Tuesday March 4, 2014
Many of you may have heard the adage "all that wheezes is not asthma." As an intern, a first year physician out of medical school, a colleague came across a case of what she thought was asthma. The child was the right age, right symptoms, and a pretty typical presentation. The only problem was she did not get better with the typical treatment. She eventually underwent a bronchoscopy, a special lighted, flexible scope is inserted into the lungs, and surprisingly the lung specialist found a mardi gras bead that was not showing up on x-ray! Happy Mardi Gras.
Photo (c) Getty Images
Tuesday February 25, 2014
Never Discount the Severity of an Asthma Exacerbation
Asthma exacerbations can be life threatening and can occur in anyone with mild to severe asthma. Only 33% of asthma deaths occur in the hospital which means many asthma patients who die are either not seeking care or are not being hospitalized with their worsening asthma. Patients at high risk of asthma related death require intensive education and special care. Make sure you know if you are in one of the increased risk groups discussed below.
Importantly, 80-85% who die from asthma develop progressive symptoms over anywhere from 12 hours to several weeks. Only 15 to 20% die in less than 6 hours after developing symptoms. Thus, the vast majority of patients dying from asthma developed symptoms in a time frame that would have allowed them to seek appropriate medical care.
Risk Factors for Asthma Related Death
All of the following are risk factors for asthma related death:
- Previous history of a near fatal asthma event
- Recent poorly controlled asthma with increased shortness of breath, nocturnal awakenings, and rescue inhaler use
- Prior severe asthma exacerbation where you were intubated or admitted to an intensive care unit.
- Two or more asthma related hospital admissions or three or more visits to the emergency room for asthma
- Using 2 or more canisters of your short acting bronchodilator like albuterol in a month
- If you have trouble identifying when your asthma symptoms are worsening or you are having an asthma attack
- Being poor and from the inner city
- Substance abuse
- Significant psychiatric disease
- Other significant medical problems like a heart attack and other lung diseases
What Do I Do if I am at Increased Risk?
All of the following may help you reduce your risk of an asthma related death:
- Know that you are at risk
- Know your asthma action plan
- Make sure you understand your asthma action plan
- Use your asthma action plan
- Use your peak flow meter regularly
- Do not delay seeking emergency care if your symptoms worsen
- Tell your asthma care provider that you are at increased risk of an asthma related death
- Make sure you can effectively communicate with an asthma care provider effectively
Have you ever had a near fatal asthma attack? Why not go to the forum and tell us about it what it was like and how you are preventing it from happening again.
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Tuesday February 25, 2014
Current asthma guidelines recommend treatment with inhaled corticosteroids to treat chronic inflammation once you need more than periodic rescue inhaler use. Currently, there are no recommendations that one inhaled steroid is better than another and the choice is often based on price and convenience. That does not mean that there is not research or other recommnendations.
A study in the Journal of Allergy and Clinical Immunology compares fluticasone and beclomethasone over a one-year period. The researchers used a patient database to compare effectiveness of these drugs based on asthma control and the number of asthma exacerbations.
The study found that beclomethasone had either a similar or better ability to achieve asthma control at a lower dose than those prescribed fluticasone. This is despite claims that fluticisone is the more potent drug. One possible explanation is that beclomethasone has been engineered to have smaller particles that may allow more of the drug to get to your lungs. This study suggests that choice of a particular inhaled corticosteroid may, in fact, alter clinical outcomes.
The Cochrane Collaboration also analyzed a number of different studies, but came to a slightly different conclusion. At the same doses, fluticasone was slightly more potent, but patients also experienced slightly more side effects such as hoarseness (but not sore throat or oral thrush).
Consumer Reports has also weighed in and made recommendations based on a number of criteria such as cost, effectiveness, and safety record. Rather than say one is better than the other they point out a number of drugs that meet certain requirements.
While it's too soon to say for sure and further long-term comparison studies are needed, you may want to discuss this with your asthma care provider at your next visit.
Monday February 24, 2014
Do you think you might benefit from participating in an asthma medical research study?
In the past I have discussed studies such as an outpatient procedure that uses a new treatment known as bronchial thermoplasty, or radiofrequency-generated heat, that may provide relief if you have severe chronic asthma. Asthma clinical trials are an important part of furthering the discovery process related to asthma. Without trials like this with human subjects we will not make treatment advances.
The goal of asthma medical research studies is to determine if a new treatment or procedure improves asthma outcomes and is safe.
Sometimes patients worry that they are being experimented on. However, everyone who participates in a clinical trial is a volunteer. Healthy volunteers participate to feel like they are contributing to science, while people with asthma might want to participate to get access to the newest treatments and the additional attention and care that you get in a clinical trial.
Clinicaltrials.gov can help you find just about any clinical trial that is currently enrolling patients. Do you have any questions about participating in medical research? What are your concerns or experiences? Please tell me what your experience was like or let me answer your questions about clinical trials in asthma.