Dallas Allergy

REMINDERS FOR PATIENTS WITH ASTHMA

There are a number of special issues and problems that arise from day to day in dealing with asthma. The following is a list of concerns that we encounter most commonly:

·Peak flow monitoring is recommended for all patients with persistent asthma five years of age and older. Daily peak flow monitoring is important for early detection of an asthma flare so that medication doses can be adjusted to prevent progression to a serious asthma attack. Peak flow monitoring is not perfect. If there are symptoms, but the peak flow is normal, treat the symptoms.

·Asthma aerosol inhalers should always be used with a spacer device. Spacer devices (e.g., Aerochamber™, InspirEase™, or Optihaler™) improve delivery of the inhaled medications to the small bronchial tubes and reduce medication side effects by reducing the amount of medication that is swallowed and absorbed through the gastrointestinal tract. (The exception is Maxair Autohaler, which is not used with a spacer device.)

·To prevent thrush, rinse your mouth after taking inhalers. Inhaled medications (especially inhaled corticosteroids) may settle in the throat and cause a whitish plaque in the mouth and on the tongue called thrush.

·Patients with asthma should get the influenza vaccine every year. Influenza may provoke a severe asthma flare. The flu vaccine is safe and usually effective in preventing this illness. Because new strains of influenza emerge every year, it is important to get the vaccine every year. For best results, you should get the vaccine sometime during the months of October or November. You may consider having all family members vaccinated for additional protection.

·Children with asthma over 12 months of age who have never had the chicken pox should receive the varicella vaccine (Varivax™). There have been a number of reports of children with asthma who had severe cases of chicken pox while taking oral steroid medications (i.e., prednisone) for treatment of an asthma flare. Because it is often impossible to know whether or not a child has been exposed to the chicken pox virus, prednisone might be prescribed during the chicken pox incubation period. Vaccination with the chicken pox vaccine is safe and gives long-term protection to the majority of vaccine recipients. Those children who have an incomplete response to the vaccine may have a very mild case of chicken pox with a subsequent exposure, followed by lifelong immunity.

·Asthma medications should be taken at school as prescribed. If the school does not have adequate nursing staff to meet your child’s needs, another adult staff member should be trained to administer the medications. Schools and day care facilities that receive federal funding are obligated to make allowances for medical needs under the Americans with Disabilities Act.

·Take extra asthma medications and supplies on vacations. You should be prepared to treat asthma flares that may occur during trips away from home. If you usually use a nebulizer to treat asthma flares, you should take one along. An electrical adapter fitted for a cigarette lighter can be used to operate compressor-driven nebulizers in a car. You should also have an emergency supply of prednisone on hand to start with our instructions in case you encounter an asthma flare that is not responding to neb treatments. People who are planning to go outdoor camping should take special care to avoid inhaling smoke from camp fires, as smoke exposure may provoke a sudden and severe asthma attack.

·Full participation in sports and recreational activities is generally encouraged, with several notable exceptions: First, people with asthma should abstain from vigorous physical activity when their asthma is active. Failure to rest when the bronchial tubes have become inflamed, much like running on an injured knee, will likely result in a more severe injury and thus a longer recovery period. A one week break from heavy exertion following an asthma flare usually allows enough time for healing to permit a return to full participation in sports activities. Second, people with asthma should avoid heavy outdoor exertion or prolonged periods of outdoor play on pollution alert days – level orange or red (particularly during the late afternoon hours). Third, while almost any sport is safe for individuals with well controlled asthma, SCUBA diving is generally not recommended because of the risk of developing lung injury with pressure changes that occur during routine diving.

·People with asthma need to avoid certain medications. Beta-blocker medications, which are commonly prescribed for treatment of heart conditions, high blood pressure, and migraine headaches, should not be taken by people with asthma. Approximately 10% of people with asthma are sensitive to aspirin and related non-steroidal anti-inflammatory (NSAID) medications, which include Advil™, Motrin™, Aleve™ and other “profen” derivatives. Please let us know if you have experienced cough or chest tightness after taking these medications.

·Asthma should be under good control prior to undergoing elective surgery. Surgical procedures that involve general anesthesia may aggravate asthma. In order to prevent an asthma flare following surgery, it is important to monitor the asthma closely and adjust the medications prior to and immediately following the procedure. Please call to schedule an appointment to check lung functions 1-2 weeks prior to elective surgery. If emergency surgery is needed, the anesthesiologist should be informed of your condition so that appropriate precautions can be taken.

·Most medications prescribed to treat asthma are safe to take during pregnancy. It is important to continue to treat asthma during pregnancy in order to prevent an asthma flare in the mother that might cause harm to the developing fetus. Please call our office if you become pregnant so we can advise you on any necessary medication changes and schedule a follow-up appointment to monitor your lung functions.

A change in insurance carriers may result in non-coverage of pre-existing conditions. It is important to understand the terms of a new insurance plan before you enroll in order to prevent a prolonged lapse in coverage for a chronic condition such as asthma. If a change to such a plan cannot be avoided, you may want to consider purchasing an additional “COBRA policy” from your old plan in order to cover the exclusion period required by the new plan.