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.

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:

• 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

exercise-induced asthma, you use it just prior to exercising as a preventative measure.

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.).

(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
asthma symptoms or if you are feeling good.

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:

"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)."

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.

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, I spared you a 607-page read. The bottom line here is that asthma awareness is an important first step to taking care of this disease. And with proper care, those with asthma can lead an active, healthy life.
There you have it. We are all caught up. I will continue to update you each Monday on my latest posting at MyAsthmaCentral.com.