Asthma and Allergies   Kathy Ladd, RRT
22
August

By Adem Lewis / in , , , , /


Good evening. We like to think that asthma
doesn’t control our lives, that we have enough control
of our asthma, so we can live our lives to the fullest. This is a picture of
your bronchial tree turned upside down. But in respiratory therapy we
call that the tree of life. The mission of your bronchial
tubes is just to get the air to the end, where it ends at
alveoli and that is the only place where the oxygen
goes to your blood. So your bronchial tubes
is just the pathway. So what is asthma? Asthma is just two components. The first component which is
your muscles around constrict, and then the bronchial
tubes inflame. So, if you have pressure going
into an inflamed tissue, you have two components that is
lessening the airway path. And here is a picture of it. And this would be normal, okay. And as you can see, little
ridges, the muscles came down, constricted, and at
the same time, this thickening of the wall. And here’s the bronchial tubes
coming down, they like to call those the grape sacks. But as I showed you the tree
of life, you can think of the branches going to the leaves,
and it is at the leaf that there’s like a
photosynthesis going on. Here we have the pathway
of the bronchial tubes. And at the alveoli that’s where
your oxygen goes to the blood. So what are the
symptoms of asthma? And the first one is cough. Especially in children. I don’t know if anybody is here
because they are thinking about a child or a grandchild. I am going to touch on
managing with children. And the first problem is
cough, not that wheeze. Yes wheeze is associated,
but it’s not the number one. You get a lot of tightness, and
that can cause night waking. We are alarmed when, especially,
on exertion or at any time you have a shortness
of breath episode. If you’re just trying to do
normal activity, and your breathing is interfering with
that, you have to try to take more control, to
manage your breathing. So imperative, and this is
especially again with the children maybe not so
much with the adults. We want to take
care of the neck up. If you have a sinus problem, you
don’t want to keep it brewing. If you have a problem with
allergies, which usually starts off with the sinus problem. So you need to take the
medications, if it’s antihistamines, your
Benadryl or something. You need to manage that. You can’t let that fester. That’s what I’m trying to say. If you let that fester and it’s
with somebody that’s got a cold, you know you’re having a
problem, and you’re not taking control to manage it. It’s managing you. I just wanted to talk
on the medications. The Albuterol inhaler,
that’s the number one line of defense in asthma. And we’d like people to just
sort of keep track of their asthma medication use, and that
is because if you start using three times a week, you’re
having a bad day, you feel the cough, the wheeze, you’re using
your Albuterol inhaler, okay. That’s when you need to have a
communication with your doctor. And he’s going to want to
probably step you up to a inhaled corticoid steroids. They actually came out with a
guideline for the doctors, and if you use it less
than two times you’re still considered mild. We have classifications
of intermittent symptoms. More than twice a week,
no nighttime waking. That might not be for the adult. That would be for the child. That is a concern if you’re the
parent trying to manage your child with asthma. The coughs, not so much,
the wheeze are what happens when they exercise. But if they’re getting
night wakings, that needs to come under control. Again you want no
limitations in activities. It’s actually encouraged if
you’re child does have asthma, that there is no
limitations on gym. You would think
“Oh they’re sick, they’re going to get coughing
or something like that.” You actually need
to encourage activity more so with children
that have asthma or allergies. Okay, there’s actually a
number of things you can do. Maybe they can’t do baseball
and breathe all the dust, but they can swim. They can bicycle. And bicycle’s one of the best breathing exercises
after walking. We find that if a child, let’s
say, young pre-school has asthma, they’re still growing. We’ve already grown. So they’re still lung
tissue development. And we don’t want to have an
impairment that starts at a young age that brings them into
their adult life with an asthma condition, or a
breathing problem. Whatever you want to call it. I don’t want to over
use that word Asthma. So if you use that Albuterol
inhaler more than three times a week, it’s strongly
suggested that you get an inhaled corticoid steroid. The Albuterol did the muscles. The inhaled corticoid steroid is
taking care of the swelling, and that is so important. Because you’re going to relax
all you want, those muscles, but if you’re really still
thickened, and have a more narrow airway; again
you’re having problems. The Albuterol is you
use when you need it. Oh I have a breathing problem,
I need to sit down, I need to take my inhaler. The inhaled corticoid steroid
you have to take every day. And that’s a commitment. If you don’t do it, you’re
not doing it justice, okay. So many people, I get them in
the hospital, and they’ll either run out, or they think they’re
good, and they’re trying to say I don’t need that medication. Bam. They’re in the emergency room. So, it is definitely something,
if you felt, I haven’t had an attack in over a year, that you
taper down with your doctor’s control of the situation. You have to stay on it. That is so important. And with the Advair and
Symbicort, there’s a long acting bronchodilator, that’s
also doing the muscles. You take that twice a day,
and hopefully you can put your Albuterol inhaler, which you
call your rescue inhaler aside. We’re going to do a
little demonstration. I actually brought these and I
encourage you when you leave if you’re on an inhaler
to take the spacer. You need the spacer. So the first thing you want to
do if you have an inhaler is really shake the inhaler. And if it’s brand new, you
sort of want to prime the cup. So you don’t want to just
do two shakes and it’s done. And then you want to
shoot it when you first open up the package. As you can see that spurt,
that’s a bit of an air. If you just put it close to your
mouth, squirt it, it’s going to blast the back of your throat
and you’re going to swallow it and it’s not going
to do you any good. So, they devised these spacers
where you would breathe in the same time you depress it. By giving it this space it
actually helps you inhale more to bring it down into the lungs,
instead of it being absorbed right away to the
back of your throat. So you would just want to
coordinate and then you hold your breath for ten seconds. You don’t immediately
take it out. You will get much more of your
medication if you put these in your pocket on your
way out, and use it. It says right on here, you’ll
hear a noise if you’re breathing in too fast. And if you start seeing the
white powder, the medicine staying in the chamber, you know
you didn’t breathe it in, so you have to pick up the breath. So again just showing you the
spacer, how it looks to use it. So I personally just suggest
that you try to stay away from the closed mouth technique. If you don’t have a spacer,
like two fingers a side. Coordinating your breath. Again, exhale completely,
get yourself ready, squirt. Hold for ten seconds at least. And then exhale. And now I want to just touch
on the peak flow meter. Especially in children, but
it can be used with adults. Anybody can use it. Or you don’t have to use it. What this is is it measures
the speed of breath. Measures your strength
of your breath. You can think of it a lot. So rather than getting out
graphs and figuring out how old you are and how much
you weigh, this is how much you should breathe, we strongly suggest you
use your personal best. And the personal best is when
you’re healthy; you’re at your normal activity level. You’re having no
cough, no problems. You haven’t used your
Albuterol in a few days. And you’re in a standing
position to do it. And you take several attempts. So, I try to explain, remember
it’s the speed of air, and everybody remembers it’s
like blowing for a spitball. You want to go (blows). A hard breath. You take maybe the average of
three of your best, and then, what are you going to do
with that number is you’re going to try to look. Do this everyday, and
stay above 80 percent. You want to be always within 80
percent of your personal best. You fall below 80 percent;
you know a little yellow flag is going off. You want to be more careful. Am I catching a cold? Do I need to go to the doctor’s
because I need an antibiotic? Things like that. If you’re below 60 percent. We do think that’s alarming,
and you should get yourself to the doctor. You’re struggling
and you know it. So you don’t really need. I don’t need that to tell me
I’m struggling, but it is in a lot of the literature. And then if anybody is just
wondering about literature you can go on, just type in asthma,
and just the EPA website alone will give you a
ton of information. Exercise, exercise, exercise. You can make that your
key of how am I doing. Can’t say, well I’ve been doing
okay, but I’ve been sitting on the couch watching TV all day. That doesn’t count.
All right? You have to just simply walk. A lot of people they have an
active lifestyle anyway, they don’t need to think
about exercising. They’re already active walking. They’re already doing stuff. But it is so key that if you
don’t have something to do, you get up off the couch
and take a walk. So here we are. You’re tracking your
medications; you want to know if you use that Albuterol too much. You can do the peak flow. You want to know your
activity level, which can replace your peak flow. You want to be active. And are things getting worse. You can always say,
“Oh I have a cough. I cough every day.” I
have patients that tell me that every time. Is the cough getting worse? If you’re coughing up
yellow, or green sputum, you have an infection. The only thing that’s going
to take care of that is an antibiotic, and you need
to get to the doctor’s. With children, their airways
are the size of our pinky. They’re so much smaller, so if
they get into a problem, and have like an allergic reaction,
to lets say renovating the home, and there’s an increase in
dust, you have to do what you have to do at that time. But you’re also hoping that
the child will outgrow it. And with an active lifestyle:
a very good chance. They actually came up in Europe,
it’s called hygiene hypothesis. You can actually type
that in and get a little reading about that. The children are healthier
when they’re exposed. Exposed to germs. Exposed to dirt. Exposed to other kids. So it’s okay.
Let them go out. Let them get dirty.
It’s okay. They have to be
exposed to other kids. They actually also showed that
children that are in daycare have less absences in
kindergarten and first grade than the child that’s always
been at home, and then starts getting the colds in
the classroom. So the air we breathe. It’s what’s in the
air that you don’t see. That’s the microscopic
stuff that will travel into the bronchial tubes. So if you’re predisposed to
asthma, having a respiratory infection or sinus flair up, you
will have problems at that time. If you’re on a rescue inhaler
it is advised that you just continue to use it during
that time, let’s say three times a day. And again, don’t
stress yourselves out. “Well I did that yesterday
and I’m feeling a little bit better.” Just do it. The whole time that you’re
on it, having problems. As long as you have good
communication with your doctor, I am sure he would be
telling you to do this. Another big flare up for
allergies: mold and mildew, dust and dust mites, animal
dander, and scents. So if you had a child with
asthma, there’s a couple of things right here that
you can think about. We don’t live in a perfect
world, but you can try to make their sleeping, their
bedroom as safe as possible. Meaning that it’s mold free. I’m not saying get rid of the
pets, but I’m saying don’t let that pet enter the
child’s bedroom. It’s just the rule of the house. The cat can’t go into
the kid’s bedroom. Put away anything
that’s scented. It’s amazing, the scented
candles, I don’t know if anybody else, but I don’t feel like I
have asthma, but when you go into a room with that scented
candle going, you feel like it’s robbed all the air. But also in the house, smoke. Chemicals, cleaning
or otherwise. Emotions.
Allergies to food. Change in weather. The dust mites are something
that can give you a flare up especially again in children. They’re very small. They do have allergy bedding,
and what it does is it prevents the dust mite from
traveling through. It’s strongly suggested
that you have that. And here’s pictures
of dust mites. There’s an army of them. You’re not going to be
able to control them. You’re not going to be
able to eradicate them. Man has been living with these
things, with mold and dust mites from the dawn of time. Mold is a fungi and if you have
a sensitivity to mold, you never get a break, because mold
is active every season. You have to take
care of the mold, especially within your home. There’s a lot of
things you can do. We’ll try to go
over that right now. It’s the mold spores that enter
the air and that’s what we breathe in, and that’s
where you get the reaction. It’s out there and we need it
for our woods, the decomposing of leaves and things like
that is a necessary component of our outdoor environment. We just have to learn
to live with it. And there’s trouble when mold
spores land on moist cellulous material, then mold will grow. Sheetrock is moist, cellulous
material if it’s wet. You will get mold
with wet sheetrock. The only way you’re going to
eradicate that completely is you pull it down. Other than that you clean it,
and then I would strongly recommend that there is actually
mold and mildew control paint. Mold can hide pretty
much anywhere. In the carpets, ventilation
systems, windowsills, bathrooms, basements, any area that’s
moist: it’s at risk. The rubber matting
underneath the carpeting. You get that wet, that’s a
sponge, and you’re going to start having problems. So what do you need? You need a really good
ventilation system. You want to keep your areas
free of clutter, dry, and well ventilated. If you have to bring in
extra fans at certain times, that’s a really good idea. But this is just us looking at
the house, and certain areas that will allow problems,
that we have to deal with our indoor environment. Smoke from the fireplace. Leaks with the pipes. You’re well ventilated
in your garage. The roof is solid. We build to keep dry and warm,
and in every room even right here there’s a
relative humidity. If we keep that relative
humidity under 60 percent, or under 50 really,
you’re doing good. You’re not going to have a
mold problem, as long as when there’s moisture, like after
a shower, there’s a well ventilation that gets
that moisture dried out. So there’s no such thing as a
sick building, there’s just a lot of sloppy building going
on where they don’t take into account moisture drainage away
from the building, ventilation problems. That means the ventilation is
usually pretty inadequate. They’re going to
stress out that system. Chronic condensation problems. You want to use fans,
dehumidifiers, fix all leaks, and discard any cellulous
material that is loaded with mold. Remember there is only control
of mold, just like there’s only control of our asthma,
just like there’s only control of our allergies. And that musty smell
is a good indicator. You can clean mold with
a strong detergent. Everybody says “Oh I
cleaned with bleach. It kills it.”
There’s no guarantee. If you’re using bleach
just use ten percent. So, helpful tools. The air filters
are really great. They’ve got them on the
vacuum cleaners even now. Mold resistant paint. Great for the bathroom. Frequent vacuuming. Especially in children’s rooms. Air conditioning is a godsend. And good old-fashioned
fresh air. Personally I always worry about
if I go to someplace, especially a motel. Now I even write it. I must be able to open a window
if I make a reservation. Nothing is worse than
not having fresh air. And I think we’ve increased
our indoor air time as our society has progressed. We’re less active. We’re breathing our air more
indoors, so therefore, nothing’s worse than not allowing fresh
air into the buildings where we live our lives. So I would be glad to
take any questions. (Man) I’ve heard many times
that asthma seems to be more prevalent today than it was in
the past, and is there any data that supports that. (Kathy) Oh Yes, oh Yes. (Man) What is the feeling
what’s causing that? (Kathy) We used to me more
outside, now we’re inside at the computer at the TV, okay. So that’s why actually we
have to really combat that with the children. They can’t grow up like that. This isn’t a talk about obesity,
but we also have that direct correlation about how our bodies
are changing to this indoor environment that we’ve
created for ourselves. Yes? (Man) You mentioned allergies
and also keeping your windows open, isn’t that a
little bit of a balance? (Kathy) Right, that’s right. If you’re sensitive to that pine
pollen, and it’s pine pollen season you have to shut
the windows and turn on the air conditioning. But you can’t, you’re not going
to stay in and never walk to your car, or just
stop your life. That why you also have to have
a component of exposure to the element that does bother you. It’s going to happen, so I think
if you really step back from whatever’s bothering you when
you do get exposed you’re going to have a much worse time. You’re going to have more of a
problem of the asthmatic attack than if you’ve been
regularly exposed. Right? Back when we were saying
with the hygiene hypothesis. The kids now, they’re exposed
to more; they’re not getting sick as much. The doctors managing children,
sometimes it’s suggested that they take their Albuterol
inhaler at the start of exercise, and with adults
too, because you just know. Again, why stress out our body? You know if you take that
mild walk, you’re going to have a proiblem. We want you to do that. Take your Albuterol first. It’s called
exercise-induced asthma. It’s a real term that doctors
use, and it is managed by taking your Albuterol prior or
sometimes the doctor says, “Well as soon as you get the problem. Stop, do it, and then continue
with your exercise.” But I think if you had a choice I would just
do the Albuterol before you start it, rather than worrying
about “Am I getting worse? Am I getting worse? Should I do it now?” (Woman) You stress
about Albuterol. What happens to people who
can’t take any medicines? Are there any natural remedies? (Kathy) All this
Albuterol and all this, it’s stimulant to the body. And they said the first thing
your line of defense, natural, was a good, strong
cup of coffee. All that caffeine,
shooting the body. (Woman) But it does the same
thing to me- (Kathy) Gets you jittery? (Woman) Yes. (Kathy) There is a new
medication that’s trying to counteract that feeling, that’s
Zopinox, which is a sister drug now to Albuterol. You could ask for that. (Woman) I use the saline
solution a lot, and that seems to keep my reactions down. (Kathy) Nasal spray? (Woman) Yes.
(Kathy) Very good. Yes.
Strongly advised. Especially with sinus problems. Okay. And if you can manage just
with saline, that’s great. Well thank you very much. It was a pleasure meeting you.


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