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Thursday, November 16, 2017

Most Common Inhalers Mistakes


(Shutterstock image)

Last week, Hubby and I had a long awaited vacation to Hawaii. As we were waiting to board the plane, a woman near us started violently coughing and then used her inhaler. 

Hubby leaned over to me and said, "She isn't using a spacer!" I leaned back and said, "She didn't wait one minute between puffs either."

I wondered if I should say something? After all, if you don't use your inhaler the right way, you aren't going to be getting as much medicine as you THINK you are getting.

But would you want a complete stranger walking up to you and say, "I couldn't help but notice you using your inhaler. As a Certified Asthma Educator, I can help you make a few changes that would you allow you to get more medicine from your inhaler. May I show you?" 

I have found that there are Happy Travelers - you know, the kind who look amazing and are full of energy. Then there are those who have obviously had a little Dramamine or a few drinks. Or those who are just plain tired and cranky.

So, I will share the Most Common Inhalers Mistakes here on my blog.

  1. Not checking the opening of the inhaler for debris 
Why check the opening of your inhaler? Well, I have heard stories of people inhaling a dime, pocket lint, cookie crumbs, etc. Anything floating around in your back pack, purse or pocket can get stuck in your inhaler.

2. Forgetting to shake your inhaler   

When you shake your inhaler, that will mix the right amount of medicine and pressurized air. Kind of like when you have to shake a can a spray paint before you use it so it mixes up. 

2. Not priming your inhaler 

You should shake your inhaler and then spray a puff (or two, or three, or four) into the air. How many puffs you spray depends on the brand of your inhaler and each company is a little different (you should look up the directions for your brand of inhaler.)  American Thoracic Society says that when you prime your inhaler, that makes sure you get the right amount of medicine in the dosing chamber. They also have a nice graphic that shows the inside of an inhaler so you can see how it works.

3. Forgetting to blow out BEFORE you use your inhaler 

You need to empty your lungs FIRST so you can take a big breathe IN and inhale all of the Albuterol. If you forget to do that, it's a little hard to breathe in when there your lungs are already full of air.

4.   Not using a spacer OR not inhaling BEFORE you puff the inhaler  

Okay, there are two options here. 

a. Use a spacer 

This is my choice because I am uncoordinated - I can't walk and chew gum at the same time! If you use a spacer, you just insert the inhaler into the end of the spacer and depress the inhaler. That allows the medicine to go into the spacer/holding chamber and stay there until you inhale it.


b. Inhale BEFORE you depress the inhaler 

Since the medicine in an inhaler comes our REALLY fast (one pharmacist told me it was over 50 miles per hour - or something like that.) So if you depress our inhaler and THEN breathe in, that puff will be at the back of your throat before you even have a chance to breathe in. You should put the inhaler between your teeth, and start to breath in BEFORE you press the inhaler. That way, the air is already swirling and being pulled down into your lungs, and the puff will go right down your lungs with it. 

This is hard to explain, so here's a video that shows How to Use an Inhaler.

5. Not holding your breath after you use your inhaler 

The New England Journal of Medicine listed this as one of the most common mistakes. You don't want to inhale, and then exhale right afterwards or you will blow all of that medicine right back out.
5. Not waiting 1 minute between puffs

 Why can't you do 2 puffs back to back? Well I had to study  "The Asthma Educator Handbook", 
 to prepare for my Certified Asthma Educator exam. In the book, it talks about how your lungs branch out 28 different times. That's a lot of twists and turns for the medicine to go through. A pharmacist explained it this way: The 1st puff will go about 1/2 way through your lungs (will sort of plow the way) and that takes time. If you wait one minute, the 2nd puff can quickly zip through that section of the lungs, then finish plowing to the end of the lungs (where the air exchange takes place.)

6. Forgetting to rinse your mouth after your controller inhaler

Controller inhalers can cause thrush if the medicine stays in your mouth. The doctor and pharmacist should tell you to rinse out your mouth after you using your controller (or maintenance) inhaler. But I always like to know WHY. The why is that you can get thrush. That's where the tongue turns white and you can also get sores on it.

So, I know that's a lot of information. With the families I have worked with, most report feeling better just by changing their inhaler technique. Some people have told me they have had asthma all their life, and they know what they are doing. And yet, they have been using their inhaler wrong for years! Once we play the video showing the proper inhaler technique, they are surprised. If they are willing to try it to change a few things, they are happy to see that they feel better and report that the medicine seems to be helping more. 
 
Take a minute to see if you are using your inhaler the right way!  
  




Wednesday, November 1, 2017

Leave it to asthma to ruin things!

Halloween is over for another year, and as usual, my co-workers did an AMAZING job decorating our office. 

It's hard to come up with a different theme each year, and this year it was The Great Pumpkin Charlie Brown. Each day when I would come back to the office, I would see something else they added. 

And true to Halloween and pumpkin patches, they brought in cornstalks and hay. It looked amazing, but I was instantly over powered by the smell of hay and cornstalks. And avoided the front office.

Within a few minutes, I had to use my inhaler. In fact, every morning for the past 3 days (since the cornstalks came), I have had to use my inhaler when I get to work. That's unusual for me.



 The cleaning crew walked in and the guy that usually vacuums for us stop dead in his tracks and looked at the floor. I shrugged my shoulders and told him it was just until Halloween. 

We reassured him that my co-workers said they would clean up. 

Since Halloween is over, I asked several of my co-workers if they could take the corn stalks out and throw them in the dumpster. 





Snoopy's house looks adorable, but I can't keep having asthma attacks every morning when I come to work. In fact, I am back in my office with my door shut and my fan blowing towards my door to try to keep the allergens out of my office.

Once again, asthma has to ruin things.

I told my co-workers that asthma has a habit of doing things like that. Where they aren't the least bit bothered by corn stalks or hay, my allergies and asthma are going crazy.

That's typical of asthma. I like give people the simplified version of asthma - that it's a "Drama Queen." For any of you that have teenagers, you know what I am talking about!

The technical term is "hyperresponsiveness and hypersensitivity." Which means that your body is overly sensitive to asthma triggers and your body over reacts.

It is what it is. It's a biological response in our bodies. We can't stop it from happening, but we can try to avoid things that set off our allergies and asthma. 

 I also try to "be part of the team", and didn't let anyone know that it was causing problems for me. But now that Halloween is over? OUT!!! 

I need those cornstalks and hay out of the office.

Anyone else have fun with fall holiday decorations?

 




Monday, October 16, 2017

Trying to stay healthy....

(Shutterstock image)


Well, it's that time of year again. Co-workers and family members are sniffling, wiping their noses and coughing.

And I am trying to AVOID them. 

Not easy when you live with one of them, and work with an office of sick people. 

The possibilities for germs are endless. And I try to avoid all of them. 

I use my sleeve to open doors (I'm not touching those handles!) I use my knuckle to punch the elevator button and then wash my hands when I finally get to my office.

I wash my hands after I touch the handle to the microwave and office fridge. Seriously....does anyone else have one of "those " office fridges that no one cleans out? I am tired of being the only one to clean the fridge, and have left that to someone else. I know no one is going to take time to clean the fridge handle if they can't clean the inside of the fridge!

And don't get me started on the people that don't wash their hands after they use the bathroom at work. Seriously?! I work with nurses! They should know better! I use a paper towel to open the bathroom door. 

Even out in public, I have to be careful. I just made a quick trip to the grocery store and always use the pop up canister of disinfecting wipes on the cart handle. Then, when I'm done and go out to my car, I use my pop up canister to wipe my hands again. 

 
Overkill? Nope, not when you have asthma! 

I had bronchitis this spring  and was VERY sick and missed a week of work. I also had to have a course of prednisone to get the swelling down in my lungs. However, prednisone can impair your immune system, so I have to be really careful now.  

Can avoid getting sick? Maybe not, but I am going to try!
 

Monday, October 9, 2017

Teal pumpkins for Halloween?





https://www.foodallergy.org/education-awareness/teal-pumpkin-project

Why am I talking about the Teal Pumpkin Project? I mean, what does that have to do with asthma?

Well, a lot! 

70% of people that have asthma also have allergies (and many of those have food allergies, not just seasonal allergies.)  

In fact, I was just telling my co-workers how our family has to inspect ALL of the food we eat - family parties, work parties, church parties and even restaurants. EVERY time I eat at a restaurant, I have to ask the wait staff to make sure that my chicken breast is not cooked anywhere near seafood. I also have to remind them not to use the same utensils on my chicken that they are using on the seafood.

On Saturday, we went to lunch at a local bakery and sandwich shop and Son #2 ordered a gourmet grilled cheese sandwich. He knew that they make their own breads there, including some with nuts. So, he asked them to make sure there was no cross contamination. He told me that the cashier just looked at him with a blank look on her face.

So, Mama Bear came out, and I marched back up the counter and caught the eye of the manager and repeated our request. I let her know that I have an epinephrine auto injector, but would prefer not to use it. 

She said that she would make sure his sandwich is not cross contaminated by a knife, cutting board, or anything else that was used to slice bread with nuts. (The repeated requests get really old after a while......some people are quick to understand and help, while others look at us like we really weird. Which we are - but that is beside the point. )
 
Sometimes, I will pull out my epinephrine auto injector and show them so they know I am serious! 

Son #2 is in college now, but when he was younger, Halloween was a tough time because there are so many treats with tree nuts (cookies, candy, brownies, etc). Some kids are allergic to peanuts too, and that can make Trick or Treating a little scary! (Think costumes are scary? Try avoiding accidental exposure to a food allergen in Halloween candy!)

FARE (Food Allergy and Research & Education) has an entire website devoted to the Teal Pumpkin Project. What is that? The project is dedicated to:

"Raising awareness of food allergies and promoting inclusion of all trick-or-treaters throughout the Halloween season"

You can print out flyers, coloring pages, lawn signs  - all sorts of Teal Pumpkin Project to let parents know that your house is a place where they can trick or treat for allergy safe treats. 



Some families will only stock non-food treats. Other families will have 2 bowls - one with candy and one with non-food treats. FARE also has ideas for non-food treats (glow sticks, bubbles, mini slinkies, etc) Do whatever works for you!


So if you are shopping for Halloween candy, consider picking up some allergy-friendly Halloween candy or non-food treats for kids with food allergies.

We want them to be safe and happy and have a fun Halloween too! 

Monday, October 2, 2017

Asthma as a family disease


(Shutterstock image)

Like many chronic diseases, asthma doesn't just affect the person who has it - it affects the whole family.

When my kids were little, they were sick - a LOT! And they were hospitalized 12 times (usually with pneumonia.) And it was always a tough time for the whole family.

And that meant plans went out the window. Sleepovers were cancelled, dinner was missed, and basic things around the house were neglected.

When one of the kids was in the hospital, that's all we would focus on. Who would spend the day/night at the hospital, who would spend the day/night at home with the other kids.

We would run out of groceries, the lawn would need to be mowed, homework would be skipped. Soccer practice? Nope. Scouts? Sometimes.

We would fit in whatever we could.

I remember driving home from the hospital late one night with Son #1 while Hubby stayed at the hospital for the night. (Son #2 and daughter Kitty were both in the hospital with pneumonia.)

We were almost home when Son #1 said, "Hey mom, the new term starts tomorrow and I need gym shorts since I'm starting a gym class." Not kidding. 

It was 10:00 at night. 

I was exhausted, had a killer headache, and just wanted to climb into bed. 

So, what's the closest store that is near me and open late - and carries gym shorts? Well, we started out at Target and had Walmart as a back up. Luckily, there was one pair of black gym shorts left in his size - what are the odds? We were in luck!

In the early years, we muddled through parenting and never won "Parent of the Year!" awards.

Were we perfect parents? No. Did the other kids get neglected? Yep. 

Did we muddle through and all survive? 

Yes.


Asthma also affected our jobs.

Hubby and I would often miss work as we tried to juggle kids in the hospital and kids at home. The kids weren't hospitalized EVERY time they were sick, sometimes they were just sick enough that they would need to stay home and miss 4 or 5 days of school. So, that meant one of us would need to stay home to take care of the kids.

What can you do when you have a kid with asthma who seems to always be sick? I would let the kid's teachers know that they had a brother or sister in the hospital and that my child may need extra love and attention that week.

I would let the neighbors or grandparents take the kids to scouts, dance, soccer games and out to dinner.

When people would ask, "What can I do?" I would tell them! 

Do you have time to drop by the pharmacy? Can you pick up milk and bread at the grocery store? 

It takes a village to raise a child, so call on your fellow villagers when you need a little extra help.




 

  


Monday, September 25, 2017

Hiking, high elevations, and asthma

We live at an elevation around 4,000 feet. So when we decided to go to Moab with all the other tourists and hike up to the world famous Delicate Arch, I wasn't too worried. It's about the same elevation as where I live now.

I have hiked Delicate Arch before - in fact just a year ago. It's 3 miles round trip, but VERY steep. So this time I brought my hiking sticks. We packed water, had good hiking shoes, and were ready to go!


Enter asthma. 

Yep.

Sometimes it can be just one trigger that causes an asthma attack, other times it can be a lot of triggers piling up until your lungs can't take it anymore.

For me, it was a few triggers piling up. 

It started in the hotel room - which must have been dusty, because I woke up in the middle of the night sneezing and coughing. Dust is one of my worst triggers. So I started out the day with 2 puffs of my albuterol inhaler.  

Strike 1.

Then we followed the long line of cars to Delicate Arch and when we arrived, I noticed the weather was unusually hot.  Heat is another of my asthma triggers. 

Strike 2.   

We grabbed our water bottles and walking sticks and off we went. We hiked for about 10 minutes when I realized I wasn't going to make it up the trail. Exercise is another asthma trigger for me.

Strike 3.

I was out.

I told my hiking group that I wasn't going to be able to finish the hike and I would wait for them back in the car. I was a little annoyed. We had planned this hike for quite a while and I thought I would be fine. 

So, I turned around and headed back to the car. There are usually a LOT of people on that trail, but I was alone and could use that time to think.

I was startled to notice a vulture flying overhead. Oh pu-leeze!! He has to be kidding me! I'm not that bad - I'm going to make it back to the car just fine. (I did have a good chuckle about it later when I related that event to my hiking party!)

As I slowly made my way back to the car, I decided to change my thinking. Instead of being frustrated that my asthma ruined a fun hiking trip. I was going to be GLAD that I listened to my body. Instead of pushing through it (and really getting into trouble with my lungs - and having no cell service to call for help), I would respect my body.

It TRIED to keep up. It really did. But a dusty hotel room, heat and exercise was just too much. But that's okay! It made it through a week of traveling. My lungs and I made it up a beautiful tram ride over a flower covered meadow - hello pollen! And survived an exhilarating ride back down the mountain on a tiny cart on a cement track. 

It made through a day of kayaking and paddle boarding on a beautiful lake. Even with a crazy wind storm that blew sand all over us, knocked over the beach chairs and tumbled our beach umbrella into the lake. My lungs made it!

It survived a long car ride, dusty hotel room, heat and exercise. And then it said "uncle!"  

Even though I couldn't finish the hike, my body and lungs had been AMAZING! What a busy week. 

So, if you have to cancel an event every now and then because of your asthma, think of all the good things your body and lungs do for you every day! 

Thank you body.

Thank you lungs.

  

Wednesday, September 6, 2017

Fires vs floods


You know, it would be REALLY nice if Mother Nature could even things out a little bit. Mothers aren't supposed to have favorites, right?!

Yet The West is experiencing abnormally high temperatures for this time of year, and very little to no rain - following years of drought.

The South is getting dumped on with crazy amounts of rain. 

I would gladly take some of their rain! (Just not all of it....)

The national news had a story about the weird weather. They showed Houston and surrounding areas covered in water and then a map of The West with  27 forest fires burning. 

I talked to a family member and friend that live on the West Coast, and they both have asthma and are struggling to breathe. Ash is falling around them, and the air is thick with smoke. They have had a horrible heat wave and are not used to high temperatures. So, they don't have swap coolers or central air to cool down, and can't open their windows at night to get fresh air - because there is no fresh air! It is full of smoke.

So, no matter where you live, you may be having problems with asthma. The floods lead to mold problems that affect asthma. 

The wild fires and smoke also affect asthma (in fact, I had a son who almost died due to smoke from a forest fire....so we are a VERY careful at our house when it comes to forest fires and smoke.)  

On my last post, I wrote about flooding, mold and asthma. 

Now it's time to talk about wildfires and smoke. 

How do you protect yourself? Well, the Centers for Disease Control has information about Protecting Yourself from Wildfire

There are things you can do such as checking the local air quality, avoiding spending time outdoors if possible, and making sure you are taking your asthma medicine, etc. All of that is listed in the "Protecting Yourself from Wildfire" website listed above.

I am changing plans to avoid time outside, am taking my controller inhaler and am also using my rescue inhaler when I feel like I need it.

Don't be afraid to call your doctor if your asthma flares up and if they ask you to evacuate, that may be the safest thing when you have asthma! 

Good luck to those affected by the wild fires and those dealing with the flood :(

 

Thursday, August 31, 2017

Cleaning up after a flood

I have seen some pretty unbelievable videos and photos images from Houston and surrounding areas this past week. They have left me speechless (and that's pretty hard to do....)

How can I help? Well, I have already donated money to the Red Cross. But, as Environmental Health Educator (and nerd for all things science), maybe I can help with a little knowledge about cleaning up?
We had a small flood in our basement a few years ago (nothing like Houston.) We had a 100 year rainstorm that cascaded down our basement stairs, overwhelmed the french drain, and rushed into the basement. 

It wasn't even close to the amount of water I am seeing in photos from Houston, but enough that we were overwhelmed. And of course insurance didn't cover it because it was "An Act of God."

So, we were on our own. The disaster companies were busy with other homes and businesses who were damaged more than we were, so I recalled my training from the National Center for Healthy Housing training. I'll spare you my story, but it took 6 weeks for the basement to dry out enough so we could re-carpet (FYI - concrete can LOOK dry....but may not be.)

Here's a photo of Hubby using a moisture meter from the hardware store to test the moisture in the basement floor. 

If your house has been damaged by flooding, here is some important info from FEMA:

    

"Cleaning up After a Flood:"

"The Federal Emergency Management Agency (FEMA) advises the homeowner to take the following steps:
  • Wear protective clothing. Rubber gloves and boots will help protect you from bacteria and possible infections.
  • Avoid putting your hands near your face or mouth when working.
  • Be sure the main power source to your home or business is turned off.
  • Check for shifts in the house or building and cracks in the foundation.
  • Open doors and windows to help dry out the rooms.
  • Remove any standing water. Basements should be pumped out slowly, about one-third of the water each day. Water soaked grounds can cause a collapse of basement walls.
  • Clean up mud, silt and other debris before they dry out.
  • Hose down walls as quickly as possible and follow up with a second hosing with water containing bleach or a disinfectant. Disinfect surfaces, like shelves.
  • Appliances that contain insulation cannot be easily cleaned. Have them checked by a service person before attempting to use.
  • Remove all soaked materials and furnishings. Fully upholstered furnishings and mattresses cannot be cleaned and should be destroyed to avoid health problems.
  • Carpets and rugs may be cleaned. Permanently attached carpeting should be removed before attempting to clean. Clean items out of doors or have them done professionally.
  • Items like sheets, bedspreads, curtains and draperies should be washed with very hot water and detergents, or professionally dry-cleaned.
  • Any flooded food items should be discarded unless they are in undamaged cans or commercially sealed glass jars. Sanitize the container before opening it.
  • Sanitize pots, pans, utensils, dishes, glassware and other items you intend to keep."
Centers for Disease Control (CDC) also has info about how to "Be Safe After a Hurricane." 
And "Clean Up Your Home."

  Every situation is different. FEMA mentions cleaning carpet - but our was sopping wet and the disaster companies were overwhelmed, so there was no place to take the carpet to let it dry out and then clean it. So, we ended up tearing out the HEAVY water logged wool berber carpet (and pad) and replacing it - at our cost.

Our flood pales in comparison to Houston's flooding. Please be careful and follow FEMA's suggestions. I know that homes in many areas still have water up to the roof tops. No telling how long it will take for the water to recede.

And watch your asthma. Water, mold and asthma are NOT a good mix. 

Monday, August 28, 2017

High school sports with asthma









Daughter Kitty is running with the cross country team again this year - which can be "interesting" when you have asthma!

Like the majority of people with asthma, Kitty also has allergies. It's estimated that 65% - 75% of people who asthma also have allergies. 

One of the things she is allergic to (and can trigger an asthma attack) is grass. Another trigger for her is exercise. On top of that, we have been in the yellow air quality zone all summer. 

So, add grass, exercise and bad air quality and it can be a recipe for disaster when you have asthma.

Since it was her first cross country meet this year, I was a little worried about her asthma. But when I stopped by the house before her meet, I was happy to see that she had used her nebulizer before her race.

Sometimes, doctors will tell a patient with asthma to use their Albuterol BEFORE they exercise. 

Is that right for everyone? NO!

Since using Albuterol can cause heart palpitations and a rapid heart rate, your doctor will decide what's best for you.  

How do you know if he wants to use it? Well, if you have asthma, you should have an asthma action plan. It's like a stop light with green, yellow and red zones. Green means you are okay, yellow means caution (you are having asthma symptoms) and red means stop (and get help now!). Your doctor will help you understand each zone and what medication you should use in each zone. 



Sometimes the doctor will check the box in the green zone that says  "use Albuterol 15 minutes before activity." Ask him what he wants YOU to do.

So, did it help Kitty? Yes! She said her lungs felt fine after the meet. On the other hand, I had to help  one of her team mates that was having problems with her asthma.

Everyone with asthma is different. We have different asthma triggers and we treat it with different inhalers. 

Case in point - my three kids and I all have asthma and allergies. We all use different allergy pills and/or allergy nose sprays. And we all have different inhalers. 

We all had to find what worked for us - and you should find out what works for you!

What has your doctor told you about using Albuterol before you exercise? 

Comment below!  




 

Tuesday, August 15, 2017

School supplies and asthma


Mmmmhhhhmm, it's that time of year again. 

The stores are full of notebooks, pencils and cool stuff for lockers. I feel like telling my daughter, "When I was your age....I was lucky I even HAD a locker -  and we didn't have stuff to decorate it!" Yep, I'm getting old.

I should probably take daughter Kitty to the store to get school supplies - since school starts next week. I'm a little slow.....

But besides school supplies, there is something else you need for school when you have asthma.


You can look of the laws of some of the states on the CDC's Public Health Law website.

You also have to have your doc fill an asthma action plan and permission form EVERY school year. There are different forms for each state. Here's one I found from American Lung Association 



 My school nurse always sends out an Asthma Action Plan and permission form every summer. That gives us time to see Asthma Doc so Kitty can have her annual asthma exam and Asthma Doc can fill out her paperwork for school.

Is your child ready to carry their inhaler in school and do they know when and how to use it? American Lung Association has a "Student Readiness Assessment Tool" that can help you decide. It's 15 questions in 4 areas that can help you find out what your child knows about asthma and if they know when to use their inhaler.
 
Don't forget to include the teacher in their asthma plans. At back to school night, I meet with all of Kitty's teacher and let them know that she has allergies and asthma, carries her inhaler (legally), and may need to use it during class. 
 
But, since it's embarrassing for Kitty to use it during class, we come up with a "sign" she can use with her teachers to let them know that she wants to leave the classroom and use her inhaler. (Personally, I don't care if anyone sees me use my inhaler. And as a Certified Asthma Educator, I want people to know how to use it correctly.)
 
So, what kind of sign does she use? Whatever the teacher wants - Kitty will catch the teacher's eye and twirl her car keys and nod. Or she may tug on her ear lobe repeatedly while looking at the teacher. Whatever she wants and whatever will be a silent clue to the teacher.
 
So, as you are getting school supplies and clothes, make sure you are ready for any asthma emergency by getting an Asthma Action Plan filled out and signed. 
 
You never know when you might need one.