What happens when you drink Albuterol???

It's not something you do on purpose, but sometimes, when you take breathing treatments a lot, or give them a lot, the medicine squirts into your mouth. It's not like it happens on purpose, it just happens .

The good news is I don't ever remember suffering from side effects. In fact, the side effects from ingesting albuterol are probably less than when you inhale it.

Years ago, when I was a student perhaps, I gave a breathing treatment to a really awesome mentally challenged young man. I started the breathing treatment using a mask, and then a conversation ensued between me his mother.

She said she set him up with a treatment using a mask a few days earlier and then left the room. When she returned, she saw the mask was off his fact and the nebulizer taken apart.

"What did you do with this?" she said, concerned.

"I drank it," he said proudly.

"YOU DRANK IT!!!!"

"Yep."

She called poison control. They said that he would be fine, that the side effects from drinking Albuterol would be no different than if you inhaled it: nervousness, dizziness, tremors, etc.

So, take it from the authorities, the next time you accidentally squirt albuterol into your mouth, take note of the fact it will do no harm.

This post was originally published on August 28, 2008 and has since been edited

Further reading:

• Some people drink albuterol on purpose 

How to hear bronchospasm

It has been said that it takes a trained ear to hear bronchospasm. There is much truth to this statement. So, that in mind, I have decided to create a lesson here on how to hear bronchospasm. This might be good for all nurses, respiratory therapists, students and even doctors to review.

First of all, the patient has to be breathing. If you are hearing no lung sounds then you know you are not hearing bronchospasm. Likewise, if a patient is breathing normal, is not short of breath, and has good air movement with clear lungsounds, you are also not dealing with bronchospasm.

Many people believe if you hear a wheeze it's automatically bronchospasm and a bronchodilator breathing treatment is indicated. They jump the gun and scream, "Hey Respiratory! Give this guy a treatment!"

The truth is, not all that wheezes is bronchospasm. Heart failure and pneumonia cause more wheezes than bronchospasm. The fluid from heart failure or pneumoonia causes increased pressure in the lungs and squeezes the air passages from the outside causing a wheeze that is quite often heard in the throat. This, my friends, is called a Cardiac Wheeze and must not be confused with a bronchospasm wheeze.

Here are some tips to help you learn to hear bronchospasm:

1. Shortness of breath alone does not indicate bronchospasm. Or, stated another way: All that wheezes is not bronchospasm. Before you rush to call an RT for a bronchodilator you should assess the patient further to determine WHY the patient is short of breath.
2. If patient is not short of breath there is no bronchospasm, and no bronchodilator is indicated. Nuff said.
3. If it's an audible wheeze it's not bronchospasm. Usually if it's audible what you are hearing is fluid sitting on the vocal cords. Many experts consider an audible wheeze stridor, and stridor is not a wheeze at all. If you hear an audible wheeze consider pneumonia or heart failure and check or watch the patients fuid intakes and outtakes.
4. A bronchospasm wheeze is NEVER audible. True bronchospasm wheezes are within the air passages of the lungs and can only be heard by auscultation. They will also NOT be heard in the throat. (Yes, I know I repeated myself. This is an important point.)
5. Listen to the throat. If you hear the wheeze by auscultating the neck area it's an upper airway wheeze, and is usually associated with excessive secretions or pulmonary edema (again think heart failure or pneunomia). If you hear this watch this patient for signs of fluid overload. Sometimes you will hear a "throat wheeze" radiating throughout the lungfields.
6. Have patient breath normal. When a patient is taking a deep breath you are more likely to hear upper airway noises that overshadow underlying bronchospasm. A true bronchospasm wheeze is best heard with normal, slow, laminar inspiration and expiration.
7. Have patient relax. This sort of goes along with #3 above, but it had to be said. Many times a patient is anxious and breathing fast and this moves secretions around causing dyspnea and wheeze. Usually the cause of dyspnea with exertion is cardiac related and what a patient needs is an oxygen boost and/or rest -- not Albuterol.
8. Have patient breath through pursed lips. If you really want to tell if a patient actually has bronchospasm, have them breathe through pursed lips. This forces them to breathe normal and you will not hear the upper airway component, and are more likely to hear the bronchospasm wheeze if it exists. You may need to listen closely, because a bronchospasm wheeze can sound very distant. This is a great trick.
9. Listen for diminished lungsounds. Bronchospasm usually results in diminished or decreased air movement in the lungfields. If a patient has good air movement even with other adventitious lungsounds, the odds are that the noises are not caused by bronchospasm. (Click here to learn why I think diminished lungsounds is better indicator of bronchospasm than wheezes.)
10. As a rule of thumb, bronchospasm wheezes are usually expiratory. If you hear an expiratory wheeze you can consider bronchospasm. If you hear an inspiratory wheeze chances are you're hearing bronchitis.
11. Exceptions to the rule. Sometimes the patient can have an upper airway wheeze or cardiac wheeze and also have an underlying bronchospasm component. In this case you may want to try one bronchodilator treatment and see if the patient gets better. If it doesn't work don't be the fool who orders continuous breathing treatments for no reason and overlooks what the patient really needs (perhaps some Lasix?).
12. If you hear increased lungsounds after the treatment you had bronchospasm to begin with. However, if the patient had good aeration before and after therapy, consider no bronchospasm existed and tell the nurse and doctor to try something else (if they'll listen to you).
13. Quite often, the best inidcator of bronchospasm is no wheeze at all. This is especially true with adults. So don't assume just because a patient isn't wheezing that he's not having bronchospasm.

For more information check out the following posts:

Indications for breathing treatments.
SOB not always caused by bronchospasm

Wheeze no longer indication for bronchospasm?

I've come to the conclusion that a wheeze should be removed from the list of indications for a bronchodilaotr, and replaced by the word "diminished lung sounds."

The reason I say this is the word "wheeze" is too subjective, and prone to lead to questionable breathing treatments or bronchodilator abuse. Bronchodilator abuse is when bronchodilator breathing treatments are ordered for patients not having bronchospasm.

The following is a list of noises that are not true wheezes:

1. cardiac wheeze
2. upper airway wheeze
3. stridor

Likewise, there are other disease processes that can cause a wheeze, such as a pulmonary embolism, cardiac asthma (CHF) and lung cancer.

Therefore, due to the fact the word "wheeze" is too open to subjective opinion, I hereby petition it be removed from as an indicator for a bronchodilator order.

In place of wheeze I would like to see the word, "diminished lung sounds." I say this because if you listen to a patient and he has good air movement, you can be pretty assured he is not having bronchospasm -- even if you think you hear a wheeze.

Perhaps this might result in true bronchodilator reform.

Indications for breathing treatments

Since I write so often on these pages reasons nurses call for breathing treatments and doctors order them (my latest version is here), I think it is due time I create a list of the true indications for a bronchodilator breathing treatments.

Keep in mind a bronchodilator only treats bronchospasm. Likewise, rescue inhalers used properly with spacer are proven to be as effective in most cases as a breathing treatments.

That in mind, here we go:

1. Asthma
2. Bronchitis (acute or chronic)
3. Emphysema (actually, this is not a true indication)
4. Cistic Fibrosis
5. Airway swelling due to allergic reaction (actually, bronchodilator doesn't treat swelling)
6. Pt with above diseases who cannot manage an inhaler (Albuterol, Atrovent, Flovent, etc.)
7. Bronchospasm secondary to other disease process such as CHF, pneumonia, pulmonary fibrosis, RSV, lung cancer, sinusitis, bronchiectasis, etc.
8. Bronchospasm secondary to allergic reaction (bee sting)

Note #1: The diseases in #8 do not necessarily cause bronchospasm, but may irritate the sensitive airways of people who have the diseases mentioned above

Note #2: It appears doctors believe treatments are cures for all ailments, and are indicated for all the wheezes and all that causes shortness of breath as you can see for yourself by reading the Real Physician's Creed.

We'll make this RT Cave Rule #25: A wise medical care worker will know the indications for ordering a breathing treatment and not request a treatment (or order one, or give one) unless a patient meets this criteria.

Note #3: Again, I am going to file this under humor, although it is not humor it is serious. Too many doctors fail to understand the true indications for breathing treatments

28 non indications for breathing treatment

Just a friendly reminder: the following are not indications for bronchodilator breathing treatments:

1. Dr. ordered it
2. Don't know what else to do
3. Nurse wanted it
4. Pt wanted it
5. Stridor
6. Sinusitis
7. Mesothelioma
8. Lupus
9. Laryngospasm
10. Audible wheeze
11. Rhonchi
12. Crackles
13. M.S.
14. Homeless
15. Depression
16. Pt has home nebs
17. Pt likes tx
18. Pt likes company
19. Bed ridden
20. History of smoking
21. Irritating lung sounds
22. Low SpO2
23. Trach
24. Intubated
25. Post operative
26. Atelectasis
27. Fever
28. Heart failure
29. Cardiac wheeze
30. Pneumonia
31. Pleural effusion
32. Pneumo
33. Rickits
34. RSV
35. ARDS
36. RDS
37. P.E.
38. Cough
39. Sputum induction
40. All wheezes (all that wheezes is not bronchospasm)
41. All SOB (SOB is not always caused by bronchospasm)
42. Just because the patient is wearing a mask

Asthma blog update

I would like to take this opportunity to update my readers on Asthma writings I from over at my MyAsthmaCentral.com Asthma blog. Due to holidays and vacations I got a little behind earlier in the year.

So, without further adieu, here goes:

1. It's true the number of people being diagnosed is increasing, but severe asthma rates are on the decline. Here are five good reasons.

Reasons Severe Asthma Rates Are Declining
by Rick Frea Wednesday, April 22, 2009 @MyAsthmaCentral.com

When I was a kid growing up in the 1980s I was a bad asthmatic who spent many nights in a hospital bed. I met many respiratory therapists (RT), and got to know some of them really well. This experience inspired me to become an RT. No one would have more empathy for these kids than myself.

Yet once I became an RT in 1997, I noticed something stunning: there were no asthmatic kids for me to empathise with. I know none "really well." I take care of an occasional asthmatic kid, but once they are dischared I never see them again.

Twelve years later there are still no asthmatic kids. I had many theories why this might be, yet I had no real evidence. Then I read the following post: "Severe Asthma Less Common than Decade Ago." Apparently I was not alone in my observations.

According to this article, researchers concluded that "patients treated from 2004 to 2007 showed significantly lower use of oral corticosteroids and rescue albuterol than patients from 1993 to 1997."

What follows are the theories why severe asthma rates are declining:

1. Better medicine: I'd say the best medicines so far for asthma are Advair and Symbicort. Both these medicines work to prevent asthma flare ups by treating both components of asthma: airway constriction and inflammation.

Likewise, leukotreine inhibitors like Singulair allow asthmatics to prevent allergy flare ups that may trigger their asthma.

With better asthma medicines doctors can place a greater emphasis on asthma education.

2. Better Asthma Education: There was something similar to Asthma Action Plans when I was a kid, but most doctors didnt' know about them -- at least my doctors didn't. That was one of the reasons I was referred to National Jewish Health in 1985 when I was 15.

Today, however, most doctors work with their patients on creating an Asthma Action Plan that is just right for them. Following the plan to a tee can help asthma patients stay out of hospitals.

3. Improved asthma wisdom: In 1984 doctors knew inhaled corticosteroids worked for asthma, but they were afraid of the steroid side effects. They also did not think of asthma as a disease of chronic inflammation, so they would often tell asthmatics to only use steroid inhalers during an asthma flare up.

Doctors are now wiser. They now know asthma is a disease of chronic inflammation, and a small amount of corticosteroid in your lungs all the time is not only safe, but it prevents asthma flare ups. (I wrote about this in greater detail here).

Because of this, asthmatics who are compliant with their inhaled corticosteroid are less likely to need Albuterol.

4. Improved Compliance: When I was a kid I had to take four puffs four times a day of Azmacort. You can see how easily it would be to slip in the compliance department. The inhaler was also a bulky thing that was a nuisance to lug around.

Today, however, both Advair and Symbicort are small, compact and simple to use. Not only that, but you only have to take one puff before you brush your teeth in the morning, and one puff when you brush your teeth before bed. It's that easy.

Now, you add those four together and you get a well controlled gallant asthmatic who needs his albuterol rescue inhaler only occasionally, is able to avoid emergency rooms, and rarely if ever needs to be admitted.

There you have it: That's why I never got to know any asthmatic kids the way RTs got to know me when I was a child asthmatic. It's good news.

2. Here is 20 Signs You're Using Your Asthma Inhaler Correctly. I wrote a while back the signs you are using your rescue inhaler incorrectly, or signs you are a bronchodilator, so I thought I ought to right the ship by showing you how a Gallant Asthmatic uses a rescue inhaler.

20 Signs You're Using Your Asthma Inhaler Correctly
by Rick Frea Wednesday, February 18, 2009 @MyAsthmaCentral.com

In a previous post I described for you the 31 signs you are overusing your (bronchodilator) rescue inhaler. In this post I would like to provide you the signs you are using your rescue inhaler correctly.

Most doctors recommend asthmatics carry a rescue inhaler with them at all times. Not only that, but every asthmatic should have one at home, in the car, at work, school, day care, and grandma's house.

The term "rescue" inhaler is actually a little misleading. An asthmatic should use the rescue inhaler at the first sign of breathing trouble. You should NOT wait until you are having a lot of trouble breathing. Most doctors also believe -- as does this humble respiratory therapist and fellow asthmatic -- that you cannot overdose on your rescue inhaler.

However, with the exception of a few hard luck asthmatics, frequent need of your rescue inhaler, most doctors believe, is an indication that your asthma is poorly controlled.

Likewise, most respiratory therapists (RTs) I know of highly recommend ALL asthmatics use their rescue inhaler with a spacer. The last study I read showed that a spacer can make the medicine work 175% better.

When I was a kid there were no manufactured spacers available, so my RT told me to use a toilet paper holder. Obviously, that wasn't something I was overly eager to use at school.

Today, spacers are pretty high tech and are manufactured. To get a spacer you should talk to your doctor and he can either give you one or write a prescription so you can pick one up at your pharmacy.

The spacer works to evenly disperses the particles of medicine to help you breathe them in, rather than having the medicine hit the back of your throat and stay there. In this way more of the medicine gets into the lungs, and deeper.

Likewise, most asthma experts recommend all asthmatics have an Asthma Action Plan to help you know when to use your inhaler and when to call your doctor or go to the ER.

Now, knowing that all of my readers are Gallant Asthmatics who use their rescue inhaler exactly as prescribed (Right?), or you are at least on the road to becoming one (40% still use them improperly), I have composed a list here of what a healthy relationship with your bronchodilator looks like.

So, that in mind, you know you are using your rescue inhaler correctly when:

• You only use it when you actually need it.
• Your asthma is relatively controlled.
• You are vigilant and if you are using it too much, you call your doctor.
• You get a new Advair inhaler more often than a new rescue inhaler.
• It lasts the prescribed amount of time as opposed to you renewing it every week.
• Your prescription is for one inhaler instead of 3 or 4.
• You actually have your inhaler long enough for it to expire.
• You don't have an asthma attack just because you forgot your inhaler.
• Someone actually says to you, "I haven't seen you use your puffer in a while."
• Your best friend is a person and not your puffer.
• You don't get that slathery, icky taste of Ventolin in your mouth 20 times a day from blasting in into the back of your throat.
• Your spacer doesn't whistle every time you use it.
• You actually use your spacer.
• You actually know what a spacer is.
• You NEVER use your Ventolin more often than every 4-6 hours, or your Xopenex more than every 6-8 hours (or as prescribed by your doctor).
• When you use it you take two puffs, 2-5 minutes apart.
• If you have

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

Even though you don't use it, you still carry it with you at all times.

You keep one at all locations where you spend the most time, and you make sure this inhaler is not expired.

You never use an inhaler that is over a year old (Have you tried inhaling expired Ventolin? Trust me, the stuff tastes awful.).

(If after reading this you suspect you are among the 40% who use their inhalers incorrectly -- and I commend you for making this admission -- you can click here or here for more information on proper rescue inhaler use with a spacer.)

There you have it, 20 reasons you are NOT a bronchodilatoraholic, not a goofus, and you are using your rescue inhaler correctly -- like a gallant asthmatic.
3. Here is one of my own favorite posts: An Asthma Action Plan will help you become a Gallant Asthmatic. In post I give you an easy step by step of how to create an Asthma Action Plan. Also in this post I list the early warning signs of an impending asthma attack. You will probably catch me referring to this post quite a bit, especially in q&a sessions.

An Asthma Action Plan will help you become a Gallant Asthmatic by Rick Frea Tuesday, February 24, 2009 @MyAsthmaCentral.com
So, you've come to the realization that you are not the best asthmatic -- you're like Joe Goofus. You use your inhaler way too often and you recognize -- perhaps from reading my post "the 31 signs you might be a bronchodilatoraholic" -- that you overuse your rescue inhaler.

Now you are wondering, "What do I do to break my inhaler abuse habit?"

Likewise, you have read about the types asthmatics, like Jake Gallant, who have their asthma so well controlled that they HARDLY EVER need to make trips to the ER for their asthma.

Now you ask: "How to I go from being a Joe Goofus to being more like Jake Gallant? How do I get it right?"

To make the transition is very easy, and, considering you have made the observation that you have a problem, you are already well on your way to becoming a Gallant Asthmatic.

Becoming a better asthmatic is easy, all you have to do is ACT. ACT is an an acronym for Admit, Call and Take.

• Admit you have a problem: (I'm short of breath, I'm a Goofus Asthmatic, I'm a bronchodilatoraholic).
• Call your physician: (or go to the ER according to your Asthma Action Plan (see below).
• Take your meds (exactly as prescribed. This includes both your preventative meds and your rescue inhaler).

That's it. It's that easy.

Your doctor will work with you on finding the best preventative medicines to control your asthma. All you have to do it take them exactly as prescribed whether you are having
asthma symptoms or if you are feeling good.

So now you are wondering: "What is an Asthma Action Plan and how can it help me?" (Sometimes they are called Asthma Management Plans. It's the same thing)

As described here and here, an Asthma Action Plan has two parts.
1. A peak flow (pf) meter
2. Understand your symptoms
Peak Flow Meter: I described what a pf meter is and how to use it to manage your asthma in this post here. For your convenience, I will sum it up here:

"According to National Jewish Health, you blow into you pf meter twice a day first thing in the morning before you take any meds, and before bed. After two weeks, you take the highest number that you blew and this is your personal best.

Now, when you blow 80-100% of your personal best, you are good to go. When you blow 60-80% of your personal best, you should use your rescue inhaler, wait 20-30 minutes, and blow in your pf gain. If your pf is now above 80%, you are okay for now, but you should be your pf every four hours.

However, if your pf is still below 80%, you should call your doctor.

When you blow in your meter and your pf is less than 60%, you should use your rescue inhaler and then have someone take you to the ER. Or, if you are bad enough, call an ambulance (you should avoid driving yourself to the ER)."

Undestanding your symptoms: Early warning signs are signs that usually occur BEFORE you have an asthma attack. You need to recognize what your signs are and treat them BEFORE it turns into a full-fledged asthma attack.

Here are some examples of early warning signs as noted at NationalJewishHealth.com:

A. Internal warnings: funny feeling in chest, headache, spacey feeling, dry mouth, scratchy throat, itchy throat, feel weak, feel droopy, chin ithces, any other signs that are unique to YOU.B. External warnings: breathing slows down, eyes look glassy, get upset easily, feel sad, get excited, feel nervous, watery eyes, feel clammy, feel feverish, cough, sneeze, runny nose, pale, fast heartbeat, being tired, want to be alone, get quiet,
slow down, mopey, dark circles under eyes, feel grumpy, head plugged up, restless, and any signs unique to YOUl.

YOU must learn to recognize these signs "so treatment can be taken to avoid an attack... being aware that an early sign can precipitate an attack by 5 minutes to as long as a few days. "
Then you must treat your asthma. You can do that by resting, doing diagphragmatic breathing, and stopping any activity when an early warning sign is noticed -- and rest. Take your rescue inhaler. Seek help if these steps do not work. Call your doctor or have someone take you to the hospital. But, by golly, don't sit around for days puffing on your inhaler until it becomes empty.

Remember, your goal is to get your asthma under control. Following your asthma action plan to a tee, like Jake Gallant, will put you on the path of complete control of your asthma.
4. Gallant Asthmatics Know and Know How To Avoid Their Asthma Triggers. This is another post I will refer to quite a bit because this post has a great list of the basic asthma triggers asthmatics may need to be on the look-out for and avoid.

Gallant Asthmatics Know and Know How To Avoid Their Asthma Triggers
by Rick Frea Wednesday, March 25, 2009 @MyAsthmaCentral.com

Being a gallant asthmatic means more than simply taking all your medicines compliantly and having an Asthma Action Plan. It also involves knowing what your asthma triggers are and how to deal with them.

We asthmatics often have chronically inflamed air passages that are sensitive to certain asthma triggers. A trigger is anything that causes you to have asthma symptoms. The challenging thing is that every person has different asthma triggers.

According to NationalJewishHealth.org, here are some common asthma triggers:

1. Airway irritants: Strong odors, tobacco smoke, smoke from woodburning stoves or kerosene stoves and fireplaces, dust, air pollution, perfume, aerosol spray, paint fumes, gasoline fumes, solvents, chemicals, etc.

2. Animals: Animal dander, saliva and urine from feathered or furry animals. These include allergies to dogs, cats, birts, etc.

3. Changes in breathing: Sneezing, coughing, laughing, crying, hyperventilating, stress, holding your breath, sleep disorders, etc.

4. Excercize: Running, jumping, general exercize, etc.

5. Food and drugs: Allergies to nuts, chocolate, milk, sulfites, tartazine, betablockers (Inderal, Lopressor, Corgard, Timoptic, etc), asprin, ibuprophen products, etc.

6. Health and physical condition: Fatigue, colds, respiratory infections, influenza, sinusitis, gastroesophogeal reflux (GERD), etc.

7. Other allergies: Molds, dust mites, medications, cockroaches, etc.

8. Plants: Allergies to trees, grasses, weeds, pollen, etc.

9. Weather and elements: Wind, weather changes, rain, snow, hot or cold temperatures, high humidity, low humidity, changes in barometric pressure, etc.

10. Emotions: Any feeling that could precipitate an attack.

11. Time: Just get it at night or during the day

So, which of the above are your asthma triggers?

A gallant asthmatic will be aware of and avoid possible asthma triggers to the best of his ability -- within reason of course.

You may even need to make changes in your life that are difficult, such as finding someone else to cut your grass, getting rid of a cat or dog, avoiding foods that you are allergic to, or staying inside or slowing down when the weather is too hot or cold, or weather changes pose a problem.

Smoke and other irritants can often be avoided with some effort. If you have asthma you should never smoke, nor allow someone to smoke near you, and you should avoid places where smoking is allowed.
Excercise triggers can often be avoided by premedicating yourself as prescribed by your doctor, and not running outdoors if the weather is too cold or hot-- a treadmill works great for these occasions.

Good body care and good health habits such as daily baths or showers, and handwashing, can help you avoid common infections. And keeping your home clean and clear of molds and dust with frequent cleaning can also be a big help.

An influenza vaccination is often recommended for asthmatics to avoid the influenza trigger.

Stress is not easily avoidable, which is why we all should consider a good stress management plan, which may include healthy eating, exercise and relaxation exercises.

New medicines like Advair and Symbicort can make your lungs stronger and make your body better capable of handling irritants. For many asthmatics, these meds are all that is needed to control asthma even in the presence of triggers.

Another great medicine is Singulair, which has allowed many asthmatics -- including myself -- to better deal with allergens.

And of course, for those days when a pesky irritant shows up and bothers your asthma despite your best efforts, you should have an Asthma Action Plan ready and roaring to go.

Learning what you're allergic to can be as easy as your doctor performing an allergy test on you. But learning what your other triggers are will mean being vigilant to the environment around you when you are having an attack.

I think most asthmatics would agree with me that avoiding asthma triggers is extremely
difficult, if not daunting. But we gallant asthmatics are up to the task.
5. 16 Interesting Asthma Facts You Should Know. This is my most recent post, yet I don't think it needs a separate post because it is basically facts I've already listed here on RT Cave. Yet these are not your basic asthma facts that you can brush off, they are facts every asthmatic should be aware of, so go ahead and read it again if you already have.

16 Interesting Asthma Facts You Should Know
by Rick Frea Tuesday, May 12, 2009

I recently read a book written for physicians called Fatal Asthma. I wouldn't recommend it though, because it was a difficult read. Yet it was filled with some excellent asthma facts I thought I'd share with you.

Now I certainly wouldn't want to rehash the same asthma facts you can get on great websites like ours, or epa.gov and AAAAI.org. So, in honor of asthma and allergy awareness month, here are 16 asthma facts I learned from reading this lawyer-like manual of a book:

• It is a common myth that a child will outgrow his asthma (despite what some Recovered Asthmatics might say as they light up a cigarette). In fact, 95% of children with persistent asthma still have symptoms into adulthood (myself included).
• The life expectancy for mild asthmatics is the same as for those who do not have asthma, which is about 80 years. (This is great news. So take care of yourself and you can live long and prosper).
• Only 10% of asthmatics develop severe asthma (That comes to less than 1-2% of the population, yet still significant).
• A major cause of severe asthma is cigarette smoke, either 1st or 2nd hand (one more reason not to smoke in front of your kids).
• Nearly all cases of asthma-related deaths result from a lack of oxygen and not from cardiac arrest (This is significant because rapid oxygen administration can prevent asthma-related deaths).
• More than 20 million Americans has asthma. This year, more than 4,000 Americans will die from asthma attacks. (most of which could be prevented with proper care and a good Asthma Action Plan).
• Most fatal asthma attacks do not occur in the hospital. Most patients who reach the hospital with an intact central nervous system survive (Take note of this if you're a Goofus or Martyr Asthmatic).
• Most people who die from a severe asthma attack delayed going to the hospital (which is something asthmatics in denial tend to do. For tips on when to go to the emergency room, click here).
• Asthmatics who have had severe or near-fatal asthma attacks have an increased likelihood of having a fatal asthma attack in the future. (This is why very close contact with your doctor is essential).
• Most asthmatics who suffer a near fatal attack hadn't been taking their medicines as prescribed (or, as I mentioned above, they delayed seeking treatment, or they abused their rescue inhaler).
• Even mild asthmatics can die of asthma (but, again, mostly due to improper care or delayed treatment).
• It's not clear that overusing Albuterol increases the risk of a fatal asthma attack (yet that's not an excuse to abuse it as I explain in this post. Click here for signs of bronchodilator abuse.)
• Using albuterol as your ONLY asthma treatment may contribute to fatal asthma, because the albuterol does not manage chronic inflammation in the airways, the cause of asthma (This is why you should always use your asthma meds as prescribed).
• Boys are twice as likely to develop asthma as girls, but the exact reason is unknown. Studies show boys are more likely to have a positive allergy tests, to show more bronchial hyperresponsiveness and to appear to have different patterns of airway function development.
• Socioeconomic status and asthma fatality are inversely related. In other words, the poorer you are, the more likely you are to die from your asthma (probably because the poor have less access to asthma wisdom, medicine and good care and they are more exposed to common asthma triggers such as pollution, dust, cockroaches and animal dander).
• African Americans have an increased incidence of asthma than whites. Socioeconomic status may be a factor, but recent studies show higher IgE serum levels and higher prevalence for bronchial responsivemenss in blacks as compared with whites.

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

Q&A about Advair and Symbicort

What follows are some of the most common questions asked in the Q&A section of MyAsthmaCentral.com and my humble answers.

Keep in mind that both Advair and Symbicort are generally the same type of medicine, both having a long acting bronchodilator to prevent bronchospasm, and a corticosteroid to treat the underlying inflammation prevalent in most asthma patients. They are also used for other respiratory illnesses, like COPD.

1. Can Advair cause you to bruise easily?: Even though bruising is not listed as a side effect of Advair, I know a lot of people who use Advair who complain of bruising. Yet, if this is an actual side effect, I also wonder if it could be eliminated with proper technique, i.e. rinsing after using it. I suspect this might be true, but I don't know for certain.

It is true that inhaling Advair directly into the lungs is supposed to eliminate systemic side effects, like bruising. At the same time, not rinsing your mouth out after using it can cause your body to absorb a small amount of the medicine, thus causing some minor systemic effects.

I'm interested in reading what other experts might have to say about this.

2. How long should anyone use anAdvair Diskus and can I use it every now and then? Advair is a medicine that is intended to treat chronic inflammation associated with asthma and prevent bronchospasm. It usually takes 2-3 weeks of continued use to fully get into your system. Therefore, it is an asthma controller medicine that must be used all the time, whether you are feeling good or not.

The corticosteroid component of this medicine (Flovent) strengthens you lungs, reduces inflammation, and creates more receptor sites for your rescue medicine to sit on, and thus makes your Ventolin work better. The long-acting bronchodilator component (Sevevent), works to prevent bronchospasm.

In this way, if you have Adviar in your system at all times, when you are exposed to your asthma triggers your lungs will be better able to prevent them from causing acute asthma symptoms, or make asthma symptoms less severe. And, in this way, the Advair may be working and you not even realize it.

So if you quit taking it on a daily basis you take away all the benefits of Advair, and risk even worse asthma symptoms when you are exposed to your triggers -- and no asthmatic wants that.
So, to answer your question, this is the type of medicine you may need to take forever to control your asthma. Do not change your asthma medicine regimen or dose without first talking to your physician.

For more information, check out this link.

3. I am using Symbicort twice daily can I use anything else to back it up for occasional relief

When I started taking Advair, which is a similar medicine to Symbicort, I had the same question.
The answer to your question is YES! Even though you are taking Symbicort twice a day you may still feel short-of-breath on occasion, and on these occasions it is safe to use your rescue medicine (Albuterol, Xopenex, Pirbuterol) as needed or as directed by your physician.

4. What is an alternative to advair and symbicort with less of an oral thrush side effect? There really is no alternative to Advair and symbicort, as they are the only meds that have both the long acting bronchodilator and the corticosteroid combination to prevent bronchospasm and combat chronic inflammation.

However, it's such a great medicine for asthma I'd hate to see you quit using it due to thrush. Thankful, there is a way to prevent and treat thrush. Check out this link here for some solutions.
5. could long time use of advair cause sore, white spotted tongue and red roof of mouth: The answer is YES.

The steroids that settle in your mouth may wipe our the normal bacteria that live in your mouth that prevent the buildup of yeast or candidiasis in your mouth. Absent this bacteria, yeast may build up and cause white patchy spots in your mouth called thrush.

After using inhaled corticosteroids for over 25 years I I had thrush only once and my doctor prescribed Diflucan. It is a pill I took for only five days, and it worked great. Nystatin is a rinse that works fine too.

Here is a good tip: The best way to prevent thrush is to rinse and spit after every use of Advair or any other inhaled corticosteroid.

6. Can inhaled steroids like Advair cause cavities?: I did read recently that inhaled corticosteroid use has been linked to cavities too, and it is a good idea to brush your teeth after using an inhaled corticosteroid along with rinsing.

If you have any further questions about asthma you can set up an account at MyAsthmaCentral.com. Or you can email me any question at freadom1776@yahoo.com

The best dose of Xoponex for neonates & infants

The following question was asked at MyAsthmaCentral.com. I thought the answer here would benefit asthmatics worldwide:

WHAT WOULD BE THE NORMAL DOSE OF XOPENEX FOR A NEONATE OR INFANT?

Great question. Most experts agree that the adult dose of 1.25 mg xopenex es equally safe for kids. I think the main reason for this is because the airways of kids is much smaller than the adult airway and so disposition of the medicine into the lungs is greatly diminished.

Likewise, the most common method of delivery of the medicine to neonates is by blowing the med by the patoent's face (blowby treatment), and this results in most of the medicine being wasted to the atmosphere (perhaps even as much as 80% of the medicine wasted).

In fact, according to respiratory therapy experts (read this article) the use of the blowby is not recommended. However, with neonates, we have no real other options. Therefore, the 1.25 mg dose is recommended.

A preferred method to blowby is using a face mask, but still 50% of the medicine is wasted to the atmosphere. The best method is using a mouthpiece, but that's not possible with the neonate population.

However, despite what I have written here, the best dose of xopenex is whatever dose works best for your child with the least side effects, and whatever dose your doctor recommends. Most doctors where I work prescribe the 1.25 mg dose, however, on occasion, they recommend the lower doses.

The same holds true for Albuterol. The best dose for neo and infants is 0.5cc Ventolin.

I hope this helps. Any further questions let us know

Here are 12 diseases Albuterol does not benefit

As many of my readers know from reading my past entries Albuterol (and Xoponex> an too) is perhaps one of the most abused medicines in the hospital. While it is a bronchodilator designed to help asthma and COPD patients catch their breath, it is often ordered for diseases that have nothing to do with bronchospasm.

The truth is, Albuterol is a bronchodilator and nothing more.

It's so bad that my Rt coworkers and I often joke that doctors believe in the theory that, "All the wheezes should be treated as bronchospasm (or asthma)," or, "If he's short-of-breath he should get a bronchodilator breathing treatment," or, "If it's a disease in the lungs, a bronchodilator is indicated."

The truth is, all that wheezes is not bronchospasm, and all illnesses that cause shortness-of-breath are not indications for a bronchodilator, and all illnesses of the lungs are not reasons to order Albuterol. Yet that often seems to be the case, as you can see by this post.

What follows are ten common ailments patients are diagnosed with that often cause a doctor to order braething traetments for when a breathing treatment is not indicated and will have no effect on the disease.

1. Pneumonia: Pneumonia is inflammation in the alveolar sacs. Ventolin is 0.5 microns, and the Alveoli are 0.1 to 0.2 microns -- Ventolin can't even deposit into the lungs. And, if by some osmosis process it did make it down that far, it won't do anything anyway because Ventolin does nothing for inflammation, and it will not remove fluid from the lungs. For more information, check out this link here.

2. Cardiac Asthma (CHF, pulmonary edema): I wrote a good article about cardiac asthma a while ago, and I will link to it here. Albuterol does does not heal the heart, and it will not reabsorb fluid from the lungs.

3. Respiratory Syncytial Virus (RSV): This is a virus that causes swelling of the airways and increased secretions in neonates. Studies have been done that prove a bronchodilator is of no use, unless there is an underlying bronchospasm. Likewise, studies show sometimes racemic epinepherine is beneficial to these patients. In most cases, though, studies show simple suctioning of the nares usually clears the lungs before a treatment is even given, making it so a treatment is no longer indicated. I wrote an article about this here and also here.

4. Pneumothorax: This is a restrictive disorder otherwise known as a collapsed lung. It may cause severe shortness of breath, but once a chest tube is in place the patient may breathe just fine. Regardless, because it takes place in the lungs, a bronchodilator is often ordered.

5. Pleural Effusion: Again, fluid buildup around the lungs is a restrictive disease that lessens the ability of the lungs to stretch. Since this process takes place outside the bronchioles, shortness of breath caused by it will not be benefited by a bronchodilator.

6. Lung Cancer: Lung cancer can cause a wheeze because the cancer can put pressure on some bronchioles causing them to become narrowed (squeezing them), and thus they whistle. Since the narrowing of the bronchioles is isolated to one area of the lungs, and the cause is outside the bronchioles (a restrictive ailment), a bronchodilator will be of no use.

7. Fever: I think the theory behind doctors ordering treatments for fever is that they think it's caused by atelectiasis, and that the bronchodilator will somehow reinflate the alveoli. As we now know, Ventolin is too large in size (0.5 microns) to get into the alveoli. And, even if it somehow could get down there, it has no chemical properties that allow it to blow up flat alveoli like a tire pump blows up a flat tire.

8. Atelectasis: See Fever above. Some doctors see atelectasis, or hear it upon auscultation, and assume a breathing treatment will be of some use. Ventolin will not reinflate deflated alveoli.

9. Post operative (prophylactic): One of the surgeons at Shoreline Medical once told me he ordered postoperative breathing treatments because they keep the lungs "clean and open." For this reason one of my co-workers jokes that doctors think Ventolin works the same as Scrubbing Bubbles in that it suds up in the lungs and washes away any crud that might be in the lungs. The truth is, if there is no bronchospasm, a bronchodilator is of no use to the post operative patient.

10. Airway congestion, colds, or influenza: Stuffiness caused by congestion caused by head and chest colds will in no way go away with Ventolin. It will also not clear a stuffy nose. However, it is often ordered for this reason. However, if these ailments may compound asthma and COPD.

11. Meet criteria: This is not necessarily a disease, but it might as well be. Many treatments given in hospitals are not ordered because they are indicated, but because they are needed to meet criteria for reimbursement. Recently I wrote about this over at RT 101. I also wrote a recent post (click here) guestimating how much money is wasted doing non-indicated breathing treatments

12. Pulmonary Embolism: I just about overlooked PE, so here I must add it to the list. A PE is a blood clot that formed in the legs or elsewhere in the body, dislodged, and finds it's way to the pulmonary artery in the lungs and bocomes lodged there. Many times a patients may have two or three PEs at one time. It usually causes symptoms such as crackles, shortness of breath, cough, rapid heart rate, wheezing, leg swelling, anxiety and fever. A PE can usually be discovered via testing, and once the symptoms are figured to be a PE no further breathing treatments should be given. This disease is a good examle of: All that is short of breath is not bronchospasm.

This RT is impressed tonight

I was in the process of doing an EKG while Tracy, the new nurses practitioner, questioned the patient. The NP said, "Does your chest pain hurt more when you take a deep breath?"

"No," the pt. said. "But my doctor did put me on breathing treatments when I saw him last week."

"Why were you put on treatments?"

"Because the doctor said the treatment would help loosen up phlegm from the part of the lung the pneumonia was and help me feel better. But I don't notice a bit of difference and I've taken them now for two weeks."

"Well," the NP said, "That's not what treatments are for."

My face lit up. Tracy looked up at me and smiled. She worked with me years ago on nights. She learned well.
---------------------
So, then I ended up back in the ER 30 minutes later with Tracy and the ER Doc standing next to us, "So, I just don't think when that guys doctor says Ventolin will thin secretions that that's the purpose of the medicine, don't you think?"

"Absolutely," I said. "The medicine doesn't even go to that part of the lung the pneumonia is. But, believe it or not, our protocol upstairs has us doing Ventolin every 6 hours on all pneumonia patients."

The old ER doc said, "I guess they just want to assume Ventolin cures everything and not just bronchospasm."

This RT was impressed. Wow! Not only is the new NP educated properly about Ventolin, so is the old ER Doc.

This is a step forward in the battle for bronchodilator reform.

My answers to your RT queries

Every week I check my statcounter to see who's typing things into Google or Yahoo and being linked to my RT Cave blog. Assuming the queries were not answered, I provide in this spot each week my humble responses.

And, hey, if the query is comical, it deserves a comical response. If it's serious, I treat it as serious. That in mind, here are this weeks queries:

1. career change respiratory therapist to rn : While I think that RT is a noble profession just like RN, we RTs are still working on developing the same kind of respect RNs have in the medical profession. We have made major strides just in the 10 years I've been an RT. But we have much farther to go. That in mind, there are some struggles in the RT community. Likewise, pay is not as great as for RNs. Fair? Well, if you don't think so, you can always become an RN yourself. Still, can you go from a mucus sucker, frivolous Scrubblin-Bubblin giver, roamer of the entire hospital to a poop scooper person who has to take care of the same patient all night. For the advantages and disadvantages of being an RT, click here.

2. how to break up wet lungs: Despite the myth that aerosolized sulfate will bind to the fluid particles in the lungs forcing the body to "exhale" the fluid, this IS -- my friends -- just a myth. Actually, if you have a patient with wet lungs, a diuretic is the best method of getting fluid from the lungs to the Kidneys and out of the body through the urinary tract. For more information about diuretics, click here. If by "break up" you are referring to pneumonia, the only thing that will "break up" pneumonia is the human body's defense system, and sometimes with a little assistance of an antibiotic.

3. what is the indication for albuterol with atrovent? It's basically the preference of the doctor. Some studies do indicate slight improvements when Atrovent is used in conjunction with Albuterol in emergency rooms. Others show that it works well for COPD to improve lung function long term (click here for more). Most studies show Atrovent is not beneficial for asthma patients. Whether they want to believe every study that's out there is up to the discretion of each individual doctor. Out of the hospital Atrovent is no longer used as a rescue bronchodilator. It is used as a "preventative" asthma medication. For more information about Atrovent as a bronchodilator click here and here.

4. coarse lung sounds: There is no such thing as coarse lung sounds. If you are hearing coarse, then what you are really hearing is rhonchi. Click here for more information.

5. dont give incentive spirometer to copd patietns: This is a fallacy. There is no reason a COPD patient couldn't benefit from good old fashioned deep breath with a breath hold followed by a cough. In fact, I would recommend it.

6. will unprescribed ventolin hurt children? Not any more than prescribed Ventolin, unless it was obtained by some illegal source; or unless it is outdated. Still, if you decide to use some other person's prescription, you should at the very least call your or your child's doctor.

7. baby's chest caves in while crying: This could be a sign of respiratory distress. Click here and check the other signs of respiratory distress.

8. atrovent pulmonary oedema: I have not seen any studies that show Atrovent does anything for pulmonary edema. If you find any studies to the contrary I would love to read about it.

9. when to stop singulair for asthmatics: Of course I'm no doctor, but I think the general consensus is you do not ever stop taking medications that are preventative in nature unless some better and safer med comes along, OR if you experience side effects that effect your quality of life. Singulair is a medication that works to prevent you from responding to your allergens, and there fore if you stop taking it you could have trouble with allergies and asthma. Asthma medicine should never be stopped without the explicit direction of a physician.

10. dummies guide to respiratory care: Sometimes that's how I think of this blog. However, none of my readers are dummies. You are all brilliant.

What happens when you drink Albuterol???

When I used to take Ventolin treatments, every once in a while I would splash the medicine into my mouth and stress that ingesting it would cause more serious side effects.

To be honest, there have been few times as an RT that I have accidentally squirted a few drops of Ventolin into my mouth as I twisted off the plastic top, or squirted it into the medicine cup.

This is not something you do on purpose, it simply happens.

Am I alone here?

However I never died, nor did I ever suffer any consequences from doing this, so I simply figured it was safe, like eating grass.

The last time I worked I was called to the ER to do a treatment on a patient who was really cool but mentally challenged.

As I was giving his treatment, his mom told me that she set him up with a mask treatment a few days earlier and left the room. When she came back, she realized the treatment was off his face.

"What did you do with this," she said.

"I drank it."

"YOU DRANK IT!"

"Yep."

She called poison control. They said that he would be fine, that the medicine would be broken down in the stomach and not even absorbed by the body.

I just thought I would share this information in case you were curious

Bronchodilator Reform: The Ventolin Pill

As I was traveling room to room the other day doing my breathing treatments, I couldn't help but get this funny feeling that only a few of the 20 patients on my list actually needed the breathing treatments.

Last night I had a little boy with asthma, and he did need them. I also have a COPD patient who might need them prn, but certainly not every four hours.

For the most part, I have come to the conclusion that about 80-90% of the breathing treatments that are ordered are for reason other than bronchospasm, and are thus not really indicated.

We have one doctor who orders Albuterol QID for all his post-op patients. We have a urologist who orders Albuterol on all his patients who develop Atelectasis or even if they simply develop a fever. And, of course, we have several doctors who order Albuterol Q4 for the diagnosis of pneumonia and CHF.

The funny thing is, none of these reasons are indications for Albuterol. Not only does the medicine not travel to the alveoli, it does not treat inflammation, which is what pneumonia is. It also does not absorb fluid or strengthen the heart.

One of the major concerns of our society is that the cost of health care is too expensive, especially for those who do not have health insurance. Hospital administrators are always looking for ways to cut back on overhead.

So, with this in mind, an epiphany struck me this morning.

Instead of having the doctors order breathing treatments that aren't indicated, and having the patient's insurance (or the patient if he has no insurance) have to pay the $88 per each non-indicated breathing treatment, why don't doctors simply order the Ventolin pill?

This pill would give the patient the same medicine, with the same result, at only a fraction of the cost, and a fraction of the manpower.

The hospital would benefit by not having to buy so much Ventolin ampules, and the RT would benefit because instead of getting burned out doing non-indicated therapies, he or she could spend quality time with the patients who truly need his or her services.

This would be a win-win situation for everybody.

For the non-acute patients with a history of asthma or COPD, they may benefit from having an MDI available on an as needed basis. We charge a fee for the MDI and the instruct, but the use of the inhaler when it is needed is free, or $88 less than a treatment.

This would be far better than giving them a treatment every four hours when they aren't even SOB.

Patients that actually shows signs of bronchospasm may still benefit from Albuterol nebulizers, but the rest can just get the Ventolin pill.

Personally, I don't think Ventolin should be used for anything other than bronchospasm (asthma, COPD, CF). But, if the doctor feels Ventolin is needed for some reason, let's start feeding these patients the pill.

That, my friends, is the Bronchodilator Reform idea of the day. Let me know your wisdom on this topic.

Ventolin does not prevent asthma -- my opinion

When I was 15 and a patient at National Jewish in Denver, all of us asthmatic kids were forced to take 2 hits off a Ventolin inhaler prior to working out.

"Why do this now, when I'm going to need it as soon as I finish working out," I said once. My gym instructor made me run an extra lap for my mouth. So I learned not to speak up, regardless of my opinion.

Still, as soon as I was done with an aerobic session, I found that I needed a little hit of Ventolin regardless of the pre-workout dose. Not always, but there was still that bit of tightness after working out.

In retrospect, I think that even 18 years ago, long before I would even think of entering RT school, I was questioning doctor orders. Still to this day I do not think that Ventolin is a preventative medicine, but it's still ordered that way.

Why else do you think doctors order it QID on COPD patients who show no signs of being short-of-breath, or TID or even Q4 for that matter. At least in the hospital, I see no need to order Preventolin. A steady dose of Allbetterol might work better for some of the sick patients we have, but not Preventolin.

The other morning I had to give a treatment of Ventolin 30 minutes prior to a stress test. This was on a lady who had a history of asthma, but has not had a problem this visit. If she's SOB I see no problem with this, but not just because.

"Well, she has exercise induced asthma," my RT co-worker said.

"So, that's not a preventative medicine."

Is it? I have heard this talk all my life, but on me personally, taking a hit of Ventolin has never prevented asthma. There are other more appropriate medicines that can work preventatively, like Flovent, Atrovent, Singulair, Advair, Azmacort, Spiriva. These are medicines made to help prevent asthma. Ventolin does not prevent.

I have talked to an Internist of whom I really respect, and I asked her if we could DC the treatments that were ordered QID on a COPD patient who had been on treatments for two weeks, but never indicated any signs of SOB.

She said, "NO. We need to keep the Ventolin in his system to prevent an attack. You know that!" She looked at me like I was a dufass.

Oh well. That's all I can do is state my opinion. I have that right. I have a right to my opinion, I have a right to be wrong. I have a right to be stupid. We all have a right to form opinions, as have all the doctors and nurses.

It's one of the better parts of living in America.

Again, I have had asthma almost my entire life. I have been using Bronchodilators off and on since I was about five, have had my own inhaler to abuse since I was 10 (Alupent), have had a prescription to Ventolin since 1991, and have never noticed Preventolin (that's what I call Ventolin when it's used to prevent asthma) ever having an effect on me.

If I was going to have an exercise induced asthma attack, it's going to happen regardless of whether I take a hit of Preventolin. In fact, that's why I take Advair and Singulair, to prevent me from having problems while running. And I do run (okay, since you want to be technical, I jog) 2.5 miles every other day without having asthma, and without using Preventolin. I also do not use Ventolin after I work out.

I've never noticed it to prevent anything. I do notice it treats bronchospasm, but that's old school now I guess. Now that Ventolin comes packaged and marketed as the next coming of holy water, it seems to have unlimited uses.

For more uses for Ventolin, check out my list of 'olins at the bottom of this blog. Of course this is all in good fun, and it's all at the expense of stupid doctor orders -- my humble opinion of course.

Please feel free to agree or disagree with a comment.

Xoponex may soon rival Albuterol in cost

Apparently, Medicare has decided to list Xoponex under the same reimbursement codes as Albuterol, meaning the cost of Xoponex may drop as much as 70-80%. This could mean a lot for any person in need of a rescue drug, because it will provide doctors, RTs and patients with more options.

Of course this decision could be reversed, but if not, it could provide another cost effective option in the care of patients with COPD and asthma. Some studies have shown that patients given Xoponex in the hospital got better faster, other more recent studies show that Xoponex works no better than Albuterol.

And, while some studies initially showed that Xoponex has fewer side effects than Albuterol, more recent studies show otherwise. These new study results may or may not have had an effect on the Medicare boards decision.

Either way, doctors at Shoreline have been instructed to stop using Xoponex as a front line bronchodilator based on the more recent studies. For more information, check out this article.

Personally, based on my experience with Xoponex, I don't think it's worth the added cost. However, if the cost of Xoponex is going to be the same as Albuterol, doctors, RTs, hospitals and, most important, patients will be able to try both meds to see which one works best for them.

Some good asthma/COPD drugs get a bad rap

When I was researching Singulair, I found an article here on the Internet about how Singulair may be linked to depression and suicide thoughts. There were so many complaints of this, that the company that makes Singulair decided to put this as a side-effect on the insert.

You can check out a related link here from Allergy notes, or click here for a full article from Forbes.com.

The same thing happened a few years ago about Serevent. There have been people who have died after taking Serevent. It became so bad that there was talk of actually taking the medicine off the market.

Needless to say, I disregarded both these scares, and now I take both Serevent and Singulair, and neither do I suffer from depression, I also have not died -- at least not yet.

People die of asthma. And it just so happened that in a majority of the cases where an asthmatic has died in recent years, the person was taking Serevent. So some people came to the conclusion that Serevent was a bad med and should be taken off the market, and released statements (like this one, or this one) that scared people.

Yet, as it turned out, there really was nothing wrong with Serevent. Serevent is a good medicine that helps asthmatics better control their asthma. Yet some people decided to abuse Serevent, use it like it were a rescue inhaler instead of one puff twice a day. More than likely, the abuse of Serevent caused the heart to become overstimulated, and the asthmatic dies.

However, and thankfully, the powers that be decided the problem was not so much with Serevent, but with people abusing an otherwise good medicine.

For the record, here is a link to what all doctors should tell their patients about Serevent: click here.

National Jewish makes light of the fears of using Serevent on its website, and in its effort to make sure its patients are fully educated, issued the following statement:

"In a large asthma study, more patients who used Salmeterol died from asthma problems compared to patients who did not use salmeterol. This has received much attention in newspapers and magazines. While the relationship between Serevent® and deaths due to asthma remains unclear, proper use of this medicine can decrease any risks"

To read the rest what National Jewish has to say about Serevent, click here.

The company that makes Singulair, and doctors, have issued statements to their patients that if a patient is currently taking the medicine, and have not had a problem, then they should continue to take it as they have -- as prescribed. If they have a problem, if they have symptoms that are new since they started taking the med, they should stop taking it and talk with their doctor.

That's common sense there, but for PR and legal purposes it has to be said. Likewise, it's something doctors should do anyway -- or at least the pharmacist. Personally, I have never had a doctor go over with me how to use a medicine, or possible side effects. That seems to be a job reserved for RTs and RNs.

But, what if a patient doesn't have contact with an RT or RN? How do these people get proper education on the medicines they take? Is that not the job of the doctor? Or is it the pharmacist?

The pharmacy here gives patients a printout about new medicines, but that's only something knew they've been doing. Only once in my life did a pharmacist ever pull me over and say, "Hey, do you think maybe you are using that thing too often?"

I might have told that pharmacist something like, "Yep, I'll try to behave myself in the future." And then went home and continued to abuse whatever medicine I was abusing -- probably Albuterol at the time.

My doctor never one time told me that I was using this medicine too much. Never. In fact, the only time my doctor ever said anything to me about this was when I brought it up. Then I got the feeling he was telling me what I wanted to hear, and then he promptly left the room before I could ask another stupid and annoying question.

While it is possible that Singulair might have a small chance of causing depression, there is also a good possibility this occurrence of depression was a mere coincidence.

I see this a lot right here in the hospital with Ventolin. I give a breathing treatment with Ventolin to a person, he coincidentally vomits, and the next day I come into work and the patient is ordered on Alupent because the doctor decided the patient was allergic to Ventolin.

Now we have this new drug on the market called Xoponex, which is marketed by the company as not causing the same side effects as Albuterol, and yet, when I give Xoponex, those patients get just as jittery as they were when they used to take Albuterol. Recent studies show there is no difference between the two drugs when it comes to side effects, yet each doctor still holds his or her own opinion.

Many times I meet an extremely short-of-breath patient in the emergency room and note the heart rate is 130. Then I give two breathing treatments to this patient, the doctor goes into the room, notes the heart rate, and says to the patient, "I'm not worried about your heart rate. I think it's just because of all the stimulation from the breathing treatments."

Then the doctor orders another treatment, this time with Xoponex. I don't have a chance to tell the doctor that he is foolish, that the heart rate was up before the patient even had one dose of Albuterol. And, chances are, that his heart rate was up because he was in distress and hypoxic, not because of any medicine he was given.

Now I'm not saying these medicines don't have side effects, nor am I concluding here that Singulair does not cause some people to have suicidal thoughts (however I have yet to have them), or that Albuterol never increases your heart rate (I don't see it very often though), but I think that many of these medicines get a bad rap.

I think these medicines get a bad rap, despite all the good they do, because people who are doing the judging of them refuse to use a little good old fashioned common sense. Instead of assessing the entire situation, they just blame the medicine.

If you take a medicine and you truly notice that something new or different is occurring, then you should stop taking it and consult your doctor. Let's just make sure it's truly a side effect, and not simply an aberration.

Yes, some medicines that are supposed to have euphoric results turn out to be bad after all, like that one medicine that was supposed to be the ideal weight loss medicine that ended up causing cardiac problems. But some medicines that are good, are simply misjudged.

And I certainly pray they don't take a good drug off the market based on a misconception, or symptoms or death that results from lack of patient education more so than the medicine itself; especially when these medicines have the potential to help so many people.

That, my friends, is the thought of the day.

Monday's class: My response to your queries

This post is my weekly attempt to answer Internet search engine queries that lead someone to clicking onto my medblog.

I know that most people click on my site and leave two minutes later frustrated that my site is not what they were looking for. When, in actuality, if they would have hung around a bit, had a cup of coffee with me, they may have found the answer they were looking for.

This is what I'm going to make an effort to do every Monday.

1. vomiting bipap: This is a good question and something that was covered extensively in RT school. There are two types of masks patients can wear who are using BiPAP. There is a nasal mask, and a full face mask. If the patient is wearing a nasal mask, then there's no problem. However, in the hospital setting we use full face masks probably 90% of the time. And, if someone is throwing up with a mask on their face, their risk of aspiration (inhaling the vomit into the lungs and risking pneumonia) increases big time. Take the mask off if a patient is vomiting. If the patient is in the hospital and is on BiPAP to prevent him from needing a vent, intubation might need to be considered to protect the airway.
2. giving mucomyst without a bronchodilator: Mucomyst has the ability to break up thick secretions and making them easier to spit up (theoretically). It can cause bronchospasm, and should always be given with a bronchodilator, such as Albuterol.
3. vaponephrine dose for kids: At Shoreline we use 0.5cc Vaponephrine on all kids. It's safe. I have rarely ever notices an increase in heart rate as a result of this medicine, and usually if the heart rate does increase, it's because of the kid crying because he's annoyed by the RT.
4. efficacy of albuterol with chf: I've repeated this many times on this blog, but Albuterol will do nothing for CHF unless -- UNLESS -- the patient also has an underlying bronchospasm component. If you want to try one treatment to see if it does anything, go for it.
5. is a nurse above a respiratory therapist: Absolutely not. We are a team. Now, RNs are know to have a little more respect in society, but that is slowly changing. The reason is that nurses have been around since the Civil War, and RTs are only just getting started. RNs also get paid more than RTs, but that's only because of the nursing shortage and, partially, because of the respect thing. But, all in all, we are a team.
6. azthmacort: I took asthma cort for about 15 years, and never had much success with it. The main reason for this was compliance, as I was prescribed to use it four times a day. I think it's better to use a steroid inhaler that allows you to use it twice a day to increase compliance. I have better success with Flovent or Advair, but there are other options.
7. barriers to being a good respiratory therapist: Lack of respect I think is the main barrier. And lack of protocols that allow us to really excell at providing the best care to our patients at the least cost to the hospitals. However, due to lack of respect by doctors, many hospitals still do not have respiratory therapy or patient driven protocols. That's a shame, I think, and is the biggest barrier in my mind.
8. albuterol blow-by neonates: I find that most babies do not tolerate masks, however the results of using a mask may vary from patient to patient. If the child is sick enough, he or she might not care. Also, a blowby may result in the loss of 80% or more of the medicine to the atmoshphere. That said, giving a blowby is often better than doing nothing for a child who is having true bronchospasm.
9. should i give my daughter albuterol for croup: Only if there is underlying bronchospasm. Albuterol does absolutely nothing for croup.
10. cpap therapy for copd how it works: CPAP works to improve oxygenation. It helps a patient oxygenate better, and thus allows more oxygen to get into the bloodstream.
11. congestive heart failure croupiness: We hear this a lot in CHF patients. And, more often than not, RNs and RTs mistake this for a wheeze and recommend or order breathing treatments. Actually, this is caused due to increased secretions or fluid in the upper airway, and will not go away with a treatment. I would say that abaout 80% of CHF patients, patients with pulmonary edema, will have this harsh, upper airway, stridorous, croupy sound. This is something they should teach in school, but I'm not sure they do.
12. what is my internet time: Huh?
13. extra shift incentive pay respiratory: What do you mean by extra shift? Do you mean overtime. We get paid overtime for anything over 40 hours just like everybody else.
14. bad experiences with advair: Some people have bad experiences with Advair mostly becaue it has Serevent in it, which can make a person shakey and irritable. I would recommend weaning yourself onto the Advair slowly, instead of starting right out taking it twice a day. I'm patenting that idea. I recently wrote a post about this, check it out by clicking here.
15. stridor and aerosol therapy: See my answer to question #9.
16. duoneb and hyperkalemia: It would be the equivelent of taking an asprin for a heart attack. Need I say more.
17. why respiratory therapists are disrespected: I tried to explain this in my answer to #7 above. Maybe one of my fellow bloggers can word it better than me with a comment.
18. my doctor gave me potassium after an asthma attack why and what does potassium do f: Hopefully he gave potassium because lab results showed hyperkalemia, not because of some frivolous idea that one treatment of Albuterol will decrease Potassium. However, for a further answer, see #16 above.
19. definite sign of impending alcoholism: Okay, sorry sir or maam, but you had to read all of the above to learn that I do not have an answer to this question. Now, I could gather a pretty good educated guess, but I'm pretty sure you'd rather hear from a professional in that area rather than a lowly RT.
20. respiratory therapist 12 hours: I do not know of any hospitals where the RT does not work less than 12 hour shifts.
21. does albuterol breathing treatments make baby sleepy: Actually, it can be soporiphic. I know for it fact it puts some babies and even some adults asleep. Ah, maybe this gives me another idea for an 'olin.

If you have a question I have not addressed here, or if you want an answer right now, feel free to contact us anytime and we'll get you an answer ASAP. You can contact us at Freadom1776@yahoo.com, or RTcave@yahoo.com.

That concludes today's class.