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Recently diagnosed with asthma?
Recently Diagnosed with Asthma?
ALittleUnderstanding Goes a Long Way
by Susan Berg
~
ick's nagging cough had been bothering him for months. It was noticeably worse after spending time in the barn on the horse farm
where he worked. His coughing fits became so violent when he went jogging, especially on cool days, that he had to give up his exercise regimen altogether. Upset and looking for answers, 44-year-old Rick finally ventured into his doctor's office. Suspecting allergies and possibly asthma, his doctor prescribed an albuterol inhaler to relieve Ricks persistent cough. This medication worked, but only temporarily. He needed to take it at least four times a day, and needed continuous refills. 22
ASTHMA MAGAZINE
to
subscribe
call
1.800.527.3284
Recognizing that Rick was relying too heavily on albuterol, Ricks doctor re-evaluated him. This time, Rick received a certain diagnosis: asthma. He was prescribed another inhaler that contained an anti-inflammatory medication. This was necessary, said his doctor, to control the inflammation in the airways of his lungs and prevent his symptoms. This should enable him to comfortably continue with his job at the horse farm. Rick left the doctor's office in disbelief. "I've never had asthma before," he thought. ';~nd besides, I can breathe just fine. All I have is a cough." Patients' May Vary
fix" albuterol. His cough soon worsened and kept him up at night. Exhausted and desperate to feel healthy again, Rick eventually began using the anti-inflammatory medication. He soon found that his cough was much less frequent, and he no longer needed albuterol on a daily basis. Rick went back to running and working confidently with his horses, with the new understanding that taking the proper medications is essential to managing asthma effectively.
Reactions
Being diagnosed with asthma can produce a range of emotional reactions and an endless number of questions. Patients may be surprised to find out they have asthma, or feel relief in knowing that they can receive treatment for their symptoms. Some may have suspected all along they had asthma, and the diagnosis just confirmed it. The most common reaction among newly diagnosed patients, however, is denial. They are convinced they just have a cold, a cough or bronchitis because often that is what their health care provider has been telling them. Physicians recognize this response as one element in the "stages of disease," the emotional roller-coaster patients often encounter when they are first diagnosed with a potentially serious or chronic condition. "Patients experience denial first, anger second, then they calm down and accept it," says Jordan Fink, MD, professor of medicine and chief of allergy at the Medical College of Wisconsin. "Most patients are also worried that it will interfere or is already interfering with their lifestyle." It is clear from Ricks reaction that he was in denial about his newly diagnosed condition. He refused to take the anti-inflammatory inhaler and continued with only his "quick-
Being diagnosed with asthma can lead to a range of emotional reactions, including denial.
First
Step
-- Education
The first step in managing your asthma is to learn about the disease. Newly diagnosed patients need to know that asthma can be controlled through environmental changes and medications, but it cannot be cured, says Lisa Sullivan, RRT, an asthma case management coordinator at Harvard Pilgrim Health Care, a Massachusetts-based HMO. Your health care provider should give you a foundation in asthma education, or refer you to an asthma educator, says Sullivan, who oversees a team of asthma educators serving patients in the Boston area. You need to understand the disease process; what triggers your asthma; how different types of medications work and their possible side effects; and the proper use of asthma ASTHMA MAGAZINE
to
devices, such as inhalers, nebulizers, spacers and peak flow meters, she says. The crash course in asthma management would not be complete without learning about warning signs. "It's crucial for patients to be able to recognize early warning signs that indicate when their symptoms are not under control," says Sullivan. "The faster you intervene with the appropriate treatment, the better you can prevent an episode from worsening." How can you tell if your asthma is worsening? One way is by using a peak flow meter. This is a small, portable, hand-held device that is used to measure how well air moves out of your lungs. This measurement is called your peak expiratory flow rate (PEFR). If your PEFR drops, this means you are beginning to experience asthma symptoms, and you should take steps to prevent a full-blown asthma episode. An asthma action plan can help guide you through these steps. This is a set of individualized, written instructions, developed by your health care provider. It tells you what your peak flow readings indicate, what medicine to take and when to take it, and when to call your health care provider. Ask your health care provider about obtaining a peak flow meter and a personalized asthma action plan, if you haven't received these already. Identify
Triggers
You may be curious about what causes your asthma to flare, and you should be. A key strategy in managing your asthma is to identify what triggers it and do your best to avoid those triggers. There are numerous substances and conditions that can trigger asthma. The largest category of triggers is allergens. Allergens are substances that produce an allergic reaction in people who are sensitive to them. They include pollen from trees, grasses and weeds; mold and mildew; dust mites; and animal dander. "After a patient is first diagnosed with asthma, it's important to identify if he or she subscribe
call
1.800.527.3284
23
When the Patient is Your Child
O n e of t h e first steps in managing a s t h m a is to w o r k w i t h your health c a r e provider to establish a personalized a s t h m a mana g e m e n t plan.
is allergic," says pediatric allergist Robert Gedachian, MD, of Dedham Medical Associates in Dedham, Massachusetts. "Since allergens can trigger asthma and cause it to be persistent, avoiding contact with them will go a long way toward preventing asthma episodes from occurring." Another category of asthma triggers is irritants. Common examples are household cleaning products, perfume, aerosol sprays, and cigarette or wood smoke. Other causes of asthma symptoms include viral infections, exercise, and exposure to cold air or high humidity. Although it may be impossible to eliminate all allergens and irritants from your home, you can take some steps to minimize their number and concentration. Depending on your allergies, you may need to: • give away your pet or, at least, keep it out of your bedroom at all times, • cover your mattress and pillow with dust-proof covers, • vacuum and dust with a wet rag once a week, • remove your bedroom carpeting, or • keep windows closed (and perhaps use an air conditioner or room air purifier to filter the air) when pollen levels are high. 24
ASTHMA MAGAZINE
to
subscribe
Turn to Resources for Help
For parents of a child with newly diag- A number of education and support nosed asthma, the learning curve is far groups are available to help patients and their families learn about asthma greater. Parents not only need to and develop coping skills. Contact understand asthma, its triggers and one or more asthma/allergy organizamedications, but also they need to be tions for materials, and ask for their closely involved in managing their child's condition. Parents of small chil- " Web site addresses (see sidebar). If you are feeling overwhelmed, dren must be able to recognize when take solace in Dr. Fink's advice. their child is having symptoms (since "Asthma education is an ongoing it ~may be difficult for him or her to process because it takes time to learn communicate this) and know how to about the disease and how to control administer medications. Once a child it," he says. "Reading literature can is old enough to use an inhaler, parents' supervision is necessary to ensure help patients because they can't always remember what the doctor medication is taken in the right tells them in the office." amount and at the right times. Dr. Fink also urges patients to Children's asthma triggers can be keep in touch with their physician. the same as those for adults. Among "People often say, 'I have a stupid children, however, there is a higher question for you,' oz 'I hope I'm not incidence of allergic asthma than in bothering you,'" he says. "There's no adults. Eighty to 90 percent of asthsuch thing as a stupid question. A matic children have allergies, most doctor's business is to take care of the commonly to dust mites and animal dander, says Dr. Gedachian. patient. But it's up to the patient to Upper-respiratory infections are a call when they need help. The patient particularly common and potentially is a partner with the physician in managing their disease." serious trigger, particularly for small children. A child's condition can worsen very quickly and without warning. Susan Berg is a freelance writer in ' ~ child can have a viral infection, or Sharon, Massachusetts. She J~equently writes about health care and consumer just a cold, and in six to 10 hours, have a full-blown asthma attack," says issues. Dr. Gedachian. "Therefore, a child's very first asthma attack often results in his or her being hospitalized. "Children under the age of 2 are particularly challenging to treat because their airways are smaller," Dr. Gedachian continues. "During an asthma episode, the child's small airways become inflamed and plugged with mucus. This limits the ability for medications to get to the lungs and blunt the attack." As children get older and their airways enlarge, often their asthma improves, says Dr. Gedachian. In the meantime, however, realize that a child's asthma may affect the entire family. That is why all family members need to learn about asthma in order for the whole family to feel comfortable dealing with it. call
1.800.527.3284
ALittleUnderstanding Goes a Long Way
by Susan Berg
~
ick's nagging cough had been bothering him for months. It was noticeably worse after spending time in the barn on the horse farm
where he worked. His coughing fits became so violent when he went jogging, especially on cool days, that he had to give up his exercise regimen altogether. Upset and looking for answers, 44-year-old Rick finally ventured into his doctor's office. Suspecting allergies and possibly asthma, his doctor prescribed an albuterol inhaler to relieve Ricks persistent cough. This medication worked, but only temporarily. He needed to take it at least four times a day, and needed continuous refills. 22
ASTHMA MAGAZINE
to
subscribe
call
1.800.527.3284
Recognizing that Rick was relying too heavily on albuterol, Ricks doctor re-evaluated him. This time, Rick received a certain diagnosis: asthma. He was prescribed another inhaler that contained an anti-inflammatory medication. This was necessary, said his doctor, to control the inflammation in the airways of his lungs and prevent his symptoms. This should enable him to comfortably continue with his job at the horse farm. Rick left the doctor's office in disbelief. "I've never had asthma before," he thought. ';~nd besides, I can breathe just fine. All I have is a cough." Patients' May Vary
fix" albuterol. His cough soon worsened and kept him up at night. Exhausted and desperate to feel healthy again, Rick eventually began using the anti-inflammatory medication. He soon found that his cough was much less frequent, and he no longer needed albuterol on a daily basis. Rick went back to running and working confidently with his horses, with the new understanding that taking the proper medications is essential to managing asthma effectively.
Reactions
Being diagnosed with asthma can produce a range of emotional reactions and an endless number of questions. Patients may be surprised to find out they have asthma, or feel relief in knowing that they can receive treatment for their symptoms. Some may have suspected all along they had asthma, and the diagnosis just confirmed it. The most common reaction among newly diagnosed patients, however, is denial. They are convinced they just have a cold, a cough or bronchitis because often that is what their health care provider has been telling them. Physicians recognize this response as one element in the "stages of disease," the emotional roller-coaster patients often encounter when they are first diagnosed with a potentially serious or chronic condition. "Patients experience denial first, anger second, then they calm down and accept it," says Jordan Fink, MD, professor of medicine and chief of allergy at the Medical College of Wisconsin. "Most patients are also worried that it will interfere or is already interfering with their lifestyle." It is clear from Ricks reaction that he was in denial about his newly diagnosed condition. He refused to take the anti-inflammatory inhaler and continued with only his "quick-
Being diagnosed with asthma can lead to a range of emotional reactions, including denial.
First
Step
-- Education
The first step in managing your asthma is to learn about the disease. Newly diagnosed patients need to know that asthma can be controlled through environmental changes and medications, but it cannot be cured, says Lisa Sullivan, RRT, an asthma case management coordinator at Harvard Pilgrim Health Care, a Massachusetts-based HMO. Your health care provider should give you a foundation in asthma education, or refer you to an asthma educator, says Sullivan, who oversees a team of asthma educators serving patients in the Boston area. You need to understand the disease process; what triggers your asthma; how different types of medications work and their possible side effects; and the proper use of asthma ASTHMA MAGAZINE
to
devices, such as inhalers, nebulizers, spacers and peak flow meters, she says. The crash course in asthma management would not be complete without learning about warning signs. "It's crucial for patients to be able to recognize early warning signs that indicate when their symptoms are not under control," says Sullivan. "The faster you intervene with the appropriate treatment, the better you can prevent an episode from worsening." How can you tell if your asthma is worsening? One way is by using a peak flow meter. This is a small, portable, hand-held device that is used to measure how well air moves out of your lungs. This measurement is called your peak expiratory flow rate (PEFR). If your PEFR drops, this means you are beginning to experience asthma symptoms, and you should take steps to prevent a full-blown asthma episode. An asthma action plan can help guide you through these steps. This is a set of individualized, written instructions, developed by your health care provider. It tells you what your peak flow readings indicate, what medicine to take and when to take it, and when to call your health care provider. Ask your health care provider about obtaining a peak flow meter and a personalized asthma action plan, if you haven't received these already. Identify
Triggers
You may be curious about what causes your asthma to flare, and you should be. A key strategy in managing your asthma is to identify what triggers it and do your best to avoid those triggers. There are numerous substances and conditions that can trigger asthma. The largest category of triggers is allergens. Allergens are substances that produce an allergic reaction in people who are sensitive to them. They include pollen from trees, grasses and weeds; mold and mildew; dust mites; and animal dander. "After a patient is first diagnosed with asthma, it's important to identify if he or she subscribe
call
1.800.527.3284
23
When the Patient is Your Child
O n e of t h e first steps in managing a s t h m a is to w o r k w i t h your health c a r e provider to establish a personalized a s t h m a mana g e m e n t plan.
is allergic," says pediatric allergist Robert Gedachian, MD, of Dedham Medical Associates in Dedham, Massachusetts. "Since allergens can trigger asthma and cause it to be persistent, avoiding contact with them will go a long way toward preventing asthma episodes from occurring." Another category of asthma triggers is irritants. Common examples are household cleaning products, perfume, aerosol sprays, and cigarette or wood smoke. Other causes of asthma symptoms include viral infections, exercise, and exposure to cold air or high humidity. Although it may be impossible to eliminate all allergens and irritants from your home, you can take some steps to minimize their number and concentration. Depending on your allergies, you may need to: • give away your pet or, at least, keep it out of your bedroom at all times, • cover your mattress and pillow with dust-proof covers, • vacuum and dust with a wet rag once a week, • remove your bedroom carpeting, or • keep windows closed (and perhaps use an air conditioner or room air purifier to filter the air) when pollen levels are high. 24
ASTHMA MAGAZINE
to
subscribe
Turn to Resources for Help
For parents of a child with newly diag- A number of education and support nosed asthma, the learning curve is far groups are available to help patients and their families learn about asthma greater. Parents not only need to and develop coping skills. Contact understand asthma, its triggers and one or more asthma/allergy organizamedications, but also they need to be tions for materials, and ask for their closely involved in managing their child's condition. Parents of small chil- " Web site addresses (see sidebar). If you are feeling overwhelmed, dren must be able to recognize when take solace in Dr. Fink's advice. their child is having symptoms (since "Asthma education is an ongoing it ~may be difficult for him or her to process because it takes time to learn communicate this) and know how to about the disease and how to control administer medications. Once a child it," he says. "Reading literature can is old enough to use an inhaler, parents' supervision is necessary to ensure help patients because they can't always remember what the doctor medication is taken in the right tells them in the office." amount and at the right times. Dr. Fink also urges patients to Children's asthma triggers can be keep in touch with their physician. the same as those for adults. Among "People often say, 'I have a stupid children, however, there is a higher question for you,' oz 'I hope I'm not incidence of allergic asthma than in bothering you,'" he says. "There's no adults. Eighty to 90 percent of asthsuch thing as a stupid question. A matic children have allergies, most doctor's business is to take care of the commonly to dust mites and animal dander, says Dr. Gedachian. patient. But it's up to the patient to Upper-respiratory infections are a call when they need help. The patient particularly common and potentially is a partner with the physician in managing their disease." serious trigger, particularly for small children. A child's condition can worsen very quickly and without warning. Susan Berg is a freelance writer in ' ~ child can have a viral infection, or Sharon, Massachusetts. She J~equently writes about health care and consumer just a cold, and in six to 10 hours, have a full-blown asthma attack," says issues. Dr. Gedachian. "Therefore, a child's very first asthma attack often results in his or her being hospitalized. "Children under the age of 2 are particularly challenging to treat because their airways are smaller," Dr. Gedachian continues. "During an asthma episode, the child's small airways become inflamed and plugged with mucus. This limits the ability for medications to get to the lungs and blunt the attack." As children get older and their airways enlarge, often their asthma improves, says Dr. Gedachian. In the meantime, however, realize that a child's asthma may affect the entire family. That is why all family members need to learn about asthma in order for the whole family to feel comfortable dealing with it. call
1.800.527.3284