Jan 31, 2011

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Dont worry, Eric. Sunday school isnt as bad as juvee! Do your dinner conversations start like that? My daughter, Emily, has decided she wants to go to Sunday school. My wife, who was brought up as a good Baptist, thinks this is great. Emily started asking Doris a bunch of questions about Sunday school. Doris explained that at Sunday school they mostly told Bible stories. Whats a Bible? Doris sighed a bit and explained. Then Emily asked What are the stories about? Well, the are about people like God and Jesus and Moses answered Doris. Is Moses Gods daughter? asked Emily. After Doris cringed some more about how little biblical knowledge her kids had she gave a brief biography of Moses. Then Emily tried to convince her brother Eric that he should go to Sunday school too. Eric wasnt convinced. That is when Emily used the not as bad as juvee sales pitch. Now assuming by juvee Emily meant juvenile detention, how Emily knows what juvenile detention is like or why she decided to compare and contrast Sunday school to juvee is an open question.

As a parent, sometimes you dont know how little your children know about a subject until you start listening to their questions. 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 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. I realize that maybe its time to go back to asthma basics

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? 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, 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 hurt, 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 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 everyday to keep the inflammation down and only use their short inhaler (like salbutamol or Ventolin) three or fewer times a week.

If your asthma still isnt under good control, come to the pharmacy. We can give you simple suggestions on how to breathe better.

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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