Which Inhaled Respiratory Medication Should You Take First?

A frequent question from those who are taking more than one respiratory medication to manage their chronic lung disease is, “In which order should I take my inhalers?” This is an important question to ask as it can determine the effectiveness of your therapy.

Knowing your medications will help you to better manage your condition as well as give you some pertinent questions to ask your physician.

The first thing you need to know is the class of each inhaled medication you are taking. For the sake of simplicity, I’ll list the classes and give a few examples of each while also giving the sequence of use.

TAKE THESE FIRST: Long-Acting Beta Agonist (alone or combination) (LABA)-Bronchodilator

  • Advair (salmeterol & fluticasone)
  • AirDuo (salmeterol & fluticasone)
  • Breo (vilanterol & fluticasone)
  • Dulera (mometasone & formoterol)
  • Serevent (salmeterol)
  • Streverdi (olodaterol)
  • Symbicort (formoterol & budesonide)

TAKE THESE SECOND: Long-Acting Anticholinergic (LAMA)-Bronchodilator

  • Incruse (umeclidinium)
  • Spiriva (tiotropium bromide)
  • Tudorza (aclidinium bromide)

TAKE THESE LAST: Steroid 

  • Arnuity (fluticasone)
  • Flovent (fluticasone)
  • Pulmicort (budesonide)
  • QVAR (beclomethasone)

 Other inhaled medications can also be added to the equation:

  • Short-Acting Beta-Agonists (SABA)-Bronchodilator: Albuterol (Ventolin, Proventil, ProAir, Xopenex)
  • Short-Acting Muscarinic Antagonist (SAMA)-Bronchodilator: Ipratropium Bromide (Atrovent)
  • Combination Short-Acting Bronchodilators- SAMA and LAMA: Duoneb, Combivent

IMPORTANT NOTES TO CONSIDER:

  1. If you are also taking a short acting beta-agonist on a regular basis (albuterol) in addition to your daily controlling medications, take it after you have taken your long-acting beta-agonist and never less than 2 hours before. For example, if you regularly take albuterol first thing in the morning, wait at least 2 hours to take your Advair, Dulera or Breo. Refer to the list above for others. The reason for this is that when you take your short-acting medication first it saturates the B2 receptors, leaving no room for the 12-hour medication (LABA) to bind if taken shortly afterwards since the SABA is already there. In a few breaths, LABA is gone and it never had a chance to work. In 4-6 hours the “rescue med” will wear off and shortness of breath will return, leaving you wondering if the medicines are not working. This same rule holds true for the short-acting and long-acting muscarinic antagonist (SAMA and LAMA). Examples of these are atrovent (SAMA) and Spiriva (LAMA).
  2. Short-acting bronchodilators should only be taken when you have symptoms or as a “rescue” unless otherwise directed by your physician. This is especially true if you are already taking long-acting or “controller” medications. You should not be taking 2 medications from the same class so taking a short-acting medication and long-acting medication from the same class is not appropriate and, as mentioned above, may do more harm than good.
  3. While in the hospital you may be receiving more medication than is ordered upon discharge. This is common and appropriate. When you’re in the doctor’s office or the hospital due to an exacerbation, you will need to take more medication until you can get back to normal breathing status. If you are taking controlling medications at home and are ordered to take albuterol as well a few times every day upon discharge, make sure to ask your doctor when you can start to cut back on it.

Remember, knowledge is power. If you still are having trouble determining how to treat your lung disease, contact your doctor for clarification.

  Ref:   www.emphysema.net/inhaler_sequence.asp

          https://www.copdfoundation.org/COPD360social/Community/Questions-and-Answers/What-is-the-preferred-order-of-taking-your-daily-inhaled-medications-Does-it-matter.aspx

Home Cleanliness and Internal Air Quality

Cleanliness of a home or building can have an effect on the internal air quality. You have to search deep to ensure that your home is truly clean. Just because you’ve managed to put the clutter away, it doesn’t mean your home is clean. On the other hand, don’t consider yourself a failure at cleanliness if you find that you have a little mold. Cleanliness is hard to quantify, but here are a few rules that can help:

  • Consistent vacuuming –This the single biggest thing a person can do to help remove allergens from a home. Most of the dirt and pollen that enters the home settles in the carpet. Most carpet warranties not only require vacuuming, but a professional cleaning about every 18 months. Additionally, Dust mites also love carpet and because they are microscopic, their presence can be very hard to perceive. If they are suspected then high thread count sheets make it hard for them to live and plant eggs.
  • Cleaning your home’s air ducts and replacing furnace filters– In a home with forced air, dust is pulled in and recirculated through the ductwork. It is recommended to have the air ducts professionally cleaned every three to five years, or earlier if you notice more dust collecting on your furniture with regular cleaning. Replacing furnace filters on a regular basis is recommended to ensure that your furnace is more effective and the recirculated air is as clean as possible. Check your furnace recommendations and replace when you see that the filter is dirty.
  • Cleaning after pets – I love dogs and cats, but four of the five people in my own family are allergic. Most people who have pets are usually not allergic, but sometimes people become “nose blind” to the issue. Vacuuming, wall washing, and regularly grooming your pets will help improve your home’s cleanliness.
  • Testing the humidity level– There are many inexpensive devices on the market that give a humidity reading in a home ($10-$20 at most local hardware stores). Get a good idea what the humidity is in your home – especially in the basement. If it is consistently above 60%, then use a dehumidifier with a condensate pump. This is also a fairly easy DIY job for most people. Controlling the humidity levels can help reduce the growth of mold.

What are you house cleaning tips? We’d love to hear them.

Back to School and the JUUL

It looks like a USB drive, comes in colors like black, rose gold, and turquoise, and it is available in flavors like fruit medley, mango, cool mint, crème brulee, and Virginia tobacco. What else do we know about the JUUL? It has a loyal and growing following among youth.

Over the past few years, teen perception of risks in using electronic cigarettes has decreased, and it’s evident on social media. Youth can be seen touting their use on social media posts by sneaking puffs in classrooms, school bathrooms, and buses. Experts believe its popularity stems from the fact that it’s easy to conceal, the vapor disappears almost immediately, and the odor doesn’t linger.

Some of the facts to keep in mind:

  • The JUUL has two components: the bottom part is the device, which includes the battery and temperature regulation system, and the top part is the e-liquid cartridge that you stick into the device.
  • The JUUL launched two years ago and is currently the most popular e-cigarette on the market. It generated $224 million in retail sales from November 2016 to November 2017.
  • There are over 50,000 posts under the hashtag #Juul on Instagram alone.
  • The nicotine content is 0.7mL (or 59 mg/mL) per pod, which is approximately equivalent to one pack of cigarettes, or 200 puffs.
  • The JUUL device costs between $35 to $50 and a package of four JUUL pods cost $15.99.

The JUUL delivers one of the highest concentrations of nicotine in comparison to any other e-cig on the market. Parents have reason to be concerned about the impact of nicotine, health risks, and addiction.

So how do we have successful conversations with youth about the hazards of vaping?  We learn the facts and start the conversation. Parents, stay informed and talk to your children. Ask them what they know about vaping and follow them on social media. Ask their teachers how kids are using these products and what the school policies are. The more you know, the better informed you will be when talking to your child.

Resources: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf

High Fructose Corn Syrup Linked to Higher Chances of Asthma

Consumption of high fructose corn syrup (HFCS) is now being linked to a higher incidence of asthma in children. Moms also can increase the chance that their baby will have asthma by 60% if they consume fructose and sugar-sweetened beverages during pregnancy.

The National Institutes of Health (NIH) in a study of children in 2018 came to the same conclusion that the intake of HFCS beverages, including apple juice, increase the likelihood of asthma in children.

The concern is that fructose might cause lung inflammation, one of the changes that takes place during an asthma attack.

The study concluded that if your child is consuming drinks with HFCS more than 5 days week, then he or she is 5 times more likely to develop asthma than a child who consumes drinks with HFCS less than once per month.

If your child likes to drink juice, there are other options. Orange juice was not a HFCS culprit, according to the study, and it is found to be a better choice than apple juice. You can also make an effort to reduce the amount of HFCS consumed per week or increase your child’s intake of water.

Sleep Apnea? Just Didgeridoo It!

Before you run out for didgeridoo lessons to fix your sleep apnea, read here to learn why you might hear mention of this ancient musical instrument as an alternative treatment for obstructive sleep apnea.

The didgeridoo is a very long cylindrical musical instrument belonging to the “wind family”. It was invented over 1,500 years ago, by Indigenous Australians. Didgeridoos are very long, from 3 to 10 feet, and are sometimes called wooden trumpets or drone pipes.

In 2009, the results of a Brazilian research study revealed that people who learned to play the didgeridoo had some mild improvement in their sleep apnea (a decrease in their apnea-hypopnea index). This is thought to be related to the “circular breathing” required to play this instrument, which allows the player to create continuous sound without interruption. This technique entails breathing in through the nose, while at the same time, blowing out through the mouth into the instrument, using air that has been stored in the cheeks. Breathing this way is thought to strengthen the muscles in the upper airway, making them less likely to collapse during sleep.

There have been other similar small research studies, also pointing to the possibility that strengthening the muscles of the upper airway may provide some help with sleep apnea and snoring. In fact, the specialty field of Orofacial Myofunctional Therapy focuses on retraining the muscles of the lips, tongue, cheeks and face. During myofunctional therapy, therapists can use different techniques to strengthen the tongue muscle, stabilize the jaw and improve the “oral resting posture” during sleep.  Oral resting posture refers how the tongue, teeth, and lips rest during sleep.

Myofunctional therapy for obstructive sleep apnea involves exercises and behavioral changes that can improve nose breathing and airflow during sleep. It is also a common treatment for children who have difficulty chewing, swallowing, speaking and breathing. While not a cure or first line treatment for sleep apnea, myofunctional therapy is used by some people along with other sleep apnea treatments to help them breathe better. After a consult and evaluation, a therapist will develop an individualized treatment plan, including daily exercises to be done at home. As with any exercise, a commitment to time will improve results.

Although CPAP is considered the most effective treatment for moderate to severe sleep apnea, more people are looking for alternative and holistic treatments to add to their current plans. If you are considering trying something new, it is important to first discuss with your doctor.

 

 

Tips for Cleaning with Chronic Lung Disease

I wish I could say that having a chronic lung disease makes you exempt from cleaning your house, but alas, it does not. However, here are some tips that can help you prepare and maybe make it easier to accomplish.

  • Use your controlling bronchodilator before you start. If you take it only once a day in the evening and you think you’ll get winded in the morning or afternoon while you clean, take two puffs of your rescue medication before you begin to clean.
  • Put all your cleaning products in one place such as a pail that you can easily carry from room to room.
  • Don’t overdo it. Clean whatever you can and rest when you need to. The rest of the stuff will still be there tomorrow.
  • Keep your windows open for ventilation while cleaning.
  • Use non-toxic cleaners that don’t have a strong scent. Mom used this back in the day for everything-it works!
    • 1 tsp. liquid soap
    • 1 tsp. baking soda
    • 1 quart warm water
  • Still washing walls? Use a mop to reach for those high areas.
  • Use a damp cloth for dusting and spray water on the bottom of a broom to prevent dust and animal hairs from filling the air you’re breathing.
  • Check for water leaks that can cause bacterial and mold growth such as in your shower area or basement.
  • Use long-handled dustpans to avoid bending over after you sweep.
  • Use a lightweight vacuum and make sure it has a clean filter.
  • Have a professional clean your air ducts.
  • If you choose to hire a cleaning service, make sure to ask what type of cleaning products they use. A service might save you time, but the products they use could cost you a trip to the ER.

For a list of cleaning products deemed safer by the EPA visit www.epa.gov/saferchoice/products.

If you take proper precautions before cleaning, you can tackle your tasks in a safe way. Grab those buckets!

 

It’s Raining, It’s Pouring, the Old Man is…Having an Asthma Attack?

Can a thunderstorm cause an asthma attack? Seems like a silly concept, but some research claims that changes in airflow patterns during a storm can increase the chances for an attack. Downdrafts of cold air create thunderstorm outflows. These drafts take concentrated levels of mold spores and pollen high into the clouds moisture where they are broken down into very small particles and are released by the rain. Due to the high concentration of these particles in the air, people who are sensitive to these allergens can have severe asthma attacks called “Thunderstorm Asthma.”

Though attacks are not likely to occur every time there is a storm, certain factors such as wind patterns, temperature changes and humidity do play a role in making the “perfect storm.”  Asthma symptoms can appear right before and up to 24 hours after a thunderstorm occurs so it is important to take the proper steps to protecting yourself from the high concentrations of pollen.

First, always make sure asthma is well controlled, this will help prevent an attack from occurring. It is also very important that your asthma treatment plan is up to date and albuterol rescue inhaler is available. Talk to your doctor about use of a regular allergy nasal spray, which will help block inhaled allergens. Try to avoid being outside on high pollen days, especially if the wind picks up and a thunderstorm occurs. Keeping windows closed and staying indoors before and during the storm will help reduce the amount of pollen inhaled.

Though “Thunderstorm Asthma” is uncommon, we have to remember that it could happen. If you are a part of this sensitive population, it is important to keep yourself safe. Take the steps to keep asthma under control so the next time decide to dance in the rain, it doesn’t turn into an asthma attack.

Do I Have COPD or Emphysema?

There is so much confusion when it comes to defining COPD, so let’s try to clear it up for you. According to the World Health Organization, Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The more familiar terms “chronic bronchitis” and “emphysema” are no longer used, but are now included within the COPD diagnosis. Other diseases that fall under the COPD “umbrella” are bronchiectasis and refractory asthma (chronic, difficult to control).

Let’s break them down:

Chronic Bronchitis causes the following changes to occur in the airways: increased mucus production, swelling and constriction of the smooth muscle that surrounds the airways.

https://www.physio-pedia.com/Chronic_Bronchitis

Emphysema is a lung condition that causes the air sacs in the lungs (alveoli) to become damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

When you exhale, the damaged alveoli don’t work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter.

https://www.drugs.com/health-guide/emphysema.html

Most people with emphysema also have chronic bronchitis.

Bronchiectasis(brong-ke-EK-ta-sis) is a condition in which damage to the airways causes them to widen and become flabby and scarred. It is usually the result of an infection or other condition that injures the walls of your airways or prevents the airways from clearing mucus. Your airways slowly lose their ability to clear out mucus, which then builds up and creates an environment in where bacteria can grow. This leads to repeated, serious lung infections. Each infection causes more damage to your airways. Over time, the airways lose their ability to move air in and out. This can prevent enough oxygen from reaching your vital organs.

http://www.cumc.columbia.edu/pulmonary/clinical-centers/bronchiectasis


Chronic or Refractory Asthma
Another frequent component of a COPD definition is refractory asthma, meaning asthma that is nonreversible, which differs from most forms of asthma. Some forms of asthma can be nonreversible and mimic emphysema. The following chart shows the differences between asthma and COPD but it is important to note that long-untreated asthma can become a chronic condition that has caused irreversible lung damage.

Global Initiative for Chronic Obstructive Lung Disease

This was meant to be a brief overview of chronic lung diseases only. If you are unsure of your diagnosis or need more information, please contact your physician.

 

 

How to Gain Weight If You Have COPD

When you have COPD, your body burns many more calories due to increased work of breathing. While much is made of the need to lose weight, we forget about those who are losing too much weight, muscle mass and strength. About 1 in 4 people with COPD are underweight, and this makes it more likely that their immune system won’t work properly. Eating more protein and getting more calories from nutrient-rich foods are good ways to prevent excessive weight loss. Here are some tips:

  1. Eat healthy fats. Because of the way fats are digested, they don’t tax the respiratory system like other foods can. Toss a salad in olive oil instead of having plain steamed veggies.
  2. Eggs and lean meats are full of protein. Eggs are easy to cook, which is a big benefit for those who find that cooking takes too much energy. Marinate a lean cut of meat in a vinaigrette and make a stir fry cooking with oil.
  3. Dairy can add calories and calcium to your diet. Add a slice of cheese to pastas, casseroles and sandwiches or add mixed powdered milk into recipes. Don’t go overboard.
  4. Nuts are a concentrated source of healthy fats. They add calories and have antioxidants (to fight inflammation). Toss into salads or make your own favorite snack by adding some dried fruit to a handful.
  5. Dessert? You Bet! Enjoy eating, even if it is a struggle at times, by allowing yourself to indulge in sweets you love. Cakes and ice cream are usually made with eggs and/or milk so you’ll be getting added protein and fats. Make sure to balance these treats with more healthful food, though.
  6. Milkshakes and smoothies can be a good choice as a supplement to your meals, but make sure they have protein, fiber and fat. You can find these already prepared and canned for a quick snack during the day. Look here for recipes- http://theindianspot.com/healthy-weight-gain/

Tips for Choosing a Portable Oxygen Concentrator

Many of you who are using oxygen are finding it more and more difficult to get out while using it, mostly because the tanks don’t last you long enough to make even short trips to the store, let alone take in a movie. For some of you a portable oxygen concentrator, which takes air from the room around you and converts it into a concentrated source of oxygen may be an answer. Before you actually buy one, here are some things to consider:

  • Check with your insurance to see if it is a covered item.
  • Talk with your physician to determine whether you can use a pulse dose (intermittent flow-IF) or will need continuous flow (CF).
  • Call your durable medical equipment company to see if they have one for you to try before you buy one or if they can rent one to you. All companies are different and have different portable concentrators that they use and supply. They should be able to help you find the most appropriate device for your circumstances.
  • Check the specifications- How much does it weigh? How much does it weigh with the battery? Is there a battery included? How long will the battery last? How much will a spare battery cost? Will it provide continuous flow (CF) or only intermittent flow (IF)?
  • If you are set on purchasing one on your own, do your homework. It is best to call the manufacturer directly to eliminate the possibility of getting one that isn’t appropriate for you or one that may have been used and refurbished. This is not to say that there aren’t companies out there that have a variety to choose from, provide decent service and sell both new and used, but if you want to be sure, buy directly from those making the concentrator or your DME company.
  • Come to our “Breathing In The ‘Burgh” boat ride on the Gateway Clipper on Friday, June 15. Our keynote speaker will be talking about this topic and can answer your questions to prevent you from making a purchase that does not suit your needs. Call 724-772-1750 or register online.