31 signs you might be a bronchodilatoraholic

You do not have to be an asthmatic to be a bronchodilatoraholic. I've met many cystic fibrosis patients and a ton of COPD patients who also use their bronchodilator inhalers more often than doctors recommend.

But some people are sick enough that they have good reason to do this. If they are like me, they have inhalers in the couch cushions, under the bed, in drawers, in the locker at work, and stuffed in placed you might never expect.

So, are you a bronchodilatoraholic? Can you spot a person who is? Check out my latest asthma blog post and I teach you in a humorous way what it's like to be what I am: a bronchodilatoraholic.

(Actually I'm recovering, but once a bronchodilatoraholic always a bronchodilatoraholic.)

Click here and I will morph you on over to my asthma blog. You can read my post about "How to Spot a Bronchodilatoraholic," or you can read the cartoon that was illustrated by famous cartoonist Dash Shaw.

How to spot a bronchodilatoraholicby Rick Frea Wednesday, October 29, 2008
See the comic strip version of this post!


For years I thought I was the lone bronchodilatoraholic in this world. When I started Respiratory Therapist school, I learned I was not the only one. They are everywhere. But to spot one, you have to be vigilant.

It was orientation day at RT school when I met Sammy. The teacher asked us to stand, state our names, and tell everyone why we wanted to be RTs.
I was first. I stood and said, "My name is Rick Frea and I have been an asthmatic mywhole life. I have met many RTs and now I would like to be one."

The next ten students stated reasons that varied from "I have a child with asthma" to "I just drew a straw and RT is what came up."

Then a lady about my age stood up. She smiled and looked at me and said, "My name is Sammy and, well, I too have asthma."

When class was over, I met Sammy in the cafeteria. Naturally we talked about asthma.

"I sleep with my inhaler," she said.

"YOU DO?" I said.

"Yeah, why?"

"You mean you are a bronchodilatoraholic too?"

"Well, I don't know if I'm a... what was that?"

"Bronchodilatoraholic."

"I don't know if I'm that, but I never leave home without it."

"Wow! That's what I always say, 'I never leave home without it.'"

Then, once I was an RT, I met Mike the asthmatic patient. His doctor's order was for me to give him an Albuterol breathing treatment every four hours. Usually, by the time I entered his room, he needed it.

"Hey, how's it going, Mike?" I asked. He was lying on his back watching TV.

"I'm feeling better," he said. He sat up, kicked his legs to the side of the bed, and an object fell from the bed and clicked on the floor.

I looked down. It was a little blue Albuterol inhaler. I picked it up and looked at it, then at Mike. He had a guilty look on his face like a kid caught with his hand in the cookie jar, which was funny to me, because this man was old enough to be my dad.

"Oops," he said childishly.

"Have you been using this between treatments?" Now I was the dad.

"Um, well, yeah I have."

"You are a fellow bronchodilatoraholic."

"A what?

"Bronchodilatoraholic."

"What's that?"

"You know, you can't live without your inhaler in your grasp."

"Well, you caught me. I'm guilty. I keep one under my pillow."

Since then, I have met many bronchodilatoraholics. In fact, even as I write this, an EMT friend of mine is sitting on the couch in my living room. She just finished telling me how she sometimes takes a "few extra hits of my inhaler so I don't have to go to the doctor."

"So," I said, "You are a bronchodilatoraholic too."

"Yep, I guess I am. There are times I find myself sleeping with that inhaler by my side, or making sure it is in my pocket before I go to bed. I feel a loss of control, dependence, anxiety when it's not around."

That in mind, we bronchodilatoraholics created an unscientific definition of bronchodilatoraholic.
You might be a bronchodilatoraholic if you do five or more of the following:

• You habitually take five puffs in a row instead of two.
• You keep a spare at all the places you might need it (school, work, car) and they are all almost empty.
• You don't wait the five minutes between puffs.
• You find yourself sneaking around corners to use it.
• It feels like a security blanket.
• You have to have your inhaler in your possession at all times.
• You have anxiety when you do not have one on you.
• You use it when you think of it rather than when you need it.
• You sleep with it in your grasp or under your pillow.
• You use it while driving.
• You use it when you are irritated at your spouse or girlfriend.
• You keep puffing regardless of side effects.
• If you ever think you should cut down on your puffing.
• People call you a "puffer-head."
• You feel guilt about using your inhaler so much.
• You have strong heart palpitations and are afraid to go to sleep.
• You are jittery or nervous due to puffing too much.
• Family members make excuses for you.
• You use it and your ARE NOT an asthmatic.
• You can't resist the urge to puff.
• You use it to get out of something (gym, yard work, household chores).
• You use it to gain sympathy from others.
• You get up in the middle of the night scrounging the house for the one you lost.
• You spend hours trying to get one more puff out of an empty canister.
• You call a buddy and ask to use theirs.
• You have lost inhalers all over your house (stuffed in the cushions of the couch, under the bed, in the car, behind the refrigerator).
• You trade your favorite baseball card for an inhaler.
• You end up in the ER because your inhaler ran out.
• You often say, "I never leave home without it."
• You use it as a stress reliever.
• You go to the hospital afraid the RT learn you took too many puffs.

Before I moved to my new home a few years ago I had a large, black garbage bag stuffed with my old inhalers and nebulizers. I even had a dozen or so Alupent inhalers and even a spinhaler. In that bag was probably every color and size inhaler ever made.

Unfortunately, when I moved to my new home, I accidentally mistook that bag as garbage and threw it away. I'm still mad at myself for doing that. Otherwise it would make for a pretty impressive picture for this blog.

Now, after reading this post, you should be able to pick a bronchodilatoraholic out of the crowd. Just listen for the puff-puff. Or, if after reading this post you decide you too are a bronchodilatoraholic, now you know you are not alone.

Not all bronchodilators are just abusing their inhaler out of habit. Some are hard-luck asthmatics who just need help breathing often. Others, like I was, are regular asthmatics whose asthma is out of control. But be careful; you become an abuser when you use the inhaler more out of habit than necessity; when you ignore the directions your doctor gives you and when you don't bother to work on as asthma action plan with your doctor.

Either way, you have to admit that you have a problem. Next, see your doctor and get some help controlling your asthma. Trust me, you'll feel much better.

I am a bronchodilatoraholic

My latest entry in my asthma blog is about aptly titled, "Confessions of a bronchodilatoraholic."

Yes, I am a bronchodilatoraholic. I did not become one by choice, merely because I grew up in the 1980s with severe asthma. When I was introduced to my first bronchodilator, and realized how well it helped me to breathe better, it became easy to become dependent on it.

Of course you have to realize in the 1980s asthma management was more difficult that it is today. So, that I became a bronchodilatoraholic really wasn't my fault. And bronchodilatoraholism isn't a bad thing really -- but bronchodilator abuse is.

What is a bronchodilatoraholic? What's the difference between a bronchodilatoraholic and a bronchodilator abuser? I answer both these questions in this post.

Click here and I will morph you on over to my asthma blog.

Confessions of a recovering bronchodilatoraholic
by Rick Frea Wednesday, October 22, 2008 @ MyAsthmaCentral.com
See the accompanying comic strip!

Along with being an RT, I am also a recovering bronchodilatoraholic, and despite what I believed before I became an RT, I am not alone.

Bronchodilatoraholism is not necessarily bronchodilator abuse. However, bronchodilatoraholism can lead one to make irrational decisions that may be considered abuse. Such as when I once went through an entire Albuterol inhaler in a day.

I know that sounds stupid, but it's true. And it's my confession. I am a bronchodilator-aholic who, when I was a kid, abused his inhaler.

In 1980, when I was 10, my doctor prescribed my first Alupent inhaler. It worked great for my asthma and soon I asked my mom for it regularly.

Two years later, mom started trusting me to carry my own inhaler. That may have been a mistake, but how was she to know I would become an Alupentaholic? Asthma was a new thing to mom and dad, and they wanted me to have RELIEF when I needed it.
I would go through about one inhaler a week. I often joked that I'd "never leave home without it." Soon, that infamous puff-puff became my calling card among my friends and family. They'd hear that and think, "Yep, Rick is here."

A few times, my asthma was really bad and I puffed, puffed, puffed on my Alupent inhaler, and my heart would thump-thump-thump in my chest. I'd lie in bed stressed, yet not say a word to my parents because then I'd have to confess I was using it too much.

I'd simply put my head on the pillow and concentrate on the strong heart palpitations, wondering if my heart might stop. Of course it never did, but the fear was there. Eventually, I learned Alupent wouldn't kill me so long as I spaced out the puffs. Once I realized that, it became easier to use the medicine when I thought I needed it.

Sometimes I knew that what I really needed was to go to the doctor or emergency room, but I'd simply use my Alupent instead. Eventually my inhaler was empty, and I was afraid to tell my mom to get me a new one because I thought she'd get mad at me for using it up so fast. And maybe I was just a boy who didn't want to see a doctor all the time.

I'd sometimes make it through the night and ask mom to get me a new inhaler when I saw her in the morning. Those were good nights; lucky nights. Other nights, I'd end up in the ER. Once there, I'd be stressed because I'd think the doctor and the RT would KNOW I was overusing my inhaler. Sometimes, not always, the doctor would order blood tests. As that needle pierced my skin, I'd wonder if there was a test to detect bronchodilatoraholism.

The funny thing is, I never heard a word about bronchodilator overuse. The doctors and nurses did what they always did to get me feeling better, and then I'd either be on my way home or, occasionally, be admitted to the hospital.

I was still afraid that my doctor would one day corner me about my bronchodilatoraholism. I mean, he had to know, right? Finally, when I was about 18, I decided to ask him before he got to me:

"Um," I said, "Is there, like, um, a long-term problem with using too much Alupent?"He calmly said, "There are far worse consequences to not being able to breathe than there are consequences to overusing your inhaler."

So I thought, "I guess you don't mind if I use my inhaler as much as I do. It must be relatively safe. Cool. Now I can get back to not worrying about it."

In 1991, when I was 21, I was introduced to Albuterol. This new medicine, I quickly learned, didn't cause palpitations like Alupent . I, in turn, became an Albuterolaholic.

I went to college and ordered four inhalers in the first month at the college pharmacy. The campus pharmacist became the first and only person EVER to corner me about my bronchodilatoraholism.

He said bluntly, "You can't be using this inhaler this much."

"My doctor knows how much I use it," I humbly said to him. "He's cool with it."

And this lead me to the point where I used an inhaler in one day.

Again, I cannot write here that all bronchodilatoraholism is abuse. Some people have asthma that is difficult to control, so they may need their rescue inhaler more often than asthma guidelines might recommend.

Yes, I made some unwise decisions when I was a child. Perhaps my doctor and even parents made some unwise decisions too. But the ultimate goal for all of them was to do what they thought was best for me, and that is why my doctor continued to renew my bronchodilator prescription, and why my parents allowed me to carry it.

Armed with the latest asthma wisdom and new preventative medicines such as Advair and Singulair, the adult me has his asthma controlled. I have turned into a gallant asthmatic.

The best part is, unlike when I was a kid, I now CAN leave home without my rescue inhaler. In fact, I hardly even think of it anymore.

I hate talking about myself, yet in Bronchodilator's Anonymous we learn that talking is good therapy. So, you might ask, why then have I taken the time to tell this story? I wrote this because I know for a fact I am not the only bronchodilatoraholic.

Since you won't read about bronchodilatoraholism in any book, some of my fellow bronchodilatoraholics and I have defined and compiled a list of the signs of bronchodilatoraholism. I will reveal this list in my next post.

How to spot a bronchodilatoraholic

Bronchodilatoraholics often hide when puffing, as they do not want to seek attention or sympathy. While hardluck asthmatics may rely on their inhalers regardless that they are gallant asthmatics, it's still a good idea to know how to spot a bronchodilatoraholic, especially if the bronchodilatoraholic is a goofus asthmatic and is abusing the inhaler. You can read the accompanying article how to spot a bronchodilatoraholic.  Otherwise, here is comic strip #5.

Do you sleep with your inhaler under your pillow? Do people call you "puffer head?" Do you have inhalers hidden all over your home? If you do, you just might be a bronchodilatoraholic. Here are 31 signs that you might be overusing your quick-relief asthma inhaler.

The Bronchodilatoraholic

I first heard the term bronchodilatoraholic from fellow asthmatic and friend, Stephen Gaudet.  He mentioned it in one of his blog posts at breathinstephen.com. I think the general definition was initially intended to refer to asthmatics who rely heavily on bronchodilators.  My publisher, on the other hand, defined it as asthmatics who abuse their inhalers.

So this was my first disagreement I had with my publisher.  I insisted that being dependent on, and abusing, are two different things.  In the end, especially considering I was new to the business at the time, she won. The term bronchodilator became synonymous with depended on and abuser of inhalers. 

Regardless, the term was one of 11 types of asthmatics.  You can also read about my confession: Confessions of a recovering bronchodilatoraholic.  You can also learn how to spot a bronchodilator, although you'll have to be vigilant, because often they surreptitiously puff.  And if you do find yourself puffing frequently, you are not alone. 

John Bottrell had long overused (and sometimes abused) his quick-relief asthma inhalers, joining the ranks of asthmatics known as bronchodilatoraholics. Find out how he broke the habit. Illustrated by Dash Shaw. (Originally published at healthcentral.com/asthma.)

I'm a hardluck asthmatic paying it forward

This post was published at asthmacentral.com/asthma on 

I'm a hardluck asthmatic paying it forward

I found one.  I get so excited when I find one.  It's the kind of feeling a little kid gets on Christmas morning.  I get excited because there aren't many people who've gone through an inhaler in a day and can claim to be former hardluck asthmatics and bronchodilatoraholics like me. 

Kendra was the lab technition drawing blood from the patient's anticubital area, and the patient had the nebulizer mouthpiece clipped between his teeth.  When the patient exhaled a fine, white mist of Albuterol wafted past Kendra's face.

I said to Kendra,  "Well, Kendra, it looks like you're getting your lungs cleaned while you're drawing that blood.  Kinda like killing two birds with one stone."

The patient laughed, and so did Kendra. 

"I have one of those at home too," Kendra said.  "I used to have pretty bad asthma until I started taking Advair.  Before I started taking Advair I used to puff on my Albuterol all the time."

Bingo!  My eyes lit up like a child seeing his first firework.  Several questions poured from my mouth as though some inner child took over my mind. The questions ultimately lead to, "Have you ever gone through an inhaler in a day?"

"Yes!" she said with a smile.  "You?"

"Oh, yes," I said.  "I've gone through more than one inhaler in a day more than once. I like to call myself a former hardluck asthmatic and bronchodilatoraholic.  I was until I started taking Advair too.  In fact, I even wrote about it online."

She smiled at that.  "Then I'm a former hardluck asthmatic and bronchodilatoraholic too," she said, adapting my terms.

No, I wasn't flirting with her.  God no!  If you're thinking that just drop that thought right now.  I'm happily married with four of the most awesome kids in the world.  And thankfully only one of my kids obtained my asthma gene as far as I know, and hers is mildly mild.

Yet when you have a medical condition like asthma, and you have a rare breed of asthma called hardluck asthma, or you're one of a few bronchodilatoraholics around (or in my case former -- fingers crossed), it's just neat finding someone who puffed down a similar path. 

In a way you make an instant friend. 

The reason I decided to write about this experience here is because I remember introducing myself in my original post here at MyAsthmaCentral as a respiratory therapist, yet I don't think I ever mentioned other than in passing that I am one of you -- I'm an asthmatic. 

Much of what I write about on this site is based not just on my experience as a respiratory therapist, but as a lifelong asthmatic.  I almost died of asthma more than once. 

In fact, my asthma was so bad in 1985 I was shipped to an asthma hospital and was admitted for six months.  Not six hours, or six days, or even six weeks, but six whole months. 

I met many asthmatics in the same boat as me when I was there, yet there was no Facebook back then and I've since lost contact with all of them. 

I've had many requests to share my experience, yet I've yet to come up with a pithy way of telling that story.  I could probably write a novel more so than a single column.

After my asthma hospital experience it was another 10 years -- 1995 to be precice -- that I met another hardluck asthmatic and bronchodilatoraholic, and since then as an RT I've met a few more, most of them patients I've taken care of over the years. 

When I decided to become an RT I figured I'd meet many asthmatics like me, yet thanks to modern wisdom and modern medicine I've met only a few, and I can count them on one hand.  Although I have met quite of few here on the Internet.

Yes, I'm one of you. That's my point.  My asthma is under control now thanks to modern medicines like Advair, and thanks to modern wisdom.  In a way, much of what I write here is based on my own experiences, and my own curiosities about this disease.

So, to reintroduce myself, I'm a respiratory therapist, and I'm also a fellow asthmatic paying it forward. 

The 11 types of asthma patients

Look! You can have a doctor who doesn't have asthma or a scientist working in a lab define the types of asthma, or you can have an asthmatic who lives with it define the types of asthma.

So, that in mind, I am the asthmatic who has created a list of the 11 types of asthmatics. By reading my latest blog entry over at MyAsthmaCentral.com you may see yourself or someone you know.

Keep in mind here that you will probably see yourself as more than one type, as no person is perfect. However, as we are all humans who strive to be the best at everything we do, most of us will want to believe we are the quintessential Gallant Asthmatic.

Okay, fine. I would say if you're even close to being a gallant even though you are not perfect, then you probably can classify yourself as one. Still, to be true to yourself, you should consider you are a gallant/?.

Or, if you are really honest, a goofus/?.

For example, I would consider myself a gallant/recovering bronchodilatoraholic

However, at times in my life I have been pretty much all of these at one point or another. When I was a kid I was a goofus/phlegmatic/martyr/hard-luck/bronchodilatoraholic/poor patient, and even an abuser at times.

I'm just being honest here.

This was fun for me to write and I think it will be an equally enjoyable and educational read. Don't take my word for it.

Click here and I will morph you into MyAthmaCentral asthma blog.

11 Types of Asthmatics -- Which One Are You?
by Rick Frea Monday, September 22, 2008

As your humble RT and fellow asthmatic, I have created a list of all the different types of asthmatics. Trust me, I have met hundreds of asthmatics, even lived with a bunch of asthmatics once.

See if you can spot yourself or someone you know in one or more of the following asthma types.

Asthma guidelines were written for the typical asthmatic, which generally fall into one (or even in two) of the following 11 types. For the most part, typical asthmatics have asthma under control and they have no symptoms. However, occasionally they do, and usually no more than 2-3 times per week. However, occasionally, they have their bad episodes and end up at a doctor's office or ER. How often the episodes come about depends on the type of typical asthmatic one falls under.

Types of Typical Asthmatics:

1. Gallant: These asthmatics are a doctor's best patients because they do everything exactly as they are directed. They have an asthma action plan. They have their bronchodilator with them at all times, but only use it when necessary. They religiously take their controller, anti-inflammatory medicines. These are the patients we see in the ER once, educate them, and never see them again.

2. Goofus: These asthmatics don't like anything to interfere with their fun. They have an asthma attack, go to the ER, half-listen to the nurses, doctors and respiratory therapists, and then take their preventative medicine until they start to feel better. Then they go back to having fun, until the next asthma attack.

3. Phlegmatic: These folks are not easily excited into action. They are very composed and calm even under the worse situations. You may not even be able to tell they are having breathing trouble.

4. Actors: They have legitimate asthma, but they take advantage of it to get out of doing things they don't want to do, like attending gym class, going to work, or going to their mother-in-law's 5th wedding.

5. Martyr: They could by dying and they still don't go to the ER. They are usually tough, macho adult men who only go to the ER at the insistence of their spouses. Their biggest fear, although they won't admit it, is that they will be told their asthma is all in their head, and then they'll feel stupid. So, they think it's easier just to pretend they are fine.

6. The Recovered: Child asthmatics who grow up and no longer have asthma symptoms so they do some unwise things -- like smoke. When their asthma comes back, they are in a world of hurt.

7. Doubting Thomas: These are mostly adult-onset asthmatics who, all of a sudden, develop mild asthma symptoms, but don't want to admit they have asthma. They would rather suffer at home than seek treatment. But when the RT gives them a treatment they will say, "Wow, I didn't even realize I was short-of-breath." Famous Olympic swimmer Dara Torres may have been this kind of asthmatic. But now, I'm sure, she is a Gallant asthmatic.

8. Sometimers: They live normal lives, feel good 95% of the time, and so are in denial about their asthma and don't take their preventative medicines. These are your adult asthmatics who sometimes have mild symptoms, and when they do they take a puff or two or three or four of their inhaler until they feel better.

9. Poor Patients: These asthmatics would be okay is they had different doctors. We RTs hate to bad mouth doctors, but we know that since this patient has been in the ER 10 times in the last year, he should be on some type of preventative, anti-inflammatory medicine and not just a bronchodilator. Poor patients may also be children whose parents don't have a clue how to manage the asthma.

10. Hard-luck Asthmatics: These are the asthmatics who, regardless of how compliant they are with their preventative medicines, still have bad asthma episodes. We don't know what bum luck would cause some asthmatics to get so bad, but some simply develop asthma that becomes difficult to control. This can happen to any asthmatic from infant to adult. They see doctors on a regular basis. They are on all the state-of-the-art medicines (possibly even oral steroids), and yet still have asthma episodes regularly. They end up in hospitals more often than they'd like.

11. Bronchodilatoraholics: These are people who use a bronchodilator frequently. Some may be abusing their medicine, but many are gallants who simply have hard luck asthma.Abusers don't work with their doctor on an asthma action plan and they may not bother with controller, anti-inflammatory medications. For them, puffing away is like a bad habit - like biting your fingernails. In contrast, some hard-luck asthmatics may just need their bronchodilator frequently - many times a day, every day.We'll learn more about bronchodilatoraholics on another post.

So, are you happy with the type of asthmatic you are? If not, there is no time like the present to become a better one.

I will go into more detail on all of the above types in my upcoming posts.

Bronchoterms you should know

This post originally published at healthcentral.com/asthma on 10/24/11 as "Asthma 'Bronchoterms' you should know.

If you're an asthmatic you should know the following bronchoterms.

1.  Broncho:  If you're an asthmatic you should know that broncho comes from the Greek word bronchos which means windpipe.

2.  Bronchus (Bronchi):  The main air passages of the lungs.  Often refers to the large airways, such as the trachea or windpipe.

3.  Bronchioles:  These are the smaller air passages in the lungs.  They branch from the bronchi deep into the lungs.

4.  Bronchiole smooth muscles:  These are muscles that wrap around the bronchioles.

5.  Bronchospasm:  This term refers to bronchiole smooth muscle spasms that squeeze the bronchioles causing an obstruction.

6.  Beta Adrenergic Receptors: These are receptors that are scattered throughout bronchiole smooth muslces that, when stimulated, cause bronchiole smooth muscles to relax and thus become dilated.

7.  Beta Adrenergic:  This refers to any medicine (like Albuterol) that  binds with beta adrenergic receptors on bronchiole smooth muscles.  A reaction then occurs that causes those smooth muscles to relax and this ultimately dilates the air passages.  This ultimately can make an asthmatic quickly breathe better.

8.  Bronchodilator:  Any medicine that dilates the air passages (bronchioles) in the lungs, including beta adrenergics like Albuterol and Xopenex.

9.  Rescue medicine:  Any beta adrenergic medicine.  It's called rescue medicine because it's been known to provide instant relief from asthma symptoms.

10.  Rescue inhaler:  This is an inhaler with asthma rescue medicine in it; a beta adrenergic.  Examples include albuterol and xopenex.

11.  Albuterol:  An asthma rescue medicine.

12.  Xopenex:  An asthma rescue medicine.

13.  Bronchodilatoraholic:  Anyone who uses a rescue inhaler more than what is recommended by the manufacturer, the Food and Drug Administration (FDA) and asthma guidelines,  but with permmission by a physician.  It's excessive use, but permissive use.  An example here would be a hardluck asthmatic who needs to use rescue medicine more frequently than once or twice in a two week period or more frequently than every 4-6 hours.  Antonym:  Bronchodilator abuser.

14.  Bronchodilator abuse:   Use of asthma rescue medicine to excess, for reasons not recommended, and without permission by a physician.   Examples here include use due to anxiety, habit, or as a performance enhancer.

15.  Bronchodilator abuser:  A person who participates in bronchodilator abuse.

16.  Bronchodilator overuse:  See bronchodilator abuse and bronchodilatoraholic.

17.  Compliant Asthmatic:  Any asthmatic who uses his rescue medicine as recommended by a physician, even if the dose and frequency is more than recommended by the manufacturer. See Gallant Asthmatic.

18.   Off Label:  Use of a medicine in ways not approved by the Food and Drug Administration (FDA) and not recommended by the pharmaceutical company. It refers to any of the following:

• Using unapproved dosing
• Using a medicine for an unapproved conditions
• Prescribing a medicine for an unapproved age group

Despite contrary belief, prescribing medications off label is perfectly legal in the United States.  This is a good thing because it allows doctors a right to use a medicine to its full potential and this greatly benefits patients.  In this way, bronchodilatoraholism is legal and bronchodilator abuse is illegal.

Asthma Wisdom

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Sources of Asthma Wisdom:

1. List of asthma blogs
2. Related blogs and recommended links
3. My Hardluck Asthma Blog
4. My Hardluck Asthma story
5. Other asthma links
6. Asthma Lexicon
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Basic Asthma Wisdom:

1. Asthma facts.
2. 20 more facts about asthma
3. Asthma Statistics
4. What is asthma?
5. The signs and symptoms of asthma
6. How to gain control of your asthma
7. How asthma is diagnosed
8. Everything asthmatics need to know about pulmonary function testing (PFTs)
9. Know your asthma triggers and how to avoid them
10. What is an asthma Action Plan and how to create one
11. Exercise Induced Asthma
12. 7 best exercises for asthmatics
13. How to use your peak flow meter
14. Why Your Peak Flow Meter Is An Important Tool
15. How to tell if your asthma is controlled
16. Why asthmatics need to exercise
17. The Hygiene Hypothesis, or what causes one to get asthma
18. How to find the best daycare for your child with asthma
19. 20 reasons not to smoke if you have asthma
20. Asthmatics, YOU are not alone! The new worldwide asthma community!
21. 10 tips to help asthmatics prepare for national disaster
22. Types of airflow obstruction
23. Don't waver! Seek help for bad asthma
24. 9 reasons you must never forget you have asthma
25. 10 things that are essential for all asthmatics
26. Is it cold or allergies triggering your asthma
27. Have baby with asthma? Here's 10 tips to watch out for
28. Is your asthma doctor out of date

Asthma medication:

1. What asthma medicine is best for you
2. Asthma medicines
3. Asthma medicine lexicon (coming soon)
4. The Debate: Albuterol or Lebalbuterol
5. Competition for Advair may soon lower prices
6. You should not be afraid to use Advair and symbicort
7. MDI or Nebulizer: Which one works best for your child
8. Here's what asthma meds cost
9. Are bronchodilators safe? A Q and A about Albuterol
10. Modern Meds may cause fatal asthma (but not the way you might think)
11. Symbicort may offer new option for asthmatics
12. A concern of expectant mothers: are asthma meds safe for baby
13. Theophylline no longer top line asthma medicine
14. Alternative medicines for asthma
15. Does Advair cause weight gain?
16. Antihistamines may cause weight gain

Asthma tips from a fellow asthmatic:

1. Asthma forgetfulness and asthma honesty

Information about exercising with asthma:

1. Alright asthmatics! Here's your incentive to get in shape this year
2. Even we asthmatics can run
3. Exercise Induced Asthma

Interesting Facts About Asthma:

1. Asthma linked to anxiety and depression
2. The link between COPD and asthma
3. Types of airway obstuction (Asthma, bronchitis, Emphysema, or a combination)
4. 10 asthma myths busted
5. 13 Things We Asthmatics Can Be Thankful For
6. Kids with asthma can and should play team sports
7. Seven Ways Asthma Has Benefited My Life
8. Seven Benefits of Being a Dad with Asthma
9. 10 tips to becoming a better asthma dad
10. Asthmatics can lead a normal life
11. What are long-term effects of asthma?
12. c-sections increase risk of asthma by 80%
13. The common sense approach to hard luck asthma
14. 8 factors may increase risk of fatal asthma
15. case study: Does intervention worsen asthma?
16. Is it possible pure asthma is NOT a fatal disease?
17. Bronchospasms don't always wheeze
18. Asthma/COPDers should avoid pop & beer
19. Chronic lungers and fans go hand in hand
20. Lack of interest in asthma means less funding
21. Cardiac asthma should not be treated as asthma
22. Some good asthma/COPD drugs get a bad rap
23. Airway remodeling in asthma patients
24. Asthma Hospitalizations on the Decline
25. Studies Link Alcohol to Worsening Asthma/Allergies
26. Asthma is not all in your head

History and future of Asthma:

1. Check out these 19th century asthma remedies
2. Check out these ancient asthma remedies
3. Neat website I found with old asthma medicines
4. Susphrine: The asthma wonder drug of old
5. It's time to bring back susphrine
6. Asthma cigarettes served a useful purpose
7. I'd like to meet asthmatic Teddy Roosevelt
8. From asthma cigarettes to a normal life
9. Asthma: A cure may be on the horizon
10. Scientists develop new cure for asthma, allergies

Types of Asthmatics and inspiring asthma stories:

1. The 11 types of asthma patients (or click here for the lexicon)
2. Meet Jake Gallant, the perfect asthmatic
3. Meet Joe Goofus: The Asthmatic You Don't Want To Be (But Probably Are)
4. Being the Best Asthma Patient You Can Be
5. Are you a bronchodilatoraholic?
6. Confessions of a recovering bronchodilatoraholic
7. Bronchodilator Anxiety
8. The "Wet Noodle" Technique Works For Keeping Calm During An Asthma Attack
9. The Phlegmatic Asthmatic
10. Some Asthmatics are Good Actors
11. The Doubting Thomas Asthmatics
12. Confessions of an asthmatic in denial
13. Meet Breathin' Stephen, the Hard Luck Asthmatic On His Way to the Boston Marathon
14. Breathin' Stephen, the Hardluck Asthmatic, completes Boston Marathon
15. The Journey of a Hardluck Asthmatic to Gallant Asthmatic, or why it's easier to control asthma in 2010 as compared to the 1970s and 1980s when I grew up
16. Josie Goofus: The Asthmatic you don't want to be
17. I am your respiratory therapist
18. Kid asthmatics love their respiratory therapists
19. Asthmatics can't live in a bubble
20. When it's asthma it's personal for me
21. Asthmatics can still attend hunting camp

Types of Asthma Doctors and wisdom about doctors:

1. The 6 types of asthma doctors
2. The 24 signs of a great asthma doctor
3. You and your doctor must be an asthma control team
4. Is your doctor doing a good job
5. Do You Need An Asthma Specialist?

Additional asthma wisdom:

1. Advice for parents of asthmatics
2. Five things that could get in the way of a healthy you (and how to get around them!).
3. What's it like to be intubated?

Asthma Book Reviews:

1. Start the asthma talk with "Alphie's Attack!"

Fun Asthma Writings:

1. Santa's elves working on new asthma medicine

Morph to Hardluck Asthma where I delve into the past and future of asthma.

Types of Asthmatics Lexicon

Types of Asthmatics:

Bronchodilatoraholic: A person who takes more than two puffs twice a week of a rescue inhaler. Some are bronchodilator abusers, and some are simply Hardluck Asthmatics. You can read my experience here and and take the test to see if you are one by clicking here.

Bronchodilator Abuser: A person who abuses his rescue inhaler when what he should be doing is checking in with his asthma physician. Overuse of an inhaler is the #1 sign of uncontrolled asthma.

Hardluck Asthma: Despite all the best asthma medicines and wisdom, these asthmatics continue to have trouble with their asthma. I wrote about one such asthmatic here and here, and I wrote about my experience here. Plus you can click on "my story" under the banner to read more of my story growing up with Hardluck Asthma.

Gallant Asthmatic: She is the asthmatic who does everything right, and has great control of his asthma. He avoids his asthma triggers, has worked with his doctor on an Asthma Action Plan, and follows it to a tee. He is also very compliant with his asthma medicines and sees his asthma physician at least twice a year, but ideally twice a year. I write about Gallant Asthmatics often, such as this post and this post.

Goofus Asthmatic: He's the asthmatic who does everything wrong. He fails to go out of his way to avoid his asthma triggers, only goes to see his doctor when he has to, and does not have an asthma action plan. If he does have one he doesn't follow it. He is not compliant with his medicines, as he takes them only when he is feeling symptoms. He is the asthma type who is most likely to be seen in the ER. On a similar note, since his asthma is so out of control and since he is not on his controller meds, he is most likely to be admitted to the hospital. I write about Goofus Asthmatics on occasion, such as this post.

Phlegmatic Asthmatic: She's the calm, cool and collected asthmatic who takes everything in stride. He could be having an asthma attack right in front of you and you'd never know it (unless you had a keen eye for asthma.) How do you know you're dealing with a phlegmatic asthmatic? You won't unless they tell you they have asthma. These are the zen asthmatics who appear to be accepting of their condition, don't lose their cool and quietly deal with breathing trouble. I am a phlegmatic asthmatic

Actor Asthmatic: He is the asthmatic who always seems to have trouble breathing when you need him most. If it's time to haul in wood for the fire, his asthma flares. If he's dreading going to work he might run laps around the living room to ignite his asthma. When it's time to haul in the groceries he'll be seen puffing on his inhaler. He'll do anything to get out of work and avoid stress. Synynom: Exaggeration of Asthma. The actors are fun to write about.

Martyr Asthmatic:They could by dying and they still don't go to the ER. They are usually tough, macho adult men who only go to the ER at the insistence of their spouses. Their biggest fear, although they won't admit it, is that they will be told their asthma is all in their head, and then they'll feel stupid. So, they think it's easier just to pretend they are fine.

Recovered Asthmatic: Child asthmatics who grow up and no longer have asthma symptoms so they do some unwise things -- like smoke. When their asthma comes back, they are in a world of hurt.

Doubting Thomas: These are mostly adult-onset asthmatics who, all of a sudden, develop mild asthma symptoms, but don't want to admit they have asthma. They would rather suffer at home than seek treatment. But when the RT gives them a treatment they will say, "Wow, I didn't even realize I was short-of-breath." Famous Olympic swimmer Dara Torres may have been this kind of asthmatic. But now, I'm sure, she is a Gallant asthmatic.

Sometimer Asthmatic: Synonym: Asthmatics in Denial: They live normal lives, feel good 95% of the time, and so are in denial about their asthma and don't take their preventative medicines. These are your adult asthmatics who sometimes have mild symptoms, and when they do they take a puff or two or three or four of their inhaler until they feel better.

Poor Patient Asthmatic: These asthmatics would be okay is they had different doctors. We RTs hate to bad mouth doctors, but we know that since this patient has been in the ER 10 times in the last year, he should be on some type of preventative, anti-inflammatory medicine and not just a bronchodilator. Poor patients may also be children whose parents don't have a clue how to manage the asthma.

Bronchodilatoraholic: These are people who use a bronchodilator frequently. Some may be abusing their medicine, but many are gallants who simply have hard luck asthma.Abusers don't work with their doctor on an asthma action plan and they may not bother with controller, anti-inflammatory medications. For them, puffing away is like a bad habit - like biting your fingernails. In contrast, some hard-luck asthmatics may just need their bronchodilator frequently - many times a day, every day.We'll learn more about bronchodilatoraholics on another post.

Unfortunate Asthmatic: These asthmatics don't have access to a healthcare provider, and cannot affort to get their prescriptions refilled. They give the appearance of Goofus Asthmatics, although they are not. Many live in downtrodden city homes filled with allergens they cannot escape. Their homes are often exposed to the elements due to things like a leaky roof, flooded and musty basement, broken windows covered with plastic and duct tape, broken plaster and peeling paint. They have poor ability to remove asthma triggers from clothing due to lack of washer and drier, or inibility to afford to pay the water bill. They are often exposed to second hand smoke due to inibility to choose their surrounding environment. Good asthma control may be hard to come by no matter hard they try.

Best asthma you can be: This is the more realistic asthma type. They strive to be the best they can be, although they are not perfect because, if you think about it, perfection is not achievable. Normal asthmatics will miss an occasional dose of medicine, and will take an occasional extra puff on their inhaler, and may even use their rescue inhaler without a spacer.

Vulnerability: (1)A feeling you get when you realize you're not going to live forever. It most often occurs when you require prolonged or frequent stays in a hospital. (2) The realization if you want to live a long, healthy life you have to take care of your self, which may include making some changes (like quitting smoking, avoiding allergens, etc.
Vulnerability: (1)A feeling you get when you realize you're not going to live forever. It most often occurs when you require prolonged or frequent stays in a hospital. (2) The realization if you want to live a long, healthy life you have to take care of your self, which may include making some changes (like quitting smoking, avoiding allergens, etc.

Bronchodilator anxiety: The feeling of anxiety because you don't have your rescue inhaler on your posession. This may bring about an asthma attack just because you don't have it.

Asthma forgetfulness: The tendency of some asthmatics to forget they have asthma because they are feeling well, and do things that they shouldn't. Examples: quit taking meds, rake leaves, clean musty basement, etc.

Joe Goofus and the empty inhaler

I'm going to violate the patient confidentiality code and give you an update on our good friend Joe Goofus.  He's not informed enough to know about laws, so I'll take a risk here and assume I'm right.

He has been showing up in the emergency room a lot recently, requiring me to give him a boatload of Ventolin, and the nurse to give him bursts of corticosteroids to open up his lungs.  The medicine works every time, although as soon as it's out of his system he's right back in the ER.

It's frustrating, I'm telling you.  I educate him on how to care for his asthma, and it goes in one ear and out the other.  To be honest with you, it gets kind of annoying.  This guy is his own worst enemy.

I think this guy is in a world of hurt.  One of these days he's going to pick up a virus, like the flu virus, and he's going to end up with an asthma episode so severe we will not be able to save him.  I'm serious.  This guy is a quintessential example of a low informed asthmatic.

As a concerned asthmatic respiratory therapist, I screen out guys like Joe.  I ask all my asthmatics the following questions:

• Do you have an asthma doctor
• Do you take your asthma medicine as prescribed

Joe Goofus answers NO and YES.  Whoa, that may have surprised you there, but not me.  I don't fall for the "yes I have an inhaler bit." 

I say, "You been using your inhaler a lot, haven't you?"

"Well, yeah, I guess I do." He says, nodding his head, rolling his eyes.  

A bronchodilatoraholic can't fool me.  I know them like I know the backs of my formerly Ventolin stained fingers.  

After a few hours in the emergency room, his breathing is better.  The nurse reads him his discharge instructions knowing he's not going to follow them.  

I'm telling you his story because I don't want you to be a Joe Goofus.  I want you to take care of your asthma so you don't have to keep seeing guys like me.  I do not want YOU to be a goofus asthmatic.  

If you are a Goofus -- and most of us are, actually, so don't be embarrassed -- you'll want to get on the path to being more like Jake Gallant.  Ah, our friend Jake Gallant even makes me look like a Goofus he's so perfect.  

Yet Joe has some advice for us:

1. See your asthma doctor at least once a year
2. Take your asthma medicine exactly as prescribed
3. Create and utilize an asthma action plan

There, how's that for keeping it simple?  

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Are you forgetful or honest about your asthma?

One of the things I notice about humans is we tend to forget the past, although we should not. For those who forget the past are doomed to repeat it. This is especially true -- I've learned the hard way -- of asthma.

My asthma was so bad I was admitted to an asthma hospital in 1985 for 6 months. This allowed me to get my asthma under control for over 10 years. Then I forgot, and the beast returned. So, are you like me and suffered at one point (or suffer right now) from asthma forgetfulness?

Or are you more into asthma honesty like I am now. Learn more by reading my latest Sharepost from MyAsthmaCentral.com

Asthma Forgetfulness And Asthma Honesty

Have you ever tried to forget your asthma past? Do you have an asthma story you've never shared with anyone? Do you have asthma forgetfulness? If you do, perhaps it's time to share your story.

Trust me. I know from first hand experience that asthma is no fun. I also know that asthma forgetfulness may be the easy route, yet it also leads to poor asthma control later on. If you bare with me I'll explain. I'll also explain why a little asthma honesty might be the cure youve been looking for.

One such experience came to light this morning. It was 6:00 a.m. and I was working as a respiratory therapist. I was paged STAT to the emergency room (ER).

Upon entering the ER I found one of our regular asthmatics sitting on the edge of the bed, slouched over, huffing and puffing to get air in. Her oxygen was so low when she arrived the nurse had put an oxygen mask on her.

I started up a breathing treatment and replaced the mask with a misting pipe in her mouth. The mist was Ventolin, the Godsend to asthmatics; the juice that gets the lungs moving air again. I could tell by the way she held the pipe firmly between her teeth -- the no hands technique -- she was an expert at this.

I sat in a chair the opposite side of the room while the nurses worked their magic: inserted an IV line, inserted Solumedrol into IV line, and asked a million questions. I couldn't help but remember the days of long ago when I was in her shoes, with a Ventolin Peace Pipe proficiently stuffed in my mouth.

Then the nurse asked this question: "So, how many breathing treatments did you give yourself at home before you came in?"

The asthmatic said, "Oh, more than enough."

That was more honest than any answer I ever gave, I thought. Then said, "When I was a kid and a nurse asked me that, I would just lie."

The patient, obviously breathing better now, said, a smile on her face, "You have asthma too."

"Oh yeah," I said, "I had it very bad too when I was a kid. In fact, I used to go through a Ventolin inhaler every day."

"You did what!" The nurse said, peering down at me, bug eyed.

"I would use an inhaler every day, and then I'd also take breathing treatments in between. In fact, back then you could only get one Ventolin refill at a time, so there were weeks when I'd have mom go to the pharmacy every day to get a new inhaler."

I wrote about this experience in more detail in my post, "Confessions of a bronchodilatoraholic."

The nurse gasped at my story, yet the patient smiled.

Years ago I wasn't able to be this honest, yet now asthma stories flow easy, and allow me to create a bond with my asthmatic patients. It also helps prevent asthma forgetfulness, as asthma forgetfulness only results in worsening asthma. Trust me: I know.

In fact, for many years I completely blacked out my severe asthma past. I'll be honest, there were days I used up my Ventolin inhaler, and then was so miserable, so afraid, that I never told my mom for fear she'd be mad at me. Then I'd suffer until about 2 in the morning when I couldn't stand it anymore and finally break down and wake her up.

Dad would take me to the emergency room having no clue how long I had suffered.

So then I'd be in the ER, shoulders high and scratching at the mattress to stretch out my lungs to get any extra air into them I could, and the respiratory therapist (perhaps one I work with now), gave me a breathing treatment.

Then came THE question: "How much Ventolin did you use at home?"

"A couple puffs," I'd say after a long delay. Yes it was a lie. A very bad lie.

My asthma -- my hardluck asthma -- was so bad my mom and dad and doctor thought I was going to die. And in 1985 they had me admitted to the asthma hospital in Denver Colorado (then it was National Jewish Health-National Asthma Center (NJH/NAC). I ended up staying there for six months (Yes, I wrote that right).

Once I was discharged my asthma was under better control than ever. I never missed school again due to my asthma, and I rarely ever needed the services of an ER. My asthma was under control -- finally.

All was great right? Well, all except for the fact asthma forgetfulness set in. After several years all the great wisdom I learned from NJH was lost.

The thing is, asthma forgetfulness only leads to worsening asthma because when you forget you have it, you forget to control it (something a gallant asthmatic would never do).

So 10 years after leaving the asthma hospital, my asthma was almost as bad as it was before I went there. I had to relearn everything.

Asthma is a very fragile and devastating disease when it's not controlled. If you don't control it, it controls you. Forgetting you have it, or pretending you don't have it, only makes matters worse.

What comlicates matters are myths that asthma goes away with age.

The best way to overcome asthma forgetfulness is with asthma honesty. Where I once had blacked out my past, I have since forced myself to relive it. I even wrote about it to some extent here. I realize now if I hadn't forgotten, my asthma never would have gotten bad again ten years later.

So my advice to other asthmatics is to never forget how miserable you were before your asthma was controlled. Don't ever forget how you gained control of your asthma. The best way of doing, the best way of being honest, is to share your asthma stories. Thankfully that's something I get to do at work and right here.

If you have an asthma story you've never shared, feel free to do so in the comments below, or create your own sharepost.

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Many asthmatics tend to be Goofus Asthmatics

No asthmatic is perfect. We all puff on our inhalers probably more often than "the experts" would recommend. We all wait longer than we should to go to the ER.

Many of us avoid using a spacer when we use our inhalers, and few of us use our peek flow meters as recommended. Hardly any of us keep an asthma diary.

We are humans. We have lives.

Still, some asthmatics do nothing right when it comes to their asthma. They mean well, but they're main focus is moving on with their lives regardless of asthma.

I define the ideal "do nothing right" asthmatics as the Goofus asthmatic. To read more about the Goofus asthmatic, click here and I will morph you over to my asthma blog.

Meet Joe Goofus: The Asthmatic You Don't Want To Be (But Probably Are)
by Rick Frea Wednesday, October 08, 2008 @ MyAsthmaCentral.com

Joe Goofus means well, but he often neglects his asthma care plan and needlessly ends up in the emergency room for asthma.

It's not that he is a bad person, he just likes to have fun. He always plans on taking care of his asthma, but something fun always seems to get in the way.

Unlike Jake Gallant, here is what Joe Goofus might say:

Education: "Who needs education? Education is for old people. I have better things to do than spend time reading about asthma control. When I have trouble breathing, I'll take a few hits on my inhaler."

Good doctor: "What difference does it make who I have as a doctor? A doctor is a doctor is a doctor. And besides, doctors tend to over treat."

Compliance: (He only takes his medicines when he feels like it. When he is feeling better he usually quits taking them all together.)

Rescue inhaler: "This thing was made to be used when needed. When I'm having mild symptoms, I'll take a hit or two." (He doesn't use a spacer, and he doesn't bother waiting 5 minutes between puffs. Being short-of-breath is annoying and he just wants to get it over with. If he needs it again in four hours he uses it and he doesn't bother to call the doctor when his need for it increases.)

Peak Flow Meter: "What a complete waste of time! My peak flow numbers are the same no matter if I'm having asthma symptoms or not, so why should I waste my time using that stupid thing?"

Asthma journal: "Only nerds waste their time with this. I have a good memory and I can keep track in my own head. Right?"

Early warning signs: (Okay, so he knows these quite well. Heck, he probably knows them better than the Gallant Asthmatic, because he has twice as many asthma attacks. He has the itchy throat, sniffles, headache, anxiety, irritability, increased respiratory rate, and everything else that goes with hanging out at his best friend's cabin after forgetting to take his Singulair the past three weeks. Oh, and by the way, he forgot his rescue inhaler at home, and he is currently at his friends cabin with no medicine. He is in a world of hurt.)

Late warning signs: (He's there right now. He has a tight chest, his respiratory rate is high, his shoulders are high, he's leaning on things to breath, he's extremely anxious, he's very irritable. Heck, he's panicked.) "Why did I forget my inhaler?"

Asthma triggers: (Well, it's pretty obvious now he's allergic to his friend's cabin where he is TRYING to sleep. Perhaps he's also allergic to his own forgetfulness and unreliability.) "Darn. Sniffle. Sniffle."

Well, he finds his Flovent inhaler and takes two puffs, hoping it will kick in. But it doesn't. He hears his friend snoring in the next room and wonders if he should wake him up. He takes in a half a breath. It hurt going in. His nose is runny. His respiratory rate is fast.

Finally he gives in. He wakes up his buddy and has him take him to the ER. This time one simple breathing treatment doesn't do the trick. He buys himself an IV, a large dose of IV corticosteroids, and then a hospital suite right next to an old man who drools and snores like a pig. Joe Goofus hits his nurse call button.

"Can I help you?" The nurse asks in a friendly tone.

"Yes, can you call RT to give me another treatment?"

"Why sure."

Two weeks later he gets to go home. Two weeks after that he's feeling better and gets out of the routine of taking his medicine. A month later his buddy invites him to a party at his cabin for more fun. The cycle continues.

The big problem with Joe Goofus, besides the fact that he is only hurting himself, is that by not treating his asthma right away he is setting himself up for permanent lung scarring. When that happens, he may end up with worse asthma. He is highly susceptible to becoming a bronchodilatoraholic or -- worse -- a bronchodilator abuser.

Any busy person is prone to being a Goofus, particularly kids who aren't monitored closely by their parents.

Don't be a Goofus. If you suspect that you are one, it is okay to admit it. Besides, you are not alone.

Just click here and read about how to be a good asthmatic. Go ahead. There's no better time to start than the present.

Are you dependent on your rescue inhaler too?

Yep, that's right! I am dependent on my rescue inhaler. It's kind of like that old commercial for Master Card: I never leave home without it. And when I do the bronchodilator anxiety strikes.

The following is one of my favorite posts over at my asthma blog at MyAsthmaCentral.com

Bronchodilator Anxiety
by Rick Frea Tuesday, November 03, 2009 @MyAsthmaCentral.com

So it's 6 a.m. and I'm driving down I-75 South in Georgia in the wee hours of the morning when the anxiety strikes. I couldn't find my rescue inhaler. My Ventolin had gone missing.

Did I leave it in the hotel? Did I leave it in the lobby? Did my wife pack it in the bathroom bag? I looked behind me and her head was resting on a pillow. I wasn't about to wake her to ask. The kids were sleeping soundly too. So I continued to roll possibilities around in my head.

Thankfully I follow my own tips for vacationing with asthma and had three inhalers packed, and all in different places. I had one in the suitcase, but that wasn't going to help me now. And I certainly wasn't going to pull the car over to check. We were on the way to Florida (Mickey was waiting) and were already running behind.

I looked on the cup holder under the radio. It wasn't there. I felt between the door and the seat. It wasn't there. I felt in my pocket. Nope! While focusing on the road, I reached my right hand over the cooler that set between the seats. Not there either.

Then a thought occurred to me: "You're being ridiculous. You're panicking over nothing." It was true. I wasn't even short of breath. The past two days of travel from Michigan I barely even used it. My asthma has been pretty well controlled the past two years, and my rescue inhaler usage greatly diminished.

Yet that didn't matter. Old habits, they say, die a long, hard death. That old faithful inhaler had been part of my life since I was first introduced to Alupent when I was a ten-year-old boy in 1980, and later to Ventolin in 1991. I wrote about being a bronchodilatoraholic, someone who used his bronchodilator medicine (which most peope call their rescue inhaler) far too often. An inhaler in my possession was my lifeline. It was like having a third hand. Even now when I need it less often, when it's gone I feel a true sense of loss.

Like at home, every morning I woke up on my vacation, one of my first thoughts was, "Where's my inhaler?" When I was a kid I slept with one in my grip, so when it's not there I get a little anxious. Then I remembered I set it on the bedside stand. There it was in all its blue glory.

When I go to bed at night I have to concentrate where I set it last, because when I get up in the night I need to know where to find it. Sometimes, though, I wake up in the middle of the night feeling alongside the bed in the dark.

My wife woke up once when I was doing this. She said, "What are you doing?" Modestly, I lied "Nothing dear!" I inhale. The breath seems somewhat tight. Now many options fill my mind: Do I try to sleep through it? Do I turn the light on? Do I rummage the house looking for the other one's I've lost?

I remember when I was growing up with hard-luck asthma excitedly racing my brothers David and Bobby to the family car shouting, "Shotgun!" I won this time. It was always nice to ride in the front seat. It was a great day. That was until half way to grandma's my heart fluttered as I realized I didn't have my inhaler with me.

I felt my pockets several times. It was not there. While my asthma was fine when I left home, I was now feeling short of breath. I knew the only reason I was short of breath was because of my bronchodilator anxiety. If I have it I'm fine. If I don't have it I'm bound to have an asthma attack. It's an asthma rule.

So now I'm an adult. I know I have two inhalers in the car somewhere. I know for a fact I have one in the suitcase. I know my asthma is not acting up. I know my asthma is controlled, and yet my bronchodilator anxiety still strikes. I'm now starting to feel a mild shortness of breath. Or am I? Maybe it's all in my head.

Throughout the entire trip my inhaler filled a portion of my mind -- or my entire life for that matter. If you'd pay close attention to me you'd see me occasionally swiping my palm over my pocket. I need that constant reassurance it's there. If I don't feel it, I have to find it. I have to know. Otherwise I'll need it.

The weather was awesome in Florida, the kids were able to meet Mickey Mouse, swim every day, and visit with their grandparents. And, thanks to good planning, the asthma was a non issue.

Ironically even as I sit here typing this I'm wondering: Where is my inhaler? Where was I the last time I used it? I don't need it right now, but...

I bet I'm not the only asthmatic with bronchodilator anxiety. If you've experienced this or something similar let us know in the comments below.

Many patients do not use inhalers properly

Studies show most asthmatics do not use their inhalers correctly. In fact, this may be a greater problem than you suspect. I recently wrote about his at MyAsthmaCenteral.com

Proper inhaler use is essential

(August 10, 2010)

Chances are most asthmatics have a metered dose inhaler (MDI) tucked away somewhere in their possession. Yet studies (like these) show too many of us do not use our MDIs correctly.

Of course improper use of your medicines will inevitably mean you're not getting as much of the medicine as you should, and may result in difficulty controlling your asthma.

Take your MDI and squirt it into your mouth. When you do this you'll note most of the medicine impacts hard on the back of your throat. You can taste it strongly. Of course then it has to make a hard turn to get into your lungs.

Studies show even with proper use only 9 percent of the medicine reaches the air passages of your lungs. Thus, with improper use, you won't be getting much medicine at all.

It's evident: proper inhaler use is essential.

So, to get the most out of your MDI, you'll have to be aware of the following facts:

1. Prime the pump: According to, "Asthma for Dummies," by Dr. William E. Berger, "Loss of prime occurs when the inhaler's propellant evaporates or escapes from the metering chamber after days or weeks of non-use. If you haven't used an inhaler recently, waste a puff of medication (often less than a full dose) to be sure you're getting a full dose.

The MDI Albuterol should be primed after three days of nonuse. To see recommendations for priming other inhalers click here.

2. Tail off: Berger notes that many asthmatics try to squeeze every last drop out of an MDI. Studies show that after so many puffs all that's left in an MDI is propellant. Most MDIs have a counter so you know how many puffs are in a canister. Do not try to get more out of it.

3. Correct use: There's more than one way to properly use an MDI, yet the most effective way is to use a spacer (see below). Since many guys don't carry a spacer, experts recommend you shake the inhaler well, and place the inhaler one to two inches from your mouth before inhaling. These one to two inches help reduce upper airway impaction of medicine. For a more detailed instruction on correct MDI use, click here.

4. Spacers and holding chambers: To see a spacer, click here. However inconvenient and bulky, spacers have two major advantages: they improve coordination and reduce your risk for systemic side effects.

Large inhalent particles are trapped inside the spacer instead of sticking to your upper airway.

When you inhale, the spacer allows you to generate a smooth, laminar flow, which improves the amount of medicine that gets to the air passages of your lungs by up to 70 percent.

In fact, studies like this one prove proper use of an inhaler with a spacer is equally as effective as a nebulizer breathing treatment.

Likewise, due to less impaction in your mouth, your risk of side effects is greatly reduced. Follow this with a good rinse, and you'll reduce the risk of side effects even more.

Asthma experts note the exception here is adults who are having an acute exacerbation of asthma. In this case airflow may be so obstructed generating enough force to properly use the inhaler may pose a problem.

For children, on the other hand, an inhaler with spacer and mask is the most effective means of inhaling the medicine even during an acute attack. This is because other methods have been proven pretty ineffective with most children. I wrote about this more extensively here.

The latest craze in asthma treatment is dry powdered inhalers (DPI) like Advair. The neat thing about DPIs is they eliminate the need for spacers. The reason is because the medicine is inhaled by the force you create, and this eliminates any coordination problems

The problem with DPIs is they cost too much, and adequate distribution of the medicine is determined by the flow you create, so it's still important to be taught proper technique. (For a neat article on DPIs, click here)

Another problem with DPIs is each device is different, so for each one you may need to learn a different technique. To refresh yourself on the proper use of your DPI, check out this link.

Actually, while many newer meds are now available as DPIs, most research shows that MDIs used properly with a spacer work better than DPIs. (For a great post comparing the MDI with the DPI click here.)

So, for this reason, and because of the chemical composition of bronchodilators like Albuterol and xopenex, the MDI will not be available as a DPI anytime soon.

To learn how to properly use an inhaler with a spacer click here.

When I was a kid spacers were hard to come by, and my doctor recommended I use a used toilet paper roll as a spacer. I couldn't find a toilet paper roll recommended here online, but I did find this and, better yet, this. In nations where spacers are unavailable or expensive, these old ideas still work.

Still, while spacers work best, one study showed that fewer than 20 percent of asthmatics use them. Recently, my asthma blogging friends and I came up with some theories why this might be:

1. Grew up in the no spacer era (old habits die hard)
2. Carrying a spacer is inconvenient
3. Laziness
4. Never showed proper inhaler technique (do you have a good doctor?)
5. Don't know what a spacer is (I get this a lot where I work)
6. Don't know advantages of spacers
7. Spacers make being discreet with inhaler use impossible
8. Personal preference
9. Don't need 70 percent more medicine
10. It works just fine without a spacer
11. Can't afford one

I'll be honest. When I was a bronchodilatoraholic kid, I spent many nights running the inhaler under warm water trying to get the last drop out. I also cringed at the idea of wasting my holy Ventolin by priming it.

I think most asthmatics are like me, and use their spacer sometimes. We may use it at home, yet when we travel we use it as is. Not many people, I think, like to carry that bulky spacer around -- yet we all should.

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