Back to the basics...Asthma 101

Oct 19, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Donald Trump. He hardly pays any income tax. He hosted a super spreader event in the White House Rose Garden. During his announcement of his Supreme Court nominee, 11 people got infected with COVD-19. There are more than 30 people associated with the White House who now have COVID-19. This includes the President, his wife and at least one of Trump's children. The US has 4% of the world's population but has 25% of the world's deaths from COVID-19. Masks slow the spread of COVID-19. COVID-19 is not a hoax. All the previous statements are indisputable facts. Belief in these facts shouldn't depend on if you are a Republican or a Democrat. However, in a highly polarized presidential election year, if I went to a Trump supporter and told him those facts, I'd be called a liar or worse.

How do you tell someone facts that they don't want to hear without insulting them? Because once you have insulted someone, they will not listen to anything you have to say. As an asthma educator, sometimes I forget how little some asthmatics know about their disease. When I hear things like: "Well, you know he has to play in goal. He can't skate with the other players. He has asthma." and "I just want to fill my blue puffer. If I use the blue one four times a day, I feel great. I don't need that steroid inhaler." I want to help these people. I want to help them live better with their condition, but I don't want them to feel dumb, insulted or belittled. But when I tell them things about their asthma that are completely different to what they've believed for years, that is what might happen.

Let's do some Asthma 101. Having asthma should not stop anyone from doing any activity. The key is to have your asthma under control. How do you know if your asthma is under control? Start with these 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. Don't get excited or upset. This doesn't make you a bad person or a Trump supporter. If your asthma is not under good control, we can do lots of things to fix the problem. Let's 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, let's 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 let's put a poison ivy rash on the back of your hand. The poison ivy will make the skin on your hand red, and inflamed. Now if we rub a feather or sprinkle some sand on your hand, the muscles in your arm will twitch, and you will spill your coffee.

To prevent you from spilling your coffee, we could treat your hand and arm in two ways. We could inject some muscle relaxants into the muscles in your arm. This would mean that even though rubbing the feather on your hand would be irritating, the muscles in your arm 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 wouldn't be irritating and you wouldn't 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. We call this type of medication a bronchodilator. 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. The fast-acting inhaler relaxes the twitchy muscles in your lungs and stops the coughing and wheezing. These short acting bronchodilators do NOT fix the underlying problem of inflammation in your lungs. As an extra problem, short acting bronchodilators like salbutamol or Ventolin, speed up the heart. So, if you use too much salbutamol or Ventolin it can be hard on the heart.

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 won't make you won't cough and wheeze. This is why we say that ideally, we want an asthma patient to use an inhaled steroid regularly everyday to keep the inflammation down and only use their short inhaler (like salbutamol or Ventolin) three or fewer times a week.

There are now five inhalers on the market that combine an airway opening bronchodilator and an anti-inflammatory steroid into one device. There is Advair, Breo, Symbicort, Zenhale and the newest one Atectura. Symbicort is still my favorite, but the new Atectura might change my mind. It only has to be used once a day and it is supposed to be priced lower than its competitors. All these newer combo puffers have about the same efficacy, so patients can decide which one they like to use the best.

I'm glad my job isn't to sway Donald Trump supporters, because that might be an impossible task. But maybe we can use Trump tactics to help educate the world about asthma. Maybe the key to Donald Trump's message is all those red hats. You know, "Make America Great Again!" or MAGA hats? What about red MATGA hats! I think they could really catch on. "Make Asthma Treatment Great Again!" Okay, another one of my dad jokes has bombed. But, I bet you can't stop thinking about red MATGA hats and steroid inhalers all day today. I'm counting that as a win.

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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