Feb 26, 2014
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Someone asked my son Eric when his birthday was. He said January 12th. I told Eric that wasnt quite the right month. I thought I could prompt him. I told him we would go through the months so he could get the right one. I started by saying January. I expected him to continue February, March etc. My plan was to stop him at July, his birth month. Instead I said, January and Eric thought for a second and continued Tuesday, Wednesday.
As a parent, sometimes you dont know how little your children know about a subject until you ask them. As an asthma educator, sometimes I forget how little some asthmatics know about their disease. I hear things like: Well, you know he has to play in goal. He cant skate with the other players. He has asthma. and I just want to fill my daughters blue puffer. If she uses the blue one four times a day, she feels so well she doesnt need that steroid inhaler. When I hear these things, I realize that maybe its time to go back to asthma basics.
I think asthmatics have two main understanding deficits. The first problem is many asthmatics don't use their inhaler properly. Many asthmatics think they've been using their inhalers properly for years. However, when researchers test asthmatics, about half of them dont have the correct technique. The simplest way to make sure you are using your inhaler properly it to take it to your pharmacist. The next time you fill your inhaler, ask your pharmacist to watch you use it and help you adjust your inhaler technique.
The next problem is many asthmatics have is they think their asthma is under good control, but it isn't. Having asthma should not stop anyone from doing any activity. How do you know if your asthma is under control? Lets start with 6 easy questions:
- Do you have problems with coughing, wheezing, breathlessness or chest tightness 3 or more times per week?
- Do you need to use your fast acting inhaler 3 or more times per week?
- Do symptoms like cough, wheeze, breathlessness or chest tightness wake you up more than once a week?
- Have there been any physical activities that you were unable to do in the past 3 months due to your asthma?
- Have you missed any school or work in the past 3 months due to asthma?
- Have you had to go to the emergency room or hospital due to asthma in the past 6 months?
If you answered yes to any of these questions, your asthma is not under good control. Dont get excited or upset. If your asthma is not under good control, we can do lots of things to fix the problem. Lets start by learning how asthma affects the lungs.
Most of the problems in asthma are from inflammation in the tubes in your lungs. Since most of us have never seen the inside of our lungs, lets talk about the back of your hand. Picture your hand holding a cup of coffee. If you rub a feather or sprinkle some sand on the back of your hand, nothing happens, right? Now lets put a poison ivy rash on the back of your hand. The poison ivy will make it red, and inflamed. Now if we rub a feather or sprinkle some sand on your hand, it will hurt, muscles will twitch, and you will spill your coffee.
To prevent you from spilling your coffee, we could treat your hand in two ways. We could inject some muscle relaxants into the muscles. This would mean that even though rubbing the feather on your hand would hurt, the muscles would be too relaxed to spill your coffee. We could also rub some steroid cream onto the red, inflamed rash on your hand. Over a few days the cream would slowly reduce the rash so that rubbing the feather on your hand wouldnt hurt and you wouldnt spill your coffee.
This is how we treat asthma in the lungs. When you are having an asthma attack (like coughing, and wheezing), we can give you something that will immediately relax the bands of muscles around the tubes in your lungs. This fast acting inhaled medication is usually called salbutamol or Ventolin which comes in a blue puffer. Just like with your inflamed hand, if a little bit of dust, cold air, or some other irritant gets into your inflamed lungs, the muscles over-react and you cough, and wheeze. So the fast acting inhaler relaxes the twitchy muscles in your lungs and stops the coughing and wheezing. The short acting inhaler does NOT fix the underlying problem of inflammation in your lungs. As an extra problem, short acting beta-agonists like salbutamol or Ventolin, speed up the heart. So if you use too much salbutamol or Ventolin it can be hard on the heart.
So how do we fix the inflammation in the lungs and not speed up the heart too much? Just like with your inflamed hand, we use a steroid. In the lungs we use a steroid puffer, not a cream, but if we use it every day, over weeks and months the inflammation in the lungs will go down. After the inflammation goes down, if you inhale a little dust or cold air it wont make you wont cough and wheeze.
This is why we say that ideally we want an asthma patient to use an inhaled steroid regularly every day to keep the inflammation down and only use their short acting inhaler (like salbutamol or Ventolin) three or fewer times a week.
We can fix the two most common problems asthmatics have. Get your pharmacist to review how to properly use your inhaler. Then if you answered yes to any of the 6 asthma control questions, talk to your doctor or pharmacist. We can make simple changes like using a steroid inhaler regularly to make you breathe better.
Eric is doing better now at distinguishing between days of the week and months of the year. He even knows his birthday is in July not January now. However, now he is still bitter that he can't go to a Kings game on his birthday, but I don't think I can fix that.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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