea.
2. breaths prevent pneumonia: Yes it's true. Check out this post.
3. respiratory therapist buy a nice house support family: Sounds like a great idea.
4. copd/ should i use my inhaler before or after i jog: It depends on what you and your doctor decide is best for you. Some doctors will have you preteat yourself with Ventolin before you exercise to prevent exercise induced asthma. However, if you are short of breath after exercising, you might need to use it then too.
5. 'perfection is in itself'': How this got someone to my "imperfect" blog I have no idea. Yet, a wise friend of mine has a saying: "Perfection in itself is a flaw. Therefore, since I am flawless, I am not perfect."
6. is it ok to mix mucomyst with duonebs: Well, technically speaking it is okay. We do it that way because some doctors order it. However, I think doctors who order this should be aware of the fact Atrovent (in Duoneb) has a drying effect on secretions, while the mucomyst has a wettening effect on secretions. So, ordering mucomyst and Atrovent is like ordering betablockers and beta adrenergics on the same patient at the same time.
7. can burning feeling in chest be sign of asthma: Yes. Click here for some other signs.
8. should albuterol be given to aid in expectorate: It's ordered that way by doctors all the time. If the patient is having trouble expectorating because of bronchospasm, then I'd say yes. However, if the patient is not having bronchospasms Albuterol will have no effect.
9. albuterol for fluid reabsorption: Albuterol does not absorb anything. But when doctors order it for patients diagnosed with pneumonia, pleural effusion and pulmonary edema, it makes you wonder if they think it does absorb fluid.
10. long term effects from asthma: If you have a good doctor, take your medicines exactly as directed, and have a good asthma action plan that you follow to a tee, you should be able to live a normal, active life. Likewise, the average lifespan of asthmatics is the same as those without asthma -- 80 years.
11. why do rns think they are better then rt: Because they are. Everybody knows that. I always tell my coworkers that if I were any smarter I'd be a nurse.
Today's focus is on random questions.
1. infants drinking albuterol for cold: Bad idea.
2. breaths prevent pneumonia: Yes it's true. Check out this post.
3. respiratory therapist buy a nice house support family: Sounds like a great idea.
4. copd/ should i use my inhaler before or after i jog: It depends on what you and your doctor decide is best for you. Some doctors will have you preteat yourself with Ventolin before you exercise to prevent exercise induced asthma. However, if you are short of breath after exercising, you might need to use it then too.
5. 'perfection is in itself'': How this got someone to my "imperfect" blog I have no idea. Yet, a wise friend of mine has a saying: "Perfection in itself is a flaw. Therefore, since I am flawless, I am not perfect."
6. is it ok to mix mucomyst with duonebs: Well, technically speaking it is okay. We do it that way because some doctors order it. However, I think doctors who order this should be aware of the fact Atrovent (in Duoneb) has a drying effect on secretions, while the mucomyst has a wettening effect on secretions. So, ordering mucomyst and Atrovent is like ordering betablockers and beta adrenergics on the same patient at the same time.
7. can burning feeling in chest be sign of asthma: Yes. Click here for some other signs.
8. should albuterol be given to aid in expectorate: It's ordered that way by doctors all the time. If the patient is having trouble expectorating because of bronchospasm, then I'd say yes. However, if the patient is not having bronchospasms Albuterol will have no effect.
9. albuterol for fluid reabsorption: Albuterol does not absorb anything. But when doctors order it for patients diagnosed with pneumonia, pleural effusion and pulmonary edema, it makes you wonder if they think it does absorb fluid.
10. long term effects from asthma: If you have a good doctor, take your medicines exactly as directed, and have a good asthma action plan that you follow to a tee, you should be able to live a normal, active life. Likewise, the average lifespan of asthmatics is the same as those without asthma -- 80 years.
11. why do rns think they are better then rt: Because they are. Everybody knows that. I always tell my coworkers that if I were any smarter I'd be a nurse.
Tuesday, May 26, 2009
Tips for the challenge of traveling with asthma
There is nothing worse than traveling with asthma. I'm telling you, I've had just about every possible miserable experience a person with asthma can go through. And, for that reason, I think I am more than qualified to create a top 11 list of tips for traveling with asthma.
Before I ever had an inhaler, sometime pre-1980, my mom forgot to take my Alupent Syrup, and as soon as I got to the hotel my asthma hit. Since it wasn't possible to transfer prescriptions to distant pharmacies back then, my parents went to the drug store and gave me cough drops to suck on. I remember almost choking that night.
When I was 11 or 12 (1980-81) my parents gave me the responsibility for my own asthma medicines. Well, after we traveled 10 hours and got to the hotel, I realized my inhaler was empty.
Twice when I was 14 I visited relatives, only to learn I was allergic to something in their homes. Since back then asthmatics were not allowed to take antihistamines (at least according to my doctor), I ended up in the ER of some out-of-state hospital.
Most people if they forget to take their pillows they simply use what is available in the hotel room. When I did that when I was kid with hardluck asthma I ended up ghasping for air all night long. It's possible that's the same night I forgot my Theophylin pills.
When I was older I visited my brother's home with the intent on partying with my brother and some friends, only I ended up with a runny nose, itchy eyes and sneezes because I was allergic to something in his house.
Oh, and I will never forget when mom and dad got caught up in a major blizzard on the way back to Michigan from Florida and we had to spend the night in some low-class hotel. The room we stayed in was a smoking room, and my asthma was awful that night.
So I can give you some great asthma/allergy traveling tips. I am not a doctor. Yet instead of my advice coming from an expert sitting in an office, my tips come right from things I personally experienced as an asthmatic with terrible allergies.
So, to find out what my tips are, click here and I will morph you over to my asthma blog where you can read, "11 tips for traveling with Asthma".
11 Tips For Traveling With Asthma
by Rick Frea Wednesday, May 20, 2009 @MyAsthmaCentral.com
So your job has you weary eyed and ready for a vacation. You decide to pack your bags and travel to... where? It doesn't matter, because wherever you go, when you have asthma you have no choice but to plan ahead.
That in mind, I have compiled 11 tips for traveling with asthma I learned from personal experience. Here goes:
1. Don't forget your allergies: If you're like me, you've spent the night at a family member's home (or a friend's) only to develop a sinus headache, runny nose, watery eyes and wheezes. You learned the hard way you were allergic to something in your relative's home.
The best solution here is to avoid places you are allergic to. Hotels are always an option (see below). However, if avoidance isn't posible, you can try taking over the counter antihistamines. Or, if that doesn't work, you can talk to your doctor about leukotriene blockers like Singulair, if you are not taking it already.
2. Don't forget your Rescue Medicine: Listen, I don't care if you haven't used your rescue inhaler in over a year, if you go on vacation take it with you -- just in case. No excuses!
If you have a nebulizer, bring it with you too. And don't forget the solvents that go with it. They won't do you any good if they are 400 miles away.
In the ER we RTs see lots of asthmatic vacationers, most of them would not have needed our services had they simply remembered their rescue medicine.
3. Make sure your meds are not expired: Before you leave, check the dates on all your medicine. If it's been in the medicine cabinet for more than a year, consider it expired. This is especially true of rescue inhalers like Ventolin. The last thing you need on a vacation is a rescue inhaler that has no potency.
4. Don't forget your Preventative meds: The last thing you want is to travel miles from home only to realize you forgot your Advair or Symbicort. Sure you might be fine a few days, but eventually your asthma may show it's ugly head without this medicine in your system as I describe in this post.
5. Pharmacies can be your saving grace: I used to get my prescriptions filled at Rite Aid because they are located in many vacation spots. I could easily have my prescription transferred to where I was staying. You can take advantage of this too in case you are forgetful. Walgreens, Walmart, K-Mart and other pharmacies offer similar programs.
However, most pharmacies are more than happy to help you out by transferring your meds to their store.
6. Keep a list of meds and a letter from your doc: Just in case you have to make a pit stop in an ER. The letter should state that you have asthma and the list of your currently prescribed medicines. It also helps to list what has worked best for you in the past.
7. Keep your meds with you at all times: I like to carry mine in the same bag I keep bathroom essentials in. Try keeping them in your carry-on bag. That way if my luggage gets lost, I still have these essential supplies on hand.
8. Avoid smoke-filled restaurants and bars: If you have to eat at a restaurant that has a smoking section, ask to be seated far from the nearest smoking table as possible (of course this tip should be followed whether you are on vacation or not.)
9. Avoid alcohol: Okay, so this isn't always easy. Just keep in mind that alcohol may act as an asthma trigger (click here to learn more). At least try to limit your consumption.
10. Don't skimp on hotels: You may have to set your frugal tendencies aside here, because when it comes to a hotel room you must be picky. You don't want to end up in a cheap, run down musty room that once hosted a shaggy dog and a smoker. I've had that room and my lungs didn't like it.
Planning ahead is the best route here. Although sometimes we travelers drive until we are weary and tired of kids screaming in the backseat, sowe pull over at the nearest hotel. Don't be fooled by the discount hotel; you never know what you're going to get.
11. Don't forget your pillows: This is especially true if you have sensitivity to certain materials. Besides, it's nice to have one so you can rest comfortably when someone else is driving.
So there you have it. If you have any tips you would like to share, please feel free to add them in the comment section below.
Before I ever had an inhaler, sometime pre-1980, my mom forgot to take my Alupent Syrup, and as soon as I got to the hotel my asthma hit. Since it wasn't possible to transfer prescriptions to distant pharmacies back then, my parents went to the drug store and gave me cough drops to suck on. I remember almost choking that night.
When I was 11 or 12 (1980-81) my parents gave me the responsibility for my own asthma medicines. Well, after we traveled 10 hours and got to the hotel, I realized my inhaler was empty.
Twice when I was 14 I visited relatives, only to learn I was allergic to something in their homes. Since back then asthmatics were not allowed to take antihistamines (at least according to my doctor), I ended up in the ER of some out-of-state hospital.
Most people if they forget to take their pillows they simply use what is available in the hotel room. When I did that when I was kid with hardluck asthma I ended up ghasping for air all night long. It's possible that's the same night I forgot my Theophylin pills.
When I was older I visited my brother's home with the intent on partying with my brother and some friends, only I ended up with a runny nose, itchy eyes and sneezes because I was allergic to something in his house.
Oh, and I will never forget when mom and dad got caught up in a major blizzard on the way back to Michigan from Florida and we had to spend the night in some low-class hotel. The room we stayed in was a smoking room, and my asthma was awful that night.
So I can give you some great asthma/allergy traveling tips. I am not a doctor. Yet instead of my advice coming from an expert sitting in an office, my tips come right from things I personally experienced as an asthmatic with terrible allergies.
So, to find out what my tips are, click here and I will morph you over to my asthma blog where you can read, "11 tips for traveling with Asthma".
11 Tips For Traveling With Asthma
by Rick Frea Wednesday, May 20, 2009 @MyAsthmaCentral.com
So your job has you weary eyed and ready for a vacation. You decide to pack your bags and travel to... where? It doesn't matter, because wherever you go, when you have asthma you have no choice but to plan ahead.
That in mind, I have compiled 11 tips for traveling with asthma I learned from personal experience. Here goes:
1. Don't forget your allergies: If you're like me, you've spent the night at a family member's home (or a friend's) only to develop a sinus headache, runny nose, watery eyes and wheezes. You learned the hard way you were allergic to something in your relative's home.
The best solution here is to avoid places you are allergic to. Hotels are always an option (see below). However, if avoidance isn't posible, you can try taking over the counter antihistamines. Or, if that doesn't work, you can talk to your doctor about leukotriene blockers like Singulair, if you are not taking it already.
2. Don't forget your Rescue Medicine: Listen, I don't care if you haven't used your rescue inhaler in over a year, if you go on vacation take it with you -- just in case. No excuses!
If you have a nebulizer, bring it with you too. And don't forget the solvents that go with it. They won't do you any good if they are 400 miles away.
In the ER we RTs see lots of asthmatic vacationers, most of them would not have needed our services had they simply remembered their rescue medicine.
3. Make sure your meds are not expired: Before you leave, check the dates on all your medicine. If it's been in the medicine cabinet for more than a year, consider it expired. This is especially true of rescue inhalers like Ventolin. The last thing you need on a vacation is a rescue inhaler that has no potency.
4. Don't forget your Preventative meds: The last thing you want is to travel miles from home only to realize you forgot your Advair or Symbicort. Sure you might be fine a few days, but eventually your asthma may show it's ugly head without this medicine in your system as I describe in this post.
5. Pharmacies can be your saving grace: I used to get my prescriptions filled at Rite Aid because they are located in many vacation spots. I could easily have my prescription transferred to where I was staying. You can take advantage of this too in case you are forgetful. Walgreens, Walmart, K-Mart and other pharmacies offer similar programs.
However, most pharmacies are more than happy to help you out by transferring your meds to their store.
6. Keep a list of meds and a letter from your doc: Just in case you have to make a pit stop in an ER. The letter should state that you have asthma and the list of your currently prescribed medicines. It also helps to list what has worked best for you in the past.
7. Keep your meds with you at all times: I like to carry mine in the same bag I keep bathroom essentials in. Try keeping them in your carry-on bag. That way if my luggage gets lost, I still have these essential supplies on hand.
8. Avoid smoke-filled restaurants and bars: If you have to eat at a restaurant that has a smoking section, ask to be seated far from the nearest smoking table as possible (of course this tip should be followed whether you are on vacation or not.)
9. Avoid alcohol: Okay, so this isn't always easy. Just keep in mind that alcohol may act as an asthma trigger (click here to learn more). At least try to limit your consumption.
10. Don't skimp on hotels: You may have to set your frugal tendencies aside here, because when it comes to a hotel room you must be picky. You don't want to end up in a cheap, run down musty room that once hosted a shaggy dog and a smoker. I've had that room and my lungs didn't like it.
Planning ahead is the best route here. Although sometimes we travelers drive until we are weary and tired of kids screaming in the backseat, sowe pull over at the nearest hotel. Don't be fooled by the discount hotel; you never know what you're going to get.
11. Don't forget your pillows: This is especially true if you have sensitivity to certain materials. Besides, it's nice to have one so you can rest comfortably when someone else is driving.
So there you have it. If you have any tips you would like to share, please feel free to add them in the comment section below.
Sunday, May 24, 2009
Thank you soldiers for protecting my right to blog
It's a great day to take off blogging so we can appreciate the fact that we can blog. It's a great day to step back, enjoy life, spend time with your family, and to smell the roses that we so often fail to even notice.I bet --no, I know -- there are millions of Americans who will go camping this weekend, or have family gatherings, or other social events, or even piece and quiet evenings outside in the warm sun reading a good book, who will take for granted that they can do that very thing.
Believe it or not, life wasn't always this simple for people. Our ancestors had to work long hours on the farm, and then they came in at sunset, ate, kissed the kids, and went to bed. Most people weren't even aloud to choose the religion they wanted, or to criticize the King.
That all changed with the American Revolution. That all changed with the U.S. Constitution.
Many people like to think it was the Bill of Rights that gave us the freedom of speech and other rights that allow this to be the greatest nation in the world.
The truth to the matter is, every human being ever born was born with the right to life, liberty and pursuit of happiness; the right to free speech, to defend oneself, to choose the religion of choice, etc. God gave us these basic freedoms.
And, as was the case with many nations including Britain, it was the government that took these rights away. In that regard, the United States Constitution was the first document ever written that guaranteed to protect these rights for its citizens -- us.
And while we quite often take our God given freedoms for granted, the young men and women who sit in a pit in Iraq, the military, NEVER stop thinking about how fragile this freedom is. While most of us never think of it, these young men and women NEVER turn a blind eye to the dangerous people of the world who hate us and want to destroy what we take for granted.
So, that said, we all need to do more than just have fun this weekend: we need to appreciate.
A perfect example of this occurred in church this morning. First God Bless America played, and then the priest stood up to give his weekly announcements. As a final gesture, he said, "I saw men in uniform as we were handing out the body of Christ. Will you two young men please stand."
They did. We gave a standing ovation that lasted for several minutes. And then, just as the clapping was about to end, one man stood up and started clapping, and then we all stood, applauding twice as loud and twice as long as the first time.
While I had no clue who these men were, I couldn't help to feel a sense of American Pride. I felt pride not just that these men protect our freedom that most of us take for granted, but the freedom of millions of people around the world.
This must have had a similar effect on my son, who reminded me of a famous quote from the WWII as we were headed to the car: "Dad," he said, "Never had so many had a reason to thank so few."
Many people sacrifice time with their families so we can spend time with ours. Many people sacrificed their lives so that we may enjoy ours. And we must always have moments of pride like this where we stop and think: "Yes, I am an American. I am proud."
And for those who gave us this opportunity we say: THANKS! Even if that thanks comes in the form of simple goose flesh during a simple standing ovation, or a sense of pride during a simple rendition of "God Bless America."
Saturday, May 23, 2009
It's finally slow again.
The hospital industry might just be the most unpredictable of any industry in the world. Of course I'm saying this as a person who works in the hospital industry and hasn't done much of anything else.
Yet, so far this year, Shoreline Medical has gone from extremely slow, to swamped, to slow again. And I can tell you something with utter honesty: when you go from being swamped to all of a sudden being slow, you appreciate every moment of slowness. That's a fact I won't back away from.
Normally my work doesn't effect my home life, but we had a three month rush that was so bad here I had no energy to do anything at home. If there were dishes sitting out I might just leave them out and let the wife gripe at me because I'm sitting around doing nothing but watching TV.
And, with children at home, that's saying a lot. When you have kids, and your wife is watching those kids for five straight days while you work long hours at night and sleep all day, she becomes weary eyed and very eager for an adult conversation and some help around the house.
Yet, after five days of hell at work, the last thing I want to do is anything more than the minimum when I'm on my days off. It's hard. It's the hardest part of this job as an RT. I would hate to work at a larger hospital that is THAT busy all the time. To come home every day with achy feet and weary head would make for a long life.
The last two days, however, were so slow I basically sat around and talked all night, or read books, or surfed the net, or blogged, or cleaned out my locker. It was nice. And, trust me, I appreciated every minute of sitting around. Not for one second was I bored.
I think one of the reason I appreciate it so much is you know -- in a heartbeat -- the good times could end. In a way, the way I felt the past two nights was not unlike a marathon runner in the moments following the race -- relief, joy.
So, for the first time in 12 years, I get to take a scheduled night off tonight. Even while I slept until 5:00 p.m. as I would if I were to work, I think I'm going to go to bed at a regular time tonight, which is right now: 10:16 p.m.
Have a great night
Yet, so far this year, Shoreline Medical has gone from extremely slow, to swamped, to slow again. And I can tell you something with utter honesty: when you go from being swamped to all of a sudden being slow, you appreciate every moment of slowness. That's a fact I won't back away from.
Normally my work doesn't effect my home life, but we had a three month rush that was so bad here I had no energy to do anything at home. If there were dishes sitting out I might just leave them out and let the wife gripe at me because I'm sitting around doing nothing but watching TV.
And, with children at home, that's saying a lot. When you have kids, and your wife is watching those kids for five straight days while you work long hours at night and sleep all day, she becomes weary eyed and very eager for an adult conversation and some help around the house.
Yet, after five days of hell at work, the last thing I want to do is anything more than the minimum when I'm on my days off. It's hard. It's the hardest part of this job as an RT. I would hate to work at a larger hospital that is THAT busy all the time. To come home every day with achy feet and weary head would make for a long life.
The last two days, however, were so slow I basically sat around and talked all night, or read books, or surfed the net, or blogged, or cleaned out my locker. It was nice. And, trust me, I appreciated every minute of sitting around. Not for one second was I bored.
I think one of the reason I appreciate it so much is you know -- in a heartbeat -- the good times could end. In a way, the way I felt the past two nights was not unlike a marathon runner in the moments following the race -- relief, joy.
So, for the first time in 12 years, I get to take a scheduled night off tonight. Even while I slept until 5:00 p.m. as I would if I were to work, I think I'm going to go to bed at a regular time tonight, which is right now: 10:16 p.m.
Have a great night
Friday, May 22, 2009
Alternative therapies for status asthmaticus
So you have a really bad asthmatic in the emergency room, and you already have him on a continuous bronchodilator breathing treatment, and the nurse has already given intravenous epinephrine and solumedrol.
Now you, the RN and the doctor are willing to grasp at straws to prevent that person from needing to be intubated. What are some choices you might be able to recommend to the ER physician?
A book called Fatal Asthma and CMAJ list some of the most common "alternative therapies."
1. CPAP: This can be started to help the patient overcome his increased work of breathing. Adding CPAP is also a great technique of overcoming instinsic PEEP that causes hyperinflation. The problem with this is that asthmatics already feel as though they are suffocating, and this might make matters worse.
However, with good equipment, good coaching, and a doctor willing to apply to the patient some sedatives, this might be worth a shot if you have a compliant patient.
2. BiPAP: All the principles of CPAP apply here, except this also applies pressure with inspiraton to help the patient take in a deeper breath, thus allowing the patient to blow off some CO2. This may be of particular use if you suspect impending respiratory failure associated with a rising CO2.
I have seen BiPAP work on at least five asthmatics in the past couple years. Usually if a patient is bad enough to require noninvasive ventilation, we skip CPAP and go right to BiPAP.
3. Heliox: This is a helium/ oxygen mixture that consists of 80% helium and 20% oxygen. With the exception of hydrogen, helium is the lowest density of gas. And, according to medscape.com, since asthma is a disease associated with narrowed passages that result in turbulent flow and increased airway resistance, heliox can help create a more laminar flow, and thus decrease the work of breathing
According to studies, some patients benefit from this and others do not. So, while this is used in some hospitals, the jury is still out on whether it is a cost worthy investment for hospitals.
So now you have a patient in status asthamticus intubated in your emergency room. You have tried all the conventional therapies, and you once again are grasping at straws. What are some options?
4. Bronchiolar lavage: Also known as lung lavage. This is done with a fiberoptic bronchoscope and washing the bronchioles out with normal saline with the intent of clearing the lungs of mucus plugs. This is still not commonly done in a crisis, but remains an option.
5. Anesthetics: These are used to relax airway smooth muscles. According to Fatal Asthma, "Rapid, dramatic improvement is reported, leading to more effective ventilation and in some cases early extubation."
Ketamine is a smooth muscle relaxant and antihistamine, and is given intravenously. Of course this medicine is a known hallucinogenic, and it is a sedative. Many doctors prefer to wait until a patient is intubated to use it, and follow it up with a paralytic, as you can read here.
Isoflurane is an anaesthetic and bronchodilator that has been proven to be efficacious in ventilated patients in status asthmaticus. According to this study, " Isoflurane improves arterial pH and reduces partial pressure of arterial carbon dioxide in mechanically ventilated children with life-threatening status asthmaticus who are not responsive to conventional management."
6. Permissive Hypercapnia: This is something I'd wish doctors where I worked would consider more often. We had an asthmatic a few years back who was admitted to CCU, and the doctor ordered a tidal volume of 750. Since I was bagging the patient, and her lungs were stiff, like ventilating a brick. When I finally got her hooked up to the vent the highest tidal volume I could get was 150. The doctor was irate. But I was right. He finally admitted as much.
So, the point with permissive hypercapnia is that you allow a high CO2 and low pH at the expense of low pressures and a lower tidal volume and an appropriate respiratory rate to allow time for the patient to fully exhale to prevent air trapping. You do this while continuously trying to get the patient's airways to open up. In this patient's case, it took two days for this to happen.
As the author's of Fatal Asthma state, "Prolonged severe hypoxemia can cause devastating neurological injury and death, prolonged hypercapnia per se is thought to have no long-term adverse consequences. Use of permissive hypercapnia has become standard practice in many intensive care units and in general has rendered unnecessary other 'heroic' measures in the critically ill asthmatic patient."
Well, those are some of the options available to today's physicians for the treatment of status asthmaticus unresponsive to conventional therapies. Where I work we've used BiPAP and Bronchiolar lavage, although rarely.
I've known about heliox and permissive hypercapnia, but the anaesthetics used to treat status asthmaticus is something new to me. If these medicines were ever used at my facility I'm unaware of it.
If any of my readers know of any other alternative therapies for asthma please share them in the comments below.
Now you, the RN and the doctor are willing to grasp at straws to prevent that person from needing to be intubated. What are some choices you might be able to recommend to the ER physician?
A book called Fatal Asthma and CMAJ list some of the most common "alternative therapies."
1. CPAP: This can be started to help the patient overcome his increased work of breathing. Adding CPAP is also a great technique of overcoming instinsic PEEP that causes hyperinflation. The problem with this is that asthmatics already feel as though they are suffocating, and this might make matters worse.
However, with good equipment, good coaching, and a doctor willing to apply to the patient some sedatives, this might be worth a shot if you have a compliant patient.
2. BiPAP: All the principles of CPAP apply here, except this also applies pressure with inspiraton to help the patient take in a deeper breath, thus allowing the patient to blow off some CO2. This may be of particular use if you suspect impending respiratory failure associated with a rising CO2.
I have seen BiPAP work on at least five asthmatics in the past couple years. Usually if a patient is bad enough to require noninvasive ventilation, we skip CPAP and go right to BiPAP.
3. Heliox: This is a helium/ oxygen mixture that consists of 80% helium and 20% oxygen. With the exception of hydrogen, helium is the lowest density of gas. And, according to medscape.com, since asthma is a disease associated with narrowed passages that result in turbulent flow and increased airway resistance, heliox can help create a more laminar flow, and thus decrease the work of breathing
According to studies, some patients benefit from this and others do not. So, while this is used in some hospitals, the jury is still out on whether it is a cost worthy investment for hospitals.
So now you have a patient in status asthamticus intubated in your emergency room. You have tried all the conventional therapies, and you once again are grasping at straws. What are some options?
4. Bronchiolar lavage: Also known as lung lavage. This is done with a fiberoptic bronchoscope and washing the bronchioles out with normal saline with the intent of clearing the lungs of mucus plugs. This is still not commonly done in a crisis, but remains an option.
5. Anesthetics: These are used to relax airway smooth muscles. According to Fatal Asthma, "Rapid, dramatic improvement is reported, leading to more effective ventilation and in some cases early extubation."
Ketamine is a smooth muscle relaxant and antihistamine, and is given intravenously. Of course this medicine is a known hallucinogenic, and it is a sedative. Many doctors prefer to wait until a patient is intubated to use it, and follow it up with a paralytic, as you can read here.
Isoflurane is an anaesthetic and bronchodilator that has been proven to be efficacious in ventilated patients in status asthmaticus. According to this study, " Isoflurane improves arterial pH and reduces partial pressure of arterial carbon dioxide in mechanically ventilated children with life-threatening status asthmaticus who are not responsive to conventional management."
6. Permissive Hypercapnia: This is something I'd wish doctors where I worked would consider more often. We had an asthmatic a few years back who was admitted to CCU, and the doctor ordered a tidal volume of 750. Since I was bagging the patient, and her lungs were stiff, like ventilating a brick. When I finally got her hooked up to the vent the highest tidal volume I could get was 150. The doctor was irate. But I was right. He finally admitted as much.
So, the point with permissive hypercapnia is that you allow a high CO2 and low pH at the expense of low pressures and a lower tidal volume and an appropriate respiratory rate to allow time for the patient to fully exhale to prevent air trapping. You do this while continuously trying to get the patient's airways to open up. In this patient's case, it took two days for this to happen.
As the author's of Fatal Asthma state, "Prolonged severe hypoxemia can cause devastating neurological injury and death, prolonged hypercapnia per se is thought to have no long-term adverse consequences. Use of permissive hypercapnia has become standard practice in many intensive care units and in general has rendered unnecessary other 'heroic' measures in the critically ill asthmatic patient."
Well, those are some of the options available to today's physicians for the treatment of status asthmaticus unresponsive to conventional therapies. Where I work we've used BiPAP and Bronchiolar lavage, although rarely.
I've known about heliox and permissive hypercapnia, but the anaesthetics used to treat status asthmaticus is something new to me. If these medicines were ever used at my facility I'm unaware of it.
If any of my readers know of any other alternative therapies for asthma please share them in the comments below.
Thursday, May 21, 2009
Flutiform to compete with Advair & Symbicort?
In my perusal of the health news world today I found this article about a New asthma drug that is probably going to hit the market soon. It's a medicine that will compete with Advair and Symbicort. This is good news, I think, for chronic lungers.This new medicine is called Futiform. Like Advair and Symbicort, it's a combination dry powder inhaler with both a long acting bronchodilator and a corticosteroid. It seems to be a copy cat medicine with the intent on profiting on the latest craze in asthma medicines that aim to treat both the major components of asthma: bronchospasm and chronic inflammation.
I should mention here that the FDA recommends that if a long-acting bronchodilator is prescribed for asthma an inhaled corticosteroid should also be prescribed to treat the underlying chronic inflammation of the air passages in the lungs.
In this sense, combination inhalers such as Advair and Symbicort are a recommended and common treatment for asthma. And, perhaps soon, we can even add Futiform to this list.
The interesting thing here is that while Futiform is a new medicine per se, neither of the medicines it is composed of are new. The corticosteroid in Futiform is Flovent, the same corticosteroid that is in Advair. The long-acting bronchodilator is Formoterol, the same that is in Symbicort.
In my lifelong experimentation with corticosteroids, I have found that none works better than Flovent. My pharmacist insists it's not any better than the other such steroids on the market, but I beg to differ. I have many asthmatic friends who feel the same way.
Serevent, the long acting bronchodilator in Advair, is a medicine I have often wondered about. While I've been using my Advair compliantly for over 2 years, I still have to use my rescue inhaler a few times a day. Of course that's not bad, but it could be better.
Serevent does not provide quick relief for asthmatics, however I have learned that formoterol does. Therefore, and I'm just speculating here, I'm wondering if perhaps formoterol is a better medicine than Serevent.
Thus, I'm wondering if this new medicine combines the best corticosteroid (Flovent) with the best long-acting bronchodilator (formoterol). If that's the case, this product should do pretty well in the world market at least until a better medicine is invented.
Of course, like you, my job as a gallant asthmatic is to always be thinking along these positive lines. We are constantly on the look out for that new asthma medicine that might help us get that much better control of our asthma. If nothing else, this "probable" new medicine may provide another option for us chronic lungers to try.
On a side note here, I don't like to be a Guinea pig for new medicines, but both Flovent and Formoterol have been on the market long enough to know they are safe if they are used only as prescribed.
Oh, and one more thing, the article referred to above mentioned something about generic forms of Advair and Symbicort perhaps hitting the market soon. It'll be interesting to see how this option benefits us asthmatics.
Whether or not the generic forms will be as efficatious as the original may always be up to debate, but a lesser expensive Advair and Symbicort might be the best thing to happen to us asthmatics during an economic downturn.
Well, we'll see.
Wednesday, May 20, 2009
Pulmonary Toilet Lexicon
Bronchial Pulmonary Hygeine: Use of a variety of procedures and medicines to try to help the patient expectorate thick secretions, or to help losen secretions from the bronchioles to the upper airways so the patient can more easily spit it up.
Pulmonary Toilet: If a patient is determined to have thick secretions and he is having trouble expectorating (spitting up), and this is deemed to be causing respiratory distress, than any effort necessary is done to break up secretions so the patient can spit them up. This usually includes bronchodilator therapy, mucolytic (mucomyst), and chest physiotherapy, cough and deep breathing and incentive spirometry.
Who needs pulmonary toilet? Any patient who has thick secretions, or presumed thick secretions, with the inability to expectorate them. Usually, you'll have a patient who has a non-productive cough but you know they have thick secretions in their lungs either by history (cystic fibrosis) or possibly by auscultation (rhonchi). You can hear it, the patient can feel it, but they can't expectorate it.
Rhonchi: Secretions heard by auscultation. They are usually louder than wheezes because they are in the upper airways. They can either sound coarse or like fluid in the lungs or throat. Sometimes this coarseness can resonate throughout the lungfields and sound like a wheeze. Some doctors and nurses confuse these as wheezes and think it's bronchospasm. When difficult to expectorate, the pulmonary toilet may be indicated.
Pulmonary toilet, or bronchopulmonary hygeine, involves any or all of the following procedures or meds:
Bronchodilator: This is a medicine that is inhaled via a nebulizer or inhaler. Once the medicine makes it to the air passages (bronchioles) in your lungs it binds with beta adrenergic receptors on the smooth muslce lining the bronchioles, and therefore causes these muscles to stop spasming. This causes the air passages to open up, making breathing easier, and releasing trapped secretions. An example of a bronchodilator is Albuterol and Xopenex.
Mucomyst: My fellow RTs should know this drug by its smell. When I was a student my teacher opened a vial and passed it around the class, insisting we each take a whiff. The stuff smells like rotten eggs.
However, regardless of smell, Mucomyst is part of the pulmonary toilet. So, according to healthsquare.com, "When inhaled by mouth, this medication is used to help treat certain lung diseases (e.g., bronchitis, cystic fibrosis, pneumonia). It is a mucolytic that works by making phlegm in the lungs more liquid. This effect helps you cough up the phlegm so that your breathing becomes easier."
This medicine should always be given with a bronchodilator.
Chest physiotherapy (CPT): A procedure that involves the cupping of the RTs hands and clapping on the back of the patient with the intent purpose of loosening secretions in the lungs so the patient can spit it up. It's often done on patients with thick secretions, such as bronchitis, cystic fibrosis, pneumonia, etc.) or on post op patients to help move secretions and prevent pneumonia. It can also be done with electronic purcussers, like these.
CPT is: "designed to use gravity to aid in draining secretion from various areas of the lungs. The patient lays in special ways to drain secretions from the smaller airways into their larger airways. While the patient is lying down, sitting up, lying on theire back or side, rhythmic clapping (percussion) is applied with moderate to vigorous strength. The percussion is applied to the chest wall. This helps loosen secretions from the respiratory tract, and forces the mucus from the smaller airways into the larger airways. The secretions can either be coughed up by the patient, or suctioned out."
Suction: If a patient has trouble expectorating, and has lots of secretions in their airway, you may need to suction it out either by deep tracheal suctioning or with a yankaur to help them get the secretions out. Ideally, other techniques of the pulmonary toilet will help patient get secretions to upper airway, and the patient will spit them out. Sometimes, though, suctioning out the mouth or back of throat is necessary. Suction is usually performed on an as needed bases on all patients with artificial airways.
Suction pressure is usually determined as follows:
Pulmonary Toilet: If a patient is determined to have thick secretions and he is having trouble expectorating (spitting up), and this is deemed to be causing respiratory distress, than any effort necessary is done to break up secretions so the patient can spit them up. This usually includes bronchodilator therapy, mucolytic (mucomyst), and chest physiotherapy, cough and deep breathing and incentive spirometry.
Who needs pulmonary toilet? Any patient who has thick secretions, or presumed thick secretions, with the inability to expectorate them. Usually, you'll have a patient who has a non-productive cough but you know they have thick secretions in their lungs either by history (cystic fibrosis) or possibly by auscultation (rhonchi). You can hear it, the patient can feel it, but they can't expectorate it.
Rhonchi: Secretions heard by auscultation. They are usually louder than wheezes because they are in the upper airways. They can either sound coarse or like fluid in the lungs or throat. Sometimes this coarseness can resonate throughout the lungfields and sound like a wheeze. Some doctors and nurses confuse these as wheezes and think it's bronchospasm. When difficult to expectorate, the pulmonary toilet may be indicated.
Pulmonary toilet, or bronchopulmonary hygeine, involves any or all of the following procedures or meds:
Bronchodilator: This is a medicine that is inhaled via a nebulizer or inhaler. Once the medicine makes it to the air passages (bronchioles) in your lungs it binds with beta adrenergic receptors on the smooth muslce lining the bronchioles, and therefore causes these muscles to stop spasming. This causes the air passages to open up, making breathing easier, and releasing trapped secretions. An example of a bronchodilator is Albuterol and Xopenex.
Mucomyst: My fellow RTs should know this drug by its smell. When I was a student my teacher opened a vial and passed it around the class, insisting we each take a whiff. The stuff smells like rotten eggs.
However, regardless of smell, Mucomyst is part of the pulmonary toilet. So, according to healthsquare.com, "When inhaled by mouth, this medication is used to help treat certain lung diseases (e.g., bronchitis, cystic fibrosis, pneumonia). It is a mucolytic that works by making phlegm in the lungs more liquid. This effect helps you cough up the phlegm so that your breathing becomes easier."
This medicine should always be given with a bronchodilator.
Chest physiotherapy (CPT): A procedure that involves the cupping of the RTs hands and clapping on the back of the patient with the intent purpose of loosening secretions in the lungs so the patient can spit it up. It's often done on patients with thick secretions, such as bronchitis, cystic fibrosis, pneumonia, etc.) or on post op patients to help move secretions and prevent pneumonia. It can also be done with electronic purcussers, like these.
CPT is: "designed to use gravity to aid in draining secretion from various areas of the lungs. The patient lays in special ways to drain secretions from the smaller airways into their larger airways. While the patient is lying down, sitting up, lying on theire back or side, rhythmic clapping (percussion) is applied with moderate to vigorous strength. The percussion is applied to the chest wall. This helps loosen secretions from the respiratory tract, and forces the mucus from the smaller airways into the larger airways. The secretions can either be coughed up by the patient, or suctioned out."
Suction: If a patient has trouble expectorating, and has lots of secretions in their airway, you may need to suction it out either by deep tracheal suctioning or with a yankaur to help them get the secretions out. Ideally, other techniques of the pulmonary toilet will help patient get secretions to upper airway, and the patient will spit them out. Sometimes, though, suctioning out the mouth or back of throat is necessary. Suction is usually performed on an as needed bases on all patients with artificial airways.
Suction pressure is usually determined as follows:
- Adults = -100 to -120 Hg
- Children = -80 to -100 Hg
- Infants = -60 to -80 Hg
What size suction catheter to use: Double the internal diameter (ID) of the endotracheal tube (ETT) and multiply by 2, then use the next smallest catheter size. For example, if the patient has a size 8 ID ETT, 8*2=16 or a size 14 suction catheter.
Yankaur: This is a device that fits into the patient's mouth, and can be used to suction secretions in the mouth to the back of their throat. This can be performed by an RT or by the patient. It can also be used to suction up vomit or food particles from the oral cavity.
Deep tracheal suction: This is where you take a suction catheter and insert it into the nose or mouth and go all the way down the trachea to just above the carina and suck up secretions. Ideally, this should NEVER be performed on any patient who is awake and alert, and should ideally be performed on a patient with an ineffective cough. Normally, this is performed on intubated patients, and patients with tracheotomies. However, on occasion, some physicians use this technique on awake and alert patients to obtain a sterile sputum samle for analysis. I think this is inhumane, as I write here.
Closes suction system: (Ballard) This is used on intubated patients so you don't have to break the circuit. This prevents loss of PEEP and reduces risk of Ventilator Acquired Pneumonia (VAP). .
Turning and rotation: This is where you turn the patient on to their right side, and then on to their left side. Ideally, you will perform CPT to each side for 5-10 minutes. This is generally performed on post-operative patients, or patient's in critical care, to help prevent retained secretions and atelectasis in patients at high risk for this complications. This is yet another method of preventing pneumonia and atelectasis.
Postural Drainage: This is where you place the patient in various positions to facilitate drainage of secretions. For example, if you have a patient with left lower lobe pneumonia, you place the patient face down in the bed (fowlers) and in trendelenberg (or reverse trendelenberg). The you do percussion to the left lower lobe. To view some of the basic positions check out this link.
Ideal positions: Ideally, you will want to position the patient with the infected side up. However, to prevent the infected side from draining to the good side of the lung. This way gravity can help move secretions to the trachea to facilitate removal. The patient who is not receiving postural drainage should ideally have the infected side down. This might be considered if the patient's SpO2 suddenly drops, and he is lying with the infected side up (i.e. a left middle lobe pneumonia patient lying on his right side may cause secretions to drain to the good lung).
Percussion: This is the technical term for cupping your hands and applying rythmic clapping on the patients back over the infected areas.
Vibration: This is where you put one hand over the other over the infected area and generate vibrations during expiration. This can also be done with a mechanical persussor. The goal here is to help loosen secretions. This is generally done after percussion, and particularly for patients with thick and copious secretions.
Postural Drainage, percussion and vibration (PDPV): Actually, CPT is more of a generic term for PDPV. This is where you do a combination of postural drainage, percussion and vibration. Generally, these techniques help loosen and clear secretions from the patients respiratory tract. For a good description of PDPV, click here.
Goals of CPT or PDPV: Increased secretions can in the lungs can be breeding grounds for bacteria, and can lead to lung infections. Therefore, CPT and PDPV can help prevent lung infections, enhance ventilation, and improve pulmonary function and gas exchange.
Indications for PDPV:
- Thick secretions
- Retention of secretions
- Difficulty clearing the airway (trouble getting phlegm up)
- Artificial airways (intubation or tracheotomy)
- Atelectasis caused by mucus plug or obstruction
- Conditions that increase amount and thickness of secretions (COPD, Cystic fibrosis, asthma)
PEP therapy: I think this is better than all of the above, and most studies show it is more effective. However many hospitals don't have a way of funding for them (at least that's the case where I work).
This is a device that when you exhale into it vibrations are caused in your lungs thus loosening secretions. Ideally, this is the most common sense approach to patients in need of CPT. It can easily be performed by the patient in virtually any position. It improves clearance of secretions, is easier to tolerate than chest physiotherapy (CPT), takes less than half the time of conventional CPT sessions and facilitates opening of airways in patients with lung diseases with secretory problems (COPD, asthma, Cystic Fibrosis). Plus, while many patients do not tolerate CPT, most patients can tolerate PEP therapy. Also it can be performed by any patient regardless of lung capacity.
A good example of a PEP device is the Acapella, which you can see here. On this product resistance can be adjusted by turning an adjustment dial.
Flutter valves: This is a device to deliver PEP therapy in a slightly different approach. The device consists of a mouthpiece connected to a cylinder in which a stainless steel ball rests in a cone shaped valve. The patient exhales through the cylinder and causes the ball to move up and down during the exhalation. The effect is threefold: first, to vibrate the airways and thus, facilitate movement of mucus; second, to increase endobronchial pressure to avoid air trapping and third, to accelerate expiratory airflow to facilitate the upward movement of mucus.
Incentive spirometry(IS): I discussed this in a previous post. It's pretty much used as incentive to get a patient to take deep breaths, which they are not inclined to do after chest or abdominal surgery or following a trauma and broken ribs. Ideally this is more a preventative measure than a treatment, and is not really part of the pulmonary toilet. To learn how to use it (or teach it), click here.
Cough and deep breathing: Same as for IS. It is preventative more so than part of the pulmonary toilet. It's not going to help you expectorate anything. Actually, I think this is way better than an IS. While I have had many patients who cannot do the IS, I have never had a patient who can't do simple cough and deep breathing exercises.
Abdominal Thrust: This is performed only on quadraplegic patients. This is where you push in and up on the abdomin to force up the diaphragn to facilitate a cough. You'll need to do this in sync with the patient. It actually feels kind of awkward doing this on an awake, alert and oriented patient, but usually the patient will walk you through it and even ask for it. The first time I did this, the patient showed me what to do.
Mechanical Insufflation-Exsufflation: It's a machine that alternates positive and negative pressure to the airway to help increase expiratory flows and remove secretions. It's a non-invasive procedure that can be performed with a mouthpiece or mask for spontaneously breathing patients, or with an adaptor to an artificial airway. It's usually used with patients with neuromuscular disorders.
Why do post op patients get pulmonary toilet? The theory here is these patients are sore and on medications, making them less likely or unable to take in a deep breath. This can increase the chance of them getting pneumonia or atelectatsis. The purpose here is to prevent post-op pneumonia and atelectasis. Yet, if a patient doesn't have pneumonia, I don't see what use this will do for the patient. It will not prevent pneumonia nor atelectasis.
While it may have some use in knocking out the pneumonia that is really stubborn, it is not going to reinflate collapsed alveoli.
Why do pneumonia patients get CPT or PDPV? The theory is that performing CPT over the infected side will knock the pneumonia out of a patient. However, studies done have been inconclusive as to its effectiveness. Personally, since pneumonia is an inflammatory process, I don't believe CPT will do much good. And, it's not listed as an indication for CPT
Why do atelectic patients get CPT or PDPV? Obviously, CPT will not reinflate collapsed alveoli. However, any movement is good for post op patients. Sometimes RTs are ordered to do CPT just to make sure the patient is moved around.
RT Assessment: I think the main reason some doctors order post op CPT is so that an RT is assessing the patient every so many hours. I think this actually can be beneficial to a few fragile patients who may be ventilator bait.
When should pulmonary toilet be stopped? Whenever the patient is able to clear secretions on her own. It should not be continued forever, unless the patient wants attention or a good massage from a happy RT. A good session of CPT should last about 5 minutes in each position. usually all that's required is CPT over the infected area, or, for post op patients, CPT to the right side for 5 minutes, and then the left side. For some patients, such as CF patients, CPT may be required for all positions.
Is the pulmonary toilet ordered sometimes when it's not needed? Yes. Some doctors listen to a patient, notice rhonchi upon ulscultation, and see that the patient has a tissue filled with thick green secretions, and think the pulmonary toilet is indicated. However, if the patient is capable of expectorating, the toilet usually isn't indicated.
Or, they listen to the patient, hear secretions, and order pulmonary toilet. I see no sense in ordering CPT on a patient who is already has loose secretions.
Who should have pulmonary toilet ordered? Any patient who has secretions trapped in the lungs and is having difficulty expectorating it. This may be the case with COPD, CF and some pneumonia patients. Occasionally it can benefit asthmatics.
When should it not be ordered: When it's not needed. Some doctors don't know what else to do so they just order it. The Clinical Practice Guidelines list many contraindications for ordering CPT.
When should CPT be performed: 60-90 minutes after meals, before meals, or, if the patient is on pain management, 30-60 minutes after pain meds are given.
Does pulmonary toilet really work? Yes it can work for the right patients who really need it, however it tends to be over-ordered as many hospital procudures. Likewise, CPT works if good technique is used, and the patient tolerates it.
Note: All of the above should be to the patient's tolerance. CPT and PDPV should be stopped once the patient is able to clear secretions on his own.
Measuring effectiveness: When to discontinue CPT or PDPV:
- Improvement in chest x-ray
- Improved vital signs
- Improved SpO2
- Less demand for oxygen (lower FiO2)
- Sputum production
- Auscultation (improved lung sounds)
- Sputum production drops below 30/ml per day
- The patient can generate an effective spontaneous cough
Tuesday, May 19, 2009
FAQ about Leukotriene Blockers for asthma
What follows are some of the most common questions asked in the Q&A section of MyAsthmaCentral.com and my humble answers. Today's focus is Leukotriene blockers.What is an allergy/ asthma attack? It is an immune response. Your immune system is normally reserved to protect your body from enemies, like bacteria and viruses. But, at some point the bodies of us asthmatics became sensitive to things that are not supposed to be considered as bad guys, such as dust, mold, trees, certain foods and medicines, etc.
When our bodies are exposed to any of these things our immune system triggers a response. In essence, it sends out chemicals that cause cells in your body to release the army, which in this case are called chemical mediators. Histamine and Leukotrienes are two such mediators that irritate us unfortunate souls with allergies and asthma.
What are Leukotriene blockers? Leukotrienes are chemical mediators released by your body when you are exposed to something you are allergic to. When released they attack to cells in your lungs and trigger your air passages to become inflamed, produce excessive secretions, and contract (bronchospasm). All of this results in a narrowing of the air passages in you lungs, thus causing asthma.
Leukotriene blockers literally block the action of leukotrienes, and thus prevent asthma. However, these medicines only work if taken every day, even when we are feeling good.
Why can't I just take an antihistamine like Claritin? Antihistamines are what the word says: anti-histamine. They block the chemical mediators called histamine from attaching to your nose, eyes and throat. This prevents allergy symptoms like itchy, watery eyes and sneezing. Histamines do have an effect on the lungs, but not as much of an effect as leukotrienes.
What are some common Leukotriene blockers? Accolate and Singulair are the leukotriene blockers available at this time. (For a list of all asthma medicines check out this link).
Which one is the best? Where I live and work Singulair seems to be the most commonly prescribed (and is what I take). However, I'm not sure if it is any better than the others.
Since medicines can have different effects for different patients, which one works best may depend on the patient. Likewise, which one is prescribed may also be based on the personal preference of the patient and/or prescribing physician. And, while side effects are rare, if you have a side effect to one of these meds your doctor may prescribe one of the alternatives.
Since medicines can have different effects for different patients, which one works best may depend on the patient. Likewise, which one is prescribed may also be based on the personal preference of the patient and/or prescribing physician. And, while side effects are rare, if you have a side effect to one of these meds your doctor may prescribe one of the alternatives.
For many asthmatics this type of medicine is the only medicine that is needed to control asthma. For other asthmatics, a combination of this and other asthma medicines are necessary.
Do all asthmatics benefit from these meds: According to The Harvard Medical School guide to taking control of asthma, 40% of asthmatics notice no benefit from these meds. Likewise, it is not possible to predict who will benefit from this medicine.
Are Leukotriene blockers a steroid: No. This is great because these medicines help reduce inflammation without the use of a steroid. However, some asthmatics may still need a steroid to help with chronic inflammation. A combination of the two medicines has worked great for many asthmatics, including myself.
What are the side effects of these meds? That's one of the nice things about this medicine is that there are relatively few side effects. However, as any Gallant Asthmatic, you should always be vigilant for possible side effects, especially when you first start taking a new medicine.
I hate taking meds all day long. Can I take it just once or twice a day? Accolate is taken twice a day, and Singulair is taken only once. This makes compliance a breeze. Singulair is recommended to be taken after you brush your teeth before bed. Accolate should be taken when you brush your teeth in the morning and then again before bed.
How long does it take to start working? It takes 5-7 days to really get established in your system, and therefore should be taken every day for the treatment of chronic asthma, and not as a treatment of accute system.
However, there is one exception. Both Singulair and Accolate have been found to work well for asthmatics who only have asthma symptoms when exercising. These meds may be used 1-2 hours prior to exercising to help with excercise induced asthma.
Hey, if you have any further questions about Leikotriene blockers or any other respiratory medicine, feel free to ask in the comments below or email me at freadom1776@yahoo.com or in the question section at MyAsthmaCentral.com
Monday, May 18, 2009
Asthma blog update
I would like to take this opportunity to update my readers on Asthma writings I from over at my MyAsthmaCentral.com Asthma blog. Due to holidays and vacations I got a little behind earlier in the year.
So, without further adieu, here goes:
1. It's true the number of people being diagnosed is increasing, but severe asthma rates are on the decline. Here are five good reasons.
Reasons Severe Asthma Rates Are Declining
by Rick Frea Wednesday, April 22, 2009 @MyAsthmaCentral.com
When I was a kid growing up in the 1980s I was a bad asthmatic who spent many nights in a hospital bed. I met many respiratory therapists (RT), and got to know some of them really well. This experience inspired me to become an RT. No one would have more empathy for these kids than myself.
Yet once I became an RT in 1997, I noticed something stunning: there were no asthmatic kids for me to empathise with. I know none "really well." I take care of an occasional asthmatic kid, but once they are dischared I never see them again.
Twelve years later there are still no asthmatic kids. I had many theories why this might be, yet I had no real evidence. Then I read the following post: "Severe Asthma Less Common than Decade Ago." Apparently I was not alone in my observations.
According to this article, researchers concluded that "patients treated from 2004 to 2007 showed significantly lower use of oral corticosteroids and rescue albuterol than patients from 1993 to 1997."
What follows are the theories why severe asthma rates are declining:
1. Better medicine: I'd say the best medicines so far for asthma are Advair and Symbicort. Both these medicines work to prevent asthma flare ups by treating both components of asthma: airway constriction and inflammation.
Likewise, leukotreine inhibitors like Singulair allow asthmatics to prevent allergy flare ups that may trigger their asthma.
With better asthma medicines doctors can place a greater emphasis on asthma education.
2. Better Asthma Education: There was something similar to Asthma Action Plans when I was a kid, but most doctors didnt' know about them -- at least my doctors didn't. That was one of the reasons I was referred to National Jewish Health in 1985 when I was 15.
Today, however, most doctors work with their patients on creating an Asthma Action Plan that is just right for them. Following the plan to a tee can help asthma patients stay out of hospitals.
3. Improved asthma wisdom: In 1984 doctors knew inhaled corticosteroids worked for asthma, but they were afraid of the steroid side effects. They also did not think of asthma as a disease of chronic inflammation, so they would often tell asthmatics to only use steroid inhalers during an asthma flare up.
Doctors are now wiser. They now know asthma is a disease of chronic inflammation, and a small amount of corticosteroid in your lungs all the time is not only safe, but it prevents asthma flare ups. (I wrote about this in greater detail here).
Because of this, asthmatics who are compliant with their inhaled corticosteroid are less likely to need Albuterol.
4. Improved Compliance: When I was a kid I had to take four puffs four times a day of Azmacort. You can see how easily it would be to slip in the compliance department. The inhaler was also a bulky thing that was a nuisance to lug around.
Today, however, both Advair and Symbicort are small, compact and simple to use. Not only that, but you only have to take one puff before you brush your teeth in the morning, and one puff when you brush your teeth before bed. It's that easy.
Now, you add those four together and you get a well controlled gallant asthmatic who needs his albuterol rescue inhaler only occasionally, is able to avoid emergency rooms, and rarely if ever needs to be admitted.
There you have it: That's why I never got to know any asthmatic kids the way RTs got to know me when I was a child asthmatic. It's good news.
2. Here is 20 Signs You're Using Your Asthma Inhaler Correctly. I wrote a while back the signs you are using your rescue inhaler incorrectly, or signs you are a bronchodilator, so I thought I ought to right the ship by showing you how a Gallant Asthmatic uses a rescue inhaler.
20 Signs You're Using Your Asthma Inhaler Correctly
by Rick Frea Wednesday, February 18, 2009 @MyAsthmaCentral.com
In a previous post I described for you the 31 signs you are overusing your (bronchodilator) rescue inhaler. In this post I would like to provide you the signs you are using your rescue inhaler correctly.
Most doctors recommend asthmatics carry a rescue inhaler with them at all times. Not only that, but every asthmatic should have one at home, in the car, at work, school, day care, and grandma's house.
The term "rescue" inhaler is actually a little misleading. An asthmatic should use the rescue inhaler at the first sign of breathing trouble. You should NOT wait until you are having a lot of trouble breathing. Most doctors also believe -- as does this humble respiratory therapist and fellow asthmatic -- that you cannot overdose on your rescue inhaler.
However, with the exception of a few hard luck asthmatics, frequent need of your rescue inhaler, most doctors believe, is an indication that your asthma is poorly controlled.
Likewise, most respiratory therapists (RTs) I know of highly recommend ALL asthmatics use their rescue inhaler with a spacer. The last study I read showed that a spacer can make the medicine work 175% better.
When I was a kid there were no manufactured spacers available, so my RT told me to use a toilet paper holder. Obviously, that wasn't something I was overly eager to use at school.
Today, spacers are pretty high tech and are manufactured. To get a spacer you should talk to your doctor and he can either give you one or write a prescription so you can pick one up at your pharmacy.
The spacer works to evenly disperses the particles of medicine to help you breathe them in, rather than having the medicine hit the back of your throat and stay there. In this way more of the medicine gets into the lungs, and deeper.
Likewise, most asthma experts recommend all asthmatics have an Asthma Action Plan to help you know when to use your inhaler and when to call your doctor or go to the ER.
Now, knowing that all of my readers are Gallant Asthmatics who use their rescue inhaler exactly as prescribed (Right?), or you are at least on the road to becoming one (40% still use them improperly), I have composed a list here of what a healthy relationship with your bronchodilator looks like.
So, that in mind, you know you are using your rescue inhaler correctly when:
Even though you don't use it, you still carry it with you at all times. You keep one at all locations where you spend the most time, and you make sure this inhaler is not expired. You never use an inhaler that is over a year old (Have you tried inhaling expired Ventolin? Trust me, the stuff tastes awful.).
There you have it, 20 reasons you are NOT a bronchodilatoraholic, not a goofus, and you are using your rescue inhaler correctly -- like a gallant asthmatic.
3. Here is one of my own favorite posts: An Asthma Action Plan will help you become a Gallant Asthmatic. In post I give you an easy step by step of how to create an Asthma Action Plan. Also in this post I list the early warning signs of an impending asthma attack. You will probably catch me referring to this post quite a bit, especially in q&a sessions.
An Asthma Action Plan will help you become a Gallant Asthmatic by Rick Frea Tuesday, February 24, 2009 @MyAsthmaCentral.com
So now you are wondering: "What is an Asthma Action Plan and how can it help me?" (Sometimes they are called Asthma Management Plans. It's the same thing)
As described here and here, an Asthma Action Plan has two parts.
Here are some examples of early warning signs as noted at NationalJewishHealth.com:
A. Internal warnings: funny feeling in chest, headache, spacey feeling, dry mouth, scratchy throat, itchy throat, feel weak, feel droopy, chin ithces, any other signs that are unique to YOU.B. External warnings: breathing slows down, eyes look glassy, get upset easily, feel sad, get excited, feel nervous, watery eyes, feel clammy, feel feverish, cough, sneeze, runny nose, pale, fast heartbeat, being tired, want to be alone, get quiet,
slow down, mopey, dark circles under eyes, feel grumpy, head plugged up, restless, and any signs unique to YOUl.
YOU must learn to recognize these signs "so treatment can be taken to avoid an attack... being aware that an early sign can precipitate an attack by 5 minutes to as long as a few days. "
Then you must treat your asthma. You can do that by resting, doing diagphragmatic breathing, and stopping any activity when an early warning sign is noticed -- and rest. Take your rescue inhaler. Seek help if these steps do not work. Call your doctor or have someone take you to the hospital. But, by golly, don't sit around for days puffing on your inhaler until it becomes empty.
Remember, your goal is to get your asthma under control. Following your asthma action plan to a tee, like Jake Gallant, will put you on the path of complete control of your asthma.
4. Gallant Asthmatics Know and Know How To Avoid Their Asthma Triggers. This is another post I will refer to quite a bit because this post has a great list of the basic asthma triggers asthmatics may need to be on the look-out for and avoid.
Gallant Asthmatics Know and Know How To Avoid Their Asthma Triggers
by Rick Frea Wednesday, March 25, 2009 @MyAsthmaCentral.com
Being a gallant asthmatic means more than simply taking all your medicines compliantly and having an Asthma Action Plan. It also involves knowing what your asthma triggers are and how to deal with them.
We asthmatics often have chronically inflamed air passages that are sensitive to certain asthma triggers. A trigger is anything that causes you to have asthma symptoms. The challenging thing is that every person has different asthma triggers.
According to NationalJewishHealth.org, here are some common asthma triggers:
1. Airway irritants: Strong odors, tobacco smoke, smoke from woodburning stoves or kerosene stoves and fireplaces, dust, air pollution, perfume, aerosol spray, paint fumes, gasoline fumes, solvents, chemicals, etc.
2. Animals: Animal dander, saliva and urine from feathered or furry animals. These include allergies to dogs, cats, birts, etc.
3. Changes in breathing: Sneezing, coughing, laughing, crying, hyperventilating, stress, holding your breath, sleep disorders, etc.
4. Excercize: Running, jumping, general exercize, etc.
5. Food and drugs: Allergies to nuts, chocolate, milk, sulfites, tartazine, betablockers (Inderal, Lopressor, Corgard, Timoptic, etc), asprin, ibuprophen products, etc.
6. Health and physical condition: Fatigue, colds, respiratory infections, influenza, sinusitis, gastroesophogeal reflux (GERD), etc.
7. Other allergies: Molds, dust mites, medications, cockroaches, etc.
8. Plants: Allergies to trees, grasses, weeds, pollen, etc.
9. Weather and elements: Wind, weather changes, rain, snow, hot or cold temperatures, high humidity, low humidity, changes in barometric pressure, etc.
10. Emotions: Any feeling that could precipitate an attack.
11. Time: Just get it at night or during the day
So, which of the above are your asthma triggers?
A gallant asthmatic will be aware of and avoid possible asthma triggers to the best of his ability -- within reason of course.
You may even need to make changes in your life that are difficult, such as finding someone else to cut your grass, getting rid of a cat or dog, avoiding foods that you are allergic to, or staying inside or slowing down when the weather is too hot or cold, or weather changes pose a problem.
Smoke and other irritants can often be avoided with some effort. If you have asthma you should never smoke, nor allow someone to smoke near you, and you should avoid places where smoking is allowed.
Excercise triggers can often be avoided by premedicating yourself as prescribed by your doctor, and not running outdoors if the weather is too cold or hot-- a treadmill works great for these occasions.
Good body care and good health habits such as daily baths or showers, and handwashing, can help you avoid common infections. And keeping your home clean and clear of molds and dust with frequent cleaning can also be a big help.
An influenza vaccination is often recommended for asthmatics to avoid the influenza trigger.
Stress is not easily avoidable, which is why we all should consider a good stress management plan, which may include healthy eating, exercise and relaxation exercises.
New medicines like Advair and Symbicort can make your lungs stronger and make your body better capable of handling irritants. For many asthmatics, these meds are all that is needed to control asthma even in the presence of triggers.
Another great medicine is Singulair, which has allowed many asthmatics -- including myself -- to better deal with allergens.
And of course, for those days when a pesky irritant shows up and bothers your asthma despite your best efforts, you should have an Asthma Action Plan ready and roaring to go.
Learning what you're allergic to can be as easy as your doctor performing an allergy test on you. But learning what your other triggers are will mean being vigilant to the environment around you when you are having an attack.
I think most asthmatics would agree with me that avoiding asthma triggers is extremely
difficult, if not daunting. But we gallant asthmatics are up to the task.
5. 16 Interesting Asthma Facts You Should Know. This is my most recent post, yet I don't think it needs a separate post because it is basically facts I've already listed here on RT Cave. Yet these are not your basic asthma facts that you can brush off, they are facts every asthmatic should be aware of, so go ahead and read it again if you already have.
16 Interesting Asthma Facts You Should Know
by Rick Frea Tuesday, May 12, 2009
I recently read a book written for physicians called Fatal Asthma. I wouldn't recommend it though, because it was a difficult read. Yet it was filled with some excellent asthma facts I thought I'd share with you.
Now I certainly wouldn't want to rehash the same asthma facts you can get on great websites like ours, or epa.gov and AAAAI.org. So, in honor of asthma and allergy awareness month, here are 16 asthma facts I learned from reading this lawyer-like manual of a book:
There you have it. We are all caught up. I will continue to update you each Monday on my latest posting at MyAsthmaCentral.com.
So, without further adieu, here goes:
1. It's true the number of people being diagnosed is increasing, but severe asthma rates are on the decline. Here are five good reasons.
Reasons Severe Asthma Rates Are Declining
by Rick Frea Wednesday, April 22, 2009 @MyAsthmaCentral.com
When I was a kid growing up in the 1980s I was a bad asthmatic who spent many nights in a hospital bed. I met many respiratory therapists (RT), and got to know some of them really well. This experience inspired me to become an RT. No one would have more empathy for these kids than myself.
Yet once I became an RT in 1997, I noticed something stunning: there were no asthmatic kids for me to empathise with. I know none "really well." I take care of an occasional asthmatic kid, but once they are dischared I never see them again.
Twelve years later there are still no asthmatic kids. I had many theories why this might be, yet I had no real evidence. Then I read the following post: "Severe Asthma Less Common than Decade Ago." Apparently I was not alone in my observations.
According to this article, researchers concluded that "patients treated from 2004 to 2007 showed significantly lower use of oral corticosteroids and rescue albuterol than patients from 1993 to 1997."
What follows are the theories why severe asthma rates are declining:
1. Better medicine: I'd say the best medicines so far for asthma are Advair and Symbicort. Both these medicines work to prevent asthma flare ups by treating both components of asthma: airway constriction and inflammation.
Likewise, leukotreine inhibitors like Singulair allow asthmatics to prevent allergy flare ups that may trigger their asthma.
With better asthma medicines doctors can place a greater emphasis on asthma education.
2. Better Asthma Education: There was something similar to Asthma Action Plans when I was a kid, but most doctors didnt' know about them -- at least my doctors didn't. That was one of the reasons I was referred to National Jewish Health in 1985 when I was 15.
Today, however, most doctors work with their patients on creating an Asthma Action Plan that is just right for them. Following the plan to a tee can help asthma patients stay out of hospitals.
3. Improved asthma wisdom: In 1984 doctors knew inhaled corticosteroids worked for asthma, but they were afraid of the steroid side effects. They also did not think of asthma as a disease of chronic inflammation, so they would often tell asthmatics to only use steroid inhalers during an asthma flare up.
Doctors are now wiser. They now know asthma is a disease of chronic inflammation, and a small amount of corticosteroid in your lungs all the time is not only safe, but it prevents asthma flare ups. (I wrote about this in greater detail here).
Because of this, asthmatics who are compliant with their inhaled corticosteroid are less likely to need Albuterol.
4. Improved Compliance: When I was a kid I had to take four puffs four times a day of Azmacort. You can see how easily it would be to slip in the compliance department. The inhaler was also a bulky thing that was a nuisance to lug around.
Today, however, both Advair and Symbicort are small, compact and simple to use. Not only that, but you only have to take one puff before you brush your teeth in the morning, and one puff when you brush your teeth before bed. It's that easy.
Now, you add those four together and you get a well controlled gallant asthmatic who needs his albuterol rescue inhaler only occasionally, is able to avoid emergency rooms, and rarely if ever needs to be admitted.
There you have it: That's why I never got to know any asthmatic kids the way RTs got to know me when I was a child asthmatic. It's good news.
2. Here is 20 Signs You're Using Your Asthma Inhaler Correctly. I wrote a while back the signs you are using your rescue inhaler incorrectly, or signs you are a bronchodilator, so I thought I ought to right the ship by showing you how a Gallant Asthmatic uses a rescue inhaler.
20 Signs You're Using Your Asthma Inhaler Correctly
by Rick Frea Wednesday, February 18, 2009 @MyAsthmaCentral.com
In a previous post I described for you the 31 signs you are overusing your (bronchodilator) rescue inhaler. In this post I would like to provide you the signs you are using your rescue inhaler correctly.
Most doctors recommend asthmatics carry a rescue inhaler with them at all times. Not only that, but every asthmatic should have one at home, in the car, at work, school, day care, and grandma's house.
The term "rescue" inhaler is actually a little misleading. An asthmatic should use the rescue inhaler at the first sign of breathing trouble. You should NOT wait until you are having a lot of trouble breathing. Most doctors also believe -- as does this humble respiratory therapist and fellow asthmatic -- that you cannot overdose on your rescue inhaler.
However, with the exception of a few hard luck asthmatics, frequent need of your rescue inhaler, most doctors believe, is an indication that your asthma is poorly controlled.
Likewise, most respiratory therapists (RTs) I know of highly recommend ALL asthmatics use their rescue inhaler with a spacer. The last study I read showed that a spacer can make the medicine work 175% better.
When I was a kid there were no manufactured spacers available, so my RT told me to use a toilet paper holder. Obviously, that wasn't something I was overly eager to use at school.
Today, spacers are pretty high tech and are manufactured. To get a spacer you should talk to your doctor and he can either give you one or write a prescription so you can pick one up at your pharmacy.
The spacer works to evenly disperses the particles of medicine to help you breathe them in, rather than having the medicine hit the back of your throat and stay there. In this way more of the medicine gets into the lungs, and deeper.
Likewise, most asthma experts recommend all asthmatics have an Asthma Action Plan to help you know when to use your inhaler and when to call your doctor or go to the ER.
Now, knowing that all of my readers are Gallant Asthmatics who use their rescue inhaler exactly as prescribed (Right?), or you are at least on the road to becoming one (40% still use them improperly), I have composed a list here of what a healthy relationship with your bronchodilator looks like.
So, that in mind, you know you are using your rescue inhaler correctly when:
- You only use it when you actually need it.
- Your asthma is relatively controlled.
- You are vigilant and if you are using it too much, you call your doctor.
- You get a new Advair inhaler more often than a new rescue inhaler.
- It lasts the prescribed amount of time as opposed to you renewing it every week.
- Your prescription is for one inhaler instead of 3 or 4.
- You actually have your inhaler long enough for it to expire.
- You don't have an asthma attack just because you forgot your inhaler.
- Someone actually says to you, "I haven't seen you use your puffer in a while."
- Your best friend is a person and not your puffer.
- You don't get that slathery, icky taste of Ventolin in your mouth 20 times a day from blasting in into the back of your throat.
- Your spacer doesn't whistle every time you use it.
- You actually use your spacer.
- You actually know what a spacer is.
- You NEVER use your Ventolin more often than every 4-6 hours, or your Xopenex more than every 6-8 hours (or as prescribed by your doctor).
- When you use it you take two puffs, 2-5 minutes apart.
- If you have
(If after reading this you suspect you are among the 40% who use their inhalers incorrectly -- and I commend you for making this admission -- you can click
here or here for more information on proper rescue inhaler use with a spacer.)There you have it, 20 reasons you are NOT a bronchodilatoraholic, not a goofus, and you are using your rescue inhaler correctly -- like a gallant asthmatic.
3. Here is one of my own favorite posts: An Asthma Action Plan will help you become a Gallant Asthmatic. In post I give you an easy step by step of how to create an Asthma Action Plan. Also in this post I list the early warning signs of an impending asthma attack. You will probably catch me referring to this post quite a bit, especially in q&a sessions.
An Asthma Action Plan will help you become a Gallant Asthmatic by Rick Frea Tuesday, February 24, 2009 @MyAsthmaCentral.com
So, you've come to the realization that you are not the best asthmatic -- you're like Joe Goofus. You use your inhaler way too often and you recognize -- perhaps from reading my post "the 31 signs you might be a bronchodilatoraholic" -- that you overuse your rescue inhaler.
Now you are wondering, "What do I do to break my inhaler abuse habit?"
Likewise, you have read about the types asthmatics, like Jake Gallant, who have their asthma so well controlled that they HARDLY EVER need to make trips to the ER for their asthma.
Now you ask: "How to I go from being a Joe Goofus to being more like Jake Gallant? How do I get it right?"
To make the transition is very easy, and, considering you have made the observation that you have a problem, you are already well on your way to becoming a Gallant Asthmatic.
Becoming a better asthmatic is easy, all you have to do is ACT. ACT is an an acronym for Admit, Call and Take.
- Admit you have a problem: (I'm short of breath, I'm a Goofus Asthmatic, I'm a bronchodilatoraholic).
- Call your physician: (or go to the ER according to your Asthma Action Plan (see below).
- Take your meds (exactly as prescribed. This includes both your preventative meds and your rescue inhaler).
That's it. It's that easy.
Your doctor will work with you on finding the best preventative medicines to control your asthma. All you have to do it take them exactly as prescribed whether you are having
So now you are wondering: "What is an Asthma Action Plan and how can it help me?" (Sometimes they are called Asthma Management Plans. It's the same thing)
As described here and here, an Asthma Action Plan has two parts.
1. A peak flow (pf) meter
2. Understand your symptoms
Peak Flow Meter: I described what a pf meter is and how to use it to manage your asthma in this post here. For your convenience, I will sum it up here:
Undestanding your symptoms: Early warning signs are signs that usually occur BEFORE you have an asthma attack. You need to recognize what your signs are and treat them BEFORE it turns into a full-fledged asthma attack."According to National Jewish Health, you blow into you pf meter twice a day first thing in the morning before you take any meds, and before bed. After two weeks, you take the highest number that you blew and this is your personal best.
Now, when you blow 80-100% of your personal best, you are good to go. When you blow 60-80% of your personal best, you should use your rescue inhaler, wait 20-30 minutes, and blow in your pf gain. If your pf is now above 80%, you are okay for now, but you should be your pf every four hours.
However, if your pf is still below 80%, you should call your doctor.
When you blow in your meter and your pf is less than 60%, you should use your rescue inhaler and then have someone take you to the ER. Or, if you are bad enough, call an ambulance (you should avoid driving yourself to the ER)."
Here are some examples of early warning signs as noted at NationalJewishHealth.com:
A. Internal warnings: funny feeling in chest, headache, spacey feeling, dry mouth, scratchy throat, itchy throat, feel weak, feel droopy, chin ithces, any other signs that are unique to YOU.B. External warnings: breathing slows down, eyes look glassy, get upset easily, feel sad, get excited, feel nervous, watery eyes, feel clammy, feel feverish, cough, sneeze, runny nose, pale, fast heartbeat, being tired, want to be alone, get quiet,
slow down, mopey, dark circles under eyes, feel grumpy, head plugged up, restless, and any signs unique to YOUl.
YOU must learn to recognize these signs "so treatment can be taken to avoid an attack... being aware that an early sign can precipitate an attack by 5 minutes to as long as a few days. "
Then you must treat your asthma. You can do that by resting, doing diagphragmatic breathing, and stopping any activity when an early warning sign is noticed -- and rest. Take your rescue inhaler. Seek help if these steps do not work. Call your doctor or have someone take you to the hospital. But, by golly, don't sit around for days puffing on your inhaler until it becomes empty.
Remember, your goal is to get your asthma under control. Following your asthma action plan to a tee, like Jake Gallant, will put you on the path of complete control of your asthma.
4. Gallant Asthmatics Know and Know How To Avoid Their Asthma Triggers. This is another post I will refer to quite a bit because this post has a great list of the basic asthma triggers asthmatics may need to be on the look-out for and avoid.
Gallant Asthmatics Know and Know How To Avoid Their Asthma Triggers
by Rick Frea Wednesday, March 25, 2009 @MyAsthmaCentral.com
Being a gallant asthmatic means more than simply taking all your medicines compliantly and having an Asthma Action Plan. It also involves knowing what your asthma triggers are and how to deal with them.
We asthmatics often have chronically inflamed air passages that are sensitive to certain asthma triggers. A trigger is anything that causes you to have asthma symptoms. The challenging thing is that every person has different asthma triggers.
According to NationalJewishHealth.org, here are some common asthma triggers:
1. Airway irritants: Strong odors, tobacco smoke, smoke from woodburning stoves or kerosene stoves and fireplaces, dust, air pollution, perfume, aerosol spray, paint fumes, gasoline fumes, solvents, chemicals, etc.
2. Animals: Animal dander, saliva and urine from feathered or furry animals. These include allergies to dogs, cats, birts, etc.
3. Changes in breathing: Sneezing, coughing, laughing, crying, hyperventilating, stress, holding your breath, sleep disorders, etc.
4. Excercize: Running, jumping, general exercize, etc.
5. Food and drugs: Allergies to nuts, chocolate, milk, sulfites, tartazine, betablockers (Inderal, Lopressor, Corgard, Timoptic, etc), asprin, ibuprophen products, etc.
6. Health and physical condition: Fatigue, colds, respiratory infections, influenza, sinusitis, gastroesophogeal reflux (GERD), etc.
7. Other allergies: Molds, dust mites, medications, cockroaches, etc.
8. Plants: Allergies to trees, grasses, weeds, pollen, etc.
9. Weather and elements: Wind, weather changes, rain, snow, hot or cold temperatures, high humidity, low humidity, changes in barometric pressure, etc.
10. Emotions: Any feeling that could precipitate an attack.
11. Time: Just get it at night or during the day
So, which of the above are your asthma triggers?
A gallant asthmatic will be aware of and avoid possible asthma triggers to the best of his ability -- within reason of course.
You may even need to make changes in your life that are difficult, such as finding someone else to cut your grass, getting rid of a cat or dog, avoiding foods that you are allergic to, or staying inside or slowing down when the weather is too hot or cold, or weather changes pose a problem.
Smoke and other irritants can often be avoided with some effort. If you have asthma you should never smoke, nor allow someone to smoke near you, and you should avoid places where smoking is allowed.
Excercise triggers can often be avoided by premedicating yourself as prescribed by your doctor, and not running outdoors if the weather is too cold or hot-- a treadmill works great for these occasions.
Good body care and good health habits such as daily baths or showers, and handwashing, can help you avoid common infections. And keeping your home clean and clear of molds and dust with frequent cleaning can also be a big help.
An influenza vaccination is often recommended for asthmatics to avoid the influenza trigger.
Stress is not easily avoidable, which is why we all should consider a good stress management plan, which may include healthy eating, exercise and relaxation exercises.
New medicines like Advair and Symbicort can make your lungs stronger and make your body better capable of handling irritants. For many asthmatics, these meds are all that is needed to control asthma even in the presence of triggers.
Another great medicine is Singulair, which has allowed many asthmatics -- including myself -- to better deal with allergens.
And of course, for those days when a pesky irritant shows up and bothers your asthma despite your best efforts, you should have an Asthma Action Plan ready and roaring to go.
Learning what you're allergic to can be as easy as your doctor performing an allergy test on you. But learning what your other triggers are will mean being vigilant to the environment around you when you are having an attack.
I think most asthmatics would agree with me that avoiding asthma triggers is extremely
difficult, if not daunting. But we gallant asthmatics are up to the task.
5. 16 Interesting Asthma Facts You Should Know. This is my most recent post, yet I don't think it needs a separate post because it is basically facts I've already listed here on RT Cave. Yet these are not your basic asthma facts that you can brush off, they are facts every asthmatic should be aware of, so go ahead and read it again if you already have.
16 Interesting Asthma Facts You Should Know
by Rick Frea Tuesday, May 12, 2009
I recently read a book written for physicians called Fatal Asthma. I wouldn't recommend it though, because it was a difficult read. Yet it was filled with some excellent asthma facts I thought I'd share with you.
Now I certainly wouldn't want to rehash the same asthma facts you can get on great websites like ours, or epa.gov and AAAAI.org. So, in honor of asthma and allergy awareness month, here are 16 asthma facts I learned from reading this lawyer-like manual of a book:
- It is a common myth that a child will outgrow his asthma (despite what some Recovered Asthmatics might say as they light up a cigarette). In fact, 95% of children with persistent asthma still have symptoms into adulthood (myself included).
- The life expectancy for mild asthmatics is the same as for those who do not have asthma, which is about 80 years. (This is great news. So take care of yourself and you can live long and prosper).
- Only 10% of asthmatics develop severe asthma (That comes to less than 1-2% of the population, yet still significant).
- A major cause of severe asthma is cigarette smoke, either 1st or 2nd hand (one more reason not to smoke in front of your kids).
- Nearly all cases of asthma-related deaths result from a lack of oxygen and not from cardiac arrest (This is significant because rapid oxygen administration can prevent asthma-related deaths).
- More than 20 million Americans has asthma. This year, more than 4,000 Americans will die from asthma attacks. (most of which could be prevented with proper care and a good Asthma Action Plan).
- Most fatal asthma attacks do not occur in the hospital. Most patients who reach the hospital with an intact central nervous system survive (Take note of this if you're a Goofus or Martyr Asthmatic).
- Most people who die from a severe asthma attack delayed going to the hospital (which is something asthmatics in denial tend to do. For tips on when to go to the emergency room, click here).
- Asthmatics who have had severe or near-fatal asthma attacks have an increased likelihood of having a fatal asthma attack in the future. (This is why very close contact with your doctor is essential).
- Most asthmatics who suffer a near fatal attack hadn't been taking their medicines as prescribed (or, as I mentioned above, they delayed seeking treatment, or they abused their rescue inhaler).
- Even mild asthmatics can die of asthma (but, again, mostly due to improper care or delayed treatment).
- It's not clear that overusing Albuterol increases the risk of a fatal asthma attack (yet that's not an excuse to abuse it as I explain in this post. Click here for signs of bronchodilator abuse.)
- Using albuterol as your ONLY asthma treatment may contribute to fatal asthma, because the albuterol does not manage chronic inflammation in the airways, the cause of asthma (This is why you should always use your asthma meds as prescribed).
- Boys are twice as likely to develop asthma as girls, but the exact reason is unknown. Studies show boys are more likely to have a positive allergy tests, to show more bronchial hyperresponsiveness and to appear to have different patterns of airway function development.
- Socioeconomic status and asthma fatality are inversely related. In other words, the poorer you are, the more likely you are to die from your asthma (probably because the poor have less access to asthma wisdom, medicine and good care and they are more exposed to common asthma triggers such as pollution, dust, cockroaches and animal dander).
- African Americans have an increased incidence of asthma than whites. Socioeconomic status may be a factor, but recent studies show higher IgE serum levels and higher prevalence for bronchial responsivemenss in blacks as compared with whites.
There you have it. We are all caught up. I will continue to update you each Monday on my latest posting at MyAsthmaCentral.com.
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