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Wednesday, June 29, 2016

Ooh! Aaahh! Fireworks!

(Shutterstock image)

It's that time of year again....Independence Day is coming up! 

And the 4th of July means all of my neighbors will be lighting fireworks. The entire block will be full of smoke.....which is a major problem when you have asthma.

I love fireworks as much as the next person, but if I didn't have to deal with all of the smoke, it would be so much more fun!

The city displays are always fun, because the smoke is higher up in the sky. For neighborhood fireworks, the smoke is down on the ground because everyone is lighting off the cheap fireworks.

Did you know that fireworks can cause problems with asthma? I can tell you personal stories, but I also found a study from Spain about fireworks and breathing problems. 

"The different colours and effects produced in these displays are achieved by adding metals to the gunpowder. When a pyrotechnic display takes place it releases a lot of smoke, liberating minute metallic particles (of a few microns in size, or even less), which are small enough to be inhaled deeply into the lungs."

"This poses a risk to health, and the effects are probably more acute in people with a background of asthma or cardiovascular problems," Moreno explains. "The effects in healthy people are still unknown, but common sense tells us it cannot be good to inhale the high levels of metallic particles in this smoke, even if this only happens a few times a year."

Fireworks make me really nervous because we had a bad experience about 15 years ago with Son #2. Son #2 had been outside playing with friends, and when I went outside to call him in for dinner, I noticed that there was a lot of smoke in the valley. I knew that there was a fire miles away on the mountain, but we lived a LONG way away from the fire. So, I was shocked to see that much smoke on the valley floor.

I ushered Son #2 inside, and he was coughing so I gave him a breathing treatment with the nebulizer. He seemed to fine during dinner.

Later, he went out with his dad to light some fireworks, and watch the neighbor's fireworks too.

When he came back inside, he was really struggling to breathe again. Since it had been longer than 4 hours, I gave him another breathing treatment.   

But he "didn't look right". I told Hubby that I was going to take Son #2 to the Emergency Department. Once there, the nurse took him right back to a room and started oxygen. The Emergency Department Doctor was really worried about Son #2, and they were trying to help him. (We found out later that Son #2 goes from bad to worse VERY FAST.) He's in that 10% of people with asthma that have severe asthma.  

With severe asthma, medicine and treatments that work on other people don't work on them. 

Son #2 was getting worse and worse, so they admitted him to the pediatric wing of the hospital.

In fact, we didn't realize how bad he was or that they had the "crash cart" parked right outside his room (the nurses were afraid he was going to stop breathing and die.) They didn't explain this until AFTER they felt he was out of danger several days later. I learned that they had put a heart monitor on him to alert them if he stopped breathing and his heart stopped. (I swear these scary situations are what has led to my grey hair.....)

So, after 3 days in the hospital, Son #2 was able to come home. But, every year since then, I have worried about fireworks and asthma. In fact, Son #2 is older now, and his asthma is much better. But I usually watch the neighborhood fireworks from inside the house. If not, I end up with an asthma attack and have to run and grab my Albuterol inhaler. 

So, enjoy celebrating Independence Day and the freedom we have living in America. And enjoy the fireworks! I'll be watching the neighborhood fireworks from my air conditioned living room while sipping on an ice cold lemonade. Now that's how I watch fireworks!

Wednesday, June 22, 2016

Coughing at night

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Coughing is one of those things that makes me sit up and listen. When my kids were little, they were sick - ALOT! They ended up in the hospital many times for asthma and pneumonia. So, every time one of my kids starts coughing, it makes me worried.

Son #1 was just coughing before he went to bed. I asked if he had been playing Ultimate Frisbee with his buddies, but he said no. He has exercise induced asthma, so Frisbee games, running, hiking, etc will set off his asthma. Usually I have to remind him to use his inhaler if he's coughing.

He said he noticed his asthma was flaring up the last few nights (he wast telling me this as he was coughing......). I said, "Well - use your inhaler - that's what it's for!" Son #1 said,  "Oh....yeah." Sigh.

I heard him coughing before he went to bed, and then during the night. The pollen count is really high right now, and he has allergies. But he always showers before he goes to bed at night. So, that helps the allergies and should also be helping his asthma. 

Then he told me that he ran out of his daily controller medicine. Ah ha! No wonder he's coughing! I said, "Well, now you know that the medicine really helps and you should probably get it refilled!" 

  Did you know you can take a 5 question quiz and find out if your asthma is in control? has an Asthma Control Test you can take. 

One of the questions is:

During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning? has a chart that shows how severe your asthma is. They list their chart as coming from: National Heart, Lung, and Blood Institute. Accessed: May 20, 2010. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma 

(Trust me - the chart from the Verywell website is a LOT easier to understand!)

It's hard to read, but if you look on the 2nd box, "Nighttime Awakenings", you can see how bad your asthma is. 

If you are waking up less than 2 times per month, you have "intermittent asthma."
If you wake up 3-4 times per month, you have "mild persistent asthma". 
If you wake up more than once a week (but not nightly) you have "moderate persistent asthma." 
If you wake up every night, you have "severe persistent asthma."

Coughing at night is just one of many ways doctors can check to see if your asthma is in control. This is hard to explain in a blog post, so it is best to talk to your doctor. He can see if you need to start on an asthma medicine, or change one that you are on now.

I talk to a lot of people who think it's normal for their asthma to wake them up at night. It's not (unless you are sick with a cold). 

So if you are one of those people with asthma that coughs during the night (and your spouse, brothers, sisters, roommates or whoever tells you that you cough at night - listen to them!) Some people don't even realize they are coughing during the night. 

If you are, it could be a sign that your asthma needs a little attention. 

Call you doc, and you and your family may all sleep a little better.

Wednesday, June 15, 2016

Asthma AND Vocal Chord Dysfunction?

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So, we were back at Asthma Doc's office AGAIN. Daughter Kitty is still having a tough time with her asthma (what else is new?)

This time, we were there for a Spirometry test.   It's a lung function test that can tell how well your lungs are doing. It measures how MUCH air you breathe in and breathe out, and how FAST you breathe out.

They can use the test to diagnose asthma and COPD.   

I was surprised to see that Kitty's graph looked normal. Asthma Doc was a little surprised too. Smart man that he is, he wondered if there is something else that is causing Kitty to have problems breathing.

He asked if she feels it more in her lungs, or in her throat? I was surprised when Kitty said she felt it more in her throat. 

One of the things that can be confused with asthma is Vocal Chord Dysfunction. Vocal what??  AAAAI -  American Academy of Allergy Asthma and Immunology explains it this way:

"Vocal Cord Dysfunction (VCD) occurs when the vocal cords (voice box) do not open correctly."
"In asthma, the airways (bronchial tubes) tighten, making breathing difficult. With VCD, the vocal cord muscles tighten, which also makes breathing difficult."
And if you are not already confused.....
"To add to the confusion, many people with asthma also have VCD."
Hm. Well, we KNOW Kitty has asthma. In our family, it's genetic because I have asthma, as does Kitty and both of her brothers. Kitty was hospitalized 4 times with pneumonia she was younger.  And she is on a daily controller medicine for her asthma.

 AAAAI lists the following symptoms for VCD:

Symptoms of VCD can include:
•    Difficulty breathing
•    Coughing
•    Wheezing
•    Throat tightness
•    Hoarse voice
•    Voice changes

You can watch a short video about VCD here. 

We first learned about VCD when Son #2 had a test to see if he had VCD. It's not a fun test - they stick a tube down your throat with a camera on the end. Then they watch your vocal chords open and close. Son #2 DIDN'T have VCD, but Asthma Doc thinks Kitty does.

You treat VCD with speech therapy. Jewish National explains it here.

Asthma Doc said he hasn't been able to find a speech therapist in our area that treats VCD. He knows that I have a knack for knowing resources and being able to find things.

Challenge accepted. 

If there is one thing we moms are good at, is taking care of our kids and getting the help they need.

Excuse me while I start my list of speech therapist for our county and start making phone calls.

Thursday, June 9, 2016

Summer Camp

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Yep, it's that time of year again. 

Summer camp. 

I am NOT a big fan of summer camp. Many parents probably worry when their kids are at camp because they miss their child, worry that they might be home sick, etc. 

 But, when you have a kid with allergies and asthma, we worry about things like - oh, breathing. You know...that thing that keeps you alive.

Daughter Kitty is at a church camp. And it's REALLY far from the closest town (and cell service), so that makes me nervous. There is a caretaker couple that lives in a house at the campground, and they have a land line, so I guess there is ONE way for Kitty to contact me if needed.

The other bad part are out in nature! To quote Melman the Giraffe from the movie Madagascar, 

"Ahhhhh! Nature! It's all over me! Get it off!" 

There's no getting away from nature when you are camping. It's not being at home, eating dinner on the patio, and then going back into your air conditioned house and a nice shower. 

With camping, you are out surrounded by trees, grasses, bushes - all sorts of things that can set off allergies (and cause an asthma attack.) The cabins can be really dusty too.

Kitty is also at a high elevation, which can make it more "fun" to try to breathe.

If you worry about your kids at camp, there is another option. 

American Lung Association has special asthma camps in most states. What's an asthma camp? That's where kids can enjoy all the fun of camp BUT - the best part is that there are doctors, nurses and/or respiratory therapist there 24 hours a day!

Camp Superkids in Minnesota has a youtube video that shows what asthma camp is like.  

They also have a nurse assigned to each cabin! How cool is that? I would really sleep easy at night knowing there were doctors, nurses and respiratory therapists that could help my child in case anything happened. 

You can look for an asthma camp near you by checking The Consortium on Children's Asthma Camps website 
I hope you find a fun camp nearby. Until then, I will just worry until Kitty gets back home (Moms are great worriers you know). I'm sure she'll be fine and there's the whole "teenage bonding thing" that is an important part of camp, right?
Speaking of camping, I am really craving some s'mores right now.....

Thursday, June 2, 2016

Prednisone: Necessary Evil

Shutterstock Image we are at Asthma Doc's office - again......

Daughter Kitty is really having a hard time with her asthma. She is on the highest dose of a combination medicine and still can't control it. In fact, she's been in her "yellow zone" for almost 2 months. 

This is an Asthma Action Plan from the Utah Department of Health. They are just like Stop Lights (Green, Yellow and Red.) And just like Stop Lights, yellow means "caution" or "warning" - your asthma is getting worse! If you keep getting worse, you may drop in the Red Zone - which means get to the hospital ASAP or all 911.

Since Kitty was in the hospital 4 times when she was younger for asthma, we would like to AVOID that again. So, the next step for her is to get Prednisone (a corticosteroid.) A corticosteroid is a medicine that brings the swelling down in her lungs. (It can be used for other things too like arthritis, lupus, etc.)

Don't panic - they're not the same kind of steroids that body builders use (she's not going to bulk up.) Many parents are worried and think that steroids aren't safe. But - it's take Prednisone pills now and stay out of the hospital. Or, be admitted to the hospital and get steroids in an I.V. (We have done both routes MANY times over the years.......and I would rather NOT go back to the hospital.) I have been told that the steroids in the IV are REALLY strong. But if they keep you alive......

Prednisone can have some nasty side effects. My kids always get angry, eat a lot, wouldn't be able to sleep, their face would puff up and their cheeks would turn red.

In fact, I texted Hubby and said, "Kitty on Prednisone. You have been warned...."

Sometimes kids need a little extra patience and understanding. Because they get a little crazy when they are on steroids, but they can't help it! :(
Sometimes the doctor and pharmacist don't "warn you" about how crazy your child might be on steroids. So, I try to warn other parents about it now! lists other side effects of Prednisone :

Other common prednisone side effects may include:
  • sleep problems (insomnia), mood changes;
  • increased appetite, gradual weight gain;
  • acne, increased sweating, dry skin, thinning skin, bruising or discoloration;
  • slow wound healing;
  • headache, dizziness, spinning sensation;
  • nausea, stomach pain, bloating; or
  • changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).
There are more side effects too (and some are really make sure to read about ALL the possible side effects - just in case.)  But don't get too worried. It seems like there are always lots of side effects things that COULD happen from Prednisone - but usually don't. 

But.....Prednisone keeps people breathing. And that's the most important thing here. So that's why many people call it a "Necessary Evil". Because it can have nasty side effects, but you still have to use it to keep breathing. 

And breathing is always a good things for asthma.

Saturday, May 28, 2016

Spacer time

 It's spacer time! (Not to be confused with Hammer time.....yes I remember the MC Hammer song from the 90's..... ) And no, I did NOT own a pair of parachute pants!

Spacers are one of those things that are SO important to use with an inhaler, but many people don't know about them. In fact, when I help families learn about asthma, the #1 thing that helps them is to learn about spacers. I have had so many people tell me that they seem to feel better just by adding a spacer to their inhaler.
What is a spacer?

As you can see from the picture above, it's a tube like device that attaches to your inhaler. Some are also called "holding chambers" because they "hold" the medicine with a one way valve until you inhale it. 

So, why use one? Well, I know this is hard to read, but this slide is from a training I attended. It was from a respiratory therapist showing how fast the spray comes out of an inhaler. He showed that it came out at 156-221 miles per hour. Woah!!!

That would make it almost impossible to suck the medicine down into your lungs fast enough. Asthma Doc told me that if I just use an inhaler, most of the medicine will just hit the back of my throat, instead of being sucked down into the lungs. Mayo Clinic explains it this way:

"Releasing the medication into the spacer gives you time to inhale more slowly, decreasing the amount of medicine that's left on the back of your throat and increasing the amount that reaches your lungs."
If you are having an asthma attack, you really need that medicine - all of it. I don't want it on the back of my throat, I want it in my lungs!

So, as you can see, we use spacers. There are several different kinds (some have whistles that will let you know if you are sucking the medicine out too fast.)

Some of mine are REALLY old (the middle spacer in the photo.) The Vortex spacer on the right lets me pull the end off and store my inhaler inside so it doesn't take up as much space in my purse.

I have noticed that most primary care doctors and pediatricians don't prescribe spacers. But asthma specialists do.

If you don't have one, ask your doctor for a prescription. Insurance should pay for it. But, in our case, our insurance is wacky and says we can only have "one per lifetime". Are they kidding? It's made of plastic!

But, we can have Asthma Doc write a prescription, and then we can get one at the pharmacy, but just pay for it ourselves. (My last spacer was about $20.)

If you don't have a spacer, get one and try it and see if you can tell a difference.

Leave comments here if it seems to work better for you!

Monday, May 16, 2016

Those perfume wearing people.....ARGH!!!!!

Since I have SO much free time (wait......I am laughing so hard I need to catch my breath........) 

As I was saying, with all my free time, I decided to take the Certified Asthma Educator Exam. Studying for it is like being back in college! I thought I would do a little "light reading" on a recent flight. I have my trusty pen to underline important parts of the book. I was hoping I could have a little peace and quiet and be able to read on the flight.

I just happened to be reading a section that said, 

"Why in people with asthma do the bronchial tubes react to asthmatic triggers in the way that they do, when the very same stimuli have no effect on the airways of someone without asthma?"
"That's for sure!" I said to my husband. He looked over at me wondering what I was talking about, and I showed him that paragraph in the book. 
I had noticed earlier that the woman sitting in the row in front of me had a REALLY stinky sweet perfume. First, it was annoying. you people have to bathe in perfume? A little goes a long way you know. 

For those of you who read my blog regularly, you know where this is going. And you know that  perfume is one of my asthma triggers. I was hoping I wouldn't have an asthma attack on the plane.

Sure enough, "The Twitch" started in my throat. I tried to adjust my air vent, but there didn't seem to be much air coming out of it. Then I started breathing with my sweater over my nose. 

The woman in front of me was traveling with a small child, and had been leaning over his seat to help him with his tablet. She looked back at me through the crack in the seats, and realizing that I must look really weird with my sweater up to my nose, I said, "I think your perfume is bothering me." She sniffed her shirt and said, "I can't smell anything."

Well, sure enough....The Twitch got worse, and then the cough started. So, I took two puffs of my  inhaler. 

Now that's ironic! I had just read the section about asthma triggers, and how normal things (like perfume) don't affect people without asthma. And just to prove my point, I had to have an asthma attack.

So, what do you do when you are stuck on a flight with someone with really stinky perfume? I was traveling with Hubby and daughter, Kitty. I looked around, but the flight was full. How do you get away from someone on a plane?! I kept breathing through my sweater. As soon as we reached our traveling altitude and the captain turned off the seat belt light, I moved 3 seats away from the woman, to the aisle, where I could get more fresh air. 

It seemed to help. That and using my inhaler. 

We had a great vacation and the beach was amazing, but on the flight back....who should board the plane and sit in front of me AGAIN?? Yeah.....the Stinky Perfume Lady. 

Seriously. I am not making this up. 

Kitty said, "Uh oh mom......look who's back!" You could smell Stinky Perfume Lady coming up the aisle. So, this time I moved to the aisle BEFORE the plane left the tarmac and used my inhaler as soon as I saw the woman.

For those of you who think there is no way your perfume could make someone have an asthma attack, you can read info from The Allergy and Asthma Foundation of America. 

This is from their page:

"What Causes or Triggers Asthma?"

Irritants in the Air

Irritants in the environment can also bring on an asthma episode. Although people are not allergic to these items, they can bother inflamed, sensitive airways:
Notice perfume listed under "strong fumes, vapors or odors?"

Yep, it's real people. Perfume causes asthma attacks. 

So, before you spray yourself with perfume, please think of those of us who will have an asthma attack because of you. I have rarely ever said to someone, "I just had an asthma attack and had to use my inhaler because of your perfume." Let me tell you....that is one awkward conversation to have to start. 

But people won't know if you don't say anything. So, for those of you reading this, PLEASE do no wear perfume to areas where we are all stuck together (planes, auditoriums, movie theaters, church, etc.)

I thank you and my poor little asthma lungs thank you.