Back to School with Asthma

The time has come and kids are heading back to school.

At the top of your list of “must dos,” should be how to prepare for another successful school year supporting the management of your child’s asthma with anyone who interacts with him or her.

Who is on that list? Maybe a few people you hadn’t considered or maybe you have but didn’t know how to get started.

The school nurse, teachers, the school bus driver, and anyone who’s on the “need to know” list set by the school nurse and you. Establishing a good network of care will help to insure your child’s safety as well as encourage him or her to participate in all aspects of the new school year.

The whole process is much easier if roles and responsibilities can be defined for the asthma doctor, the school nurse, teachers, the school bus drive and, of course, for you and your child.

You and your child need to complete an Asthma Action Profile to verify what you do and don’t know about your child’s asthma. It is important your child be included in establishing a current asthma record because you won’t always be there when he/she needs help. Visit www.breathepa.org  or call 800-220-1990 and request an Asthma Action Profile. Make a copy of the one-page Asthma Record for the school nurse.

Next, meet with your physician, so your child and you can discuss, then create an Asthma Action Plan. This plan should cover medications used at home and school, purpose, dose, and what to do if your child has an asthma attack at school. Remember to provide current contact information and provide the needed medication for the school nurse office.

Meet with your school nurse and discuss what information should be shared with teachers and school bus driver. Your school nurse can determine the best way to share this information.

Everyone on the same page will help support your efforts in keeping your child healthy, in school and ready to learn. For additional information or to find out how you can bring an asthma program to your school, contact Jeannie Simms at 412-855-4594.

 

How Vaping Affects Your Asthma

It is widely believed that vaping is “safer” than smoking cigarettes, but that doesn’t mean that it is safe.

E-cigarette aerosol contains harmful substances that could include nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. There are new concerns that are surfacing regarding secondhand e-cigarette aerosol’s impact on people with asthma — in particular, the correlation between electronic nicotine delivery systems (ENDS) and increased asthma symptoms.

The Chest Journal, official publication of the American College of Chest Physicians, identified a correlation between ENDS and an increase of asthma symptoms in youth, ages 11-17, after doing a study on the impact of second-hand ENDS. This research concluded that healthcare professionals may need to include this type of exposure when working on asthma self-management and action plans as well as in the home environment assessments.

If you have asthma, it is important that you minimize exposure to inhaled irritants, including e-cigarette aerosol. Not only should you not vape, but you should avoid other people’s vapor. Prepare now by walking through a situation in which you find yourself around people vaping. What could you say to help minimize your exposure? Educating yourself on the impact of vaping on asthma is the first step. For more information on asthma and vaping visit www.breathepa.org.

For additional information visit:

Asthma and Type 2 Inflammation

Asthma is characterized by airflow obstruction, increased mucus production, and increased inflammation in the airways. If you’ve ever experienced an asthma attack you know the feeling of struggling to catch your breath and coughing up mucus. But what about inflammation? There is one kind of inflammation, known as Type 2 inflammation, which is an immune system response that causes an intense response to inhaled irritants.

Asthma severity is classified into one of four categories: intermittent, persistent mild, persistent moderate, or persistent severe. Your severity classification is based on your asthma symptoms, its impact on your daily activity, lung function, how often you use your rescue medication, and how often you experience nighttime awakenings due to asthma. There is a link between Type 2 inflammation and increased asthma severity. About 50-70% asthmatics have Type 2 inflammation, along with 50% of individuals with nasal polyps, and 80% of individuals with atopic dermatitis. Type 2 inflammation has also been linked to chronic rhinosinusitis, aspirin-exacerbated respiratory disease, gastroesophageal reflux disease, and sleep apnea.

Controlling inflammation is an important strategy in asthma management. When a person has severe asthma it often requires several layers of medications and it can be hard to manage. If asthma has become difficult to manage and treat, talk with your asthma doctor about Type 2 inflammation. There may be a way to reduce the severity and frequency of symptoms. For additional information on this topic, visit Allergy & Asthma Network.

Patient Perspective: Living with Severe Asthma

Kristin Nowack, a severe asthma patient, contributed this blog post for Breathe Pennsylvania.

Have you been diagnosed with severe asthma?   I have been living with severe asthma and know the trials and tribulations one may face.  Severe asthma is not your typical asthma as many of you know.  Severe asthma as defined by the European Respiratory Society (ERS)/American Thoracic Society (ATS) as “asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic CS) to prevent it from becoming ‘uncontrolled’ or which remains ‘uncontrolled’ despite this therapy.”

I was diagnosed with asthma when I was 3.  I was in and out of the emergency department and in high school, I ended up in the ICU for two weeks.  Fast forward a few years and I quickly became steroid-dependent and was diagnosed with steroid-resistant severe asthma.  Those are words you never want to hear.  To say I was scared was an understatement.  I will be the first to tell you I was in denial.  There was no way I was resistant to the mainstay of treatment for severe asthma; corticosteroids!  I felt alone, scared and embarrassed.  I was not going to let my severe asthma take control of my life.  I completed my Doctorate of Nursing Practice on daily high dose IV steroids.  Side effects of high dose steroids are truly awful.  Weight gain, moon face, insomnia, diabetes and extreme emotions are just a few.

Living with severe asthma is a struggle.  Although I don’t look sick, I have an invisible disease and struggle daily to breathe, often not even being able to walk across the room.  I hide my disease very well and don’t want others to know I am having trouble breathing.  I will always tell you, “I am fine,” even if I am not.  I don’t want family and friends to worry.  I don’t want them to cancel their plans because I can’t breathe “again.”  Often times during a severe attack, I tell myself I am not sick enough to go to the emergency department because I am scared.

I have been on typical treatment for severe asthma; however, I did not respond to the medications and my symptoms kept getting worse.  Prednisone is one of my main treatments, but not the typical lower dose that may be required to keep severe asthma symptoms under control.  Every day I take 60mg of prednisone just to keep my symptoms somewhat manageable.  By manageable I mean using my inhaler or nebulizer every two to three hours, while still wheezing and experiencing shortness of breath all day. I use a BiPAP (Bilevel Positive Airway Pressure) machine every night and require supplemental oxygen when I am extremely ill.

If you’re living with severe asthma, always remember:

  1. You are NEVER alone – 5 to 10% of asthmatics suffer from severe asthma.
  2. ALWAYS keep in close contact with your asthma doctor and follow your treatment plan.
  3. You are NOT a burden on others; accept or ask for their help.
  4. ALWAYS have your inhaler within reach. I always have my inhaler and carry prednisone with me.
  5. Reach out to others with severe asthma.
  6. New and effective treatments are available for some severe asthma patients.
  7. If your asthma is uncontrolled, see an asthma expert for up to date treatment.
  8. When in doubt about your breathing; don’t hesitate! Seek emergency treatment immediately.

Some FAQs about COPD

Dr. Tiffany DuMont and the Breathe PA team

Dr. DuMont is a pulmonologist with Allegheny Health Network and member of the Breathe Pennsylvania Board of Directors.

As a pulmonologist, I get a lot of questions from patients. Here are some common questions I hear in the pulmonary office regarding COPD. If you have any questions, please send them to Breathe PA at info@breathepa.org and we will do our best to answer them in a future blog or in the next newsletter.

They told me I had an Exacerbation. What is this?

A COPD exacerbation is defined as worsening respiratory symptoms that requires additional therapy.  There are varying degrees of exacerbations.  They are categorized based on the treatment needed as mild, moderate, and severe.

Ok, so I had an exacerbation… what’s the big deal?  I feel better now.

COPD exacerbations can negatively affect your life, increase your chances of being hospitalized and can cause progression of your COPD.  Your doctor would like to know each time you’ve had an exacerbation especially if it was moderate or severe, as it may change the category of your COPD and change the treatment plan.  A prior exacerbation is a predictor of future exacerbations.  Lung function, how well the lungs move air and process gases, declines as people get older. People who smoked see their lung function decline faster.  Each exacerbation may cause an acute worsening of your lung function and you may not return to your prior baseline.

Come on doctor, can’t you just leave me on steroids all the time for my COPD? I feel so much better when I am on them!  

This is a line I hear in the office all too much.  And although I want my patients to feel their best, chronic steroids are not always the best decision.  Steroids are used short term to treat COPD exacerbations but are rarely recommended for long term use for COPD.  Steroids can cause multiple side effects.  These side effects include, but are not limited to, high blood pressure, osteoporosis (fragile bones), high blood sugar/diabetes, weight gain, cataracts, glaucoma, easy bruising, thinning of the skin, and increased risk of infection.  If you are experiencing frequent COPD exacerbations, there are alternative medications to chronic steroids.  I would suggest talking to your doctor about the alternative options that exist.

If you want to learn more about your disease, have more questions, or want to meet people who are experiencing similar symptoms, join us on the Breathing in the ‘Burgh COPD Cruise on June 21.  We look forward to seeing you!

 

References:

Walters JA, Walters EH, Wood-Baker R Oral corticosteroids for stable chronic obstructive pulmonary disease.
Cochrane Database Syst Rev. 2005

Horita N, Miyazawa N, Morita S, Kojima R, Inoue M, Ishigatsubo Y, Kaneko T. Evidence suggesting that oral corticosteroids increase mortality in stable chronic obstructive pulmonary disease. Respir Res. 2014;15:37. Epub 2014 4 3.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD Science Committee Report 2019.  Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Criner GJ, Frith P, Halpin DMG, Han M, López Varela MV, Martinez F, Montes de Oca M, Papi A, Pavord ID, Roche N, Sin DD, Stockley R, Vestbo J, Wedzicha JA, Vogelmeier C. Eur Respir J. 2019 Mar 7. pii: 1900164. doi: 10.1183/13993003.00164-2019.

World Asthma Day 2019

Join Breathe Pennsylvania as we celebrate World Asthma Day on Tuesday, May 7, 2019. This annual event was originally organized in 1998 by the Global Initiative for Asthma (GINA) supported by USA based National Heart, Lung, Blood Institute (NHLBI) and the World Asthma Foundation.

More than 24 million Americans have asthma, affecting 1 in 12 children and 1 in 14 adults. Asthma seems to be most prevalent in areas that are underserved and have low quality air. Racial and socioeconomic disparities still impact the quality of care and treatment received. There are genetic interactions and environmental issues that can also play a role in the severity of asthma.

Asthma is a chronic lung disease which causes breathing difficulties. There is still no cure for asthma, but with proper awareness, education, and management it can be controlled. A good place to start is to identify your personal asthma triggers. Triggers can include but aren’t limited to:

  • Allergens- pollens, animal dander, certain foods, mold
  • Irritants- cigarette smoke, fumes, pollution
  • Physical triggers – exercise, cold air, emotions

By identifying your triggers you can reduce, avoid, and/or eliminate coming in contact to reduce asthma’s impact on your lifestyle.

Managing asthma takes a team effort. You can take an active role in managing your asthma: create a personal asthma action plan, take your medications according to your doctor’s direction, know when your symptoms are getting worse, and be prepared by carrying your rescue albuterol with you at all times.

Let’s work together this May and raise awareness of asthma and how it impacts everyone. To view the most current statistics on adult and pediatric asthma visit www.cdc.gov/asthma/default.htm

To learn more about your local asthma news, events, programs and resources visit www.breathepa.org

 

Radon Testing Instructions

I often get questions about testing protocols for radon test kits.  First, when doing home testing with a kit, make sure all the directions are read.  In our own test kits – which are similar to others – there are basic instructions that talk about how to physically set the kit.  However, on the back there are more in-depth instructions that should be read and followed.

First, the most important instructions are to maintain closed house conditions starting 12 hours before the test.  Close all windows and exterior doors and turn off any fans that vent to the outside.  This also includes a door to the garage if you have one.  Normal heating and AC can be used and normal use of doors is acceptable as long as doors are immediately closed after use.  If outside air is allowed to circulate through the house this will give a false low to the testing.  It is also important to note that in certain situations it can also give a false high reading.  So it is important to be strict with this protocol.

Second involves placement.  The state of Pennsylvania requires – in a non-real estate test – for a kit to be placed in the lowest lived in area of the house.  This would be a basement, but not a crawl space, garage or any other unheated unused space.  Additionally, bathrooms and washrooms should not be used, but this is more for humidity issues.

Radon is usually highest in the basement, and also tends to be more consistent there.  This allows for the most consistent measurement.  This assures that other areas of the house will be probably be lower.

Third, the device should be placed at a level where people normally breathe.  This is between 2 and 6 feet.  This should be obvious.  We want to measure the air people will actually inhale.  Also the devices should be more than 3 feet away from doors, vents, exterior walls and exterior windows.  Moving air can also have an effect on testing results.  Interior fans, even though they are not exhausting air, should also be turned off if in the same room as a test kit.

In the end all of these “rules” are about getting the most accurate reading for the home owner.

To learn more about radon test kits or to purchase one, visit www.breathepa.org/radon-test-kit.

Navigating Air Quality Alerts and Children

Spring is here and we are all ready to make the transition of wintry weather to warm and breezy weather with regards to our clothes and outside activity. Ok, there are probably still a few who hate to see the snow go, but not me! So for those of us ready to make the move to a warmer time of the year and moving our exercise and activity outside, let’s talk about air quality.

This is an important issue for the children I work with who have asthma. Parents often ask if it is safe to send their children outside to play when the news is listing a day as a “poor air quality day.” With this issue as with others, it’s important to talk to your doctor, follow the recommended guidelines provided and use your best judgement.

Here are some recommendations:

  • Limit your activity to one that doesn’t require moving and breathing too fast. For example, consider walking instead of running or yoga in place of soccer.
  • Arrange your activity near or in water. Winds tend to be stronger around water so consider kayaking or swimming. Swimming can also be a great indoor activity if it is recommended you stay indoors.

According to the Pennsylvania Department of Environmental Protection, levels for ozone, particulate matter, carbon monoxide and sulfur dioxide are the determinants that impact air quality in Southwestern Pennsylvania. The Air Quality Index Report has six categories: Good, Moderate, Unhealthy for Sensitive Groups, Unhealthy, Very Unhealthy and Hazardous.

Follow the links below to learn more:

Air Quality Index Categories
AQI Reports in the area
Air Quality Index for Kids- Parents Reference Page

The Importance of Pulmonary Rehab

At Breathe Pennsylvania, we are big proponents of pulmonary rehab. It is a drug-free intervention that teaches individuals with respiratory disease how to safely exercise while maintaining control of their breathing. Individuals who attend pulmonary rehabilitation not only reduce their breathlessness and improve stamina, but learn about exercise options that can be implemented long-term, even when the formal pulmonary rehabilitation program ends.

Pulmonary rehabilitation is a multidisciplinary program and should be considered as part of a care plan for patients with respiratory disease. The supervised exercises, education, training, and assessments can help improve your quality of life. What are you waiting for? Talk to your lung doctor about pulmonary rehabilitation. A list of pulmonary rehabilitation facilities near you can be found at www.livebetter.org.

Air Quality and Your Lungs

Recently in western Pennsylvania, there has been a lot of discussion about air quality, pollution, and the importance of protecting your lungs when you are considered part of a “sensitive” population. However, the terminology and classification may be confusing. What does it mean to be “sensitive” to dips in air quality, and how would someone know that they need to protect their lungs?

The Clean Air Act is a law that mandates that the Environmental Protection Agency’s (EPA) Office of Air Quality Planning and Standards (OAQPS) set national ambient air quality standards (NAAQS). These standards evaluate pollutants that are considered harmful to people and the environment, and include six criteria:
• Ground-level ozone
• Particulate matter
• Carbon monoxide
• Lead
• Sulfur dioxide
• Nitrogen dioxide

In order to communicate these pollutant levels to the public, the EPA has established an Air Quality Index (AQI), which quantifies local air quality levels using five of the six pollutants previously mentioned (lead is excluded). The AQI ranges from 0-500, and is color-coded for ease of communication to the public. The AQI alerts individuals about when they should take actions to protect their lungs.

Some individuals are considered to be part of “sensitive populations.” This terminology means that it would be harder for an individual to protect themselves—and recover from—dips in air quality. The elderly, children, individuals with lung disease, and individuals with heart disease are included in this classification. Therefore, when pollutant levels rise, they tend to feel the effects before the rest of the population does.

It is important for individuals from sensitive populations to be aware of the air quality levels in their community, so that they may take steps to protect their lungs. You may register online at www.enviroflash.info for daily AQI email alerts, or visit www.airnow.gov to review current air quality levels.

Exposure to pollutants can reduce the ability for the lungs to function normally. This is particularly true for sensitive groups. To protect your lungs when the AQI level is high, reduce the amount of time you spend outdoors, and limit your exertion levels outdoors. For more information on the Clean Air Act, visit www.epa.gov/sites/production/files/2015-08/documents/peg.pdf.

1. Environmental Protection Agency (2016). Air quality. Retrieved from https://www3.epa.gov/airquality/cleanair.html
2. Environmental Protection Agency (2016). Air quality index (AQI) basics. Retrieved from https://airnow.gov/index.cfm?action=aqibasics.aqi