Question:

ARoberts wrote:

I believe you are missing that his article said that the parents and kids were tested contemporaneously for IgE levels.

Well it really didn’t say "contemporaneously" and I didn’t take it as such at first but I can see that I did misinterpret it.

Response:

March 21, 2005 08:41:13 PM PST By Amanda Gardner HealthDay Reporter MONDAY, March 21 (HealthDay News) — Scientists have found significant differences in a blood marker for allergies between parents and their children, indicating that kids today may be more subsceptible to allergies than previous generations were. This appears to be the first quantitative, objective evidence that allergies and asthma are on the rise in the world today. The findings were presented Monday at the annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI) in San Antonio. Although there have been numerous reports that allergies and allergic disease such as asthma are on the rise, most of the evidence so far has been anecdotal, said Brock Williams, the author of the study and a clinical professor of allergy immunology at Children’s Mercy Hospital in Olathe, Kan. To see if there might be any objective evidence for these claims, Williams and his colleagues tested IgE levels in 1,481 people — 667 parents and 804 children. At least one parent in each family had to have asthma. "IgE is the factor in the blood that is responsible for producing symptoms of allergies," Williams explained. "An increase in allergy and asthma should be reflected in IgE levels." As it turned out, children had IgE levels at a minimum of four or five times higher than their parents. The children also had higher IgE levels for specific allergens: 45.3 percent of parents and 60.1 percent of their children had IgE readings for dust mites. Levels were also elevated, although not as sharply, for cat and mold. "It looks like the increase in asthma and in allergic disease could actually be due to increased sensitization to mites," Williams said. Dust mites are fairly ubiquitous, except in high, dry locations such as Denver, where last year’s AAAAI meeting was held. "There are more dust mites in San Antonio than Denver," said Dr. Kathleen Sheerin, public education chair of the AAAAI and moderator of the news conference. "We’re suffering this year." There are several hypotheses explaining the increase but no sure answer. It’s "fairly plausible that we’ve made it happier for mites to live in our indoor environments," Williams said. "We spend more time indoors. Kids spend more time indoors. We have regulated temperature. We feed them pretty well because they eat skin scales from humans." Children are also treated today for infectious illnesses, which might mean they don’t build up their immune systems enough, although Williams was quick to emphasize he did not advocate not treating kids for infections. In other presentations Monday, two studies looked at the link between obesity and allergies in children. Both conditions are on the rise in children, as well as adults. Dr. Kentaro Matsuda, assistant professor of pediatrics at Kurume University School of Medicine in Fukuoka, Japan, found that obese children had significantly higher IgE levels than normal-weight children. His study involved 49 obese children and 49 children who served as controls. The elevated IgE levels did not seem to be related to allergic disorders, but there was as correlation between IgE levels and leptin levels. Leptin is a hormone that regulates appetite, which may start to explain a link between obesity, allergies and future development of asthma. Obesity has been associated with respiratory problems in older people. A second study wanted to see if there were differences in asthma severity and air flow between obese asthmatic children and their normal weight asthmatic counterparts. The researchers looked at the charts of 278 children aged 5 to 20 years. Forty percent of the children were normal weight, 41 percent were obese, 17 percent were overweight and 2 percent were underweight. Obese children did not have more severe asthma, said Dr. Sitesh Roy, assistant professor of pediatrics at the University of Mississippi in Jackson. Nor did they have a reduced level of asthma control. There was, however, a slight reduction in the FEV1/FVC ratio, a measure of airflow obstruction. "The difference was small and still in the mild-to-minimal obstructive range, but this still could be a very valid finding," Roy said. "This may indicate some degree of increased airway inflammation, but it also could be a more mechanical factor."

Response:

"afdr9lk" <9e…@dikmd.com

wrote in message

news:aPehe.339$X92.221@newsread2.news.pas.earthlink.net… – Hide quoted text — Show quoted text -

Woody Long wrote: afdr9lk wrote: Woody Long wrote: March 21, 2005 08:41:13 PM PST By Amanda Gardner HealthDay Reporter MONDAY, March 21 (HealthDay News) — Scientists have found significant differences in a blood marker for allergies between parents and their children, indicating that kids today may be more subsceptible to allergies than previous generations were. <snip Maybe we’re just getting better at detecting it. Obviously, you did not understand the article.  Read it again. Why are you confused about what I said?  Maybe 20 years ago the tests that show IgE levels were not as accurate.  It’s just a guess.  I don’t have any tests or scientific knowledge to back it up.  I’m not trying to pass off what I said as fact.

I believe you are missing that his article said that the parents and kids were tested contemporaneously for IgE levels.

Response:

- Hide quoted text — Show quoted text -Woody Long wrote:

afdr9lk wrote: Woody Long wrote: March 21, 2005 08:41:13 PM PST By Amanda Gardner HealthDay Reporter MONDAY, March 21 (HealthDay News) — Scientists have found significant differences in a blood marker for allergies between parents and their children, indicating that kids today may be more subsceptible to allergies than previous generations were. <snip Maybe we’re just getting better at detecting it. Obviously, you did not understand the article.  Read it again.

Why are you confused about what I said?  Maybe 20 years ago the tests that show IgE levels were not as accurate.  It’s just a guess.  I don’t have any tests or scientific knowledge to back it up.  I’m not trying to pass off what I said as fact.

Response:

Woody Long wrote:

March 21, 2005 08:41:13 PM PST By Amanda Gardner HealthDay Reporter MONDAY, March 21 (HealthDay News) — Scientists have found significant differences in a blood marker for allergies between parents and their children, indicating that kids today may be more subsceptible to allergies than previous generations were.

<snip

Maybe we’re just getting better at detecting it.

Response:

- Hide quoted text — Show quoted text -afdr9lk wrote:

Woody Long wrote: March 21, 2005 08:41:13 PM PST By Amanda Gardner HealthDay Reporter MONDAY, March 21 (HealthDay News) — Scientists have found

significant

differences in a blood marker for allergies between parents and

their

children, indicating that kids today may be more subsceptible to allergies than previous generations were. <snip Maybe we’re just getting better at detecting it.

Obviously, you did not understand the article.  Read it again.

Response:

Question:

Hi everyone. I have had Exercise induced asthma for a while now, but lately I have been getting coughing fits 2-3 times a week that require me to use my inhaler, and I’m not even exercising during it. The inhaler definitely helps. I want to know if this change in my asthma is significant enough to warrant a visit to the doctor.  I already have albutero. Is it bad enough that I will need preventative medication? Like Intal or Flovent or something to that effect? Thanks!! Kristen

Yes. — CBI, MD

Response:

Any increase in asthma severity should trigger a visit to your doctor, especially if you are not on preventative meds.  Flovent has worked wonders for me;  I can’t remember the last time I needed a rescue inhaler (but I keep it with me, nonetheless!). – Hide quoted text — Show quoted text – Hi everyone. I have had Exercise induced asthma for a while now, but lately I have been getting coughing fits 2-3 times a week that require me to use my inhaler, and I’m not even exercising during it. The inhaler definitely helps. I want to know if this change in my asthma is significant enough to warrant a visit to the doctor.  I already have albutero. Is it bad enough that I will need preventative medication? Like Intal or Flovent or something to that effect? Thanks!! Kristen

Response:

Hi everyone. I have had Exercise induced asthma for a while now, but lately I have been getting coughing fits 2-3 times a week that require me to use my inhaler, and I’m not even exercising during it. The inhaler definitely helps. I want to know if this change in my asthma is significant enough to warrant a visit to the doctor.  I already have albutero. Is it bad enough that I will need preventative medication? Like Intal or Flovent or something to that effect? Thanks!!

It sounds like you need to talk to your doctor. "Being responsible sometimes means pissing people off."    General Colin Powell

Response:

Hi everyone. I have had Exercise induced asthma for a while now, but lately I have been getting coughing fits 2-3 times a week that require me to use my inhaler, and I’m not even exercising during it. The inhaler definitely helps. I want to know if this change in my asthma is significant enough to warrant a visit to the doctor.  I already have albutero. Is it bad enough that I will need preventative medication? Like Intal or Flovent or something to that effect? Thanks!! Kristen

Response:

Question:

Exhaling.  Prolonged exhaling and effort although quite common with inhalation too.  The wheezes are usually heard on exhalation.  The others have given you a bit of physiology — Jim Picotte Michigan State University College of Human Medicine MS-III

– Hide quoted text — Show quoted text – I have been reading conflicting descriptions of symptoms of asthma, both on this ng, and also on various web sites.  Some say that there is a difficulty with exhaling.  Others say that there is a difficulty with inhaling, as a difficulty with exhaling is actually an obstructive disease, namely emphysema.  So, which is truth? Vicky

Response:

In a normal, about half of total system compliance (volume/pressure) is related to elastic recoil of the lung tissue and about half is due to the effects of the chest wall. Surface tension has a role at the alveolar level in that you have surfactant that increases distensibility at low lung volumes to prevent total collapse of the alveoli at low lung volumes. There are disease states such as ARDS (Acute Respiratory Distress Syndrome) and RDS of the newborn were surfactant is deficient btw. Humidity of the air you breathe doesn’t have much to do with your ability to exhale though there are some asthmatics who may have an attack started by exposure to cold or perhaps dry air but that’s due to the direct physical stimulation of their airways and not related to surface tension or changes in lung/system compliance.

EIA is known to be due to drying and nocturnal asthma is related, when an attack is occurring it has been shown that exhaled moisture drops sharply indicating a breakdown of the hydrating physiology.  The effects on lung compliance are not well researched as far as I can tell.  Drying due to atmospheric conditions/exercise certainly preceeds sensitivity to allergens/irritants, obstruction, breathlessness and the ability to exhale in my experience.  I have reversible chronic asthma (now mild.) Cold air cools the surface of the airways and so drops the water vapor pressure which then reduces air hydration.  Cold air also causes existing warm surface vapor to condense and return to the surface. Fully hydrated air at the surface is very unstable and a drop in temp or the presence of particulates  will cause condensation (ask your friendly meterologist about CCN). Atmospheric moisture even in ideal conditions always falls far short of the lungs moist requirements.  Your deeper lung needs 44mg of water per litre of inspired air and atmosphere typically supplies only about 10 mg. The remainder must come from surface vapor collected in the nasopharynx and the airways.  It is unlikely that airway surface moisture can sustain this demand for long without replacement from expired moist air. Normally about 16 mg is collected on expiration and the remainder is lost.  Surface flow from the alveolus up the bronchial tree assists but this will slow if drying occurs.  Finally immature, old and diseased airways do not hydrate inspired air well, all of which correlates with the appearance of asthma over a lifetime in atopics. Bill

Response:

… So the bottom line is, if you’re having an asthma attack, obviously first make sure you’re taking medication, and second, make sure you exhale fully and not too fast, right?

Response:

Asthma is an obstructive disease. Emphysema refers to microscopic hyperinflation at the alveolar level and indicates permanent damage usually due to smoking. COPD is any chronic obstructive disease which could technically include asthma but usually refers to people with fixed obstructive disease while asthma by definition is reversible. There are a few asthmatics with fixed disease due to under use of anti-inflammatories and there are many COPD/Emphysema patients who also have some reversibility (i.e. asthma). I have been reading conflicting descriptions of symptoms of asthma, both on this ng, and also on various web sites.  Some say that there is a difficulty with exhaling.  Others say that there is a difficulty with inhaling, as a difficulty with exhaling is actually an obstructive disease, namely emphysema.  So, which is truth?

– Don Elton Columbia, SC http://www.midcarolina.org

Response:

– Hide quoted text — Show quoted text – Depending on the asthma severity, both can be quite a task.  But the most characteristic is that it’s harder to exhale than to inhale.  I have to admit I don’t know why this is true.  Does anyone have the answer? It has to do with air pressure.  When you inhale, air pressure forces air into your lungs.  When you exhale, you must overcome this pressure. We literally live at the bottom of a ocean of air and we (since we are fully adapted to it) never even notice the weight of the air above us. Normally the force for exhalation is produced via the weight and elasticity of the chest.  However, when there is some sort of obstruction physical effort is required in order to force the air out in a timely manner.

Elasticity or retractibility of the lung is 25% due to the tissue and 75% due to moisture surface tension, according to a prominent researcher.  So in a dry lung you would expect a loss of retractibility? In forcing the air out, the intralobular airways are pressed shut prematurely, slowing its escape and trapping air in the lung.  Breathing out slower reduces this obstruction and also allows more time for exhalation. Breathing through the nose helps to hydrate the air and the lung, especially if inspiration is done quickly with audible turbulence and a little more deeply, reducing drying.  In a short time time the tidal volume of air does increase and relaxation sets in.  Note the respiration rate need not change all that much, however you will be able to reduce it quite comfortably to low rates with practice.  (Learn to sleep with your mouth closed to assist with nocturnal asthma.) Bill. – Hide quoted text — Show quoted text – Note:  The exhaustion of accessory muscles when used for exhalation is commonly the mechanism of death in fatal asthma attacks in children. "Being responsible sometimes means pissing people off."    General Colin Powell

Response:

Depending on the asthma severity, both can be quite a task.  But the most characteristic is that it’s harder to exhale than to inhale.  I have to admit I don’t know why this is true.  Does anyone have the answer? Knox – Hide quoted text — Show quoted text -I have been reading conflicting descriptions of symptoms of asthma, both on this ng, and also on various web sites.  Some say that there is a difficulty with exhaling.  Others say that there is a difficulty with inhaling, as a difficulty with exhaling is actually an obstructive disease, namely emphysema.  So, which is truth? Vicky

Response:

I have been reading conflicting descriptions of symptoms of asthma, both on this ng, and also on various web sites.  Some say that there is a difficulty with exhaling.  Others say that there is a difficulty with inhaling, as a difficulty with exhaling is actually an obstructive disease, namely emphysema.  So, which is truth?

There will be no problems breathing when the asthma is properly controlled, which happily is possible most of the time for most of the asthmatics. Vicky

Surfer!    Send email to: surfer at                nevis-view dot                    demon dot co dot uk "I can resist anything but temptation" – Oscar Wild

Response:

In asthma airway resistance is increased due to a combination of bronchoconstriction (smooth muscle action) and edema/mucus plugging. Lungs tend to be hyperinflated because of the increased difficulty at getting air out of the lungs. A forced exhalation further increases airway resistance because of pressure on the outside of the airways causing further collapse/constriction. – Hide quoted text — Show quoted text – Depending on the asthma severity, both can be quite a task.  But the most characteristic is that it’s harder to exhale than to inhale.  I have to admit I don’t know why this is true.  Does anyone have the answer? Knox I have been reading conflicting descriptions of symptoms of asthma, both on this ng, and also on various web sites.  Some say that there is a difficulty with exhaling.  Others say that there is a difficulty with inhaling, as a difficulty with exhaling is actually an obstructive disease, namely emphysema.  So, which is truth? Vicky

– Don Elton Columbia, SC http://www.midcarolina.org

Response:

It has to do with air pressure.  When you inhale, air pressure forces air into your lungs.  When you exhale, you must overcome this pressure. We literally live at the bottom of a ocean of air and we (since we are fully adapted to it) never even notice the weight of the air above us. Normally the force for exhalation is produced via the weight and elasticity of the chest.  However, when there is some sort of obstruction physical effort is required in order to force the air out in a timely manner. Note:  The exhaustion of accessory muscles when used for exhalation is commonly the mechanism of death in fatal asthma attacks in children.

Actually, the pressure of air outside the body has nothing to do with this since the pressure inside your body is the same as the pressure outside when there’s no air movement. The pressure that matters is pleural pressure, which is drawn to a subatmospheric level when your diaphragm moves down. This creates the pressure gradient between the alveoli and the outside air allowing air to move into the chest. Further, the pressure drop from the inside to the outside of the elastic airways causes a degree of airway dilation resulting in lower inspiratory resistance. When you exhale against resistance as one would during an asthma attack, the pressure outside of the airways becomes above atmospheric thus further compressing already restricted airways resulting in further resistance. This tends to prolong expiratory time requirements and over 6 breaths or so the lungs remain hyperinflated as a new breath tends to start before the last one is exhaled until the lungs are full enough that there is sufficient elastic recoil force available to help push as much air out as was inhaled during the prior breath (i.e. a new steady state of hyperinflation exists). — Don Elton Columbia, SC http://www.midcarolina.org

Response:

In a normal, about half of total system compliance (volume/pressure) is related to elastic recoil of the lung tissue and about half is due to the effects of the chest wall. Surface tension has a role at the alveolar level in that you have surfactant that increases distensibility at low lung volumes to prevent total collapse of the alveoli at low lung volumes. There are disease states such as ARDS (Acute Respiratory Distress Syndrome) and RDS of the newborn were surfactant is deficient btw. Humidity of the air you breathe doesn’t have much to do with your ability to exhale though there are some asthmatics who may have an attack started by exposure to cold or perhaps dry air but that’s due to the direct physical stimulation of their airways and not related to surface tension or changes in lung/system compliance. – Hide quoted text — Show quoted text – Elasticity or retractibility of the lung is 25% due to the tissue and 75% due to moisture surface tension, according to a prominent researcher.  So in a dry lung you would expect a loss of retractibility? In forcing the air out, the intralobular airways are pressed shut prematurely, slowing its escape and trapping air in the lung.  Breathing out slower reduces this obstruction and also allows more time for exhalation. Breathing through the nose helps to hydrate the air and the lung, especially if inspiration is done quickly with audible turbulence and a little more deeply, reducing drying.  In a short time time the tidal volume of air does increase and relaxation sets in.  Note the respiration rate need not change all that much, however you will be able to reduce it quite comfortably to low rates with practice.  (Learn to sleep with your mouth closed to assist with nocturnal asthma.) Bill.

– Don Elton Columbia, SC http://www.midcarolina.org

Response:

I have been reading conflicting descriptions of symptoms of asthma, both on this ng, and also on various web sites.  Some say that there is a difficulty with exhaling.  Others say that there is a difficulty with inhaling, as a difficulty with exhaling is actually an obstructive disease, namely emphysema.  So, which is truth?

First of all asthma is an obstructive disease of the airways.  The difference between asthma and COPD is that the obstruction in asthma is reversible. In adult asthma a process known as ‘air trapping’ can take place. This is the result of the time necessary to fully exhale is longer than allowed by the body’s demand for oxygen.  When this occurs a second inhalation begins before all the air is exhaled and the feeling of not getting enough air is experienced. Note:  Air trapping is frequently the mechanism of death for adults who experience a fatal asthma attack. "Being responsible sometimes means pissing people off."    General Colin Powell

Response:

Depending on the asthma severity, both can be quite a task.  But the most characteristic is that it’s harder to exhale than to inhale.  I have to admit I don’t know why this is true.  Does anyone have the answer?

It has to do with air pressure.  When you inhale, air pressure forces air into your lungs.  When you exhale, you must overcome this pressure. We literally live at the bottom of a ocean of air and we (since we are fully adapted to it) never even notice the weight of the air above us. Normally the force for exhalation is produced via the weight and elasticity of the chest.  However, when there is some sort of obstruction physical effort is required in order to force the air out in a timely manner. Note:  The exhaustion of accessory muscles when used for exhalation is commonly the mechanism of death in fatal asthma attacks in children. "Being responsible sometimes means pissing people off."    General Colin Powell

Response:

I have been reading conflicting descriptions of symptoms of asthma, both on this ng, and also on various web sites.  Some say that there is a difficulty with exhaling.  Others say that there is a difficulty with inhaling, as a difficulty with exhaling is actually an obstructive disease, namely emphysema.  So, which is truth? Vicky

Response:

Question:

Is anyone on this group sensitive to asprin? I am sensitve to any NSAID it appears. see http://www.jcaai.org/Param/Asthma/Asthma5H.HTM for more details on the phenomena. Rick Merrill

Response:

Is anyone on this group sensitive to asprin? I am sensitve to any NSAID it appears.

We have never given my daughter aspirin, but she wheezes with ibuprofin…Doc says to stay away from aleve as well.  He prescribes something called trylisate(sp).

Response:

Is anyone on this group sensitive to asprin? I am sensitve to any NSAID it appears. We have never given my daughter aspirin, but she wheezes with ibuprofin…Doc says to stay away from aleve as well.  He prescribes something called trylisate(sp).

Sorry to hear it.  Take a look at this link:  http://www.jcaai.org/Param/Asthma/Asthma5H.HTM RMM

Response:

Sorry to hear it.  Take a look at this link: http://www.jcaai.org/Param/Asthma/Asthma5H.HTM

Interestin..are they saying they becomer steroid dependent due to the inability to take NSAIDS ??????    She is steroid dependent due to her asthma severity. She has many drug allergies as well as food allergies.   Her Dr. mentioned the MSG factoe, but is there a test for it.  We could use some help figuring this aout. She gets hives as well, and had a severe allergic reaction, but are not sure what caused it.

Response:

Sorry to hear it.  Take a look at this link: http://www.jcaai.org/Param/Asthma/Asthma5H.HTM Interestin..are they saying they becomer steroid dependent due to the inability to take NSAIDS ??????

They are just saying it is a danger (caution) that one could become steroid dependent (with side effects). She is steroid dependent due to her asthma severity. She has many drug allergies as well as food allergies.   Her Dr. mentioned the MSG factor, but is there a test for it.  We could use some help figuring this aout. She gets hives as well, and had a severe allergic reaction, but are not sure what caused it.

Your allergist will give you lists of things for the sufferer to eat and procedures to help identify and isolate the cause. It is sometimes simple (the spot tests) and sometimes extraordinarily difficult to isolate the primary cause or causes. The complex situations often involve trace ingredients that can be ubiquitous (found everywhere). Rick Merrill

Response:

Is anyone on this group sensitive to aspirin? I am sensitive to any NSAID it appears.

Sorry to hear it, so am I. The good news is that people who are aspirin sensitive asthmatics frequently respond well to the leukotriene blockers such as Singulair or Accolate. Trilisate is sort of an NSAID. It is the least like aspirin and the other true NSAIDS so if you have a good reason to be taking an anti-inflammatory agent but are allergic to them then this agent will frequently be tried and tolerated. BTW the newer agents Vioxx and Celebrex, useful in people with gastric upset due to NSAIDS, should not be taken by aspirin sensitive asthmatics (or people with kidney or bleeding problems). — CBI, M.D. Please note: It is impossible to accurately diagnose medical problems without seeing the patient and reviewing the entire history. These posts are intended to be helpful and informative. Always check with your doctor before following any advice given. – Hide quoted text — Show quoted text – see http://www.jcaai.org/Param/Asthma/Asthma5H.HTM for more details on the phenomena. Rick Merrill

Response:

Hi CBI, Thanks for the information on leukotriene blockers. They prevent/interrupt the progression which appears to be NSAIDs = prostaglandins = eosinophils = leukotrienes, granule proteins, toxic oxygen products,  cytokines := fibroblast contraction. Does Trilisate produce prostaglandins? Rick Merrill – Hide quoted text — Show quoted text – Is anyone on this group sensitive to aspirin? I am sensitive to any NSAID it appears. Sorry to hear it, so am I. The good news is that people who are aspirin sensitive asthmatics frequently respond well to the leukotriene blockers such as Singulair or Accolate. Trilisate is sort of an NSAID. It is the least like aspirin and the other true NSAIDS so if you have a good reason to be taking an anti-inflammatory agent but are allergic to them then this agent will frequently be tried and tolerated. BTW the newer agents Vioxx and Celebrex, useful in people with gastric upset due to NSAIDS, should not be taken by aspirin sensitive asthmatics (or people with kidney or bleeding problems). — CBI, M.D. Please note: It is impossible to accurately diagnose medical problems without seeing the patient and reviewing the entire history. These posts are intended to be helpful and informative. Always check with your doctor before following any advice given. see http://www.jcaai.org/Param/Asthma/Asthma5H.HTM for more details on the phenomena. Rick Merrill

Response:

Hi CBI, Thanks for the information on leukotriene blockers. They prevent/interrupt the progression which appears to be NSAIDs = prostaglandins = eosinophils = leukotrienes, granule proteins, toxic oxygen products,  cytokines := fibroblast contraction. Does Trilisate produce prostaglandins?

Yes, it is a salicylate similar to aspirin. It is used in people truly allergic to aspirin with good success but if you believe the theory of why some asthmatics are sensitive to aspirin, outlined below, then you will see why it might cause problems too. Normally, fatty acids that are part of the inside of the cell wall/membrane are cleaved in the first step of inflammation releasing arachadonic acid. This arachadonic acid can then be metabolized by one of two main pathways. Cyclooxygenase can send it down the prostaglandin pathway or lipoxygenase can send it to the leukotriene pathway. The prostaglandins are central to fever, inflammation seen in infections and injury, pain, regulation of renal (kidney) blood flow, maintenance of fetal circulation, maintenance of the stomach’s mucus barrier to acid, and other things. The thromboxanes are an offshoot of this pathway that is seen in platelets and is involved in their function, and prostacyclin is in another branch that is also involved in blood vessel diameter regulation. The salicylates (aspirin/Trilisate) and the NSAIDs (Motrin etc.) block the cyclooxygenase enzyme. This why they are good in treating pain, inflammation, and fevers but can also cause bleeding, kidney failure, gastritis/ulcers, and should not be taken by pregnant women. The effects on thromboxanes (platelet function- bleeding) and prostacyclin (blood vessel dilation) also explains why aspirin is useful in treating and preventing coronary artery disease. The leukotrienes seem to be the inflammatory mediators of allergic diseases and asthma. They are relapsed along with other mediators (cytokines, toxic oxygen products, etc.) by mast cells and eosinophils, causing the swelling, edema (increased fluid/mucus), and smooth muscle cell contraction seen in asthma attacks. Fibroblasts are central to immune regulation as antigen presenting cells which process foreign proteins and "show them" to the immune system. The theory about aspirin sensitive asthmatics is that the inhibition of cyclooxygenase by aspirin and NSAIDs causes a shift to making more leukotrienes and hence more asthma symptoms. This is why aspirin sensitive asthmatics frequently respond well to the leukotriene inhibitors, or so we think. It also suggests a mechanism by which leukotriene inhibitors could cause the achyness in the joints that many asthmatics complain about, and the drug companies deny happens, by shifting things toward the prostaglandin side of the pathway. — CBI, M.D. Please note: It is impossible to accurately diagnose medical problems without seeing the patient and reviewing the entire history. These posts are intended to be helpful and informative. Always check with your doctor before following any advice given.

Response:

… The theory about aspirin sensitive asthmatics is that the inhibition of cyclooxygenase by aspirin and NSAIDs causes a shift to making more leukotrienes and hence more asthma symptoms. This is why aspirin sensitive asthmatics frequently respond well to the leukotriene inhibitors, or so we think. It also suggests a mechanism by which leukotriene inhibitors could cause the achyness in the joints that many asthmatics complain about, and the drug companies deny happens, by shifting things toward the prostaglandin side of the pathway.

Ah ha! I had not mentioned it before, but I am being treated for double (quad?) tennis elbow (a.k.a. aching joints) and it is not reponding very dramaticly. Perhaps I need more fatty acids (but my wife won’t serve ‘em). RMM – Hide quoted text — Show quoted text – — CBI, M.D. Please note: It is impossible to accurately diagnose medical problems without seeing the patient and reviewing the entire history. These posts are intended to be helpful and informative. Always check with your doctor before following any advice given.

Response:

- Hide quoted text — Show quoted text – … The theory about aspirin sensitive asthmatics is that the inhibition of cyclooxygenase by aspirin and NSAIDs causes a shift to making more leukotrienes and hence more asthma symptoms. This is why aspirin sensitive asthmatics frequently respond well to the leukotriene inhibitors, or so we think. It also suggests a mechanism by which leukotriene inhibitors could cause the achyness in the joints that many asthmatics complain about, and the drug companies deny happens, by shifting things toward the prostaglandin side of the pathway. Ah ha! I had not mentioned it before, but I am being treated for double (quad?) tennis elbow (a.k.a. aching joints) and it is not reponding very dramaticly. Perhaps I need more fatty acids (but my wife won’t serve ‘em). RMM

Interesting you should say that.. Flax Seed oil in capsule form, 1 cap per day cured my arm in about 6 months.. I could not raise it above my shoulder or throw a ball overarm without excruciating pain.  Now I have no pain whatsoever can throw a ball full pelt without a twinge and have ceased taking the caps… BTW did nothing for my asthma.. but it does suggest a deficiency of Omega 3 FA. Bill. – Hide quoted text — Show quoted text – — CBI, M.D. Please note: It is impossible to accurately diagnose medical problems without seeing the patient and reviewing the entire history. These posts are intended to be helpful and informative. Always check with your doctor before following any advice given.

Response:

Interesting you should say that.. Flax Seed oil in capsule form, 1 cap per day cured my arm in about 6 months.. I could not raise it above my shoulder or throw a ball overarm without excruciating pain.  Now I have no pain whatsoever can throw a ball full pelt without a twinge and have ceased taking the caps…

Just out od idle curiosity – how  can we be sure that the arm did not simply heal on its own in those six months? There is no place for the hyphen in our citizenship… We are a nation, not a hodge-podge of foreign nationalities. We are a people, and not a polyglot boarding house.  - Theodore Roosevelt

Response:

re: leukotriene hypothesis & Aspirin: allergy or intolerance – FYI Rev Med Interne 2000 Mar;21 Suppl 1:75s-82s                        [Aspirin: allergy or intolerance].                        [Article in French]                        Pradalier A, Vincent D                        Service de medecine interne IV, centre d’allergie de l’Ouest parisien, hopital Louis-Mourier,                        Colombes, France.                        PURPOSE: The paper describes the clinical characteristics of patients with aspirin-induced                        asthma and/or urticaria, angioedema, shock, the results of the challenge tests and the evolution of                        this disease. MAIN POINT: The authors present the different arguments supporting the                        physiopathological mechanisms from genetics to the inhibition of cyclooxugenase or the                        leukotriene hypothesis. PROSPECTIVES: Finally, they recall the methodology to be used for a                        good clinical practice on this controversial field of research.                        Publication Types:                             Review                             Review, tutorial                        PMID: 10763208, UI: 20226418 – Hide quoted text — Show quoted text – … The theory about aspirin sensitive asthmatics is that the inhibition of cyclooxygenase by aspirin and NSAIDs causes a shift to making more leukotrienes and hence more asthma symptoms. This is why aspirin sensitive asthmatics frequently respond well to the leukotriene inhibitors, or so we think. It also suggests a mechanism by which leukotriene inhibitors could cause the achyness in the joints that many asthmatics complain about, and the drug companies deny happens, by shifting things toward the prostaglandin side of the pathway. Interesting you should say that.. Flax Seed oil in capsule form, 1 cap per day cured my arm in about 6 months.. I could not raise it above my shoulder or throw a ball overarm without excruciating pain.  Now I have no pain whatsoever can throw a ball full pelt without a twinge and have ceased taking the caps… BTW did nothing for my asthma.. but it does suggest a deficiency of Omega 3 FA. Bill.

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Question:

I rather found it amusing to see the post and knew it was from Colin when I saw the posting. CMC

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I rather found it amusing to see the post and knew it was from Colin when I saw the posting.

Your point being?  (Has another ‘chip’ been detected?) It’s a terrible responsibility – but somebody has to be the Americans.

Response:

Maybe in your opinion.  Of course I do find it amusing when people try to tell me what I think.

Am I right in believing that you have a sense of humour? Now, surely no one here would have the audacity to tell *you* what you think, would they? Jo.

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I know emotional upheavle can bring on an asthma episode are we pushing buttons to see who grabs their inhaler first?

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and here i thought it was intelligent and witty self-irony. You seem to forget that the primary reason it is there is because the responses it produces tend to amuse me.

i used to have a rot13′ed sig that deplored the newbies of today, all so ignorant they didn’t even know what rot13 is. that got some pretty amazing feedback, too.

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Am I right in believing that you have a sense of humour? Now, surely no one here would have the audacity to tell *you* what you think, would they? Jo.

http://x41.deja.com/getdoc.xp?AN=548791975 http://x41.deja.com/getdoc.xp?AN=547704347 http://x41.deja.com/getdoc.xp?AN=546430695 http://x41.deja.com/getdoc.xp?AN=542323390 http://x41.deja.com/getdoc.xp?AN=541980484 http://x41.deja.com/getdoc.xp?AN=533885631 http://x41.deja.com/getdoc.xp?AN=497655565 If you can’t tolerate posts, ignore them! Jo. It’s dumb responses like this that perpetuate this cycle. In this instance we see a thick head’s fatuous diatribe, created in the absence of wit and brain cells. Even your stooges have their doubts You would argue that ‘black is white’. Perhaps you missed the point. Your insulting remarks above are sadly not what I would have expected from an intellectual reply. Really? I thought you just resorted to hurling insulting remarks challenging their intelligence. This NG is not for the purpose of advocating scientifically proven techniques Has anyone tested it scientifically, or are we just making sweeping statements off the top of our heads?? You should go to one of the med, sci newsgroups, this one is alt, which I think stands for alternative. There’s irony for you! The more I read and the more Drs I see, it appears that there is a long way to go yet. It strikes me that what they don’t know they make up! Have you just had a brainstorm or personality transplant or what? Why the sudden, unwarranted outburst of abuse? don’t put up just shut up! Personally, I don’t care what gets posted as I just skip past the gibbering moronic posts. Who do you propose should moderate the group? The FDA? I don’t care about the science, the fact that it helps is good enough for me. I see that humour and the point made just passed by you. Looks like we need another subgroup, alt.support.asthma.exchange-insults. Would this be the stuff about doctors pushing poisonous medicines from fat drug companies making people sicker? That is your opinion. Oh well, we all have our own opinions. Don’t get put off by the few vociferous, pompous, pontiffs that appear to denigrate all things not endorsed by the medical establishment. Visit 45 of Loughborough University of Technology And, finally, let’s pooh-pooh the idea anyway with dismissive tones. Do you mean people have died as a result of practising the Buteyko method? In my opinion, this means that you give Buteyko a go, and if/as your asthma severity lessens, you go to your doc and maybe get the dosages reduced. The ultimate achievement I think is to become medication free. You don’t quit the medicines the day you start Buteyko and then wind up in the ER. We occasionally see posts on here where someone has written some hogwash confusing relievers with preventers, yet no one has overreacted in the manner you do by attempting to cast aspersions in order to ridicule the theory. Rubbish! Even so, a lot of folk accept Buteyko because it is demonstrably effective. Even more so, some folk have had scientifically plausible treatment which has been demonstrably *ineffective*. Which planet is that on ? Certainly not in my part of the world! Yes, but all their posts could be condensed into a couple of lines of insulting verbiage and tagged onto the end of an FAQ, issued once a week, say. Loughborough University of Technology United Kingdom

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I like it because it tends to shut up the rather monotonous and repetitive people with a chip on their shoulders. In this newsgroup it appears to expose the chips on various shoulders. You seem to be harbouring bitter feelings towards fellow contributors to this news group. Have you checked your own shoulders recently?

Maybe in your opinion.  Of course I do find it amusing when people try to tell me what I think. It’s a terrible responsibility – but somebody has to be the Americans.

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The tag line is actually stolen from a guy in a military newsgroup explaining how lucky the various America-haters are to have such a convenient scapegoat.  Without the US they would have to admit that most of their problems are the result of bad decisions on their part. and here i thought it was intelligent and witty self-irony.

You seem to forget that the primary reason it is there is because the responses it produces tend to amuse me. It’s a terrible responsibility – but somebody has to be the Americans.

Response:

The tag line is actually stolen from a guy in a military newsgroup explaining how lucky the various America-haters are to have such a convenient scapegoat.  Without the US they would have to admit that most of their problems are the result of bad decisions on their part.

and here i thought it was intelligent and witty self-irony.  - lynx, who doesn’t hate americans – heck, he even loves one – but          still doesn’t think this is any heaven on earth, and that          americans in general, as a vague rule of thumb, are likely          to be just a little bit cruddier than other people, due to          their extreme insularity. multinationalism is _good_,          einsprachigkeit ist heilbar, et cetera.

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It has given me a few smiles to read this little post script, so hope I keep seeing it !  Sheila. – Hide quoted text — Show quoted text – It’s a terrible responsibility – but somebody has to be the Americans. OK, what’s the responsiblity and what’s terrible about it? Jo.

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I like it because it tends to shut up the rather monotonous and repetitive people with a chip on their shoulders. In this newsgroup it appears to expose the chips on various shoulders.

You seem to be harbouring bitter feelings towards fellow contributors to this news group. Have you checked your own shoulders recently? Jo.

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It’s a terrible responsibility – but somebody has to be the Americans. OK, what’s the responsiblity and what’s terrible about it?

Americans are responsible for having a truly overinflated sense of their own importance on the planet we call Earth, and it really is terrible. Might this be it? Viva America! Before you buy.

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It’s a terrible responsibility – but somebody has to be the Americans.

OK, what’s the responsiblity and what’s terrible about it? Jo.

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It’s a terrible responsibility – but somebody has to be the Americans. OK, what’s the responsiblity and what’s terrible about it? Jo.

And what makes Americans any more superior than the rest of the planet’s population?

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No one said "superior", just held to a higher level of responsibility. You have to see the whole quote to understand. Unfortunately, I don’t have it. — CBI

– Hide quoted text — Show quoted text – It’s a terrible responsibility – but somebody has to be the Americans. OK, what’s the responsiblity and what’s terrible about it? Jo. And what makes Americans any more superior than the rest of the planet’s population?

Response:

It’s a terrible responsibility – but somebody has to be the Americans. OK, what’s the responsiblity and what’s terrible about it?

The tag line is actually stolen from a guy in a military newsgroup explaining how lucky the various America-haters are to have such a convenient scapegoat.  Without the US they would have to admit that most of their problems are the result of bad decisions on their part. I like it because it tends to shut up the rather monotonous and repetitive people with a chip on their shoulders. In this newsgroup it appears to expose the chips on various shoulders. It’s a terrible responsibility – but somebody has to be the Americans.

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Question:

Well, I went to the dr. today and now I am on Azmacort. I have no experience with this type of medicine. Has anybody who tried it had problems with it or has it worked really well?  They don’t seem worried about the hiatal hernia and gave me some Axid to try.  Switching meds makes me nervous although I have never had a serious attack (no ER visits anyways). Thanks for all the good advice and links you have all given me.  It makes you feel less alone. Share what you know. Learn what you don’t.

Share what you know. Learn what you don’t.

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Well, I went to the dr. today and now I am on Azmacort. I have no experience with this type of medicine. Has anybody who tried it had problems with it or has it worked really well?  They don’t seem worried about the hiatal hernia and gave me some Axid to try.  Switching meds makes me nervous although I have never had a serious attack (no ER visits anyways). Thanks for all the good advice and links you have all given me.  It makes you feel less alone.

Azmacort is one of the older steroid inhalers; works OK on low to medium dose, at controlling bronchial inflammation due to asthma. If higher doses are needed, there are better newer steroid inhalers; Pulmicort or Flovent. Axid is one of the H2 blocker drugs used in GE reflux. Stronger drugs are available, like omeprazole. Other measures that should be taken for GE reflux are to prop the head of the bed 6-8" with wood blocks; and no meals within 3 hours of bedtime; per my previous post from the Asthma Education:  Interactive Guidelines http://www.vh.org/Providers/ClinGuide/AsthmaIM/comp2/Control.html Control of Factors Contributing to Asthma Severity click on Gastroesophageal reflux Ellis

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I go see my dr. tomorrow after having an upper Gi to check for reflux (none).  There is a hiatal hernia though.  Any of you have that with your asthma?  Maybe all the coughing caused it. I am not very assertive in the dr. office.  My systoms are always better there and I feel like they think I am making it out worse than it is (although they don’t act like that). I guess I am afaid to say too much.  Any advice?  I guess I am just nervous today.

A hiatal hernia is a predisposing factor for GE reflux. The upper GI test does not prove you don’t have reflux. Actual proving is very difficult (may require 24 hour pH monitoring test) Often GE reflux therapy is tried to see if it improves the asthma, as this is easier to do. Many asthmatics have GE reflux to a greater or lesser degree. Mild GE reflux at night may be managed without drugs; more severe cases require drugs. Links: http://www.vh.org/Providers/ClinGuide/AsthmaIM/comp2/Control.html#Gas… Reflux "Medical management of gastroesophageal reflux should be instituted for any patients with asthma complaining of frequent heartburn or pyrosis, particularly those with frequent episodes of nocturnal asthma. Medical management of gastroesophageal reflux includes:  Avoiding food and drink within 3 hours of retiring (Nelson 1984)  Elevating the head of the bed on 6- to 8-inch blocks (Nelson 1984)  Using appropriate pharmacologic therapy (Hixson et al. 1992) For patients who have persistent symptoms following optimal  therapy, further evaluation is indicated. For patients with poorly controlled asthma, particularly with  a nocturnal component, investigation for gastroesophageal  reflux may be warranted even in the absence of suggestive  symptoms (Irwin et al. 1989). The symptoms of  gastroesophageal reflux are common in both children and  adults with asthma (Nelson 1984). Reflux during sleep can  contribute to nocturnal asthma (Martin et al. 1982; Davis  et al. 1983). Both medical (Ekstrom et al. 1989) and surgical  (Perrin-Fayolle et al. 1989) therapy of gastroesophageal  reflux have been reported to reduce the symptoms of asthma." http://www.vh.org/Providers/ClinRef/FPHandbook/Chapter04/09-4.html Gastroenterology: Esophageal Diseases Ellis

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I go see my dr. tomorrow after having an upper Gi to check for reflux (none).  There is a hiatal hernia though.  Any of you have that with your asthma?  Maybe all the coughing caused it. I am not very assertive in the dr. office.  My systoms are always better there and I feel like they think I am making it out worse than it is (although they don’t act like that). I guess I am afaid to say too much.  Any advice?  I guess I am just nervous today. Share what you know. Learn what you don’t.

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Yes I have just finished an upper G.I. and yes I have a small hiatal hernia also, and I also seem to have less symptoms when the dr. is around.  I also have extremely high cholesterol, over three hundred , and continuous cramping in the right upper quadrent or what is called the hepatic flexture.   This pain was with me long before the dr.s ever diagnoised asthma.   (over ten years)  I use to think it was cancer but surely it would have gotten worst by now.  All in all I have little faith in the practicing physician of today, I think they can stitch you up and write precriptions but  they can’t make decisions like they use too, I think they are afraid of getting sued.    My favorite doctor was over 50 years ago when I wasx a kid growing up, he had time for a patient baCk then.  Now they are forming a UNION as in todays news. MONEY;MONEY,MONEY;  ANY WAY DON’T BE AFRAID TO TALK TOI THEM, THEY ARE NO MORE THAN MORTALS EVEN THOUGH THEY HAVE CONVINCED THEIRSELVES THEY ARE GODS  .Wish you well, frannymae.   Nothing ventured, nothing gained.

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Question:

So in your opinion Buteyko assumes that hyperventilation is caused by having too litle O2 ? Of course Mr. Buteyko assumes that ’self cleansing’ reactions are also associated with he treatment.

I would not assume that is the answer for my question adressed to Loki, should I ?

Response:

Buteyko could kill her.  It’s quackery. Loki

Well, could you tell us then what Dr. Buteyko recommends for such cases ? Or is your opinion that it is quackery based on such understanding as you have shown in your previous messages ? I find Buteyko uselss.  Besides, hyperventilation is actually caused by having too much O2 not too little as Buteyko assumes.  The purpose of breathing into a sack during hyperventilation is to increase the amount of CO2 in the bloodstream which ends the attack.

So in your opinion Buteyko assumes that hyperventilation is caused by having too litle O2 ? You clearly got that basic point wrong.

Response:

So in your opinion Buteyko assumes that hyperventilation is caused by having too litle O2 ?

Of course Mr. Buteyko assumes that ’self cleansing’ reactions are also associated with he treatment. "Fifteen experienced "sanogenes" or self-cleansing reactions, manifesting themselves through nervous excitement, chills, raised temperatures (up to 39%), headaches, muscular pains, intestinal pains, chest pains, weakness and hyper-secretion of mucus. Some experienced appetite loss, nausea, vomiting, thirst, excessive salivation (smelling of their medication) and increased urination and defecation. These reactions lasted from a few hours to two days and happened two to three times. " Interesting how the Buteyko supporters claim no side effects while the author of the technique states that they exist. BTW, I notice that the New Zealand Buteyko site is still misrepresenting Hillary’s paper.  Since they know that this is a misrepresentation (the actual research does not support Buteyko) then it is apparent that this is a knowing deception on the part of the webmaster.

Response:

Ann, First, I’m sorry your friend is so ill, and I hope for the best for you and for her. I spent five days on a respirator in March of ‘97, so people *do* recover from attacks like this!  I had no lasting effects other than a somewhat damaged voice (no biggie) and a determination not to wait so long before calling an ambulance Your friend is young and strong, and there is a lot of reason to be hopeful.   Something from my own family’s experience that might be useful: When the doctors say they "don’t know," don’t interpret that as a terrible sign; it really does mean they don’t know, not that you shouldn’t hope. People do get better, even when they’re intubated this long and longer — I and many other people here can attest to that. For information and resources, here are a couple of good places to start: www.aanma.org The Allergy and Asthma Network’s home page and www.njc.org National Jewish Hospital’s home page.   Good luck, Brida

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Hi, reference your friend with the severe asthma…..get  in touch with a "Buteyko" practioner.. If you can’t find one – let me know….There’s always a way… Paul Goldin (behavioral psychologist (Dublin)

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Since the friend is on a ventilator and under sedation, it is somewhat difficult to understand how Buteyko could be of particular help in her present condition. Emily Hi, reference your friend with the severe asthma…..get  in touch with a "Buteyko" practioner.. If you can’t find one – let me know….There’s always a way… Paul Goldin (behavioral psychologist (Dublin)

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Buteyko could kill her.  It’s quackery. Loki – Hide quoted text — Show quoted text – Hi, reference your friend with the severe asthma…..get  in touch with a "Buteyko" practioner.. If you can’t find one – let me know….There’s always a way… Paul Goldin (behavioral psychologist (Dublin)

Response:

HELP!  I can’t get information.  A very close friend who has asthma  had a very severe asthma attack last week and has been in the ICU ever since.  She is only 29 years old!  She is on a feeding tube and on a respirator and, of course, she is very heavily sedated!  She has been on the respirator for five days!  Anyone know where on the web I can find out more information….and any anecdotals as to people recovering from such a severe attack!  Is there a chance for recovery?  This is just an awful nightmare!  Thanks for any help!

The rule of thumb is that if an asthmatic is still alive when he/she gets to a hospital then they will recover. The respirator is assisting her with her breathing while her lungs heal.  Be careful of what you say around her – because she can hear you.

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Hi, reference your friend with the severe asthma…..get  in touch with a "Buteyko" practioner.. If you can’t find one – let me know….There’s always a way…

So you are recommending that somebody with severe, life threatening asthma risk her life on a theory that has no scientific basis?  Not only that but there are indications that Buteyko may merely reduce the patient’s perception of asthma severity? FYI, she was not intubated because she was "breathing too much." The more you learn about asthma, the sillier Buteyko theory becomes.

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HELP!  I can’t get information.  A very close friend who has asthma  had a very severe asthma attack last week and has been in the ICU ever since.  She is only 29 years old!  She is on a feeding tube and on a respirator and, of course, she is very heavily sedated!  She has been on the respirator for five days!  Anyone know where on the web I can find out more information….and any anecdotals as to people recovering from such a severe attack!  Is there a chance for recovery?  This is just an awful nightmare!  Thanks for any help! Ann O’Neamus

I know that and ICU experience can be terrifying for family and loved ones.  All that I can say try not to think too much about all the bells and whistles.  Instead concentrate on your friends emotional and spiritual healing in this time.  There are capable medical professionals there who will do everything in their powers to get your friend through this crisis.

Response:

Dear All –                     I’m presently doing a university project on asthma and its causes. In particular I’m looking at inhalers – both preventative and relievers.  I would appreciate any help that anyone could give me in this area. Does anyone have childhood memories of using them? Or likewise does anyone have children that use inhalers?     Please do drop me a line – no matter how trivial. Many Thanks Michael McLannahan (Chester, England)

Response:

HELP!  I can’t get information.  A very close friend who has asthma  had a very severe asthma attack last week and has been in the ICU ever since.  She is only 29 years old!  She is on a feeding tube and on a respirator and, of course, she is very heavily sedated!  She has been on the respirator for five days!  Anyone know where on the web I can find out more information….and any anecdotals as to people recovering from such a severe attack!  Is there a chance for recovery?  This is just an awful nightmare!  Thanks for any help! Ann O’Neamus

Response:

First, I understand that respirators are terrifying.  Second, please understand that it is keeping your friend alive till her body can heal itself.  OK? Now, on to the detail stuff.   Basically what is going on is that your friend is having trouble breathing.  Her body doesn’t seem to be able to correct that all alone.  The respirator will take on the work her body would normally have to do just to breathe.  Once that load is off the body it can concentrate it’s energies on actual healing. Think of the respirator as an aid and not as a terrifying machine.  It makes things easier on your friend the same way that crutches help you keep your weight off your feet when you sprain an ankle.  Nothing more. The feeding tube has the same effect.  It allows her body to take in nutrients and not put forth the effort that would otherwise be required. Also the sedation makes the whole process much easier on her.   Her body will be hard at work just healing.  Now it can concentrate all of it’s energy on that without having to spend energy to maintain it’s normal functions. Others will have to answer your other questions, but from what I’ve seen most folks recover from these things.  It may take a while, but the respirator has saved your friends life.  Try to remember that. Loki – Hide quoted text — Show quoted text – HELP!  I can’t get information.  A very close friend who has asthma  had a very severe asthma attack last week and has been in the ICU ever since.  She is only 29 years old!  She is on a feeding tube and on a respirator and, of course, she is very heavily sedated!  She has been on the respirator for five days! Anyone know where on the web I can find out more information….and any anecdotals as to people recovering from such a severe attack!  Is there a chance for recovery?  This is just an awful nightmare!  Thanks for any help! Ann O’Neamus

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Question:

Prednisone is your best friend and worst enemy in a bottle …Paul

Response:

If you have reflux, losec may not be enough to prevent the GERD Here are some quick guidelines Put objects under the legs at the head of your bed, so that the whole bed is on a slant. We suggest a 6 inch height to be a good starting point. Some people use 2 by 4s or books etc. This will allow gravity to pull your abdo contents down and take the pressure of the valve at the top of the stomach while you sleep. Reflux is all about malfunction of this valve. Anything that puts pressure on the valve may cause acid to creep up through it. This includes over-eating, body position, tight clothing, belts etc. Do not crunch your stomach after eating and eat small meals more often, rather than 3 squares. No caffeine, booze , spice, high fat foods, aciditic foods such as tomato sauce or orange juice. Lose weight if you are overweight. Nothing by mouth 3 hours prior to bedtime. Sounds terrible huh?  Be aware of any reflux so you can inform your doctor if you are having trouble with GERD. When you say bronchitis, do you mean you are coughing up a lot of sputum? Infection is a potent trigger for asthma and I wonder if you are having bronchospasm, edema, mucus plugging which I guess could be called bronchitis but we usually refer to it as a severe asthma exacerbation. You may require the prednisone as your doctor prescribed, it is hard to know. A peak flow monitor maybe useful. We have patients who have a similar protocol only they stage their attack into zones. If the peak flow drops to a certain point (zone), they may double their inhaled corticosteroid and continue to monitor. If drops below a worse point into another zone, they may start on oral steroids. That is the beauty of the peak flow meter, it gives objective indication of asthma severity and allows you to tailor the therapy accordingly. You must develop a plan with your doctor, including a zone where you go to the emergency room if you drop severely. Preventing infection is difficult in some chronic patients, especially those taking antibiotics and oral steroids. Take care of yourself: walk, exercise and avoid sick people. In addition get lots of sleep  ***unfragmented sleep is best which means no booze/caffeine and dealing with psychosocial issues which may disturb your slumber. I tell all patients whom I have contact with to cherish sleep; sleeping = healing. I recomend a walk and a hot bath before bed as this tends to promote a good sleep Were your ulcers from H. pylori ; the kind that responds to antibiotics or chemical? In my opinion a spacer is mandatory. Make sure you keep the valve leafs clean so they filter. Eventually Aerochambers degrade and need replacement. They work well when they are kept in good shape. Remember to rinse and SPIT after inhaled steroids. A lot of our patients get thrush despite rinsing. Nystatin is given to these patients so they can treat thrush if it pops up. — thanks and best regards Paul Horn says… – Hide quoted text — Show quoted text -Hi Paul and thank you for the response.  Yes , I forgot to mention that cold air is a definate trigger for me.  If my respiration increases while I’m in cold air I will eventually begin to wheeze.  Then I will resort to the Ventolin. Acid reflux…..I had a diagnosis of ulcers after a Endoscopy in Nov 97 and currently take 20 mg 2x daily of Prilosec. I haven’t noticed a difference in my asthma since taking this medication. Every time I get a cold, generally within 3 day’s everything starts to settle in my lungs. That’s when my dr said to start on the prednisone.  I get bronchitis every time.  Is there any way to prevent this from happening? The bronchitis that is.  Instead of using the prednisone is there an alternative during the bronchitis stage? I do have a peak flow meter but I don’t really use it like I should. If I’m having problems I will monitor , otherwise I don’t use it. I would rate my asthma as moderate.  As long as I’m on the Azmacort I’m ok. During cold’s it doesn’t keep up. I am using a spacer because I developed thrush a few times. I’m pretty good at the inhalation process even w/o a spacer. I do wash my mouth after use and still have developed thrush. I use the Aero-Chamber. Thank you again for your response. Take care, Kevin

Response:

<snip for brevity Every time I get a cold, generally within 3 day’s everything starts to settle in my lungs. That’s when my dr said to start on the prednisone.  I get bronchitis every time.  Is there any way to prevent this from happening? The bronchitis that is.  Instead of using the prednisone is there an alternative during the bronchitis stage?

The same thing happens to me. I think the dilemma is that the steroid does dampen down the immune systems, which helps the breathing and probably somewhat impedes fighting off the infection. Of course, not breathing is pretty likely to kill you entirely, so that has to be the primary concern. As my pulmonoligist once said to me, learn to love prednisone. It has saved your life. (I still don’t love it, but I use it when I have to.) Emily

Response:

? The same thing happens to me. I think the dilemma is that the steroid does dampen down the immune systems, which helps the breathing and probably somewhat impedes fighting off the infection. Of course, not breathing is pretty likely to kill you entirely, so that has to be the primary concern. As my pulmonoligist once said to me, learn to love prednisone. It has saved your life. (I still don’t love it, but I use it when I have to.) Emily Dear Emily :

Thanks for the info. Interesting to know you have the same problem.  I did read somewheres that steroid use can impede fighting infection.  I don’t like using the prednisone because of what I think it did to my eyes.  Of course I don’t know this for a fact.  I will only use it when I get really sick.  Kevin

Response:

Hi Paul and thank you for the response.  Yes , I forgot to mention that cold air is a definate trigger for me.  If my respiration increases while I’m in cold air I will eventually begin to wheeze.  Then I will resort to the Ventolin. Acid reflux…..I had a diagnosis of ulcers after a Endoscopy in Nov 97 and currently take 20 mg 2x daily of Prilosec. I haven’t noticed a difference in my asthma since taking this medication.

GERD (gastroesophageal reflux) is a frequent trigger of asthma. The treatment is: 1. elevate head of bed 6" with wood blocks, 2. no meals within 3 hr of going to bed 3. drugs like Prilosec Regarding ulcers, it’s now known they are often caused by a bacteria. H. Pylori. It can be detected with a blood test or breath test (or by endoscopic exam). Here’s a link: http://www.maxinet.com/mansell/helico.htm Helicobacter pylori Excerpt: "Helicobacter pylori(also known as H. pylori) was identified first  in Australia by Dr. Barry Marshall in 1983 as a potential cause of  peptic ulcers. In February 1994 a National Institute of Health  Consensus Development Conference was held and stated that all  patients with peptic ulcer disease require treatment with antibiotics  in addition to acid reduction treatment. It is estimated that 10% of the people of the US are afflicted by  peptic ulcer disease. The Helicobacter pylori bacteria is felt to be  the cause of most of these ulcers. "Stress" and diet are no longer  thought to cause ulcers. Aspirin and other arthritis medications can  cause ulcers independently of H. pylori." For H Pylori, the treatment is a short course of antibiotics. Every time I get a cold, generally within 3 day’s everything starts to settle in my lungs. That’s when my dr said to start on the prednisone.  I get bronchitis every time.  Is there any way to prevent this from happening? The bronchitis that is.  Instead of using the prednisone is there an alternative during the bronchitis stage? I do have a peak flow meter but I don’t really use it like I should. If I’m having problems I will monitor , otherwise I don’t use it.

Use an Action Plan to increase inhaled steroids based on Peak Flow readings or/and symptoms, per my previous post. I would rate my asthma as moderate.  As long as I’m on the Azmacort I’m ok.  During cold’s it doesn’t keep up.

You really need a stronger steroid inhaler; 12 puffs/day Azmacort is a  hassle. Try Flovent, Pulmicort, or Vanceril DS. I am using a spacer because I developed thrush a few times. I’m pretty good at the inhalation process even w/o a spacer. I do wash my mouth after use and still have developed thrush. I use the Aero-Chamber. Thank you again for your response. Take care, Kevin

Azmacort has a small built-in spacer. I don’t think its recommended to try to attach an AeroChamber spacer in series with the Azmacort built in spacer. Nor should you switch the Azmacort canister to another delivery device. Ellis

Response:

Hi Paul and thank you for the response.  Yes , I forgot to mention that cold air is a definate trigger for me.  If my respiration increases while I’m in cold air I will eventually begin to wheeze.  Then I will resort to the Ventolin. Acid reflux…..I had a diagnosis of ulcers after a Endoscopy in Nov 97 and currently take 20 mg 2x daily of Prilosec. I haven’t noticed a difference in my asthma since taking this medication. Every time I get a cold, generally within 3 day’s everything starts to settle in my lungs. That’s when my dr said to start on the prednisone.  I get bronchitis every time.  Is there any way to prevent this from happening? The bronchitis that is.  Instead of using the prednisone is there an alternative during the bronchitis stage? I do have a peak flow meter but I don’t really use it like I should. If I’m having problems I will monitor , otherwise I don’t use it. I would rate my asthma as moderate.  As long as I’m on the Azmacort I’m ok.  During cold’s it doesn’t keep up. I am using a spacer because I developed thrush a few times. I’m pretty good at the inhalation process even w/o a spacer. I do wash my mouth after use and still have developed thrush. I use the Aero-Chamber. Thank you again for your response. Take care, Kevin

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