Kristin Nowack, a severe asthma patient, contributed this blog post for Breathe Pennsylvania.
Have you been diagnosed with severe asthma? I have been living with severe asthma and know the trials and tribulations one may face. Severe asthma is not your typical asthma as many of you know. Severe asthma as defined by the European Respiratory Society (ERS)/American Thoracic Society (ATS) as “asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic CS) to prevent it from becoming ‘uncontrolled’ or which remains ‘uncontrolled’ despite this therapy.”
I was diagnosed with asthma when I was 3. I was in and out of the emergency department and in high school, I ended up in the ICU for two weeks. Fast forward a few years and I quickly became steroid-dependent and was diagnosed with steroid-resistant severe asthma. Those are words you never want to hear. To say I was scared was an understatement. I will be the first to tell you I was in denial. There was no way I was resistant to the mainstay of treatment for severe asthma; corticosteroids! I felt alone, scared and embarrassed. I was not going to let my severe asthma take control of my life. I completed my Doctorate of Nursing Practice on daily high dose IV steroids. Side effects of high dose steroids are truly awful. Weight gain, moon face, insomnia, diabetes and extreme emotions are just a few.
Living with severe asthma is a struggle. Although I don’t look sick, I have an invisible disease and struggle daily to breathe, often not even being able to walk across the room. I hide my disease very well and don’t want others to know I am having trouble breathing. I will always tell you, “I am fine,” even if I am not. I don’t want family and friends to worry. I don’t want them to cancel their plans because I can’t breathe “again.” Often times during a severe attack, I tell myself I am not sick enough to go to the emergency department because I am scared.
I have been on typical treatment for severe asthma; however, I did not respond to the medications and my symptoms kept getting worse. Prednisone is one of my main treatments, but not the typical lower dose that may be required to keep severe asthma symptoms under control. Every day I take 60mg of prednisone just to keep my symptoms somewhat manageable. By manageable I mean using my inhaler or nebulizer every two to three hours, while still wheezing and experiencing shortness of breath all day. I use a BiPAP (Bilevel Positive Airway Pressure) machine every night and require supplemental oxygen when I am extremely ill.
If you’re living with severe asthma, always remember:
- You are NEVER alone – 5 to 10% of asthmatics suffer from severe asthma.
- ALWAYS keep in close contact with your asthma doctor and follow your treatment plan.
- You are NOT a burden on others; accept or ask for their help.
- ALWAYS have your inhaler within reach. I always have my inhaler and carry prednisone with me.
- Reach out to others with severe asthma.
- New and effective treatments are available for some severe asthma patients.
- If your asthma is uncontrolled, see an asthma expert for up to date treatment.
- When in doubt about your breathing; don’t hesitate! Seek emergency treatment immediately.
Dr. Tiffany DuMont and the Breathe PA team
Dr. DuMont is a pulmonologist with Allegheny Health Network and member of the Breathe Pennsylvania Board of Directors.
As a pulmonologist, I get a lot of questions from patients. Here are some common questions I hear in the pulmonary office regarding COPD. If you have any questions, please send them to Breathe PA at firstname.lastname@example.org and we will do our best to answer them in a future blog or in the next newsletter.
They told me I had an Exacerbation. What is this?
A COPD exacerbation is defined as worsening respiratory symptoms that requires additional therapy. There are varying degrees of exacerbations. They are categorized based on the treatment needed as mild, moderate, and severe.
Ok, so I had an exacerbation… what’s the big deal? I feel better now.
COPD exacerbations can negatively affect your life, increase your chances of being hospitalized and can cause progression of your COPD. Your doctor would like to know each time you’ve had an exacerbation especially if it was moderate or severe, as it may change the category of your COPD and change the treatment plan. A prior exacerbation is a predictor of future exacerbations. Lung function, how well the lungs move air and process gases, declines as people get older. People who smoked see their lung function decline faster. Each exacerbation may cause an acute worsening of your lung function and you may not return to your prior baseline.
Come on doctor, can’t you just leave me on steroids all the time for my COPD? I feel so much better when I am on them!
This is a line I hear in the office all too much. And although I want my patients to feel their best, chronic steroids are not always the best decision. Steroids are used short term to treat COPD exacerbations but are rarely recommended for long term use for COPD. Steroids can cause multiple side effects. These side effects include, but are not limited to, high blood pressure, osteoporosis (fragile bones), high blood sugar/diabetes, weight gain, cataracts, glaucoma, easy bruising, thinning of the skin, and increased risk of infection. If you are experiencing frequent COPD exacerbations, there are alternative medications to chronic steroids. I would suggest talking to your doctor about the alternative options that exist.
If you want to learn more about your disease, have more questions, or want to meet people who are experiencing similar symptoms, join us on the Breathing in the ‘Burgh COPD Cruise on June 21. We look forward to seeing you!
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Horita N, Miyazawa N, Morita S, Kojima R, Inoue M, Ishigatsubo Y, Kaneko T. Evidence suggesting that oral corticosteroids increase mortality in stable chronic obstructive pulmonary disease. Respir Res. 2014;15:37. Epub 2014 4 3.
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD Science Committee Report 2019. Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Criner GJ, Frith P, Halpin DMG, Han M, López Varela MV, Martinez F, Montes de Oca M, Papi A, Pavord ID, Roche N, Sin DD, Stockley R, Vestbo J, Wedzicha JA, Vogelmeier C. Eur Respir J. 2019 Mar 7. pii: 1900164. doi: 10.1183/13993003.00164-2019.
Join Breathe Pennsylvania as we celebrate World Asthma Day on Tuesday, May 7, 2019. This annual event was originally organized in 1998 by the Global Initiative for Asthma (GINA) supported by USA based National Heart, Lung, Blood Institute (NHLBI) and the World Asthma Foundation.
More than 24 million Americans have asthma, affecting 1 in 12 children and 1 in 14 adults. Asthma seems to be most prevalent in areas that are underserved and have low quality air. Racial and socioeconomic disparities still impact the quality of care and treatment received. There are genetic interactions and environmental issues that can also play a role in the severity of asthma.
Asthma is a chronic lung disease which causes breathing difficulties. There is still no cure for asthma, but with proper awareness, education, and management it can be controlled. A good place to start is to identify your personal asthma triggers. Triggers can include but aren’t limited to:
- Allergens- pollens, animal dander, certain foods, mold
- Irritants- cigarette smoke, fumes, pollution
- Physical triggers – exercise, cold air, emotions
By identifying your triggers you can reduce, avoid, and/or eliminate coming in contact to reduce asthma’s impact on your lifestyle.
Managing asthma takes a team effort. You can take an active role in managing your asthma: create a personal asthma action plan, take your medications according to your doctor’s direction, know when your symptoms are getting worse, and be prepared by carrying your rescue albuterol with you at all times.
Let’s work together this May and raise awareness of asthma and how it impacts everyone. To view the most current statistics on adult and pediatric asthma visit www.cdc.gov/asthma/default.htm
To learn more about your local asthma news, events, programs and resources visit www.breathepa.org
I often get questions about testing protocols for radon test kits. First, when doing home testing with a kit, make sure all the directions are read. In our own test kits – which are similar to others – there are basic instructions that talk about how to physically set the kit. However, on the back there are more in-depth instructions that should be read and followed.
First, the most important instructions are to maintain closed house conditions starting 12 hours before the test. Close all windows and exterior doors and turn off any fans that vent to the outside. This also includes a door to the garage if you have one. Normal heating and AC can be used and normal use of doors is acceptable as long as doors are immediately closed after use. If outside air is allowed to circulate through the house this will give a false low to the testing. It is also important to note that in certain situations it can also give a false high reading. So it is important to be strict with this protocol.
Second involves placement. The state of Pennsylvania requires – in a non-real estate test – for a kit to be placed in the lowest lived in area of the house. This would be a basement, but not a crawl space, garage or any other unheated unused space. Additionally, bathrooms and washrooms should not be used, but this is more for humidity issues.
Radon is usually highest in the basement, and also tends to be more consistent there. This allows for the most consistent measurement. This assures that other areas of the house will be probably be lower.
Third, the device should be placed at a level where people normally breathe. This is between 2 and 6 feet. This should be obvious. We want to measure the air people will actually inhale. Also the devices should be more than 3 feet away from doors, vents, exterior walls and exterior windows. Moving air can also have an effect on testing results. Interior fans, even though they are not exhausting air, should also be turned off if in the same room as a test kit.
In the end all of these “rules” are about getting the most accurate reading for the home owner.
To learn more about radon test kits or to purchase one, visit www.breathepa.org/radon-test-kit.
Spring is here and we are all ready to make the transition of wintry weather to warm and breezy weather with regards to our clothes and outside activity. Ok, there are probably still a few who hate to see the snow go, but not me! So for those of us ready to make the move to a warmer time of the year and moving our exercise and activity outside, let’s talk about air quality.
This is an important issue for the children I work with who have asthma. Parents often ask if it is safe to send their children outside to play when the news is listing a day as a “poor air quality day.” With this issue as with others, it’s important to talk to your doctor, follow the recommended guidelines provided and use your best judgement.
Here are some recommendations:
- Limit your activity to one that doesn’t require moving and breathing too fast. For example, consider walking instead of running or yoga in place of soccer.
- Arrange your activity near or in water. Winds tend to be stronger around water so consider kayaking or swimming. Swimming can also be a great indoor activity if it is recommended you stay indoors.
According to the Pennsylvania Department of Environmental Protection, levels for ozone, particulate matter, carbon monoxide and sulfur dioxide are the determinants that impact air quality in Southwestern Pennsylvania. The Air Quality Index Report has six categories: Good, Moderate, Unhealthy for Sensitive Groups, Unhealthy, Very Unhealthy and Hazardous.
Follow the links below to learn more:
At Breathe Pennsylvania, we are big proponents of pulmonary rehab. It is a drug-free intervention that teaches individuals with respiratory disease how to safely exercise while maintaining control of their breathing. Individuals who attend pulmonary rehabilitation not only reduce their breathlessness and improve stamina, but learn about exercise options that can be implemented long-term, even when the formal pulmonary rehabilitation program ends.
Pulmonary rehabilitation is a multidisciplinary program and should be considered as part of a care plan for patients with respiratory disease. The supervised exercises, education, training, and assessments can help improve your quality of life. What are you waiting for? Talk to your lung doctor about pulmonary rehabilitation. A list of pulmonary rehabilitation facilities near you can be found at www.livebetter.org.
Recently in western Pennsylvania, there has been a lot of discussion about air quality, pollution, and the importance of protecting your lungs when you are considered part of a “sensitive” population. However, the terminology and classification may be confusing. What does it mean to be “sensitive” to dips in air quality, and how would someone know that they need to protect their lungs?
The Clean Air Act is a law that mandates that the Environmental Protection Agency’s (EPA) Office of Air Quality Planning and Standards (OAQPS) set national ambient air quality standards (NAAQS). These standards evaluate pollutants that are considered harmful to people and the environment, and include six criteria:
• Ground-level ozone
• Particulate matter
• Carbon monoxide
• Sulfur dioxide
• Nitrogen dioxide
In order to communicate these pollutant levels to the public, the EPA has established an Air Quality Index (AQI), which quantifies local air quality levels using five of the six pollutants previously mentioned (lead is excluded). The AQI ranges from 0-500, and is color-coded for ease of communication to the public. The AQI alerts individuals about when they should take actions to protect their lungs.
Some individuals are considered to be part of “sensitive populations.” This terminology means that it would be harder for an individual to protect themselves—and recover from—dips in air quality. The elderly, children, individuals with lung disease, and individuals with heart disease are included in this classification. Therefore, when pollutant levels rise, they tend to feel the effects before the rest of the population does.
It is important for individuals from sensitive populations to be aware of the air quality levels in their community, so that they may take steps to protect their lungs. You may register online at www.enviroflash.info for daily AQI email alerts, or visit www.airnow.gov to review current air quality levels.
Exposure to pollutants can reduce the ability for the lungs to function normally. This is particularly true for sensitive groups. To protect your lungs when the AQI level is high, reduce the amount of time you spend outdoors, and limit your exertion levels outdoors. For more information on the Clean Air Act, visit www.epa.gov/sites/production/files/2015-08/documents/peg.pdf.
1. Environmental Protection Agency (2016). Air quality. Retrieved from https://www3.epa.gov/airquality/cleanair.html 2. Environmental Protection Agency (2016). Air quality index (AQI) basics. Retrieved from https://airnow.gov/index.cfm?action=aqibasics.aqi
It is estimated that up to 17% of adult asthma cases may be caused by exposure to inhaled irritants in the workplace, making people with COPD at even greater risk from these types of jobs. Occupational lung diseases are preventable using a little common sense and control measures. Here are 10 fields that can cause you problems over time:
- Construction: Inhaled dust can cause mesothelioma, asbestosis and lung cancer.
- Firefighting: Inhaled smoke and chemicals caused by burning structures as well as asbestos exposure after the fire has been extinguished can be harmful over time.
- Textiles: Byssinosis is common among those who make upholstery, socks, towels and clothes who have inhaled cotton dust or other materials.
- Automotive Repair: Spray-on paints can irritate skin and the lungs causing severe breathing problems.
- Transportation: Delivery truck drivers, railroad workers and those who unload materials on loading docks can be at risk for COPD. Diesel exhaust is the culprit.
- Manufacturing: Factory workers are exposed to myriad of irritants such as dust, chemicals and gases. Diacetyl, a flavoring agent used in microwave popcorn, is linked to bronchiolitis obliterans, a relative of COPD.
- Health Care: Up to 12% of health care workers are allergic to latex. This can cause a severe airway reaction. Many places have switched to latex-free gloves.
- Baking: Exposure to flour dust and enzymes used in dough-making can lead to developing of an allergic sensitization. Also a danger are allergens shed by insects that are found in flour.
- Mining: Dust exposure from coal, rocks, minerals, and sand can lead to black lung and silicosis.
- Bartending: Smoke-filled bars and restaurants put workers at high risk for developing lung disease.These days most states have banned smoking which has helped immensely.
What should you do if you work in these high-risk fields? First, if you smoke, stop! Use a mask or respirator, make sure the room is well-ventilated, and use gloves and goggles if needed. Don’t think that because you are young you don’t need to be concerned. Lung damage takes place over time so start now to protect yourself.
Reference: Time Health Winter 2018
January is National Radon Awareness Month. Radon comes from the breakdown of trace amounts of uranium in our soil. As a gas, it moves up into our homes where it is trapped and presents a danger to us in the form of lung cancer. Radon is considered the second leading cause of lung cancer after smoking.
As a former radon measurement technician, I know about the importance of testing your home, and the effects of radon really hit close to home a few years ago. I was in the same neighborhood that my grandmother lived in about 25 years prior. I was there to pick up a radon test, and my equipment indicated a level of about 17.0 picocuries per liter of air (pCi/L) – the recommended remediation level is 4 pCi/L, so this measurement was clearly extremely high.
After leaving the house, I cruised through the old neighborhood and I noticed many houses that had radon remediation systems. Their white PVC piping terminating above the roofs and fan housings near foundations were an obvious give away. It’s possible that there were probably just as many on the opposite side and rear of the houses that I could not see.
It got me thinking.
My grandmother died of lung cancer, and her death was a little perplexing because she was never a smoker. My parents just assumed it was related to her growing up in the “smoky city” that Pittsburgh has been known for. She grew up near the old American Bridge Steel facility where my grandfather worked.
Though scientists were aware of the dangers of radon at the time, it had not yet become a common issue to check a home for such during a sale.
My state training has told me that just because one house has high levels of radon, it doesn’t mean the one next door will (and vice versa). I have certainly encountered such situations.
However, after seeing so many houses with radon mitigation systems near and around my grandmother’s old home, I seriously wonder if the reason for her death had more to do with radon than living in the “smoky city.” In my profession, I have heard people talk about radon testing and mitigation as being an excuse for home inspectors to make a buck on an unnecessary service. However, I could not think of a more important, lifesaving service for people to have during a home sale and inspection.
Exposure to radon is a preventable health risk. For more information about radon and testing for radon, or to order a radon test kit, visit www.breathepa.org/radon-test-kit.
Eosinophilic Asthma (E-Asthma), is a severe form of asthma that affects the entire respiratory system. What sets this type of asthma apart from the asthma you might know, is the high levels of white blood cells called eosinophil. These white blood cells are part of your immune system and help to fight off infection.
High levels of eosinophils can cause inflammation (swelling) that affects the sinuses and nasal passages as well as your lower airways. This kind of asthma is often seen in people who are 25-35 years old.
At this time, we are not sure what causes this type of asthma. Scientists are exploring whether or not there could be a genetic link. What they do know is that this particular kind of asthma is not triggered by an allergen.
Here are some of the symptoms a person might experience with E-Asthma:
- Shortness of breath
- Tightness on the chest
- Stuffy nose
- Chronic sinus infections
- Nasal drainage
- Nasal polyps
- Lost sense of smell
It is important to see your doctor if you are experiencing any of these symptoms. This type of inflammation of your airways can lead to permanent damage to your airways and scarring of the lung tissue.
A doctor will be able to decide if you have E-Asthma by measuring the eosinophils in your blood or saliva and by conducting a bronchial biopsy.
There are injectable medications available to treat E-Asthma along with inhaled corticosteroids: Cinqair, Fasenra, Xolair and Nucala. There is also a new oral medication being tested called Fevipiprant. Though still in development, this experimental drug reduced symptoms and improved lung function in studies completed so far. If Fevipiprant is approved, it would be the first new oral asthma drug to be introduced in 20 years. These treatments take place under the direct supervision of a physician.
To learn more visit https://www.verywellhealth.com/what-is-eosinophilic-asthma-4156744