In The News: Asthma

New Asthma Guidelines Just Announced

The field of science is ever-changing with new discoveries and ideas about life and diseases. Scientific textbooks have become obsolete over past millennia and recently, as frequently as a decade or two! Our ideas about what causes various diseases and appropriate management have changed drastically over the last 500 years. Our team receives official updated recommendations for the treatment of our patients and we are pleased to share that the accredited organizations we look to for guidance have shared the latest recommendations on treatment for patients with asthma. In the last 30 years, we have learned much more about asthma pathophysiology and management as new medications have become available for treatment of asthma. If you’re wondering why these might change overtime, Dr. Harper has shared a bit of perspective…

In the 1970s and 80s, I had the opportunity to train at National Jewish Hospital in Denver, Colorado where the sickest asthmatics in the United States are referred. We managed children and adults from every state in the US. What we observed at that time was the marked disparity in asthma understanding and management by referring physicians and hospitals. For example, some of these patients referred to our hospital for severe asthma didn’t even have asthma! The National Institute of Health (NIH) was also concerned about this disparity in the understanding of asthma diagnosis and management. In 1991, an expert panel was convened by the NIH which included physicians, respiratory therapists, and nurses and they assembled uniform guidelines for assessment and management of asthma.

This organization was designated the National Association for Asthma Education and Prevention Program (NAEPP). The document generated by this group was extensive and covered recommendations for asthma evaluation and diagnosis, identification of asthma triggers, assessment of asthma severity, and a stepwise approach to medications for asthma management in children and adults. Simultaneously, the international community also developed guidelines for asthma management (Global Initiative for Asthma or GINA) which are updated yearly. The guidelines from this international group generally parallel American guidelines although there have been some recent differences.

Since 1991, this expert panel has reconvened periodically to update guidelines in an effort to share new ideas about asthma pathophysiology, triggers and new medications available for management with practicing physicians. These updates were published in 1997, 2002 and 2007. Since the last guidelines were released in 2007, our understanding of asthma pathophysiology has greatly changed and a wide variety of new asthma medications have become available. One of the most important new concepts is that asthma appears to be more than one disease with major differences in inflammatory pathways leading to the characteristic twitchy airways and airway obstruction seen in asthma. Depending upon which type of asthma inflammatory pathway is present in an asthmatic, certain therapies may be more or less effective. Monoclonal antibody therapies (medicine that targets the chemicals involved in the inflammatory reactions resulting in airway narrowing) to block these various inflammatory pathways are rapidly evolving and becoming available. In 2021, we have finally obtained a new NAEPP update for asthma management which was just published this past week.

New NAEPP asthma guidelines are similar to previous guidelines, identifying individual asthma triggers, determining the severity of asthma and suggesting a stepwise approach to the management of increasing asthma severity. Here are the new major changes outlined for you:

  1. A major change in the new guidelines is the concept of using a single inhaler containing an inhaled corticosteroid and fast onset but long acting bronchodilator (currently only Symbicort or Dulera) as both controller therapy and rescue therapy. This has not been recommended in previous NAEPP guidelines but has been present in GINA guidelines. This new strategy has been suggested for children over 4 years old, adolescents, and adults. It’s a safer way to use short term higher dose steroids to control an acute flair up for asthma than oral steroids.
  2. It is recommended that measurement of exhaled nitric oxide, which is a marker of eosinophilic driven airway inflammation, can be used to accurately direct specific therapy. Eosinophils are white blood cells that all people have but those with allergies and asthma tend to have higher numbers.
  3. The new guidelines also confirm the benefits of reducing indoor allergens in individuals with allergen sensitivity, particularly to dust mite.
  4. Lastly, allergy extract immunotherapy (allergy shots) has also been confirmed to be of benefit in select individuals with allergy triggers for their asthma.

These new guidelines have just been published and it is not certain when insurance companies will alter their coverage for asthma medications based on these new guidelines. These guidelines will help the board-certified allergists at Charleston Allergy & Asthma determine the most appropriate management strategy and medications for their many asthma patients.

If you’re seeking treatment for your asthma symptoms, request an appointment with one of our board-certified allergists today.

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What are inhalers & how do they work?

Bronchodilators, or most commonly called inhalers, are medications that are breathed through the mouth and into the lungs to help relax muscles that tighten around your airways. The medicine helps open the airway and lets more air move in and out of your lungs and helps you breathe more easily. 

People with asthma use inhalers during an attack when their airways swell and become narrower. These attacks cause the person to cough, wheeze and have trouble breathing. Almost everyone with asthma will use a bronchodilator to help open their airways. Others may use one at some point in their life if diagnosed with a persistent cough, COPD, bronchitis, etc. Different inhalers have different medications, or a combination of drugs, to address different illnesses. 

Different Kinds of Inhalers

There are three basic types of inhalers that deliver medications. The most common is the metered-dose inhaler (or MDI) which uses pressure to push the medication out of the inhaler. Nebulizers use air or oxygen and deliver a mist of the medication through a tube or mask that fits over your nose and mouth. Dry powder inhalers (or DPIs) deliver medication, but they require a strong and fast inhalation.

Short-acting bronchodilators are used as “quick-relief”, “reliever”, or “rescue” inhalers. These bronchodilators open the airways and help stop or relieve acute asthma attacks very quickly. While they’re best known for working on sudden attacks, they’re also great to use before exercise to help stop asthma during your workout. 

While many people use short-acting bronchodilators, the overuse of an inhaler, tablet, or liquid/nebulizer, is a sign of uncontrolled asthma that needs better treatment. If you are using short-acting bronchodilators more than twice a week, call Charleston Allergy & Asthma about improving your asthma control therapy.

Long-acting bronchodilators provide control, not quick relief, of asthma. Your board-certified allergist will prescribe the medication, which is usually taken twice a day along with inhaled steroids for long-term monitoring of symptoms. 

Unlike short-acting inhalers, long-acting inhalers do not work on muscle inflammation directly. Instead, they help the airways relax, allowing more air to pass through.

If you’re struggling with your asthma or think you may be in need of a prescribed inhaler, request an appointment online today.

 

Sources:

https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/asthma-inhalers

https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/bronchodialator

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Meet the Girls: Our Charleston Allergy Trio!

Let’s hear it for the girls! Our Charleston Allergy & Asthma team has been blessed with some fantastic board-certified providers who all go above and beyond in giving exceptional care for our patients. For more than 30 years, we’ve been providing relief from allergies and asthma to the people of the Lowcountry.

To celebrate the incredible women in our lives, we’re thrilled to introduce you to our three female providers and share their stories of how they came to lead the way for women in healthcare. Get to know our favorite female allergists below!

Dr. Meredith Moore
Did you want to be a doctor when you were a little girl?
“Yes, I had to have a surgery when I was young and afterward, had to stay in a big ward with no parents. A burn victim was next to me and they would change her dressings. She was so sad and would cry. One night, she was crying and hysterical. All the physicians and nurses had left her, no parents were there and I went over and sat with her and made her feel better. I knew that I wanted people to have a better experience.”

What is your favorite part about being a doctor?
“Hard to answer because there are so many things! It’s the relationships you develop with people. They have allowed you the privilege of sharing their lives with you. It’s an awesome privilege and an amazing experience that someone was able to open themselves up to you and then you help make their lives better.”

What’s it like to balance personal and work life as a doctor?
“Practicing medicine with passion takes a lot out of you, whether you are a man or a woman, mom or not. Universally, it’s difficult if you want to approach medicine as a calling. It’s a very rewarding but demanding profession, no matter who you are.”

Dr. Carolyn Word
Why did you become a doctor?
“Growing up, my grandfather was a general practitioner and when we visited him in his office, I loved seeing how he interacted with patients and how he was able to help them. It seemed like a great way to help people. I always loved math and science, so I did biomedical engineering for undergrad. In the process of that, I realized that though I loved science, I loved working with people more. It’s a great way for me to take my love of science and apply it to patient care, which led me to medicine. I loved my rotation in allergy/immunology and all the ways we can make a difference in our patients’ lives.”

Have you overcome any obstacles as a female in the medical field?
“I think there certainly are stereotypes about women in medicine. There have been times when patients have thought I was a nurse because I was a woman or question my knowledge but more often, they have been grateful. When I was a medical student, I felt more pressure as a woman to work harder, push harder and prove myself to be accepted. I have never felt like that in my practice now and I’m grateful to work in such a wonderful practice.”

What’s your favorite part about your job?
“When I get to see a patient for a follow-up and hear that they are feeling so much better. When a patient has recently started allergy shots and has been coming in for frequent injections for a couple of months, then they share that after years of medicine, they had no idea how they could feel so much better; that’s the best part! Patients who have been struggling with a food allergy and who have passed their food challenge, then seeing their excitement. It’s a great thing to be a part of. And just getting to know my patients in general. We catch up about their lives beyond helping them find relief. We’re building relationships. It’s personal.”

Dr. Lindsey Stoltz Steadman
Why did you want to become a doctor?
“I was always interested in the sciences: biology, anatomy, physiology. On top of that, I enjoy interacting with people and going into a profession that was going to allow me to give back was important to me. I really enjoy teaching. I believe as a physician, my job is to educate our patients, our patients’ families and the community about our field.”

What’s it like to balance personal and work-life in the medical industry?
“My husband is a physician as well, so a major part of our relationship is that we’re very understanding of what the other person is going through. We bounce ideas off of each other and educate each other. There are a lot of sacrifices made when you decide you want to be a doctor and it doesn’t end after graduation of medical school, fellowship, etc. We understand that about each other. I understand when he needs to do a surgery in the middle of the night and he understands when I have to take a call over the weekend. Our training kept us a part in different cities and different states, but we understood what the other person was going through. We may have been a part, but we were together.”

What do you love most about your job?
“Critical thinking. I really enjoy the process of meeting a patient and getting to put the pieces of the puzzle together to help them. I’m grateful that I get to improve people’s quality of life. Nothing is more rewarding than hearing their success stories.”

Is there anything you want to add about being a doctor?
“You can know all the science but if you can’t explain it to your patient then it all goes out of the window. Rapport with your patients is equally as important as understanding the science. Patients need to feel comfortable with their doctor. At the end of the day, you just need to be good at what you do.”

We’re thankful for the incredible team of compassionate and talented providers that we have here at Charleston Allergy & Asthma! If you think you may be suffering from allergy symptoms or if you’re in need of a local board-certified allergist, schedule an appointment with our team today.

 

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Little girl in class wearing a mask. How COVID is making back to school look.

Back to School: COVID-19 and Asthma

Many families are faced with the unusual question of “Should I send my child back to school this fall?” COVID-19 has changed a lot about our lives, and it will affect how our children learn, too. For parents of a child with asthma, this can be a particularly difficult decision and many families are divided on how to proceed. The information presented here is based on our current understanding of COVID-19 to help families make informed decisions. Ultimately, the family will need to decide whether it is in their child’s best interest to return to in-person learning.

The risk of being exposed to COVID-19 is statistically higher when attending school in person; however, the individual clinical implications of COVID-19 are still largely unknown due to our limited and rapidly changing knowledge after limited experience with this new virus.  Early in the pandemic, the CDC identified asthma as a risk factor for severe COVID-19 illness.  Subsequent studies have not supported this, and the CDC guidance has changed to state that asthma may be a risk factor for severe COVID-19 illness. The American Academy of Allergy, Asthma and Immunology COVID-19 Response Task Force has stated, “…there are no data suggesting that asthma is a risk factor for becoming infected with SARS-CoV-2; and there are no data to suggest that, if infected, asthma patients have a more severe course of COVID-19 disease. Further, there are no data that suggest SARS-CoV-2 exacerbates asthma. As such, the task force members do not see a reason that asthma would be a reason to avoid school. ” 

In-person learning plays a critical role in childhood development with opportunities for hands-on education, consistent supervision, structure which is crucial for learning task & time management, and social and psychological support. Your family will have the best understanding of the social and educational risks to your child with continued social isolation.

Here are some things to consider:

  • Your child’s overall health.
  • Your family’s health – is someone in your household at high risk of severe COVID illness?
  • The community transmission rate – higher rates mean higher risks of infection.
  • Family work demands – is there someone who can supervise children at home in a healthy and engaging environment? Can the household support possible loss of income?
  • Your child’s academic needs. Does your child need the structure of the classroom and teachers for success? Does your child receive special services that require in-person learning?
  • Schedule uncertainty – if your child’s class or school is quarantined will your family be able to adjust to the changing schedule? How will your child adjust to a changing schedule?

For families who decide their children will return to in-person learning, then it is imperative to ensure all  CDC and AAP recommended social distancing measures are followed. Additionally, the CDC recommends remote learning when community transmission is substantial, as is currently the situation this August in Charleston. In-person learning during times of substantial community transmission would be expected to increase the likelihood of exposure to COVID-19.

Based on what we currently understand, well-controlled asthma does not appear to significantly increase the risk of severe COVID-19 illness. Your family will need to balance the physical risks, educational risks, and family impacts of returning to school versus virtual learning to determine the best course of action for your situation.  With either decision, it is always important to follow CDC COVID-19 social distancing guidelines.

 

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Smiling woman using laptop.

Telehealth tips: How to get the most out of your telehealth visit

Due to the COVID-19 pandemic, and in an effort to practice social distancing, many patients are experiencing telehealth visits for the first time. Whether you’re meeting with our team of board-certified allergists or another medical provider, there are some simple and practical steps you can take to make the most out of your visit. 

As our providers have been serving patients via telehealth, we’ve compiled our list of the best tips and tricks so that your visit is smooth sailing and we can provide the best possible care – virtually!

Check your tech

Make sure you have a smartphone or computer with a front-facing camera that is positioned at eye-level. Check that your internet connection is strong prior to your visit and be sure that your camera and microphone is turned on at the start of your call. For the most reliable internet connection, use a wired connection when possible. And don’t forget to make sure your battery is fully charged or that a charger is closeby. 

Quiet is key

Find a private space where your provider will be able to hear you clearly. It can be difficult to hear or distracting when there is lots of background noise. Using headphones can make it easier to keep your conversation private and ensure you can always hear your provider throughout the call.

Bright light

If possible, set up in a well-lit space so that your provider can see you clearly. Try turning on overhead lights and blocking light from windows, which can lead to a bright glare. Try not to sit directly in front of windows, this could cause a “shadow” effect and make it difficult to see your face.

Question cues

Are there symptoms that you’ve been experiencing or particular questions that you know you want to address with your provider? Given that your appointment setting is different than normal, preparing ahead of time and writing those questions down ensures that you don’t forget anything you want to cover. Be ready to share information regarding your symptoms and any questions or concerns you might have.

Practice patience

If you’re new to using telehealth technology, don’t worry! If the call drops, simply follow the original instructions to jump back into the session. Technology can be finicky and unpredictable and our staff is taking that into consideration throughout telehealth appointments.

Telehealth has been an incredible asset during COVID-19. Our team is dedicated to providing you with the best appointment experience possible and we want to be sure you get the most out of it as well. Are you in need of an appointment? Visit our telehealth webpage today to sign up for your visit.

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Lady cleaning counters with facemask and gloves on.

Safe Spring Cleaning

Recently, we have all become part of a whole new world brought on by the COVID-19 virus. As we are isolated and quarantined to our homes to reduce exposure, we are finding ourselves cleaning…and cleaning out…and cleaning some more! A spring cleaning would seem like a great way to occupy our time and help our family’s underlying allergies and asthma; however, many of us have allergies and asthma, which can frequently be triggered by indoor household exposure. Not to worry, you can still give your space a good cleaning, just be careful with your choice of cleaning products. Our goal is to keep you safe and healthy!

Dr. Harper once had a patient who was hospitalized because they were cleaning floor tiles with diluted bleach. Unbeknownst to the patient, her supervisor had sprayed ammonia ahead of her cleaning efforts. The mixture of diluted bleach and ammonia produced chlorine gas, which was used as chemical warfare in WWI.

Certain household cleaning products that are readily available can trigger significant respiratory problems, even in individuals without prior lung disease. A recent study in the American Review of Respiratory and Critical Care Medicine indicates that women who are employed as household cleaners have an accelerated loss of lung function, particularly if they are using spray cleaners.

Allergy sufferers should make household chores part of their allergy management plan. Cleaning reduces the number of allergens in homes which can ultimately help alleviate your allergy and asthma symptoms. Indoor allergen avoidance would include reducing dust-collecting clutter, regularly vacuuming with a HEPA filter vacuum, regularly washing blankets and throw rugs, washing all bed linens in hot water once a week, keeping counter surfaces clean and dry, and not leaving food out. 

Individuals who have asthma have increased airway twitchiness which can be triggered by irritant and noxious odors including cigarette smoke, chlorine, fragrances and ammonia. If one has asthma or allergies, care should be taken to choose cleaning products which are milder and do not trigger worsening of your symptoms. 

 Certain potent cleaning products can be mucosal irritants and can cause a worsening of respiratory symptoms in patients with allergies and asthma. The best way to avoid irritation from cleaning products is to have someone else in the household do the cleaning when the allergy sufferer is away from home. This could be a perfect time for your spouse to clean while you enjoy a walk!

There are particular home cleaning products which should be avoided by individuals with allergies and asthma. These products include formaldehyde, ammonia, sodium lauryl sulfate, D-limonene and sodium hypochlorite (bleach). Unfortunately, these chemicals can be found in a wide variety of available cleaning products including furniture polish, disinfectants, mold removers, dish detergents, hand soaps, laundry detergents, fabric softeners, all-purpose cleaners and drain/oven/grill cleaners. “Green” cleaning products can be milder and better for those with allergies, but labels should be read carefully. Interestingly, simple baking soda and vinegar in varying concentrations can clean just about anything in your home!

The best cleaning tools for allergen reduction include a vacuum cleaner, particularly with a double bag system or HEPA filter system. Additionally, a fabric allergen sanitizer vacuum can eliminate 99.9% of dust mites and bacteria from fabric surfaces. Washable microfiber cleaning cloths are safe and effective. Likewise, disposable dust wipes, protective mask and gloves and unscented and dye-free laundry products are safe and work well.

There are many, many cleaning products advertised on the internet, although the safety and effectiveness of these products can be questionable. How do you choose a safe cleaning product? The Allergy and Asthma Foundation of America (AAFA) has developed a certification program to document specific advertised products as being safe from false, exaggerated, or misleading claims. These products can be found on the AAFA website.    

If one is inclined to be a “do-it-yourselfer,” safe gentle homemade cleaners can be prepared without an advance chemical degree or access to industrial-strength petrochemicals. The following is a list of a safe products which can be easily prepared.

  1. All-purpose cleaner: Mix 2 cups of vinegar and 2 cups of water to create an all-purpose cleaner and disinfectant. Do not use this cleaner on marble. It can be used on both kitchen and bathroom surfaces.
  2. Scouring cleaner: Mix ¾ cup of baking soda and ¼ cup of water to create a paste for cleaning sinks, tubs, toilet, ceramic, aluminum, chrome, and stainless steel. This same paste can be used to polish silverware. Alternatively, mix ¼ cup of baking soda, 1 tablespoon of liquid detergent and enough white vinegar to make a creamy texture. You can also add a squeeze of lemon into the paste for a fresh and clean smell.
  3. Drain cleaner: Pour ¼ cup of baking soda in one cup of vinegar down drains.      The combination of the two will create a fizzy cleaner that will scour inside of your drain pipes. Rinse with hot water.
  4. Dishwasher cleaner: Pour ½ cup of vinegar into the reservoir of your dishwasher and run an empty cycle to disinfect and cleaning the interior of your dishwasher.
  5. Mold and mildew cleaner: Spray vinegar on shower walls and curtains to clean and prevent mold and mildew. Wait 15 minutes, rinse and let dry thoroughly.
  6. Window cleaner: Mix together one cup of water, one cup of rubbing alcohol and 1 tablespoon of vinegar. This cleanser works great at cleaning glass without leaving streaks or residue.
  7. Garbage disposal cleaner: Grind peels from oranges, lemons and limes in the garbage disposal with a handful of ice. The ice will sharpen the disposal blades while the citrus peels cleans and freshen the air.

So, while we’re all at home right now twiddling our thumbs for the next clean out project, make sure you are using the best cleaning product for your allergy and asthma needs. If you can’t find what you need, hopefully this list of DIY cleaners is helpful. But if you have suspected or confirmed COVID-19, please see the CDC’s cleaning instructions.

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Man on park bench blowing nose.

Flu, coronavirus & allergies: Do you know the different symptoms?

Coronavirus (COVID-19) has very similar symptoms to the flu, like fever and cough. But, patients with the flu often experience additional symptoms like a runny nose, nasal congestion, sore throat, headaches, muscle/body aches and fatigue (overall tiredness). With allergies, on the other hand, you will NOT have a fever. But, allergies can cause a runny nose, nasal congestion, sinus pressure, sneezing, post-nasal drip, itchy/watery eyes and worsening cough/wheeze for those with asthma.

Symptoms of Coronavirus

The primary symptoms of Coronavirus include fever (100.4 or higher), cough and shortness of breath. Patients usually begin experiencing fever and cough first, then several days later develop an acute or rapid onset of shortness of breath and difficulty breathing. There has been very little wheezing, nasal congestion, runny nose or sinus pressure reported. Symptoms occur within 2-14 days after exposure to this virus. Coronavirus can be transmitted within six feet of infected patients through their cough or sneeze. Patients who are at particularly high risk for severe Coronavirus symptoms are the elderly population and those with a weakened immune system.

How to avoid the Coronavirus

Ways to help decrease the spread of Coronavirus include good hand hygiene, avoiding those who are sick, wearing masks and gloves while in a large crowd, refraining from handshakes and hugs and limiting travel as much as possible. Good hand hygiene includes washing hands for at least 20 seconds with warm soap and water or using waterless alcohol-based hand sanitizer. 

Most patients have fairly mild symptoms and only need a lot of rest, fluids and over the counter medications. But, those who develop more concerning symptoms like shortness of breath and difficulty breathing require treatment. 

Here’s a comprehensive look at the symptoms you need to look for:

If you are experiencing fever and cough or shortness of breath, please either call our clinic or utilize the Roper or MUSC Coronavirus telehealth screening resources.

For revolving information on the Coronavirus/COVID-19, please follow the CDC here

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Top 9 Asthma Triggers

Asthma is an inflammatory condition of the airways in your lungs. It effects 8-10% of the population – that’s 24 million Americans! Asthma usually begins in childhood but can occur in adulthood and is the #1 cause of missed school and work. Asthma is triggered by a variety of exposures detailed below.

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Children looking at things in the woods through a microscope

5 Hidden Allergies To Watch Out For

Sometimes allergies can be fairly obvious and occur in response to common exposures, for instance, when pollen covers your car in the springtime, and you can’t stop sneezing!  Other times it can be hard to recognize what is causing an allergic reaction. The cause may be something that you would never relate your symptoms to. We will discuss a few of these less recognized allergies below. 

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Woman injecting EPI pen

FDA Extends Expiration Date For Certain Lots of EpiPens

In an effort to mitigate EpiPen shortages, the FDA is extending the expiration date for specific lots of 0.3 milligram products.

“We are doing everything we can to help mitigate shortages of these products, especially ahead of the back-to-school season. We’ve completed the necessary reviews of the data to extend the expiration date by four months for specific lots of EpiPen that are expired or close to expiring.” – Exerpt from the FDA in Brief

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