How do you define smart? Idealism -vs- realism

William F. Buckley Jr. once wrote a piece for Playboy -- I actually have never read Playboy -- and the title of the piece, it was brilliant. The title was: "How Do You Define Smart?"

I never read Playboy. Honest -- I never did.

I learned about this article through various other media outlets I read. You know, the one's that warp my mind. Actually, nothing I read ever warps my mind because I'm a free thinker. I believe as long as one is a free thinker nothing and no one can warp him or her.

So I think the question Buckley posed in this playboy article was a brilliant question. The answer to it, though, is multifaceted.

When I was a kid I always thought of my grandpa as smart. I say this knowing my grandpa quit high school despite his principal telling him he'd never amount to anything if he quit. He ended up starting an auto dealership from the ground up, and this ultimately became a Chrysler dealership in Shoreline.

Whenever I had a question he always had the answer. Yet there are old people in Washington and Lord knows many of them sure aren't smart.

So do we become smarter when we become educated? Well, Lord knows there are graduates of Harvard in Washington, and there are tons of ignorant politicians making laws who have no clue what they are doing.

We have many doctors who are definitely educated who don't have a clue what a bronchodilator is supposed to do, and they order bronchodilators for anything that causes a wheeze and treat any person who's short of breath as though they had asthma. And there are doctors who think a 1,000 tidal volume is appropriate for a 5 foot lady just because she's 550 pounds.

So there are lots of doctors who are not smart.

So what is smart?

Here you have a lifelong asthmatic who abused his inhalers because his asthma wasn't controlled, and yet all the other asthmatics he knew were gaining control of theirs. Then one day he woke up and thought, "Hey! Take your medicine, stupid!"

Yet, how can a blogger who has gotten every thing wrong for so long, be called smart. How can someone who did everything wrong in every way, shape, manner, or form be called smart? How does that compute? He's educated; he can string a couple sentences together; proper syntax. What the hell is smart? Why would someone read his blog.

This has always been something that has bugged me. Common sense is smart. Education does not mean you're smart. In fact, education, depending on where you get it, can corrupt you.

There are idiots with degrees all over Washington, DC. There are idiot doctors prescribing medicine and running ventilators. So how do you define smart?

Either way, I don't think it takes a smart person to make a smart decision. All you need are the facts on your side. Yet sometimes talking to people who think they are right yet they are wrong can be frustrating.

Let me explain my situation to you this way by asking you a question. Have you ever been in a situation, you're arguing or not even arguing, you're just discussing things with a group of people, and you know you're right, and you know you can prove it, and it doesn't matter to them.

And the reason that you know you're right is that you know things they don't know. And because they don't even have that baseline of knowledge to chat with you, they can't even understand where you're coming from. They get mad and walk away. Or, better yet, they laugh and mock at you and tell you that you are being ridiculous.

They'll say things like, "Well, that breathing treatment is toooooo doing that pneumonia patient some good. It dilates his lungs so he can cough up that pneumonia."

Yet you know that not only is the 0.5 micron particle size of Albuterol too large to get to the 0.1-2 micron sized alveolar sacs, there are no beta receptors in the Alveoli for the Albuterol to attach to. And even if there were, there are no bronchial muscles in the alveoli, to dilate, so the medicine will have no effect. Likewise, it's not an anti-inflammatory.

Yet your wisdom doesn't matter. You are the unruly one. You're the one who is being lazy and trying to get out of work. You're the grumpy one. Your the one who is out of his or her league. You're the one who's inappropriate. You're the one who's going to be written up if you take your stupid facts too far.

Have you ever been in a situation like that? You can go into politics here too. There are people who have a political position, and then you come into the discussion and say, "Hey! Wait a minute! If you consider this fact, what you guys are saying is poppycock!"

In fact, if I remember right, Socrates was sentenced to death for this exact reason. He questioned authority. He would walk up to successful business men and question them about how to succeed in business, and he'd get some very useful wisdom. Then he'd ask the businessman about how to make, say, horse shoes. The person would talk as though he knew what he was talking about, as though he were an expert in that area too, when Socrates knew he was not an expert in horse shoes. The businessman, in essence, was pretending to know everything, when in fact he was ignorant in nearly every area except running a business.

So, for questioning authority, for encouraging people to think, and to admit they did not know what they did not know, he was sentenced to drink a poison that killed him. Although, Socrates went down in infamy by his dying.

Anyway, they make you feel like an outcast. And that's how I feel every time a doctor orders a stupid breathing treatment and a nurse defends it. I feel like an outcast. I am the one with the facts, I'm being smart here, and yet I'm the outcast because, to the doctor, it "feels" good to order a bronchodilator. It' doesn't matter that it's doing any good, it just feels good to give it.

These bronchodilator-is-a-cure for-everything crowd are the idealists. People like me with the facts on our side are the realists. There is no science to back up their ideology. We know it's fake science. We know it's a fallacy. Yet these people have educations and degrees in the sense they are great nurses and doctors, yet they continue to fall for this crap.

Yet I've been an RT for 14 years. I know these people like the backs of their hands. I know exactly what they are going to say when I confront them even before I say it -- even before they speak.

Yet I'm always the dummy in their eyes. I'm behind the times. I'm "behind on my research," as one doctor recently told me.

I even make jokes about what they'll do on my blog and the jokes come true.

The only way to understand what's going on here is to understand the difference between different ideologies. You have idealism and realism. Education, years on this planet, experience, has nothing to do with how people think. I think it has more to do with idealism and realism.

Idealists don't like it when you come up to them and are truthful. They say that when you do that you are confrontational. You are causing confrontation. Yet, if you don't, you are being an enabler. I think way too many of us RTs are enablers: we enable doctors and nurses to get away with their false theories about bronchodilators. And all these nurses and doctors think that they're really smarter than everybody else by not having firm opinions on things.

I'm open-minded, I study both sides of the issue, and then I make an informed decision. If that's you, you are one of the biggest dupes, because you are sitting around judging both sides while one of them is lying through their teeth with everything they say to you.

The bronchodilator idealists will say they have the truth on their side, and yet when you tell them to "prove it!" they get all upset and start to quiver in their pants. They do this because they know there is no proof to what they are proposing. There is the history of stupid bronchodilator orders that's for sure, but there is no evidence to back it up the reason for all these orders. You'll even see insurance companies allowing breathing treatments to meet admission criteria because some doctor said this is what will help them get better quicker, but there is no real proof to back up that bronchodilators do any good for anything other than (ahem) bronchospasm.

Bronchodilators are but a small thing and a safe thing thankfully. Yet when you challenge these idealists on their political views, that's when it gets real interesting. Yet when you consider the cost of all the needless bronchodilators given daily, and the costs of employing RTs to dole them out, you'll realize how deep, complicated, and puzzling this really gets.

So I have to consider these things very seriously, the nature of the evidence, the seriousness of the charge that bronchodilators cure everything from rickets to pneumonia, these people are saying we really are saving the planet with Albuterol and so forth. (To get off topic for a minute, I recently read a book written in 1913 about asthma that spent 24 pages trying to prove Rickets was the cause of asthma. He also tried to prove via 24 more pages that asthma was a disease of toxicity, and it was related to urine. He was wrong, but the same principle applies: idealism versus realism).

Many people look at people like me and you as being realists. And they link realism with being judgemental -- which is true. If that's the case, I am more than happy to judge.

So, to come full circle: what is smart? Well, I'm going to tell you. Anyone with an average brain
can see idealism. We know what it is doing to the planet. We know what it is doing to the health care industry. We know what it is doing to the economy with it's regulations and taxes and government programs to create their ideal world.

We know what it is doing to the lungs (Well, nothing if you consider bronchodilators for pneumonia and CHF and rheumatoid arthritis and rickets.)

All you have to do is look at Detroit and California to see where idealism will take you. All you have to do is look at all the failing nations. Look at the old Soviet Union. Look at Cuba. Look at France for crying out loud. France is about to go bankrupt because idealists have been running it for years, if it isn't bankrupt already. Creditors have recently decided France bonds are junk bonds, and no one will loan that country any more money because it has no credibility. Sure idealists have good intentions, but good intentions and sound economics don't always jibe.

All you have to do is look at what is going on in Washington. All you have to do is look at all the people who are scared because the people in Washington want us to be scared. All you have to do is look at your own emergency room at all the people who really don't need to be there, who are complaining because you aren't taking care of them in a timely manner.

That's where idealism has taken us. That's what happens when we all become sheep and never think and never question and never judge. Everywhere idealism has taken you you'll see real disaster.

Don't these idealists understand that it might sound good to give out free health care, but all this free health care has done is make health care more unaffordable, as when you increase demand (more patients) and the supply stays the same (same # of nurses and doctors) the price goes up. Since Medicare and Medicaid have been started, all that's happened to the price of medicine is it's gone up and up and up. Heck, now we have federalized medicine, so one should expect this to get even worse. Although, they'll say, it was done with "good intentions."

Bronchodilator abuse may be a small piece of the pie, but it's a perfect example of what is wrong with our health care system. And even while you have 24 million or so who have no health insurance who really want it, we're going to screw up the whole system for all those who have it and are happy. That's idealism. It's all with the intent of creating equality for everyone, but it results in inequality. Unless you consider that everyone with a lung problem gets a bronchodilator regardless of need and regardless of cost.

I think, if we were real smart as a nation, we'd listen to the people like you and me at the bottom of the ladder, the people who actually see what is going on, the people with average brains and average educations, to get ideas for real reform.

I know I'm right because I know who these idealists are. They will not look at it ideologically and the only way they're going to be able to solve our problems is if he asks, "What are we doing here?" The numbers don't make sense. It's a total waste of time here. I don't see the point in doing all this if the numbers are so far off. Is this really science that we're dealing with?" Because if they asked these questions, they'd realize how humorous all their bronchodilator fallacies are. They'd realize our U.S. health care system really is the best in the world as is (or as it was).

Yet they won't ask these questions. They'll continue to believe in their idealist theories and they will continue to bog down the medical system with waste. I know, because I know these people like the backs of my hands.

A scientists should not take the idealistic route because that would pollute science. Yet we see that all the time too. Look at the global warming scandal for one example. I'm neither a believer nor a disbeliever in the global warming theory, yet you have those who support it -- even scientists, willing to do anything to show it is real -- even lie and twist facts. If global warming is real, let the facts and stats speak. So you can see why it's so easy for politicians, scientists, doctors, nurses and even RTs to become rapt in idealism.

But I'm just telling you, folks, the only way to understand this with certitude, with confidence, and then to be able to explain it to others is to understand what being a realist means, and what being an idealist means. Once you understand that it is so easy, because all you have to know is
that everything idealists say -- I know this sounds extreme -- everything they say is a lie. That's basically it. Once you come to accept that, then rest is easy.

Idealists will tell you world peace is possible, while idealists know it's not. Realists believe if we get rid of all our nuclear weapons all the bad guys will all of a sudden go away and the world will be at peace. A realist will look into the past and see that there was war way before nuclear weapons were discovered. Realists know there will always be some scum ready to take advantage of the good guy who is not prepared, which is what would happen if the U.S. ever truly disarmed.

Idealists will tell you that if you raise taxes high enough you will be able to afford enough government programs to help all the needy and to get rid of all the poor. I know this because I've seen the studies, and I've asked questions of them. They really believe some day world poverty will end if we stick to idealist programs. Yet, the realist will know from historical fact that increased taxes raise more money up front, but in the long run revenue will go down, and the country won't be able to afford all the programs. That's what's going on in the U.S. right now.

Idealists will tell you bronchodilators work for all that wheezes, or for all annoying lung sounds, or for all lung diseases. The realist at the bedside giving the treatment sees the truth, that the treatment did nothing.

Once you know that everything doctors and nurses who think bronchodilators cure everything is a lie, the rest is easy. It's easy to understand. You might not want to accept that, might be too tough. "Oh, my gosh, I don't want to think half the doctors and nurses are lying." Well, think about it, they're either lying, or they are simply flat out ignorant. Those are the only options.

Ignorance is not a bad thing. I'm ignorant about what nurses do, and I don't try to do their job. Doctors know much more about how to fix patients. Yet, when it comes to bronchodilators, no one knows more than the realist RT at the bedside who mumbles under his breath, "I'm just wasting my time giving this treatment." And, in the next breath, is defending the doctor's stupid order because he wants to keep his job.

Believe it or not, despite what I just wrote, respiratory therapy is a great career. The nursing program has advanced brilliantly over the years, and the challenge now before us RTs is to advance the RT program forward, which will not happen if idealism continues. Yet it won't happen either if we RTs continue to be enablers, and no one stands up and, in a professional manner, works to make the needed changes. To me this kind of challenge is fun, because I know the facts are on my side. Yet, at the same time, vexing, frustrating, and even daunting.

We gotta face it, folks, because this is, as they say in football training camp, nut-cracking time.

Restless Leg Syndrome

As we RTs are doing our rounds we occasionally see a patient with restless leg syndrome. When we do we now know there is a 50% chance that person has coronary artery disease (as I wrote about here). Still, we wonder what is this strange disease.

Basically, according to the Mayo Clinic, Restless leg syndrome (RLS) is a genetic disorder that causes the patient to feel leg discomfort while sitting or lying down, and temporary relief can be found by getting up and walking around.

The discomfort is often noted as "unpleasant sensations in their calves, thighs, feet or arms."

The Mayo clinic notes there is no known cause for RLS, although "researchers suspect the condition may be due to an imbalance of dopamine (a chemical found in the brain that sends messages to control muscle movements)."

This disorder can start at an early age, get progressively worse with age, and make sleeping and traveling difficult.

The Mayo clinic notes the disease is not particularly linked to other diseases, although is occasionally linked to:

• Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.


• Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.


• Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS.

While this is not noted by the Mayo Clinic, many studies (like this one) link RLS to coronary artery disease. In fact, it has been noted that those with RLS may be at twice the risk as those without the disease.

Doctors suspect RLS may cause cardiovascular complications due to spikes in blood pressure during symptoms of RLS. When this occurs on a daily and nightly basis, the risk of coronary artery disease is at its highest.

However, this study is only preliminary, and further tests will be needed to confirm its findings.

Emotional state

So how do you describe the emotional state of your patients. Here is a guide:

Emotional State:

1. Anxiety/ nervousness: watching every movement; asthma, respiratory failure, hypoxia
2. Depressed: quiet, denial
3. Anger/ combative/ irritable: electrolyte imbalance
4. Euphoria: drugs, OD
5. Panic: hypoxia, tension pneumothorax, status asthmaticus.

For a printable cheat sheet with this information and more, click here.

What is normal peak flow rate?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: what is a normal peak expiratory flow rate on a 46 year old male who is 6 feet tall?

My Humble Answer: Check out this calculator. This is basically your predicted normal peak flow or peak expiratory flow rate(PEFR).

This is the normal for a person of your age and height. However, it may not be YOUR normal. The best way to determine your normal peak flow -- better known as your PERSONAL BEST PEAK FLOW -- is to blow in your peak flow meter every morning and every evening. Whatever is the highest peak flow you blew is considered your Personal best. That is what you use to monitor your asthma.

Your Question: What isi a normal peak flow reading for an adult? I blow into it every day, but I don't know what is normal.

My Humble Answer: Actually, what is normal is dependent on you. What you'll want to do is blow in your peak flow every day for two weeks when you're feeling well, and whatever your highest peak flow is, that is your personal best. That is what you should base your peak flows on.

For more information on this, click here.

That said, you can see how your peak flow measures up against other people your age and height by clicking here.

If you have any further questions email me, or Visit MyAsthmaCentral.com's" Q&A section.

How to know YOU're being a good asthma patient

Part of being a good asthma patient, and gaining control of your asthma, is to maintain a good relationship with your doctor. A few weeks ago I wrote about how to know if your doctor is keeping up on his end of the bargain (click here). In this post, I describe how YOU can keep up on your end of the bargain.

You and Your Asthma Doctor Must Be An Asthma Control Team

By Rick Frea, April 21, 2010 @ MyAsthmaCentral.com

Most asthma experts and guidelines recommend the best way to gain control of your asthma is to create a partnership with your asthma doctor. That's right, YOU need to work WITH your asthma doctor.

Modern research has proven that the more you're doctor is in tune with you the better controlled your asthma will be.

I recently had a patient say to me, "Every time my doctor leaves the room I feel I have twice as many questions as when he came in."

Later, after he finished his breathing treatment, he said, "I don't even know why I'm getting treatments, they don't do me any good."

While I was searching my brain for a good response, he said, "Well, I guess my doctor ordered 'em, so I must need 'em."

I said, "You're paying him to take care of you. YOU are the boss, not the other way around. You should work WITH your doctor to control your asthma, not for him."

"Oh," he said, "I never thought of it that way."

I used to be the same way with my doctor. It's easy just to "assume" he knows all, and to take it for granted he's doing a good job. But is he really?

To help your doctor be the best asthma doctor he can be, the National Heart, lung and Blood Institute set recommendations for your asthma doctor to follow in it's Asthma Guidelines. I wrote about this here.

A doctor shouldn't simply enter your room, assess you in a rush, check you over and be gone in a flash, leaving you with more questions than when he came. If this describes your doctor, perhaps it's time to seek a new one.

A Gallant asthma doctor should anticipate your needs, answer all your questions, and work with you in deciding what needs to be done to control your asthma.

While you'll want your doctor to live up to his end of the bargain, you need to do the same. You need to keep up on your asthma wisdom too (which you're doing by hanging out here on this site).

Likewise, you'll need to be a Gallant Asthmatic.

• Take your meds as prescribed
• Use a spacer with your rescue inhaler
• Use your peak flow meter daily to monitor your asthma, and record the results in your asthma journal.
• Know your personal signs and symptoms of asthma.
• Know your asthma triggers and how to avoid them.
• Follow your asthma action plan to a T.
• Keep an asthma journal (a simple notebook will do) and bring it to your doctor's appointments. It's hard to remember how your asthma was doing two to three weeks ago, so this can help you and your doctor manage your asthma long-term. (click here for an example journal).
• Show up to your appointments on time and with questions.
• Never leave an appointment with questions unanswered.

Instead of your doctor just "assuming" your asthma is controlled, he can look at your asthma journal to get a true assessment of how well controlled your asthma has been since your last appointment.

You'll need to work with him to learn what your asthma triggers are. He may recommend allergy testing, and you'll have to be vigilant to what else triggers your asthma (such as cigarette smoke or strong perfume) and learn to avoid those things.

You'll need to work with him to create an asthma action plan, and together you can make adjustments based on your description of how well your asthma is controlled, and your asthma journal.

You'll need to work with him to determine the best treatment plan. If your asthma remains uncontrolled, he may recommend new meds to try, and so can you based on your own research.

Yet only through your efforts, by being observant, and by keeping up on your asthma journal, will your doctor get a true and reliable picture of how the current course of treatment is working.

So, you can see, it's important you and your doctor work together, as an asthma control team, to get your asthma under the best control possible.

Respiratory Therapy Humor

When you work in the medical field you either have a sense of humor or you lose your sanity. Sure we have the stressful job of saving lives, and the best way of lightening the tension is with a little fun and games, and humor

Humor is also a release for all the stupid doctors orders we have to deal with.  Yes, sometimes we can be a little off the wall, and sometimes even morbid.  Yet it's all in good fun.  .

For more Respiratory Therapy Humor click right here.

Ventolin linked to EKGs

A patient who came in with palpitations had low voltage on his EKG, which historically is indicative of either COPD or obesity. However, due to low voltage, the ER physician ordered that a repeat EKG be given. The RT student inquired of the doctor why a second EKG was indicated, and the doctor looked at him funny.

The student later inqured his fellow RTs regarding this manner, and the following is the response he got:

"Another indication for low voltage on the EKG is because you're thinking too much. If you think too much your brain requires extra voltage to continue functioning, and therefore the brain has to draw some of the conductivity off of the hearts charge. One of the side effects of this is cardiac arrhythmias. The course of this process is non-continuous, and repeat EKGs are indicated.  To resolve this problem the physician will want to order 0.5cc stopthinkolin. Exact methodology unknown."

Perhaps this is the reason small town RT departments ended up with EKGs as a procedure. We may never know.

The Ventolin-types list has been updated. Click here for more.

Neil Cavuto chooses to enjoy life, despite illnessess

I so happened to be in a patent's room tonight and Neil Cavuto was giving his daily "common sense" editorial. Jack Kevorkian had been on his show he evening before, and told Cavuto life sucks, and Cavuto basically has no clue about what it's like to suffer.

"Just once," Cavuto said, "I'm going to do this just once." He was referring to himself: he wanted to respond to what Kevorkian said by talking about himself, and that he does know what it's like to suffer.

What he said thereafter was very interesting to me, especially considering I work with people who don't such good fortune, and yet find a way of enjoying life regardless.

Here's what Cavuto said on his April 22, 2010, show's common sense editorial, "I don't know Jack":

"I know everyone's focused on how Jack Kevorkian helped so many die, but I was much more interested in why he was so down on living.

"He said it was tedious and empty — often painful and lonely. And then, the not-so-good-outlook doctor said, it was over. Hard to be happy, Kevorkian told me, when so much in life is not; especially for those dealing with illness and pain.

"I strongly disagreed. I said life is not miserable; that I wasn't remotely miserable.

"He just smiled; Jack all but saying I didn't know jack. That I couldn't know, I wouldn't know. Easy for me to smile, he said, when I have so much for which to smile.
"Some of you agreed:

"Kevin Myler, New York City: "Listen to Dr. Death, Mr. Good Life. Get out of your perfect world and feel some pain. It'd do you good not to feel so good."

"Sarah Emerling, Boston: "I like you, Neil, but Dr. Kevorkian is right. You have lived a sheltered life. Walk in my shoes before you start lecturing anyone on skipping in theirs."

"Larry Mahan, Lebanon, Missouri: "Neil, you are a young man, I'm sure have a nice family… everything is good. I am now 60… I have two herniated discs, pinched sciatic nerve… renal cell carcinoma… borderline emphysemic now too… you will just have to be there someday… no way can you understand…"

"You're wrong, Larry. And Sarah, and Kevin. And you too, Dr. Kevorkian.

"You're all wrong saying your woes define your life and your attitude about life. And you're wrong assuming mine is a sheltered life, unaware of your pain and unsympathetic to those in pain.

"I am not here to win your sympathy; just this once — and I promise, just this once — your attention. I know pain better than you think and illness better than you know. It's public record, but for the record, let me be clear and go on the record. Again, just this once.

"I have multiple sclerosis; a pretty tough neurological disease for which there's no cure. And I got it only a few years after beating back a pretty serious cancer for which it once looked there might not be a cure.

"Again, I'm not trying to win points, just make this point: Illness doesn't define who I am or how I feel. It's shaken my life, but it hasn't sapped one iota of my enthusiasm for life.

"Sure, there are many days I wish my voice could be stronger, my legs sturdier, and my eyesight clearer, but I can't count on these things. Only that living is worth dealing with all of these things.

"Jack is right: I don't know jack about misery, but that's only because I choose not to be miserable."

I think this is similar to something I wrote about having asthma, as you can read here.

And, believe it or not, I received emails noting to me the following, "How could you be so stupid to find so many good things about a disease such as asthma."

The answer is similar to Cavuto's, in that I "choose" to find something good even in those things which I don't particularly want. Life is what you choose it to be, and I choose to enjoy it regardless.

I think most people are this way, and not so pessimistic as Jack is.

Setting up vent on pediatric

Guidelines for Set-up of Servo for Pediatrics:

1. Pt Range: Pediatric (if ideal VT greater than 40cc or less than 400cc)
2. Mode: PC if less than 10kg, otherwise PRVC
3. VT: 5-7 cc/kg post-term to 14 YO
4. PIP: Not greater than 30
5. PEEP: Start 4 – 5 CWP
6. FiO2: 5 – 10% above pre-intubation adjust to maintain desired SpO2.
7. Rate: Normal for age
8. I-time: a. Maintain I:E of 1:2
9. I-Rise time: As appropriate for patient to create pseudo sign wave.
10. PIP limit: 2-3 greater than PIP (other alarms as appropriate)

For a printable cheat sheet with this information and more, click here.

For a cheatsheet on setting up ventilator for neonates, click here.

What effect does theophylline have on fetus?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: What are the effects of Theophylline on the fetus?

As you can see here and here , this is a topic that has been investigated quite extensively. The general consensus of most asthma experts is that good asthma control is essential, and whatever asthma meds are needed to maintain control is the focus. I think most studies show there is a minimal risk of side effects with most asthma meds on the fetus, like less than 2%. However, if a fetus isn't getting any oxygen due to poor asthma control, this can cause problems for the fetus too. So, asthma control is essential.

That said, you want specifics on theophylline. Check out this link and this link . Or, better yet, this article noted the following: "When given to pregnant mice, theophylline caused cleft palate and finger or toe birth defects. Theophylline also caused small jaws, small or short limbs, and miscarriages."

If you have any further questions email me, or Visit MyAsthmaCentral.com's" Q&A section

What happens if you stop using Advair?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: What happen when I stop using Advair for a while & then using it again as needed?

My humble answer: Advair is a preventative medicine that takes 2-3 weeks to get into your system. The steroid in it (Flovent) treats and reduces inflammation so your lungs are stronger and better able to deal with your asthma triggers. The long acting bronchodilator (Serevent) in it treats and prevents bronchospasm. When you stop taking these, not only is your asthma more likely to flare up when you're exposed to your asthma triggers, you're flare-ups are are more likely to be more severe. Therefore it is recommended by asthma experts that if you're using Advair to control asthma, that you stay on it especially when you are feeling well.

If you have any further questions email me, or Visit MyAsthmaCentral.com's" Q&A section

The natural order of mistakes

When a patient goes into respiratory failure, or cardiac failure, or both, this presents a stressful moment for the medical workers taking care of the patient. Basically, if nothing was done the patient would die, and therefore without our intervention the patient would die.

This provides many of us with an adrenaline rush. During these stressful moments even the best trained mind can fail to work adequately. I've seen the best of the best RTs bag with the mask upside down. I saw a doctor forget to order Epinephrine. I've seen nurses who never miss IVs miss up and down the arm, with blood spattering everywhere. I've seen nurses and lab technicians get overanxious and forget to cap a contaminated needle, and poke someone with it. I've seen an RT set up a vent and yet forget to turn it on. I've seen the medical workers so focused on what to do next that I had to yell, "Um, someone better get on the chest and do CPR!"

Once I was bagging the same time I was holding the mask over a patients face, and the patient was getting good chest movement. The doctor decided to take the mask from me and she squeezed the mask so tight over the patient's face he wasn't able to get any air in. I tried to explain this to the doctor, but he said, "This is what they say to do in ACLS!" Well, ACLS also recommends common sense and constructive intervention. Thankfully that doctor who was obviously acting on adrenaline found something else to do.

You see, we prepare for this all the time, and yet when it comes you have to realize we are only humans. Some of the time our experience and education saves the life of the patient, and other times the patient does not make it. Still, there are many times that no matter what we did the patient would have died.

Yes, it is true, there are moments in the emergency room, especially when the patient is someone you know, or a kid, where the tension is so high you can feel it as something palpable in the air we breath in. You can smell it. You can even hear it. Yet, still, we are trained over and over again as to do what we do, so during these tense moments our bodies naturally do what is right.

Still, we are, after all, humans. And that is why after watching someone do something stupid, I usually take it with a grain of salt. Usually something stupid was something so minor it made no difference to the outcome of the patient whatsoever. For instance, recently I assisted with an intubation, and it took me 10 seconds instead of the two seconds the doctor expected to inflate the cuff on the ETT following the intubation. What I did had absolutely no impact whatsoever on the patient outcome. Yet, Instead of being understanding and appropriate, the doctor was condescending and inappropriate.

I was called stat to OB to be on standby for a 34 week gestation baby. As soon as I arrived in the delivery room the baby was delivered by the nurse. It appeared to me the nurse did everything appropriate, yet later, after the doctor arrived, the nurse was scolded. He said, referring to her delivering the baby, "That was a rookie mistake that will never be repeated again." I saw the whole thing. If she had not delivered the baby, it would have probably flopped on the floor.

One thing that I learned by the first RT to orientate me before I worked at Shoreline was that every other person at a code, or at the birth of a bad baby, will be stressed and the adrenaline will be flowing. She said that if any person is calm and level headed it should be you the RT. Make sure you know your stuff right side up and upside down, and know as much about what the nurse should be doing too so you can offer level headed advice and suggestions during the process. "As we are, in fact, a team. Our jobs are to help each other out. What you forget, it's my job to remember. What I forget, it's your job to remind me."

Yet, while most doctors, nurses and RTs are understanding of this rule, some continue to be inappropriate and condescending. They expect everything to be run as perfect. The truth is, I have never in my life left a code and said, "Well, that one went great." I am always saying to myself, "What could I have done better."

I had a discussion regarding this recently with four nurses. I said, "Do you think I think too much. Should I just assume I did my best, the nurse did her best, and so too did the doctor?"

We all came to the conclusion that we all second guess ourselves. It's natural. We also decided that the medical worker who doesn't second guess himself is the one we should be worrying about. The condescending doctor, the arrogant nurse, the omniscient RT are the one's who are the problem.

We must never forget we are a team. We work together for the benefit of the patient. We are all humans prone to doing stupid things, or making mistakes. It's our job to help the other members of the team do their jobs right when a natural brain infarct occurs.

Likewise, if a mistake is made, it should be addressed appropriately.

Here's a good analogy. Brandon Inge swiftly swoops up the ball and, instead of setting his feet and making a good throw, he tosses it over the head of the first baseman. Jim Leyland doesn't say anything, because he knows Brandon knows what he did wrong. Yet, Leyland decides, if he does it again, then he didn't learn and I'll have to address it.

That's the way things go in baseball. It's common sense. And it's also the way things go in life. Yet, some condescending people don't care about the natural order of things. Empathy lacking, you did wrong and therefore you need to be treated as a kid.

Patient complainers

You know they complain about every little thing. They get a headache and they'll be in the ambulance faster than you can say, "You're fine."

The thing about complainers is you must take them seriously every time, because the moment you don't is the time they'll be having a true emergency.

Crease in ear, RLD, linked to CAD?

I read there was a link between restless leg syndrome and cardiac disorders. I have also read that there is a link between a crease on the ear and cardiac disorders. Whether these are true or not I have no clue, yet my observations on the matter have me convinced.

Every time I have a patient with coronary artery disease, or any symptoms of heart failure, I look at their ear lobes to see if there is a crease there. Most often I find that there is a crease on their ear lobes.

So, now, as I travel to McDonalds, I can't help myself but to look at the earlobes of all the customers. Sometimes, I find that crease on half the middle aged customers, all of whom are eating fries and a high calorie, high fat burger.

Why coronary artery disease would cause a crease in the ear is beyond the imaginations of the world's best doctors. Yet, why restless leg syndrome is linked to coronary artery disease makes a little more sense, as you can see by this video/ article here.

Either way, I bet this is good information for doctors, who, as they observe the crease and take note of complaints of restless leg syndrome, can start to investigate for cardiac disease as well.

The basics of neonatal CPAP

If you work for a smaller hospital and rarely see bad baby's and yet are asked to set up CPAP on one, you ought to know what you're doing. We usually stabilize the baby and then ship the baby to a regional neonatal intensive care unit.

To help us stabilize the patient, we often use CPAP.

That in mind, here's the advice I received from our regional intensive care unit on setting up CPAP on neonates:

Setting up CPAP for a neonate:

1. 5–6 CWP good place to start
2. 2. 7 – 8 CWP if FiO2 needs greater than60%, or signs increased SOB
3. If SpO2 greater than target range, down FiO2 by 5–20, then allow 4 minutes for stabilization between each change.
4. If SpO2 less than target range, up FiO2 by 5–20, then wait 4 min for stabilizing between changes
5. Continue assuring AW patent, HR greater than 100, & infant not apneic.

(For a printable cheat sheet with this information and more, click here. )

It's also important to know when to use CPAP and when not to.

Indications for setting up CPAP on neonate:

1. PaO2 less than 50-60 and FiO2 greater than 60
2. Infant needs increased level of respiratory support but does not yet need intubation and positive pressure breaths
3. Infant experiencing increased frequency or severity of apnea, yet episodes not severe enough to warrent intubation
4. Infant has increased work of breathing and/or increasing oxygen requirements (Retractions, grunting, etc.)
5. Infant has mild CO2 retention and mild acidosis
6. Infant has atelectasis on x-ray
7. Infant has trancheobronchomalacia
8. Respiratory Distress Syndrome
9. Meconium Aspiration
10. Apnea of Prematurity
11. Patent Ductus Arteriosis

(Information obtained from STABLE program.

Contraindications for setting up CPAP on neonate:

1. Infants with rapidly progressing respiratory failure
2. Infants with increasing CO2, decreasing pH, and progressive hypoxemia
3. Diaphragmatic hernia
4. Tracheosophageal fistula
5. Choanal atresia
6. Cleft palate
7. Cardiovascular instability and poor heart function
8. poor respiratory drive
9. no respiratory drive

(Information obtained from STABLE program)

Pulmonary effects of CPAP:

1. Decreases respiratory rate, tidal volume and minute ventilation
2. Increases FRC
3. Decreasees lung compliance and dynamic compliance
4. Decreases total aireway resistance
5. Protective effect on surfactant

(Information obtained from this slide presentation Thrathip Kolatat MD)

Does nasal drainage cause asthma?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: Any truth to the rumor that chihuahuas can stave off the effects of asthma?

My humble answer: I actually heard about this a while ago, yet I'm not sure there is any scientific basis behind it. I'm sure if this were "scientifically proven" to work asthma doctors would be prescribing this chihuahua therapy for asthmatics on a regular basis.

Yet we'll continue to keep an open mind. If we learn anything further about this we'll be sure to let you know.

Your Question: First time inhaler help because I don't want to OD. So, I was prescribed 2 inhalers yesterday. One is Flovent, the other albuterol. the flovent i take 1 puff 2x a day. does that mean i press the inhalor, hold my breath, wait 30 seconds and puff again? is that the equivilant of one use or 2?

My humble answer: It sounds here like you ought to get a clarification of the original doctor's order. Whether you take two puffs twice a day, or 2 puffs all at once once a day is left to your doctor. Usually, however, this medicine is taken once in the morning, and once in the evening (or twice a day).

Just as a tip here, make sure that you use a spacer when you use any inhaler, and you rinse your mouth out when you are finished. Rinsing your mouth out is important because it will prevent side effects.

For more information about how to correctly use an mdi with a spacer, click here.

Your Question: I'm wondering if my trouble breathing is caused by my sinus problems or asthma. Can you help?

My humble answer: Sometimes it's hard to determine why a person is having trouble breathing. It's also possible the 2 are interrelated. Such as it's possible a sinus infection can cause nasal drainage that can get into your lungs and irritate your asthma. I wish I could be of more help to you, but I think the real solution you are looking for is one only your doctor can answer for you. Hope things get better for you real soon.If you have any further questions email me, or Visit MyAsthmaCentral.com's" Q&A section.

Here's how to diagnose asthma

As an asthma expert for MyAsthmaCentral I get a lot of questions about how to tell if it's asthma, and, if the doctor suspects asthma, what to expect. It was with these type of questions in mind I wrote the following post for MyAsthmaCentral.com.

Is It Asthma? Here's How to Find Out

by Rick Frea Wednesday, January 27, 2010 @MyAsthmaCentral.com
So you or your child are having asthma-like symptoms lately and now you're wondering if it's asthma. You've called a doctor and made an appointment. Now what?

According to "Allergy and Asthma: Practical Diagnosis and Management", asthma can be difficult to diagnose because there are many conditions that mimic asthma. Thus, "There is no specific test for asthma. Rather, one goes through a series of elimination processes until the diagnosis is arrived at."

What follows is what you should expect on the road to diagnosing your asthma:

1. Assessment: A doctor will perform a physical assessment of you. He'll check to see if you're:

• Chest is hyper expanded (very common in child asthmatics)
• Shoulders hunched (also common in children)
• Working hard to breathe
• Lungs are wheezy or diminished or tight (some asthmatics don't wheeze)
• Nasal passages are swollen (sinusitis is common trigger of asthma)
• Skin shows signs of eczema (many asthmatics have this)

2. Medical history: Your doctor will ask you specific questions about your medical history that might cue him into an asthma diagnosis. The following are indicators that you might have asthma:

• Coughing (especially at night)
• Shortness of breath (especially at night)
• Chest tightness
• Productive cough (asthmatics usually have white sputum)
• Other signs and symptoms of asthma (click here)

Asthma for dummies, a great book to keep handy, and the asthma guidelines, note the following as common questions you might be asked:

• Do symptoms differ with the seasons?
• Do symptoms come on fast or slow?
• Are your symptoms worse during the day or night?
• Do you wake up at night with breathing trouble?
• Do symptoms get worse when you have a cold?
• Do symptoms get worse when you exercise?
• Do symptoms get worse when exposed to cold air? Humidity?
• Does smoke, dust mites, pollen, or moldworsen symptoms?
• Have you missed school or work due tosymptoms?

3. Family history: Asthma is considered genetic, so if there is an extensive family history of asthma, then chances are that's what you have. Some doctors diagnose by this alone. That was the case with my daughter. Since I have it and she had symptoms, the diagnosis was made and it was treated swiftly with no costly testing.

If the above information gives your doctor the information he needs, further testing may not be needed. Otherwise, he may need to do further testing, such as those listed here:

1. Allergy testing: 75 percent of asthmatics also have allergies. So, based on your answers to the above questions (and especially in children), your doctor might want you to undergo this testing.

2. Pulmonary Function Test (PFT): This is a series of tests where you blow into a mouthpiece and a Spirometer measures your lung function. This test can tell a doctor if you have obstructed air passages in your lungs and how severe it is. It can also determine if the obstruction is reversible. Since asthma is a reversible obstructive airway disease, this test can be very helpful in diagnosing asthma. To learn all you need to know about PFTs, click here.

3. Bronchoprovocation: If your doctor suspects asthma, yet you are not presently showing symptoms, he may have you breath methacholine (called a methacholine challenge) or have you run on a treadmill to see if this induces bronchospasm. This is done in conjunction with PFTs. A negative result to this test will rule out asthma.

4. Lab tests: Asthma is known to cause an increase in basophils, eosinophils and IgE. A sample of your sputum and blood may be tested to check for these and other chemicals that might indicate you have asthma.

5. X-ray: Asthma is a disease that causes air to be trapped in your lungs, and this can show up on an x-ray as your lungs will appear hyper inflated during a flare up (click here to view this). Likewise, this can rule out other disorders (differential diagnosis) such as pneumonia or cardiac problems that might be causing your symptoms. Note, however, that uncomplicated asthma will not show up on an x-ray.

6. Differential diagnosis: Your doctor will want to rule out other diseases that might be causing your symptoms. When I was a patient at National Jewish as a kid, I had a sweat test to rule out cystic fibrosis, a barium swallow under fluoroscopy to rule our structural abnormalities of mediastinum or cardiovascular abnormalities, a pH probe to rule out acid reflux (GERD), and an EKG done to rule out heart problems.

Other conditions that might mimic asthma are: upper airway obstruction (something stuck in your throat), vocal cord dysfunction, Bronchopulmonary dysplasia, enlarged lymph nodes, cancer, viral infections, sinus infection, COPD, bronchiolitis, pulmonary embolism, pneumonia, recurrent cough not due to asthma, and the use of medicines like beta blockers.

Some of the above tests are a bit uncomfortable, although none are that big of a deal. Spirometry can be tiring, allergy testing itchy, but it's always neat seeing what the results reveal.

Once asthma is diagnosed, you'll want to work with your doctor on finding the best treatment to control it. Likewise, you'll want to work together with your doctor to find an asthma action plan so you know exactly what to do the next time you have an asthma flare up.

How intelligent are you?

How intelligent are you

How smart are you? I bet you are smarter than you think. While you might not necessarily be smart in one area, you are smart in another. I always joke with my friends that I'm "not as smart as the average man." When I said this to a patient the other day, he introduced me to the philosophy of Mr. Howard Gardner and "The Nine Types of Intelligence."

1. Natural Intelligence: I don't have the ability to relate things to my natural surroundings, so this is not me.

2. Musical Intelligence: I don't even need to go here. I have none of this.

3. Logical-Mathematical Intelligence (Number/Reasoning Smart): This included scientists, mathematicians and detectives. That is not me.

4. Existential intelligence: Sensitivity and capacity to tackle deep questions about human existence, such as the meaning of life, why do we die, and how did we get here. I have this. My blog is all about this. In fact, all my blogs tackle this.

5. Interpersonal Intelligence (People Smart): I'm not this in the slightest.

6. Bodily Kinesthetic Intelligence (Body Smart): This is the ability to manipulate objects and use a variety of physical skills. No, I'm not athletic, although I might pretend to be.

7. Linguistic Intelligence (Word Smart): This is the ability to think in words and to use language to express and appreciate complex meanings. I definitely am this.

8. Intrapersonal Intelligence (Self Smart): This is the capacity to understand oneself and one's thoughts and feelings, and to use such knowledge in planning and directing one's life. This involves not only an appreciation of the self, but also of the human condition. It is evident in psychologists, spiritual leaders and philosophers. Well, I consider myself a philosopher of sorts, and therefore I am definitely this.

9. Spatial Intelligence (Picture Smart): This is the ability to think in three dimensions. core capacities include mental imagery, spatial reasoning, image manipulation, graphic and artistic skills, and an active imagination. Sailors, pilots, sculptors, painters and architects all exhibit spatial intelligence. Young adults with this kind of intelligence may be fascinated with mazes or jigsaw puzzles, or spend free time drawing or daydreaming. I typed this all out because I initially thought this was not me, yet now I'm thinking about it. Although I'm not necessarily picture smart per se, I do spend free time drawing and daydreaming. Likewise, I am a writer of fiction and I once took an advertising class in which my teacher told me I had one of the best creative minds in the class. Likewise, on the top of one of my A+ advertising campaigns, he wrote, "You have a visual head, Freahead."

So, there you have it. You can head on over and check out where your intelligence stand. Click here.

Everybody dies of the same thing

When I was in RT school we had an instructor who decided that everyone dies of the same thing: Hypoxic Hypoxemia. This is lack of oxygen to the lungs, and then to the tissues and brain. Regardless of the cause, most of us die because our brains do not receive enough oxygen. Thus, we all die of the same thing.

There was only one exception we could think of:

1. Explosion

Can you think of any more exceptions?

The wisdom of the RT

When I started working as an RT I had a coworker named Dave who complained all the time. He kept saying stuff about Ventolin being over prescribed. He'd say things like, "60% of what we do is senseless."

As a new RT, my thinking was, "Why does he have to complain so much. There's no way all these doctors could be wrong and Dave be right."

Well, lo and behold, the wisdom or bronchodilator abuse caught up with me soon thereafter, or the silliness of Albuterol abuse, and I realized that what I never expected was actually the truth: that one RT was in the right, that bronchodilators are abused more often than any other med in the hospital, aside from perhaps Tylenol.

Facts about second hand smoke

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Question: What are the hazards of second hand smoke? work at a nursing facility where the majority of the staff still smoke. The smoking shed is right next to my work shop and I can smell the smoke. Also, while I am working in the yard, smokers come up to me and continue to smoke. How dangerous is all of this? Can you help me with literature or information that I can give to my boss? He thinks I am over re-acting

My humble answer: Here's some ammo for you. All you have to do is follow the links:

1. Second hand smoke : facts about second hand smoke
2. Third hand smoke : Interesting article
3. Smokers quit kit: There's some info in here I think you'll find very useful, such as the listing of all the ingredients in a cigarette. Must read.
3. Second hand smoke and lung cancer

The is a war. We are in a war against ignorance. However, we can't just say, "Hey! You're ignorant." More or less, we have to lead by example, and we have to continue to learn the facts, and to share the facts.

You are wise to be concerned. Keep learning. And good luck on your quest to educate your friends and coworkers.

The curse of restless leg syndrome

You don't see it very often, yet the last time I worked I had a patient in the ER with Restless Leg Syndrome. Her chief complaint was nausea and vomiting, yet as the morbidly obese lady set their in semi fowlers sleeping, her legs were waning this way and that.

I tapped her shoulder, and she didn't wake. So I nudged her harder, yelled her name, and she woke up long enough for me to tell her I needed to do an ABG on her. As I set up to do the procedure, I noticed her legs were flailing this way and that, her left way up in the air that way, her right way up in the air this way. How she could sleep with her legs moving like this I had no idea.

"I'm going to poke you now," I said, needle ready to pierce.

She said nothing.

"I'm going to poke you now!" I yelled.

Her eyes popped half way open. "Yeah, that's fine."

"Well, I don't want you to fall asleep and whack me a good one with your foot," I said.

"Oh, don't worry, I won't."

Yet just as I said that her feet were up in the air, moving around like those of a one-year-old happily kicking.

"I'm poking! I'm poking!"

"Yeah, go ahead!" Her legs were calm a moment, her eyelids at half mast.

I poked. As the blood returned into the syringe I saw through the corner of my eye her old legs just-a-movin'. I wondered if this had something to do with Ondine's Curse. Or perhaps Ondine had a sister who was crushed by an obese sleeping man's legs, so she cursed him to never sit still while sleeping again?

I removed the syringe, held the site, and observed as she didn't even acknowledge my existence except for the occasional unintelligible utterance. She woke up briefly as I was exiting the room, and I asked, "Do you have BiPAP at home?"

"I have one, yet I hate that...," as she trailed off, she grunted briefly, and her legs were off to their business once more.

I remember reading once how restless leg syndrome was linked to cardiac disease. Another thing that was linked to cardiac disease was a crease on the ear lobe (I write about this here). As she slept, I glanced a peak at her earlobe. Yet, the crease was there. Perhaps there was some validity to this theory.

We'll investigate this further later (see here for more on RLD).

Normal Neonatal ABGs and Vitals

Normal Neo ABGs & Vitals:

1. Target ABG:

• PH: 7.25 – 7.40
• PCO2: 45 – 59
• PaO2: 50 – 70
• BE: 0 - to negative 4

2. pulse ox (SpO2):

• 82-92% if less than27 wks
• 85–93% if less than 33 wk
• 88 – 95% if greater than 33 wks

3. Respiratory Rate

• Term = 30–50
• Premie = 40 - 70

4. Heart Rate:

• Term =120 – 160

5. Blood Pressure

• 50 – 90 systolic

For a neonatal cheat sheet, click here.

What asthma medicine works best for your child?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your Question: What asthma medicine will work best for my child?

My humble answer:

What medicine works best for your child is basically a matter of trial and error. What works for one child may not work the same for others. It also depends on how bad your child's asthma is. Another thing that complicates treating childhood asthma is this question: Are the same medicines used to treat adult asthma safe for children? As usual, though, there's a ballance of risk versus benefits when trialing any new asthma medicine.

The basic premise, however is the same for adults as it is for children. Every asthmatic should have a Ventolin inhaler on hand at all times. That's pretty well established. If your child cannot have one on his possession, whichever adult is responsible for him at the time should have one handy (like you or a teacher).

If your child is requiring the Ventolin more than 2-3 times in a two week period, this is considered uncontrolled asthma (in most cases). In this case, he'll want to trial your child on other asthma meds, such as you can read about in this post (while written for adults, it should give you a general idea of what meds are available).

You may also want to consider reading this post , which notes a recent study that shows that most asthmatic children benefited the most from a medicine like Advair or Symbicort due to the fact this medicine treats both the components of asthma: bronchospasm and chronic inflammation.

Actually, to state it simply, the best asthma medicine is whichever one helps your child live a normal active life.

For further information you may want to consider posing this question to your childs pediatrician or asthma doctor.

If you have any further questions email me, or Visit MyAsthmaCentral.com's" Q&A section.

Asthma myths

There's so many myths about asthma that have been busted over the years you could probably fill a 1,000 page novel. This post just touches the surface.


Trust me when I say this is the first of many such posts.


10 Asthma Myths Busted
by Rick Frea Wednesday, January 13, 2010 @MyAsthmaCentral.com

Asthma myths go back as far as 3,000 B.C with the first recordings of "gasping breaths" in ancient Sumerian cuneiform. In fact, since asthma is such a mysterious disease, once someone came up with an idea, it was accepted as fact until further proof was obtained.

As I write about some old remedies for asthma, you might just cringe. Thankfully, these myths have been busted.

1. Trepanation cures asthma: Trepanation was a medical procedure in which a hole was drilled into the skull to treat health problems. Of course there's no proof this was actually used for asthma, yet I'd imagine some severe asthmatics had their heads split open to release the evil spirits that were causing this inexplicable disease. Thankfully this myth was busted years ago.

2. Bleeding cures asthma: Be it evil spirits or demons, in the middle ages diseases were thought to be caused by evil. A Byzantine doctor recommended cutting a vein on the arm and making the evil come out that way. This therapy was used even through the 19th century. Another Byzantine doctor recommended blistering an asthmatic's skin as a means of letting the evil substances out.

3. Animal dung cures asthma: Desperate for a cure, the Ancient Egyptians believed swallowing elephant or camel dung would cure asthma. While the ancient Greeks accurately defined asthma, their remedies weren't any better.

4. Cold air cures asthma: One renaissance doctor believed asthmatics got sick because they were too cold. He recommended asthmatics avoid fresh air and to "sit next to a fire of peat or coal at all times." (I learned about the above myths in this handout).

5. Asthma is psychosomatic: 19th century doctors were so convinced asthma was a psychological disorder they dedicated books to it. Dr. Henry Hyde Salter wrote the most famous one in 1860 called "On Asthma." While his myth was busted in the 1950s, some of Salter's recommended cures were alcohol, smoking cigarettes, Indian Hemp, coffee, opiates and even making yourself pass out by using formaldehyde. I expound on these asthma remedies in this post. Now we know that while anxiety and stress are asthma triggers, they do not cause asthma. Instead asthma is a disease of chronic inflammation of the air passages in the lungs.

6. Jaw reshaping cures asthma: In the 1940s some doctors observed in the Middle East, where most of the people had "lantern-jaws," asthma was rare. So they recommended asthmatics have their jaws reshaped. Asthmatic Harold Beck wrote about his experiences with this here. Actually, since there were few asthma remedies that could be relied upon, nontraditional therapies like this became commonplace.

7. You'll someday outgrow your asthma: This is a myth that is still spread, even by the best asthma doctors. The truth is, while your asthma may go into hiding, it never goes away. This is why former childhood asthmatics (as I wrote about here) would be wise to be vigilant to asthma triggers like smoke and viruses, and continue to see an asthma doctor at least once a year. It's possible your asthma might show up again in adulthood if you don't watch out.

8. Asthma should be treated only during an acute attack: As recently as 1990 my doctor told me to stop taking my inhaled steroids when I was feeling better because he feared the side effects. He also believed asthma only needed to be treated during an acute attack because that was when the lungs were inflamed. Modern wisdom busted this myth based on the following facts:

• Asthmatics always have inflamed bronchi that are sensitive to asthma triggers.
• Asthma can be prevented if meds are used every day to control this inflammation.
• Proper use of inhaled steroids, followed by rinsing, makes side effects rare.
• It takes 2-3 weeks for controller meds to start working, so you should never stop taking them without first consulting with your physician.

9. Nebulizers work better than inhalers: Test after test has been done on this topic, and every one I've ever seen reveals that if you take your inhaler properly and with a spacer, it works just as well as a nebulizer. Another fallacy is that hospital nebulizers work better than the ones you have at home. The truth is, we use the same Albuterol and Xopenex that you use at home.

10. Asthma is a good excuse not to exercise: Think again. In fact, the opposite holds true. Asthma makes it urgent that you do exercise, even if you have hardluck asthma. Exercise makes your heart and lungs stronger, and ultimately makes it easier to control your asthma. So, even if you have hardluck asthma, you still need to get off your butt and stay active.

Even in my lifetime -- and yours -- I have seen some pretty good asthma myths BUSTED! Yet even busted myths have a way of sticking around way longer than they should.

Believe it or not, this post just scratches the surface on asthma myths busted through the years. If you were the victim of an asthma myth that was later busted, please let us know in the comments below.