Asthma and COPD – Part I – Introduction

Heart and lungs

Image via Wikipedia

The following is excerpted from my upcoming book, Armageddon Medicine.

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Does the thought of not having a rescue inhaler on hand fill you with panic?  What will you do if albuterol is suddenly unavailable?   

I remember the days when severe asthma attacks were a common occurrence, often necessitating hospital admission.  Since controller medications became a mainstay of therapy over a decade ago, the incidence of severe illness has markedly decreased.  With so many options now available, it is nearly always possible to keep an asthmatic patient healthy and out of the hospital. 

But what will you do if the drug supply chain is interrupted?  Will you be able to breathe freely?  If an evacuation is ordered, will you be able to keep up? 

Asthma does not behave the same in every patient.  Many cases are so mild the patient is unaware of the diagnosis.  In other patients the disease is life-threatening.  But in every situation there are steps you can take to limit the impact of the disease. 

Probably the most common type of asthma is the mild, intermittent form.  These patients usually have no symptoms, though they may develop a cough, wheeze, or shortness of breath on occasion, usually in response to a trigger.  Common triggers include respiratory infections, allergies, dust or chemical exposure, changes in temperature, or exercise-induced.  People who are subject to ‘chest colds’ may well have low-grade asthma (or COPD, in the case of smokers). 

These patients require either no asthma medication or only occasional use of an inhaler or steroids.  Avoiding triggers is the best way to prevent an asthma flare:  limit exposure to respiratory infections, get an annual flu shot, stay away from pets or anything else to which you are allergic.  Although the printed directions for many antihistamines say to avoid their use in asthmatic patients, for allergic asthma, over-the-counter antihistamines may actually be helpful (Benadryl, Claritin, Zyrtec, and chlorpheniramine).  Pseudoephedrine, the best decongestant for upper respiratory tract congestion, is also often effective for lower respiratory congestion, and may improve mild bronchial swelling

Patients with intermittent symptoms may find they benefit from occasional use of an albuterol inhaler as well, but this is not the only option. Caffeine opens the airways similar to aminophylline, the mainstay of asthma therapy twenty years ago.  Like caffeine, essentially any medication that has the benefit of opening the airways by dilating the bronchial tubes has the potential side-effects of jitteriness and insomnia. 

How does mild asthma compare with a severe case?  Patients with severe asthma or COPD never breathe normally.  They may think they do so because they’ve become accustomed to the situation over the years, but on pulmonary function tests doctors find their breathing capacity is decreased, particularly the ability to exhale.  Fortunately, the body has a significant degree of reserve capacity.  People can live with only one lung or the equivalent. 

With multiple medications, severely affected patients can live normal lives.  Generally this involves taking an inhaled steroid, perhaps along with another controller drug such as Singulair or a long-acting bronchodilator.  Many patients still require albuterol and/or ipratropium inhalers on a daily basis, and would be expected to need oral steroids when a flare occurs.  Some require oxygen.  For severely affected patients, avoiding triggers is even more important. 

If you or your child suffers from asthma and if medications were suddenly unavailable, what would you do?  Could you stand by helplessly and watch your youngster suffocate?  Fortunately there are options to help you prepare. 

To start with, asthma and COPD patients should do all they can to remain healthy.  Maintain a healthy body weight, don’t smoke, exercise regularly, eat well. 

Next, become an expert at avoiding triggers.  Stay away from dust, fumes, and pollen.  Wearing a mask or face-protector is a consideration.  Limit exposure to animals, especially pets.  Many patients believe their own pet is not causing a problem, but while an asthmatic may not suffer an asthma attack when holding his or her own pooch, chronic exposure may also cause on-going low-level symptoms. 

Patients who have exercise-induced asthma may choose to avoid the level of exertion that brings on symptoms.  On the other hand, many of these patients may find they can actually exercise longer if they first induce asthmatic symptoms with a short bout of exercise, followed by a recovery period of 10 to 30 minutes.  When breathing has returned to normal and exercise is then again attempted, the airways frequently exhibit less of a tendency to constrict.  

Two peak flow meters.
Image via Wikipedia

Third, get a peak flow meter.  Repeat, get a peak flow meter.  This handy little device, costing under $30 (and often covered by insurance) will help you assess your breathing even before you experience symptoms.  Physically, you may not notice a 10% reduction in your breathing, but it may be a signal to you that a flare is about to occur.  Then you can act proactively to ramp up your medicine or adjust your behavior if needed.

Medication remains the mainstay of asthma treatment.  Although prescription medication is essential for the majority of patients, are there any over-the-counter remedies that work, something easy to stockpile without a doctor’s permission?

Copyright © 2010 Cynthia J. Koelker, MD

To be continued in Part II

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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8 Responses to Asthma and COPD – Part I – Introduction

  1. Deanna says:

    I have aquired inhalers from my doctor by asking for samples. It gives me a chance to see which ones work best (Advair, Qvar, Serevent etc.) Most docs have samples and can aquire more from the drug company sales rep.

    As for outdated inhalers, I have used the old (before HFA) as old as 8 yrs out dated with no problems. I feel that they give me faster relief than than a new HFA inhaler.

    It all comes down to using what you have if there is no medical treatment available. I would use an expired inhaler (no matter how old) on myself or my son rather than use nothing at all.

  2. Stephanie says:

    I know you’ve looked into medication shelf-life before, but what about albuterol inhalers? They seem to have a fairly short shelf-life and as the mother of an asmatic child (allergic & respiratory illnesses), it’s my biggest emergency planning/stockpiling concern. Are they stable and effective for emergency use after the expiration date? If so how long?

    [I have only anecdotal evidence to answer this, based on what my own patients have done. The manufacturer would certainly say to discard outdated medicine, but I have had patients who (mostly inadvertently) used inhalers at least 2-3 years old with good relief and no ill-effect. The Advair, Serevent, and Flovent Diskus devices have each dose individual packaged in aluminum foil, so it is hard to imagine how the powder can go bad. Metered dose inhalers may be less accurate in the delivery of the dose. One thing you can do when you purchase inhalers is to ask your local pharmacist for the box with the latest expiration date. They may not want to do sell their stock “out of order” but if you insist, they’ll probably at least check. Mail-order pharmacies are unlikely to comply. – Doc Cindy]

  3. The price for Spiriva I find online is $230 for a month prescription. Seems high, doesn’t it?

    The closest alternative to Spiriva is ipratropium bromide, which is in either Atrovent or Combivent (neither of which appears to currently come in generic since changing to the HFA formulation). Combivent is $190 at . . . still a pretty penny. Inhaled steroids work as well for many people – a month of Flovent is about $116. Other inhaled steroids may cost less – ask your pharmacist which is the least expensive before asking your doctor about switching your prescription.

    The CHEAPEST way to go is with iprotropium aerosol solution. Once you have a nebulizer, the medicine is only about $10/month at WalMart, which also has Ventolin ReliOn (albuterol 60 dose inhaler) for only $9.

  4. Rick N. says:

    Is there anything cheaper than Spiriva? Maybe a generic or something natural? Thanks a lot.

  5. Ron Tedwater says:

    Great work keep it coming

  6. Ron T. says:

    Great work – keep it coming.

  7. CNA says:

    Do you people have a facebook fan page? I looked for one on twitter but could not discover one, I would really like to become a fan!

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