A good treatment for bad asthma

While looking for something else, we stumbled upon an action-packed blog post by a patient with virulent, relentless asthma who was rescued by her UChicago physicians using a treatment with a scary name, but a comforting outcome. Her story also involves a tornado. Below, in her own words (slightly trimmed for space), Melody Papazis, RN, tells her harrowing tale.

For most of my life, it seemed like constant coughing and chest tightness would be a daily occurrence. When I was 14, my deep, dry cough caught the attention of a pediatric pulmonologist. I had asthma. I had it bad. He prescribed inhalers. This helped. During high school, I only landed in the hospital once.

In nursing school, I went on a home-health visit. The house was infested with cockroaches. I learned that day that roaches are especially problematic for people with asthma. I wound up in an intensive care unit twice that semester.

In my early 20s, I was otherwise healthy, a runner. This enabled me to ignore my asthma. Prednisone, a steroid that can reduce inflammation, became my best friend. Its side effects were my worst enemy.

Then my asthma progressed from moderate to severe. I was hospitalized about 15 times. Each time, I would wake up in the ICU in respiratory failure. But I loved my job as a pediatric pulmonary nurse. I worked with the doctor who first diagnosed my asthma. I stuck with it. I could empathize with my patients and their parents.

Nurses, the saying goes, make the worst patients. I was an excellent bad example. I spent hours each day teaching patients about peak flows and asthma action plans, but I never paid much attention to my own plan. I wheezed. I struggled to breathe.

My coworkers offered advice. I neglected to listen. I had multiple trips to the ER, and a frequent-flier ticket to the ICU. My hospital stays involve tubes down my throat, continuous nebulizer treatments, steroids, magnesium, fluids, all followed by lectures on how to take control of my asthma.

Eight months after I got married, my asthma, already bad, took a nose dive. This time, my pulmonologist sent me to the University of Chicago, one of the leading centers in the country, for a treatment called bronchial thermoplasty (BT).

Here’s how doctors think BT works. Smooth-muscle tissue lines the human airway. It serves no known purpose, but it causes many asthma symptoms. This tissue can be hypersensitive. When annoyed, it contracts, narrowing the breathing passages, making it hard to breathe.

In BT, doctors slip a thin flexible tube through the nose or mouth, down the throat and into the major airways of the lungs. Then they pass a smaller tube through the first tube. The tip of this inner tube has a tiny expandable heat source. It is positioned to touch smooth muscle that lines the airway. Then the heat source is turned on, to about 150 degrees Fahrenheit – a little cooler than a hot cup of coffee. That lasts for 10 seconds.

This heat gets rid of about half of the smooth muscle cells that line that segment of the airway. The catheter is repositioned and re-heated about 30 times, until all the accessible airways from one lobe of the lung have been treated. This takes about 45 minutes. It takes three treatments to reach the entire lung.

At the University of Chicago Medicine, asthma expert Dr. Stephen White listened to my lungs. They were functioning at less than 20 percent. After a pulmonary function test we met and he carefully explained my options.

  • First choice: Try bronchial thermoplasty.
  • Second choice: Prepare for a lung transplant.
  • Third choice: Die from asthma.

We ruled out choices two and three.

The U of C helped pioneer this treatment. They were part of the initial trials, beginning in 2006. BT was approved by the FDA in 2010. Nevertheless, it can be difficult to get insurance companies to cover BT. With my history, however, I got approved right away. Dr. White put me in touch with his colleague, another asthma specialist, Kyle Hogarth, the University’s BT specialist. Two months later I had my first procedure.

Bronchial thermoplasty, Hogarth explained, consists of three separate bronchoscopy procedures done under anesthesia. Each procedure takes roughly 40 minutes and involves a separate region of the lung.

Although it is usually performed on an outpatient setting, mine was done in the hospital. That was wise. My asthma, Dr. Hogarth told me, was more severe than had been previously studied.

I spent a week in the ICU after each of my three procedures. After they were completed, I had multiple visits to the ICU. My lungs were angry.

After five months, however, my lungs recovered. They opened up like never before. I could breathe freely. My peak flow prior to the treatments was 300. After BT, it zoomed up to 560. I went back to work. For the first time since I was 14, life was looking good for our family.

Then, at 11 am on Nov.13, 2013, a devastating tornado passed through my town, Washington, IL. It destroyed hundreds of homes and businesses. We were lucky. Our house was fine.

But my lungs were not fine. The airborne debris from the tornado annoyed everyone, but it was much worse for me. Despite BT, my lungs clamped down hard. I was in asthma crisis. I needed help, quick. By the time we got to Chicago, my oxygen level was down to 72 percent and falling. I lost consciousness in the clinic. I wound up on a ventilator for a day.

The air quality in my town took months to return to normal. I went to stay at my sister’s house in Missouri. I was in good hands there. Melissa is a nurse and her husband is an ER doctor. But I was homesick for my husband and my son. After three months, we felt it was safe to go back home.

Now comes the fun part. I did phenomenally well. I was never hospitalized. That had not happened to me since I was 19. I went back to work, started exercising again, and lived the life God gave me. When I come home from work, I am not exhausted. It’s amazing how breathing freely has raised my spirits and quality of life.

I still use three inhalers, but I no longer take daily prednisone. I have a great support system, crucial for anyone living with a chronic illness. My 12-year-old son Lance has diabetes. His strength and endurance give me extra courage. My husband, Chris, is possibly the world’s best. Without his help and encouragement, I would not be alive today.

In the end, with a lot of help, I chose not to let asthma define me. The trials I have endured strengthened me. I keep a plaque, a daily reminder, on my office wall. “Life is not measured by the breaths you take,” it says, “but by the moments that take your breath away.”

 

Article provided by https://sciencelife.uchospitals.edu/2017/03/28/a-good-treatment-for-bad-asthma/ posted by John Easton

ORAL MANIFISTATIONS OF ASTHMA

Most asthma patients and health care practitioners are familiar with the common oral side effects of

inhaled and systemic medications to control asthma. This may be a review for some of you, but may

contain new information for others.

SOME OF THE MOST COMMON SIDE EFFECTS OF INHALED AND SYSTEMIC ASTHMA MEDICATIONS:

1.) Thrush-the dreaded yeast infection that can arise from frequent use of inhaled corticosteroids.

2.) Mucous membrane irritation

3.) Dry mouth

SOME OF THE LESS FREQUENT SIDE EFFECTS:

1.) Low ph — acidity in the mouth

2.) Gastroesophageal reflux

3.) Tongue enlargement

4.) Burning sensation in the mouth or tongue

5.) Mouth breathing

Let’s look at these:

Oral inhaled and systemic medications can alter the “normal” bacterial counts in the mouth allowing the

yeast organisms to dramatically increase. This whitish, painful infection needs to be treated with

medication and is best prevented as we will talk about later.

Mucous membrane irritation is also associated with inhaled medications and can lead to oral infections

in the mouth and even further in the throat and esophagus.

Dry mouth-many medications, not just those associated with asthma, have as a side effect “dry mouth”.

The clinical manifestation of this is a dry mouth can lead to an increase in dental cavities, bad breath,

and gum disease(periodontitis).

In the less common side effect category is the possibility of lower ph in the mouth(higher acidity), again

leading to an increase in dental cavities(caries). Gastroesophageal reflux means that stomach acid

normally contained in the stomach backs up into the esophagus, again causing irritation and burning in

the esophagus and increasing the acid content in the mouth. Tongue enlargement, although rare,

obviously leads to more difficulty in breathing, swallowing, and even speaking . Burning mouth/tongue-

this is a very difficult to diagnose and control condition that is extremely uncomfortable to those

afflicted-making eating and speaking a painful experience. Mouth breathing-once again here we have

the beginnings of dry mouth, increase in dental caries, mouth soreness and the potential of yeast

growth due to the lack of saliva “bathing” the teeth to remove plaque and bacteria.

THEREFORE: BE VERY PROACTIVE IN YOUR DENTAL HEALTH

1.) RINSE YOUR MOUTH THOROUGHLY AFTER USING AN INHALER!!!!!!!

2.) Brush, floss, and rinse after each meal

3.) See your dentist for a thorough cleaning and exam every 3-4 months

4.) Look for “white spots” on the enamel of your teeth-a sign that acids are starting to weaken the

enamel possibly causing future problems

5.) Drink lots of water frequently. We are supposed to have 8 glasses of water(8X8 ounces) every

day-people with asthma should consume at least that and more

6.) AVOID SUGARY FOODS AND SNACKS-THIS IS THE “FOOD” BACTERIA NEED TO ATTACK THE TEETH

AND CAUSE CAVITIES AND GUM PROBLEMS

7.) Try sugarless gum (Xylitol containing) to increase saliva flow and to help clean the teeth if

brushing and flossing are not possible after a meal

8.) Use a spacer for your inhaler and make sure your health care professional has observed that

you are correctly inhaling the medication. This is to insure that the meds are not just stopping in

your mouth, but are actually getting deeply in to the lungs

9.) If you have a history of dental caries, dry mouth, or periodontal disease, talk to your dentist

about using fluoride rinses and/or fluoride trays. This use of topical fluoride can decrease the

possibility of cavities, gum disease and can even decrease sensitivity to cold and sweet things

Charles A. Matlach, DDS

Clinical Director AEGD

Advance Education in General Dentistry

A.T. Still University Arizona School of Dentistry and Oral Health

5835 E Still Circle

Mesa, Az 85206

THE LINK BETWEEN VITAMIN D AND ASTHMA

The exact etiology of asthma still remains a mystery to health care practitioners.  Part of the difficulty is that there are numerous forms and types of asthma and varying degrees of severity in the categories.  It is well known that asthma cases are on the increase dramatically since the 1960s, and many theories  exist to account for this—diet changes, environmental influences, a decrease in exercise and a lack of exposure to sunlight.(1) There has been significant research showing a correlation between Vitamin D intake and reduction in asthma severity.

Vitamin D has long been recognized to reduce inflammation (2), and “boost” the immune system. It has been theorized that this reduction in inflammation could help individuals suffering from asthma since asthma is inflammation of the airways.  The immune system helps the body to fight off infections,  so, in turn, reducing the chances of inflammation and subsequent infections after attacks.(3)

There are numerous studies linking Vitamin D intake with reduction in childhood asthma attacks and frequency, however, more research needs to be done to see if proper dosing of Vitamin D to newborns and infants can decrease the likelihood of developing asthma later in life.(4)

People living in areas with less sunshine, overcast winters and lower temperatures had higher rates of asthma and also had lower blood levels of Vitamin D. The lower Vitamin D levels make sense since this vitamin is produced by the body when in contact with sunlight.  The correlation for this is that we have many studies showing people that spend more time in the sun have reduced risk of asthma and reduced number of attacks.(5)(6)

The bottom line is, there are studies that show a major correlation between Vitamin D intake and decreased asthma incidence and attacks in children, and studies that show very little correlation(especially in adolescents and adults).(7)  Should we all take Vitamin during our lifetime as a preventative for asthma and severity of attacks if you have the disease?  How does this affect me and my family?  The best recommendation from the Vitamin D Council is: children take 1,000 units of Vitamin D a day for every 25 pounds of their weight up to 5,000 units for a 125 pound child or adolescent.  The same 5,000 units a day for adults-although the federal government has stated that up to 10,000 units will probably do you no harm. Vitamin D is stored in the body fat, so it is possible to over due it. Stick to the guidelines and consult your health care professional if you have and questions.

The Vitamin D Council also recommends that pregnant women take 6,000 units a day of D.  How this affects the risk of your child developing asthma later in life is not known, but it does appear to reduce some of the complications associated with pregnancy.(8)

In summary, my best advice is to follow the guidelines of the Vitamin D council for ALL age groups. If taken appropriately, Vitamin D can’t hurt you and it most certainly can help with your immune system,  an increase in skeletal strength, cardiovascular health, etc.  Get outside, exercise and enjoy the sunshine(in Moderation), take your appropriate supplements and consult your health care professional with any questions!

Charles A. Matlach, DDS  MM

Clinical Associate Director, AEGD

A.T.Still University  Az School  of Dentistry and Oral Health

5835 E. Still Circle

Mesa, Az. 85206

480-248-8107

 

References

  1. National Institute of Health. What is Asthma? 2014
  2. Gupta, A., Bush, A., Hawrylowicz., et al., Vitamin D and Asthma in Children.

Paediatr  Respir Rev, 2012. 13(4): p. 236-43

  1. Ibid
  2. Niruban, S.J., Alagiakrishan, K., Beach,J., et al., Association Between Vitamin D

And Respiratory Outcomes in Canadian Adolescents and Adults. J Asthma, 2015: p.1-33

  1. Krstic, G., Asthma Prevalence Associated with Geographical Latitude and Regional Insolation
  2. In the United Sates of America and Australia Plos One, 2011. 6(4): p. e14892
  3. Castro, M., et al., Effect of Vitamin D3 on Asthma Treatment Failures in Adults with Severe

Bronchial Asthma and lower Vitamin D Levels. JAMA, 2014. 311(20): p. 2083-91

  1. Wagner, CL., Baggerly, C., McDonnell, S., Baggerly, KA., French, CB., et al., Post Hoc Analysis
  2. Of Vitamin D Status and Reduced Risk of Preterm Birth in Two Vitamin D Pregnancy Cohort Compared with South Carolina March of Dimes Rates. Steroid Biochem Mol Bio. 2015 Nov7