What happens if you have an asthma attack while sleeping, and how do you relieve a flare-up?

You should definitely get someone to get your inhaler for you! In the meantime, steam from a warm shower could help your airways some. You still need the inhaler though so you don’t keep getting worse. I would guess a major flare up would wake you up.

On vacation & forgot your meds: what can you do? How long do drugs last in the med cabinet?

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

Question: I forgot my nebulizer at home i dont have any of my asthma meds what can i do im felling very tight. I normally carry a resuce inhaler with Albuteral and use it in my nebulizer as well but i left everything at home

My humble answer:
First of all, know that you are not the first nor the last asthmatic to do something like this. I’ve done it, and so do many other asthmatic vacationers I see in the ER.

I have a couple options for you.

1. Most pharmacies allow prescriptions to be transferred. If you go to a Walgreens back home, for example, you can go to the Walgreens wherever you are vacationing and just have them transfer over your scripts. You won’t be able to get a new nebulizer this way, but at least they should be able to get you a rescue inhaler. Other pharmacies that will do this are Rite Aid, Walmart, Kmart, etc.

2. In fact, I’m pretty sure any pharmacist would understand your predicament and help you out. I’ve gone to random pharmacies before and have never had a problem having my prescriptions transferred.

3. Don’t be afraid to go to the nearest emergency room. The people that work there will understand your predicament, give you a quick breathing treatment in the ER, and send you home with a rescue inhaler. If you need it, they can also contact the local home health care company and have them supply you with a machine to use until you go home. The doctor there can also write prescriptions for any other medicines you might have forgotten. Since you should never wait too long to treat your asthma symptoms, this might be the best option for you.

4. You might be able to go to whatever home health care company in the area you are vacationing and see if they can hook you up with a nebulizer and vials of meds to last you until you get back home. I’m not positive exactly if they would be able to help you, but you could try.

Good luck!

Question: What is the shelf life of Theodur

My humble answer: Here is a neat article I found concerning the shelf life of medicines.

Basically, most new drugs like Theodur (theophylline) are good for 2-3 years from the date of manufacture. However, once the “original container is opened for use or dispensing, the expiration date on the container no longer applies.” When the product is repackaged for you — the consumer, it is “usually” dated by the pharmacist to expire within one year.

The expiration date of a medicine is the predicted date at which the drug will lose10% of its potency, according to this ABC News post.

The expiration date also assumes you are storing the medicine at the recommended temperature and humidity. According to our own site, theophylline should be “stored between 59-86 degrees F (15-30 degrees C) and away from light and moisture.” This means that it should not be stored in the bathroom where it will be exposed to high humidities during and after showers.

While most drugs like Theodur are not hazardous if used after their expiration dates, the efficacy of the medicine after that date can no longer be guaranteed. Thus, if you are using an expired medicine you may not be getting the expected results.

Question: Is breathing-in more difficult for Asthma patient or breathing-out ?

My humble answer: Believe it or not, asthma is a disease of air trapping. What happens is air comes in, the airways constrict and swell, and air gets trapped in the lungs. While it may feel as though you can’t get air in, the reality is you can’t get air out. In fact, this air trapping is one of the reasons that during an asthma attack it often feels like you can only take in half a breath, or a quarter of a breath.

Those in the medical field may think of this air trapping as intrinsic PEEP. PEEP is air that is left in your lungs after you exhale. Normally PEEP is 2-3 CWP. During an asthma attack, this PEEP increases, thus causing hyperinflation of the lungs (which can be seen on an x-ray). If this intrinsic PEEP gets severe enough, it can lead to a severe asthma attack, and (possible although rare) even death.

This air trapping is also one of the reasons that diaphragmatic breathing is a technique often taught to asthma and COPD patients. The idea is if you give your lungs more time to exhale some more air might escape your clamped down air passages. Of course you probably know your rescue inhaler also works to relax your air passages to, thus letting out this trapped air.

Question: Intal versus Advair for asthma: have problems with asthma (wheezing sometimes) and respiratory allergies. Age 62M. I heard that Advair is a “ramp up” medication for sicker people and has more side effects and causes weight gain. Is Intal less problematic and am I better off with it if it helps or will I create more long term problems by not using Advair right away? Thanks

My humble answer:
You are wise to ask this question. Intal was a popular controller med for asthma in the past, (in fact I was on it in the 1980s) but it is less commonly used today due to much better medicines. It is a anti-inflammatory medicine, but I rarely ever see it used anymore, especially with adults.

The most common asthma controller medicines used today for asthma are inhaled corticosteroids such as Flovent (a ramp up from Intal). Flovent is much more effective for treating inflammation than Intal (at least most asthma experts conclude this).

If you continue to have trouble with your asthma despite inhaled corticosteroid use alone, your doctor might prescribe Advair (or Symbicort). Advair (a ramp up from Flovent) is a combination drug with both Flovent and a long acting bronchodilator called Serevent in it. Advair has been very effective in controlling asthma for many asthmatics, including myself.

There used to be a fear that inhaled corticosteroids had the same side effects as oral corticosteroids (prednisone), but many studies have been done to prove this is not true. If you take your Flovent or Advair properly, and you rinse really well after each use, side effects from these meds should be rare.

In my opinion, if Intal is working for you great. Your doctor may have been wise to have you try it before resorting to inhaled corticosteroids.

If, as you describe, Intal is not working, you might want to talk with your doctor about other options, such as the Advair you mention. Either way, it’s always a good idea to keep in touch with you physician as I’m sure you are doing.

Good luck getting your asthma under control.

If you have any further questions you can contact me by clicking the “contact me” icon above.

National Research Foundation of Korea

Images gallery of national research foundation of korea

National Research Foundation Welcome to the NRF

Call for proposals, Co-operation, National Research Foundation, NRF, funding, human resource development, South Africa

National Research Foundation Home

Expand Singapore’s research capacity and nurture innovation and entrepreneurship: Strategic Research Programmes: National University of Singapore.

National Research Foundation of Korea NRF

On 16 November 2010, Dr. Napoleon P. Hernandez, NRCP Executive Director, had a chance of meeting Dr. Sung Wook Hwang and Ms. Suk Joon Kim of the National Research

JDRF

Juvenile Diabetes Research Foundation International presents research, publications, advocacy, and how to get involved.

National Research Foundation of Korea NRF Asia Science

The National Research Foundation of Korea is one of the leading research funding and management agencies supporting all areas of academic discipline. Subject Area:

National Research Foundation of Korea

Contents NRF overview › History, Organization, Vision › Budget, Programs, Features Global Research Laboratory(GRL) Program › Objectives › Program Details

Republic of Korea National Research Foundation of Korea NRF

The NRF is a national organization responsible for the overall planning and funding of research in all academic disciplines, including basic and applied science and

National research foundation of Korea Academia.edu

Academia.edu helps academics follow the latest research. Home; Log In; Sign Up; National research foundation of Korea edit. Department: Join Academia.edu. Find

Posted by Admin on Sunday, July 14, 2013 – Rating: 4.5

Title : National Research Foundation of Korea
Description :
Images gallery of national research foundation of korea



National Research Foundation Welcome to the NRF


Call for proposals, …

Share to

Facebook Google+ Twitter

How to run better with asthma?

i have asthma, ive had it since i was a kid. i have inhalers, and take meds for it, but it affects my athletic performance. i go to my doc a few times a year for it, but how can i run and not get out of breath quickly, i can run for about 5 min non-stop but then i have to slow down to breath. its annoying. ik there are lots of athletes with asthma. any tips on how to build endurance even with asthma causing me to have rlly heavy breathing?

DREAM Act Supporters Plan "Sabbath Push" In September

A few days ago, I posted on the despicable habit that our prelates seem to have in entangling themselves in dubious alliances with those who publicly support and promote intrinsic evils such as abortion, homosexual lifestyles, euthanasia, abuse of embryos.  All these prelates do is weaken their own voices and compromise their own credibility when they simply must raise their voices – as with the “gay marriage” plans about which Governor O’Malley is noising.

Well, today’s Catholic Standard provides us with a quintessential “case in point”, with Cardinal McCarrick having a “photo-op” with Dick Durbin, one of the most rabid Catholic pro-abortion members of the US Senate and one desperately in need of the medicine mandated by Canon 915 – a mandate that Cardinal McCarrick (and others) refuse to obey, to the detriment of so many souls, including Durbin’s.

In the July 5th issue of the Washington Examiner, (scroll to page 12) Chris Core highlights some “inconvenient truths” about the DREAM act.   The cost of this act will be approximately $ 40,000 per student.  For those Maryland citizens who are already struggling to send their own children through school, this represents an unconscionable burden.  Even more troubling is the injustice to military families.  Many have been stationed here for years, yet they do not get in-state breaks.  We’re talking of children of soldiers, soldiers who are often risking their very lives for their country.  It is patently unjust that those who break the law are being given considerations over and beyond those who put themselves in harm’s way for their country.  You won’t hear one peep from that from the DREAM supporters – not even the Church’s “social justice” clache.

Let’s get back to the Standard piece.  While this McCarrick-Durbin schmooze-event seems to deal with Durbin’s national version of the DREAM Act, clergy of various faiths took the opportunity to announce their “Sabbath push in September”.  It entails “devoting a weekend in September to teaching their congregations about the faith-based reasons to work for its passage”.  Supposedly it’s a national push, and we can be fairly certain that this will happen in the Maryland Catholic Churches.  Else, why would they be touting this?

If we are going to “be taught” during “a weekend”, I might suspect that we’ll have a politically-correct excuse for a homily inflicted upon us.  At the very least, there probably will be some sort of “pastoral letter” read sometime during the Mass.  Do I think we should politely just sit there and endure it?  No!  Don’t worry, I’m not in the least advocating any uproar during Holy Mass.  I am weighing ideas and want to bounce them off others.  Watch this blog for suggestions in the near future.

The many faces (various clinical phenotypes) of asthma

I was planning to make this blog post very pretty with some graphs and tables from a recent journal alrticle. Imagine my dismay to discover that my tardiness to renew my ATS membership had resulted in the suspension of my access to the online blue journal. All good now; subs paid, but access not yet restored. Still, the blog must be posted. Ugly though it may be….

Around 8% of the adult Australian population suffers from ‘asthma’. This means that asthma is a big public health problem. As such, asthma has been given the ‘pathway’ treatment; that is, rules and guidelines have been generated to direct asthma management. These rules and guidelines are also brought into play when asthma management is evaluated.

However, all of this ‘proceduralising’ of asthma mangement assumes that we know and are agreed on what asthma actually is, and how we diagnose it and measure its severity. Unfortunately, this is more of a problem than it should be!

Classically, asthma has been said to be a disease of allergic inflammation in the airways. Eosinophils and mast cells are supposed to be the main mediators of this inflammation; fibrosis and scarring develops early; corticosteroids (such as prednisolone) settle the
inflammation down. If we are agreed on that definition – and that it applies to all ‘asthmatics’ – we then measure severity of asthma by frequency of symptoms and use of bronchodilator medications (such as salbutamol / Ventolin), measurements of airway ‘obstruction’ (such as spirometry and peak flow variability) and ‘exacerbations’ requiring attendances at the doctor’s clinic or hospital and/or use of oral corticosteroids (such as prednisolone).

Those of us who see lots of patients with asthma know how deeply unsatisfactory this approach to classification can be. Some patients present with profound symptoms which settle quickly on classic treatment with inhaled steroids, while others have persistent symptoms and lung function abnormality in spite of mulitple treatments. Some never take their puffers but struggle on with persistent symptoms, never getting very sick. Others have no symptoms for months and months, take their medication then present desperately unwell after an inadvertent exposure.

We need fresh eyes on asthma classificatoins.

I have been encouraged to read a paper, with accompanying editorial, in the Blue Journal from the middle of February which sought to reevaluate how we ‘categorise’ asthma sufferers. Over seven-hundred subjects from the ‘Severe asthma research program’ (SARP) in the USA completed questionnaires as well as physiological tests of lung function. Biological markers of disease were also measured in some patients (exhaled nitric oxide, induced sputum eosinophils). Not all of the subjects had ‘severe’ asthma.

Ultimately five ‘clusters’ of patients were identified:

Cluster 1: 15% of subjects. Younger, predominantly women (80%), childhood onset / atopic asthma and normal lung function. 40% on no controller medication; those on controllers generally on two or fewer. 70% reported no significant exacerbations in the previous year. However 30 to 40 % had almost daily symptoms (perhaps predominantly exercise related?)

Cluster 2: 44% of subjects. Slightly older, 67% women. Mainly childhood onset / atopic asthma. Baseline pre-bronchodilator lung function normal or can be reversed to normal in 94% of subjects. More prevalent medication use (only 26% on no medication, more on 3 puffers). Higher doses of inhaled steroids.

Cluster 3: only 8% of subjects. Significantly different. older women, with older age at onset of asthma and more overweight (58% BMI > 30). Less likely to be atopic. Lower baseline FEV1 with only 64% whose lung function ‘normalised’ after bronchodilator. Higher doses
of medication use and, in spite of this, health care utilisation. (Despite the fact that they are a small portion of the patient population, they are disproprotionately represented in hospitals I think). They have symptoms / quality of life impairments that seem out of proportion to their physiological impairment.

Cluster 4 and 5: the remaining 33% of subjects. 70 or 80% fulfill the ATS criteria for severe asthma. These are the patients with legitimate bad asthma. Cluster 4 was the only cluster in which both genders were equally represented, and atopy predominated (83%). Cluster 5 was later onset, mainly women with less atopy. Each cluster has long duration of disease, and significantly impaired pre- bronchodilator FEV1 commonly. More subjects in cluster 4 had significant bronchodilator responsiveness. Health care utilisation and medication doses were high in both clusters.

These clusters ring true. They fit with my impression of the population of patients with asthma; they differ significantly in important markers of severity, and in particular health care and medication utilisation; ultimately they may provide us with a step towards identifying groups of patients with asthma who sholud be offered significantly different management programs.

Ultimately, the authors found that discrimination between these clusters was possible 80%of the time simply using FEV1 pre- and post- bronchodilator and gender (this is where the missing diagrams would’ve been helpful).

We should trawl through our patient data and assign patients to ‘clusters’ based on lung function and gender. I suspect that we would be weighted towards cluster 3-5. What would be really interesting would be to see if there were medications or management strategies that worked, or failed, for each cluster. Another audit project? Must discuss it with the clinical staff!

Andrew

A Hospital Stay and Asthma Diagnosis

Ramsey’s cough began early this week. A day later, he sounded so bad I knew something was wrong.  We took him to the local ER where they quickly discovered his oxygen was on the low side (it should preferably be 93 or greater; it was falling into the 80′s). To me it didn’t seem quite so alarming compared to his NICU days when 80 was good. I recalled the near ECMO day when his oxygen dropped in the 30′s.  Still, I didn’t want my little guy to be so sick and so upset. Aside from the coughing he was developing a temperature. He threw up several times in the triage area, possibly because he was so distressed over just being there. Let’s just say he has an aversion to most scrub-wearing individuals.

We spent several hours at the local ER. They gave him an IV for some fluids and offered some albuterol to help with the breathing. Next, they decided to transfer him to Children’s Hospital. Based on the stormy weather, Ramsey’s history, and the fact that he was borderline critical, they decided to transport him by air. In typical fashion, I casually told my family that they were “flying us there”. I couldn’t bring myself to say they were life flighting him. I know it was partly because I knew he was going to be OK, and partially because those words would cause sheer panic to anyone that heard them.

In the midst of it all, my husband Dennis made a surprise phone call from his trip to Canada, near Saskatchewan. We live in PA….so we’re talking 2,000 miles apart. I was tempted to lie, instead I told him where we were. I believe at that point, Dennis had a helpless all-out meltdown while Ramsey and I prepared for our flight to Pittsburgh. I told him Ramsey how lucky he was that we were sharing our first helicopter ride together but he wasn’t buying it. He did not enjoy the ER experience. The transport team arrived, and ironically we recognized one another; they had also attended church many Sundays at he hospital. They were absolutely great. They assured me Ramsey would fall asleep once he was lulled by the vibrations of the helicopter and thankfully they were correct. The flight was 10 minutes long and he slept the whole way. I can’t lie, I was strangely tempted to take his picture on that helicopter…but I decided a photo opp was likely inappropriate.

We arrived at Children’s and spent several hours in their ER giving Ramsey more albuterol before receiving a room at 4:30 am. Fortunately, Dennis was vacationing with the husband of our original NICU nurse. (Let’s just say Dennis made a bit of a promise as she tended to Ramsey that first critical day) She contacted the hospital, and with my permission, they were able to release info. about his status. She was able to calm Dennis and to confirm that he didn’t need to find a way to rush home.

They kept Ramsey for two nights. They determined that he had a viral infection that triggered Asthma. Also he had an ear infection that was causing the fever. Finding out he has asthma was not so much a surprise. I’ve expected it all along. I just hope that it remains a mild form of asthma, that he will outgrow it and that we will learn when/how to properly treat him.

I have to keep reminding myself that Ramsey’s surgery is still approaching. I had been preparing for his hospitalization and now a part of me feels like we already got that over with. June 20 will be here before we know it.

Being at the hospital brought back all sorts of memories…I’ll save that for my next post!