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Tuesday, January 16, 2018

How much does asthma cost?





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Allergy & Asthma Network recently shared a story on their Facebook page from The Daily Mail. 

(I found it rather funny because a newspaper from England was reporting about asthma in America!)

How expensive is asthma? Well, it ranks right up there with cancer, which costs $87 billion in healthcare. Asthma costs $80 billion. Wow!

How much does that mean for the average person with asthma? The Daily Mail article says:

$3,266 for the average person

That breaks down to:


  • $640 for doctor appointments
  • $1,830 for prescriptions
  • $105 for ER visits
  • $176 for outpatient hospital visits
  • $529 for hospital care
Where does The Daily Mail get that data?

 "The research is based on a six-year survey on more than 200,000 people from the Medical Expenditure Panel Survey, the most comprehensive source of data on health care use in the US."
You may be thinking, "We don't spend that much!" 

 Or you may think, "We spend WAY more than that!" 

I had a son that started on biologic injections (those are shots for people with severe asthma, whose asthma can't be controlled with standard asthma medicines.) My son began getting shots in 2008, and his vial of medicine for his shots was $1,000 back then. I'm sure it's closer to $1,500 now. So, we would be spending the average of $3,266 in three month (when you add in doctor's office visits for the shots, inhalers, etc.)

Hospitalizations for us were more than $529, ours averaged about $1,000 a day. The kids were usually hospitalized for 3 days, so we would easily top $3,000 for a hospital stay (and sometimes we had 2 kids in the hospital at the same time - thanks to pneumonia!)

Add to that missed school and work days, and it really adds up. (They estimate $3 billion in missed school and work days.) 

When my kids were hospitalized for asthma, they would usually miss the following week of school after they were discharged from the hospital. Asthma Doc stressed the importance that they rest, rest, and rest some more!

So, now that we know we're expensive to treat, what do we do?

The study recommends expanding asthma education so people can better manage their asthma, and to reduce environmental triggers in the home (dust mites, mold, dander from animals, etc.)

You can search for "Asthma Education" online and find a LOT of information, here is info from The CHEST Foundation 

The Centers for Disease Control (CDC) lists many asthma triggers and how to reduce those in  your home.

We may be expensive, but we're worth it!
  




 

 






Tuesday, January 9, 2018

Thoughts from a respiratory therapist

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I was at a family party over the holidays and was talking with a family member who is a respiratory therapist. 

Since I work in Public Health, I see things very differently from those who work in the medical field. I wanted to know what the respiratory therapist saw in the hospital every day.

Here are his biggest frustrations/thoughts:



  • Don’t buy cigarettes, buy Advair or Dulera instead (they are controller inhalers). If you stay on your controller, you may not need to go to the ER. (Controller inhalers work to control the swelling in the lungs that happen when you have asthma. If you can keep the swelling down in your lungs, you will breathe much easier.)
  •  Don’t run out of your inhaler! Gotta do those refills! (I am guilty of running out of my controller inhaler - twice! I love that my inhaler has a counter on the back....but you actually have to LOOK at the counter. Oops!)
  •  Don’t smoke (Easier said than done, right? I have 2 family members who have smoked for decades and have tried to quit. It's been a struggle for them, but there are lots of resources out there, including one to help with your Quit Day.)
  • Don’t go to ER and smoke pack of cigarettes afterwards and have to come right back (he can give you a breathing treatment to open up your lungs, but they can tighten right back up after smoking.)

  • Take your inhaler correctly (He says he tries to correct people on their inhaler technique, and they get defensive.)

  • If you like spending money and only getting half the medicine, don’t listen when I try to correct your technique. (He's not trying to make you mad, he just wants you to get all of the medicine that you should be getting!)

  • People who say, "You’re wrong, I’ve been taking it this way for years." He has to tell them, "Well, it’s still wrong, no matter how many years you’ve been taking it that way." ( I hear that all the time - I know what I'm doing! I've had asthma all my life! One study looked at various  research studies and found that between 50% - 100% of people do not use their inhalers correctly. )

  • Don’t get defensive, I’m here to help you get the most out of your medicine. (Notice a theme going on here?)
  • When people say, “no one has ever told me that before!(As a parent of 3 kids with asthma, who were hospitalized 12 times when they were young, I'm sure I missed a lot of what respiratory therapist, doctors, and nurses were trying to tell me at 3am while I was sleep deprived and struggling with a migraine at my kid's hospital bedside. So I understand how people can miss what is said. You really can learn something new every day!)

He finished with, "It's frustrating because I know people are going to do what they want to do, and go right back smoking, not using their controller inhaler, and not using correct technique."

Think YOU are using your inhaler the right way? Here's a video that shows correct inhaler technique

So remember, the respiratory therapist is your friend! He's not trying to make you mad by correcting your inhaler technique, he's not trying to annoy you by asking when you're going to quit smoking, etc. He WANTS you to be healthy, be able to breathe well - and NOT have to come back to the Emergency Room.  



Tuesday, December 26, 2017

Who to call, email or chat with for help?


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Do you ever have questions AFTER you  leave your doctor's office? Or on the weekend, and you just want to ask a few questions?

Your doctor should be your first go to person. I can usually leave a message with my doctor's nurse and she will call me back with the answer to my question.

But maybe you doctor doesn't have a great bedside manner or you want to talk to someone else? 

Enter American Lung Association's Lung HelpLine. It's a free resource that is staffed by Registered Nurses and Registered Respiratory Therapists who can answer questions about "lungs, lung disease and lung health, as well as helping people quit tobacco."

What is their background?

".....rehabilitation, education, acute care, emergency medicine, public health, neonatal care, home care and adult intensive care. Some staff members are addiction counselors who crossed over from drug and alcohol treatment programs to tobacco cessation, and we have staff who are bilingual (Spanish), allowing us to help even more people. Our translation service helps with more than 200 different languages as well."

You can call them at:

1-800-LUNGUSA (1-800-586-4872)

or 


The staff will research your question and answer back via email.

or


(I actually tried the "chat online" and couldn't get the page to load, but maybe my computer was just being slow? So good luck if you can get that option to work!)

Of course your doctor should be your first option, since she/he is treating you. But if you want to talk to someone else, this might be worth a try!  

 

 

Friday, December 22, 2017

When you're sick after hours





Wouldn't it be nice if those of us with asthma could have a "simple cold" without it going into bronchitis?

Yeah, wishful thinking!

This was me 3 weeks ago. I knew it was coming - Hubby had bronchitis first, then it slowly went through all 3 kids and ended with me. Since I am a germaphobe and extremely careful at washing my hands, not touching my face, and disinfecting everything at home, I thought I had escaped the illness.

No such luck.

I knew I was in trouble one Sunday morning when I woke up and was still struggling to breathe even after I used my nebulizer. I had lost my voice and was also coughing up colored phlegm. I know from my Asthma Action Plan, that doc wants me on prednisone (oral steroid) and an antibiotic when that happens.

But, what to do on a Sunday morning? I had a few options:


  • My asthma specialist After Hours
  • My primary care doctor After Hours
  • Telemedicine (where I Facetime or Skype with a doctor)
  • Urgent Care
  • Emergency Department 


I decided to send a page my primary care doc since he has a better After Hours network. For those of you that are younger  - this is what we used before they had cell phones! You call the After Hours phone number, enter your cell or home phone number, then the pager beeps to alert the doctor to call a patient back at that number.  

Since I had lost my voice, Hubby had to answer my cell phone and explain that I was sick, had asthma, and needed a steroid and antibiotic (according to my Asthma Action Plan.)

Hubby found a 24 hour pharmacy (since my normal pharmacy is closed on Sundays), and Doc called in an antibiotic and steroid.

Since those of us with asthma can't wait until morning when the doctor's office opens, we need to know what to do after hours.

What do any of you do on a Sunday morning or evening when you get sick?

Friday, December 15, 2017

Watching for drug interactions

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This month, I got bronchitis (again!) It had gone through the whole family and I thought I wasn't going to get it because I am a germaphobe and so careful with washing my hands.

But, as soon as the scratchy throat started, I knew I was in for the long haul.

With any medical condition that needs a prescription, it's hard to juggle medications and find one that won't interact with another.

As my cold turned into bronchitis, I knew it was time for an antibiotic and an oral steroid. How did I know? I have an Asthma Action Plan that Asthma Doc filled out for me. 

Asthma Action Plans are like stop lights - green, yellow and red zones. Each zone tells you what to do if you are in that zone. Green means "GO", or you are good and not having symptoms. Yellow means "CAUTION" because you are starting to cough, are short of breathe, wheezing, etc. The Red Zone means "STOP" and call 911 or go to the closest hospital.

I was in the bottom of the yellow zone because I was taking my controller inhaler twice a day, using my nebulizer with albuterol, and was still struggling to breathe. 

You can see that this Asthma Action Plan says "Keep ORAL STEROIDS on hand in case you fall into STEP 3 of the yellow zone or into the red zone." 

    
Since my steroids had expired, I had to call the doc to call in a prescription. Since I have asthma, and was coughing up colored phlegm, he decided to put me on an antibiotic too.

However, Pharmacist called to say there was a possible drug interaction between the many medications that I take. 

I am SO glad he flagged that as a problem! That's why it's important to always use the same pharmacy.

If you have to use an after hours pharmacy, make sure they know about ALL of the medicines you usually take. My pharmacy has a program that will alert the pharmacist to a drug interaction.

There is also a website you can use, on Drugs.com click on the Drug Interactions Checker. (It's not a substitute for talking to your doctor or pharmacist, but can help in a pinch.) 

I found out that I could have had some VERY serious complications if I had taken the antibiotic that the doc called into the pharmacy. So, doc called in a different medication.

It's taken 2 weeks, and I missed a week of work (and time I could have spent getting ready for Christmas!) but I am on the mend.

Make sure you know what to do if you are in the green, yellow or red zones for asthma. And if you need a new medication, make sure you use your regular pharmacy to check for drug interactions. Or tell the after hours pharmacy about ALL of the medicine you take so they can check for a drug interaction.

If you are already sick, the last thing you need is a serious drug interaction!

 

Thursday, December 7, 2017

New Epinephrine autoinjector for babies and small children!

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For those of you that have kids with food allergies (or maybe you have them yourself!?) You know how scary it to be to try to eat out at times.

I don't trust anyone! How do I know if they have the same cooking utensils on my chicken that they used on seafood? 

Did they put my chicken on the same area of the grill as the seafood when they cooked it?

Are there desserts that have tree nuts on the tray? If so, Son #2 can't eat ANYTHING on the tray because it is all contaminated!
 
Whew! It can be tiring to always be on the lookout for food allergies.

If you have babies or younger kids with food allergies, that can be really scary. Because they didn't make epinephrine auto injectors for them - until now!

The needle length and dose of this auto injector is made just for them. 

Kaleo is the same company that makes Auvi-Q, known as "the talking auto injector". It looks very different from other auto injectors (it's about the size of a pack of gum.) And  it will "talk you through" using the device, step by step.

Kind of helpful if you panic during an allergic reaction.

I didn't see a photo of the new Auvi-Q, but its' the 0.1 dose. The dosing for older children and adults is usually 0.15 or .3, so this dosing is much less. 

If you have a baby or small child with food allergies, talk to your doctor and pharmacist about getting the new auto injector. 

It is expected to be available "the first half of 2018". 

Good luck!

Monday, November 27, 2017

Using an inhaler for younger kids

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Last week, I wrote a post on the "Most Common Inhaler Mistakes", which was mostly for older kids and adults.

If you have a younger child, let's review the right way to use an inhaler.

The first thing you may notice is that there is a mask on the end of the spacer (the spacer is the long tube that is attached to the inhaler.) So, you will have a spacer with 1) an inhaler attached to one end and 2) a mask attached to the other. See the photo above. 

(One thing I don't like about this photo is that the child is using a spacer, not a valved holding chamber. Usually, you would use a valved holding chamber with a mask. You can learn more from The University of Arizona Health Science Center. )

The mask kind of looks like an oxygen mask. It helps seal the area around the mouth and nose to get a nice, tight fit so the kids will get all the medicine from the inhaler. (For all of you parents with squirming kids - you know what I'm talking about!) It's hard to get them to sit still to take their medicine, so the mask helps with that.

You do the same basic steps as using an inhaler with a spacer:

  • Check the opening of the inhaler for crumbs or lint (you can find all sorts of stuff in pocket, purses and backpacks - which can clog up your inhaler!)
  • Shake the inhaler
  • Prime inhaler if needed (check out this website to see how many times to prime each brand)
  • Breathe out before you press down on the inhaler

If your doctor wants you to use a mask with a younger child, you hold the mask on your child's face while they breathe in and out 6 or 7 times. (With adults, you usually inhale from your spacer and then remove it from your lips.) 

I like to watch a video from Children's Health Care Atlanta, because if you look closely, you can watch the yellow valve go back and forth. That lets you know that your child is breathing in and out (and actually getting the medicine!) 

This video from UNC Health Care also shows how to use an inhaler with a spacer and mask, but is a little more detailed on how to clean your spacer and mask each week. It's important to clean them because if your spacer and mask are dirty, you will be inhaling any germs that are inside of them!

I hope this helps. To review how to use an inhaler or inhaler with spacer for older kids and adults, you can can watch these videos:




 As always, ask your doctor or pharmacist for help if needed.