Week 5 – Question of the Week: How should asthmatics prepare to survive an Armageddon event?

Week 5:  2011-04-07

 Today I’m asking our professionals to weigh in on the question:    How should asthmatics prepare to survive an Armageddon event?

You, too, are welcome to post your responses and questions below. 

Check back soon and see what our panel of over 100 professionals has to say.

– Doc Cindy
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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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13 Responses to Week 5 – Question of the Week: How should asthmatics prepare to survive an Armageddon event?

  1. Katie H says:

    I have asthma and I discovered that taking a combination of good quality fish oil like Carlson’s with organic flax oil and a good probiotic will lessen asthma and allergy symptoms considerably. After taking this mixture in a daily morning smoothy for two weeks I went from using my rescue inhaler daily to not having to use it more than twice in a month. It was during the spring allergy season and I had minimal symptoms if any. Don’t underestimate the importance of proper nutrition in treating ailments!

  2. james says:

    Exercise has “cured” many asthmatics and is one of the best preventions. If poorly tolerated, there are other options to increase lung volume (such as incentive spirometers).

    Reduce triggers, something that should be done anyway.

    There are many compact battery powered nebulizers available,and some that can be used with 12v adapters.

    A good stockpile of your prefered beta-agonist in both MDI and nebulizer forms.

    An ECA stack(ephedrine, caffeine, ASA) is a potent beta-agonist, just don’t forget the alpha effects. This can be substituted for with herbal alternatives with somewhat lessened effect. Doc Cindy adds: remember, aspirin may trigger an asthmatic response in many individuals, so use with caution}

    An o2 concetrator that uses 12v and produces low concentration o2 can be used along with a reservior nasal cannula (OXIMIZER) can be used to provide higher concentrations of inspired o2(up to 4 times the flowrate)

  3. pa4ortho says:

    The only thing I can add to the discussion is:
    1. A neb can be run by air from a boat foot pump without all the fuss of electricity or air/O2 tanks.
    2. Control sinus drainage aggressively if that is the trigger. Antihistamine, decongestant, nettie pot/iv tube irrigation, ABO, last ditch for those with the training is an awl driven up and in over the incisor root will drain the maxilary sinus into the oral cavity. {Doc Cindy adds – don’t try this at home}
    3. Asthma with pneumonia trigger, change from supine to prone, lower the head, percussion, humidity.
    4. Recognize a losing battle if this is a long term chronic severe condition, and assess your resources.
    5. Cooking and heating with wood can be a trigger.
    6. A clean room with little stuff, hard floors, no window (mold), mite-free bedding should be planned for known environmental allergic folks. This room doubles as a sick room, isolation room, place a vacuum with the hoses reversed venting into the room, creating positive pressure to keep allergens out. (assuming grid is up)
    7. Wash hands, don’t get sick. A retreat maintaining strict isolation will go a long way in preventing illness that may be rampant in poor hygiene, malnurished “zombies”
    8. Albuterol mdi stores well. Dexamethasone tabs store well, has anyone located bulk Albuterol powder for reconstitution into syrup or neb solution? Liquids don’t store well.
    9. Nebulized saline can sooth airways and loosen secretions, similar to steam.
    10. In severe cases with onset of respiratory fatigue, bvm assist resp can be a temporary solution, just let the patient breath and assist with inhalation. It does not assist with exhalation. Air trapping is still a problem.
    11. A crich will reduce dead space ventilation. see suggestion #4
    12. Perform a history and physical exam on prospective members of your team. Screen for this and if you still want ’em, store lots of meds.

  4. JLyo says:

    1. Stay healthy. Avoid known triggers, smoking, and areas of poor air quality.
    2. Stockpile daily medications.
    3. Stockpile emergency inhalers.
    4. Obtain home 02 Rx, and high flow 02 delivery devices. The bag on the non-rebreather mask may be removed and a nebulizer attached at this port.
    5. Obtain Albuterol 2.5mg/3cc and/or Ipratroprium Bromide, another bronchodialator that works on the opposing side of the PNS than Albuterol.
    6. Obtain epinepherine 1:1000. 0.3-0.5mg administered sub-cutaneously. *
    7. Obtain antihistamines such as Benadryl. Don’t forget that other prehospital drugs that are used for other purposes (e.g. haldol, promethazine) are in the antihistamine class. This is a grid-down risk-a-lot to save-a-lot proposition.*
    8. For attacks that are not controlled by first-line medications, or “status asthmaticus,” other medications such as Magnesium Sulphate 2mg IV as a smooth muscle relaxant and steroids such as prednisone or solumedrol may be needed in conjunction with advanced airway procedures and assisted ventilations.*
    9. Other medications that may be available in your locale may include Aminophylline, Theophylline, Serevent, and Caffiene.
    *should only be performed by trained personnel.

  5. Chevalierde says:

    Asthma is often triggered by environmental factors: allergens. So, see an allergy specialist and get tested to determine which environmental allergens are causing the asthma. Then get allergy shots – basically a vaccination course against the allergen. This takes 1.5 to 2 years and will essentially permanently decrease (possibly cure) your asthmatic reaction to the allergens.

    In the meantime, while you have access to professional medical advice and modern medicine, be diligent about managing the asthma symptoms. DO NOT ‘tough it out’ without seeking medical help, including pharmaceutical aids to manage symptoms. This can cause permanent damage and scarring to the lungs.

    Everyone’s lung function deteriorates with age. What you want to do is make/keep the lungs as healthy as possible, so you are deteriorating from a very high peak function. So get plenty of cardio exercise and otherwise take good care of your lungs. For example, wear a filter mask (or test out your emergency gas mask) when working with airborne particulates or chemicals which could cause lung damage.

  6. 1. Extra supply of inhalers. If power goes out, nebs won’t be easy to do in your home.
    2. Consider purchasing a few aluminum oxygen cylinders (E size) with regulators. Very lightweight. Need an Rx from your MD for the oxygen, but gives you a backup for neb delivery, and/or supplemental oxygen.
    3. Epinephine! Epi Pens are expensive, but the 3cc ampules of Epi and 1cc syringes are really cheap. Talk with your MD, but Epi 0.5mg SQ – 1.0mg SQ hasn’t failed me yet in a serious asthma attack or anaphylaxis.
    4. Antihistamines… Benadryl, Pepcid AC (or generic equivilant). Keep histamine responses limited as much as possible.
    5. The dreaded “E” word… Exercise… Get your lungs as “strong” as possible BEFORE an emergency… You will have a much better “reserve”, and ability to deal with a serious asthma “attack”.

    • Jeff M, EMT says:

      I forgot to mention that you can absolutely use Epinephrine in a nebulizer. It’s not as fantastic as Racemic Epi, but it works pretty well… We mix 1cc 1:1,000 Epi with 2ml. sterile saline or sterile water.

  7. Lucinda G says:

    Primatene mist is the only OTC asthma inhaler available in the US.
    it is being pulled from the market on Cec 31, 2011 because it’s propellant has chlorofluoracarbons in it, which are bad for the ozone layer! Stock up on some. It may save a life.

  8. KF says:

    Obviously, asthmatics who have a history of the condition know what precursors trigger and worsen their onset of pulmonary attack.
    If, it is an allergen, avoid it.
    If is triggered by exertion or stress, avoid it.
    If you have NO idea what triggers the onset, start logging everything you do, eat, drink, sleep, wear, come in contact with, or touch or smell, (perfumes, animals, cleansers,etc.) just before the symptoms begin.

    Also, document what helped, if anything, to ease the symptoms? A steam enclosed bathroom?
    The use of a menthol topical rub like Vicks Vaprorub applied on your chest?
    The calm voice of a friend or loved one assisting you through the strident breaths?
    The act of induced vomiting? Yes. Some children need all the square inch space available above their diaphragm to exchange that air in an emergency.

    If you are already on prescriptive meds that are effective in controlling your asthma, then request several months of prescriptions from your M.D. so you have at least 2 years in storage for hard times.

    Sometimes, you can gain relief to open bronchioles with inhalant or nebulizer treatments.

    A nebulizer and an ample 2-year supply of equipment tubing and in-line medication cups should also be stocked and stored. Sterile water can be made at home by boiling the water for 10 minutes and bottling it in a sterile (boiled) canning jar and lid. Keep several jars on hand if you are making your own. If you wish to make saline, add only non-iodized salt at 1/4th tsp. per quart (1 Liter) into the boiling water.

    If no Rx meds (like albuterol or Epinephrine), are available, and all the above suggested still have not ceased the stricture, wheeze and stridor, then attempt to give an OTC inhalant like Primatene Mist. Use with caution and forewarning that one puff is quite potent and can cause unintended consequences of cardiac symptoms. Primatene Mist, (epinephrine) has been slated for revamping of it’s formula to reduce it’s current potency, by it’s maker at the end of this calendar year. There have also been some consumer concerns and rumor that it would be taken completely off the OTC market.

    Don’t forget the availability of either an inverter to power that AC nebulizer with a 12 volt battery, in the event of loss of electrical power, or the use of a generator.
    The 12 volt battery is a lot quieter.

    One thing is for certain, stress will be abundant in a TEOTWAKI event, so expect a full moon effect for asthmatics!

  9. Drew says:

    Though the military will not release the actual results of their SLEP study, we do know that many medications are good long past their expiration dates. I have received advice from a chemist that the albuterol chemical contains few points for oxidation to occur. I believe it would be prudent to stock up on albuterol MDI’s and home nebulizer treatments if available to you.

    You could also talk to your doctor about other non-inhaled medications that help to prevent asthma attacks, like Singular, and stock up on those.

    Primatene mist is an inhaled form of epinephrine. The FDA, in their infinite wisdom, will be banning primatene at the end of this year, so get it while you can.

    Find a source of injectible Epinephrine 1:1000 (like at a feed store) and learn how to use that as a last resort post-TEOTWAWKI. AKA take an EMT class.

    Also take an A&P class at your community college to learn more about your disease process.

    Create a stockpile of caffeine products. Caffeine is chemically similar to theophylline, and is a weak bronchodialator. One pubmed article found that caffeine improved respiratory function for up to 4 hours.

  10. Chris MD says:

    As with anyone who has a chronic, medicine-dependent illness, you may be well and truly screwed if you are a brittle asthmatic and a true TEOTWAWKI situation occurs. But for the vast majority of situations we are likely to face (limited in scope and time) making sure you keep your prescriptions current, and that you have a rotating stock of your meds is the best advice. Now, for asthmatics, there are some herbal options. Theophylline is found in tea, and can be used up to the limit if the systemic side effects. However, none of these alternatives will replace an inhaler or nebulizer if you are in deep trouble. As I have said in previous threads, if we lose our manufacturing base, medical care falls back to 1700’s era quickly.

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