Question:

actually, my wife’s got a nebulizer now where the mist is held in with backflow valves. only what she exhales can escape, the rest is kept inside until she next inhales. quite ingenious, i’d say, and well manufactured too – the whole thing can be boiled and should last six months of use. if i knew the manufacture i’d mention it, it looks like a very nice thing to me, and my wife’s happy with it too. of course, her doctor has ordered ten-minute treatments only, claiming that whatever medicine remains in the solution after that time isn’t worth the effort, so…

The medicine would probably be worth the effort but when you change the equation with a design like that you’re basically increasing the dose above what is normally given. Maybe that’s good and maybe that’s not but it is something the doctor should be made aware of if it’s non-standard.  – Don Elton Columbia, SC http://www.midcarolina.org

Response:

There are lots of confounding factors when you compare MDI’s to nebulizers. Particle sizes vary and particle size tells you where in the airway medication is likely to rain out and how much of what’s inhaled is going to be exhaled back out again. Tiny particles penetrate deeper but are more likely to be exhaled again still suspended in air thus less medication reaches the target airways. Larger particles are likely to rain out short of the trachea with less exhaled but less delivered to the lung at all. Add to this that an MDI, properly used, only delivers medication while the patient is inhaling while a neb delivers it during both phases, usually 3/4 or more of the time is during exhalation thus that proportion of medicine has no chance at all of entering the patient.

actually, my wife’s got a nebulizer now where the mist is held in with backflow valves. only what she exhales can escape, the rest is kept inside until she next inhales. quite ingenious, i’d say, and well manufactured too – the whole thing can be boiled and should last six months of use. if i knew the manufacture i’d mention it, it looks like a very nice thing to me, and my wife’s happy with it too. of course, her doctor has ordered ten-minute treatments only, claiming that whatever medicine remains in the solution after that time isn’t worth the effort, so… —    PGP/GnuPG key (ID 1024D/BFE0D6D0) available from keyservers everywhere        "Everything I am today, I owe to people whom it is now too late                                    to punish."

Response:

There are lots of confounding factors when you compare MDI’s to nebulizers. Particle sizes vary and particle size tells you where in the airway medication is likely to rain out and how much of what’s inhaled is going to be exhaled back out again. Tiny particles penetrate deeper but are more likely to be exhaled again still suspended in air thus less medication reaches the target airways. Larger particles are likely to rain out short of the trachea with less exhaled but less delivered to the lung at all. Add to this that an MDI, properly used, only delivers medication while the patient is inhaling while a neb delivers it during both phases, usually 3/4 or more of the time is during exhalation thus that proportion of medicine has no chance at all of entering the patient. The equivalency of MDI and nebs though is based on studies done in ER settings where outcomes are compared. In that setting there’s no statistically significant difference detected between the two. Given all the uncertainties associated with aerosols though it basically comes down to treating for the proper effect as it’s very difficult to even guess how much medicine any particular patient will get. This is why I, (and many other) physicians use the same dose form/concentration whether treating a 2 day old or a 90 year old. You just treat until you get the effect you’re after or some effect you’re not after (unusual). – Hide quoted text — Show quoted text – Right on Don. Many patients compare 2 puffs of albuterol by MDI with a typical nebulizer treatment [equivalent to 10 puffs by MDI] and conclude the nebulizer is more effective. However this is an apples to oranges comparison since they are actually comparing 2 pf albuterol to 10 pf albuterol. During an exacerbation, 4-6 pf albuterol by MDI can be administered; then 20 min later repeated. This would then be equivalent to a nebulizer treatment and should achieve the same result. Of course a spacer should be used with the MDI. Ellis MDI’s are just as effective if used properly at equivalent doses. That’s a big "if" of course. From all of the stuff I have read on here lately is that this is the latest medical advice concerning nebulisers: However current asthma guidelines indicate that albuterol administered by MDI [metered dose inhaler] thru a spacer [Aerochamber] is just as effective as by nebulizer in most cases. Also MDI’s are fast to use and portable. I really do much better with a nebuliser. Is it all in my head????? — Don Elton Columbia, SC http://www.midcarolina.org

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

Response:

MDI’s are just as effective if used properly at equivalent doses. That’s a big "if" of course. – Hide quoted text — Show quoted text – From all of the stuff I have read on here lately is that this is the latest medical advice concerning nebulisers: However current asthma guidelines indicate that albuterol administered by MDI [metered dose inhaler] thru a spacer [Aerochamber] is just as effective as by nebulizer in most cases. Also MDI’s are fast to use and portable. I really do much better with a nebuliser. Is it all in my head?????

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

Response:

Right on Don. Many patients compare 2 puffs of albuterol by MDI with a typical nebulizer treatment [equivalent to 10 puffs by MDI] and conclude the nebulizer is more effective. However this is an apples to oranges comparison since they are actually comparing 2 pf albuterol to 10 pf albuterol. During an exacerbation, 4-6 pf albuterol by MDI can be administered; then 20 min later repeated. This would then be equivalent to a nebulizer treatment and should achieve the same result. Of course a spacer should be used with the MDI. Ellis – Hide quoted text — Show quoted text – MDI’s are just as effective if used properly at equivalent doses. That’s a big "if" of course. From all of the stuff I have read on here lately is that this is the latest medical advice concerning nebulisers: However current asthma guidelines indicate that albuterol administered by MDI [metered dose inhaler] thru a spacer [Aerochamber] is just as effective as by nebulizer in most cases. Also MDI’s are fast to use and portable. I really do much better with a nebuliser. Is it all in my head????? — Don Elton Columbia, SC http://www.midcarolina.org

Response:

From all of the stuff I have read on here lately is that this is the latest medical advice concerning nebulisers: However current asthma guidelines indicate that albuterol administered by MDI [metered dose inhaler] thru a spacer [Aerochamber] is just as effective as by nebulizer in most cases. Also MDI’s are fast to use and portable. I really do much better with a nebuliser. Is it all in my head?????

my wife does much better with a nebulizer also. could be you’re just the exceptions to the generalization, out on the edge of whatever bell curve is involved here. every person is different, after all. —    PGP/GnuPG key (ID 1024D/BFE0D6D0) available from keyservers everywhere        "Everything I am today, I owe to people whom it is now too late                                    to punish."

Response:

- Hide quoted text — Show quoted text – From all of the stuff I have read on here lately is that this is the latest medical advice concerning nebulisers: However current asthma guidelines indicate that albuterol administered by MDI [metered dose inhaler] thru a spacer [Aerochamber] is just as effective as by nebulizer in most cases. Also MDI’s are fast to use and portable. I really do much better with a nebuliser. Is it all in my head????? my wife does much better with a nebulizer also. could be you’re just the exceptions to the generalization, out on the edge of whatever bell curve is involved here. every person is different, after all.

I wonder if the people who wrote the studies had asthma?   "Being responsible sometimes means pissing people off."    General Colin Powell

Response:

With a nebulizer treatment  you get to sit and relax for a few minutes and notice your breathing.  That’s good for your lungs  a n d   your head, isn’t it?

Response:

Hello, Yes, definitely agree nebulizers work much better, when I was away for 5 days and just used inhalers, I started to develop that nasty cough again.  After resuming nebulizer for 3 days I was back to normal breathing and no cough. For5

Response:

From all of the stuff I have read on here lately is that this is the latest medical advice concerning nebulisers: However current asthma guidelines indicate that albuterol administered by MDI [metered dose inhaler] thru a spacer [Aerochamber] is just as effective as by nebulizer in most cases. Also MDI’s are fast to use and portable. I really do much better with a nebuliser. Is it all in my head?????

Note that a typical nebulizer treatment is equivalent to 10 puffs of albuterol/salbutamol by MDI. Albuterol/salbutamol is normally administered as 2 puffs/4 hr; however during an exacerbation can be adminstered as 4-6 puffs every 20 minutes. Link on comparison of MDI & nebulizer: http://www.ama-assn.org/special/asthma/library/readroom/oa6523.htm  Metered-Dose Inhaler Accessory Devices in Acute Asthma   Efficacy and Comparison With Nebulizers: A Literature Review Excerpt: "Conclusions: The data support the effectiveness of MDI/ADs as  first-line treatment in acute childhood asthma. In view of  clinical benefit, safety, lower cost, personnel time, and  speed and ease of administration of MDI/ADs compared with  SVNs, MDI/ADs should be considered the preferred mode of  treatment of children with acute asthma."  Arch Pediatr Adolesc Med. 1997;151:876-882 MDI=metered dose inhaler AD=accessory device [spacer] SVN=small volume nebulizer Ellis

Response:

From all of the stuff I have read on here lately is that this is the latest medical advice concerning nebulisers: However current asthma guidelines indicate that albuterol administered by MDI [metered dose inhaler] thru a spacer [Aerochamber] is just as effective as by nebulizer in most cases. Also MDI’s are fast to use and portable.

I really do much better with a nebuliser. Is it all in my head?????

Response:

Question:

I started using my mothers industrial strength guai.  She uses it not only for her asthma (hers is really bad) but it is also recommended for her fibromyalgia.  I started using guai and ibuprofen to thin the mucous and prevent inflammation of my sinuses after I had head-banging-on-wall level sinus infections.  I am lucky that I have "indicator" teeth… that is the nerve to some of my upper teeth runs thru the sinus and when it starts swelling it pinches on the nerve and my teeth tingle.  So now when that happens I start the guai and ibu.  However, I know suspect that the inflammation is due to the allergies that is also triggering the asthma. Adequate water must be taken with the guai.  Normally, 1200 mg of guai is taken 2X per day.  I dont know of any side effects with guai, it is one of the safest meds out there.   INgrid I have found that using guaifensin in the morning is effective in thinning the mucous. I take a swig and it starts working pretty quick.

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Response:

Do you use guaifenesin for thinning mucous?  Adults normally make a quart or better per day just maintenance level.  Ingrid My experiece with it has been I do feel much better than I do with just an MDI of Proventil. It also seems to break up some of my old friend "mucous" and makes it easier to cough up.

List Manager: Puregold Goldfish List for care of goldfish go to http://puregold.aquaria.net/ Solve the problem, dont waste energy finding who’s to blame

Response:

The Ventolin and Atrovent solutions for the nebulizer have a bit of salt in them (normal saline?) likely beneficial, moreso than the propellant in the MDI (puffer).  I feel a measure of calm  and peace using the couple of times on posts in the last few days.   Long before I learned I had asthma I use to take guaifenesin with codeine or dextromethorphen for the congested head or chest.   I’d like to hear more about of your responces. –Jack

Response:

Response:

In my experience, the nebulizer is better for two things–non-emergency situations and major emergency situations.  I feel better when not breathing in suddenly (as in the case of taking a MDI puff) because it makes my chest hurt a little, so if my peak flow is just kind of low I’ll use my neb.  If I’m pressed for time or away from my neb, I’ll use the MDI when I have a slight problem. I also use my neb when I *can’t* breathe in much (red zone, esp.) because my lungs keep opening a little more as time goes on.  After I’m out of the red zone I’ll use my MDI, but if I can barely breathe it won’t do me much good. Any situation in between these extremes, I’ll use my MDI. -Lannieta p.s.–I don’t use spacers, they are more trouble than it’s worth in my case.

Response:

Do you use guaifenesin for thinning mucous?

I have found that using guaifensin in the morning is effective in thinning the mucous. I take a swig and it starts working pretty quick.

Response:

My experiece with it has been I do feel much better than I do with just an MDI of Proventil. It also seems to break up some of my old friend "mucous" and makes it easier to cough up. How come the hospitals still use them so much? I don’t mean to be argumentative….. I don’t use my neb. regularly, but it seems to help when I get severe.

Response:

- Hide quoted text — Show quoted text – The nebulizer is an inefficient delivery system compared to MDI or DPI, so you would need a larger dose for same benefit. I thought a nebulizer was much more efficient and that is why it is used when symptoms are bad. PLease explain….i want to learn. Don The nebulizer has the advantage of being able to deliver a large dose of albuterol to someone who is not well coordinated at using an MDI [metered dose inhaler]. Also, unlike the MDI, it doesn’t deliver any propellant, which can have a negative effect on lung function. The typical nebulizer dose is 2.5 mg [2500 mcg] albuterol. The equivalent puffs of albuterol MDI is 10 puffs, which is 1,000 mcg albuterol measured at the MDI nozzle or 900 mcg at the mouthpiece. Using this analysis, albuterol by nebulizer is about 40% as efficient as by MDI. [2500 mcg in, 1000 mcg out] Several studies have shown that albuterol by MDI or DPI is just as effective as by nebulizer, except for a cases where the patient can’t properly operate the MDI. Even then, an AeroChamber spacer and mask can be used with the MDI. See: http://www.ama-assn.org/special/asthma/library/readroom/oa6523.htm  Metered-Dose Inhaler Accessory Devices in Acute Asthma   Efficacy and Comparison With Nebulizers: A Literature  Review "Conclusions: The data support the effectiveness of MDI/ADs as  first-line treatment in acute childhood asthma. In view of  clinical benefit, safety, lower cost, personnel time, and  speed and ease of administration of MDI/ADs compared with  SVNs, MDI/ADs should be considered the preferred mode of  treatment of children with acute asthma." This is also consistent with current asthma guidelines in the US, as called out by the Expert Panel Report 2 from the NIH. Ellis

The other problem with nebulizer efficiency is that the majority of the medication is delivered when the patient is not inhaling given a normal I/E time ratio of about 1:3 or so thus most of the medicine winds up on the floor or elsewhere. — Don Elton Columbia, SC http://www.midcarolina.org

Response:

The nebulizer is an inefficient delivery system compared to MDI or DPI, so you would need a larger dose for same benefit.

I thought a nebulizer was much more efficient and that is why it is used when symptoms are bad. PLease explain….i want to learn. Don

Response:

The nebulizer is an inefficient delivery system compared to MDI or DPI, so you would need a larger dose for same benefit. I thought a nebulizer was much more efficient and that is why it is used when symptoms are bad. PLease explain….i want to learn. Don

The nebulizer has the advantage of being able to deliver a large dose of albuterol to someone who is not well coordinated at using an MDI [metered dose inhaler]. Also, unlike the MDI, it doesn’t deliver any propellant, which can have a negative effect on lung function. The typical nebulizer dose is 2.5 mg [2500 mcg] albuterol. The equivalent puffs of albuterol MDI is 10 puffs, which is 1,000 mcg albuterol measured at the MDI nozzle or 900 mcg at the mouthpiece. Using this analysis, albuterol by nebulizer is about 40% as efficient as by MDI. [2500 mcg in, 1000 mcg out] Several studies have shown that albuterol by MDI or DPI is just as effective as by nebulizer, except for a cases where the patient can’t properly operate the MDI. Even then, an AeroChamber spacer and mask can be used with the MDI. See: http://www.ama-assn.org/special/asthma/library/readroom/oa6523.htm  Metered-Dose Inhaler Accessory Devices in Acute Asthma   Efficacy and Comparison With Nebulizers: A Literature  Review "Conclusions: The data support the effectiveness of MDI/ADs as  first-line treatment in acute childhood asthma. In view of  clinical benefit, safety, lower cost, personnel time, and  speed and ease of administration of MDI/ADs compared with  SVNs, MDI/ADs should be considered the preferred mode of  treatment of children with acute asthma." This is also consistent with current asthma guidelines in the US, as called out by the Expert Panel Report 2 from the NIH. Ellis

Response:

Question:

I have just come back from my wonderful physical which besides RA and the other add-on immune deficiencies has added hyper tension 148/98 to the bricks in my back pack. Has anyone received high blood pressure as a gift and is it also tied in to RA??? Thanks for any feed back. Sincerely, EMP

Response:

Hi Eric, I’ve had RA for nearly 30 years. My blood pressure is always in the 110/70 range. So for me, RA and hypertension do not go together. Jennie

Response:

Eric, Sometimes pain can cause blood pressure to rise.  I am not a doctor and do not claim to be part of a medical profession anymore.  If you go to the pharmacy you can purchase a blood pressure kit.  If you check it daily you might be able to help your doctor with your high blood pressure.  One reading of it being high is not meaning you have high blood pressure. Stress can cause it being nervous can also cause your blood pressure if you smoke that can also raise your blood pressure.  To much salt (sodium) can also raise your blood pressure gaining weight can also cause it to go high. I used to be a medical assistant and I know a lot about it and how to gain control of the problem.  Diet has a lot to do with your blood pressure as well as your pain level.  Like I said before there are so many factors causing it.  Your own kidneys can cause it.  If it continues to be high your doc should do several test to make sure everything is okay. Do not want to scare you but strokes do happen to young and old.  Even Though I do not think it is real high to some it can be real high.  Mine has been as high as 380/178.  Your talking major headache pain.  High blood pressure is a silent killer.  Watch for headaches sometimes your body will tell you your blood pressure is high through headaches.  I know this is long but high blood pressure is nothing to take lightly. Cheers, Linda

– Hide quoted text — Show quoted text – I have just come back from my wonderful physical which besides RA and the other add-on immune deficiencies has added hyper tension 148/98 to the bricks in my back pack. Has anyone received high blood pressure as a gift and is it also tied in to RA??? Thanks for any feed back. Sincerely, EMP

Response:

shoot hit the wrong key 280/178 Cheers, Linda

– Hide quoted text — Show quoted text – Eric, Sometimes pain can cause blood pressure to rise.  I am not a doctor and do not claim to be part of a medical profession anymore.  If you go to the pharmacy you can purchase a blood pressure kit.  If you check it daily you might be able to help your doctor with your high blood pressure.  One reading of it being high is not meaning you have high blood pressure. Stress can cause it being nervous can also cause your blood pressure if you smoke that can also raise your blood pressure.  To much salt (sodium) can also raise your blood pressure gaining weight can also cause it to go high. I used to be a medical assistant and I know a lot about it and how to gain control of the problem.  Diet has a lot to do with your blood pressure as well as your pain level.  Like I said before there are so many factors causing it.  Your own kidneys can cause it.  If it continues to be high your doc should do several test to make sure everything is okay. Do not want to scare you but strokes do happen to young and old.  Even Though I do not think it is real high to some it can be real high.  Mine has been as high as 380/178.  Your talking major headache pain.  High blood pressure is a silent killer.  Watch for headaches sometimes your body will tell you your blood pressure is high through headaches.  I know this is long but high blood pressure is nothing to take lightly. Cheers, Linda I have just come back from my wonderful physical which besides RA and the other add-on immune deficiencies has added hyper tension 148/98 to the bricks in my back pack. Has anyone received high blood pressure as a gift and is it also tied in to RA??? Thanks for any feed back. Sincerely, EMP

Response:

I have just come back from my wonderful physical which besides RA and the other add-on immune deficiencies has added hyper tension 148/98 to the bricks in my back pack. Has anyone received high blood pressure as a gift and is it also tied in to RA???

Pain can cuse an elevation in BP. I was at 210/115 until I was given some approriate pain control. It now sits around 125/75. Interesting how one thing affects another. Jim S

Response:

Hi ,I  am new to the group. Was  wondering if anyone has High Blood Pressure   with the Asthma?

Response:

Yes I do.  I was diagnosed with hypertension years before I was diagnosed with asthma.  Both conditions are controlled very well currently.

Response:

Hi ,I  am new to the group. Was  wondering if anyone has High Blood Pressure with the Asthma?

Those who have coexisting asthma and HBP should be aware that: *asthma rescue drugs like albuterol can raise BP *in general asthmatics should not use beta blocker drugs to control their HBP; the asthma rescue drugs are beta agonists, just the opposite effect of a beta blocker. So a beta blocker drug could bring on an asthma attack. Ellis — Free audio & video emails, greeting cards and forums Talkway – http://www.talkway.com – Talk more ways (sm)

Response:

I too have high blood pressure and was diagnosed with it long before being diagnosed with asthma.  I use medication daily to control the blood pressure and this has been quite successful.  The use of asthma medication rarely, if ever, knowingly heightens my BP.   cloud – Hide quoted text — Show quoted text – Hi ,I  am new to the group. Was  wondering if anyone has High Blood Pressure   with the Asthma?

Response:

Check out " There is Help Out There!!"  High blood pressure is not normal, but medications do not solve the problem.  They merely artificially cover up the malfunction of the body.  Several studies have shown that certain  blood pressure medications are very dangerous and can increase the chance of heart attack by 60% in the person taking them.

Response:

There are many incidences where high blood pressure IS normal. The body reacts that way in response to certain environmental, as well as, biologic factors. Where you got your information about BP meds being more likely to cause problems is anyone’s guess. This simply isn’t true. There is a great deal of evidence that people on meds for HBP have a far better chance of surviving a heart attack and recovering from surgery than those who are not.

Response:

Uh, is this all the evidence you are using to support your conclusions? A report from _one_ person seems to be rather shaky evidence to support something being given as medical advice. I used that as an example of how quickly one can see results. If you recall my original posting: In the book: Can A GLUTEN-FREE DIET HELP? How? by Lloyd Rosenvold, M.D., [Keats Publishing, 27 Pine Street (Box 876) New Canaan, CT 06840-0876, 1992, ISBN 0-87983-538-9] he states that a study was done in the 1930’s where a group with high blood pressure was put on a gluten-free diet. The whole group experienced a reduction in bp.

Sorry about the delay in my reply – my ISP’s usenet server is apparently operated by chimpanzes. The first ‘red flag’ I see here is that the study quoted is 60 years old.  The next ‘red flag’ is the phrase "The whole group . . ." this impluies that no control group was used and the patients knew that their blood pressure was expected to drop (placebo effect).  Finally, I notice that the Dr. published in the popular press (which does not review for correct science) rather than in a peer- reviewed scientific journal. Note it says the whole group. That means every single participant lowered their bp on a gluten-free diet.

And also warns us that the origional research may not have used valid statistical research protocols. There is a site that tells you how to read a research paper.  I don’t have the address but I seem to remember that it was at a Canadian university.  If I can find it again I’ll post it. ‘Reply to’ address changed to foil email spammers.

Response:

Ursula, my guess is this doctor was talking about "sinopulomonary syndrome", not sinal pulmonary syndrome. I am not familiar with sinopulmonary syndrome as an entity, but it would seem to be a very general term for problems involving the pulmonary and sinus tracts. There is a lot of research on "sinopulmonary" disease. I would try that as a keyword search. Diana Walker – Hide quoted text — Show quoted text – I’m still looking for information on this SINAL PULMONARY SYNDROME. Ursula Holleman Macey’s Mom in RM 405

Response:

"Gluten-free" means not eating foods or food derivatives of wheat, rye and other grains that contain gluten. Rice is a good substitute, as are oat products. I don’t know anything about what effect this has on blood pressure. Diana Walker – Hide quoted text — Show quoted text – O.K. so someone tell me what a gluten-free diet is.  I have three hours tonight to look into all of this before I have to relieve my husband at the hospital.

Response:

O.K. so someone tell me what a gluten-free diet is.

My page of links points to an enormous amount of info:   The Gluten-Free Page:  http://www.panix.com/~donwiss/ The first three links are the best. But a good overview is the FAQ of the gluten-free mailing list. The be obtained by putting GET CELIAC FAQ in the body of a message to the list server. Many other documents also exist, send GET CELIAC FILELIST. Don (at panix com).

Response:

O.K. so someone tell me what a gluten-free diet is.  I have three hours tonight to look into all of this before I have to relieve my husband at the hospital. By the way all your ideas and chatter is appreciated very much

Hi Ursula, I would like to add another perspective to the chatter. I have had asthma all my life. I have undergone brochoscopy, a variety of medications, and a host of associated problems including unexplained bronchial bleeding. One asthma attack led to a 5 day stay in hospital…. (due to its severity). Since I was diagnosed with gluten intolerance 3 years ago, I have come to the opinion that there is a connection (for me). I follow a gluten-free diet. It is a diet without wheat, rye, barley, or oats. More information is available at http://www.celiac.com. Please don’t leap to the conclusion that it is an awful diet. It is great! I have never enjoyed food so much! Many who have never tried the diet characterize it very negatively. That just isn’t so. It is inconvenient, but that is the only problem I’ve found. The great part of it is that it can’t hurt. It can only help. best wishes Ron Hoggan

Response:

Based on a report from someone taking his bp often, a gluten-free, and other starch-free diet, can reduce bp in a few days. He measured a difference in hours. Unfortunately hospitals are not geared for gluten-free diets, so it isn’t really an option as long as the child is there. But they are delaying the operation until it resolves…. Uh, is this all the evidence you are using to support your conclusions? A report from _one_ person seems to be rather shaky evidence to support something being given as medical advice.

I used that as an example of how quickly one can see results. If you recall my original posting: In the book: Can A GLUTEN-FREE DIET HELP? How? by Lloyd Rosenvold, M.D., [Keats Publishing, 27 Pine Street (Box 876) New Canaan, CT 06840-0876, 1992, ISBN 0-87983-538-9] he states that a study was done in the 1930’s where a group with high blood pressure was put on a gluten-free diet. The whole group experienced a reduction in bp. Note it says the whole group. That means every single participant lowered their bp on a gluten-free diet. Don.

Response:

O.K. so someone tell me what a gluten-free diet is.  I have three hours tonight to look into all of this before I have to relieve my husband at the hospital. By the way all your ideas and chatter is appreciated very much Ursula Holleman – Hide quoted text — Show quoted text – Based on a report from someone taking his bp often, a gluten-free, and other starch-free diet, can reduce bp in a few days. He measured a difference in hours. Unfortunately hospitals are not geared for gluten-free diets, so it isn’t really an option as long as the child is there. But they are delaying the operation until it resolves…. Uh, is this all the evidence you are using to support your conclusions? A report from _one_ person seems to be rather shaky evidence to support something being given as medical advice. I used that as an example of how quickly one can see results. If you recall my original posting: In the book: Can A GLUTEN-FREE DIET HELP? How? by Lloyd Rosenvold, M.D., [Keats Publishing, 27 Pine Street (Box 876) New Canaan, CT 06840-0876, 1992, ISBN 0-87983-538-9] he states that a study was done in the 1930’s where a group with high blood pressure was put on a gluten-free diet. The whole group experienced a reduction in bp. Note it says the whole group. That means every single participant lowered their bp on a gluten-free diet. Don.

Response:

Thank you so much for clearing this up for me.  I have found multiple hits on this term and am fast becoming educated on it.  As my pediatrician says " You have just enough knowledge to make you dangerous". Ursula Holleman – Hide quoted text — Show quoted text – Ursula, my guess is this doctor was talking about "sinopulomonary syndrome", not sinal pulmonary syndrome. I am not familiar with sinopulmonary syndrome as an entity, but it would seem to be a very general term for problems involving the pulmonary and sinus tracts. There is a lot of research on "sinopulmonary" disease. I would try that as a keyword search. Diana Walker

Response:

Macey began seeing a pediatric allergist in last May who was recommended to us by her pediatric pulmonologist.  Her allergist is the one who put us on Prelone as well as the Proventil and Intal as well as a nasal steriod called Vancanese.  He said she was doing so poorly we needed a more aggressive approach.   Macey’s respiratory therapist today remembered my mother being in the same hospital 10 years ago with asthma and that we had a long haul ahead of us. We had a good night though and the BP’s running 130/70.  Our surgery eval is tomorrow so we’ll see where we stand.  I also already had two first opinions on Macey’s sinus’s.  The ENT that’s doing the surgery is the third opinion and the best surgeon amongst the three.  Wish us luck. I’m still looking for information on this SINAL PULMONARY SYNDROME. Ursula Holleman Macey’s Mom in RM 405 – Hide quoted text — Show quoted text – If your doctor is not familiar with these guidelines it may be time to ask for a referral to a pediatric allergy or asthm specialist. The guidelines specify that a child with severe asthma should be seen by an asthma specialist. You didn’t mention if her allergies had been evaluated. Asthma is often allergy related, and reduction of allergens, like dust mites, could reduce symptoms. Age 2 seems a little young for sinus surgery; I would get a 2nd opinion. There is a lot of info available at www.aaaai.org and www.njc.org National Jewish Center answers questions at 800-222-LUNG Ellis

Response:

Based on a report from someone taking his bp often, a gluten-free, and other starch-free diet, can reduce bp in a few days. He measured a difference in hours. Unfortunately hospitals are not geared for gluten-free diets, so it isn’t really an option as long as the child is there. But they are delaying the operation until it resolves….

Uh, is this all the evidence you are using to support your conclusions? A report from _one_ person seems to be rather shaky evidence to support something being given as medical advice. There are so many possible causes of high blood pressure that I think that we should leave the diagnosis and treatment to people with the appropiate training.

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– Hide quoted text — Show quoted text -Wiss) writes: Macey’s blood pressure has still not leveled out.  She stays 160’s / 80’s.  Now to me (and her nurses) this is a little high for a two year old. Any ideas would be appreciated. Here is something that is alternative: In the book: Can A GLUTEN-FREE DIET HELP? How? by Lloyd Rosenvold, M.D., [Keats Publishing, 27 Pine Street (Box 876) New Canaan, CT 06840-0876, 1992, ISBN 0-87983-538-9] he states that a study was done in the 1930’s where a group with high blood pressure was put on a gluten-free diet. The whole group experienced a reduction in bp. At almost the same time, the first really effective medication for reducing bp was put on the market. The study was soon forgotten, and patients were given a magic pill to help high bp. Taking a pill is a lot easier than following a g-f diet. Also in an informal survey in the alt.support.diet newsgroup, some on a lowcarb diet reported improved blood pressure. Such a diet would be reduced in gluten. For more info on the gluten-free diet, this page has annotated links to all Don.

You post is not relavent to the childs condition.  She is in serious condition in a hosptial with asthma.   "listen here ye little children and remember the truth how ever so pain, will set you free." Seek to find the joy in the truth…..

Response:

You post is not relavent to the childs condition.  She is in serious condition in a hosptial with asthma.  

Based on a report from someone taking his bp often, a gluten-free, and other starch-free diet, can reduce bp in a few days. He measured a difference in hours. Unfortunately hospitals are not geared for gluten-free diets, so it isn’t really an option as long as the child is there. But they are delaying the operation until it resolves…. Don.

Response:

– Hide quoted text — Show quoted text – Macey’s blood pressure has still not leveled out.  She stays 160’s / 80’s.  Now to me (and her nurses) this is a little high for a two year old. Her pediatrician has ordered that her BP be taken right before her Proventil treatment  and 5 minutes after.  But so far the readings are the same.  I’ve looked up her meds and the Proventil and Prelone are hypertensive drugs, but we’re not at a point with her breathing where we can take her off either.  Is hypertension something that is a routine side effect of bronchodialators or is something else happening here. Her sinus surgery is being put off until the BP stablizes.  I’m not sure what hypertension can do to a child? Any ideas would be appreciated. Ursula Holleman Macey’s mom.

Oral steroids like Prelone can cause high blood pressure as well as a host of other side effects. New asthma guidelines issued by the Nat’l Inst. of Health this year (Expert Panel Report 2) call out a stepwise approach for managing asthma in infants and young children. Oral steroids are only prescribed for the most severe step 4 asthma; the preferred treatment for most cases is inhaled steroids using a spacer/holding chamber and face mask, like an AeroChamber with mask. This allows a much lower steroid dose, typically factor of 30 lower, since steroid goes directly to the lung. Inhaled steroids include Vanceril, Beclovent, Azmacort, Flovent, Pulmicort. Also bronchodilators like Proventil should only be used as needed, not on a regular basis. This treatment guide appears in Figure 3-6, page 3b-27 of the report. It can be viewed at http://www.ama-assn.org/special/asthma/treatmnt/treatmnt.htm Guidelines for the Diagnosis and Management of Asthma National  Asthma Education and Prevention Program Expert Panel Report II,   National Heart, Lung and Blood Institute February 1997 If your doctor is not familiar with these guidelines it may be time to ask for a referral to a pediatric allergy or asthm specialist. The guidelines specify that a child with severe asthma should be seen by an asthma specialist. You didn’t mention if her allergies had been evaluated. Asthma is often allergy related, and reduction of allergens, like dust mites, could reduce symptoms. Age 2 seems a little young for sinus surgery; I would get a 2nd opinion. There is a lot of info available at www.aaaai.org and www.njc.org National Jewish Center answers questions at 800-222-LUNG Ellis

Response:

Macey’s blood pressure has still not leveled out.  She stays 160’s / 80’s.  Now to me (and her nurses) this is a little high for a two year old. Her pediatrician has ordered that her BP be taken right before her Proventil treatment  and 5 minutes after.  But so far the readings are the same.  I’ve looked up her meds and the Proventil and Prelone are hypertensive drugs, but we’re not at a point with her breathing where we can take her off either.  Is hypertension something that is a routine side effect of bronchodialators or is something else happening here. Her sinus surgery is being put off until the BP stablizes.  I’m not sure what hypertension can do to a child? Any ideas would be appreciated. Ursula Holleman Macey’s mom.

Response:

Macey’s blood pressure has still not leveled out.  She stays 160’s / 80’s.  Now to me (and her nurses) this is a little high for a two year old. Any ideas would be appreciated.

Here is something that is alternative: In the book: Can A GLUTEN-FREE DIET HELP? How? by Lloyd Rosenvold, M.D., [Keats Publishing, 27 Pine Street (Box 876) New Canaan, CT 06840-0876, 1992, ISBN 0-87983-538-9] he states that a study was done in the 1930’s where a group with high blood pressure was put on a gluten-free diet. The whole group experienced a reduction in bp. At almost the same time, the first really effective medication for reducing bp was put on the market. The study was soon forgotten, and patients were given a magic pill to help high bp. Taking a pill is a lot easier than following a g-f diet. Also in an informal survey in the alt.support.diet newsgroup, some on a lowcarb diet reported improved blood pressure. Such a diet would be reduced in gluten. For more info on the gluten-free diet, this page has annotated links to all Don.

Response:

Thank you very much for the info. It has been most helpful. Best Regards, Rich Martell

Response:

Please let us know how your mother is doing. We are concerned, and I’m sure the group would join me in hoping for as favorable an outcome and as quick and complete a recovery as possible. Thank you for sharing. All the best, Jood – Hide quoted text — Show quoted text – Thank you very much for the info. It has been most helpful. Best Regards, Rich Martell

Response:

You are more than welcome. Thank *you* for taking the time to read and respond. Best regards, Jood

– Hide quoted text — Show quoted text – Jood, you have been reading…wow!  thanks for all the neat info. — Just Plain ‘O Bonita, an Irish wit (twit?) NIDDM for 3 yrs., quit denying since 2/00 Actos 45 mgs. & Glucotrol 5 mgs. X2 daily One possibility is a pheochromocytoma. This is an endocrine tumor, I’ve enclosed a link. There’s tons of information about this condition, how to diagnose and treat. It is a deadly problem mostly because it is so often missed until grave or irreversible consequences have occured, or until autopsy. I do not mean to frighten you. It’s worth exploring if the doctors have considered all the usual possibilities, and still have no answer. There are other possibilities too, but of the rarer ones, this is at the top of the list. There’s a saying in medicine that doctors shouldn’t chase zebras every time they hear hoofbeats because 9 times out of ten it turns out to be just ordinary horses. But, every once in a while a zebra does run by, and if you *aren’t looking* you can’t see it. http://www.endocrineweb.com/pheo.html http://www.medhelp.org/glossary/new/gls_3340.htm All the best to you and to your mother, Jood Hello Every One, My mum has been a non insulin dependant diabetic for 10 years. She is in hospital at present as her blood pressure is dangerously high cuasing her to vomit, this has led to wieght loss, dehydration etc. The doctors here in the UK are baffled by her blood pressure as they cannot get it to stay down for more than two days. Has anyone else on this NG had any simular problems, and if so, how was it resolved? Any help would be most welcome. Regards, Rich Martell.

Response:

– Hide quoted text — Show quoted text – One possibility is a pheochromocytoma. This is an endocrine tumor, I’ve enclosed a link. There’s tons of information about this condition, how to diagnose and treat. It is a deadly problem mostly because it is so often missed until grave or irreversible consequences have occured, or until autopsy. I do not mean to frighten you. It’s worth exploring if the doctors have considered all the usual possibilities, and still have no answer. There are other possibilities too, but of the rarer ones, this is at the top of the list. There’s a saying in medicine that doctors shouldn’t chase zebras every time they hear hoofbeats because 9 times out of ten it turns out to be just ordinary horses. But, every once in a while a zebra does run by, and if you *aren’t looking* you can’t see it. http://www.endocrineweb.com/pheo.html http://www.medhelp.org/glossary/new/gls_3340.htm All the best to you and to your mother, Jood

This is very good information.  We can’t have too many links to *authoritative* information.  Thanks. Jude – Hide quoted text — Show quoted text – Hello Every One, My mum has been a non insulin dependant diabetic for 10 years. She is in hospital at present as her blood pressure is dangerously high cuasing her to vomit, this has led to wieght loss, dehydration etc. The doctors here in the UK are baffled by her blood pressure as they cannot get it to stay down for more than two days. Has anyone else on this NG had any simular problems, and if so, how was it resolved? Any help would be most welcome. Regards, Rich Martell.

–         Crouch Enterprises – Telecom, Internet & Unix Consulting       Oak Park, IL  708-848-0134  URL: http://www.pobox.com/~jcrouch

Response:

Jood, you have been reading…wow!  thanks for all the neat info. — Just Plain ‘O Bonita, an Irish wit (twit?) NIDDM for 3 yrs., quit denying since 2/00 Actos 45 mgs. & Glucotrol 5 mgs. X2 daily – Hide quoted text — Show quoted text – One possibility is a pheochromocytoma. This is an endocrine tumor, I’ve enclosed a link. There’s tons of information about this condition, how to diagnose and treat. It is a deadly problem mostly because it is so often missed until grave or irreversible consequences have occured, or until autopsy. I do not mean to frighten you. It’s worth exploring if the doctors have considered all the usual possibilities, and still have no answer. There are other possibilities too, but of the rarer ones, this is at the top of the list. There’s a saying in medicine that doctors shouldn’t chase zebras every time they hear hoofbeats because 9 times out of ten it turns out to be just ordinary horses. But, every once in a while a zebra does run by, and if you *aren’t looking* you can’t see it. http://www.endocrineweb.com/pheo.html http://www.medhelp.org/glossary/new/gls_3340.htm All the best to you and to your mother, Jood Hello Every One, My mum has been a non insulin dependant diabetic for 10 years. She is in hospital at present as her blood pressure is dangerously high cuasing her to vomit, this has led to wieght loss, dehydration etc. The doctors here in the UK are baffled by her blood pressure as they cannot get it to stay down for more than two days. Has anyone else on this NG had any simular problems, and if so, how was it resolved? Any help would be most welcome. Regards, Rich Martell.

Response:

Hello Every One, My mum has been a non insulin dependant diabetic for 10 years. She is in hospital at present as her blood pressure is dangerously high cuasing her to vomit, this has led to wieght loss, dehydration etc. The doctors here in the UK are baffled by her blood pressure as they cannot get it to stay down for more than two days. Has anyone else on this NG had any simular problems, and if so, how was it resolved? Any help would be most welcome. Regards, Rich Martell.

Response:

One possibility is a pheochromocytoma. This is an endocrine tumor, I’ve enclosed a link. There’s tons of information about this condition, how to diagnose and treat. It is a deadly problem mostly because it is so often missed until grave or irreversible consequences have occured, or until autopsy. I do not mean to frighten you. It’s worth exploring if the doctors have considered all the usual possibilities, and still have no answer. There are other possibilities too, but of the rarer ones, this is at the top of the list. There’s a saying in medicine that doctors shouldn’t chase zebras every time they hear hoofbeats because 9 times out of ten it turns out to be just ordinary horses. But, every once in a while a zebra does run by, and if you *aren’t looking* you can’t see it. http://www.endocrineweb.com/pheo.html http://www.medhelp.org/glossary/new/gls_3340.htm All the best to you and to your mother, Jood – Hide quoted text — Show quoted text – Hello Every One, My mum has been a non insulin dependant diabetic for 10 years. She is in hospital at present as her blood pressure is dangerously high cuasing her to vomit, this has led to wieght loss, dehydration etc. The doctors here in the UK are baffled by her blood pressure as they cannot get it to stay down for more than two days. Has anyone else on this NG had any simular problems, and if so, how was it resolved? Any help would be most welcome. Regards, Rich Martell.

Response:

Hi abarry, When I am on any more than 20mg of Prednisone, I have problems with high blood pressure and a elevated heart beat… 140 when sitting. I felt like I was on the old V8 (veggy drink) comercial that showed people walking at a 45% angle  I had to have something nearby to lean on to help keep my balance when I walked anywhere. My doctor had me on heart regulator pills to keep my heart beating at a normal pace which helped.   Three months later, I weaned off the prednisone, my heart beat returned to normal. But it did take the blood pressure about 6 months to a year to go back to normal. The prednisone did the trick to keep the CD in check, but the side effects are something else. Take Care, Mary  :)

Response:

Well when you figure that cardiovascular disease is now known as an inflaamatory disease it ’s not hard to see the similarities of the 2.

You can have hypertension without cardiovascular disease. (It can be caused by kidney disease, e.g.)

Response:

Isn’t that started with just blood tests?  I forget.  UM MOM Susan

– Hide quoted text — Show quoted text – Well when you figure that cardiovascular disease is now known as an inflaamatory disease it ’s not hard to see the similarities of the 2. You can have hypertension without cardiovascular disease. (It can be caused by kidney disease, e.g.)

Response:

or even pred! Debs – Hide quoted text — Show quoted text – Well when you figure that cardiovascular disease is now known as an inflaamatory disease it ’s not hard to see the similarities of the 2. You can have hypertension without cardiovascular disease. (It can be caused by kidney disease, e.g.)

Response:

yes and maybe no…. after a bout of pyoderma gangrenosum, they had me on 120mg prednosone at one time.  my blood pressure has shot up to high/normal and has remained there. i am hopefully, that after all the pred effects wear off (could take a year) and i lose the extra 30 lbs of padding it got from it, that i will go back to slightly below normal again.  who knows?  krap shoot at best.  if that don’t work, than yeah, it could be the cd doing it.  i have had cd for at least 3 years tho, and my blood pressure never shot up until this last go around with pred. jeffy

– Hide quoted text — Show quoted text – Hi All! Has anyone experience high blood pressure from CD? If you have can you give some insight?

Response:

yup, i have been off pred for 4 months and my pb is still what your’s is. jeffy

– Hide quoted text — Show quoted text – Hi All! Has anyone experience high blood pressure from CD? If you have can you give some insight? I just went to the doctor, after one month on prednisone (recently as high as 30mg), and was shocked when he told me I have high blood pressure.  I’m ALWAYS 120/70 every time.  Today I was 160/90.  He said it was the prednisone.  Now I’m on a salt-free diet and I see him again next week. I’m also going to try cutting the prednisone down, it’s killing me worse than crohn’s!

Response:

Well when you figure that cardiovascular disease is now known as an inflaamatory disease it ’s not hard to see the similarities of the 2. Ken.W  7 Years Med Free

– Hide quoted text — Show quoted text – Hi All! Has anyone experience high blood pressure from CD? If you have can you give some insight? I just went to the doctor, after one month on prednisone (recently as high as 30mg), and was shocked when he told me I have high blood pressure.  I’m ALWAYS 120/70 every time.  Today I was 160/90.  He said it was the prednisone.  Now I’m on a salt-free diet and I see him again next week. I’m also going to try cutting the prednisone down, it’s killing me worse than crohn’s!

Response:

Hi All! Has anyone experience high blood pressure from CD? If you have can you give some insight?

Hi, I just got out of hospital a couple of weeks ago, was admitted with UC.  I was put on IV hydrocortisone & then pred (40mg) daily. My bp went up to 185+ /90 (usually about 120/60) & pulse went up to the mid 90s (usually mid 50s). BP now only slightly high but pulse still in the mid 80s (am on 25mg pred & 100mg Azathioprine). Apparently pred raises bp & pulse as does pain, not sure abt Azathioprine. Just saw my Dr today & he said side effects are tough but we have to live with them, if I did not get the pred I would prob be dead by now!  Was better to have high bp than have no bp!   He said that UC was one of the worst non malignant conditions someone could get & although side effects were not nice, they were better than the alternative!! HTH Tony — Outgoing mail is certified Virus Free. So check it anyway!  No attachments unless advised in body of email. Checked by AVG anti-virus system (http://www.grisoft.com).

Response:

Hi All! Has anyone experience high blood pressure from CD? If you have can you give some insight?

Response:

Hi All! Has anyone experience high blood pressure from CD? If you have can you give some insight?

I just went to the doctor, after one month on prednisone (recently as high as 30mg), and was shocked when he told me I have high blood pressure.  I’m ALWAYS 120/70 every time.  Today I was 160/90.  He said it was the prednisone.  Now I’m on a salt-free diet and I see him again next week.  I’m also going to try cutting the prednisone down, it’s killing me worse than crohn’s!

Response:

I will reply to some of your comments on studies later, but would like to address one point now. I say that you should get independant unbiased, advice before obtaining your progesterone Kim. Advice from someone who does not have her fingers grabbing in the money bag. Oh, she must be making tons of money selling ads in her little newsletter!

The newsletter is put out by Phillips Publishing International. The website can be found at: http://www.phillips.com/index.html A subsidiary of this company is Phillips Business List Sales. Guess what they sell among other things, yup, the subscription list to the newsletter.    http://www.phillips.com/lists/ Another subsidiary of the company is Doctors Preferred, Inc. [ see http://www.phillips.com/ppi.htm ] Doctors Preferred sells Dr. Julian Whitaker

Question:

I agree generally with this statement, but what about the additives put into commercial NEB solutions, those could cause a reaction in those that are

This is true and is a potential problem for almost any medication or product that sensitive people use.  There are three entire classes of antibiotics that I can’t use because I am allergic to them, but that doesn’t detract from their effectiveness for others, just for me and those who happen to be allergic to them… sensitive.  The MDIs generally do not have those additives.

MDI’s have propellants [to which many people react] and many have additives.  There are some DPIs [like the Turbuhalers] that are pure drug, no additives, no propellants, but most people don’t use DPIs and there aren’t very many available in the US to begin with [relative to some other countries]. My Albuterol Sulfate, USP Inhalation Solution 0.083% by Warrick has the following ingredients: "each mL contains 0.83 mg albuterol as the sulfate in an aqueous solution containing sodium chloride and benzalkonium chloride; sulfuric acid used to adjust the pH between 3 and 5." SW.

Response:

Some other points on the matter: My belief is that the higher doses delivered by the nebs have another advantage. In many asthmatics there are areas of collapsed lung (atalectasis) that are poorly ventilated. In these people those areas will not received airborne medication. I think that more of the nebulized drug is absorbed into the blood and thus has another route to get to the collapsed areas. That this happens can be seen by observing the drop in oxygen saturation and increase in heart rate that is much more marked after nebs than MDI’s and reflects systemic absorption of the drug.

I agree generally with this statement, but what about the additives put into commercial NEB solutions, those could cause a reaction in those that are sensitive.  The MDIs generally do not have those additives.

Response:

I was always under the impression that nebulizer treatments were more ‘effective’ than MDI delivery of the same meds. I recently came across a statement that MDIs actually produce a smaller particle size than nebs, thus reach further into the small airways.

I have seen some studies that indicate that *some* nebulizers can get particles down to or just a little bit larger than MDI-size particles. Also, keep in mind that there is an optimum particle-size range, so smaller is not always better… Is this true? If so, why does a nebulizer seem to do a better job of relieving my son’s symptoms than an MDI dose, with spacer?

Because, all other things being equal [technique is perfect, etc etc etc], the nebulizer dose is about 10 times that of a single MDI dose. In the studies comparing MDI to nebulier treatments, they usually use one standard neb treatment compared to TEN or so MDI ‘doses’ to reach equivalency.  Subjectively one can notice the difference by the level of shakiness, the increase in heart rate, and the degree of headache or other symptoms one gets after a neb treatment vs. an MDI or other inhaler treatment.  I know for myself that I am a lot shakier, my heart rate is higher, and if I get a headache it is usually worse after a neb than after a single dose from my Bricanyl Turbuhaler [or when I was using a Ventolin MDI, after the MDI dose]. Finally, some people can’t use MDIs, even with a spacer.  I react to the propellants [at least that is what my MD and I think is doing it] in MDIs, and even with a spacer there is enough propellant to cause problems; even trigger asthma attacks.  So, I use a Pulmicort Turbuhaler, and a Bricanyl Turbuhaler [terbutaline; it is not available and never will be in the US, so I have to import it, which is an adventure in and of itself], and have since 1991 when I was still living in Canada [where both are available].  THe Bricanyl is great [not only is it not an MDI, but I don't get as significant side effects as I did when using Ventolin MDIs] except that every so often I need a neb treatment, so I also have a nebulizer.   SW.

Response:

Some other points on the matter: My belief is that the higher doses delivered by the nebs have another advantage. In many asthmatics there are areas of collapsed lung (atalectasis) that are poorly ventilated. In these people those areas will not received airborne medication. I think that more of the nebulized drug is absorbed into the blood and thus has another route to get to the collapsed areas. That this happens can be seen by observing the drop in oxygen saturation and increase in heart rate that is much more marked after nebs than MDI’s and reflects systemic absorption of the drug. This is why if the patient is hypoxic or has physical exam evidence of atalectasis or if the person is breathing fast or has poor MDI technique I greatly prefer nebs to MDI’s. There are not many new admissions to the hospital for asthma that do not meet these criterion. If the admission is for something else such as pneumonia with an only moderate to mild increase in asthma symptoms or for non-pulmonary disease then I think MDI’s are fine. I use the hospital and the availability of RT’s to help the person work on MDI technique and will usually try to get the asthmatics onto MDI’s a day or two before discharge for this reason. I have two other comments that shouldn’t matter but unfortunately do. 1) If the asthmatic is not hypoxic and not on IV medications they will sometimes reject the hospital days if the person is on MDI’s saying the hospital did not do anything they couldn’t do at home. 2) In every hospital I have worked the RT’s are covering several units and don’t have the time to spend with the patients that was given in the studies. Until someone does a study in this environment I don’t think the current literature is easily applied to the majority of US hospitals. — Good Luck, CBI, M.D. – Hide quoted text — Show quoted text – IT IS VERY DIFFICULT TO ARGUE WITH THE RADIOLABELED  STUDIES PERFORMED BY MCMASTER UNIVERSITY ADN DR NEWHOUSE ET AL.  ALSO, THE DJAND STUDIES OUT OF HINES VA, AND THE IDRIS ER STUDY ETC.   I AGREE THAT EDUCATION OF TECHNIQUE IS KEY (IN MOST SELF MANAGED DISEASE STATES) AND SINCE THIS TEACHING SHOULD BE DONE AT SOME POINT IN THE VISIT, WHY NOT DURING.  THERE IS NO EXCUSE FOR THE LACK OF "CARE" THAT YOU DESCRIBE BY THE NURSES SHOWING THE PUFFER.  PROPER EDUCATION, ALONG WITH PHYSICIAN INVOLVEMENT IS KEY.  I KNOW THAT WHEN I HAVE AN EPISODE, I WOULD MUCH RATHER KNOW THAT THE MEDICINE I AM GIVING MYSELF IS GETTING TO THE TARGET SITES, AND NOT OVERMEDICATING ME AND CAUSING UNNECESSARY SIDE EFFECTS.

Response:

– Hide quoted text — Show quoted text -(STEELERBP) writes: IT IS VERY DIFFICULT TO ARGUE WITH THE RADIOLABELED  STUDIES PERFORMED BY MCMASTER UNIVERSITY ADN DR NEWHOUSE ET AL.  ALSO, THE DJAND STUDIES OUT OF HINES VA, AND THE IDRIS ER STUDY ETC.   I AGREE THAT EDUCATION OF TECHNIQUE IS KEY (IN MOST SELF MANAGED DISEASE STATES) AND SINCE THIS TEACHING SHOULD BE DONE AT SOME POINT IN THE VISIT, WHY NOT DURING.  THERE IS NO EXCUSE FOR THE LACK OF "CARE" THAT YOU DESCRIBE BY THE NURSES SHOWING THE PUFFER.  PROPER EDUCATION, ALONG WITH PHYSICIAN INVOLVEMENT IS KEY.  I KNOW THAT WHEN I HAVE AN EPISODE, I WOULD MUCH RATHER KNOW THAT THE MEDICINE I AM GIVING MYSELF IS GETTING TO THE TARGET SITES, AND NOT OVERMEDICATING ME AND CAUSING UNNECESSARY SIDE EFFECTS.

Who you shittin’… with all that lung power you can’t possibly have Asthma! KNOCK OFF THE SHOUTING!!! Sheldon On a recent Night Court rerun, Judge Harry Stone had a wonderful line: "I try to keep an open mind, but not so open that my brains fall out."

Response:

IT IS VERY DIFFICULT TO ARGUE WITH THE RADIOLABELED  STUDIES PERFORMED BY MCMASTER UNIVERSITY ADN DR NEWHOUSE ET AL.  ALSO, THE DJAND STUDIES OUT OF HINES VA, AND THE IDRIS ER STUDY ETC.   I AGREE THAT EDUCATION OF TECHNIQUE IS KEY (IN MOST SELF MANAGED DISEASE STATES) AND SINCE THIS TEACHING SHOULD BE DONE AT SOME POINT IN THE VISIT, WHY NOT DURING.  THERE IS NO EXCUSE FOR THE LACK OF "CARE" THAT YOU DESCRIBE BY THE NURSES SHOWING THE PUFFER.  PROPER EDUCATION, ALONG WITH PHYSICIAN INVOLVEMENT IS KEY.  I KNOW THAT WHEN I HAVE AN EPISODE, I WOULD MUCH RATHER KNOW THAT THE MEDICINE I AM GIVING MYSELF IS GETTING TO THE TARGET SITES, AND NOT OVERMEDICATING ME AND CAUSING UNNECESSARY SIDE EFFECTS.

Response:

where are you drawing your info from?  One cannot deny the multiple studies, both bench and clinical that prove that MDI with a VALVED HOLDING CHAMBER (aerochamber in all of the studies) is equal to an Neb.  I too am a therapist, B.S. RRT, and I have seen clinical outcomes proving this arguement.  I would be happy to share them with you.

Response:

There are studies on both side of this argument, so I think it is a waist of time for everyone to start listing them. Usually the studies showing equivalence are in hospital settings, either the floors or in the ER and most show that the outcomes are similar. They do, however, usually disqualify people with less than optimal technique (as much as 30% of subjects) and the doses are still administered with the RT there coaching and waiting a full minute between puffs. Also, the subjects get a lot of teaching at the start. Most places will not match this but instead use this to justify putting the MDI at the bedside and having the nurse go in and tell the patient to take a few puffs on schedule. They are not really the same thing. There have been several studies that used brochoconstricting challenges and varied the stimulus and the doses tested. These usually show that nebs deliver a much higher dose of drug(about 10:1). I guess the question is how much is enough, and does the difference matter ? — Good Luck, CBI, M.D. – Hide quoted text — Show quoted text – where are you drawing your info from?  One cannot deny the multiple studies, both bench and clinical that prove that MDI with a VALVED HOLDING CHAMBER (aerochamber in all of the studies) is equal to an Neb.  I too am a therapist, B.S. RRT, and I have seen clinical outcomes proving this arguement.  I would be happy to share them with you.

Response:

it all depends on what "spacer" device you are using?  The Aerochamber has been shown in hundreds of clinically produced studies to perform as well as a nebulizer, saving time and money adn convenience

Response:

I was always under the impression that nebulizer treatments were more ‘effective’ than MDI delivery of the same meds. I recently came across a statement that MDIs actually produce a smaller particle size than nebs, thus reach further into the small airways. Is this true? If so, why does a nebulizer seem to do a better job of relieving my son’s symptoms than an MDI dose, with spacer?

Because he gets the meds a little at a time over the course of several minutes, with liquid.  This is easier on the throat. Chris Owens

Response:

I was always under the impression that nebulizer treatments were more ‘effective’ than MDI delivery of the same meds. I recently came across a statement that MDIs actually produce a smaller particle size than nebs, thus reach further into the small airways. Is this true? If so, why does a nebulizer seem to do a better job of relieving my son’s symptoms than an MDI dose, with spacer? TIA Jeanne Ed’s Asthma Track  http://asthmatrack.com

A typical nebulizer dose (2.5 mg) delivers the equivalent of ten (10) puffs of albuterol; so it may seem to be more effective than a couple puffs of albuterol for this reason. Current asthma guidelines recommend MDIs over nebulizers for most exacerbations. Now that albuterol should only be used for ‘rescue’, not maintenance, the MDI makes a lot of sense. It’s instantly available, you don’t have to crank up a compressor and fill with solution; easy to maintain (nebulizers need to be kept scrupulously clean). MDIs are more portable (important at school or while traveling). There is evidence albuterol from MDIs is inhaled deeper into lungs since you take a full breath when inhaling from the MDI. Also fewer side effects with MDIs, see below. Nebulizers are preferred in certain situations such as treating patients who can’t take a full breath, babies; delivery of Intal (the Intal MDI gives a rather small dose compared to the nebulizer, more Intal is more beneficial). Some patients are sensitive to the propellant in MDIs; there are now DPIs (dry powder inhaler) versions with no propellant. (Ventolin Rotacap) http://www.ama-assn.org/special/asthma/treatmnt/drug/ventolin.htm http://www.ama-assn.org/special/asthma/library/readroom/oa4093.htm  Metered-Dose Inhalers With Spacers vs Nebulizers for  Pediatric Asthma Excerpt: "In summary, in our study sample, patients treated with MDIs  with spacers achieved the same degree of improvement in  symptoms as patients treated with nebulizers, while spending  significantly shorter treatment times in the ED. Although we  did not perform a cost-benefit analysis, it may be reasonably  assumed that shorter treatment times for asthmatics treated  with MDIs with spacers would result in fewer number of  personnel and resources utilized. In our study, significantly  fewer patients treated with MDIs with spacers experienced  vomiting while in the ED, and the mean percent increase in  heart rate from baseline to final disposition was  significantly greater in the nebulizer group, suggesting  that there may be fewer systemic effects of beta-agonist therapy  with MDIs with spacers. We conclude that an MDI with a spacer device is an effective  alternative to nebulizers for the ED treatment of children  with mild to moderate asthma exacerbations."

Question:

- Hide quoted text — Show quoted text – i posted before about my daughter having so many side effects from her medication. she is 7 years old and was taking intal three times a day with a nebulizer and also inhaling azthmacort 2 a day. she couldn’t sleep at night and was very moody. Anyways….. i finally after getting no help from the doctor , took her off everything. i continue to check her peak flow every one attack in two years) and so far she has been fine without the medication. My question is….should i tell the doctor that i took her off everything…….and also i have read here that there are many different does not cause as many side effects)or any of the other drugs i’ve seen posted about here are for children?does anyone have any suggestions on how to handle the doctor? thanks for any help you can give,        kristin

It’s best to tell your doctor what actions you are taking involving medications. If you can’t communicate effectively with your doctor, it may be time to find a new one. Intal has virtually no side effects for most people, certainly not insomnia and mood changes. However nebulized Intal 3x/day would be a hassle if not really needed. Azmacort can cause mood changes in  high doses. Current asthma guidelines recommend using an Action Plan to increase or decrease meds based on symptoms and peak flows. This should be worked out with the doctor. If your daughter has intermittent rather than persistent asthma, she may not need to take medications all year around. Some asthmatics only take medications during the pollen season. Have your daughter’s allergies been tested by an allergist? This is useful so you know what allergens to avoid. Regarding Serevent, it’s not approved under age 12 but the doctor could prescribe it off label. It’s a long acting bronchodilator which should not be used without also using a steroid inhaler, Azmacort in your case. Serevent can cause jitteriness and insomnia, so it’s probably not a good choice. You should have a rescue inhaler, usually albuterol (can cause jitteriness and insomnia). If symptoms increase, the albuterol inhaler will be needed for rescue, and maybe an anti-inflammatory preventative, Azmacort. Intal is a mild anti-inflammatory but may take several weeks to take effect. Intal is often recommended for children as a prophylaxis. Ellis

Response:

i posted before about my daughter having so many side effects from her medication. she is 7 years old and was taking intal three times a day with a nebulizer and also inhaling azthmacort 2 a day. she couldn’t sleep at night and was very moody. Anyways….. i finally after getting no help from the doctor , took her off everything. i continue to check her peak flow every one attack in two years) and so far she has been fine without the medication. My question is….should i tell the doctor that i took her off everything…….and also i have read here that there are many different does not cause as many side effects)or any of the other drugs i’ve seen posted about here are for children?does anyone have any suggestions on how to handle the doctor? thanks for any help you can give,

Of course you tell the doctor that you aren’t giving the child her meds any more.  And ask to try something else.  If your daughter has persistent asthma, no matter how mild, she is at risk for long-term lung damage unless you keep it under control.  BTW, Singulair is reputed to work very well with child asthmatics. Chris Owens

Response:

just to let you know,i have had my daughter tested for allergies.Both of the test they ran came back negative. I Have discussed all of this with her doctor..but the doctor continues to tell me that its not the medication thats effecting her. although a week after i took her off all meds… she was sleeping at night and much calmer. is there any medication i could i just keep monitoring her peak flow and use the albuterol when needed???

Response:

i posted before about my daughter having so many side effects from her medication. she is 7 years old and was taking intal three times a day with a nebulizer and also inhaling azthmacort 2 a day. she couldn’t sleep at night and was very moody. Anyways….. i finally after getting no help from the doctor , took her off everything. i continue to check her peak flow every one attack in two years) and so far she has been fine without the medication. My question is….should i tell the doctor that i took her off everything…….and also i have read here that there are many different does not cause as many side effects)or any of the other drugs i’ve seen posted about here are for children?does anyone have any suggestions on how to handle the doctor? thanks for any help you can give,                     kristin NO MAIL PLEASE

Response:

Question:

Westmed who makes the neb, can suggest a compressor that would power the device.       Regarding anatomy, you seem to have missed the point.  The medication is delivered in aerosol form during breathing. It impacts on the back of the throat, collects there, and is swallowed.  All swallowing occurs between breaths.  What I described to you has been published peer reviewed medical fact for several years.  Would you like a list of references? John

Response:

Why on earth is she taking both intal and azmacort?

Intal has a very good safety record in children and frequently doctors will add it rather than increase the steroid dosage.

Response:

If you believe this, call me, I have a bridge to sell you. — Good Luck, CBI, M.D. – Hide quoted text — Show quoted text – Sharon, Most nebs including inhalers output medication to the lungs, but a large portion of the medication goes to the stomach.  The aerosol spray hits the back of the throat and is swallowed to the stomach.  The medication that gets into the stomach cause the side effects that you describe with your son.  There are new nebulizers that are used for albeuterol delivery that don’t deliver medication to the stomach and are more effective for med delivery to the lung.  One device is the Circulaire Nebulizer.  It is manufactured by Westmed (800-975-7987).   Call and get the info to give to your doc. John

Response:

  My son also has mild asthma. He gets a coughing variant that only shows up every spring and fall (but allergery testing was negative).

Gee sharon, this almost has got to be some sort of allergy, how else do you get a seasonal dependence? If it were solely cold air irritation, then winter should be a problem too. Allergy tests only can test one specific antigen per skin prick.  There are zillions of varietys of molds and pollens and dead leaf dust;  unless your son had a massive battery of tests (and even then) they may have missed something.  It makes no sense that something regularly seasonal and is not cold air is not an allergy.  Get a second opinion and make sure it is from someone who specializes in allergies.  This area is easily complex enough to be a career on its own. — DON’T ‘RE’ this message.  I use a bogus address to thwart email harvesters for junk lists.  Reply on the newsgroup or respond David

Response:

Hmmm….I tried that nebulizer and it was terrible….maybe in a hospital it works great with high flow oxygen(which it says at least 8 lpm or enough to keep bag inflated) but these portable compressors just do not put out enough liter per minute flow to keep that oxygen bag inflated.   It didn’t work any faster or better than my other nebulizer set ups.. Now as far as the matter of the med going in the stomach. I think you have forgotten your anatomy.  Humans can not smallow and breath at the same time so unless you are a big air swallower this is not true.  If we could do both swallowing and breathing at the same time with our current anatomy then we’d have lungs full of food or known as aspiration.  If you remember your anatomy we have a flap of skin called an epiglottis which closes to keep food out of our lungs when we swallow and the physiology of the esophagus being somewht soft and floppy in nature and requires the muscle wave action to get the food to go down and the trachea is far more rigid and always hollow open tube like structure makes me think what you have is a case of hype by a medical supply company to sell there wares…. toni6 – Hide quoted text — Show quoted text – Sharon, Most nebs including inhalers output medication to the lungs, but a large portion of the medication goes to the stomach.  The aerosol spray hits the back of the throat and is swallowed to the stomach.  The medication that gets into the stomach cause the side effects that you describe with your son.  There are new nebulizers that are used for albeuterol delivery that don’t deliver medication to the stomach and are more effective for med delivery to the lung.  One device is the Circulaire Nebulizer.  It is manufactured by Westmed (800-975-7987).   Call and get the info to give to your doc. John

Response:

Hi Sharon, I have the "mild asthma" cough. I went to three different pulmonary specialists. All agreed. I thought i just had a chronic cough due to my chronic sinusitis. I read that if my asthma as mild I should be using my inhalers a few time a week PRN not 4 times a day. I had two inhalers, flovent and serevent were the last, plus nasal inhalers, plus stuff for acid reflux that they all insisted I had to have because I did experience heartburn occassionally…especially if I ate poorly (junk foods…empty calories) The meds made me feel worse than I’ve ever felt. Clouded my concentration, couldn’t read, etc., pain, discomfort, nose bleeds and worse… I finally figured it could be dietary related food intolerances. I’ve changed my diet. No dairy. No coffee. No Sodas. Little meat. Lots of fresh raw fruits and veggies, etc. I only recommend to other to do whatever they can to improve their diet. Drink 1/2 ounce of water per pound of lean body weight per day. That’s essential to keep from dehydrating the lungs and increasing the histamine production. See if improved diet helps. It did me. I stopped all meds 6 months ago. Sunny – Hide quoted text — Show quoted text – Hi Kristin,   My son also has mild asthma. He gets a coughing variant that only shows up every spring and fall (but allergery testing was negative). We only use the albuterol when absolutely necessary–and it wires the poor kid. He gets nervous tremors, hyperactive…. I hate the stuff. My son’s ped. pulmonologist said that he is going to be a test site w/in a week or so for a new form of albuterol that isn’t  supposed to affect the nervous system (or some such description–bascially it is not supposed to make you bonkers  I know nothing more than that though. My son is currently on Vanceril Double strength , 4puffs 2xday (down from 4 puffs 3 xday) . I’m hoping the dosage will drop even more soon. He has been recently diagnosed. I’ve been pulling my hair out for 4 years. He gets this terrible barking cough every spring and fall. The ped. insists for months that it’s not in his lungs until they finally hear something and put him on the nebulizer w/ albuterol.  Which wouldn’t stop the cough but sent him bouncing off the walls. It’s been horribly frustrating.  We entered the same cycle this fall, but this time I bought a peak flow meter (which none of the pediatricians ever mentioned). When he started barking I could see that his lung capacity was diminished–but the ped. still said it wasn’t his lungs.  That’s when a friend said I should jump up and down and insist on a referral to a pulmonologist.  I did, we went and he has asthma.  Gee, sorry to dump- this had nothing to do with the question. Guess I needed to vent Sharon Stewart my daughter has mild asthma.  she is on intal,azmacort,and ventolin. she has just started this treatment and seems to have changed her herself.   does anyone have any information on this,or any experience with this medication? i would appreciate any help i could get.                           kristin

Response:

chris… is there something i should know about using intal and azthmacort together???

Response:

- Hide quoted text — Show quoted text – Hi Kristin,   My son also has mild asthma. He gets a coughing variant that only shows up every spring and fall (but allergery testing was negative). We only use the albuterol when absolutely necessary–and it wires the poor kid. He gets nervous tremors, hyperactive…. I hate the stuff. My son’s ped. pulmonologist said that he is going to be a test site w/in a week or so for a new form of albuterol that isn’t  supposed to affect the nervous system (or some such description–bascially it is not supposed to make you bonkers  I know nothing more than that though. My son is currently on Vanceril Double strength , 4puffs 2xday (down from 4 puffs 3 xday) . I’m hoping the dosage will drop even more soon. He has been recently diagnosed. I’ve been pulling my hair out for 4 years. He gets this terrible barking cough every spring and fall. The ped. insists for months that it’s not in his lungs until they finally hear something and put him on the nebulizer w/ albuterol.  Which wouldn’t stop the cough but sent him bouncing off the walls. It’s been horribly frustrating.

A typical nebulizer dose of albuterol is equivalent to 10 puffs of Ventolin (albuterol) by MDI (metered dose inhaler). New asthma guidelines recommend in most cases administration of albuterol by MDI is sufficient; which normally would result in a much lower dose with lower side effects. So if you are routinely using nebulized albuterol at home, check with the doctor on switching to an MDI. http://www.ama-assn.org/special/asthma/library/readroom/oa4093.htm Metered-Dose Inhalers With Spacers vs Nebulizers for Pediatric Asthma Excerpt: "Conclusions: These data suggest that MDIs with spacers may be an effective alternative to nebulizers for the treatment of children with acute asthma exacerbations in the ED." (Arch Pediatr Adolesc Med. 1995;149:201-205) Ellis  We entered – Hide quoted text — Show quoted text – the same cycle this fall, but this time I bought a peak flow meter (which none of the pediatricians ever mentioned). When he started barking I could see that his lung capacity was diminished–but the ped. still said it wasn’t his lungs.  That’s when a friend said I should jump up and down and insist on a referral to a pulmonologist.  I did, we went and he has asthma.  Gee, sorry to dump- this had nothing to do with the question. Guess I needed to vent Sharon Stewart my daughter has mild asthma.  she is on intal,azmacort,and ventolin. she has just started this treatment and seems to have changed her herself.   does anyone have any information on this,or any experience with this medication? i would appreciate any help i could get.                           kristin

Response:

Hello I recieved two of those circulair nebulizers to use with my old compressor drive machine.  It was terrible it has an Oxygen bag on it and the nebulizer just doesn’t put out enough flow to keep the bag inflated.   It is simular to using a non rebreather mask with no additional oxygen flow.  Those out there in the medical profession know what I am talking about.   I think this device may work well in hospitals with oxygen driving the nebulizer but not for home use. Just my $0.02 Toni – Hide quoted text — Show quoted text – Sharon, Most nebs including inhalers output medication to the lungs, but a large portion of the medication goes to the stomach.  The aerosol spray hits the back of the throat and is swallowed to the stomach.  The medication that gets into the stomach cause the side effects that you describe with your son.  There are new nebulizers that are used for albeuterol delivery that don’t deliver medication to the stomach and are more effective for med delivery to the lung.  One device is the Circulaire Nebulizer.  It is manufactured by Westmed (800-975-7987).   Call and get the info to give to your doc. John

Response:

my daughter has mild asthma.  she is on intal,azmacort,and ventolin. she has just started this treatment and seems to have changed her herself.   does anyone have any information on this,or any experience with this medication? i would appreciate any help i could get.                            kristin

Azmacort is a corticosteroid inhaler; it could cause mood changes tho not very likely at a Low Dose; side effects of drugs are dose dependent. Albuterol can cause hyperactivity in some; however the need to use more than once/day indicates the need for more long-acting preventor med, ie inhaled corticosteroids like Azmacort. Side effects of albuterol can be minimized by using an AeroChamber spacer and rinsing out the mouth after inhaling. More details on these drugs from the Prescribing Information which the druggist can give you; or online at www.rxlist.com or the Mayo Clinic site. It would be best to talk to your doctor about this. If she hasn’t seen an allergist, ask for a referral. Ellis

Response:

my daughter has mild asthma.  she is on intal,azmacort,and ventolin. she has just started this treatment and seems to have changed her herself.   does anyone have any information on this,or any experience with this medication? i would appreciate any help i could get.                            kristin

Response:

my daughter has mild asthma.  she is on intal,azmacort,and ventolin. she has just started this treatment and seems to have changed her herself.   does anyone have any information on this,or any experience with this medication? i would appreciate any help i could get.

Intal is a mast cell stabilizer (mast cells are an important player in the allergic reaction).  This medication is considered to have very few side effects, and has a good history of usage in children.  Since it is considered to be one of the safest medications it is popular for use in children.  The downside is that this is also considered to be a very weak medication. Azmacort is one of the older steroid inhalers.  As far as I can tell its popularity is mostly due to the fact that it is inexpensive.  At low doses it has few side effects, however it seems to have more side effects than most other similar medications at anything above a low dose.  Since steroids can have psychological side effects I would discuss this with her doctor. Albuterol is a bronchodilator.  Basically this is a form of adrenalin that has had its structure tweaked so that it has its primary effect on the lungs with reduced effects on the rest of the body.  However this is a form of stimulant and may be a culprit here also.  Current medical guidelines are for this medication only to be used ‘as needed’ to treat actual asthma symptoms.  If she is using this medication on a regular basis you might talk to your doctor about reducing it to an as needed basis.

Response:

Hi Kristin,   My son also has mild asthma. He gets a coughing variant that only shows up every spring and fall (but allergery testing was negative). We only use the albuterol when absolutely necessary–and it wires the poor kid. He gets nervous tremors, hyperactive…. I hate the stuff. My son’s ped. pulmonologist said that he is going to be a test site w/in a week or so for a new form of albuterol that isn’t  supposed to affect the nervous system (or some such description–bascially it is not supposed to make you bonkers  I know nothing more than that though. My son is currently on Vanceril Double strength , 4puffs 2xday (down from 4 puffs 3 xday) . I’m hoping the dosage will drop even more soon. He has been recently diagnosed. I’ve been pulling my hair out for 4 years. He gets this terrible barking cough every spring and fall. The ped. insists for months that it’s not in his lungs until they finally hear something and put him on the nebulizer w/ albuterol.  Which wouldn’t stop the cough but sent him bouncing off the walls. It’s been horribly frustrating.  We entered the same cycle this fall, but this time I bought a peak flow meter (which none of the pediatricians ever mentioned). When he started barking I could see that his lung capacity was diminished–but the ped. still said it wasn’t his lungs.  That’s when a friend said I should jump up and down and insist on a referral to a pulmonologist.  I did, we went and he has asthma.  Gee, sorry to dump- this had nothing to do with the question. Guess I needed to vent Sharon Stewart – Hide quoted text — Show quoted text – my daughter has mild asthma.  she is on intal,azmacort,and ventolin. she has just started this treatment and seems to have changed her herself.   does anyone have any information on this,or any experience with this medication? i would appreciate any help i could get.                           kristin

Response:

Sharon, Most nebs including inhalers output medication to the lungs, but a large portion of the medication goes to the stomach.  The aerosol spray hits the back of the throat and is swallowed to the stomach.  The medication that gets into the stomach cause the side effects that you describe with your son.  There are new nebulizers that are used for albeuterol delivery that don’t deliver medication to the stomach and are more effective for med delivery to the lung.  One device is the Circulaire Nebulizer.  It is manufactured by Westmed (800-975-7987).   Call and get the info to give to your doc. John

Response:

my daughter has mild asthma.  she is on intal,azmacort,and ventolin. she has just started this treatment and seems to have changed her herself.   does anyone have any information on this,or any experience with this medication? i would appreciate any help i could get.

Why on earth is she taking both intal and azmacort? Many asthma drugs cause perceptible mood shifts and physicl effects.  Your doctor should be able to work out a dosage schedule that minimizes them whilst still helping her asthma. Chris Owens

Response:

There is no rational basis for colon cleansing. The concept goes back at least to the early 1900’s when a surheon, ARbunot Lane gained fame for needlessly removing colons for many and varied totally unrelated conditions including headaches. Norman Sohn, MD writes: – Hide quoted text — Show quoted text -Recently I have been trying natural remedies and they all seem to advocate cleaning the colon, claiming that foods (and parasites) cling to the colon walls, and rots .  Some even seem to think this condition causes flare ups with IBD.  I have tried two products of these cleansing methods (very briefly, because of the problems they caused me.  Mainly diarrhea, cramping and bleeding.)  Now I can’t seem to get back to any semblance of normal bowel habits, not that I was all that normal to start with.  I was diagnosed with uc 10 yrs ago, and have had an ongoing bout for last 2 1/2 yrs.   I really need to get some feedback on this subject, good or bad. Good health to all.   Thanks.

Response:

Recently I have been trying natural remedies and they all seem to advocate cleaning the colon

I have heard about that. However, since we already have one problem I would be wary of trying on something that could make things worse. Why not consult your doctor? Ora

Response:

- Hide quoted text — Show quoted text -Recently I have been trying natural remedies and they all seem to advocate cleaning the colon, claiming that foods (and parasites) cling to the colon walls, and rots .  Some even seem to think this condition causes flare ups with IBD.  I have tried two products of these cleansing methods (very briefly, because of the problems they caused me.  Mainly diarrhea, cramping and bleeding.)  Now I can’t seem to get back to any semblance of normal bowel habits, not that I was all that normal to start with.  I was diagnosed with uc 10 yrs ago, and have had an ongoing bout for last 2 1/2 yrs.   I really need to get some feedback on this subject, good or bad. Good health to all.   Thanks.

IBD can have causal agents of undesirable bacteria and parasites therefore colon cleansing would seem to be a logical step.  However, many of the pathogen bacteria and parasites are particularly tenacious at holding on to the intestinal wall so they are not flushed out.  Also colon cleansing cleans out many of the desirable bacteria which help the intestines to be healthy.   Considering this information there is little benefit to colon cleansing.   However if it is a method chosen to help improve IBD it should be followed by reforestation of the gut with desirable bacteria.  The easiest safest way to do this is to use natural yogurt that has a live bacterial culture. Amanda

Response:

Read Jethro Kloss’ Back to Eden.

Response:

Recently I have been trying natural remedies and they all seem to advocate cleaning the colon, claiming that foods (and parasites) cling to the colon walls, and rots .  Some even seem to think this condition causes flare ups with IBD.  I have tried two products of these cleansing methods (very briefly, because of the problems they caused me.  Mainly diarrhea, cramping and bleeding.)  Now I can’t seem to get back to any semblance of normal bowel habits…

This may be a case where the "natural" remedy precipitated a flare-up of your UC. You don’t say which, if any, of the standard therapies you’re using. If you’re not actively being treated now, I’d say it’s time to see your doc. You don’t necessarily have to tell the doc what you think caused the flare, if you’re embarrassed about it. —

Response:

Recently I have been trying natural remedies and they all seem to advocate cleaning the colon, claiming that foods (and parasites) cling to the colon walls, and rots .  Some even seem to think this condition causes flare ups with IBD.  I have tried two products of these cleansing methods (very briefly, because of the problems they caused me.  

<snip I have been researching colonic cleansing products and methods for the chapter I am writing about digestion. Every doctor, gastroenterologist, and even a coroner I’ve talked to has said the same thing: there is simply no buildup of old stools or mucus layers in the intestines. Every colon therapist, every person who has persevered through a fast, series of colonics, or herbal cleanse has said the opposite: "Was on the pot for four days…!!!" "You wouldn’t BELIEVE the stuff that came out!" "Feel tons better!!" After about $50 in phone bills, my editor said to knock it off and just present it as a mystery. I am still curious. Anyway, as far as colonics go, you should stick with a registered colonic hydrotherapist. They have a lot of training. The problem with colonics and enemas is if your colon is already very thin…it could rupture from the water pressure. Other dangers of colonics and enemas: the chlorine in the water can kill off the beneficial bacteria. Colonic therapists usually reinnoculate with them. The water may not be pure enough and contain cysts of parasites. If doing home enemas, use only distilled water. The distilled water may pull minerals from your system. Take more minerals. Coffee enemas are used for detoxing the system (like to the liver), but they may weaken the tissue walls of the colon. Doing colonics, enemas, or laxatives may make your bowel system weak. Some suggest a final rinse of cool water to help tonify the colon. A doctor I interviewed said that colonics ARE THE THING that works for ulcerative colitis and crohns disease. He works with a registered colon therapist and often Rx substances to be infused in the water (garlic was one thing he mentioned.) I’ve interviewed many colon therapists who say they’ve pulled many patients back from the brink of resections and colostomies. There are probably horror stories from them as well, but I have not heard of any.

Response:

Recently I have been trying natural remedies and they all seem to advocate cleaning the colon, claiming that foods (and parasites) cling to the colon walls, and rots .  Some even seem to think this condition causes flare ups with IBD.  I have tried two products of these cleansing methods (very briefly, because of the problems they caused me.  Mainly diarrhea, cramping and bleeding.)  Now I can’t seem to get back to any semblance of normal bowel habits, not that I was all that normal to start with.  I was diagnosed with uc 10 yrs ago, and have had an ongoing bout for last 2 1/2 yrs. I really need to get some feedback on this subject, good or bad. Good health to all.   Thanks.

It is simply not true that fecal matter builds up and encrusts on the intestinal walls. Ask the doctor who did your colososcopy whether or not he/she saw any of that in your examination, or anyone elses. People who advocate that theory have no idea of how the colon functions, let alone have any understanding of the causes of IBD, and are out merely to sell product. If you suspect you have parasites, get adequately tested. Great Smokies Diagnostic Labs is good for this. Simon Simon

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I just recently had a flare up for crohn’s, actually it spread to my colon.  Before it was only in my small intestines.  Now my doctor has me on so much medication that it is ridiculous.I take 1000mg of Pentasa, 4 times a day, 125mg 6-MP, 60mg prednisone, prilosec and bentyl.  My body was doing weird thing.  I was real shaky for a while.  I think my body is now starting to adjust to all the meds.  Now that I’m starting to feel better which medication is helping?  I’m trying to do everything the doctor says so I don’t have to have surgery.  I’m just complaining cuz I’m tired of taking so many pills a day. Bonnie F. (New to the group)

Response:

Recently I have been trying natural remedies and they all seem to advocate cleaning the colon, claiming that foods (and parasites) cling to the colon walls, and rots .  Some even seem to think this condition causes flare ups with IBD.  I have tried two products of these cleansing methods (very briefly, because of the problems they caused me.  Mainly diarrhea, cramping and bleeding.)  Now I can’t seem to get back to any semblance of normal bowel habits, not that I was all that normal to start with.  I was diagnosed with uc 10 yrs ago, and have had an ongoing bout for last 2 1/2 yrs.   I really need to get some feedback on this subject, good or bad. Good health to all.   Thanks.

Response:

Question:

Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo

Response:

Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo

Regarding albuterol inhaler, side effects include nervousness. However the albuterol inhaler is for rescue; if needed more than once/day it indicates the need to add or increase long acting preventor meds like inhaled steroids. See: http://www.rxlist.com/cgi/generic/albut1.htm Side effects of MDI inhalers like albuterol can be minimized by using an AeroChamber spacer. Ellis

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Gloria,        The inhalers deliver most of their medication to the throat and then by swallowing to the stomach.  The medication is absorbed by the cardiovascular system and gets sent to the brain and heart. The medication can cause nausea, light headedness and rapid heart rate. The best way to avoid this is to use the inhaler with a spacer device.       Ask your pharmacist, call a respiratory therapy department at a hospital, or ask your physician to give you info on spacers. The spacer is just that an enclosed space between you and the inhaler. The inhaler delivers its dose to this space and the large medication particles in the aerosol have time to drop out. These are the particles that get into the mouth and stomach. The smaller particles stay in the air space and can be inhaled. John

Response:

Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help?

I had had that effect using Ventolin. My doc switched me to Berotec and I did not have that problem any more. – Hide quoted text — Show quoted text -Glo

Response:

Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it?

A bronchodilator is basically a stimulant.  They have tried to engineer the products so that they only affect the Beta-2 receptor sites which are predominantly in the airways.  However a few are elsewhere in the body. Your best bet for avoiding the shakes is to 1) use a spacer device whenever possible, and 2) maintain your asthma control so you can minimize the use of the medication. Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol.

Could be post nasal drip.

Response:

Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo

this is my first post, I’m new to the newsgroup…. I’ve got sports induced asthma diagnosed just this past summer, after years of simply avoiding running etc….I’m so glad I’m not the only one with that problem, my inhaler is albuterol (as-needed) and besides the fact that it often tastes really really bad, it frequently causes my hands to shake and the like. It’s annoying but tends to go away within 1/2 hour, so I guess it’s better than the alternative….

Response:

– Hide quoted text — Show quoted text – Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo Regarding albuterol inhaler, side effects include nervousness. However the albuterol inhaler is for rescue; if needed more than once/day it indicates the need to add or increase long acting preventor meds like inhaled steroids. See: http://www.rxlist.com/cgi/generic/albut1.htm Side effects of MDI inhalers like albuterol can be minimized by using an AeroChamber spacer. Ellis

not true… for those with sports induced asthma, whihc is triggered by nothing else, it can be used 1/2 hour before activity as a preventative….and in fact sometimes is used on a daily basis according to the package insert, though I was only given mine for prevention as-needed, and emergency use. -Emily

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- Hide quoted text — Show quoted text – Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Glo Regarding albuterol inhaler, side effects include nervousness. However the albuterol inhaler is for rescue; if needed more than once/day it indicates the need to add or increase long acting preventor meds like inhaled steroids. See: http://www.rxlist.com/cgi/generic/albut1.htm Side effects of MDI inhalers like albuterol can be minimized by using an AeroChamber spacer. Ellis not true… for those with sports induced asthma, whihc is triggered by nothing else, it can be used 1/2 hour before activity as a preventative….and in fact sometimes is used on a daily basis according to the package insert, though I was only given mine for prevention as-needed, and emergency use. -Emily

Its true albuterol can be used for EIA. However the latest asthma guidelines (EPR2) state that if a beta2 agonist is needed for maintenance on a daily basis, it indicates the need for increasing long acting preventor meds (Steps 2,3,4); and for Step 1 if needed more than twice a week, that long term preventor meds should be started. Many doctors are not up to date on the Expert Panel Report 2 (244 pages) from the NIH, which is what asthma doctors should be going by. Here’s the link: http://129.255.168.54/Providers/ClinGuide/AsthmaIM/comp3/3-4b.html Figure 3-4b: Stepwise Approach for Managing Asthma in Adults and Children Older that 5 Years of Age: Treatment Excerpt: "Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term-control therapy. " For asthma exacerbations, an Action Plan can be used to allow beta2-agonist use as needed when peak flows drop into yellow zone (50-80% personal best) The Package Insert dose for albuterol is not the appropriate dose for asthma control; the Expert Panel Report Guidelines should be used, since they represent up-to-date thinking from the top asthma experts in the US, as of 1997. Ellis

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oes anyone else get lightheaded and the shakes from using their :inhalers?  Can anything be done to help this?  What causes it? : : I had had that effect using Ventolin. My doc switched me to Berotec : and I did not have that problem any more. Interesting… I used to get the shakes occasionally with Berotec, and the standard 100 microgram? Ventolin does not give me the shakes.  Note that the Berotec is far more powerful, and longer acting than Ventolin, so is more likely to have side effects.  Of course, I only need one dose of Ventolin to open my lungs up (and it works much slower than the Berotec). Cheers, Kin Hoong

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writes: I’m so glad I’m not the only one with that problem, my inhaler is albuterol (as-needed) and besides the fact that it often tastes really really bad,

just a quick note here… my daughter HATES the name brand "Preventil" inhaler and will only use the generic one from a company called Warrick. She say the Preventil tastes "yucky"! Donna Donna

Response:

I’d agree with that – brand name Proventil tastes awful! As far as the shaking goes, I shook terribly with MaxAir, but a switch to plain old generic Albuterol got rid of the shakes – tell your doctor you want to switch brands of inhaler. janet – Hide quoted text — Show quoted text – writes: I’m so glad I’m not the only one with that problem, my inhaler is albuterol (as-needed) and besides the fact that it often tastes really really bad, just a quick note here… my daughter HATES the name brand "Preventil" inhaler and will only use the generic one from a company called Warrick. She say the Preventil tastes "yucky"! Donna Donna

Response:

oes anyone else get lightheaded and the shakes from using their :inhalers?  Can anything be done to help this?  What causes it? : : I had had that effect using Ventolin. My doc switched me to Berotec : and I did not have that problem any more. Interesting… I used to get the shakes occasionally with Berotec, and the standard 100 microgram? Ventolin does not give me the shakes Kin Hoong

I’ve found that it depends on how I take the ventolin.  If I use the inhaler it will "loosen" the tightness in my lungs without and shakes.  When I’m experiencing a sinus/bronchial infection–or last winter when I was recovering from pneumonia– the Dr switches me to nebulized ventolin and then I do get the shakes afterward. My daughter also has this reaction to the nebulzed ventolin–when she’s experiencing distress and her PFM readings are 50% 0r less below normal, and one doe ventoin with the MDI doesn’t alleviate the distress, we use nebulized ventolin. The dosing on the MDI is acutally higher, too. It’s that the nebulzed treatment has more of an "impact". Lesa

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Makes me shake like a cat in a room full of rocking chairs – and try to convince them at work that you are not an alcoholic – just an asthmatic. – Hide quoted text — Show quoted text – Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo

Response:

Albuterol and Serevent give me the shakes.  Serevent also gives me headache, flushing (red face) and jitteriness, _and_ they do not relieve my symptoms (coughing).  I do _not_ understand why these are the first drugs handed out to people with the coughing, and only when that doesn’t work (surprise, surprise) do they give us the inhaled steroids.  This happened with me, my 4-yr-old daughter (before I knew better), and my mother – all 3 of us were diagnosed (separately) with asthma this year. A. Shores – Hide quoted text — Show quoted text – Makes me shake like a cat in a room full of rocking chairs – and try to convince them at work that you are not an alcoholic – just an asthmatic. Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo

Response:

Glo Fungal infections (yeast, "candidiasis") in the throat are common after antibiotics and/or coritcosteroid inhalants such as albuterol, and can become chronic and/or systemic.  Identifying and dealing with them can be challenging — involving sugar-free diet and prescription anti-fungal drugs.   Or you may be fortunate and get it diagnosed and treated easily. If not, you may need to find a doctor who treats moderate chronic candidiasis.  (Some doctors deny the existence of intermediate chronic candidiasis, or, in any case, are not "up" on the subject).  To learn get up-to-date information search the Web on "candidiasis". Roger

– Hide quoted text — Show quoted text – Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo

Response:

writes: I’m so glad I’m not the only one with that problem, my inhaler is albuterol (as-needed) and besides the fact that it often tastes really really bad, just a quick note here… my daughter HATES the name brand "Preventil" inhaler and will only use the generic one from a company called Warrick. She say the Preventil tastes "yucky"! Donna Donna

If you are "tasting" your inhalers, you may not using you MDI (inhaler) correctly (and therefore not receiving the benefit of the medication). Seek out a pharmacist specializing in asthma care to assist you in learning the correct MDI technique.

Response:

For me the shakiness and lightheadedness depends on the severity of the attack.  On the occasions that I have been to the ER with asthma and they have administered high doses of ventolin or albuterol I get very shaky.  But only once I start responding to the treatment not before.  It can also make me vomit and nauseated.  But I think alot of that has to do with using the wrong muscles for breathing and those muscles shaking from fatigue. – Hide quoted text — Show quoted text – Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Please help? Glo this is my first post, I’m new to the newsgroup…. I’ve got sports induced asthma diagnosed just this past summer, after years of simply avoiding running etc….I’m so glad I’m not the only one with that problem, my inhaler is albuterol (as-needed) and besides the fact that it often tastes really really bad, it frequently causes my hands to shake and the like. It’s annoying but tends to go away within 1/2 hour, so I guess it’s better than the alternative….

Response:

Glo Fungal infections (yeast, "candidiasis") in the throat are common after antibiotics and/or coritcosteroid inhalants such as albuterol,

Albuterol is not a corticosteroid.

Response:

For me the shakiness and lightheadedness depends on the severity of the attack.  On the occasions that I have been to the ER with asthma and they have administered high doses of ventolin or albuterol I get very shaky.  But only once I start responding to the treatment not before.  It can also make me vomit and nauseated.  But I think alot of that has to do with using the wrong muscles for breathing and those muscles shaking from fatigue.

 No, I’m not talking about when I use it for an attack, after it happens…the attack itself often makes me shaky once I start to recover. But with the abuterol, since my asthma is sports induced, I use it before I do physical activities and things, and I get shaky right after I use it.

Response:

Sorry, I meant Asmacort.  What about the main point, though?  Is it accurate? – Hide quoted text — Show quoted text – Glo Fungal infections (yeast, "candidiasis") in the throat are common after antibiotics and/or coritcosteroid inhalants such as albuterol, Albuterol is not a corticosteroid.

Response:

:Interesting… I used to get the shakes occasionally with Berotec, and :the standard 100 microgram? Ventolin does not give me the shakes : :Kin Hoong : I’ve found that it depends on how I take the ventolin.  If I use the inhaler : it will "loosen" the tightness in my lungs without and shakes.  When I’m : experiencing a sinus/bronchial infection–or last winter when I was : recovering from pneumonia– the Dr switches me to nebulized ventolin and : then I do get the shakes afterward. : My daughter also has this reaction to the nebulzed ventolin–when she’s : experiencing distress and her PFM readings are 50% 0r less below normal, and : one doe ventoin with the MDI doesn’t alleviate the distress, we use : nebulized ventolin. : The dosing on the MDI is acutally higher, too. It’s that the nebulzed : treatment has more of an "impact". This is very interesting.  I have experienced it myself, moreover, when I did get nebulised (standard dose) my heart rate went up to 150 bpm, so I was told… The obvious question is: how are you measuring dose? The dosage delivered to the lungs versus the amount entering the rest of body might be significant here. Cheers, Kin Hoong

Response:

Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it?

Albuterol is a central nervous system stimulant….not unlike a wopping dose of adrenaline (or epinepherine).  Thus, it makes everything "hyper".  Your heart rate goes up, you become shaky, etc. As the stimulant wears off, everything returns to normal.   Unpleasant, perhaps, but perfectly normal…and no way to avoid it. Hope this clarified things a bit. -deanie-

Response:

I think this part of the guideline is a little tricky to interpret. I believe that if the person is using the albuterol inhaler as a preventative only, and having no other symptoms, you should not start a steroid inhaler simply because they exercise every day, and hence, use the albuterol daily. When I hear they are using it daily I question then closely about whether they are truly asymptomatic at the time of taking the meds before exercise and if they are having any symptoms at other times. I am then quick to start another med if they are having other symptoms. I don’t think exercising daily, and taking the albuterol solely for prophylaxis in this situation should count the same as a person who has daily symptoms and uses as needed doses for this. — Good Luck, CBI, M.D. – Hide quoted text — Show quoted text – Does anyone else get lightheaded and the shakes from using their inhalers?  Can anything be done to help this?  What causes it? Also, I’ve had a sore throat for 3 weeks.  Was on antibiotics for pneumonia (boy that helps the breathing!) so I know it isn’t strep. But that is when I started using the albuterol. Glo Regarding albuterol inhaler, side effects include nervousness. However the albuterol inhaler is for rescue; if needed more than once/day it indicates the need to add or increase long acting preventor meds like inhaled steroids. See: http://www.rxlist.com/cgi/generic/albut1.htm Side effects of MDI inhalers like albuterol can be minimized by using an AeroChamber spacer. Ellis not true… for those with sports induced asthma, whihc is triggered by nothing else, it can be used 1/2 hour before activity as a preventative….and in fact sometimes is used on a daily basis according to the package insert, though I was only given mine for prevention as-needed, and emergency use. -Emily Its true albuterol can be used for EIA. However the latest asthma guidelines (EPR2) state that if a beta2 agonist is needed for maintenance on a daily basis, it indicates the need for increasing long acting preventor meds (Steps 2,3,4); and for Step 1 if needed more than twice a week, that long term preventor meds should be started. Many doctors are not up to date on the Expert Panel Report 2 (244 pages) from the NIH, which is what asthma doctors should be going by. Here’s the link: http://129.255.168.54/Providers/ClinGuide/AsthmaIM/comp3/3-4b.html Figure 3-4b: Stepwise Approach for Managing Asthma in Adults and Children Older that 5 Years of Age: Treatment Excerpt: "Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term-control therapy. " For asthma exacerbations, an Action Plan can be used to allow beta2-agonist use as needed when peak flows drop into yellow zone (50-80% personal best) The Package Insert dose for albuterol is not the appropriate dose for asthma control; the Expert Panel Report Guidelines should be used, since they represent up-to-date thinking from the top asthma experts in the US, as of 1997. Ellis

Response:

<<<<However the albuterol inhaler is for rescue; if needed more than once/day it indicates the need to add or increase long acting preventor meds like inhaled steroids.

Not neccesariuly true. I use an  albuterol inhaler on a regular daily basis  - prescribed by Pulmonary specialist. Most emphesema patents with an asthma component do the same.  I use the stetroid inhaler only twuce a day. I rarely have wheezing & coughing & sputum,  My doc does not increas emy steroid inhaler use because i need the Albuterol more than once a day. Simplicity is not one of the major components of COPD is it? REGARDS LOU LEDDA

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Question:

I am very seriously thinking about dumping this guy and finding someone else who will accept my case history for what it is and leave me with the drugs that work for me. Am I being unreasonable ?

No. As you stated earlier: My asthma was under control

This is The Goal, to get your asthma under control so you can have A Life. Your personal solution works so stick with it.  And find/stay with a Doctor who keeps You healthy. You know what you want.  Fight for it. Good Hunting!

Response:

- Hide quoted text — Show quoted text – I’ve had moderate to severe asthma since day one.  My younger years were pretty rough and nothing seemed to work. When I was about 10 years old, my Dr. told me about theophylline and put me on it.  That was the best move any of my Dr’s ever made!<snip My new Dr. is against theophylline due to its numerous and dangerous interactions with other drugs.  I’ve checked in to this claim and there are many dangerous interactions with other drugs. He’s took me off the theo and gave put me on the serevent inhaler.  This actually seemed to work for a few months, then it did nothing.  <snip So, I decided to switch back to the serevent and after a week I gave up.  For the last month, I’ve been on the theo again. I went to talk with my Dr about it so I could get back on theo full time and he wouldn’t do it!  He said he wanted to try something new (again!).  This time, he has me on vanceril double strength (a steroid inhaler).

I had a doctor like this.  His favorite trick was throwing more and more inhaled and oral steriods at my asthma.  Sounds like you have another one who flies south with the ducks in winter going QUACKQUACKQUACK! My Dr. also says that all theo drugs will soon be yanked by the FDA.  Is this true?  I don’t believe him.

Somehow I think not. I am very discouraged at this and feel I am being used as his guinea pig.  I don’t see the problem with drug interactions – especially when I know about them.  If I ever needed to see a different Dr. for whatever reason, I would tell them I am on theo and "I believe it has lots of other bad drug interactions". That would prompt him/her to check it out (hopefully) before giving me whatever prescription or treatment.

Very good idea, you should always tell any medical person you see for anything all the drugs you are on So, I’m hoping there are a few Dr’s here that specialize in asthma treatment that can tell me if my Dr. is being unreasonable.

I’m not a doctor but your guy sounds like some of the worse cases I have seen……hide-bound, old-fashioned, stubborn, unwilling to listen to you.  I’d say that qualifies as unreasonable. I am very seriously thinking about dumping this guy and finding someone else who will accept my case history for what it is and leave me with the drugs that work for me. My asthma was under control until I had to find this new Dr. Am I being unreasonable ?

Not at all.  They are your lungs, it is your body, and only you can say how your quality of life is.  If this quack is decreasing your quality of life with his pigheaded refusal to listen to you, time to find someone new.  Where are you located, perhaps someone here is near you and could recommend a pulmonary specialist for you. Jennifer, been there, done that, found a new doctor! Jennifer Landry

Response:

I went to talk with my Dr about it so I could get back on theo full time and he wouldn’t do it!  He said he wanted to try something new (again!).  This time, he has me on vanceril double strength (a steroid inhaler).

Curreent medical doctrine stresses anti-inflamitory medication such as the Vanceril.  The reason is that the theophyline and the serevent are bronchodilators.  Since asthma is an inflamitory disease, it is considered better to treat the underlying inflamation rather than the effects. You should discuss your concerns with your doctor and have him explain the reasoning behind his treatments.  Get the doctor cannot explain to you: Why you are getting the medication, What the expected benefits are, and How to tell if it is working.  If he is either unable or unwilling to do this then seek another doctor. I am very seriously thinking about dumping this guy and finding someone else who will accept my case history for what it is and leave me with the drugs that work for me. My asthma was under control until I had to find this new Dr. Am I being unreasonable ?

No.  remember they are _your_ lungs!

Response:

I had a somewhat similar experience.  I’ve been on theophyline for years, and my internist suggested Serevent as a replacement.  I tried it for a few days, while reducing my theophyline dosage, and found I just couldn’t get a deep breath.  I dumped the Serevent and went back to my full dosage of theophyline.  My internist had no problems with that. Recently, I went to an allergist and he also suggested I dump the theophyline but increase my dosage of Beclovent (inhaled steroid).   Again, I just couldn’t manage to get a deep satisfactory breath, so I went back to my old routine.  What is so bad about theophyline?  Sure, it has some well-known side effects, but only because it’s been around for so long and there’s a long data record.  Personally, I’d rather be able to breath.

Well, I understand where my Dr. is coming from, but he needs to understand that I am well aware of that risk, AND, his ‘new’ treatments aren’t working nearly as good as the theo does. It’s not that there are side-effects from theo.  It’s the dangerous interactions from mixing with other drugs that’s the problem. Check out www.rxlist.com and look up THEOPHYLLINE.  Check the 5th hit (that’s the specific med I’m taking), and you’ll see tons of interaction precautions. But, back to the point.  I’ve been on it for 13 years.  Why should I be concerned NOW?  I’m not, but the Dr. is.  And, at my expense, he’s experimenting on me. The more I think about it, the more I believe I’m right and will switch Dr’s soon. I’m just hoping there are other Dr’s here that possibly explain why I shouldn’t. My Dr. isn’t the best with his ‘bedside manners’.  (another reason to switch, I suppose).

Response:

I’ve had moderate to severe asthma since day one.  My younger years were pretty rough and nothing seemed to work. When I was about 10 years old, my Dr. told me about theophylline and put me on it.  That was the best move any of my Dr’s ever made! The stuff works great.  I was on it for 13 years and things were very acceptable to me. Within the last 4 years, I had to change doctors due to insurance/job changes. My new Dr. is against theophylline due to its numerous and dangerous interactions with other drugs.  I’ve checked in to this claim and there are many dangerous interactions with other drugs.

Side effects and drug interactions of theophylline and most other drugs are dose dependent, meaning the bigger the dose, the more severe the side effects. Theophylline is chemically related to caffeine. A typical 200 mg theophylline tablet has side effects and drug interactions similar to a cup of Starbucks coffee. Actually less since the theophylline is normally taken in sustained-release form, like TheoDur. He’s took me off the theo and gave put me on the serevent inhaler.  This actually seemed to work for a few months, then it did nothing.  I was having trouble just sitting and doing nothing.  I decided to switch back to my theo on my own and everything came back to normal.  I figured maybe I had the onset of some small virus that triggered my asthma and that was the real problem. So, I decided to switch back to the serevent and after a week I gave up.  For the last month, I’ve been on the theo again.

Serevent is a long-acting bronchodilator; it is recommended in conjunction with a  steroid inhaler, like the Vanceril DS; not by itself. Theophylline is normally considered to be a long-acting bronchodilator but new research shows in low doses it has a mild anti-inflammatory effect, like the Vanceril. I went to talk with my Dr about it so I could get back on theo full time and he wouldn’t do it!  He said he wanted to try something new (again!).  This time, he has me on vanceril double strength (a steroid inhaler). My Dr. also says that all theo drugs will soon be yanked by the FDA.  Is this true?  I don’t believe him.

Your doctor is misinformed, or you misinterpreted him. Theo drugs have been yanked from OTC meds, along with ephredine, as the FDA feels you should be under a doctors care to take it. Does not impact the prescription forms, like TheoDur. Actually theophylline is making a comeback as an additive med and steroid-sparing drug. Turns out the inhaled steroids are not all that safe in Medium and High Doses–can start to cause some of the same side effects as prednisone–trying reading the product info sheet on side effects of prednisone. Theophylline is recommended as 2nd line therapy in the latest asthma guidelines, EPR2; and is considered safe in pregnancy in Low Doses. Thats the key, keep the dose low (equivalent blood levels at 5 or below, when theophylline was the primary asthma control med, blood levels of 15-20 were often achieved, along with many bad side effects) I take 200 mg TheoDur twice a day, along with Serevent and Vanceril DS. My doctor had no problem in renewing my TheoDur prescription this month. He said I could try Accolate if I wanted, but for most people its no more effective than theophylline. Note that theophylline is also used for other airway diseases, like COPD. – Hide quoted text — Show quoted text – I am very discouraged at this and feel I am being used as his guinea pig.  I don’t see the problem with drug interactions – especially when I know about them.  If I ever needed to see a different Dr. for whatever reason, I would tell them I am on theo and "I believe it has lots of other bad drug interactions". That would prompt him/her to check it out (hopefully) before giving me whatever prescription or treatment. So, I’m hoping there are a few Dr’s here that specialize in asthma treatment that can tell me if my Dr. is being unreasonable. I am very seriously thinking about dumping this guy and finding someone else who will accept my case history for what it is and leave me with the drugs that work for me. My asthma was under control until I had to find this new Dr. Am I being unreasonable ?

Its time to find a new doctor. If you do have any side effects from theophylline, just reduce the dose, don’t quit (I sometimes get headaches at higher doses, also diarrhea). When taken in High Doses under older guidelines, a periodic blood test was required to confirm level in the blood; this is not required at Low Doses like I take (200 mg x 2). Beware of the 24 hr versions and generic versions. The 12 hr TheoDur tablet works well. You might have to add other meds like the Vanceril DS, it works well for me, 2 pf x 2; and Serevent 2pf x 2. For asthma exacerbations I increase the Vanceril DS. Here’s a link: http://www.health-line.com/articles/ap960108.htm Theophylline (Spring 96) Excerpt: Even with the advent of safe, potent topical steroids, theophylline remains an important drug for many patients with asthma and other forms of reversible airway disease. Besides its well-known bronchodilatory effects, theophylline appears to demonstrate many anti-allergic and anti-inflammatory effects. It can stabilize or inhibit certain inflammatory cells, and reduce histamine release from mast cells and basophils. Theophylline also can attenuate the activity of macrophages, neutrophils and platelets. And it can combat inflammation directly by improving mucociliary transport and reducing microvascular permeability and plasma exudation.  Sustained-Release Theophylline Numerous studies have shown that 24-hour sustained-release theophylline preparations are associated with preserved lung function at the end of the dosing interval, at or near the time of trough theophylline blood levels. The preparations are also well tolerated, despite the relatively large single doses involved. Because of their demonstrated safety, effectiveness and convenience, once-daily theophylline preparations are becoming the favored theophylline formulation. To obtain the most consistent blood levels throughout a 24-hour period, however, the agents can be divided into two doses and administered at 12-hour intervals. In recognition of asthma’s inflammatory component, most asthma patients now receive aggressive anti-inflammatory treatment initially. For bronchodilation, drugs such as the beta-agonists and anticholinergics have become the first choice. Theophylline is now the second-line bronchodilator. Despite scientific rationale supporting this sequencing, however, there is no proof that any of the newer drugs alter the natural history of asthma in children or adults. Furthermore, it is becoming increasingly clear that asthma can be a disease composed of several different inflammatory pathways. As our understanding of asthma grows, it is important for clinicians to recognize the heterogeneity of asthma, and to individualize drug regimens to best suit each patient’s circumstances. " Dr. Incaudo is Clinical Associate Professor of Internal Medicine and Pediatrics at the University of California, Davis. He is a Diplomate of the National Board of Medical Examiners and the American Academy of Allergy and Immunology.  

Question:

I definitely have more trouble with my sinus problems in the winter months, beginning a few days after my heating system starts.  It is forced air, gas heat and I blame it, rightly or wrongly, for my problem.  I have tried a number of things, including medication, but the best has been HEPA portable room filtration.  I use three units in my home.  My best solution has been to go to a warmer climate in the winter and, since I am retired, I go to Florida at least once a year.  I realize this isn’t practical for a working person and I keep wishing for a solution at home.  I wish there were some way to tie down exactly where the problem lies–dust mites, gas fumes, mold/mildew, etc.  It is just impratical to take a shotgun approach to it. Good luck, Al

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Although since April that has worked great—in the past 3 weeks, they don’t seem to be working any longer. My Dr. says to just keep using them but I wonder if I should press for a change in meds.  Could it be the colder weather?  

Every winter I have more problem with asthma than the other nine months. If you are really congested and tight in the chest, you might need additional meds during winter. Perhaps more of your inhaled steroids might be in order. Vanceril is now available in double strength. Flovent is the latest addition to the inhaled steroids available, and is available in three strengths. If you seem to be using your bronchodilator (albuterol) more often than you should, this might be the answer. You might also ask about a nebulizer, which delivers the albuterol over a 10-15 minute period and gets into the very tiny places in your lungs, making it easy to expel the mucus and breathe better. This will only make the symptoms less severe, except for possible side effects of felling a little jittery. But, better to feel jittery than go to the ER for a nebulizer treatment you can get at home. You should ask your doctor about all of this. You might see a specialist, like an allergist or pulmonary specialist for more suggestions and better treatment of your problem. Donald Hellen (Note: Anti-Spam Measure… remove the "*" in front of our address to reply by email.)

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I have the coughing type asthma. Meaning, I have bad episodes of dry unproductive coughing that is worse when I laugh or try to breath deeply.  I was diagnosed in April of last year.  Using Vanceril and Albuterol 2 puffs each 4x a day.  Although since April that has worked great—in the past 3 weeks, they don’t seem to be working any longer. My Dr. says to just keep using them but I wonder if I should press for a change in meds.  Could it be the colder weather?   I am just sick of the coughing, it is embarassing and becomes painful–my chest hurts and it gives me a headache by days end.  When I try not to cough, I end up looking and sounding like I am in distress!!!  Does anyone else every have to change or increase meds during the winter months? Thanks, Lynn

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I have the coughing type asthma. Meaning, I have bad episodes of dry unproductive coughing that is worse when I laugh or try to breath deeply.

Are you sure your cough is "dry"?  That’s the way mine feels at first.  But I have found that if I inhale lots of steam, this will loosen up the phlegm and make the cough productive.  Then I notice that the phlegm is discolored, which is apparently dripping down from my chronically inflamed sinuses.  In my case, the bottom line is that it’s chronic sinusitis that is triggering my asthma, and my sinusitis is definitely worse in the winter.  I would recommend you be evaluated for sinusitis if you haven’t already. Does anyone else ever have to change or increase meds during the winter months?

Yes, I have to increase my dose of Vanceril (steroid).  Last winter I was on antibiotics the whole winter to keep my sinusitis under control.  And no, sinus surgery hasn’t helped me much. — Steven D. Litvintchouk Disclaimer:  As far as I am aware, the opinions expressed herein are not those of my employer.

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Due to the dryness caused by gas heat my son often develops a dry cough in the winter. To avoid this I keep a humidifer going in his bedroom at night. Maybe one would help you too. – Hide quoted text — Show quoted text -I have the coughing type asthma. Meaning, I have bad episodes of dry unproductive coughing that is worse when I laugh or try to breath deeply.  I was diagnosed in April of last year.  Using Vanceril and Albuterol 2 puffs each 4x a day.  Although since April that has worked great—in the past 3 weeks, they don’t seem to be working any longer. My Dr. says to just keep using them but I wonder if I should press for a change in meds.  Could it be the colder weather?   I am just sick of the coughing, it is embarassing and becomes painful–my chest hurts and it gives me a headache by days end.  When I try not to cough, I end up looking and sounding like I am in distress!!!  Does anyone else every have to change or increase meds during the winter months? Thanks, Lynn

Response:

I have the coughing type asthma. Meaning, I have bad episodes of dry unproductive coughing that is worse when I laugh or try to breath deeply.  I was diagnosed in April of last year.  Using Vanceril and Albuterol 2 puffs each 4x a day.  Although since April that has worked great—in the past 3 weeks, they don’t seem to be working any longer. My Dr. says to just keep using them but I wonder if I should press for a change in meds.  Could it be the colder weather?   I am just sick of the coughing, it is embarassing and becomes painful–my chest hurts and it gives me a headache by days end.  When I try not to cough, I end up looking and sounding like I am in distress!!!  Does anyone else every have to change or increase meds during the winter months? Lynn

Under current asthma guidelines, your dose of albuterol, 8 puffs/day, is excessive. That’s 240 puffs/month or 1.2 canisters/month. 4 puffs/day of Vanceril is considered a Low Dose for Mild Intermittent asthma.  "Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term control therapy." See Expert Panel Report 2 Fig 3-4b: http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/comp3/… Fig 3-4b      Stepwise Approach for Managing Asthma in Adults & Children over 5: TREATMENT Did the same doctor ‘diagnose’ the cough variant asthma? If so, did he refer you to a pulmonologist  for evaluation? Did you take a methacholine challenge test (often required to diagnose cough asthma)? If you really have asthma, the normal thing to do here is increase the inhaled steroid, Vanceril. A Low Dose of Vanceril 42 (beclomethasone) is 4-12 puffs/day, per Fig 3-5b. Certainly it would be worth a try going to 8 puffs a day of Vanceril; suprising your doctor didn’t have you try it; but then 8 puffs/day of albuterol is also suprising. You might have sinusitis, with or without asthma. Maybe its time to try another doctor or ask for a referral to a Sinusitis doctor (ENT); diagnosis is done with a CAT scan. GER (gastroesophageal reflux is another possibility) Here are some links to research:  COUGH http://www.ummed.edu/dept/pulmonary/irwin/pitfalls.htm Common Pitfalls in Managing  Patients with Chronic Cough http://www.vh.org/Providers/TeachingFiles/PulmonaryCoreCurric/Chronic…  Virtual Hospital, U. of Iowa Med School http://www.mayo.ivi.com/mayo/9411/htm/cough.htm  Cough, Mayo Clinic http://www.scl.ncal.kaiperm.org/medadvice/cough/index.html Cough/Nasal Congestion http://www.ama-assn.org/special/asthma/library/scan/interp.htm Interpretation of Positive Results of a Methacholine Inhalation Challenge and 1 Week of Inhaled Bronchodilator use in Diagnosing and Treating Cough-Variant Asthma  SINUSITIS http://www.ama-assn.org/special/asthma/treatmnt/updates/sinus.htm Asthma and Sinusitis 11-97 http://www.vh.org/Beyond/PeerReviews/50Sinusitis.html  Virtual Hospital,  Sinusitis Links http://www.vh.org/Beyond/PeerReviews/14URI.html Virtual Hospital, Upper Resp Infect http://www.aaaai.org/patpub/resource/publicat/tips/tip23.html          SINUSITIS AAAAI http://www.njc.org/MFhtml/SIN_MF.html  Sinusitis, 1993, National Jewish http://www.niaid.nih.gov/factsheets/sinusitis.htm  Sinusitis, NIAD/NIH http://www.entnet.org/sinusitis.html  Sinusitis http://www.wdn.com/mirkin/6712.html  Sinusitis http://www.aaaai.org/profinfo/publicat/paramete/treatmen/nasal.html AAAAI Ellis

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Question:

Hello Amy & Joe, A good web site is  http://www.sequentialhealing.com/diets/food-introduction.html which has information on foods and diet for infants that have food allergies. There is a well documented link between food allergies and asthma, especially in children. – Hide quoted text — Show quoted text – I’m looking for info on treatment of Asthma for infants less than 1 year old.  What is the collective wisdom on how severe should it be before treatment and what sort of treatments are reccomended?  Either Web sites or published references would be helpful. Thanks, Joe

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I’m looking for info on treatment of Asthma for infants less than 1 year old.  What is the collective wisdom on how severe should it be before treatment and what sort of treatments are reccomended?  Either Web sites or published references would be helpful. Thanks, Joe

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I’m looking for info on treatment of Asthma for infants less than 1 year old.  What is the collective wisdom on how severe should it be before treatment and what sort of treatments are reccomended?  Either Web sites or published references would be helpful. Thanks, Joe

Here’s some links: If Your Infant Has Asthma You Will Have To Take Extra Care http://www.meddean.luc.edu/lumen/MedEd/medicine/Allergy/Asthma/asthws… Asthma & Wheezing in the First Six Years of Life http://www.nejm.org/collections/asthma/OA-4/1.htm http://www.aap.org/policy/office.htm  Acute Exacerbation, child http://www.arbon.com/njc/PSGMF.htm Pediatric Self-Management Guidelines http://www.pedipress.com/  Pedipress, Inc. (CHILDREN WITH ASTHMA, PLAUT) http://www.healthy.net/library/cybrarian/hotbed/asthma.htm  Childhood Asthma http://www.aaaai.org/patpub/resource/publicat/tips/tip20.html  CHILDHOOD ASTHMA http://www.ama-assn.org/special/asthma/treatmnt/guide/aaps.htm Acute  Exacerbations, child The 1997 Expert Panel Report 2: Guidelines Asthma, has some info on infant asthma. See http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/guidel… Ellis

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I’m looking for info on treatment of Asthma for infants less than 1 year old.  What is the collective wisdom on how severe should it be before treatment and what sort of treatments are reccomended?  Either Web sites or published references would be helpful.

I’ve seen very little published information about treating infants with asthma. This is what the doctors in our HMO do: In determining whether it’s time to head to the hospital, we watch for these:   retractions near the collarbone   retractions between ribs   breathing with accessory muscles (primarily stomach muscles)   racing pulse   rapid, shallow breathing   breathing out takes much longer than breathing in   disturbed sleep   listlessness   wheezing (may not be any in small children) The 1997 asthma guidelines list average pulse and breath rates. Children tend to deteriorate fast, so our doctors recommend starting treatment at the first sign of symptoms. Anytime I have called the doctor’s office asking whether we should head to the emergency room, I get a definitive "YES!! If it’s a breathing problem, GO NOW." First couple of attacks — Give albuterol via nebuliser in the emergency room (three treatments if needed, 20 minutes apart), plus first dose of Prelone (oral steroid). Keep child in ER until blood oxygen SAT is at least 95%, and preferably 97%. Send home with liquid Ventolin (broncodilator) and Prelone. Use Prelone for up to 5 days, and schedule a follow-up visit after that. Continued asthma attacks — Start using a portable nebuliser at home for albuterol treatments. Give a treatment as often as every 4 hours. If symptoms worsen, start a 5-day course of Prelone. If symptoms worsen, go to the emergency room for closely-spaced treatments of albuterol. (Because albuterol acts like adrenalin, they do not recommend closely-spaced treatments at home.) If ER treatment doesn’t bring blood SAT up, admit for 1-2 day observation and treatment. Continued asthma attacks — Add Intal via nebuliser 4 times a day. Intal stabalizes mast cells, so works well for allergy-triggered asthma. There are NO known side effects from Intal, and it’s considered one of the safest medications around. Continue albuterol treatments as needed, up to every 4 hours (can mix the Intal and albuterol in the nebulser). Start a 5-day course of Prelone as needed. Persistant severe asthma — Continuous or every-other-day use of Prelone along with Intal and albuterol. Only in persistant severe cases will an allergist or pulmonologist add an inhaled steroid. There are none approved in the U.S. for nebuliser use, but some pulmonologists will use a nasal steroid in a nebuliser for severe cases. Even though it’s not an approved use, they figure there are fewer side effects than continuous use of oral steroids. An inhaled steroid via a metered-dose inhaler can be added once the child is around 3 years old and able to take a deep breath to hold the medication. That’s MY interpretation of our HMO treatment of infants with asthma. Mary

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