Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice

GUIDELINE TITLE
Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice recommendations.

BIBLIOGRAPHIC SOURCE(S)
Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J. Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr 2009 Mar-Apr;33(2):143-9. [65 references]

GUIDELINE STATUS
This is the current release of the guideline.

open here to see the full-text:
Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice

Is asthma a disease of sunlight/vitamin D deficiency?

Yes. Asthma, to a great extent, is caused by sun avoidance and consequent vitamin D deficiency.

Asthma, a devastating respiratory illness, is increasing rapidly in the US. The latest statistics I have show that the overall prevalence of asthma increased 75% from 1980-1994, and asthma rates in children under the age of five increased more than 160%.[1]

There is little doubt that the profound increase in asthma in the last few decades has been caused to a great extent by our societal exodus from sunlight exposure along with the increased use of sunscreen, which can inhibit up to 99% of vitamin D production by the skin.[2]

Drs Litonjua and Weiss, in a medical hypothesis presented in 2007, made a strong case for vitamin D deficiency as a major player in the increase in asthma incidence among both children and adults.[3] They hypothesized the following:

1. “… as populations grow more prosperous, more time is spent indoors, and there is less exposure to sunlight, leading to decreased cutaneous vitamin D production.”
2. “Vitamin D has been linked to immune system and lung development in utero, and our epidemiologic studies show that higher vitamin D intake by pregnant mothers reduces asthma risk by as much as 40% in children 3 to 5 years old.”
3. “Vitamin D deficiency has been associated with obesity, African American race (particularly in urban, inner-city settings), and recent immigrants to westernized countries, thus reflecting the epidemiologic patterns observed in the asthma epidemic.”

Other research demonstrates that vitamin D reduces the production of inflammatory chemicals (chemokines) in the respiratory passages,[4] which would dampen the asthmatic response.

Another study assessed the asthma risk of children whose mothers had the highest vitamin D consumption during pregnancy, and compared them to children whose mother had the lowest levels. The high-vitamin D group showed an impressive reduced risk of asthma of 52-67%.[5] The researchers believe that inadequate vitamin D levels in the fetus leads to improper development of the lungs and immune system.

Still other research, conducted on three-year old children whose mothers were in the highest quartile (fourth) of vitamin D consumption during pregnancy, showed them to have a 61% reduced risk of a “recurrent wheeze,” a symptom of asthma, when compared to those whose mothers were in the lowest quartile.[6] Each 100-IU increase in vitamin D consumption resulted in a 19% risk reduction. That’s about the amount that could be produced in the summer sunlight in one minute, or a good tanning bed in half a minute! How sad that these women have been frightened out of the sunlight, the natural way to produce vast quantities of vitamin D.

[1] Centers for Disease Control. Surveillance for Asthma – United States, 1960-1995, MMWR. 1998; 47 (SS-1).
[2] Matsuoka, L. et al. sunscreens suppress cutaneous vitamin D3 synthesis. Journal Clini Endocrinol Metab 1987; 64:1165-68.
[3] Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol 2007;120:1031–1035.
[4] Banerjee, A. et al. Vitamin D and glucocorticoids differentially modulate chemokine expression in human airway smooth muscle cells. Br J Pharmacol 2008; 155: 84–92.
[5] Devereux, G. et al. Maternal vitamin D intake and early childhood wheezing. Am J Clin Nutr 2007;85:853-59.
[6] Camargo, C. et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y. Am J Clin Nutr 2007;85:788-95.

Getting Records for a Child SSI Disability Claim

I’ve only said this about a thousand times here. Disability cases boil down to what’s in the records. Typically, that means medical evidence in medical records. However, for an SSI child disability claim, records can also include school records, and this can be the case whether the child’s impairment is physical or is a mental impairment.

Why would you have to gather school records for a child who is applying for disability on the basis of, say, ADHD, autism, a learning disability, or impaired cognitive functioning (mental retardation, or borderline intellectual functioning)? Because child disability claims are very different from adult cases.

For adults who file for disability, the deciding factor will be whether or not the individual can engage in work activity, either past work or some type of other work.

For child disability claims (SSI), cases are decided on the basis of whether not the claimant can engage in age-appropriate activities. This typically boils down to intellectual and academic performance in comparison to one’s peers. And, of course, even a physical impairment, such as seizure disorder or asthma, can have an effect on things like this. One has simply to remember that the social security administration is chiefly concerned with functionality. The reason why (i.e. the condition itself) is largely irrelevant.

What type of academic records do you gather for a child SSI disability claim and how do you gather them? Let’s discuss the “how” first. This can vary tremendously, depending on the school district. Sometimes, record requests are sent to a centralized records department for a school district, sometimes they are sent to a school’s guidance office, sometimes they are sent to a school’s main office (the principal’s office), and sometimes, less frequently, they are sent to the direct attention of a teacher.

How will you know where to send the record request to? There’s really only one way, especially since protocol can vary even between different schools in the very same school district. You should call the school in question and ask them where a request for records on a student in attendance should be sent. As always, of course, send a release form and make sure the request is detailed enough so that you’ll actually get back the records you need (otherwise, you could end up getting nothing but grade reports when what you really need is achievement and IQ records).

Problems you may run into in gathering records from a school may include A) general incompetence and B) the school’s operating schedule. Regarding A, it can be difficult to gather academic records because many schools (this may or may not surprise people) are run poorly from an administrative standpoint. Regarding B, it can be very difficult to obtain records when a school is on break. Summer breaks can literally mean an inability to obtain records for months at a time, which can be extremely problematic for a disability hearing that is being held in a summer month.

What type of records will be requested on a child SSI Disability claim? Really, anything that may point to functionality and impaired functioning. Logically, this includes grade reports, IEPs, and copies of specialized testing, such as intelligence testing and academic achievement testing. However, it can, and should, also include completed questionaires from a child’s teacher, or teachers. Such questionaires can deliver (to an administrative law judge holding a hearing) a detailed first-hand account from the one individual who is uniquely qualified to report on a child’s ability to engage in age-appropriate activities in a school setting; namely, the child’s teacher.

How do you send such a questionaire to a teacher? You may first wish to determine which teacher to send the form to. If the child has a single teacher, the choice is obvious. If the child has multiple teachers such as in higher grade levels, this may be a matter of sending multiple questionaires in the hope that at least one teacher will fill one out and return it.

Where are teacher’s questionaires obtained? This is not the type of form that is used by the social security administration, which is odd considering that SSA will obtain reports on a adult claimant’s ADLs, or activities of daily living. However, SSA also does not send RFC, or residual functional capacity forms, to a claimant’s doctors, so this should not be too surprising.

Teacher’s questionaires are typically sent out by a claimant’s disability attorney, and generally this effort is only made in preparation for a disability hearing.

As this is the case, a parent who is filing for child disability benefits may actually wish to ask their chosen disability representative if an attempt will be made to obtain such a questionaire. Not doing so is equivalent to being less prepared for a hearing than ideally would be the case. And for this reason, a parent who learns that their child’s attorney will not attempt to gather such information may wish to find other representation.

Return to the Social Security Disability SSI Benefits Blog

Social Security Disability and SSI, what is the difference?
Can I win my social security disability claim?

Introducing Asthma

      Asthma is a disease that effects the lungs due to inflammation of the airways. Symptoms of asthma are episodes of breathlessness, chest tightness, and wheezing. These symptoms make breathing a challenge and in the United States this affects nearly 25 million individuals, this accounts for both adults and children alike (CDC, 2009.) While there is no cure for asthma right now there are ways to limit the severity of the onset of asthma “attacks.” Some ways of doing this are through awareness of possible asthma triggers as pertaining to the individual and with the help of medicine which will further be discussed.

Clinical implications suggest that examining the ecological context may enable practitioners to identify social and environmental factors that challengethe management of childhood asthma. (Yinusa-Nyahkoon 2007)

Asthma: “Inflammation of the air passages resulting in the temporary narrowing of the airways that transport air from the nose and mouth to the lungs. Asthma symptoms can be caused  by allergens or irritants that are inhaled into the lungs, resulting in inflamed, clogged and constricted airways. Symptoms include difficulty breathing, wheezing, coughing tightness in the chest. In severe cases, asthma can be deadly.”
(AAFA; Asthma and Allergy Foundation of America)

• There is no cure for asthma, but asthma can be managed with proper prevention and treatment.


• Asthma has a genetic component. If only one parent has asthma, chances are 1 in 3 that each child will have asthma. If both parents have asthma, it is much more likely (7 in 10) that their children will have asthma.


• More Americans than ever before say they are suffering from asthma. It is one of this country’s most common and costly diseases.

Every person who struggles with asthma needs to recognize the catalyst of an attack via coughing, chest tightness, wheezing, and trouble breathing (symptoms.) Every person has their own personal triggers that set off an asthma attack. It is important for individuals to be knowledgeable of their particular triggers in order to avoid or at least reduce attack situations.(CDC)

Common triggers:

                           Dust mites

                           Secondhand smoke

                           Strenuous Physical Activity

                           Outdoor air pollution

                           Cockroach allergen

                           Pets

                           Mold

Here is an interesting link that will guide to a well done and informative brochure titled “You Can Control Asthma” CLICK HERE

Parent-Child:
Overall, four routines are looked at and managed by both the children and parents of the children with asthma. These routines are adapted by both the children and adults to which they adjust treatment recommendations to be utilized within their personal ecological context.
          1. Child with asthma given responsibility for medication use
          2. School nurse availability monitored
          3. Air quality analyzed managed at best efforts
          4. Home environment cleaned often

(Yinusa-Nyahkoon, 2007)

Family/Friends:
The education of family and friends on the topic of asthma is very important. If an individual diagnosed with asthma is surrounded by people unaware of the triggers of that individual then that individual will suffer. It is also important that the diagnosed individual is not the only person monitoring their use of medication/inhaler. The more aware and educated the family and friends are of the diagnosed individual the more likely that person will be able to live at a higher quality of life.

Social Support:
The more support and understand that surround the diagnosed individual the more they will accept their condition themselves. As an adolescent it can be viewed as embarrassing to be wheezing and struggling to breath in front of their peer group. With this embarrassment can come the lack of using an inhaler and being physically active (if a trigger.)

Support groups for both adults and children are much more readily active and available then one might think. Through the Asthma and Allergy Foundation a variety of support groups can be found. By clicking on SUPPORT GROUPyou will be able to find out more about support groups and what they offer as well as locate a possible local and convenient support group for yourself or someone you know.

In response to the growing asthma problem the United States Environmental Protection Agency (EPA) created a national asthma education and outreach program.While there is no cure, asthma can be controlled through medical treatment and management of environmental triggers.

THE GOAL: Reduce exposure to indoor asthma triggers and improve the quality of life for 6.5 million people by 2012.

Asthma Awareness and Education:
The month of May is “Asthma Awareness Month”

Follow the provided link to access the Asthma Awareness Month Event Planning Kit (February, 2010) to kick off your activities. The Kit includes tips for:

• Holding an asthma awareness event at a school, local hospital or clinic, library, or your state’s capitol building;


• Distributing asthma materials and educating parents on the risks of second-hand smoke;


• Partnering with local organizations to pool resources and increase publicity for your event;


• Collaborating with local leaders/celebrities to boost awareness for your campaigns;


• Garnering media attention for your event; and Much more

The growing awareness of asthma is great but it is important that those who have been made aware continue their duty by making others aware! They can do so by contributing to any of the previously listed bullet points.

Asthma in the Schools:Asthma awareness in school should be of great focus. Being aware that asthma is the most common chronic condition among children (AAFA) and knowing that children spend almost half of their days in a school setting shows that schools and their facilities can essentially contribute to half of the problem that is asthma. With that said, taking these preventative measures in the school settings can only make a positive impact.

1. Establish and Continuously Evaluate an Indoor Air Quality – IAQ – Management Program in Your School or District.

2. 
   Develop an Asthma Management Plan in Your School or District.
   Incorporate school policies to encourage a safer and more stable environment for students with asthma. This could range from access to inhalers to faculty education training on the topic of asthma.
   
   

3. 
   Reduce Environmental Asthma Triggers.
   This can be done by inspecting the school facilities thoroughly on a regular basis. Topics of focus should be mold, moisture, and source of indoor air pollutants.

(EPA)

Facilities:
As widely discussed with asthma it is very important that individuals with asthma recognize and avoid their personal triggers. Many possible triggers can be found indoors such as mold, pets, and chemical odors. With this knowledge it is important that thorough inspections are given in any facility that the individual who has asthma finds themselves spending amounts of time in.

Racial/Demographic:
In regards to asthma and the racial disparities of outcomes of the chronic disease African-American children demonstrate poorer clinical outcomes that any other racial group. Among children with asthma a higher level of quality of life is typical for the children who live in rural areas in comparison with those from cities.

• African Americans are three times more likely to be hospitalized from asthma. [13]


• African Americans are three times more likely to die from asthma.  African American Women have the highest asthma mortality rate of all groups, more than 2.5 times higher than Caucasian women.
  

(AAFA)

The American Lung Association (ALA) worked with partners to develop the National Asthma Public Policy Agenda to reduce the suffering and death from asthma. The ALA hope that groups and individuals who care about asthma will embrace the recommendations found in the Agenda and push to get them put in place nationwide.

This agenda focuses on health-care, homes, outdoor air, public health infrastructure, schools, and workplaces. I list both health-care and home agendas to give you, the readers, an idea of the direction of ALA while you can find information on the rest of the categories and sub categories by following this link …

National Asthma Public Policy Agenda

Health-Care:
1.All health-care systems, including public and private providers, purchasers and payers, should provide access to services and medications consistent with the National Asthma Education and Prevention Program (NAEPP) guidelines. 
The health-care needed is not provided to many people with asthma as a means of controlling it. Asthma is an individualized disease and each person needs a specific diagnosis and plan of attack in order to properly control their struggle with asthma. With that said each asthma patient should be given acces to adequate care, medications, and education.

2. Standardized national performance measures should be adopted for monitoring and evaluating asthma quality of care.
Monitoring performance measures will allow for the tracking of hopeful progress of asthma patients. In doing so not only will the patients be looked after but the quality of care for these patients will be studied.

3. Promote quality improvement activities and develop and disseminate tools that support achievement of performance goals. 
Support for these activities can help make sure the quality of care is at its best.

Homes:
1. Housing code ordinances should protect people with asthma against indoor air problems. Housing codes are an established tool that can and should be used to reduce asthma triggers in homes. However, these codes vary considerably in their requirements and are often underused.

2. Housing code enforcement should be strengthened to reduce prevalence of indoor air quality problems.  Unhealthy indoor air can be a threat to anyone at home, especially those with asthma. Reducing these risks can lead to better management of the disease.

3.  Multi-unit housing should be smoke-free. Second hand smoke is a threat for people with asthma and a serious indoor air pollutant that should be eliminated. Having smoke-free housing is an important step to help those with lung disease.
(ALA)




REFERENCES

Asthma Facts and Figures. Retrieved November 13, 2010 from Asthma and Allergy Foundation of America Website: http://www.aafa.org/display.cfm?id=8&sub=42

 

CDC - Asthma - Basic Information. (2009, October 20). Centers for Disease Control and Prevention. Retrieved November 11, 2010, from http://www.cdc.gov/asthma/faqs.htm  

Yinusa-Nyahkoon, L., Cohn, E., Tickle-Degnen, L., Cortés, D., Lieu, T., & Bokhour, B. (2007). Examining
     routines to understand the ecological context: managing childhood asthma. OTJR: Occupation,
     Participation & Health, 2797S-99. Retrieved from CINAHL with Full Text database.

(2010, October 5). May is Asthma Awareness Month. Retrieved     November 14, 2010 from U.S. Environment Protection Agency     Website: http://www.epa.gov/asthma/awm/index.html

 

(2010). Health-Care Systems and Financing. Retrieved November 14, 2010 from American Lung Association Website: http://www.lungusa.org/lung-disease/asthma/advocacy/reports/health-care-systems.html 

(2010, October22). Managing Asthma in School Environment. Retrieved November 13, 2010 from U.S. Environmental Protection Agency Website: http://www.epa.gov/iaq/schools/managingasthma.html

 

(2009, April 24). Asthma. Retrieved November 13, 2010 from Center for Disease Control and Prevention Website: http://www.cdc.gov/asthma/ 

 

Asthma, -little information...

Asthma is a common disease which affects the respiratory system. It constricts the airways and they become inflamed and lined with mucus. It can be managed well.

Many children develop asthma, which eventually they grow out of. The triggers associated with asthma include:

• Allergies
• Stress
• Exercise
• Cold air

Genes may also play a role who is getting asthma and who not.

The symptoms of asthma include:

• Wheezing
• Coughing
• Chest tightness
• Short of breath

Early detection, diagnosis and treatment is important, otherwise asthma could become a life-threatening disease.

25% of the children will develop asthma and the percentage is not increasing, but only staggering.

The children must get enough breast milk as long as possible. The antibodies and the combination itself is the best for the infant to develop its immune system. Try to avoid cow milk for the infants till 12 months and here we observe these children get less allergies and asthma. If you are not having enough breast milk, select other food, but not milk or milk powder based formulas. Now-a-days without any problems this could be done.

Good medicines are available. Theophylline is the medicine used and it belongs to the group of thioxanthenes. Caffeine also belongs to this group and is good for persons who have asthma. But there is no cumulative effect from both. If we find theophylline values in toxic levels we ask the patient to drink four cups of strong coffee and the caffeine present there helps for the quick excretion of theyphylline.

Asthma is one of the fastest growing health problems in all developed countries.

This a short article to give you quick information.

Allergy asthma

Allergy asthma

Asthma and allergy  can often go hand in hand. Asthma is a disease of the branches of the trachea (bronchi) that carry air in and out of the lungs. There are several different types of asthma. Allergic asthma is a type of asthma that is triggered by allergies (eg pollen or mold spores). According to the American Academy of Allergy, Asthma and Immunology, half of the 20 million Americans with asthma suffer from allergic asthma

Family history of allergies is an important risk factor for allergic asthma. Another risk factor is to have hay fever or other allergies. More than one in four people with hay fever also develop asthma. Although allergic asthma is the most common are other forms of asthma and active asthma such as exercise-induced asthma and allergic asthma triggered by infections or cold air or gastroesophageal reflux disease (GERD). Some people have asthma caused by more than one type of trigger.
If you have a bothersome allergy and asthma symptoms, talk with your doctor. Recognize the relationship between immune system and how the airways react has improved asthma symptoms for many. Knowing that you start, when the measures to avoid them, and work with your doctor to find the right treatment to manage symptoms to help maintain both the symptom control of asthma and allergies.

Warning signs of asthma attack

The first signs begin before symptoms most influential of asthma and are the first signs of a person’s asthma. Signs and symptoms of asthma are:

• Frequent cough, especially at night.


• Taber breath easily or shortness of breath.


• Feeling very tired or weak when exercising.


• In addition to wheezing, coughing, shortness of breath rates or changes in peak expiratory flow is a measurement of air speed of your lungs when you breathe heavily signs of a cold or other respiratory infections or allergies.


• Sleep disorders.


• If you have any of these symptoms of asthma, seek treatment as soon as possible to avoid suffering a severe asthma attack.

Some medications for allergies and asthma, but may be different. For example, corticosteroids reduction you spray in your nose inflammation from hay fever. Corticosteroid creams applied to the skin, reduce inflammation of allergic skin reaction. And inhaled corticosteroids, which you breathe into the lungs using an inhaler device, reduce inflammation of the bronchi caused by asthma. Taken in pill form, montelukast (Singulair) is used to help with symptoms caused by allergies and asthma. Called leukotriene modifier, this drug helps regulate the immune system chemicals released during an allergic reaction. Some other drugs are much more effective for a condition for a second. Antihistamines, for example, are commonly used to treat hay fever, but does not function well in the treatment of asthma. bronchodilator inhalers, which open congested airways, are a big part of asthma treatment, but they are used to treat hay fever.

You Can Exercise, Even If You Have Asthma | Asthma Treatment Tips ...

If we have asthma, we substantially can not use properly or safely. Contrary to what many consider of this issue, there have been ways we can get fit as well as exercise, even if we have asthma.

Asthma is a chronic lung disease, which is marked with features such as coughing, wheezing, crispness of breath as well as chest tightness. Asthma tends to start in people who have been genetically or environmentally presdisposed is okay.

Some triggers which might initiate or have an conflict worse include exposure to allergens, viral respiratory infections, airway irritants, use as well as exposure to things similar to dirt mites or cockroaches.

You can forestall asthma attacks as follows:

1. Rinse your pet upon a weekly basis.

2. Do not smoke or smok
ing in your home.

3. When I imitation or Pollentia is great, we should stay indoors with air conditioning.

4. Wash bedding as well as stuffed toys weekly in hot water.

5. Wash your hands every time we get.

6. Get a influenza shot.

7. Use a headband over his mouth as well as nose in a winter months.

8. Be proactive as well as know your triggers as well as how we should avoid.

Now which we know what we know about asthma, we might wonder if a use is similar to most doctors will discuss it you, do not give up in sport or use at all. Just be smart about how to play as well as take special precautions to forestall attacks before.

Almos
t all doctors determine which a most appropriate approach to forestall attacks during use is to keep your inhaler as well as medication tighten by. You should never use a inhaler more than 3 times during a game session or practice. If we have been up a previous night with coughing as well as wheezing, it is regularly most appropriate to go light your use a next day.

Something known as IEA (exercise induced asthma), symptoms have been somewhat different, which demeanour similar to after 6-10 minutes of physical activity as well as is mostly worse in cold air or dry.

If we have IEA, there have been several activities we can enjoy such as swimming, walking, cycling, skiing as well as team sports based. There have been many activities for we to select to safeguard we get a use we need as well.

Remember which a condition of asthma is not all in your
head, is a real physiological healing diagnosis which requires diagnosis for a impediment as well as treatment. Even if a doctor is your most appropriate friend for a diagnosis of asthma, six a usually one who can equivocate a symptoms.

There is regularly a leg, take drugs as well as be proactive. Do not let which have living in misery how can we enjoy exercising similar to everyone else

weslo cadence treadmill

Asthma inhalers

The New York Times has an excellent piece today on the phasing out of old asthma inhalers, which has already begun. However, the old asthma inhalers will completely unavailable by the end of the year. Many asthma inhalers are pressurized metered dose inhalers (pMDI’s) which means that when you push down on them, the medication sprays out like an aersol spray. Not all inhalers are pMDI’s. Some of the newer inhalers are dry powder inhalers (DPI’s) where the medicine is not sprayed out, but simply inhaled (Advair and Pulmicort are both DPI’s). However, all the rescue medication products available in the US (which is almost always albuterol) are only available in pMDI’s. The problem is that the propellant in these sprays was a CFC, which is bad for the enviornment. CFC’s have been banned by the government, and the asthma inhalers are the last remaining consumer products to have them. The new pMDI’s are made with another propellant, that is more environmentally friendly, HFA. However, there are several differences between the CFC pMDI’s and the HFA pMDI’s.

There is no generic albuterol HFA
The FDA considers the HFA inhalers new drugs, even though the active ingredient is off patent.
Issue #1- if the physician just writes albuterol, the pharmacist will likely dispense the CFC pMDI which will not be available in January 2009, and more importantly may not be available now because supplies are limited
Issue #2- if the physician writes albuterol HFA, since this product does not exist, the pharmacist will likely substitute one of the 3 branded products (ProAir, Ventolin HFA, and Proventil HFA). However, it may matter to you which one of these you get because………
Issue #3- each insurance company has a different policy regarding the CFC to HFA transition. The HFA inhalers are much more expensive. On the other hand, insurers worry that increasing the cost of the co-pay may decrease the use by patients and land them in the Emergency Room. Some insurers have picked one of the 3 products and assigned it a generic co-pay while others have no preference and assign all products the same higher co-pay.

There are some differences between the old CFC inhalers and the new HFA inhalers
The spray from the HFA inhalers is weaker. Inhalers require more priming (wasting the first few pumps) before the first use. Patients may feel a difference in the force and taste of the spray ( and confuse this for the medication not working). The HFA inhalers also require a slower and deeper inhalation.

There are some differences between the new inhalers
ProAir, Ventolin HFA, and Proventil HFA are all albuterol products. Ventolin HFA (made by GSK) has one advantage in that it has a dose counter. Research has shown that many asthmatic patients incorrectly estimate how much medication is left in their inhaler. Most inhalers will continue to spray propellant even when the active ingredient has been used up.
Finally, there is a 4th product called Xopenex, which is levalbuterol. The medication is very similar, but because of its structure may have fewer side effects such as shaking or rapid heart beat. Though the branded Xopenex HFA is currently more expensive than the generic albuterol CFC, when compared to the other three albuterol HFA’s, Xopenex may be the same or even less of a co-pay then the others, depending on your insurance.

What you should do
1. If you have asthma, disccus the CFC to HFA conversion with your doctor to make sure you are getting the right medication.

2. Know the co-pay level that your insurance will charge you for ProAir, Ventolin HFA, Proventil HFA and Xopenex HFA. If any of these are a generic co-pay, switch now. All things being equal, Ventolin (dose counter) and Xopenex (fewer side effects) may be preferred.

3. Use these medications for rescue only. The medications are really only for bad symptoms and emergencies. Current guidelines state that if you are using these medications more that two times a week, your asthma is not well controlled, and you need a better maintenance inhaler, which is an inhaler you take every day to control your asthma.

4. Recognize the differences between the HFA and CFC inhalers. As above, the spray will feel different, and will require some adjustments (priming, slower inhalations) than your previous albuterol pMDI.

5. Do not use Primatene Mist to save a few bucks. This is an over the counter asthma inhaler. It is dangerous and would never be approved by the FDA today. Older medications that are currently over the counter need to have been proven to kill or severely injure people before they will be pulled from the market. This is hard for Primatene Mist, because hard to say whether or not it was the inhaler or the asthma. The active ingredient is epinephrine which has a lot of side effects.

Denver Zoo (Follow Up)

As a family we journeyed to the Denver Zoo on a very cold Saturday afternoon. As I mentioned in my previous post, it was a free day. I also mentioned that it didn’t feel crowded the week day I went. Well, Saturday felt crowded. I’m not sure whether it was because it was a Saturday or because it was cold, so we spent a lot of the time indoors viewing the animals(with everyone else). Not many animals to see outside.  Maybe it was a bit of both. Anyway, I was a little disappointed. My kids on the other hand had a great time and can’t wait to go back. I’m anxiously awaiting for the free dates for 2011 to be posted. If the free dates are only scheduled for the colder parts of the year I may have to get an annual pass.

Go to www.DenverZoo.org to check out the current prices, upcoming events, and free days (hopefully posted soon). To find free days: click on the quick links drop down menu and click Free Days.

Asthma - refine your technique

Tweet

   I was reading the Australian Prescriber catching up with the latest advice for Doctors on controlling asthma, and was disturbed by some of the information I found there. Thankfully the number of deaths has fallen over the years and yet asthma still causes considerable health problems and impacts on the lives of many millions around the world.

Although medications haven’t changed fundamentally over the years, the way they are used and the way patients should be reviewed has. But we are falling dramatically short of good and effective care partly due to poor education and partly due to poor compliance by the asthmatics themselves: ” more than half of the people aged 15–34 years (who have asthma) .. (pick up their) medications only once in a year. Most patients use their inhalers incorrectly, and only 22% of patients have a written asthma action plan”. These are not encouraging findings!

Picking up on the poor technique of most asthmatics, I’ve cut and pasted the suggestions from the Oz Prescriber so that those of you with asthma, or who have children/adolescents with asthma, can review what you are/they are doing and see if you can do it better.

                                                     Common problems with inhaler devices

• breathing out through the inhaler mouthpiece leads to condensation and clogging of the nozzle


• difficulty actuating inhaler (for patients with arthritis, an aid may be available and fitted around the inhaler to ensure easier use)


• failure to coordinate actuation with inhalation. At its worst, medication will be seen to escape from the top of the inhaler.


• too fast an inhalation


• failure to hold breath after inhalation


• multiple actuations without shaking between doses, or on the same breath


• failure to replace cap on inhaler (leaves patient at risk of inhaling foreign bodies from pocket or handbag)


• failure to use a spacer with an inhaled corticosteroid-containing medication (the spacer increases lung deposition and hence efficacy, and reduces the risk of local adverse effects)

                                              Pressurized metered dose inhaler with spacer

• failure to prepare spacer before first use, to reduce the static charge which will otherwise prevent medication reaching the airways (wash in warm detergent water, do not rinse, allow to air dry,


• reassemble; there is no need to prime with puffs of a salbutamol inhaler)


• too-frequent washing without detergent priming (regenerates the static charge)


• sticky valve (the spacer should be washed once a month as above, or if the valve sticks)


• multiple actuations of preventer inhaler into the spacer at one time


• delay between actuation and inhalation


• too-fast inhalation, without a breath-hold at the end

                                                                       Autohaler

• failing to lift the lever before inhaling


• stopping breathing in when the click is heard


• failure to hold breath

                                                                      Accuhaler

• breathing out into inhaler


• not loading dose (by pushing lever) before inhaling


• not holding breath after inhalation


• not closing inhaler cover after use

                                                                      Turbuhaler

• not holding Turbuhaler upright during priming (loading) of dose


• not twisting base both around and back (note: it does not matter whether the click is heard at the end of rotation around, or at the end of the rotation back, as long as the base is rotated in


• both directions)


• not breathing in strongly enough


• not holding breath after inhaling dose


• breathing out into inhaler

reference
image

How To Save Someone From An Asthma Attack

Asthma is a condition that inflames the airways, making it difficult to manage normal breathing. There are a wide variety of ‘asthma triggers’ such as dust and fur from pets. These nuisances cause the body to release histamine, which inflames and narrows the airways. It usually takes a course of medication to alleviate the symptoms of an asthma attack. A small amount of training on the treatment protocol can go a long way in helping a sufferer.

One of the main symptoms of an asthma attack is an overall feeling of breathlessness. The resulting narrowing of the airways will also cause the chest to tighten up, whereby the sufferer may even be clutching on this region of the body. Bouts of coughing can accompany the above symptoms, alongside ‘wheezing noises’, which are caused by a blockage when breathing in and out.

Cyanosis is also quite common. This is visible by the skin taking a grey / blue appearance, and may also be evident in the extremities like the lips and finger tips. These symptoms are similar to other serious breathing disorders; therefore it is important to talk to the casualty and those around them to work out if they suffer from the condition.

The first port of call when treating a casualty is to sit them down, and allow for a period of rest. This is by no means the cure; however the sufferer will increase the pressure on the respiratory system by standing up, or by being in an agitated state. The next step after recognising an ‘asthma attack’ is to search for the sufferer’s medication. This usually takes the form of a small blue / brown cylinder, which should be carried at all times. The casualty should be encouraged to draw two puffs from this, every two minutes, for a maximum of ten puffs. The emergency services should be called if there is no access to medication, no improvement, or after ten puffs from the inhaler.

As with most conditions, the treatment protocol does not always go entirely to plan. The main issue that arises is insufficient access to the sufferer’s medication. This may be because they have forgotten to take it out with them, or possibly as a result of not being diagnosed with the condition. The inhalers are vital in alleviating the symptoms of an attack. A casualty’s breathing will become more and more laboured without medication, up to a point where they could even suffer from a cardiac arrest. Those who have received first aid training need to be prepared to start cardio pulmonary resuscitations (CPR) in the event of a cardiac arrest.

Luckily there appears to be a new vaccination on the way, which could help stop asthma attacks all together. It has been dubbed the ‘supercharged’ vaccine as it fires electrical pulses through the skin, directly into the cells within the immune system. This then naturally increases the amount of helper cells, which fight against the harmful effects from mites and house dust. It may well be in the early stages, but this could be the answer that asthma sufferers have been searching for.

Bill Casserley is an experienced first aider, who truly believes “life is for learning”. Could you spot the signs of asthma? If not then visit the first aid training courses blog @ http://www.train-aid.co.uk for video tutorials.

Article Source: http://EzineArticles.com/?expert=Bill_Casserley

Good news for asthmatics: Obama administration set to ban over-the-counter inhalers to save ozone layer

““Everybody knows that it makes no sense that you send a kid to the emergency room for a treatable illness like asthma, they end up taking up a hospital bed, it costs, when, if you, they just gave, you gave them treatment early and they got some treatment, and a breathalyzer, or inhalator, not a breathalyzer. I haven’t had much sleep in the last 48 hours.”” –Barack Obama, 9 October 2008

Wonderful news from the environmental do-gooders in Washington: the Obama administration is poised to ban over-the-counter breathalyzers, I mean inhalators, I mean inhalers in order to save the ozone layer

Remember how Obama recently waived new ozone regulations at the EPA because they were too costly? Well, it seems that the Obama administration would rather make people with Asthma cough up money than let them make a surely inconsequential contribution to depleting the ozone layer:

Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government’s latest attempt to protect the Earth’s atmosphere.

The Food and Drug Administration said Thursday patients who use the epinephrine inhalers to treat mild asthma will need to switch by Dec. 31 to other types that do not contain chlorofluorocarbons, an aerosol substance once found in a variety of spray products.

The action is part of an agreement signed by the U.S. and other nations to stop using substances that deplete the ozone layer, a region in the atmosphere that helps block harmful ultraviolet rays from the Sun.

But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for around $ 20, whereas the alternatives, which contain the drug albuterol, range from $ 30 to $ 60.

As Anthony Watts observes, “Let the hoarding begin“:

The eco-world has gone beserkers with this one, even CBS News is asking: Why? Me too especially since global ozone is predicted to recover [according to a 2004 EPA Report].

…What will really happen is that this will turn regular people and children into scofflaws, and they’ll buy over the counter inhalers in other countries like Mexico and have them shipped here. It will be another giant sucking sound.

So when some kid dies in 2012 because they couldn’t get access to an inexpensive, over-the-counter inhaler, let’s all give thanks to President Obama — because that’s one less ozone destroyer that we have to worry about.

European Medicines Agency - Human Medicines - Referrals - Article 29 paediatric referrals

Human Medicines – Referrals
List of Referrals – Article 29 – ‘paediatric referrals’
Background
Article 29 of Regulation (EC) No 1901/2006 as amended foresees that an application as referred to in article 8 of the said regulation can be submitted, in accordance with the procedure laid down in articles 32, 33 and 34 of Directive 2001/83/EC, for products authorised under Directive 2001/83/EC.

In this referral procedure, the marketing authorisation holders may apply for a new indication, a new pharmaceutical form or a new route of administration.

The application shall comply with the requirements laid down in point (a) of article 7(1) of Regulation (EC) No 1901/2006, regarding the inclusion of the results of all studies performed and details of all information collected in compliance with an agreed paediatric investigation plan.

At the end of the referral, the CHMP opinion may contain a recommendation for some changes to the prescribing information (such as the Summary of Product Characteristics wording), for the approval of a new pharmaceutical form and/or a new route of administration. It can also contain some conditions to the marketing authorisation, to ensure the safe and effective use of the medicine in the paediatric population. The assessment is limited to the specific sections of the product information to be varied.

open here please:
European Medicines Agency – Human Medicines – Referrals – Article 29 paediatric referrals

Getting your dog trained for wearing Dog Clothes

The fabulous pet fashion is tempting a lot of owners; actually, it has become quite normal to have your own designer for your small pet. The owner is accustomed t believing that his pet is a real treasure and he will be interested in buying small dog clothes that are matching the pet’s personality. The dog will thus be fully integrated in the human family and culture; the family dog is likely to eat in the kitchen and sleep in his owners’ bedroom. Therefore, the pet is a special creature that demands for your attention; therefore, it is quite normal for you to try to dress your pet with designer clothes and accessories. There are many choices when it comes to searching for the perfect canine outfit; actually, there is something for almost every breed and the clothing will come in the necessary sizes as well.

But you will have to train your dog in order to wear the chosen clothing; you will have to be patient enough because this type of training is going to last for a while. Time is required in order to teach your dog about the small dog clothes. The dog must feel comfortable in these clothes; otherwise, he will try to tear them apart. Every dog is likely to be an amazing and very adaptable animal; he will get accustomed to his new outfits but you have to choose the clothing that is less restrictive when it comes to the dog’s freedom to move. Most dogs are likely to enjoy the extra attention that will come along with the dressing time but you have to pay attention to the dog’s personality in order to decide whether a canine clothing is the best choice for him or not.

You may be lucky enough to have a good dog but you also have to take into account the fact that bad dogs are likely to be found anywhere. Therefore, you have to make sure that you choose a responsible breeder who can provide you with a good and healthy puppy. The dog needs to find that you are his genuine friend in order not t be afraid of you; actually’ this recognition is the first step to be made in order to train your dog in the appropriate manner. You may put a warm t-shirt right in his face when is chilly outside in order to make him feel secure about your friendly presence. You will be able to mold him into a good dog by learning how to establish a warm relation with your pet. If you manage to achieve this, you will also be able to train him in order to be dressed in Dog Clothes. The dog will be pleased to receive your extra attention and he will enjoy every moment of it. Therefore, a good dog is likely to come along with a good owner because you are able to mold your pet in whatever you want him to be.

Every owner should expect to constant dealing with mistakes because the housetraining may come along with barking, digging, health crisis, nipping and chewing regardless of the results you have obtained with your dog. No dog is likely to be trouble free but you should not be scared of this feature; on the contrary, this feature is perfectly manageable and you will be able to take advantage of all the dog’s behavior patterns. The dog should not be let to scare you because the good results will outweigh the bad ones. Dog keeping skills must be acquired in order to train your dog to wear Dog Clothes; these skills will require some actions, sacrifice, planning and even resolving problems.

Somehow, every dog is likely to know if his owner is committed to him or not. He will try to take full advantage of this knowledge but the owner can also use this situation for his benefit in order to build a strong relationship with his pet. Therefore, dressing your little puppy with small dog clothes may be the perfect way to show your commitment to your puppy. Dressing your dog with Dog Clothes is a terrific method that can end up in a marvelous relationship between the owner and his pet.

You will also have to pay attention to the possible health problems that may affect your pet; every breed is likely to come along with its specific health troubles and you may choose the canine clothing according to this criterion. You must avoid the clothes that are extremely fashionable but too restrictive and uncomfortable; you have to think about your pet before choosing a particular outfit. Little training is always to be considered because you should not expect the pet to enjoy wearing Dog Clothes from the first time. The training sessions may be fun as well and they must not be omitted in order to have a happy dog that is wearing the small dog clothes.

Allergy Season: What Makes It Worse

May 2011 – Are the drugs you take for allergy making you gain weight?

Whether you are a Climate Change believer or not, allergies do seem to be coming on earlier in the year, and are causing more problems for more people.

I always advise to look at your environment and your diet as both these areas have a major impact on allergy.  I think it will be interesting to see how the increase in GMO crops and that pollen will start to affect people.

Remember too that cell phone and other wireless devices that are so popular contribute to this problem by creating electrolytically charged pollen and pollutant particles which makes it easier for these to stick to the mucous membrane lining inside your respiratory system.  This finding from a decade ago also shows correlation to increasing asthma rates.

There are several excellent approaches to natural allergy therapy, find out more here -

and if you’d like a personal program designed specifically for you contact us for this clinical service.

A new USDA-led study finds a warming planet makes for more pollen and a longer, more intense allergy season in many parts of the United States.

By Leah Zerbe

If you’re planning a vacation during prime hay fever season—summer and fall—opt for a spot near water, where pollen counts tend to be lower.

RODALE NEWS, EMMAUS, PA—Given the millions of allergy sufferers held hostage by the drippy noses, burning, watery eyes, and continuous sneezing sessions it induces, ragweed may be one of the most hated plants on the planet. And a new the U.S. Department of Agriculture (USDA)-led study published in the Proceedings of the National Academy of Sciences confirms what many allergy sufferers and allergists have already been noticing—hay fever season caused by ragweed seems to be getting more intense and lasting longer.

The study is the latest to make the connection between climate change and a more potent allergy season. (Allergy-related issues cost the United States about $ 21 billion a year, so a warming planet affects economics, too.) “The main takeaway is that we are already seeing a significant increase in the season length of ragweed; and that this increase in season length is associated with a greater warming at northern latitudes, consistent with the Intergovernmental Panel on Climate Change projections regarding climate change,” explains lead study author Lewis Ziska, PhD, research plant physiologist with USDA’s Crop Systems and Global Change Lab.

THE DETAILS: Researchers used ragweed pollen and temperature data recorded between the late 1990s and 2005 in 10 different locations in the U.S. and Canada and found that in all but two of the areas analyzed, the ragweed pollen season increased—in some cases by nearly a month. The lengthening of the allergy season coincides with an increase in warmer, frost-free days. Researchers noticed a general trend—the ragweed allergy season grew longest in the higher latitudes of the northern United States and Canada. Winnipeg, Ontario, allergy sufferers endured a 27-day-longer ragweed pollen season in 2005 compared to just 16 years earlier. In the U.S., Fargo, ND, and Minneapolis, MN, experienced a more than two-week increase in ragweed allergy season, with LaCrosse and Madison, WI, not far behind.

WHAT IT MEANS: Climate change threatens human health in a number of ways, but allergies may be the most immediate, easy-to-recognize ailment thus far. And our increasingly chaotic climate’s allergy-accelerating properties are already afflicting millions of people. Ragweed is one of the most common weed allergens, affecting about 10 percent of the population. Among allergy sufferers, nearly a third endure hay fever misery brought on by ragweed pollen. Under normal circumstances, a single ragweed plant creates 1 million pollen grains; but a climate change–charged, more CO2-rich environment boosts that number to upwards of 3 to 4 million pollen grains per plant, according to Clifford Bassett, MD, medical director of Allergy and Asthma Care of New York and a member of the public-education committee at the American College of Allergy, Asthma and Immunology. (Don’t your eyes water just thinking of it?)

And scientists are also suspect of other potentially climate change–infused weed species. Ziska says there are concerns that other specific plant allergens are worsening due to climate change. His research group is working with Rutgers University in New Jersey and the Environmental Protection Agency to begin assessing pollen production and season length for other annual weeds like lambsquarters, mugwort, and plaintain, in addition to ragweed.

Consuming less, using less energy, eating organic, and demanding that clean energy subsidies replace incentives to fund dirty fossil fuels like coal, oil, and natural gas that make us sick are all important tactics to help stabilize global climate and protect our health. It’s also important to realize that we’ve already set ourselves up for a lifetime of climate-related problems. Here’s how to deal with the allergy aspect as we all work to keep things from getting worse.

Here are some solutions to think about now, before ragweed allergies strike later this year:

• Make sure you’re actually allergic to ragweed. It may sound silly, but allergists recommend being tested to confirm you’re allergic to what you actually think is making you sneeze. If ragweed is really making your life miserable (the longer you’re exposed to the allergen, the worse the symptoms become), consider getting allergy shots. The ongoing climate shift could be a cue to reassess your antiallergy options. “It might make people who previously had mild ragweed seasons to consider interventions they hadn’t though of before, like getting ragweed allergy shots,” says study coauthor Jay Portnoy, MD, chief of allergy, asthma, and immunology at Children’s Mercy Hospitals and Clinics in Kansas City, MO.

• Plan vacations accordingly. For many people, February still marks the cold season, months away from hay fever hell. But take your ragweed allergy into consideration as you plan this year’s summer or fall getaway. Dr. Bassett notes that pollen counts are generally lower around water. So if you vacation during prime ragweed season—summer and fall, or year-round in places like Florida or Hawaii—plan some time on the beach or around rivers and lakes for some ragweed relief.

• Create better indoor air. Now’s the perfect time to grow your own houseplants for free. They should be flourishing by ragweed season. While houseplants can’t rid your air of pollens you’re allergic to, certain houseplants can counteract indoor air pollution that further aggravates your allergy problem.