Asthma

If you’ve paid any attention to my workout log on the side of the blog you’d would have noticed a lot of walking miles being counted. I’d like to clairify that those aren’t exercise miles, they are walking the dog/errand miles. Some of you know this, but I have never owned a car. That’s right, I’m 27 years old and never had a set of car keys in my hand that belonged to me. I either bus it, walk it, or bike it places. Everyonce in awhile I’ll catch a ride with a friend or my grandparents.

I’ve always traveled on foot. My sister and I walked to elementary school (~5 blocks), we walked to middle school (~ a mile), and we walked to high school (~ a mile). I walked to work at the zoo (I once ran a mile to the zoo in a severe thunderstorm to get the flamingoes in the barn). For several years after I moved out on my own I used to walk ~1.5 miles with my laundry to my Mom’s house to use the washer and dryer. I still walk to get groceries. It is just something I’m used to doing. My sister does the same thing too.

I decided to try and keep track of how many miles I walk as a means of entertainment. This week since I’ve been on spring break my mileage walking is slightly inflated because I’ve had extra time but the total is about 30 miles.

And before you ask, the tread on my shoes get worn out pretty quickly.

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As the photos I posted yesterday showed, I spent some time at the zoo hanging out with my old coworkers and soaking up some much needed exotic animal vibes. Wednesday my old boss suggested I bring my brain to help try and solve the mystery of Ms. Robert’s symptoms. He suggested that they were looking into avian TB as a possible diagnosis so I sent him a paper from the Journal of Zoo an Wildlife Medicine (the AAZK’s publication) on M. avium in penguins and how they diagnosed and handled the case. That sparked some interested in pursuing that line of testing, but no one knew where to send the sample. So, I came out of the zoo with the project of coming up with the technique to use, how to pack the sample, and where to send it. I think this is good practice for when I’m actually a vet, don’t you? The fun part of it is, I may be going to the zoo to help with it next week. They are going to be doing either a leopard physical or baboon physicals next week, so it’ll be interesting if I go!

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Two-toed sloth getting ready to have blood drawn to check a CBC and BUN

Fruit bat getting neutered
Fruit bat recovering from surgery

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Are you compliant with priming the pump before using a metered dose inhaler (MDI) like Albuterol? If you are, congratulations! I have to be honest: I’m not a pump primer.

So, what is MDI pump priming? It’s when you waste 1-4 puffs of the medicine so that when you take it for real you are getting the maximum medicine available.

According to the American Associacion for Respiratory Care’s “Guide to Aerosol Dellivery Devices,” the following are the recommended Priming Requirements for Commercially Available MDIs:

Medication Propellant Time to Prime # of Sprays Albuterols:

1. Albuterol* HFA Prior to first use 3 (With 3 days of nonuse 3)
2. Levalbuterol HFA Prior to first use 4 (With 3 days of nonuse 4)
3. Maxair Autohaler CFC Prior to first use 2 (With 2 days of nonuse 2)
4. Azmacort® CFC Prior to first use 2 (With 3 days of nonuse 2)
5. Flovent® HFA Prior to first use 4 (With 3 weeks of nonuse 4)
6. QVAR® HFA Prior to first use 2 (With 10 days of nonuse 2)
7. AeroSpan™ HFA Prior to first use 2 (With > 2 weeks of nonuse 2)
8. Atrovent® HFA Prior to first use 2 (With 3 days of nonuse 2)
9. Combivent® CFC Prior to first use 3 (With 1 day of nonuse 3)
10. Intal® CFC Prior to first use 1

Despite the recommendation that all MDIs be primed before each use, I have never in my life ever done it — not once.

I have good reason, though, for not doing it. First, when I learned how to use an MDI by my physician in 1980 the practice was never taught. Back then you were taught to place the inhaler two finger lengths from your mouth and squirt.

Second, when I was a kid I was a hardluck asthmatic and a bronchodilatoraholic. That meant that quite often my rescue inhaler (my Alupent back then) lasted me seven days or less, when it was supposed to last 4-6 weeks. So I had to do whatever I could to make the inhaler last longer, and that meant not wasting puffs.

Likewise, as a child asthmatic, I never wanted to bother my mom to run to the pharmacy, so that was another reason to make my inhaler last longer. Yet, even by not priming, my inhaler still only lasted about a week.

Third, I never heard of MDI priming until a few months ago. So after 30 years of not priming the pump, it’s going to take me a while get into the habit.

This is probably the stubborn me talking, but I really don’t see a need to prime. Even if I’m only getting 2% of the medicine when I take my two puffs, that 2% seems to be sufficient. So I really don’t see a need to prime the pump.

Yet theres an old saying this reminds me of: We do the best we can with the wisdom we have, and when we learn better we do better. So perhaps it’s time to change my ways.

As a respiratory therapist, I suppose I’m going to have to add pump-priming to my how-to-use-an-MDI regime.

So, what about you? Did you know about the need to prime the MDI pump? Are you an MDI pump primer? If you’re an RT, do you teach this to your patients?

* Note that Proventil and Ventolin HFA have the same priming requirements.

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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. how do you know someone is a co2 retainer: Their CO2 is elevated, the pH is normal and the HCO3 is elevated. An example gas on room air would be CO2 50, pH 7.40, HCO3 36, PO2 55. Usually the HCO3 will be in the 30s.

2. particle size of advair: For particles to impact in the bronchioles of the lungs the particle size has to be about 0.5 microns.

3. ink: We still need it occasionally when we write in the charts, and to take notes on our clipboards.

4. albuterol stunt growth: No! Albuterol does not stunt growth.

5. does albuterol contain alcohol: Some of the new HFA bronchodilators do contain ethonol. You’ll have to check the package insert to see if your inhaler does. For more information check out #3 above.

6. too tight to hear a wheeze: Sometimes a patient’s lungs are so tight you will not hear a wheeze. In fact, it is quite common that bronchospasm does not result in a wheeze in both COPD and asthma patients. I’ve written here before that I think most wheezes that are heard are not bronchospasm (you can read more here). The best indicators of bronchospasm in my opinion are diminished lung sounds and shortness of breath.

7. asthma go away: There is no cure for asthma. However, by working with you doctor to find the best combination of asthma medicines most asthmatics do manage to gain control of their asthma (check out this post). Be patient, however, because it may take time. You will also have to do your part by learning of and avoiding your asthma triggers, taking all your medicines exactly as prescribed (check out this post). This includes taking your asthma controller meds even when you feel well. It is also recommended you have an asthma action plan to help you decide what to do when you question yourself. Check out the links in this answer and you should be well on your way to better asthma control.

8. how success came about : How do you define success? Do you define it by how much money you make? How much love you get? How happy you are? How satisfied you are? I like to define success as satisfaction. Either way, there is only one way to achieve success and that is by using common sense and making a gallant effort to do your best at whatever you do.

10. deep breathing exercises prevent pneumonia for immobile patient: It can but there is no guarantee. What you have to realize is that healthy people sigh 3-4 times every hour, and the reason they do this is to stretch and exercise the parts of the lungs that are not used on a regular basis — like the lung bases. This ultimately prevents the alveolar sacks from collapsing (atelectasis) and can also prevent pneumonia. It helps you to expectorate any secretions deep in your lungs, particularly in the bases of your lungs. Taking 4-10 deep breaths with a 3-10 second breath hold has been proven to prevent pneumonia.

If you disagree or agree with my opinion feel free to leave a comment below, as we are all entitled to an opinion. If you have further comments or questions, feel free to write it below or email me.

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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. how do you know someone is a co2 retainer: Their CO2 is elevated, the pH is normal and the HCO3 is elevated. An example gas on room air would be CO2 50, pH 7.40, HCO3 36, PO2 55. Usually the HCO3 will be in the 30s.

2. particle size of advair: For particles to impact in the bronchioles of the lungs the particle size has to be about 0.5 microns.

3. ink: We still need it occasionally when we write in the charts, and to take notes on our clipboards.

4. albuterol stunt growth: No! Albuterol does not stunt growth.

5. does albuterol contain alcohol: Some of the new HFA bronchodilators do contain ethonol. You’ll have to check the package insert to see if your inhaler does. For more information check out #3 above.

6. too tight to hear a wheeze: Sometimes a patient’s lungs are so tight you will not hear a wheeze. In fact, it is quite common that bronchospasm does not result in a wheeze in both COPD and asthma patients. I’ve written here before that I think most wheezes that are heard are not bronchospasm (you can read more here). The best indicators of bronchospasm in my opinion are diminished lung sounds and shortness of breath.

7. asthma go away: There is no cure for asthma. However, by working with you doctor to find the best combination of asthma medicines most asthmatics do manage to gain control of their asthma (check out this post). Be patient, however, because it may take time. You will also have to do your part by learning of and avoiding your asthma triggers, taking all your medicines exactly as prescribed (check out this post). This includes taking your asthma controller meds even when you feel well. It is also recommended you have an asthma action plan to help you decide what to do when you question yourself. Check out the links in this answer and you should be well on your way to better asthma control.

8. how success came about : How do you define success? Do you define it by how much money you make? How much love you get? How happy you are? How satisfied you are? I like to define success as satisfaction. Either way, there is only one way to achieve success and that is by using common sense and making a gallant effort to do your best at whatever you do.

10. deep breathing exercises prevent pneumonia for immobile patient: It can but there is no guarantee. What you have to realize is that healthy people sigh 3-4 times every hour, and the reason they do this is to stretch and exercise the parts of the lungs that are not used on a regular basis — like the lung bases. This ultimately prevents the alveolar sacks from collapsing (atelectasis) and can also prevent pneumonia. It helps you to expectorate any secretions deep in your lungs, particularly in the bases of your lungs. Taking 4-10 deep breaths with a 3-10 second breath hold has been proven to prevent pneumonia.

If you disagree or agree with my opinion feel free to leave a comment below, as we are all entitled to an opinion. If you have further comments or questions, feel free to write it below or email me.

Go to Source

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: Will underlying asthma go away?

My humble answer: Asthma a tendency to disappear for months or even years, but once you have asthma you have it forever. Some asthmatics never have symptoms, and some have symptoms all the time. But most asthmatics have occasional asthma symptoms. It is an old fallacy that asthma disappears as one grows older. Still, many child asthmatics see their asthma improve as their lungs grow bigger. Once you are diagnosed with asthma, you should continue to see your physician once a year, and continue to take the asthma controller meds he prescribes whether you are having symptoms or not. Some asthmatics will need to take controller meds all the time, and some asthmatics may eventually and successfully be weaned off their asthma meds.

Question: Should I be taking a second medication with Foradil? Likewise, if I’m on this new medicine, should I keep taking Atrovent?

(Note: Foradil is the brand name of the long acting bronchodilator Formeterol. Formeterol is one of the two medicines in Symbicort. Foradil is a similar medicine to Serevent.)

My humble answer: Great question. Asthma is now believed to be associated with chronic (always there) inflammation (swelling) of the air passages in your lungs. Therefore, most asthma experts now believe that asthma that is not controlled by other medicines should be controlled with inhaled corticosteroids. Likewise, most asthma experts also recommends (as well as the asthma guidelines) that if a medicine like Foradil is required to treat asthma, that an inhaled corticosteroid be used with it. Thus, Foradil alone does not treat the chronic inflammation. Therefore, I highly recommend you talk to your doctor about Symbicort. Check out the link and read about it. It has both Formoterol (which is what Foracort is) and Budesonide (an inhaled steroid) in it. Many asthmatics have had great success with this medicine.

Likewise, if you take Formoterol (or Symbicort) you will not need to take Atrovent unless your doctor requires it. Atrovent is no longer a top line medicine for the treatment of most asthma cases.

Go to Source

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: Will underlying asthma go away?

My humble answer: Asthma a tendency to disappear for months or even years, but once you have asthma you have it forever. Some asthmatics never have symptoms, and some have symptoms all the time. But most asthmatics have occasional asthma symptoms. It is an old fallacy that asthma disappears as one grows older. Still, many child asthmatics see their asthma improve as their lungs grow bigger. Once you are diagnosed with asthma, you should continue to see your physician once a year, and continue to take the asthma controller meds he prescribes whether you are having symptoms or not. Some asthmatics will need to take controller meds all the time, and some asthmatics may eventually and successfully be weaned off their asthma meds.

Question: Should I be taking a second medication with Foradil? Likewise, if I’m on this new medicine, should I keep taking Atrovent?

(Note: Foradil is the brand name of the long acting bronchodilator Formeterol. Formeterol is one of the two medicines in Symbicort. Foradil is a similar medicine to Serevent.)

My humble answer: Great question. Asthma is now believed to be associated with chronic (always there) inflammation (swelling) of the air passages in your lungs. Therefore, most asthma experts now believe that asthma that is not controlled by other medicines should be controlled with inhaled corticosteroids. Likewise, most asthma experts also recommends (as well as the asthma guidelines) that if a medicine like Foradil is required to treat asthma, that an inhaled corticosteroid be used with it. Thus, Foradil alone does not treat the chronic inflammation. Therefore, I highly recommend you talk to your doctor about Symbicort. Check out the link and read about it. It has both Formoterol (which is what Foracort is) and Budesonide (an inhaled steroid) in it. Many asthmatics have had great success with this medicine.

Likewise, if you take Formoterol (or Symbicort) you will not need to take Atrovent unless your doctor requires it. Atrovent is no longer a top line medicine for the treatment of most asthma cases.

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About a month ago I got a letter from the humane society saying that someone had donated a new macaw cage they were looking to give to a needy/deserving bird. Dr. B had talked to them and told them about Hiway. This morning Dr. K and I picked it up and I spent a good two hours putting it together. The result was a cage big enough for me to stand upright in. Needless to say Hiway’s got some wing space now!

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About a month ago I got a letter from the humane society saying that someone had donated a new macaw cage they were looking to give to a needy/deserving bird. Dr. B had talked to them and told them about Hiway. This morning Dr. K and I picked it up and I spent a good two hours putting it together. The result was a cage big enough for me to stand upright in. Needless to say Hiway’s got some wing space now!

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