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Monday, May 18, 2009

Asthma blog update

I would like to take this opportunity to update my readers on Asthma writings I from over at my 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

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

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.

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
    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

    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

    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, 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.

    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 and 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


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