Showing posts with label know. Show all posts
Showing posts with label know. Show all posts

Friday, September 27, 2013

SAMTER"S TRIAD - INFORMATION TO KNOW

The disorder is caused by an anomaly in the arachidonic acid cascade, which causes undue production of leukotrienes, a series of chemicals involved in the body’s inflammatory response. When prostaglandin production is blocked by NSAIDS like aspirin, the cascade shunts entirely to leukotrienes, causing overproduction of LT-4 and producing the severe allergy-like effects.
There may be a relationship between aspirin-induced asthma and TBX21, PTGER2, and LTC4S.[3]
In addition to aspirin, other vaso-dilators may induce the same reaction, such as alcohol.


Medication
The preferred treatment now is desensitization to aspirin, undertaken at a clinic specializing in such treatment. Patients who are desensitized then take a maintenance dose of aspirin daily; they have reduced need for supporting medications and fewer asthma and sinusitis symptoms than previously; many have an improved sense of smell.
Treatment formerly focused on relieving the symptoms. Even desensitized people may continue to use nasal steroids, inhaled steroids, and leukotriene antagonists.
Leukotriene antagonists and inhibitors (montelukast, zafirlukast, and zileuton) are helpful in treating Samter’s.
Some patients require oral steroids to alleviate asthma and congestion, and most patients will have recurring or chronic sinusitis due to the nasal inflammation. Desensitization reduces the chance of recurrence.



[edit] Surgery


Occasionally surgery may be required to remove polyps,[4] although they typically recur, particularly if desensitization is not undertaken.



[edit] Diet


A diet low in omega-6 oils (precursors of arachidonic acid), and high in omega-3 oils, may also help.[citation needed]
Some people find relief of symptoms by following a low-salicylate diet such as the Feingold diet. They may need to eliminate the other salicylate-containing foods identified by Swain in 1985 as well.[5] For those who need them, these salicylates are listed in charts in the Feingold Handbook based on level of salicylate measured in the item. Unfortunately, any such list is only a rough guideline since amounts will vary depending on fruit/vegetable variety and where grown; in fact, organic foods have been shown to contain more salicylate than conventional produce because the plant is more likely to be under attack from pests, and salicylate is produced by the plant as protection


Bronchiolitis: Everything you need to know

Bronchiolitis, otherwise known as Respiratory Syncycial Virus (RSV), is a condition common in children that has symptoms very similar to asthma, and is most common between November and April.


It’s more common in children because their airways are smaller and more susceptible to narrowing. Usually it occurs within the first two years, with it’s peak at 3-6 months.This condition presents nearly identical with asthma, and is often treated or misdiagnosed as such.


In fact, according to “Allergy and Asthma: Practical Diagnosis and Management,” it is “clinically indistinguishable from bronchial asthma.”Yet the course of treatment for bronchiolitis is different from that of asthma.


For instance, while corticosteroids and bronchodilators work great to reverse airway obstruction caused by asthma, these medicines do little for bronchiolitis (or RSV). So it’s important to be able properly diagnose RSV from asthma.


According to Allergy and Asthma, “there are laboratory studies designed to identify viral antigens to pinpoint any of the six different viruses that can cause acute bronchiolitis.” This test starts by the RN, RT or lab technician performing a nasal swab to retrieve cells from the nasal passage.


A viral swab won’t rule out asthma, but it can rule in RSV so proper treatment can be
determined. Other viruses that might cause bronchiolitis are: Adenovirus, enterovirus, Influenza virus and Chlamydia pneumoniae.


So, technically speaking, RSV is common cause of bronchiolitis, and not a synonym for it. Yet the two are usually linked hand in hand.


We know that asthma is a disease that causes airway narrowing due to increased secretions and inflammation of the air passages in the lungs (bronchioles) due to exposure to asthma triggers. This results in bronchospasm that is reversible with time or, when more severe, bronchodilators such as Albuterol. Corticosteroids are used to treat the inflammation.


Bronchiolitis, on the other hand, is inflammation of the bronchioles due to a virus. (click here for a good picture of this). Narrowing of the airways can occur, resulting in air trapping and hypoxia.
Another complication of this is increased secretions. Bronchospasm is not a complicaiton of bronchiolitis, and therefore bronchodilators are of little use.


Bronchodilators are of little use for bronchiolitis because this medicine does not treat inflammation, it treats bronchospasm.


However, if asthma is suspected to be exacerbated by a virus (and viruses are the #1 cause of asthma exacerbations), bronchodilators should be ordered prn, or as needed.


I have heard of some doctors prescribing Atrovent for bronchiolitis. Our Pediatricians seldom use this, however our ER doctors do.


However, according to Glenn Campell, RRT and Respiratory Clinical Specialist at Children’s Hospital in New Orleans, Atrovent should rarely be used to treat asthma and bronchiolitis because “it has been our experience that Iprotropium Bromide (Atrovent) will actually exacerbate the issue by possibly causing mucus plugs secondary to “thickening of secretions”.


This, however, is also controversial.


Since there isn’t much we can do to treat viruses, the main treatment is supportive measures.


Usually patients with this don’t need to be admitted, and usually those admitted for it are obligate nose breathers and are dehydrated due to the child being unable or unwilling to take in fluids, such as refusing to breast feed, or refusing the bottle. So IV fluids is usually indicated.


Antibiotics usually are of little use unless a bacteria is the suspected cause (which is rare).


Otitis media may, however, be treated with antibiotics.


Studies show that bronchodilators should be tried, but if no improvement is observed these should be stopped.


Corticosteroids are also often used to treat this condition, however most studies show they have little to no effect on bronchial inflammation due to a virus.


However, some studies show that racemic epinepherine and dexamethasone have shown to be beneficial.


Still, most of the above therapies other than supportive measures remain controversial.


Supportive care may include oxygen and humidity, keeping the head upright, fluid intake (IV may be indicated), and constant monitoring of pulse oximetry to maintian an SpO2 between 91 and 94%.


One of the most effective therapies for bronchiolitis is simply clearing the airway of secretions, . A bulb syringe works nice, although in the hospital booger be gones work very well. Many times, if the SpO2 drops, suctioning alone will resolve the problem.


Nasal Steroid and Neosynephrine also work well to help keep the nasal passages open.For decreased sats and increased respiratory distress, suctioning should always be attempted before a breathing treatment, and many times suctioning alone will resolve the crisis. According to emedicine, the following are common symptoms of RSV:



  • Runny nose

  • Cough

  • Low grade fever

  • Increased work of breathing

  • Wheezing

  • Cyanosis

  • Grunting

  • Noisy breathing

  • Vomiting, especially post-tussive

  • Irritability

  • Poor feeding or anorexia

  • Increased Respiratory rate (50-60 breaths per minute)

  • Increased heart rate

  • Diffuse expiratory wheezing

  • Nasal flaring

  • Cyanosis

  • Inspiratory crackles

  • Ear infection (otitis media)


There is evidence that children who experience RSV are at an increased risk to develop asthma later in life. For more information, check out the following links:


National Guideline Clearinghouse: Guidelines for management of bronchiolitisRC Journal: Respiratory Care of Bronchiolitis Patients: A Proving Ground for Process ImprovementSeattlechildrens.org: Bronchiolitis


Sunday, September 22, 2013

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.


Wednesday, September 18, 2013

Frank Nash: the Most Inspirational English Teacher I Ever Did Know! By Vincent Zandri author of The Remains



I never set out to be a writer. Back in 1979, when I entered the Second Form in a 200 year old, all boys, military school called, The Albany Academy, I simply wanted to become a rock n’ roll star. Like Ringo or Keith Moon, I wanted to play drums in a huge rock band, make a ton of money doing it, get lots of girls, and see the world. While most of the uniformed boys sat attentively in math class, taking copious notes, I drew illustrations of huge drums sets and stared out the window.


All that changed when for the first time, I was introduced to Frank Nash in my second term English lit and writing course. First thing that caught my attention was the classroom itself. The Academy was an old building even back then, having been built in the 1920s. Made of stone and strong woods, with real blackboards instead of chalk boards, the place seemed like a kind of time warp. A school caught perpetually in the 19th century instead of one that would see the 21st century in only two more decades.


But Mr. Nash’s room had a special allure to it since it was filled with photos of famous authors, the most notable for me, was Ernest Hemingway. The framed photo was a famous headshot that I would later learn had been taken by the world renown photographer, Karsh, in 1957, the lens having captured the 58 year old Pulitzer and Nobel Prize winning writer dressed in a big, bulky, turtleneck sweater, his Old Man and the Sea style beard and matching white hair giving him the look of a sea captain or world explorer, which of course fit the bill perfectly for since the adventurous Hemingway was all of those things and more.


I recall Mr. Nash entering the classroom on the very first day of school, the weather still warm and bright and summer-like. He was a tall, thin man, who wore cowboy boots and jeans—a casual style which seemed to go against the more conservative wool-suited style of some of the more uptight Academy profs. A decorated war vet, he sat on a bar stool in the front of the class, and he talked with us like we were his bar buddies, not as if we were a bunch of stupid kids. Our first read for the semester was A Farewell to Arms, and when he described the novel to us, he did so in manner that seemed strange. First off, he referred to the author not as Ernest Hemingway, but as “Papa.” Was Frank Nash Hemingway’s kid? He talked about Papa’s writing habits, about his fishing and hunting and travelling, about his eventual suicide by self-inflicted gunshot. He even demonstrated how Papa placed both barrels of the shotgun inside his mouth, pressed them against the soft palate, and how he triggered the hammers with his thumb. I remember looking up at the Karsh photo and trying to imagine the writer’s head blown off, and I recall being thoroughly spooked, but somehow excited.


Then, and only then, did Nash crack the book and begin to read that lovely, lush opening about being at war with the dust from the road clinging to the leaves on the trees and each sentence connected to the other with the conjunction “and.” Nash loved that opening and as tough and worldly as he seemed, I could see now that it was possible for a hard man to also be a sensitive man of letters.


We talked a lot about Hemingway and war and adventure that first month of school and I came to realize that Frank Nash was an expert on Hemingway. I found myself so immersed in reading “Farewell” and listening to Nash’s lectures on writing and Papa, that I never once felt like scribbling a drum set in my notebook or felt the need to fight off boredom by looking out the window. That is, unless Nash was inviting us too.


I listened and I learned and I wrote my first essays on Hemingway. I also wrote my first short story which Nash read aloud in class as an example of promising material. It was a story about spending a grueling Easter Sunday with my family and it was graded with a big fat, red, “A.” Nash pulled me aside and he asked me what I wanted to be when I grew up. I told him a rock drummer. And he laughed, and said, “Well, maybe you should write some stories along the way.”


When we arrived back at school after the Christmas break, I was excited to see Frank Nash again. It had been a long Christmas break and I was eager to read some more classic novels and to write more stories. But something had changed. Nash was still there, but something had happened to him in the short time that we’d been apart. His hands shook almost uncontrollably, and he seemed out of it. His eyes were glassy and he looked gaunt and pale and sick.


He lasted a few more days that second semester, but then he didn’t show up at all. When the Dean of the upper school sent someone to his downtown Albany apartment to check up on the English teacher, they found a reclusive Nash consumed in whiskey. Empty bottles of Jack Daniels were strewn about the living room and the bathtub was full of ice and cans of beer. The shades had been drawn on the windows and aside from stacks and stacks of books, there was only a desk with an old Royal typewriter sitting on top of it. The pile of manuscript pages beside it contained stories about the old Albany Academy. It turned out Frank was writing a biography of the old military school. He was, at the same time, drinking himself to death.


In the Fall of the next year, the Albany Academy was still there, but Frank Nash did not go to it anymore. Eventually he sought out help for his alcoholism and returned to his native Vermont where he lived with fellow veterans, and wrote some of his own stories and poems. When my first big novel As Catch Can was published in 1999, my publisher sent him an autographed copy. But I never heard back from him. I wondered if he remembered me at all. I wondered if he read the book and if he had, if he liked it. But then, it wasn’t important if he did or didn’t. What was important was the fact that for three months, I was lucky enough to be taught by a man who felt as though he was so close to the words of Ernest Hemingway he could refer to him as Papa in every bit of the fatherly sense of the word. To this day, I think of Nash as Papa in the same inspirational manner. Nash altered the course of my young life and because of him I became a writer. I’m lucky to have known him and even more lucky to remember him the way he was when he was teaching and writing and was very happy.


You can find Vincent at www.vincentzandri.com


or http://vincentzandri.blogspot.com


ABOUT THE REMAINS:
Thirty years ago, teenager Rebecca Underhill and her twin sister Molly were abducted by a man who lived in a house in the woods behind their upstate New York farm. They were held inside that house for three horrifying hours, until making their daring escape.
Vowing to keep their terrifying experience a secret in order to protect their mother and father, the girls tried to put the past behind them. And when their attacker was hunted down by police and sent to prison, they believed he was as good as dead.
Now, it’s 30 years later, and with Molly having passed away from cancer, Rebecca, a painter and art teacher, is left alone to bear the burden of a secret that has only gotten heavier and more painful with each passing year.
But when Rebecca begins receiving some strange anonymous text messages, she begins to realize that the monster who attacked her all those years ago is not dead after all. He’s back, and this time, he wants to do more than just haunt her. He wants her dead.


Purchase the Kindle edition of The Remains for $ 2.99 by clicking here!


Read the Excerpt!


October 2, 2008
Albany, New York


In the deep night, a woman sits down at her writing table. Fingering a newly sharpened pencil, she focuses her eyes upon the blank paper, brings the black pencil tip to it.
She begins to write.


Dear Mol,


I’ve been dreaming about you again. I don’t think a night has gone by in the past few weeks when I haven’t seen your face. Our face, I should say. The face is always in my head; implanted in my memories. The dream is nothing new. It’s thirty years ago again. It’s October. I’m walking close behind you through the tall grass towards the woods. Your hair is loose and long. You’re wearing cut-offs, white Keds with the laces untied and a red T-shirt that says ‘Paul McCartney and Wings’ on the front. You’re walking ahead of me while I try to keep up; but afraid to keep up. Soon we come to the tree line, and while my heart beats in my throat, we walk into the trees. But then comes a noise—a snapping of twigs and branches. The gaunt face of a man appears. A man who lives in a house in the woods.


Then, just like that, the dream shifts and I see you kneeling beside me inside the dark empty basement. I hear the sound of your sniffles, smell the wormy raw earth, feel the cold touch of a man’s hand. You turn and you look at me with your solid steel eyes. And then I wake up.


We survived the house in the woods together, Mol, and we never told a soul. We just couldn’t risk it. Whelan would have come back for us. He would have found us. He would have found mom and dad. Even today, I know he surely would have. He would have killed them, Mol. He would have killed us. In just five days, thirty years will have passed. Three entire decades and I’m still convinced we did the right thing by keeping that afternoon in the woods our secret.


When I see you in my dreams it’s like looking in a mirror. The blue eyes, the thick lips, the dirty blond hair forever just touching the shoulders. My hair is finally showing signs of grey, Mol.


I wonder, do you get gray hair in heaven? I wonder if Whelan’s hair burned off in hell? I wonder if he suffers?


All my love,
Your twin sister,
Rebecca Rose Underhill


Exhaling, the woman folds the letter neatly into thirds, slips it into a blank stationary envelope, her initials RRU embossed on the label. Running the bitter sticky glue interior over her tongue, she seals the envelope, sets it back down onto the writing table. Once more she picks up the pencil, brings the now dulled tip to the envelope’s face. Addressing it she writes only a name:
Molly Rose Underhill


The job done, the woman smiles sadly. Opening the table drawer, she sets the letter inside, on top of a stack of nine identical letters-never-sent. One for every year her sister has been gone.


Closing the drawer she hears her cell phone begin to vibrate, then softly chime. Picking it up off the desktop, she opens the phone, sees that a new text has been forwarded to her electronic mailbox. Fingering the in-box, she retrieves the message.
Rebecca is all it says.


Punching the command that reveals the name and number of the sender she finds “Caller Unknown.” The sender’s number has been blocked. Closing the phone back up, she sets it down on the desk. That’s when the wind picks up, blows and whistles through the open window.
“Mol,” she says, staring out into the darkness. “Mol, is that you?”



Monday, September 16, 2013

How do I know if my asthma is under control? Lifestyle Management


General Tools – Asthma Action Plan
An Action Plan is a written, customized plan to help you take action to manage your asthma. If you know what to watch for and what steps to take, you will be able to make timely and appropriate decisions about managing your condition help prevent your asthma from getting worse. The Action Plan is based on changes in respiratory symptoms and peak flow numbers, and it specifically will:
Give you and your family information about when and how to use daily medications, emergency medications and your peak flow meter.
Help you decide when to call your healthcare provider and when to seek emergency medical care.
Serve as an easy place to keep your crisis intervention plan, self-management instructions or written guidelines.


Components of an Asthma Action Plan
Action Plans should be individualized. Your healthcare provider will develop an Action Plan specifically for you, and your action plan should include the following information:
1. Peak Flow Numbers and Peak Flow Zones
Peak flow numbers measure how well you are breathing. If your peak flow number drops, it means you are having trouble breathing. Peak flow zones can be used to signal you when your peak flow drops a certain percentage. Your healthcare provider will consider certain characteristics of your asthma and help you determine your zones.
2. Asthma Symptoms
Your action plan should tell you what to do when you experience asthma symptoms and when you need to increase treatments to manage asthma symptoms. Your plan will be based on the severity or seriousness of these symptoms.
3. Asthma Medications
Together with your healthcare provider, you will develop instructions about when to take asthma medications.
4. Emergency Telephone Numbers and Locations of Emergency Care
Your written action plan should include information about who to call and where to get emergency care. Your healthcare provider will be able to give you telephone numbers and locations for emergency care during the day or night. You should also include numbers of relatives, friends and other people who can help you in an emergency.
Specific Points to Clarify with Your Healthcare Provider
These are five points that your healthcare provider should specifically clarify for you for inclusion in your Action Plan.
• When should you call your healthcare provider?
• When should you seek emergency care?
• When is quick relief medicine not enough?
• When or if you should increase inhaled steroids?
• When or if you should start taking oral steroids?


Making Your Asthma Action Plan Work for You
Your Action Plan can help you manage your asthma symptoms. Here are tips to make sure it’s available and update for you to use:
Photocopy your written plan and give it to those who can assist you in using the plan, including your spouse or significant other, relatives and work personnel.
Keep a current action plan with you at all times for use in an emergency.
Review your action plan with your healthcare provider at least once a year. Changes in your personal best or baseline peak flow number or medications may mean your action plan also needs to be changed.
If you ever have questions or concerns about your Action Plan, please discuss them with your healthcare provider.


General Tools – Peak Flow Meter
A peak flow meter is a small, easy-to-use instrument that reveals how well your lungs are working. It does this by measuring your peak expiratory flow, which tells you how fast you can blow out air after a maximum inhalation. You use the peak flow meter to help you identify lung performance patterns, which give you information to prevent asthma episodes and develop your asthma management plan.
How it Works
First, you establish your “personal best,” or the highest number you regularly blow. This helps you see when you have changes with your asthma, because it gives you something to measure against. Once you know you personal best, you and your doctor establish treatment rules or “zones.”. You establish your personal best by recording the peak flow values for two weeks first thing in the morning before taking any medications and late afternoon when your asthma is under control..
If your peak flow is less than 80% of your personal best, you take your rescue medication, then wait 20 to 30 minutes and check your peak flow again.
If your peak flow is not back above 80%, report this to your doctor.
If your peak flow is back above 80%, recheck your peak flow about every 4 hours for a day or so. Call your doctor if you continue to need rescue medicine
If your peak flow is less than 60% consider this an emergency: Take your rescue medicine, and call your doctor or go to the emergency room right away.


How to Measure Your Expiratory Flow
Whenever you measure your flow, it is a good idea to write your peak flow numbers in a place where you can track them. Establish one central place to do this so you can more easily keep track of your numbers, such as in a peak flow sheet or Asthma Health Diary. Here’s how to regularly measure your expiratory flow:
Grab your peak flow recording sheet or health diary and a pen and record the date and time, along with any changes in how you feel, changes in your medicines, and/or anything you think may be making your asthma worse.
• Stand up or sit up straight.
• Slide the indicator to the base of the meter.
• Take in a deep breath.
• Place the mouthpiece in your mouth and seal your lips around it.
• Blow out as hard and fast as you can (one quick blow).
• Repeat that process 2 more times.
• Select the highest number of the 3 efforts.
• Record this number on your peak flow diary or on a graph.


When to Check Your Expiratory Flow
When the numbers do not change much from time to time: The peak flow number should be checked once a day (ideally in the morning when you wake up).
When you are doing well: Use the peak flow meter two times during the week and once on the weekend.
When you:
Begin to wake at night with asthma symptoms
Experience more daytime asthma symptoms
Have a respiratory infection (a cold)
You are sick or have asthma symptoms
Check your peak flow number at least twice a day (once in the morning and once in the evening)
When you need to use “rescue medicine”: This is medicine prescribed by your doctor to be used for quick relief of asthma symptoms. Check your peak flow before taking the rescue medicine, then check it again 20-30 minutes later.


Reporting Peak Flow Numbers to Your Doctor
Take your peak flow meter and your asthma health diary with you each time you visit with your doctor or nurse. If you have an Asthma Action Plan from your doctor, follow the plan for each peak flow zone, and compare your peak flow numbers to your personal best.


Signs Your Asthma is Getting Worse
Your peak flow meter is only an aide to you, so do not rely on your peak flow numbers alone when deciding whether to take your rescue medicine or call your doctor. In addition to measuring your peak flow on a daily basis, you should always look out for early warning signs of an asthma attack, which are:
• Runny, stuffy nose
• Fatigue
• Chin or throat itches
• Headache
• Moodiness
• Cough with activity or laughing
• Wheezing with activity
• Waking up at night or early morning with a cough or wheeze
• Faster breathing rate
• Irritability


General Tools – Peak Flow Zone Chart
The following shows an example of how these zones work. Your doctor can help you create a similar table for your own asthma.


Green: 80-100% of your personal best
• Your breathing is good.
• You do not have any early warning signs or asthma symptoms.
• Take all your medicines every day, as your doctor tells you.
• Take your inhaler before exercise, as your doctor tells you.


Yellow: Caution 60-80% of your personal best
• Runny, stuffy nose.
• Feel more tired.
• Chin or throat itches.
• Sneezing.
• Restless
• Red or pale face
• Coughing
• Dark circles under your eyes
• Use “rescue” medicine
• Recheck peak flows after 20-30 minutes
• Call your doctor, healthcare professional, or nurse care manager:
• if your peak flow is not back to the Green Zone
• if your peak flow drops into the Yellow Zone again in less that 4 hours.


Red: Danger Below 60% of your personal best
• Cough, more at night
• Wheezing
• Chest feels tight or hurts
• Breathing faster than normal
• Get out of breath easily
• Use your quick-relief medicine by inhaler or nebulizer right away!
• Call your doctor or 911 NOW


Article source: http://www.nationaljewish.org/healthinfo/conditions/asthma/lifestyle-management/tools/action-plan


Picture source: http://srxa.wordpress.com/2011/05/03/you-can-control-your-asthma-2


Friday, September 13, 2013

Here"s how to know if you need asthma specialist

I’ve received many questions from asthmatics who were having difficulty managing their disease and were wondering what to do next. Often the answer is to seek an asthma specialist. Recently I wrote a post at MyAsthmaCentral.com regarding this topic.


Do You Need An Asthma Specialist?
By Rick Frea, Tuesday, May 25, 2010, @ MyAsthmaCentral.com





So, when is a good time to see an asthma specialist? That is a good question, and a common one.


Thanks to modern science and the National Heart, Blood and Lung Institute’s asthma guidelines, most doctors are able to treat most asthmatics, and treat them well.


Yet, from time to time, there comes along an asthmatic whose asthma is difficult to control. When this occurs it’s time for your doctor to call in the reinforcements: the asthma specialist or other specialist.


In my opinion, a wise person — wise doctor in this case — is one who knows the boundaries of his study, and knows when it’s time to refer his patients to a specialist.


1. Asthma Specialists: According to the asthma guidelines, this constitutes:



  • An Allergist: Specially trained in allergy and asthma

  • A Pulmonologist: Specially trained in lung disease

  • Ear, nose and throat doctor: They specialize in these areas

  • Other: Any doctor who has extensive training and specializes in asthma


Thankfully, in today’s medical world, doctors can refer to the asthma guidelines for a little help. The asthma guidelines (see page 71) recommend your physician refer you (or your asthmatic child) to an asthma specialist when:



  • You had a life-threatening asthma attack

  • You aren’t meeting goals of asthma therapy after three to six months of treatment

  • You have difficult-to-manage asthma (hardluck asthma)

  • Your signs and symptoms of asthma are atypical

  • Your doctor has trouble diagnosing your asthma

  • Other conditions complicate your asthma, like allergies, sinusitis, nasal polyps, and severe rhinitis, GERD or COPD.

  • Additional diagnostic testing is needed, such as allergy testing, scope of your nose (rhinoscopy), pulmonary function studies, or scope of your lungs (bronchoscopy)

  • You need additional education or guidance. Let’s face it, sometimes it’s hard to adjust to this disease. You may need help learning what your asthma triggers are or how to avoid them. You also may need help remembering to take your medicines, or taking them correctly.

  • Your doctor thinks you might benefit from allergy testing or allergy shots (immunotherapy)

  • Your doctor suspects you need more than just typical asthma care, or need closer managing or specialized asthma medicines.

  • You needed more than two bursts of corticosteroids within one year, or you needed to be hospitalized for your asthma

  • Your asthma is being caused by something you inhaled at work or other environmental inhalant that is complicating your asthma or treatment.


2. Psychological and Social Specialists: Another thing that can complicate asthma are social or psychological circumstances. These, among other things, may trigger asthma or complicate your (or your childs) ability to care for yourself:



  • Anxiety

  • Depression

  • Stress

  • Substance abuse

  • Marital problems

  • Abusive spouse or parents

  • Poverty


In this case, your doctor will want to refer you (or your child) to specialists such as a psychologist or social worker.


When I was 15 in 1985 my asthma was so bad that my doctor referred me to the specialists at National Jewish Health (NJH). While getting my asthma under control, my doctors realized anxiety was triggering my asthma and complicating my ability to care for myself.


I ended up staying at this asthma hospital for six months while they treated all these problems, and I have to admit, what I learned there still benefits me to this day.


While at NJH I also met kids who were addicted to cigarettes or — believe it or not — drugs. As you can imagine, these things complicated their asthma.


I also met a couple kids who had terrible home circumstances. One kid had alcoholic parents, the other abusive parents.


Thankfully there were, and are, specialists to help us get our lives and our asthma under control despite these exceptional circumstances.


3. Family Counseling: Sometimes family members, especially parents, need to see a specialist to learn how they can better take care of their family members, particularly their children.


The following are some examples of when family members might need help from a specialist:



  • General guidance in how to manage asthma

  • Parents of children with hardluck asthma

  • Parents of children with anxiety or depression

  • Parents in abusive homes

  • Substance abuse in home

  • Cigarette smoke in home


My parents received counseling before I left NJH to teach them what my asthma triggers were, and to show them how to make their home more asthma friendly. They also learned how to better help me manage my asthma.


While specialty hospitals like NJH are still around to help asthmatics and asthmatic parents, their programs are mostly outpatient orientated. Also, doctors are better educated today so most of us can get the care we need by specialists close to our homes.


And, while most doctors know when it’s time to refer you to a specialist, sometimes you may need to nudge your doctor. After all, doctors are only human.


If you think you or your child needs to see a specialist, don’t be afraid to talk to your doctor.