A nebulizer is a machine of asthma that uses an air compressor to mix liquid medicine with air and form a mist that is inhaled through a mouthpiece
or face mask. (Technically, the "machine" part is the air compressor, and the "nebulizer" is the tubing with medicine cup. "Nebulizer" is used here in its broader, more common meaning as the whole device.) When children are first diagnosed with asthma, many times they are treated using a nebulizer. After this initial experience, parents may think that a nebulizer is the most preferred way to administer medi-cine. Nebulizers are just one way to give asthma medicines. Other devices may be more effective and less cumbersome. While many parents and even some health care professionals think that the nebulizer is the best way to give asthma medicine, research has not shown that to be true. Many children, especially infants and tod-dlers, don't seem to improve on a nebulizer because their caretakers have not been taught the proper technique for giving a nebulizer treat-ment. Proper technique is just as important when medicine is given by nebulizer as it is when given by an MDI/spacer or a DPI.
Sometimes parents observe incorrect techniques for nebulizer treatments administered by the "blow-by method," which is holding the tube, with mist coming out of it, in the child's face. This technique is often used when a child won't cooperate by wearing a mask or is too young to use a mouthpiece. The main problem with the blow-by method is that very little medicine gets down deep into the lungs where it is needed, and most of the medicine is wasted. When a mouthpiece or face mask is used with a nebulizer, it's important to be sure that your child takes slow, deep breaths and holds each breath for five to ten seconds before inhaling the next breath. If a child is allowed to breathe normally during the nebulizer treatment, the medicine won't get into the airways effectively. Another problem with using a nebulizer for an infant or toddler is that, while you may get him to wear the face mask, he is also crying and taking fast, shallow breaths rather than the proper deep, slower breaths. (See chapter 12 for more about infants and toddlers.)
Even when the proper technique is used, nebulizer treatments take about ten minutes or longer. Another drawback is that a nebulizer is not easily portable. This is an important issue because families are constantly on the go, and children may need to take medicine at day.
controller medicines. If a child uses Advair, for example, she would also have to be able to take quick-relief medicine by MDI with a spacer or nebulizer (discussed later in this chapter). The Diskus comes with a dose counter. Another controller medicine, budesonide, is an inhaled cortico-steroid that comes in two forms: Turbuhaler is a dry powder, and Respules are a liquid solution for a nebulizer. If a child is on the Pulmi-cort Turbuhaler, she'll need to take her quick-relief medicine (albuterol) by MDI/spacer or nebulizer. The Turbuhaler has an indicator to let you know when it's running empty. A third DPI device is the Aerolizer that contains formoterol (Foradil), which is similar to salmeterol. Both formoterol and salmeterol are long-term controller medicines, but they are not anti-inflammatory medi-cines. If formoterol or salmeterol is prescribed for your child, she will also need both an anti-inflammatory medicine and a quick-relief medi-cine. The Aerolizer is loaded with a one-dose capsule for each use so it's easy to check that the whole dose has been taken. When you discard the capsule after taking the dose, you can see whether or not the capsule is empty.
It's important to understand that there may be variations in how different DPIs are used. For example, the Pulmicort device is twisted one way, then the other. With Advair, the device is opened and then a lever is pulled. For both of these, a child must breathe in quickly and deeply once the tablet is crushed, and the medicine is deposited into his lungs. Advair has a slightly sweet taste, and Pulmicort does not. Often par-ents of children taking Pulmicort worry that their children aren't getting the medicine because they cannot taste anything. Your physician or .nurse practitioner can assess whether your child is capable of inhaling deeply enough to draw the powder into her lungs. These devices are very easy to use, and they have counters that tell how many doses are left.
Wednesday, January 28, 2015
Medicine the Right Way of Asthma
Asthma medicines come in several different forms. When you think of medicine, you probably think of liquids or pills, but only a few asthma medicines are taken by mouth. Asthma is best treated by inhaled medicine because it goes directly where it needs to work—the lungs—rather than into the intestinal tract, the bloodstream, and throughout the whole body. This chapter focuses on the correct ways to use inhaled medicines and the proper methods of taking care of them. One of the most important issues in controlling asthma is matching the treatment to the individual child. That means not only giving the most appropriate medicine, but also being sure its delivery device is used the right way for it to work effectively.
Treatment for asthma comes primarily in three types of inhaled midi-cines: metered dose inhalers (MDIs), dry powder inhalers (DPIs), and neutralizers.
MDIs have been used for Asthma medicines and other lung diseases for several decades. These small, plastic, handheld devices contain medicine in an aerosol canister. When sprayed, the inhaler expels an exact, measured dose of medicine either a controller or a quick relief type. The MDI container also contains a chemical propellant that delivers the medicine very fast. If you've ever put an MDI in your mouth and sprayed it, you have felt a wet, cold spray in your mouth and throat. But the problem with feeling that spray is that the medicine landed in your mouth and throat instead of going deep down your windpipe and into the lungs where it needs to work. In the past, many children used an MDI by itself, but today it is highly recommended that a spacer be added to the MDI for a more effective treatment. A spacer—also called a "holding chamber"—holds and slows down the spray so a child can inhale a slower, deeper breath. When a child uses a spacer with a one-way valve, he can't exhale air into the spacer, so he's able to inhale all the medicine deep into his lungs. (Other kinds, without a one-way valve are available, but the one-way valve type is preferable.) He will not feel a wet cold spray in his mouth. When using a spacer with an MDI, a child should be reminded to take a slow, deep breath and hold it for ten seconds.
A number of different brands of spacers are on the market. They require a prescription, and prices vary. Most brands have a mouthpiece that adults, teenagers, and children as young as five or six years old can use correctly and consistently. Spacers are also made with a face mask for babies and toddlers. Many children, particularly those with mild asthma, have been using MDIs without spacers for some time. They and their parents may assume that the MDI alone is enough, but it can present problems, as this fifteen-year-old discovered: David had been taking Flovent 44 as his controller medicine without a spacer for over two years. He used it when he was supposed to,
every morning and every night, but he still had symptoms during colds and exercise. When his nurse practitioner asked David how he knows when the inhaler is empty and how often he refills it, David said that he asks his mother for a refill whenever the inhaler feels empty and no spray comes out. The nurse explained that David's par-ticular MDI comes with 120 "actuations" (individual doses of med-icine). That means that if David takes four puffs a day (two puffs twice a day) for thirty days, one Flovent MDI should last a month. The nurse practitioner also urged David to get a new MDI every month even if he still feels liquid in the canister and sees spray come out. After.120 puffs of medicine have been taken, there may still be some liquid (preservative and propellant) in the canister. It may not "feel empty," but it contains no medicine.
Not all medicines that come as MDIs contain 120 doses per canister or are priescribed for four puffs a day. Be sure you understand how often your child is supposed to use the MDI/spacer and check the individual canister for its number of total doses. Sometimes parents worry that older children, who are allowed to monitor their own medicine, are taking it too often or too little. A rule of thumb to remember is that quick-relief medicine, such as albuterol dispensed as an MDI, should contain 200 doses. If a child's asthma is well controlled, a refill will be needed every six months. If your child is using more than this, or is taking albuterol twice a week or more, dis-cuss this with your child's health care professional. After David's nurse practitioner explained this, he and his mother decided to keep better track by writing down the date on the kitchen cal-endar each time he starts a new MDI—both controller and quick-relief medicines. This not only reminds them to call the pharmacy for a refill before the medicine runs out, but it also helps them both be aware of how much quick-relief medicine David is using so they can keep an eye on over-use or under-use.
Instead of increasing his dose of Flovent to 110, David's nurse prac-titioner considered two options. One was to continue the Flovent 44, but teach David how to use a spacer and explain that it will also help him get better relief by controlling airway inflammation and preventing symptoms. The second option was to switch him to a dry powder inhaler
DPIs are the newest device on the market. They deliver medicine to the airways as a dry powder. Taking medicine with a DPI is quick—it takes less than a minute to take a dose. DPIs require no special care except to keep them dry. Most children older than five years of age are able to learn the administration technique. But regardless of a child's age, par-ents still must pay attention to make sure their child performs the correct technique consistently. If your child has previously used an MDI/spacer and is just begin-ning to use a DPI, be sure she understands that the DPI is used differ-ently—she must be able to take in a fast, deep breath rather than the slow, deep breath required by an MDI/spacer. With both an MDI and DPI, a child should hold the breath for ten seconds after inhaling the puff of asthma medicine.
Since not all asthma medicines are available in the DPI form, your child needs to know the proper technique for more than one device—in other words, she'll have to become a switch-hitter and learn when and how to use at least two or maybe even three techniques for taking dif-ferent inhaled medicines. You may wonder what difference it makes whether she inhales a fast, deep breath or a slow, deep one. The answer lies simply in the fact that an MDI contains a chemical propellant that expels the spray very fast. As discussed earlier, the spacer holds the puff of medicine so, as a child slowly inhales it, the medicine is more effectively delivered deep down into her lungs. DPIs, however, do not contain a propellant. A DPI can only work and get deep down to her lower airways if she takes a fast, deep breath.
Treatment for asthma comes primarily in three types of inhaled midi-cines: metered dose inhalers (MDIs), dry powder inhalers (DPIs), and neutralizers.
MDIs have been used for Asthma medicines and other lung diseases for several decades. These small, plastic, handheld devices contain medicine in an aerosol canister. When sprayed, the inhaler expels an exact, measured dose of medicine either a controller or a quick relief type. The MDI container also contains a chemical propellant that delivers the medicine very fast. If you've ever put an MDI in your mouth and sprayed it, you have felt a wet, cold spray in your mouth and throat. But the problem with feeling that spray is that the medicine landed in your mouth and throat instead of going deep down your windpipe and into the lungs where it needs to work. In the past, many children used an MDI by itself, but today it is highly recommended that a spacer be added to the MDI for a more effective treatment. A spacer—also called a "holding chamber"—holds and slows down the spray so a child can inhale a slower, deeper breath. When a child uses a spacer with a one-way valve, he can't exhale air into the spacer, so he's able to inhale all the medicine deep into his lungs. (Other kinds, without a one-way valve are available, but the one-way valve type is preferable.) He will not feel a wet cold spray in his mouth. When using a spacer with an MDI, a child should be reminded to take a slow, deep breath and hold it for ten seconds.
A number of different brands of spacers are on the market. They require a prescription, and prices vary. Most brands have a mouthpiece that adults, teenagers, and children as young as five or six years old can use correctly and consistently. Spacers are also made with a face mask for babies and toddlers. Many children, particularly those with mild asthma, have been using MDIs without spacers for some time. They and their parents may assume that the MDI alone is enough, but it can present problems, as this fifteen-year-old discovered: David had been taking Flovent 44 as his controller medicine without a spacer for over two years. He used it when he was supposed to,
every morning and every night, but he still had symptoms during colds and exercise. When his nurse practitioner asked David how he knows when the inhaler is empty and how often he refills it, David said that he asks his mother for a refill whenever the inhaler feels empty and no spray comes out. The nurse explained that David's par-ticular MDI comes with 120 "actuations" (individual doses of med-icine). That means that if David takes four puffs a day (two puffs twice a day) for thirty days, one Flovent MDI should last a month. The nurse practitioner also urged David to get a new MDI every month even if he still feels liquid in the canister and sees spray come out. After.120 puffs of medicine have been taken, there may still be some liquid (preservative and propellant) in the canister. It may not "feel empty," but it contains no medicine.
Not all medicines that come as MDIs contain 120 doses per canister or are priescribed for four puffs a day. Be sure you understand how often your child is supposed to use the MDI/spacer and check the individual canister for its number of total doses. Sometimes parents worry that older children, who are allowed to monitor their own medicine, are taking it too often or too little. A rule of thumb to remember is that quick-relief medicine, such as albuterol dispensed as an MDI, should contain 200 doses. If a child's asthma is well controlled, a refill will be needed every six months. If your child is using more than this, or is taking albuterol twice a week or more, dis-cuss this with your child's health care professional. After David's nurse practitioner explained this, he and his mother decided to keep better track by writing down the date on the kitchen cal-endar each time he starts a new MDI—both controller and quick-relief medicines. This not only reminds them to call the pharmacy for a refill before the medicine runs out, but it also helps them both be aware of how much quick-relief medicine David is using so they can keep an eye on over-use or under-use.
Instead of increasing his dose of Flovent to 110, David's nurse prac-titioner considered two options. One was to continue the Flovent 44, but teach David how to use a spacer and explain that it will also help him get better relief by controlling airway inflammation and preventing symptoms. The second option was to switch him to a dry powder inhaler
DPIs are the newest device on the market. They deliver medicine to the airways as a dry powder. Taking medicine with a DPI is quick—it takes less than a minute to take a dose. DPIs require no special care except to keep them dry. Most children older than five years of age are able to learn the administration technique. But regardless of a child's age, par-ents still must pay attention to make sure their child performs the correct technique consistently. If your child has previously used an MDI/spacer and is just begin-ning to use a DPI, be sure she understands that the DPI is used differ-ently—she must be able to take in a fast, deep breath rather than the slow, deep breath required by an MDI/spacer. With both an MDI and DPI, a child should hold the breath for ten seconds after inhaling the puff of asthma medicine.
Since not all asthma medicines are available in the DPI form, your child needs to know the proper technique for more than one device—in other words, she'll have to become a switch-hitter and learn when and how to use at least two or maybe even three techniques for taking dif-ferent inhaled medicines. You may wonder what difference it makes whether she inhales a fast, deep breath or a slow, deep one. The answer lies simply in the fact that an MDI contains a chemical propellant that expels the spray very fast. As discussed earlier, the spacer holds the puff of medicine so, as a child slowly inhales it, the medicine is more effectively delivered deep down into her lungs. DPIs, however, do not contain a propellant. A DPI can only work and get deep down to her lower airways if she takes a fast, deep breath.
Prevention and Treatment of Asthma
Many treatments continue to be developed to fight airway inflammation found in asthma. New approaches are aimed at cells, chemicals, and antibodies responsible for allergic inflammation. Some of these involve genetically engineering antibodies to affect parts of the immune system. Some may involve injections and may be rather expensive. As a result, they may initially be indicated for individuals on high doses of corti-costeroids or those with symptoms despite traditional therapies. Other treatments are being developed to prevent or alter the natural history of asthma by introducing immune-modifying treatment of asthma in early childhood.
Despite the possible side effects of some of these medicines standard, traditional, and complementary the biggest asthma risk is the disease itself. In some children, untreated inflammation can lead to irreversible changes in the airways. Asthma is the most common cause of hospital-ization in children, and each year about 200 American children die from asthma. Even children with mild asthma are at risk for any or all these complications. Fortunately, taking medicine appropriately can minimize all the risks.
Saiboku-tois is the most popular anti-asthmatic herbal treatment used in Japanese Kampo medicines. In China, it is called chaipu-tang. It is supposed to decrease the metabolism of steroids, and it therefore increases the potency and effectiveness of inhaled steroids. It also increases the risk of side effects from inhaled steroids, but when taken by itself, it has not been found to be as effective as inhaled steroids.
Tylophora indica is an herb used commonly in the Ayurvedic system of medicine practiced in India. It is claimed to increase mucus clearing and is also recognized as a bronchodilator similar to a quick-relief med-icine like albuterol. The effectiveness of this medicine is quite variable, with helpful effects in one study and no effects in other studies. Several studies have examined high-dose vitamin C in the treatment of asthma. Similar to many herbal therapies, vitamin C's effects vary, with some studies reporting beneficial effects and other studies report-ing none.
Interestingly, many current Western medicines are based on previous complementary medicines. An old therapy for asthma, for example, was ground adrenal glands of animals. Adrenal glands have steroids and albuterol-like compounds that have similarities to the inhaled steroids and bronchodilators used today. Many herbal supplements can be safe when used appropriately, but known and potential risks of such compounds do exist. A misconception exists that herbs are safe because they come from plants. The chemical makeup of plants and herbs is sophisticated, and many are toxic. Often other medicines, such as steroids and aspirinlike medicines, are added to these herbal supplements to improve their effect and potential side-effects. Other factors can cause problems, including inconsistent dosing and drug interactions
There is also no licensing body for the practice of herbal medicine in the United States. Most herbs are marketed as dietary supplements and are not regulated by the FDA. There is no guarantee, therefore, of qual-ity or consistency. The advantage of traditional Western medicines is that they are controlled, regulated, and given in more palatable formats.
Despite the possible side effects of some of these medicines standard, traditional, and complementary the biggest asthma risk is the disease itself. In some children, untreated inflammation can lead to irreversible changes in the airways. Asthma is the most common cause of hospital-ization in children, and each year about 200 American children die from asthma. Even children with mild asthma are at risk for any or all these complications. Fortunately, taking medicine appropriately can minimize all the risks.
Saiboku-tois is the most popular anti-asthmatic herbal treatment used in Japanese Kampo medicines. In China, it is called chaipu-tang. It is supposed to decrease the metabolism of steroids, and it therefore increases the potency and effectiveness of inhaled steroids. It also increases the risk of side effects from inhaled steroids, but when taken by itself, it has not been found to be as effective as inhaled steroids.
Tylophora indica is an herb used commonly in the Ayurvedic system of medicine practiced in India. It is claimed to increase mucus clearing and is also recognized as a bronchodilator similar to a quick-relief med-icine like albuterol. The effectiveness of this medicine is quite variable, with helpful effects in one study and no effects in other studies. Several studies have examined high-dose vitamin C in the treatment of asthma. Similar to many herbal therapies, vitamin C's effects vary, with some studies reporting beneficial effects and other studies report-ing none.
Interestingly, many current Western medicines are based on previous complementary medicines. An old therapy for asthma, for example, was ground adrenal glands of animals. Adrenal glands have steroids and albuterol-like compounds that have similarities to the inhaled steroids and bronchodilators used today. Many herbal supplements can be safe when used appropriately, but known and potential risks of such compounds do exist. A misconception exists that herbs are safe because they come from plants. The chemical makeup of plants and herbs is sophisticated, and many are toxic. Often other medicines, such as steroids and aspirinlike medicines, are added to these herbal supplements to improve their effect and potential side-effects. Other factors can cause problems, including inconsistent dosing and drug interactions
There is also no licensing body for the practice of herbal medicine in the United States. Most herbs are marketed as dietary supplements and are not regulated by the FDA. There is no guarantee, therefore, of qual-ity or consistency. The advantage of traditional Western medicines is that they are controlled, regulated, and given in more palatable formats.
Allergy Medicines for Asbestosis and Asthma
Many children with asthma also need allergy medicine. Treating allergy symptoms in the nose has been shown to help control asthma and per-vent flares. One often-overlooked function of the nose is to warm, moisturizer, and filter the air we breathe. Some children with allergies cannot breathe through their noses so they inhale colder, drier, dirtier air through their mouths, which can aggravate their asthma. Antihistamines with or without decongestants and nasal steroids may be prescribed to control allergies. If allergies are not adequately controlled, allergy shots may be given to make your child's body less allergic.
About one of every three Americans has tried herbal medicines, acupuncture, traditional Chinese medicine, homeopathy, yoga, chiropractic manipulation, high-dose vitamins and minerals, and relaxation techniques. These types of complementary medicine, also called "alter-native" or "integrative" medicine, have not been studied and evaluated with controlled studies as rigorously as traditional Western medicines. But alternative approaches are coming into mainstream medicine. At least seventy-five medical schools—including University of Pennsylvania, Harvard, Yale, Johns Hopkins, and Columbia now offer courses in complementary medicine. Because complementary therapies have become so widely used in recent years, parents may wonder if they could help relieve their child's asthma symptoms. The following review of the most common alter native therapies is based on published studies of their merit. Chiropractic manipulation was not found to be helpful for asthma in any study. The results were more mixed for acupuncture. Five studies found that acupuncture was not beneficial, and eight studies found that it worked better than nothing. But in all studies, acupuncture didn't work as well as al buterol in treating asthma symptoms.
Yoga was studied in conjunction with standard asthma medicines, such as inhaled corticosteroids. Individuals who did yoga or relaxation therapies noted an improvement in their asthma symptoms (fewer, milder symptoms and improved lung function). Yoga did not replace standard therapies but was added to them in these studies. Many modern medicines are derived from herbal therapies. The advantage of modern medicine over herbs, however, is that potential benefits are maximized, while potential serious side effects are mini mized. One of the most common herbal therapies is Ma Huang, whose active ingredient is distantly related to albuterol, the common quick-relief medicine for asthma. Its active ingredient, L-ephedrine, is also very similar to Sudafed, an over-the-counter decongestant. High doses of ephedrine are known to have adverse effects that include high blood pressure, rapid heart rate, nervousness, headache, insomnia, dizziness, seizure, stroke, and fatal myocardial infarction (heart attack).The second most common herb used to treat asthma is Atropa bel-ladonna (deadly nightshade).
Its active ingredient is atropine, which is similar to the active ingredient in Atrovent, a common medicine for other lung diseases. Belladonna was once burned in cigarettes, referred to as "asthma cigarettes." These primitive "inhalers" were a popular treatment for asthma and other respiratory conditions in Europe and North America in the early part of the twentieth century. Potential side effects include dry mouth, dangerously low heart rate, nausea, and headache.Ginkgo biloba is used around the world for a variety of illnesses. The main ingredients, ginkgolides, may prevent twitchy airways or cough-ing. Side effects of ginkgo include nausea, vomiting, diarrhea, saliva-tion, anorexia, headache, dizziness, ringing in the ears, and allergic reactions. No controlled studies have shown a benefit of ginkgo biloba for asthma. Licorice root is used to prevent cough and increase the clearance of mucus. Its active ingredients include glycyrrhizin, which may prolong the action of steroids. No controlled studies of licorice have been conducted for asthma in humans, so it's important to discuss with your child's physi-cian any complementary medicines you are using, particularly in the case of an herb like licorice.
About one of every three Americans has tried herbal medicines, acupuncture, traditional Chinese medicine, homeopathy, yoga, chiropractic manipulation, high-dose vitamins and minerals, and relaxation techniques. These types of complementary medicine, also called "alter-native" or "integrative" medicine, have not been studied and evaluated with controlled studies as rigorously as traditional Western medicines. But alternative approaches are coming into mainstream medicine. At least seventy-five medical schools—including University of Pennsylvania, Harvard, Yale, Johns Hopkins, and Columbia now offer courses in complementary medicine. Because complementary therapies have become so widely used in recent years, parents may wonder if they could help relieve their child's asthma symptoms. The following review of the most common alter native therapies is based on published studies of their merit. Chiropractic manipulation was not found to be helpful for asthma in any study. The results were more mixed for acupuncture. Five studies found that acupuncture was not beneficial, and eight studies found that it worked better than nothing. But in all studies, acupuncture didn't work as well as al buterol in treating asthma symptoms.
Yoga was studied in conjunction with standard asthma medicines, such as inhaled corticosteroids. Individuals who did yoga or relaxation therapies noted an improvement in their asthma symptoms (fewer, milder symptoms and improved lung function). Yoga did not replace standard therapies but was added to them in these studies. Many modern medicines are derived from herbal therapies. The advantage of modern medicine over herbs, however, is that potential benefits are maximized, while potential serious side effects are mini mized. One of the most common herbal therapies is Ma Huang, whose active ingredient is distantly related to albuterol, the common quick-relief medicine for asthma. Its active ingredient, L-ephedrine, is also very similar to Sudafed, an over-the-counter decongestant. High doses of ephedrine are known to have adverse effects that include high blood pressure, rapid heart rate, nervousness, headache, insomnia, dizziness, seizure, stroke, and fatal myocardial infarction (heart attack).The second most common herb used to treat asthma is Atropa bel-ladonna (deadly nightshade).
Its active ingredient is atropine, which is similar to the active ingredient in Atrovent, a common medicine for other lung diseases. Belladonna was once burned in cigarettes, referred to as "asthma cigarettes." These primitive "inhalers" were a popular treatment for asthma and other respiratory conditions in Europe and North America in the early part of the twentieth century. Potential side effects include dry mouth, dangerously low heart rate, nausea, and headache.Ginkgo biloba is used around the world for a variety of illnesses. The main ingredients, ginkgolides, may prevent twitchy airways or cough-ing. Side effects of ginkgo include nausea, vomiting, diarrhea, saliva-tion, anorexia, headache, dizziness, ringing in the ears, and allergic reactions. No controlled studies have shown a benefit of ginkgo biloba for asthma. Licorice root is used to prevent cough and increase the clearance of mucus. Its active ingredients include glycyrrhizin, which may prolong the action of steroids. No controlled studies of licorice have been conducted for asthma in humans, so it's important to discuss with your child's physi-cian any complementary medicines you are using, particularly in the case of an herb like licorice.
Sunday, January 25, 2015
Antihistamines for Asbestosis
The most popular medicines for allergies are antihistamines. As the name suggests, antihistamines counteract the swelling and other effects of histamine. They are very effective for keeping allergy symptoms from starting and for treating them when they do. The most widely used antihistamines today are called H1 receptor antagonists and are available by prescription only. They are sometimes also called second-generation antihistamines because they have taken over from the older, first-generation antihistamines that used to cause drowsiness. H1 receptor antagonists block the release of histamine and help reduce or prevent inflammation. They dry up runny noses, stop sneezing, and help prevent wheezing. Desloratadine (Clarinex), fexofe-nadine (Allegra), and cetirizine (Zyrtec) are the most commonly pre-scribed antihistamines and have been approved for children as young as two years of age. They're also long-lasting, and some are available in syrups or dissolving tablets to make dosing easier for young children. Your doctor will choose which medication to prescribe, depending on your child's age and symptoms. In 2002, a formerly prescribed H1 receptor antagonist antihistamine, loratadine (Claritin), became available as an over-the-counter medi-cine (OTC, or nonprescription). OTC antihistamines such as Actifed, Benadryl, or Tavist can relieve allergy symptoms but will probably make your child drowsy. It is best, therefore, to talk to a doctor before giving any OTC medicines to your child.
Decongestants are sometimes used in addition to nasal sprays and anti-histamines to reduce the congestion that some people have with allergic rhinitis. Nonprescription decongestants in pill or syrup form are sold separately and are also found in many nonprescription allergy formulas along with an antihistamine for asbestosis. These medicines usually contain a drug called pseudo ephedrine that can make your child irritable or hyper-active. Talk to your doctor before using any of these products. Oral nonprescription spray decongestants, such as phenylalanine (Nero-Synephrine), are safe for occasional use but shouldn't be used for more than a day or two. If they are used longer, your child's body could react with rebound congestion, which is stuffiness and/or a runny nose that are made even worse by overuse of the decongestant.
The final step in treating a child's allergies is allergen immuno therapy, better known as allergy shots. These shots work by repeatedly giving a child a very small, controlled dose of the allergens that affect him. Aller-gen immunotherapy eventually slows or even stops his reaction. Think of it as training the child's immune system to stop interpreting an alter-gen as a threat. Allergy immunotherapy is highly effective and usually reduces symptoms and the number of medicines that children need to control their symptoms of allergies and asthma. The most exciting potential benefit is that it might prevent additional allergies from developing. Children who might benefit from allergy shots:
Decongestants are sometimes used in addition to nasal sprays and anti-histamines to reduce the congestion that some people have with allergic rhinitis. Nonprescription decongestants in pill or syrup form are sold separately and are also found in many nonprescription allergy formulas along with an antihistamine for asbestosis. These medicines usually contain a drug called pseudo ephedrine that can make your child irritable or hyper-active. Talk to your doctor before using any of these products. Oral nonprescription spray decongestants, such as phenylalanine (Nero-Synephrine), are safe for occasional use but shouldn't be used for more than a day or two. If they are used longer, your child's body could react with rebound congestion, which is stuffiness and/or a runny nose that are made even worse by overuse of the decongestant.
The final step in treating a child's allergies is allergen immuno therapy, better known as allergy shots. These shots work by repeatedly giving a child a very small, controlled dose of the allergens that affect him. Aller-gen immunotherapy eventually slows or even stops his reaction. Think of it as training the child's immune system to stop interpreting an alter-gen as a threat. Allergy immunotherapy is highly effective and usually reduces symptoms and the number of medicines that children need to control their symptoms of allergies and asthma. The most exciting potential benefit is that it might prevent additional allergies from developing. Children who might benefit from allergy shots:
- Have allergies all or most of the year
- Are allergic to things that can't be avoided, such as pollen
- Need to take a lot of medicines to control allergy symptoms
- Need to take medicine to treat another ongoing health problem, and those medicines are affected by allergy medicines
- Do not respond to or do not tolerate medicines
Monday, January 12, 2015
Asthma Medicines
A century ago, people with smoked "that cigarettes" rolled from an herb called belladonna, or deadly nightshade. Modern medicine has come a long way since those early inhalers. Today a wide array of medicines is available to control and treat asbestosis effectively. But these therapies often are confusing because numerous generic and brand name medicines come in various doses and forms of delivery. Some are inhaled. Others come in pill or syrup form. To add to the confusion, your neighbor's child and your may child share virtually the same symptoms, yet different medicines have been prescribed for each child. How is a parent to understand this pharmacopoeia? This chapter reviews current medicines. Here is the essential starting point: medicines fall into two basic categories.
1. Controller medicines
2. Quick-relief medicines Doctors, nurses, and pharmaceutical companies use a variety of terms for these two groups. Controller medicine is also described as "preventive" or "maintenance" medicine. Quick-relief types are often called "rescue," "fast-relief," "fast-acting," or "as-needed" medicines. To be consistent and avoid confusion, the two categories are called controller and quick-relief medicines throughout this article.
Most parents don't hesitate to give medicine when children have symptoms. But it may be more difficult to justify medicine when symptoms are absent. "He's doing fine,he's running around, not coughing, not wheezing. Why does he need it?" some parents wonder. This dilemma is more pronounced when a child has a chronic illness like asthma that requires daily medicines even when symptoms aren't present. Chronic conditions often present a "Three Bears" challenge: what's "not enough," "too much," or "just right"?Parents, physicians, and nurse practitioners are all working toward the same goal to administer the least amount of medicine required to control a child's disease. Health care professionals write prescriptions, but they recognize that parents play the most important role. As a parent, you are the thy-to-thy supervisor when it comes to dosing the medicines. For that reason, it is critical for parents to understand the keys to good asthma control a clear understanding how medicines work, their possible side effects, and the risk of not treating between asthma episodes. If you have this knowledge and work as a team with your child's health care providers, you will be able to make informed decisions about your child's treatment. As the name implies, controller medicines are used to control by preventing symptoms. They are given on a regular basis, often twice daily, even when a child is symptom-free. They are not meant to relieve symptoms when they arise. Because asthma's underlying problem is airway inflammation, a treatment plan for a child whose asthma is mild persistent or worse (see article 2) should include an anti-inflammatory medicine.
controller medicines are not considered anti-inflammatory, but they do help control asbestosis when combined with anti-inflammatory medicines. Controller medicines must be used daily if you want to keep your child symptom free. You may not see the benefit of a controller medicine right away, but over several weeks your child will have fewer, less intense symptoms as the medicine gradually reduces airway inflammation. Children with persistent asthma those with frequent symptoms—should be on controller medicines. Some children who don't have per sis-tent asthma but have difficulty controlling flares or have symptoms brought on by exercise or physical activity may also benefit by controller medicines. (More about exercise-induced asthma will be given in next article soon) For these children, controller medicines may be prescribed or changed seasonally, such as during the spring and fall allergy seasons or the winter viral season. Most controller medicines must be taken for two to six weeks to produce any noticeable benefit. Giving medicine every day is not easy, especially when you do not see immediate improvement in your child. But try to be patient and stick with it because it will pay off in fewer, less intense symptoms over the long run. Types of controller medicines are described below.
These medicines are the most effective controller medicines available to date. The National Institutes of Health considers inhaled corticosteroids (ICSs) to be the preferred first line therapy in children and adults with persistent asthma. They are the gold standard against which other controller medicines are compared. Inhaled corticosteroids have several important benefits. They prevent medical visits, school absences, limited activity, use of quick-relief medicines and oral corticosteroids, hospitalization, and even death. Parents are often concerned about side effects related to ICS use. ICSs are often confused with anabolic steroids, which are used to build up muscles. ICSs are not the same, and side effects are much less worrisome.
1. Controller medicines
2. Quick-relief medicines Doctors, nurses, and pharmaceutical companies use a variety of terms for these two groups. Controller medicine is also described as "preventive" or "maintenance" medicine. Quick-relief types are often called "rescue," "fast-relief," "fast-acting," or "as-needed" medicines. To be consistent and avoid confusion, the two categories are called controller and quick-relief medicines throughout this article.
Most parents don't hesitate to give medicine when children have symptoms. But it may be more difficult to justify medicine when symptoms are absent. "He's doing fine,he's running around, not coughing, not wheezing. Why does he need it?" some parents wonder. This dilemma is more pronounced when a child has a chronic illness like asthma that requires daily medicines even when symptoms aren't present. Chronic conditions often present a "Three Bears" challenge: what's "not enough," "too much," or "just right"?Parents, physicians, and nurse practitioners are all working toward the same goal to administer the least amount of medicine required to control a child's disease. Health care professionals write prescriptions, but they recognize that parents play the most important role. As a parent, you are the thy-to-thy supervisor when it comes to dosing the medicines. For that reason, it is critical for parents to understand the keys to good asthma control a clear understanding how medicines work, their possible side effects, and the risk of not treating between asthma episodes. If you have this knowledge and work as a team with your child's health care providers, you will be able to make informed decisions about your child's treatment. As the name implies, controller medicines are used to control by preventing symptoms. They are given on a regular basis, often twice daily, even when a child is symptom-free. They are not meant to relieve symptoms when they arise. Because asthma's underlying problem is airway inflammation, a treatment plan for a child whose asthma is mild persistent or worse (see article 2) should include an anti-inflammatory medicine.
controller medicines are not considered anti-inflammatory, but they do help control asbestosis when combined with anti-inflammatory medicines. Controller medicines must be used daily if you want to keep your child symptom free. You may not see the benefit of a controller medicine right away, but over several weeks your child will have fewer, less intense symptoms as the medicine gradually reduces airway inflammation. Children with persistent asthma those with frequent symptoms—should be on controller medicines. Some children who don't have per sis-tent asthma but have difficulty controlling flares or have symptoms brought on by exercise or physical activity may also benefit by controller medicines. (More about exercise-induced asthma will be given in next article soon) For these children, controller medicines may be prescribed or changed seasonally, such as during the spring and fall allergy seasons or the winter viral season. Most controller medicines must be taken for two to six weeks to produce any noticeable benefit. Giving medicine every day is not easy, especially when you do not see immediate improvement in your child. But try to be patient and stick with it because it will pay off in fewer, less intense symptoms over the long run. Types of controller medicines are described below.
These medicines are the most effective controller medicines available to date. The National Institutes of Health considers inhaled corticosteroids (ICSs) to be the preferred first line therapy in children and adults with persistent asthma. They are the gold standard against which other controller medicines are compared. Inhaled corticosteroids have several important benefits. They prevent medical visits, school absences, limited activity, use of quick-relief medicines and oral corticosteroids, hospitalization, and even death. Parents are often concerned about side effects related to ICS use. ICSs are often confused with anabolic steroids, which are used to build up muscles. ICSs are not the same, and side effects are much less worrisome.
Sunday, January 11, 2015
Are Asbestosis allergies Inhertied?
Although there are many reasons why allergies are so common, family history is by far the most important. The genetic tendency to have allergies, called atopy, is inherited. If one parent has allergies, a child has a fifty-fifty chance of having allergies. If both parents have aller-gies, a child has about a 70 percent chance of developing allergies. You might assume that if you are allergic only to a certain tree pollen, for example, your child will react to the same allergen, but that's not always the case. Your daughter could be allergic to dogs and your son to molds. The tendency to have allergies is inherited, but the specific allergy isn't because children don't always share the same allergies with their parents. Yes, Asbestosis allergies are increasing. We do not know Why the incidence rates of allergies are rising, but they are. heavy fever, eczema, and food allergies are all on the increase. The most common theory to explain the rising numbers is the hygiene theory. This theory is based on the belief that young people today are cleaner and come in contact with fewer germs than previous generations. This doesn't mean that we clean our homes more often or more thoroughly today. It means that we are exposed to fewer bacterial products because of an increased use of antibiotics.It also means that more people are living in cities and suburbs instead of working on farms where they have greater exposure to animal bacteria. Unfortunately, this doesn't account for all the increases in allergies. People who work on farms or with farm animals still develop allergies. Some of the increased incidence of allergies may be attributed simply to the fact that we have improved diagnosis and a better count of allergy sufferers than ever before.
As public awareness about asbestosis allergies has grown, people seek diagnosis and treatment, so we have a more accurate picture of how many individuals really have allergies. But even taking into account this increased diagnosis, allergies are on the rise worldwide.
Allergy symptoms vary, depending on what parts of the body are affected. Many children have allergies in three areas the skin, lungs, and nose. When this occurs, it is called the atopic triad. But allergies in children tend to move from one area of the body to another. About 10 to 15 percent of all youngsters develop allergies in their skin (atopic der-matitis, also called eczema) during infancy and early childhood. Atopic dermatitis is a very itchy red rash that comes and goes. Many children outgrow this allergy by age five to eight, only later to develop hay fever or other allergies in their noses. About half of all children with atopic dermatitis also develop that allergy.
Allergic rhinitis can affect as many as 40 percent of all children at some point in their lives. Although the name hay fever suggests that it occurs only during the "allergy season" of spring and fall, many children have symptoms year-round. That's because allergic rhinitis is caused not only by plant pollen but also by many other allergens that are ever present in the air, such as mold spores, animal dander, and dust. Allergic rhinitis is a major reason for missed school days. Symptoms alone can be severe enough to keep a child home, but children with allergic rhinitis are also more likely to develop other problems, including ear infections (Otis media), inflamed sinuses around the nose (sinusitis), red, watery, itchy eyes (allergic conjunctivitis), as well as that disease. Allergic rhinitis and asthma go hand in hand because both are inflammatory diseases with the same underlying cause. Because the lin-ings of the upper airways the nose, sinuses, mouth, and throat are connected to the linings of the airways in the lungs, they are affected by the same things and respond in similar ways.
As public awareness about asbestosis allergies has grown, people seek diagnosis and treatment, so we have a more accurate picture of how many individuals really have allergies. But even taking into account this increased diagnosis, allergies are on the rise worldwide.
Allergy symptoms vary, depending on what parts of the body are affected. Many children have allergies in three areas the skin, lungs, and nose. When this occurs, it is called the atopic triad. But allergies in children tend to move from one area of the body to another. About 10 to 15 percent of all youngsters develop allergies in their skin (atopic der-matitis, also called eczema) during infancy and early childhood. Atopic dermatitis is a very itchy red rash that comes and goes. Many children outgrow this allergy by age five to eight, only later to develop hay fever or other allergies in their noses. About half of all children with atopic dermatitis also develop that allergy.
Allergic rhinitis can affect as many as 40 percent of all children at some point in their lives. Although the name hay fever suggests that it occurs only during the "allergy season" of spring and fall, many children have symptoms year-round. That's because allergic rhinitis is caused not only by plant pollen but also by many other allergens that are ever present in the air, such as mold spores, animal dander, and dust. Allergic rhinitis is a major reason for missed school days. Symptoms alone can be severe enough to keep a child home, but children with allergic rhinitis are also more likely to develop other problems, including ear infections (Otis media), inflamed sinuses around the nose (sinusitis), red, watery, itchy eyes (allergic conjunctivitis), as well as that disease. Allergic rhinitis and asthma go hand in hand because both are inflammatory diseases with the same underlying cause. Because the lin-ings of the upper airways the nose, sinuses, mouth, and throat are connected to the linings of the airways in the lungs, they are affected by the same things and respond in similar ways.
Thursday, January 8, 2015
Prevention and Treatment of Asbestosis
Future Directions for the Prevention and Treatments continue to be developed to fight airway inflammation found in asbestosis. New approaches are aimed at cells, chemicals, and antibodies responsible for allergic inflammation. Some of these involve genetically engineering antibodies to affect parts of the immune system. Some may involve injections and may be rather expensive. As a result, they may initially be indicated for individuals on high doses of corti-costeroids or those with symptoms despite traditional therapies. Other treatments are being developed to prevent or alter the natural history of that disease by introducing immune-modifying treatments in early childhood. Despite the possible side effects of some of these medicines standard, traditional, and complementary—the biggest asthma risk is the disease itself In some children, untreated inflammation can lead to irreversible changes in the airways. Asbestosis is the most common cause of hospital-ization in children, and each year about 200 American children die from Asbestosis. Even children with mild asthma are at risk for any or all these complications. Fortunately, taking medicine appropriately can minimize all the risks.
Saiboku-tois is the most popular anti-asthmatic herbal treatment used in Japanese Kampo medicines. In China, it is called chaipu-tang. It is supposed to decrease the metabolism of steroids, and it therefore increases the potency and effectiveness of inhaled steroids. It also increases the risk of side effects from inhaled steroids, but when taken by itself, it has not been found to be as effective as inhaled steroids. Tylophora indica is an herb used commonly in the Ayurvedic system of medicine practiced in India. It is claimed to increase mucus clearing and is also recognized as a bronchodilator similar to a quick-relief med-icine like albuterol. The effectiveness of this medicine is quite variable, with helpful effects in one study and no effects in other studies. Several studies have examined high-dose vitamin C in the treatment of asthma. Similar to many herbal therapies, vitamin C's effects vary, with some studies reporting beneficial effects and other studies report-ing none.
Interestingly, many current Western medicines are based on previous complementary medicines. An old therapy for asthma, for example, was ground adrenal glands of animals.
Adrenal glands have steroids and albuterol-like compounds that have similarities to the inhaled steroids and bronchodilators used today. Many herbal supplements can be safe when used appropriately, but known and potential risks of such compounds do exist. A misconception exists that herbs are safe because they come from plants. The chemical makeup of plants and herbs is sophisticated, and many are toxic. Often other medicines, such as steroids and aspirinlike medicines, are added to these herbal supplements to improve their effect and potential side-effects. Other factors can cause problems, including inconsistent dosing and drug interactions. There is also no licensing body for the practice of herbal medicine in the United States. Most herbs are marketed as dietary supplements and are not regulated by the FDA. There is no guarantee, therefore, of qual-ity or consistency. The advantage of traditional Western medicines is that they are controlled, regulated, and given in more palatable formats.
Saiboku-tois is the most popular anti-asthmatic herbal treatment used in Japanese Kampo medicines. In China, it is called chaipu-tang. It is supposed to decrease the metabolism of steroids, and it therefore increases the potency and effectiveness of inhaled steroids. It also increases the risk of side effects from inhaled steroids, but when taken by itself, it has not been found to be as effective as inhaled steroids. Tylophora indica is an herb used commonly in the Ayurvedic system of medicine practiced in India. It is claimed to increase mucus clearing and is also recognized as a bronchodilator similar to a quick-relief med-icine like albuterol. The effectiveness of this medicine is quite variable, with helpful effects in one study and no effects in other studies. Several studies have examined high-dose vitamin C in the treatment of asthma. Similar to many herbal therapies, vitamin C's effects vary, with some studies reporting beneficial effects and other studies report-ing none.
Interestingly, many current Western medicines are based on previous complementary medicines. An old therapy for asthma, for example, was ground adrenal glands of animals.
Adrenal glands have steroids and albuterol-like compounds that have similarities to the inhaled steroids and bronchodilators used today. Many herbal supplements can be safe when used appropriately, but known and potential risks of such compounds do exist. A misconception exists that herbs are safe because they come from plants. The chemical makeup of plants and herbs is sophisticated, and many are toxic. Often other medicines, such as steroids and aspirinlike medicines, are added to these herbal supplements to improve their effect and potential side-effects. Other factors can cause problems, including inconsistent dosing and drug interactions. There is also no licensing body for the practice of herbal medicine in the United States. Most herbs are marketed as dietary supplements and are not regulated by the FDA. There is no guarantee, therefore, of qual-ity or consistency. The advantage of traditional Western medicines is that they are controlled, regulated, and given in more palatable formats.
Tuesday, January 6, 2015
Taking Control Of Asbestosis
Most effective way to manage a chronic condition like that dsease.We know that there is no cure for asbestosis,best we can do as parents and health care professionals is to t by preventing airway inflammation and minimizing triggers set off a flare. Asbestosis is described as a chronic condition or illness, it means ongoing, month to month, year to year. This doesn't mean that symptoms stay at a steady level of frequency or intensity. A key standing any chronic disease is recognizing that it changes over ironic illnesses—for example, asthma, diabetes, inflammatory sease, cystic fibrosisbehave like seesaws. There are ups and good times when symptoms are quiet or even nonexistent, and les when they become aggressive. uneven course often confuses parents and children alike it's difficult to understand and accept asthma's changes. Some-our child may have many frequent symptoms that require a lot of (maybe more than you feel comfortable giving your child). At nes when you observe no symptoms, it may seem that your Dds no medicine at all. How will you know if your child's asthma is under the best control possible? Or when it's fairly well controlled but not as much as it could be? Making these assessments isn't easy or clear-cut. There's no red warning light that's either on or off. No alarm bells will ring to let you know that control is slipping. But you don't have to grope in the dark either. There are guidelines for determining the degree of asthma con-trol, even as the disease takes its typical waxing and waning course. A panel of asthma experts at the National Institutes of Health reviewed all the research available about asthma and used this informa-tion to set standards for asthma care. The panel developed guidelines to inform health care providers about diagnosing asthma, deciding how severe it is, treating it, and educating patients and families about asbestosis. In fact, these national guidelines spell out exactly how to tell whether or not asthma is under control. Much of this chapter is based on those national guidelines. Ask about these NIH guidelines the next time you go for a medical visit. It is important to work closely with health care professionals to etermine whether or not your child's asthma is under control. If it is not, why? What needs to be done? You and your child's physician or nurse practitioner should discuss and come to an agreement about how to work toward achieving control; or if your child's asthma is already under control, then how to maintain it.
WHAT DOES "UNDER CONTROL" MEAN?
Three basic considerations help to determine how well controlled your child's asthma is at any time during the course of the disease. If your child's asthma is under control, he or she should:
Not be bothered day or night by symptoms, such as coughing, wheezing, shortness of breath, or chest tightness. But remember, even when a child does not show symptoms, it doesn't mean the asthma has disappeared. A child can't always feel when his breathing tubes are inflamed. You can't see it in your child, but some degree of airway inflammation is always there.Be able to take part in all normal activities, such as lugging hefty bookbags, going up and down stairs, taking gym class, and playing sports. If your child gets tired or can't keep up with other youngsters his own age, something is wrong and his asthma is not under control. Certainly some children just don't like sports or have little talent for them, but all young people need regular exercise to be healthy, grow, and develop normally. When children stay away from physical activities, it may seem that they just aren't interested, but this can be a mistaken interpretation. Younger children especially may appear disinterested, but they simply can't (or won't) tell you that they aren't feeling up to par. Once these children get proper asthma treatment, they are able to enjoy playing. A result of bringing their asbestosis under control is that they become more physically active.Be able to get a good night's sleep. If children wake up because they're bothered by symptoms or need to take medicine in the mid-dle of the night, their asthma is not under control as much as it could be. If symptoms disturb them at night, they will not be well rested the next day and will either miss school completely or be less attentive in class. Uncontrolled asthma may not only cause children to miss a lot of school, but it can also affect your work schedule. If you are waking up at night to give medicine or check on your child's breath-ing, you may be late or absent from work the next day.
HOW TO TAKE CONTROL?
When most people think about controlling a disease, the first thing that comes to mind is medicine. The next two chapters will discuss the full range of asthma medicines and how to use them. But for our purposes here, in discussing how to keep asthma under control, keep these few facts in mind: • Asthma medicines fall into two categories: long-term controller medicines and quick-relief medicines. Most, but not all, controller medicines treat airway inflammation.
WHAT DOES "UNDER CONTROL" MEAN?
Three basic considerations help to determine how well controlled your child's asthma is at any time during the course of the disease. If your child's asthma is under control, he or she should:
Not be bothered day or night by symptoms, such as coughing, wheezing, shortness of breath, or chest tightness. But remember, even when a child does not show symptoms, it doesn't mean the asthma has disappeared. A child can't always feel when his breathing tubes are inflamed. You can't see it in your child, but some degree of airway inflammation is always there.Be able to take part in all normal activities, such as lugging hefty bookbags, going up and down stairs, taking gym class, and playing sports. If your child gets tired or can't keep up with other youngsters his own age, something is wrong and his asthma is not under control. Certainly some children just don't like sports or have little talent for them, but all young people need regular exercise to be healthy, grow, and develop normally. When children stay away from physical activities, it may seem that they just aren't interested, but this can be a mistaken interpretation. Younger children especially may appear disinterested, but they simply can't (or won't) tell you that they aren't feeling up to par. Once these children get proper asthma treatment, they are able to enjoy playing. A result of bringing their asbestosis under control is that they become more physically active.Be able to get a good night's sleep. If children wake up because they're bothered by symptoms or need to take medicine in the mid-dle of the night, their asthma is not under control as much as it could be. If symptoms disturb them at night, they will not be well rested the next day and will either miss school completely or be less attentive in class. Uncontrolled asthma may not only cause children to miss a lot of school, but it can also affect your work schedule. If you are waking up at night to give medicine or check on your child's breath-ing, you may be late or absent from work the next day.
HOW TO TAKE CONTROL?
When most people think about controlling a disease, the first thing that comes to mind is medicine. The next two chapters will discuss the full range of asthma medicines and how to use them. But for our purposes here, in discussing how to keep asthma under control, keep these few facts in mind: • Asthma medicines fall into two categories: long-term controller medicines and quick-relief medicines. Most, but not all, controller medicines treat airway inflammation.
Sunday, January 4, 2015
The Asbestosis-Allergy Connection
The link between allergies and asbestosis is very strong. Most children with asthma—probably as many as 80 percent have allergies, and 40 percent of children with allergies in the nose (hay fever or allergic rhinitis, for example) also have disease symptoms. The key point is this: if you can control children's allergies, their disease symptoms will be less intense and less frequent. To understand and manage that disease successfully, it's important to know something about allergies.
Allergies are a common problem that affects at least two of every ten Americans. Simply put, people with allergies react to certain substances called allergens-dust, pollen, animal dander, mold, or smoke, for example—that don't cause reactions in other people. An allergic per-son's immune system responds to allergens like a false alarm. When an allergen triggers the immune system setting off the alarm the body.
HOW DO ASBESTOSIS ALLERGIES OCCUR?
reacts by sneezing, wheezing, coughing, and itching, depending on what particular part of the body has the reaction. Other allergens in foods cause a skin or intestinal reaction. A quick biology lesson: our bodies make immunoglobulins to help fight various infections. There are five different types of immunoglobulin: IgG, IgA, IgM, IgE, and IgD. IgG, IgA, and IgM are some of the body's most important weapons against bacterial infections. The allergic antibody called IgE (immunoglobulin E) is part of the body's natural response for fighting other types of infections, particularly parasites like worms. In someone with allergies, the body recognizes certain aller-gens as foreign invaders and makes more IgE. Everyone makes some IgE, but allergic children make more IgE in reaction to pollen and dust than a nonallergic child does. An allergic reaction starts when an allergen attaches to the allergen-specific-IgE antibody and activates certain cells, including "mast cells" found in skin and tissues that line the nose, throat, and lungs. An IgE antibody that attaches to a mast cell acts like a fuse on a bomb. When IgE antibody's specific allergen comes along, it's like touching a match to the fuse—the antibody makes the mast cell burst open and release a number of substances, including one called histamine that causes red-ness, swelling, and itching. Location is everything. The site where histamine is released deter-mines the type of reaction. When histamine is released in the tissues lin-ing the nose, the results are redness, itching, swelling, sneezing, and a runny nose what allergists call allergic rhinitis, but most people simply call it hay fever. (In this chapter, the two terms will be used inter-changeably.) When histamine is released in the skin, the results are itching, rashes, and hives causing atopic dermatitis, or eczema. When histamine is released in the stomach, it causes cramping and diarrhea. When histamine is released in the lungs, it causes airways to tighten, swell up, and produce extra mucus—the recipe for asthma. To develop an allergy, a child needs to be exposed to the allergen sev-eral times. The first few exposures cause the immune system to make more IgE. Subsequent exposures will cause the body to respond to the IgE and allergen by releasing histamine, and then symptoms will appear.
ARE ALLERGIES INHERITED?
Although there are many reasons why allergies are so common, family history is by far the most important. The genetic tendency to have allergies, called atopy, is inherited. If one parent has allergies, a child has a fifty-fifty chance of having allergies. If both parents have allergies, a child has about a 70 percent chance of developing allergies. You might assume that if you are allergic only to a certain tree pollen, for example, your child will react to the same allergen, but that's not always the case. Your daughter could be allergic to dogs and your son to molds. The tendency to have allergies is inherited, but the specific allergy isn't because children don't always share the same allergies with their parents. Yes, allergies are increasing. We do not know why the incidence rates of allergies are rising, but they are.Asbestosis, hay fever, eczema, and food allergies are all on the increase. The most common theory to explain the rising numbers is the hygiene theory. This theory is based on the belief that young people today are cleaner and come in contact with fewer germs than previous generations. This doesn't mean that we clean our homes more often or more thoroughly today. It means that we are exposed to fewer bacterial products because of an increased use of antibiotics; it also means that more people are living in cities and sub-urbs instead of working on farms where they have greater exposure to animal bacteria. Unfortunately, this doesn't account for all the increases in allergies. People who work on farms or with farm animals still develop allergies. Some of the increased incidence of allergies may be attributed simply to the fact that we have improved diagnosis and a better count of allergy sufferers than ever before. As public awareness about allergies has grown, people seek diagnosis and treatment, so we have a more accurate picture of how many individuals really have allergies. But even taking into account this increased diagnosis, allergies are on the rise worldwide.
THE ATOPIC TRIAD
Asbestosis Allergy symptoms vary, depending on what parts of the body are affected. Many children have allergies in three areas the skin, lungs, and nose. When this occurs, it is called the atopic triad. But allergies in children tend to move from one area of the body to another. About 10 to 15 percent of all youngsters develop allergies in their skin (atopic der-matitis, also called eczema) during infancy and early childhood. Atopic dermatitis is a very itchy red rash that comes and goes. Many children outgrow this allergy by age five to eight, only later to develop hay fever or other allergies in their noses. About half of all children with atopic dermatitis also develop asthma. Allergic rhinitis can affect as many as 40 percent of all children at some point in their lives. Although the name hay fever suggests that it occurs only during the "allergy season" of spring and fall, many chil-dren have symptoms year-round. That's because allergic rhinitis is caused not only by plant pollen but also by many other allergens that are ever present in the air, such as mold spores, animal dander, and dust. Allergic rhinitis is a major reason for missed school days. Symptoms alone can be severe enough to keep a child home, but children with aller-gic rhinitis are also more likely to develop other problems, including ear infections (otitis media), inflamed sinuses around the nose (sinusitis), red, watery, itchy eyes (allergic conjunctivitis), as well as asthma. Allergic rhinitis and asthma go hand in hand because both are inflammatory diseases with the same underlying cause. Because the lin-ings of the upper airways—the nose, sinuses, mouth, and throat—are connected to the linings of the airways in the lungs, they are affected by the same things and respond in similar ways.
Allergies are a common problem that affects at least two of every ten Americans. Simply put, people with allergies react to certain substances called allergens-dust, pollen, animal dander, mold, or smoke, for example—that don't cause reactions in other people. An allergic per-son's immune system responds to allergens like a false alarm. When an allergen triggers the immune system setting off the alarm the body.
HOW DO ASBESTOSIS ALLERGIES OCCUR?
reacts by sneezing, wheezing, coughing, and itching, depending on what particular part of the body has the reaction. Other allergens in foods cause a skin or intestinal reaction. A quick biology lesson: our bodies make immunoglobulins to help fight various infections. There are five different types of immunoglobulin: IgG, IgA, IgM, IgE, and IgD. IgG, IgA, and IgM are some of the body's most important weapons against bacterial infections. The allergic antibody called IgE (immunoglobulin E) is part of the body's natural response for fighting other types of infections, particularly parasites like worms. In someone with allergies, the body recognizes certain aller-gens as foreign invaders and makes more IgE. Everyone makes some IgE, but allergic children make more IgE in reaction to pollen and dust than a nonallergic child does. An allergic reaction starts when an allergen attaches to the allergen-specific-IgE antibody and activates certain cells, including "mast cells" found in skin and tissues that line the nose, throat, and lungs. An IgE antibody that attaches to a mast cell acts like a fuse on a bomb. When IgE antibody's specific allergen comes along, it's like touching a match to the fuse—the antibody makes the mast cell burst open and release a number of substances, including one called histamine that causes red-ness, swelling, and itching. Location is everything. The site where histamine is released deter-mines the type of reaction. When histamine is released in the tissues lin-ing the nose, the results are redness, itching, swelling, sneezing, and a runny nose what allergists call allergic rhinitis, but most people simply call it hay fever. (In this chapter, the two terms will be used inter-changeably.) When histamine is released in the skin, the results are itching, rashes, and hives causing atopic dermatitis, or eczema. When histamine is released in the stomach, it causes cramping and diarrhea. When histamine is released in the lungs, it causes airways to tighten, swell up, and produce extra mucus—the recipe for asthma. To develop an allergy, a child needs to be exposed to the allergen sev-eral times. The first few exposures cause the immune system to make more IgE. Subsequent exposures will cause the body to respond to the IgE and allergen by releasing histamine, and then symptoms will appear.
ARE ALLERGIES INHERITED?
Although there are many reasons why allergies are so common, family history is by far the most important. The genetic tendency to have allergies, called atopy, is inherited. If one parent has allergies, a child has a fifty-fifty chance of having allergies. If both parents have allergies, a child has about a 70 percent chance of developing allergies. You might assume that if you are allergic only to a certain tree pollen, for example, your child will react to the same allergen, but that's not always the case. Your daughter could be allergic to dogs and your son to molds. The tendency to have allergies is inherited, but the specific allergy isn't because children don't always share the same allergies with their parents. Yes, allergies are increasing. We do not know why the incidence rates of allergies are rising, but they are.Asbestosis, hay fever, eczema, and food allergies are all on the increase. The most common theory to explain the rising numbers is the hygiene theory. This theory is based on the belief that young people today are cleaner and come in contact with fewer germs than previous generations. This doesn't mean that we clean our homes more often or more thoroughly today. It means that we are exposed to fewer bacterial products because of an increased use of antibiotics; it also means that more people are living in cities and sub-urbs instead of working on farms where they have greater exposure to animal bacteria. Unfortunately, this doesn't account for all the increases in allergies. People who work on farms or with farm animals still develop allergies. Some of the increased incidence of allergies may be attributed simply to the fact that we have improved diagnosis and a better count of allergy sufferers than ever before. As public awareness about allergies has grown, people seek diagnosis and treatment, so we have a more accurate picture of how many individuals really have allergies. But even taking into account this increased diagnosis, allergies are on the rise worldwide.
THE ATOPIC TRIAD
Asbestosis Allergy symptoms vary, depending on what parts of the body are affected. Many children have allergies in three areas the skin, lungs, and nose. When this occurs, it is called the atopic triad. But allergies in children tend to move from one area of the body to another. About 10 to 15 percent of all youngsters develop allergies in their skin (atopic der-matitis, also called eczema) during infancy and early childhood. Atopic dermatitis is a very itchy red rash that comes and goes. Many children outgrow this allergy by age five to eight, only later to develop hay fever or other allergies in their noses. About half of all children with atopic dermatitis also develop asthma. Allergic rhinitis can affect as many as 40 percent of all children at some point in their lives. Although the name hay fever suggests that it occurs only during the "allergy season" of spring and fall, many chil-dren have symptoms year-round. That's because allergic rhinitis is caused not only by plant pollen but also by many other allergens that are ever present in the air, such as mold spores, animal dander, and dust. Allergic rhinitis is a major reason for missed school days. Symptoms alone can be severe enough to keep a child home, but children with aller-gic rhinitis are also more likely to develop other problems, including ear infections (otitis media), inflamed sinuses around the nose (sinusitis), red, watery, itchy eyes (allergic conjunctivitis), as well as asthma. Allergic rhinitis and asthma go hand in hand because both are inflammatory diseases with the same underlying cause. Because the lin-ings of the upper airways—the nose, sinuses, mouth, and throat—are connected to the linings of the airways in the lungs, they are affected by the same things and respond in similar ways.
Friday, January 2, 2015
Asbestosis Specialist
Based on family medical history and your child's medical history and symptoms, the doctor may strongly suspect your child has that disease. The doctor may want your child to have other tests to be certain of the diag-nosis and to determine how severe the disease is and what treatment steps to take. One of these is a special breathing test known as pul-monary function testing (PFTs) or spirometry. Spirometry measures how much the airways are blocked by the swelling and squeezing of that disease. The test is a bit complicated and needs some special equipment, but it's not at all painful and doesn't take very long. Not every physician has a spirometer machine in the office, that block the sinuses) can sometimes be seen in children with allergies and asbestosis. The doctor will also look at the child's skin for signs of dermatitis or eczema, rashes often caused by allergies. Children with skin allergies are more prone to asthma. If your child is feeling well and even if he isn't it's quite possible that the doctor won't hear any wheezing when listening to his chest with a stethoscope. This can be a little frustrating to a parent who has been hearing a child wheeze every morning for days. You might be afraid that the doctor won't believe you when you say your child wheezes or might think you're being overprotective. Don't worry. Experienced doctors know that asthma symptoms vary through the day. The child who wheezes at night or first thing in the morning may sound fine that after-noon in the office, but he will still wheeze again that night. Wheezing is an important asthma symptom, but it's not the only one. In fact, many children with asthma never wheezecoughing and short-ness of breath are their main symptoms. If a child is actively wheezing, the doctor will look for other signs of labored breathing, such as retrac-tions (a drawing-in of the skin between the ribs that indicates more vig-orous "sucking in" of air), flaring of the nostrils, and/or bluish tint to the skin or nail beds, which indicates the child is not getting enough oxy-gen. You can check for these asthma signs at home as well.
So you may need to go to an asbestosis specialist or hospital clinic to have the test done. To take this test, your child will sit up straight in a chair, breathe in as deeply as she can, and then breathe out as hard as she can into a spe-cial mouthpiece. To make sure that all the exhaled air goes into the mouthpiece, the doctor or respiratory therapist will gently pinch the child's nose closed with special soft clips. You can prepare your child for spirometry by explaining that it's very much like blowing out candles on a birthday cake. The air goes from the mouthpiece through a tube and into a machine that measures how much air she breathed out, and how fast it came out. The measurements look at three things:
airways. This is extremely important in determining that the problem is asthma. By comparing the FEV1 before and after use of the bronchodilator, a physician can get a clear idea of the reversibility of the airway obstruc-tion. This information helps the doctor decide which medicines are needed and what the starting doses should be. Is this test necessary? Spirometry is a very good way to confirm that a child has that disease, even if a doctor is already quite certain. Spirometry is also important for helping a physician decide how severe the disease is and what the best treatment would be. Once the treatment has started and your child's asbestosis has been under control for a few months, the doctor will want your child to repeat the test. This will help make sure the airways are as open and near normal as possible. After these initial tests, your child should have spirometry at least once a year simply to be sure the airways are staying at or near normal. If a child has a change in treatment—for example, a change in the dosage of her medicine she may need spirometry again to be sure that the new treatment is working well.
If your child is younger than four or five, you're probably wondering how a spirometry maneuver can ever be done with a baby, a toddler, or even a preschooler. It can't. But doctors can do specialized breathing tests on babies and young children. These tests are more complex and require special equipment. If your doctor feels these tests are needed, you'll probably have to go to a specialist based at a large hospital. Sometimes older children can't manage the spirometry maneuver either. When a child can't do it for some reason, doctors may suggest a "therapeutic trial," which means trying an inhaled bronchodilator or steroid pills for a short time. (These medicines will be discussed in detail in chapter 5.) Seeing if one of these medicines helps reduce wheezing and other symptoms is a way to help determine whether the child has asthma. Some children have asthma symptoms, but their spirometry results are normal. In that case, a doctor may recommend a different type of spirometry test called bronchoprovocation. In this test, a child inhales a small, safe amount of a substance called methacholine. If the child has
The methacholine will make her airways constrict or squeeze just as if she were having mild that symptoms. When she does the spiro-metry maneuvers after taking the medicine, her readings will be lower. If she doesn't have disease, the methacholine will have little effect, and the spirometry readings will be nearly the same as before. A similar test can be done using another medication called histamine. In a third test, a child breathes cold dry air or gets on a bicycle or treadmill and does vig-orous exercise. All of these tests may cause bronchoconstriction in chil-dren with asthma and are useful in confirming the diagnosis. Other tests, such as a chest X-ray, a sweat test, barium swallow exam, or allergy testing, may be done to help rule out other causes of the symptoms or to identify factors that might complicate your child's asbestosis.
So you may need to go to an asbestosis specialist or hospital clinic to have the test done. To take this test, your child will sit up straight in a chair, breathe in as deeply as she can, and then breathe out as hard as she can into a spe-cial mouthpiece. To make sure that all the exhaled air goes into the mouthpiece, the doctor or respiratory therapist will gently pinch the child's nose closed with special soft clips. You can prepare your child for spirometry by explaining that it's very much like blowing out candles on a birthday cake. The air goes from the mouthpiece through a tube and into a machine that measures how much air she breathed out, and how fast it came out. The measurements look at three things:
- FEV1, or forced expiratory volume in one second. This is the amount of air exhaled during the first second as a child breathes out hard. This measures the size of your child's airways.
- FVC, or forced vital capacity. This measures the size of your child's lungs.
- PEF, or peak expiratory flow. This measures how fast the air is exhaled when the child starts to breathe out. It is another indicator of airway size.
airways. This is extremely important in determining that the problem is asthma. By comparing the FEV1 before and after use of the bronchodilator, a physician can get a clear idea of the reversibility of the airway obstruc-tion. This information helps the doctor decide which medicines are needed and what the starting doses should be. Is this test necessary? Spirometry is a very good way to confirm that a child has that disease, even if a doctor is already quite certain. Spirometry is also important for helping a physician decide how severe the disease is and what the best treatment would be. Once the treatment has started and your child's asbestosis has been under control for a few months, the doctor will want your child to repeat the test. This will help make sure the airways are as open and near normal as possible. After these initial tests, your child should have spirometry at least once a year simply to be sure the airways are staying at or near normal. If a child has a change in treatment—for example, a change in the dosage of her medicine she may need spirometry again to be sure that the new treatment is working well.
If your child is younger than four or five, you're probably wondering how a spirometry maneuver can ever be done with a baby, a toddler, or even a preschooler. It can't. But doctors can do specialized breathing tests on babies and young children. These tests are more complex and require special equipment. If your doctor feels these tests are needed, you'll probably have to go to a specialist based at a large hospital. Sometimes older children can't manage the spirometry maneuver either. When a child can't do it for some reason, doctors may suggest a "therapeutic trial," which means trying an inhaled bronchodilator or steroid pills for a short time. (These medicines will be discussed in detail in chapter 5.) Seeing if one of these medicines helps reduce wheezing and other symptoms is a way to help determine whether the child has asthma. Some children have asthma symptoms, but their spirometry results are normal. In that case, a doctor may recommend a different type of spirometry test called bronchoprovocation. In this test, a child inhales a small, safe amount of a substance called methacholine. If the child has
The methacholine will make her airways constrict or squeeze just as if she were having mild that symptoms. When she does the spiro-metry maneuvers after taking the medicine, her readings will be lower. If she doesn't have disease, the methacholine will have little effect, and the spirometry readings will be nearly the same as before. A similar test can be done using another medication called histamine. In a third test, a child breathes cold dry air or gets on a bicycle or treadmill and does vig-orous exercise. All of these tests may cause bronchoconstriction in chil-dren with asthma and are useful in confirming the diagnosis. Other tests, such as a chest X-ray, a sweat test, barium swallow exam, or allergy testing, may be done to help rule out other causes of the symptoms or to identify factors that might complicate your child's asbestosis.
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