How To Order Acapella (a.k.a. Crapapella)

What They Teach in RT School

Description & Indication:
The Acapella device is a medical tool designed to help loosen and remove thick, stubborn mucus from the airways. When a patient exhales into the mouthpiece, it generates vibrations that travel through the airways, helping to dislodge mucus. This device is commonly used for people with lung conditions such as cystic fibrosis, bronchiectasis, or COPD. It is particularly helpful for patients who struggle with coughing up phlegm or have difficulty clearing their airways.

How to order them? An RT will recommend one and give it to the patient if it's needed. 

What They Teach in Medical School

Description & Indication:
The Acapella device is a magical contraption that helps patients bring up secretions—whether they have secretions or not. Clear lung sounds? No problem! This device can apparently summon mucus from thin air. Need to "treat" someone who has absolutely no issue coughing? Perfect! The Acapella is your go-to device for solving problems that don’t exist.

How to order them? If you think of it order it. It can't hurt. Who cares about RTs complaining that they are overworked. 

The Link Between Anxiety and Asthma: What You Need to Know

Anxiety is a natural response to stress or challenging situations, but when it becomes overwhelming, it can negatively impact your health. For people with asthma, anxiety can further complicate management of the condition. Various studies have shown a connection between asthma and anxiety, with one potentially exacerbating the other. Understanding this relationship is crucial for effective asthma control. Here's what you need to know.

Anxiety and Asthma: The Statistics

A 2004 study found that approximately one-third of children with asthma also experience anxiety. Among adults with asthma, 6.4-24% reported having panic attacks (1, Katon). In comparison, the general population only sees about 1-4% of individuals with diagnosed panic disorders (2, Deshmukh). These statistics suggest that anxiety is more common in people with asthma than in the general population, highlighting the need for awareness and management of both conditions.

Theories Behind the Connection

Several theories help explain why asthma and anxiety may often occur together.

1. Dyspnea-Fear Theory
   One theory suggests that severe asthma attacks may trigger a heightened fear response to breathlessness, making individuals more likely to develop anxiety or panic attacks in response to various stimuli later in life. This "dyspnea-fear" cycle could lead to an ongoing pattern of anxiety (3, Ley).

Managing Anxiety for Better Asthma Control

If you have asthma and experience anxiety, addressing the anxiety may help improve your asthma control. Both conditions can be managed with the right approach. Here are a few key strategies:

• Therapy: Cognitive behavioral therapy (CBT) is often recommended to help manage anxiety. This can help break the cycle of fear and breathing difficulties.
• Breathing exercises: Learning how to control your breathing can be an effective tool for reducing both asthma and anxiety symptoms.
• Medication: Sometimes, medication may be necessary to manage either condition, so working closely with your healthcare provider is essential.

Conclusion

The connection between anxiety and asthma is clear, and addressing both conditions can lead to better overall health. By understanding the theories behind their relationship and seeking proper treatment, individuals with asthma and anxiety can gain greater control over their health and well-being.

References:

• Katon, W.J., et al. “The relationship of asthma and anxiety disorders.” Psychosomatic Medicine, 2004 May-Jun;66(3):349-355.
• Deshmukh, V., et al. “Anxiety, panic, and adult asthma: a cognitive behavioral perspective.” Respiratory Medicine, 2007 February, 101(2):194-202.
• Ley, R. “Respiration and Emotion.” Springer, 2001, pages 65-74.

New Study Shows Hypertonic Solution Cures Everything

Back in the 1970s, doctors frequently prescribed hypertonic saline (salt water) as a treatment. The idea was that the salty solution would draw water out of the airways, thinning mucus and making it easier to cough up. However, this theory was later disproved, and by the 1990s, hypertonic saline was largely phased out as an aerosolized treatment.

Fast forward to 2020, and a shift in medical thinking emerged: the longer the treatment, the better the potential outcome. This led to renewed interest in hypertonic saline, particularly for cases involving mucus plugging, often identified through X-rays or CT scans.

Common symptoms:  Excessive mucus production tied to conditions like asthma, COPD, or bronchiectasis—or sometimes, a vague “other” category when the cause isn’t entirely clear but the treatment is worth trying.

Frequency: Typically prescribed every six hours.

Effect: Designed to thin mucus by creating a hydrating, salt-infused "hurricane" in the airways. Even if no visible sputum is produced, the treatment is believed to work on a microscopic level.

Annoying CT Results? Maybe Pulmicort Can Save the Day!

Doctors are supposed to practice evidence-based medicine—prescribing treatments backed by solid research, clear indications, and measurable benefits. But what happens when they start making things up?

Take this case: a patient  who recently had a CT scan. The scan showed "a few tree-in-bud infiltrates, which could indicate infection, inflammation, or aspiration." according to the report. There were also no systemic signs of infection. 

The doctor wrote in his notes: "Will trial Pulmicort for this." He followed through and prescribed Pulmicort (budesonide) at 0.25 mg BID—a pediatric dose nonetheless.

The problem? Aside from the pediatric dose, the CT scan alone doesn’t justify ICS therapy. There aren’t any well-established studies supporting this approach. In fact, I doubt it has even been studied. In fact, I even used AI to try to find one, and AI came up empty. That says a lot.

So why did the doctor prescribe it anyway?

Possible Explanations (None of Them Good)

• Guesswork – The doctor doesn’t know what to do and is throwing an ICS at the problem, hoping for the best.
• Overtreatment Culture – Some doctors feel the need to “do something,” even when doing nothing is the better option.
• Misinterpretation of Evidence – The doctor may think ICS reduces inflammation in any lung condition, despite the lack of proof for this scenario.
• Covering Their Bases – Writing a prescription makes it look like they’re addressing the issue, even if there’s no clear benefit.

What the Science Actually Says

There’s no established research supporting the use of ICS in asymptomatic patients based solely on CT findings. Worse, unnecessary ICS use carries risks: increased susceptibility to pneumonia, and oral thrush.

The Bigger Issue: When Doctors Prescribe Without Evidence

This isn’t just about one bad prescription—it’s about a broader problem in medicine. When doctors ignore evidence-based guidelines and prescribe treatments without justification, it doesn’t necessarily undermine patient trust. Most patients don’t question what they’re given; they simply accept what the doctor orders.

The people who do question these decisions? Respiratory therapists like me—the ones actually administering the treatments. We see firsthand that these treatments are a waste of time and money. When there’s no clear benefit, no solid evidence, and no logical reason for a prescription, it’s frustrating to be the one carrying it out. Instead of blindly following orders, we should be asking the real question: Why are we doing this in the first place?

Medicine should be guided by science, not guesswork.

Final Thoughts

When doctors prescribe treatments without solid evidence, they’re not helping patients—they’re relying on assumptions. That’s a problem.

Meanwhile, the doctor might feel good about “doing something.”
But to me, it’s just another pointless task.

And for the patient?
It’s one more unnecessary treatment.

Sadly, there's a lot of this type of waste in healthcare. 

Your Thoughts: What do you think is the most interesting aspect of being an RT?

A while back, I conducted a highly scientific survey. I asked readers to email me (you can find the link in the right column if you want to chime in!) with their answers to this pressing question:

"What do you think is the most interesting aspect of being a respiratory therapist? Sarcasm welcome."

Now, I’ll admit—this wasn’t exactly a formal study. Let’s just say the results are more qualitative than quantitative. But hey, why let facts get in the way of a good blog post?

What follows is a collection of insights, anecdotes, and observations that definitely aren’t my own sarcastic takes on the job. Nope, totally not mine. These are purely the thoughts of my loyal readers—who, for all I know, could also be my bosses.

1. We could write off nearly all breathing treatments and not one discharge would be impacted. 
2. I find it interesting how so many doctors and nurses think an asthma medicine will cure all annoying lung sounds and ailments.
3. All wheezes are to be considered bronchosasm -- according to most doctors -- and treated as such.
4. No study needed: If it sounds good just order it -- who cares if it really works. 
5. Why is it that in the hospital setting all we do is nebulizers. Why can't we ever do inhalers? And then when preventative inhalers are ordered, doctors still order Q4 nebulizers of the same medicine. Huh?
6. Most of what we do is a waste of time or delays time (This is an actual quote from a wise respiratory therapist I will not name who used to work for the AARC). 
7. Nothing like treating post-op atelectasis with yet another nebulizer. Because obviously, albuterol is magical and can heal incisions, fix pain, and force patients to deep-breathe. Who needs incentive spirometers when we have bronchodilators?
8. Q-forever. You can dc it via protocol if you deem it as useless. But the doctor will just re-order it. So why have protocols in the first place? 

So, there you have it—a not-so-scientific collection of observations, gripes, and sarcastic takes from some of you. As respiratory therapists, we see the absurdities of the job every day, and sometimes, all we can do is laugh (or sigh heavily into our masks). If you’ve got your own stories, insights, or sarcastic gems to share, I’d love to hear them! Drop me an email—there’s a handy link in the right column of this blog. Who knows? Your wit and wisdom might just inspire the next round of this "survey."

Navigating life around flare-ups can certainly be done

My Gymnast.

When you have asthma, sometimes you have to do things a little differently than other people. That’s just how it is. You learn to adapt, make adjustments, and—most importantly—listen to your body. Some days, that means skipping out on fun. Other days, it means letting your girlfriend scrape her own windshield in the middle of a snowstorm.

Two days ago, it was a beautiful 70 degrees. After a long winter, it was nice to see people outside again. Moms and dads were out with their kids—yelling, laughing, bouncing basketballs, jumping on trampolines. People walked their dogs, chatting as they strolled through the neighborhood. Even my kids and I were outside, tossing a baseball back and forth. From the outside, I probably looked like a normal dad, enjoying the fresh air with his kids. But inside, I felt it—that tightness in my chest, the ever-present urge to cough. It sat deep in my lungs, a reminder that even on the best days, my asthma was always there. It as on this day I decided to start my 5 day course of 40 mg of steroids. 

 

Yesterday was just as nice as the day before, but I spent most of it inside. My daughter, Laney, had a Girl Scouts meeting in Muskegon, so we drove the hour and I dropped her off early in the morning. Then, I had to sit through a parent meeting. It was informative—I learned about her upcoming trip to the island for a Girl Scout event in July—but after about 30 minutes, they opened the floor to questions. And, of course, the unnecessary questions started, stretching the meeting to an hour.

Finally, I escaped and met my girlfriend for lunch. The Girl Scout meeting was in Muskegon, an hour from Shoreline, so after lunch, we found a nice spot on the beach to hang out for a few hours. Despite the warm weather, the lakefront was cooler, with high waves crashing on the shore. We walked to a bench overlooking the water but found it too windy and cold to sit. Instead, we opted to stay in the car, playing the day’s episode of The Bible in a Year with Fr. Mike Schmitz.

My asthma had been acting up for weeks, making it difficult to play catch with Laney the day before, and nearly impossible to work out. So, in a way, being stuck in meetings and sitting in a car all day was probably good for me. If I had been home, I’d have found something to do—like cleaning the garage—something my lungs wouldn’t have appreciated.

By 3 p.m., we left the beach to pick up Laney and drop her off at gymnastics. Meets take time, and while it's fun to see the girls' progress, after two hours on a hard bench—with two more to go—it gets tough. Eventually, I stepped outside to take a break, only to find that my car battery had died.

I went back inside, now short of breath and struggling to talk. Years of dealing with severe asthma as a child made me good at pretending I was fine, but my girlfriend saw through it right away. She told me to sit and take it easy, but I was determined to fix my car. She moved her car next to mine while I set up the jumper cables, and we got it started. Being from a big city, she was cautious about leaving a running car unattended. I, on the other hand, was less concerned, but she stayed outside in her car just to be safe while I went back in for the awards ceremony. What a good person she is. 

Once it wrapped up, Laney and I headed home. Jean drove in her own car, being that Muskegon was our half way point -- she lives in Grand Rapids. We stopped at Subway for dinner, where she noted, “It’s been 12 hours since I ate.” And I thought this was an odd comment, because she did pack a lunch. And she also said earlier that she had donut. 

And then, because this is Michigan, a snowstorm hit the next day. We went from almost no snow to at least 2–3 feet overnight. My girlfriend joined us for church, then we spent the day playing games with the kids and making burritos. Later, we sat on the couch by the large picture window, watching the snow fall hard. It kept coming down the whole time, blanketing everything outside.

When it was time for her to leave, I walked her to her car in my shorts, grateful that my asthma was finally improving after three days on steroids. Still, I knew I had to take it easy to avoid another flare-up. She started her car but didn’t let it warm up long enough to clear the ice from the windows. Grabbing a scraper, she handled it herself.

I noticed my neighbor Dave watching from across the street. I imagined he thought I was a terrible boyfriend for letting her scrape her own windows in the snow. But the truth is, people usually aren’t judging us as much as we think. And even if he was, I knew there was a good reason I wasn’t out there helping—sometimes, when you have a chronic illness, you have to make adjustments to protect your health.

Today is Monday, and my lungs feel so much better. In a few hours, I’ll put them to the test—I plan to clean and organize my basement to make room for a new weight bench arriving soon. My goal this spring and summer is to lose weight and get in shape, which should help my lungs too.

Fit testing time again, and again, and again...

Ah, fit testing season is upon us once again—the annual ritual where we confirm that the mask we’ve been wearing all year still fits. Because, of course, logic demands it. Nothing says "efficiency" like repeating a test for something you already know the answer to. Bureaucracy at its finest!

This tradition is brought to you by none other than OSHA—the overlords of occupational safety—and their local enforcers, MIOSHA. These fine folks ensure that anyone donning an N95 mask to fend off airborne germs is officially deemed fit to do so. And not just once, mind you. No, we must endure this spectacle every single year. Why? Because... well, because.

Seriously, didn’t we just do this? Oh wait, that was last year. And now it’s time again, because seven people sitting in ridiculously expensive leather chairs needed to justify their existence. So, they came up with a rule: Annual fit testing! That way, when they visit our hospital, they have something to check off their clipboard.

But let’s not forget the hidden genius of this policy: It doubles as a convenient way for the hospital to deal with "that guy." You know the one—the person nobody likes but HR hasn’t found a good excuse to fire. Skip your fit test this year? Boom. You’re fired. Thanks for playing.

Now, let’s talk about logic. The only time fit testing should be necessary is when something significant changes—like if you’ve gained or lost a lot of weight or decided to embrace your inner lumberjack and grow a full beard. But apparently, common sense isn’t part of the rulebook. Instead, we’re stuck in a cycle of pointless repetition, because doing things the logical way would be far too convenient.

So here we are, dutifully squeezing into masks we’ve already proven fit us perfectly, all for the sake of compliance. Not like we have enough to do already... right?