Asthma

SARA LOMAX-REESE: Good afternoon, you are listening to the Tuesday edition to the midday café, Health Quest Live.  I am Sara Lomax-Reese and I will be here with you for the next hour and of course you know you can always listen to us online in crystal clear sound at WWW.900AMWURD.com or on tune in radio on your mobile phones or tablets.  As you know, this Saturday is our next Word Speaks event, State of Mind II, the impact of Race, History and Culture on Body, Mind and Spirit, featuring an incredible panel, Dr. Joy Degrew, Dr. Robin Smith, Ruth King and Dr. Thurman Evans.  Today we will be giving two pairs of tickets away during today's edition of Health Quest Live so you won't want to miss your opportunity. There is no doubt in my mind that this event will be both healing and transformational.  So in a few minutes we will be joined by Dr. Donee Patterson from Einstein Medical along with Dr. Randy Young, who is the Chief of the Division of Pulmonary and Clinical Care medicine at Einstein.  We are going to be talking today about asthma.  If you are an asthmatic or if you have a child who is, this can be a really difficult time of year, so you definitely want to stay tuned.   Later on, we will be joined by Councilwoman Cindy Bask to talk about the local implication of President Obama's healthcare reform battle in the Supreme Court.  Again, remember you can listen at WWW.900AMWURD.com.  Right now I want to welcome Dr. Donee Patterson and Dr. Randy Young, both from Einstein Medical.  We are going to be talking today about asthma.  Welcome to the show Dr. Donee and Dr. Young.

DONEE PATTERSON, MD: Thank you Sara.

RANDY YOUNG, MD: Thank you very much.

LOMAX-REESE: Dr. Donee, you usually get us started during our Einstein segment.  We are focusing in on asthma.  I know I actually have an 8 year old son who has asthma and so I know this is a particularly difficult time of year when the seasons change and a lot of allergies and asthma really start to kick in.  Why don't you set us up in terms of the basics?

PATTERSON: Sure.  Thank you Sara.  We really thought it was very important to talk about asthma today for those exact reasons.  We want people to recognize how common asthma is.  In fact, there are about 20 million asthmatics in the US, so we want you to know how common it is.  Also, it is very important for people to know that asthma can be treated, but often, the treatment is ineffective and that truly can change the quality of a person's life and it can be fetal.  We want people to be informed and we want to give some tips on how to be healthier.

LOMAX-REESE: OK, so the first thing that you said is really concerning.  You said treatment can often not be very effective.  I am going to turn to … why don't you answer…

PATTERSON: No, not that treatment is ineffective, but that people are not being well controlled on their asthma so we want to teach people that there are different levels of how your asthma can be well controlled and a lot of times people don't come to us, they are just suffering in the community, they don't come to us.  Their treatment out in the community is not being effective because they don't come in.

LOMAX-REESE: OK, so it is not necessarily that the prescribed medications that people can take for asthma don't work very well, it's just that there are not enough interaction with the healthcare community to control it well.

PATTERSON: Exactly.

LOMAX-REESE: So let's turn to you, Dr. Young and you are the Chief of the Division of Pulmonary and Clinical Care Medicine.  It is interesting that pulmonary and critical care medicine go together.  Why are those two things connected?

YOUNG: That is an interesting observation that you make.  In my mind it has always been an historical link because the earliest ICUs, intensive care units in hospitals around American were respiratory units and because pulmonary physicians had experience treating respiratory distress and managing ventilator care, they gradually became the ICU physicians and that juncture between the two specialties has been formally recognized.  The vast majority of critical care physicians in the US are pulmonary critical care physicians so it has always been kind of what we have done.

LOMAX-REESE: And pulmonary is the lungs, correct?

YOUNG: It is the study of lungs and lung disease, that's right.

LOMAX-REESE: So I see these statistics; it's amazing.  When we look at chronic disease or different illnesses and most of us think of life threatening illnesses, like heart attacks or heart disease, but when we look at asthma and allergies, the statistics I got was 60 million people in the US live with asthma and allergies; 20 million with asthma in particular.  So let me ask you this question, how is asthma diagnosed?

YOUNG: Asthma is a clinical diagnosis.  That means that it is made by recognizing the signs and symptoms that patient display.  Do patients have symptoms like wheezing or cough or breathlessness as manifestations of their asthma and can you detect wheezing when you listen to them; can you measure obstruction of airflow limitation of how quickly the air comes out of the lungs when people exhale and if you put all of those things together in the right setting, you can make a diagnosis of asthma.  Oftentimes asthma and allergies coexist as you said; sometimes they are entirely separate from one another.

LOMAX-REESE: It seems like there is a lot more people that have people now than maybe when I was growing up.  Is that a function of having better diagnosis or is it a factor of our environment? What is that about?

YOUNG: I think it is a matter of both of those things.  We are probably better at recognizing it than we use to be but there is a real sense of born out by health statistics that the frequency or the prevalence of asthma is increasing in many countries around the world, especially, we will call us a enveloped country. There is a fascinating hypothesis that your listeners may have heard about called the "hygiene hypothesis" says that as we keep our environment cleaner, as we vaccinate our children against formerly life threatening disease like measles, that our immune systems are now left over with some time on their hands to do mischief if you will and it is that that leads to the increasing prevalence of asthma, so I think you are right on both of those counts.

PATTERSON: Dr. Young and I wanted to make sure we emphasize that people realize that asthma is an inflammatory disease, much like arthritis and eczema, it's an inflammatory disease, so inside the airway tubes, there is inflammation and the whole goal of treatment is to get that inflammation down.  We have to take every single person as an individual, so some people may cough like Dr. Young says and people may wheeze, but we have to take everyone as an individual.  In a physician's mind, we have different ways that we guide whether a person is well controlled.  We say is a person well controlled?  Are they poorly controlled or are they severely poorly controlled and those things make a difference to us.  We want our patients to be thinking on those terms as well.

YOUNG: If I may, I think one of the most important things for asthma patients and parents of asthmatic children to recognize is that we all too often allowed ourselves to live with symptoms that really speak to the fact that our asthma is not well controlled.  We accept limitations on our activities; we gradually adjust our activities; we realize that we are using our medicines more often than we really should without recognizing that those are signs that the disease is less than optimally controlled and that we need to be in touch with our physician, our healthcare provider to get the asthma under control so as to avoid really bad outcomes.

LOMAX-REESE: Yeah, I am definitely guilty of that as a parent.  It is real because I know for a long time I didn't want to kind of admit that my son had asthma and so he would have these coughing…he has the coughing type and he would have these coughing jags and coughing jags and I adjusted his diet, I did all of these different things and finally it was controlled with the Albuterol and then that stopped working that well so fortunately he has been fine but what I find is really confusing as a parent is that he will be fine for these long stretches and then seemingly from out of nowhere he.….it turns into this major outbreak or attack.  Are there triggers?  I know there are triggers….

PATTERSON: I am so glad that you said that.  It is so important for people to know that a lot like arthritis, you may have symptoms today and its winter and it's cold but then in the summer you are fine.  Asthma can be the same way.  You have flairs so you can be doing really well but then your child may start soccer season or a season where people start cutting grass round them frequently and then they start to flair so you constantly have to be aware that asthma can flair up at any time.  We want people to consciously think about this.  Do you have symptoms of asthma more than twice a week?  Do you use your albuterol more than twice a week?  Your albuterol, your rescue inhaler more than twice a week.  Do you have night symptoms?  Are you short of breath at night? Are you having a hard time at night?  Do you wake up wheezing?  We also want to know are you getting around, doing your normal activities; are you getting around just fine, things that would otherwise be easy for you to do, just walk a flight to stairs or walk to your mailbox, normal simple things for you.  Are you having a hard time doing it?  If you answered yes to any of those, if you are answering that you are using your albuterol very frequently, you need to contact your healthcare provider, your asthma is not fully controlled.  I often tell my patients, they say no I haven't needed my albuterol, they say they haven't used their albuterol.  I say have you not used it because you lost it or you just kinda pushing by because you otherwise are healthy or did you actually really need it?  Were there some cases where you actually needed it and you just didn't have it?  We have to educate people not to ignore those symptoms.

YOUNG: None of us wants to either have a chronic illness ourselves or label our children as having chronic illnesses.  There is a very powerful tendency to ignore symptoms or as Dr. Patterson says to push through them, not admit to ourselves that we are suffering from those things.   So a real honest self examination is an important first step and that ought to trigger a conversation with your healthcare provider about not only an action plan, what to do in those situations, but help identify what the triggers are.  As you mentioned, asthma is a disease that can be quiet for a long period of time, then something happens, the patient gets a cold, they expose themselves to some pollen, they go visit a friend with a cat, who knows what it is, it is different for every patient and that needs to be part of the discussion that you have with your healthcare provider.

LOMAX-REESE: So there is albuterol, but what are some of the other treatment options and then we have a guest on the line we are going to go to in just a moment.

YOUNG: We classify asthma medications into two categories; albuterol is the most commonly used example of what we call a reliever.  It is a rescue medication that ideally would never be required because a patient's disease may be so well controlled.  But in realty we give prescriptions for albuterol to all of our asthma patients so that they can rescue themselves from symptoms.  The other category is called control medications and those are things in many patients need to be taken week in and week out, even if they have no symptoms.  Two examples of controller medications would be an inhaled corticosteroid, some of the brand names would be Advair, Symbicort, DuoNeb, Dulera.  There are pill medications, which would be singular, these are controller medications that don't relieve symptoms immediately, they have to be taken chronically to keep the inflammation down and the airways under control.

PATTERSON:  So I want to emphasize to people, a lot of times my patients will use their albuterol inhaler and they get an immediate relief from that but again, that is rescue.  The maintenance is the medicine that you have to take every day to decrease the inflammation and I tell my patients that if you take it every day and decrease the inflammation, that decreases the risk of having life long irritation from asthma.  It really does improve your health as opposed to using albuterol which is just rescue.  You can overuse your albuterol and actually cause problems.  So if you are using your albuterol more than twice a week, that is too much and if you are needing a refill of your albuterol more than once a year for most patient, then that's too much and you need to see your doctor.

LOMAX-REESE: Great information.  We are talking with Dr. Donee Patterson and Dr. Randy Young, both from Einstein and Dr. Young is the Chief of the Division of Pulmonary and Clinical Care medicine at Einstein and Dr. Donee is a family  medicine expert at Einstein and right now we are going to……