Asthma and Allergies Kathy Ladd, RRT

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.