Tuesday, March 31, 2015


A Peak Flow Meter (Breathe-o meter) is a simple, affordable, hand held device which helps diagnose breathing problems and asthma in children and adults. It is also used as an instrument to monitor your progress when you are under treatment for asthma.Just as you have a BP instrument to check blood pressure and the Glucometer for diabetics, the Peak Flow Meter (Breathe-o meter) is like a thermometer for asthma. As a patient, you will have to blow into the mouthpiece of the device, and the reading will be taken to check your lung power. Most doctors have the device in their clinic but it is also available at most leading chemists if you want to keep your asthma in check.

         Peak Flow

Peak Flow

If you have asthma you can use the Peak Flow Meter (Breathe-o meter) to actually measure whether you are improving or not making progress. Your doctor will show you what number or reading on the Peak Flow Meter (Breathe-o meter) is good or normal for you, according to your age and height. If there is a drop in the reading, it means that your asthma is not well controlled and you are likely to get an attack in the near future or within days. This is like an early warning signal that you need to contact your doctor. If required, the doctor might increase the dosage of your medication. If the number is higher than your previous reading, it means your asthma is better controlled and you are improving. When the Peak Flow Meter (Breathe-o meter) reading is normal, it suggests that your asthma is under control.

All you wanted to know about peak flow meter?


A peak flow meter is a portable, inexpensive, hand-held device used to measure how air flows from your lungs in one "fast blast." In other words, the meter measures your ability to push air out of your lungs.

Peak flow meters may be provided in two ranges to measure the air pushed out of your lungs. A low range peak flow meter is for small children, and a standard range meter is for older children, teenagers and adults. An adult has much larger airways than a child and needs the larger range.

There are several types of peak flow meters available. Talk to your health care provider or pharmacist about which type to use.  


Many health care providers believe that people who have asthma can benefit from the use of a peak flow meter. If you need to adjust your daily medication for asthma, a peak flow meter can be an important part of your asthma management plan.

Children as young as three years have been able to use a meter to help manage their asthma. In addition, some people with chronic bronchitis and emphysema may also benefit from the use of a peak flow meter.

Not all physicians use peak flow meters in their management of children and adults with asthma. Many health care providers believe a peak flow meter may be of most help for people with moderate and severe asthma. If your asthma is mild or you do not use daily medication, a peak flow meter may not be useful for asthma management.

Measurements with a peak flow meter can help you and your health care provider monitor your asthma. These measurements can be important and help your health care provider prescribe medicines to keep your asthma in control.

A peak flow meter can show you that you may need to change the way you are using your medicines. For example, peak flow readings may help be a signal for you to implement the medication plan you and your health care provider have developed for worsening asthma.

On the other hand, if you are doing well, then measuring your peak flow may be helpful as you and your health care provider try to lower the level of your medicines.

A peak flow meter can help you when your asthma is getting worse. Asthma sometimes changes gradually. Your peak flow may show changes before you feel them. It can allow your health care provider to adjust your treatment to prevent urgent calls to the health care provider, emergency room visits or hospitalizations.

A peak flow meter may help you and your health care provider identify causes of your asthma at work, home or play. It may help parents to determine what might be triggering their child's asthma.

A peak flow meter can also be used during an asthma episode. It can help you determine the severity of the episode; decide when to use your rescue medication; and decide when to seek emergency care.
Knowing your "personal" peak flow rate allows you to evaluate your readings. Being at your "best" can provide reassurance and make you feel more self-confident.

Step 1: Before each use, make sure the sliding marker or arrow on the Peak Flow Meter is at the bottom of the numbered scale (zero or the lowest number on the scale).

Step 2: Stand up straight. Remove gum or any food from your mouth. Take a deep breath (as deep as you can). Put the mouthpiece of the peak flow meter into your mouth. Close your lips tightly around the mouthpiece. Be sure to keep your tongue away from the mouthpiece. In one breath blow out as hard and as quickly as possible. Blow a "fast hard blast" rather than "slowly blowing" until you have emptied out nearly all of the air from your lungs.

Step 3: The force of the air coming out of your lungs causes the marker to move along the numbered scale. Note the number on a piece of paper.

Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.)

Step 5: Record the highest of the three ratings. Do not calculate an average. This is very important.

You can't breathe out too much when using your peak flow meter but you can breathe out too little. Record your highest reading.

Step 6: Measure your peak flow rate close to the same time each day. You and your health care provider can determine the best times. One suggestion is to measure your peak flow rate twice daily between 7and 9 a.m. and between 6 and 8 p.m.

You may want to measure your peak flow rate before or after using your medicine. Some people measure peak flow both before and after taking medication. Try to do it the same way each time.

Step 7: Keep a chart of your peak flow rates. Discuss the readings with your health care provider.


Chart the HIGHEST of the three readings. The chart could include the date at the top of the page with AM and PM listed. The left margin could list a scale, starting with zero (0) liters per minute (L/min) at the bottom of the page and ending with 600 L/min at the top.

You could leave room at the bottom of the page for notes to describe how you are feeling or to list any other thoughts you may have.


A "normal" peak flow rate is based on a person's age, height, sex and race. A standardized "normal" may be obtained from a chart comparing the patient with a population without breathing problems.

A personal best normal may be obtained from measuring the patient's own peak flow rate. Therefore, it is important for you and your health care provider to discuss what is considered "normal" for you.

Once you have learned your usual and expected peak flow rate, you will be able to better recognize changes or trends.


Three zones of measurement are commonly used to interpret peak flow rates. It is easy to relate the three zones to the traffic light colors: green, yellow, and red. In general, a normal peak flow rate can vary as much as 20 percent.

Be aware of the following general guidelines. Keep in mind that recognizing changes from "normal" is important. Your health care provider may suggest other zones to follow.

Green Zone: 
80 to 100 percent of your usual or "normal" peak flow rate signals all clear. A reading in this zone means that your asthma is under reasonably good control. It would be advisable to continue your prescribed program of management.

Yellow Zone: 
50 to 80 percent of your usual or "normal" peak flow rate signals caution. It is a time for decisions. Your airways are narrowing and may require extra treatment. Your symptoms can get better or worse depending on what you do, or how and when you use your prescribed medication. You and your health care provider should have a plan for yellow zone readings.

Red Zone: 
Less than 50 percent of your usual or "normal" peak flow rate signals a Medical Alert. Immediate decisions and actions need to be taken. Severe airway narrowing may be occurring. Take your rescue medications right away. Contact your health care provider now and follow the plan he has given you for red zone readings.

Some health care providers may suggest zones with a smaller range such as 90 to 100 percent. Always follow your health care provider's suggestions about your peak flow rate.


It is important to know your peak flow reading, but it is even more important to know what you will do based upon that reading. Work with your health care provider to develop an asthma management plan that follows your green-yellow-red zone guidelines.

Record the peak flow readings that your health care provider recommends for your green zone, yellow zone, and red zone. Then work out with your health care provider what you plan to do when your peak flow falls in each of those zones.


Use of the peak flow meter depends on a number of things. Its use should be discussed with your health care provider.

If your asthma is well controlled and you know the "normal" rate for you, you may decide to measure your peak flow rate only when you sense that your asthma is getting worse. More severe asthma may require several measurements daily.

Don't forget that your peak flow meter needs care and cleaning. Dirt collected in the meter may make your peak flow measurements inaccurate. If you have a cold or other respiratory infection, germs or mucus may also collect in the meter.

Proper cleaning with mild detergent in hot water will keep your peak flow meter working accurately and may keep you healthier.


A peak flow meter is not a medicine. For most people, it has no major side effects. However, sometimes pushing the air out of your lungs in a "fast blast" may cause you to cough or wheeze. The deep breath in before blowing out may also cause tightening within the lungs for some people.

Check with your health care provider before you start using a peak flow meter or if you have any discomfort while using one.

Using the meter is as simple as taking a deep breath and blowing out a candle. If used properly, it can only help.

You must realize that measuring peak flow is only one step in a program to manage asthma. Its importance must not be exaggerated or over-interpreted.

Using a peak flow meter is not a substitute for regular medical care. Ask your health care provider to help you understand your peak flow measurements.


Now you are aware of some of the techniques for using and caring for peak flow meters. You also know how meters may help manage asthma and other breathing problems.

Discuss the use of a peak flow meter with your health care provider. Make measuring your peak flow rate a part of your personal asthma management program.

Source: American Lung Association



Asthma is a chronic inflammatory condition of the airways, which constrict, narrow and swell when a person comes in contact with a trigger. This causes coughing, wheezing and shortness of breath. The most common form of asthma is caused by allergies to certain triggers.

Asthma is caused by a combination of factors, which include genes, environmental and biological triggers, such as infections, dietary patterns, hormonal changes in women and allergens. Allergic asthma is one of the primary causes of asthma, but other types exist. Exercise-induced asthma and nocturnal asthma are two types not associated with allergies.

 Risk factors for asthma include gender, obesity, smoking, socio-economic status, living in urban environments, and geographical location.

The symptoms of asthma can vary in severity and progress over a period of hours or days, after being exposed to triggers. Symptoms inlcude wheezing, shortness of breath, coughing, chest tightness or pain, rapid heart rate, and sweating.

Being tested for asthma will typically include a medical history, including any pattern related to the symptoms or possible precipitating factors. Spirometry, which uses pulmonary function tests to study the air volume and flow rate within the lungs,  can help detect asthma. Your doctor will look at vital capacity, peak expiratory flow rate and forced expiratory volume.

If you are experiencing symptoms of asthma, or just find that you are overly fatigued, it might be beneficial to talk to your doctor about getting tested for asthma. Talking to your doctor is the first step to getting a diagnosis and begin treating your asthma.


Asthma action plan

Having an asthma action plan is an essential part of successful asthma management. The plan should be developed with your doctor and should include steps to take in three separate zones of asthma health. This will allow you to know what to do in any situation to prevent the problem from worsening.

lifestyle at home 
Although household asthma triggers can not be completely eliminated there are steps you can take to "asthma-proof" your home as much as possible.  The most common triggers in the home are dust mites, animal dander, urine and saliva, and mold. Taking steps to eliminate these triggers will do wonder for your asthma control.

Diet and exercise

Diet and exercise can be an important tool to control asthma. People who have asthma and are overweight may help reduce asthma symptoms if they lose weight. Long-term exercise may even help control asthma and reduce hospitalization. Healthy eating is also an important factor.

Emotional health
If you suffer from asthma, it is extremely important for you to manage your emotional health - especially your stress levels - as this can trigger symptoms, including shortness of breath and wheezing.

Minimise triggers

Determining what your asthma triggers are is the first step in controlling your asthma symptoms. Some of the top asthma triggers include stress, allergies, cold air, and exercise.

Compliance to Medicines

Even when an asthma patient is symptom-free, it is still very important to take their medications. Taking inhaled corticosteroids work better than any other asthma medicine at controlling chronic  inflammation in the airways of asthmatics.


 Asthma maintenance medication is used to treat the underlying cause of asthma -  inflammation in the airways and lungs. Long-term bronchodilators and anti-inflammatory drugs are taken on a regular basis to prevent asthma attacks and control chronic symptoms. These include inhaled corticosteroids, long-acting  beta2 agonists, cromolyn, leukotriene-antagonists, theophylline and omalizumab.

Quick relief medications are used to immediately control acute asthma attacks. Short-acting beta2 agonists are bronchodilators that relax and open constricted airways during an acute attack. They do not reduce inflammation or airway responsiveness. If an asthma attack is severe enough that a hospital visit is required, systemic corticosteroids will be given.

Alternative therapies for asthma include relaxation and stress reduction techniques, as asthma can be triggered by stress, the Buteyko Breathing Method, desigined to increase the leves of carbon dioxide in the body, probiotics and herbal remedies. Alternative therapies should be considered supplemental to traditional medical treatment, as most therapies have not been proven to be effective.


Take medicines as per the asthma action plan, consult your doctor immediately.


Allergy season is coming and you shouldn't let yourself or anyone else in your family become victims.  Here are seven ways you can help reduce the misery.

Take your antihistamine daily
If you are already taking a long-lasting antihistamine, make sure to take those meds daily, not just when your symptoms flare up. Regular daily dosing may better block the effect of histamine release when allergy triggers are inhaled.

A prescribed intranasal spray steroid is a cornerstone to seasonal allergy management. Ask your doctor for a prescription if you don't have one. An alternative would be an antihistamine based nasal spray. Occasionally both types of nasal sprays are recommended.

Have your nasal spray technique checked with your doctor at least twice a year. Flaws in the use of nasal sprays can considerably impact the effectiveness of the medication
Review your skin test results
Review the results of allergy skin test with your doctor in order to ensure that you have taken adequate steps to reduce the impact of indoor triggers, such as dust mites, mold and pet dander. If you have not had allergy tests, ask your doctor about getting them.

Keep windows closed
Keep your windows at home closed at all times. Turn on your air conditioner early in order to keep humidity levels in your home from rising. This may reduce dust mite and mold growth as well as filter some of the allergens in your indoor environment.

Check your filters
Check to see if the filter on your cooling system needs changing. If you use an indoor air cleaner device, determine if filters or other maintenance matters need to be addressed.

Many people have been aided by rinsing their nasal passages with nasal saline spray during peak periods of the allergy season. Simple flushing of the nose with a saline mist or buying a Neti pot can make a big difference.

This British study may change the views on peanut allergy forever!

  • Striking new evidence shows that feeding peanuts to high-risk children in their first year of life can reduce the likelihood of peanut allergy years later by up to 80 percent.

    Dr. Hugh Sampson, past president of the American Academy of Allergy, Asthma and Immunology recently wrote in an editorial: “We believe the results from this trial are so compelling, and the problem of the increasing peanut allergy so alarming, that new guidelines should be forthcoming very soon”.

    Over the past years, Dr. Sampson has published many articles on food allergy. But here he is referring to the LEAP (Learning Early About Peanut Allergy) study. It was published in the New England Journal of Medicine last month, and led by George Du Toit, M.B., B.Ch. (see links below.)

    This study included 640 children between the ages of 4-11 months who were high-risk for development of peanut allergy. High-risk was defined, in this study, as having a history of severe eczema, egg allergy or both. The children were divided into one group that would be regularly fed peanut snacks, and another that would be restricted from peanuts. They were monitored for five years.

    The investigators began the study by dividng the children into two groups based on the results of a peanut allergy skin-test. Only the children that tested negative for peanut were divided into those that would either be given or restricted panuts for the study. Those who skin-tested or orally tested positive were immediately removed from the study. However, researchers kept children who showed a slight peanut allergy. These included those who skin-tested positive to peanut, but didn't react to an oral allergy test. 

    The results of the study were described as astonishing. At 5 years of age, only 3 percent of the children getting peanuts were found to be allergic to them, but 17 percent of the peanut avoidance group became peanut-allergic. Furthermore, the skin-test positive children were far less peanut-allergic at age 5 if they had been exposed to peanut snacks (10.6 percent if fed peanuts versus 35 percent if restricted). The overall percentage of peanut allergy in the country was 2 percent (the study included only high-risk children).

    Up until 2008, allergists advised parents of high-risk children to restrict their young from peanuts and tree nuts until school age. Based on developments over the last decade, and highlighted by this study, the opposite is true.

    What does this mean?

    National guidelines for prevention of peanut allergy will change in oncoming months. They will likely recommend early peanut testing of high-risk infants and consultation with allergists.

    Unanswered Questions Include:

    • How long does peanut tolerance last once achieved?
    • Do children need to continue to eat peanut products three times weekly in order to maintain tolerance (as done in the study)? How much peanut snack needs to be consumed? 
    • What happens if there is an interruption in peanut consumption during the first several months or years?
    • What if the infants don’t want to eat peanut butter snacks? Feeding them peanuts won’t be an option because of the risk of choking.
    • Wouldn’t early introduction of peanuts place other peanut allergic members of the family at risk for accidental exposure? 
    • What can we do about young children already allergic to peanut? 
    • Would this work for other food allergies?

  • Bottom Line:

    The Leap study is truly a game changer, but only for high-risk children under one year of age. In this group the results showed a 70 to 80 percent reduction in the development of peanut allergy. Health experts in the U.S. will further review these findings and make appropriate recommendations to allergists, pediatricians and other primary care doctors, so stay tuned!

    It is important to understand that conclusions in this study are to be reviewed and utilized by physicians to manage patients. Parents should not expose their infants to peanut if they are at increased risk, before discussing it with their doctor.



    Studies suggest that about 50 percent of people who smoke will develop lung disease.  This might explain why so many smokers develop COPD, and why COPD is now the third leading cause of death in the U.S. So what is it that so closely links COPD with smoking?

    Chemicals.  There are over 5,000 chemicals in a cigarette, and these are inhaled with both first and second hand smoke.  They sit on the moist lining of the respiratory tract.  While the exact mechanism is yet unknown, long term (chronic), or repeated, exposure to these chemicals has an influence on a person's genetics. 

    Genetics.  Genes cause the production of proteins, and each protein carries out some bodily function. So some genes and the proteins they make are responsible for the normal development and maintenance of lung tissue. Long-term exposure to chemicals in cigarette smoke may cause genetic mutations that result in proteins that destroy instead of build lung tissue.   Since each person has a unique genetic makeup, the impact of genetics on COPD may vary from person to person.

    Tissues.  The proteins from gene mutations cause changes within the lungs.  Some prevent the normal development and maintenance of lung tissue, resulting in emphysema.  Others cause changes to the tissues lining airway walls, causing airways to be chronically thick and narrowed.  Others cause an increase in goblet cells that cause an abnormal amount of mucus. Others cause the destruction of cilia (hairlike structures) lining the airways, making it so this excess mucus is difficult to cough up.

    Disease.  These changes are permanent, meaning they are chronic (always there). While lung disease will naturally occur in most adults, cigarette smoking speeds up this process by as much as 50 percent, resulting in a diagnosis of lung disease by the ages of 45 or 55.  Loss of lung tissue is called emphysema, making it so your lungs have less capacity to move air. Excessive secretions and chronically narrowed air passages is chronic bronchitis.  Together these make up a disease called chronic obstructive pulmonary disease, or COPD. 

    Living Well.   Smoking is proven to both cause COPD, and speed up the natural progression of the disease.  While there is no way to reverse the disease process, quitting smoking is proven to slow its progression.  This is why it is of utmost importance that you quit inhaling cigarette smoke, whether its from your own or someone else's cigarette called second hand smoke or passive smoking.

    Adult Onset Asthma.what is it????

  • Adult Onset Asthma (AOA) is the term used to describe cases of asthma that are diagnosed after the age of 20, although they are usually not diagnosed until after the age of 40. Sometimes, when diagnosed after the age of 50, it is called Late-Onset Asthma.  

    Here are some facts to consider.

    Intrinsic Asthma.  It's usually intrinsic, meaning it's caused by something other than allergies. Usually it results from long term or repeated exposure to any of the following:  
    • Hormones from menopause
    • Pollution in the air
    • Chemicals in the air at work or home (such as those in common household cleaners)
    • Chemicals in cigarette smoke (tar, arsenic, cadmium, formaldehyde, chromium, etc.)
    • Lung infections (mainly the viral type)
    • Non-steroidal anti-inflammatory (NSAID) medicine (such as Aspirin)
    • Hormones released from fat tissue (obesity or high fat foods)
    • Vigorous exercise (especially during freezing conditions).
    Extrinsic Asthma. sometimes extrinsic, meaning it’s A modern term for this is “Allergic Asthma,” and it’s much more common in Childhood Onset Asthma than AOA.  However, researchers have learned it is still possible to develop allergies in adulthood.  Allergic Asthma is less likely to cause chronic airway changes. This means it’s usually milder and easier to control with traditional asthma medicines, such as corticosteroids.

    Women. According to the American Lung Association, 10.8 million males and 15.1 million females have asthma. This shows that women are more likely to be diagnosed than men.  This trend is reversed in childhood, where boys are more likely to have it than girls. The reason for this remains a mystery; although, one theory attributes this to hormones from pregnancy and menopause resulting in AOA.

    Severity. Because it’s usually intrinsic, and the result of repeated exposure to some substance in the body or in the air inhaled, it’s more likely to cause airway changes (airway remodelling), such as a thickening of airway walls. This makes it so those diagnosed in adulthood tend to lose lung function more rapidly than children.  This also might explain why they have an increased likelihood of responding poorly to traditional asthma medicines, such as corticosteroids. They have a greater risk of having more severe asthma than those diagnosed in childhood.

    Treatment.  The mainstay treatment is corticosteroids.  However, due to chronic airway changes, some adult asthmatics will respond poorly to corticosteroids.  This may require creative treatment options that may vary from patient to patient.  Also complicating treatment are other chronic diseases that may be present.

    Co-Morbidities.  Adults tend to have other ailments due to aging or environmental exposure. Examples include COPD, heart disease, diabetes, hypertension, sinusitis, upper respiratory infections, and nasal polyps. These may make asthma difficult to treat and control.  Some cause breathing trouble, making an asthma diagnosis difficult.  

  • Remission.  It’s a myth that a person can outgrow their asthma.  However, some children do seem to have their asthma disappear for a while, or go into remission, as they grow older. This is less likely to occur among those diagnosed in adulthood.  This may be due to the greater likelihood of chronic airway changes developing in adults. It may also be due to other factors yet unknown.

    Confusion.  Asthma was once thought to be a disease of childhood.  This meant that most cases of AOA were misdiagnosed as some other lung disease, such as COPD.  More than likely this lead to suboptimal treatment.  With improved wisdom, physicians are now much better at both diagnosing and treating adult asthma.

    Conclusion.  It’s important for physicians to understand the difference between childhood and adult onset asthma.  When a person develops a disease it may impact how it is diagnosed and what treatment options will work best.   
  • Childhood Asthma.

  • Childhood Onset Asthma (COA) is the term used to describe cases of asthma that are diagnosed before the age of 20. While asthma may be diagnosed at any age, most children are diagnosed by the age of five. This is mainly due to the nature of childhood asthma, which usually tends to be allergic.

    Here are some more facts to consider.

    Statistics. According to the Centers for Disease Control and Prevention, 7 million children under the age of 18 have asthma. That means that 9.3 percent of all children have it. Asthma is the most common chronic disease in childhood, and the most likely cause of days missed from school. It results in 14.2 million physician office visits and 1.8 million emergency room visits each year.

    Allergic (Extrinsic) Asthma. Most children have asthma triggered by allergies.  This means their bodies develop an exaggerated response to substances in the air called allergens that are innocuous (harmless) to most people.  Examples of allergens are dust mites, cockroach urine, mold, pollen, and animal dander. While allergies can develop at any age, they are most likely to develop early in life, and this might explain why most cases of COA are diagnosed early.  It usually doesn’t take long for susceptible children to be exposed to their allergens, particularly boys.

    Boys. According to the American Lung Association, about 4 million boys and 3.2 million girls have it. This means boys are 16 percent more likely to have asthma than girls. Boys are also more likely to have an asthma attack, more likely to miss school days, more likely to visit an emergency room for asthma, and more likely to be admitted to the hospital for asthma. The reason for this remains a mystery, although one theory suggests that boys are simply more likely to participate in activities that expose them to their allergens, such as running around in pollen-filled forests, or hiding under dusty, moldy porches. This trend starts to reverse itself during teenage years, and in adulthood women are more likely to have it than men. 

    Non-Allergic (Intrinsic) Asthma. Some children have asthma triggered by something other than allergens. Examples include:
    • Chemicals in cigarette smoke
    • Air pollution
    • Viral infections (RSV)
    • Gastrointestinal contents (GERD)
    • Cold and dry air
    • Hot and humid air
    • Anxiety and depression
    • Exercise (especially in cold, dry air)

    Severity. Allergic Asthma usually doesn’t cause airway remodeling or scarring that sometimes occurs with intrinsic asthma. For this reason, childhood asthmatics generally have less severe asthma that responds well to corticosteroids.

    Asthma Treatment. This makes it easier to control with asthma controller medicines such as Advair, Symbicort, Dulera, Breo, Flovent, Asmanex, and Pulmicort. Since every asthmatic is unique, finding out which medicine works best is often a matter of trial and error. Most asthma experts recommend all asthmatics have an asthma rescue inhaler like Albuterol nearby at all times for those inevitable asthma flare ups.

  • Allergy Treatment. Allergy testing may help a physician diagnose allergies. Treatment usually involves efforts to avoid allergens, or medicines such as Claritin, Zyrtec, Benadryl, and Singulair.  Preventing and controlling allergies is often the best way to prevent and control asthma.

    Remission. Physicians used to tell asthmatics children that they would outgrow their asthma. Modern evidence suggests this is not true, that asthma never truly goes away. However, sometimes it does go into remission. One theory is that once children go through puberty their airways become larger and less sensitive. Another is that older children are less likely to expose themselves to their asthma triggers. For instance, older kids are less likely to crawl under dusty porches, or play in pollen-filled forests.

    Conclusion. The good news is that, while there is no cure for asthma, it can be controlled by avoiding and controlling asthma triggers, and by taking asthma controller medicines on a daily basis, such as inhaled corticosteroids. By working with a physician and following a treatment plan, asthma may appear to go into remission.
  • Monday, March 30, 2015

    6 Tips for Asthmatics to Manage Allergies During Springs!!!!

    • After the winter we have had-- like most of you-- we are ready for the warmer spring weather.  After a week of our wish being granted we remembered some of the pitfalls of the gorgeous spring temperatures: pollen, pollen and more pollen.  If you have asthma and allergies this can mean a huge increase in asthma symptoms.

      Early in the spring tree pollens can wreak havoc on asthma symptoms.  Some of the most common include ash, birch, cypress, elm, hickory, maple, oak, poplar, sycamore, walnut and western red cedar.  In later spring the grass pollens like bermuda grass, orchard grass, red top grass and timothy grass kick in and trigger flare ups in people allergic to grasses.

      Allergies can result in additional inflammation in the airway of asthmatic patients, which is why most emergency rooms see an increase in visits due to asthma complications in the spring.  Additional symptoms of spring allergies can include: sneezing, runny nose, itchy nose or throat, watery eyes, wheezing, coughing and difficulty breathing.  While allergies are not contagious, they can definitely make you feel like you have a nasty illness.

      If allergies are aggravating your asthma it is important to treat and prevent those reactions to decrease your airway inflammation.  Here are a few tips to get your spring allergies under control.

      Keep up with your asthma medications.

      If winter doesn't produce any issues for your asthma, you may need to hit the pharmacy and refill your asthma medications in preparation for spring.  Be sure to have a rescue inhaler on hand in case it is needed.  Reducing airway inflammation with the use of a maintenance medication like Flovent, QVAR or Advair can help prevent asthma attacks.

      Get tested for allergies.

      If you suspect that allergies might be a trigger for your asthma you may want to consider being tested.  An allergist can help you to determine exactly what you are allergic to and tailor treatments to those specific issues.  Allergy tests may include blood tests or skin testing.

      Take allergy medications.

      If you have spring allergies your physician may recommend that you start taking an allergy medication a week or so before the season begins and continue it throughout the allergy season.  Antihistamines like Claritin or Zyrtec can be taken daily to prevent reactions.  Some people may also do well with steroid nasal spays to reduce the sneezing, coughing and sinus drainage that can aggravate asthma.

      Consider allergy shots.

      Once you have been tested for allergies your physician may decide to start you on an immunotherapy shot to reduce your body's reaction to allergens.  This therapy can take some time -- up to three or more years--so it is best to start it as soon as possible.

      Avoid high pollen hours.

      The morning tends to have the highest pollen counts.  It is best to avoid being outdoors between those peak hours of 5 a.m. to 10 a.m.  Staying inside in the air conditioning and recycling the air in your vehicle can help limit your exposure to pollen during those peak hours.  Check out the Weather Channel's allergy tracker tool to determine the pollen levels in your specific area.

    • Shower at night.

      While it may seem small, showering at night can make a big difference in your allergies.  During the day pollen and other triggers latch on to your skin, clothing and hair.  Taking those clothes off immediately upon returning inside and showering-- including washing your hair-- can dramatically reduce the allergens on your body.  If you don't shower at night those allergens will be in your bed to cause reactions while you sleep and even on future nights.

      Allergy season can be miserable, but with a few of these tips you can make it through with the least amount of symptoms and irritation to your asthma.


    As sure as Diwali ( or any festival /new year) is a festival of lights, sweets, gaiety, splendor & fireworks, it is also one of deafening noise, blinding light, risky fire & suspended particles. And this has direct effects on our health & environment. When the entire nation looks forward to Diwali as a celebration of life, patients suffering from Asthma & COPD (Chronic Obstructive Pulmonary Disease) begin readying there lifesavers – Inhalers, nebulizers or whatever gives them a breath of life. For these people Diwali is not a festival of light & gaiety but that of smoke, coughing & wheezing.
    Fireworks are sources of some of the highly toxic inhalants produced during Diwali celebrations. Firecrackers are “power packed” with potassium nitrate, carbon & sulfur. Apart from this they also contain toxic contents like copper, cadmium, lead, manganese, magnesium, zinc, sodium, potassium, and aluminum powder & barium nitrate.  When ignited, the crackers burst allowing these powerful chemicals to come in contact with atmosphere and the smoke thus generated contains increased amounts of carbon monoxide, carbon dioxide, nitrogen dioxide, hydrocarbons, hydrogen sulfide & particulate matter which worsen the quality of Diwali air. The suspended particles hog like a thick blanket reducing visibility and suffocating the atmosphere. In fact studies have demonstrated that during Diwali festival the concentration of sulfur dioxide increased by 10 times & that of nitrogen dioxide, PM10(Particulate matter of size less than 10 microns) & TSP(Total Suspended Particles) increased by 2 to 3 times. The Overall air pollution during Diwali increases by about 200 %. The biggest culprits among firecrackers are the colour sparkles (“Phuljari”), “Anar”, “Chakri”, Fire pencils, Snake tablets & “Hydrogen” bomb.
    A special mention may be made of PM10. With the average PM10 charge, we inhale millions of fine particles with each breath. The larger particles( 5 to 10 microns) are filtered in the nose & throat, smaller particles (3 to 5 microns) arrive in the bronchial tube, bronchi (2 to 3 microns), bronchioles (1 to 2 microns) & in alveoli (0.1 to 2 microns) & finally in the blood. These particles can no longer be coughed up & as deposits lead in long term to inflammation, particularly in asthmatics, & also with healthy people, although they may not notice the immediate irritant effects.
    When we inhale such a highly toxic and polluted air during Diwali, how can escape from its ill effects? The harmful oxides present in the Diwali fumes come into contact with the moisture while passage from the nostrils to the lungs & form acids which cause immense damage to the body.
    The Diwali smoke potentially leads to development of various respiratory ailments like –Allergic bronchitis, acute exacerbation of bronchial asthma & COPD (Chronic Obstructive Pulmonary Disease), allergic rhinitis, laryngitis, sinusitis, pharyngitis, common cold, acute eosinophilic pneumonia, reactive airway dysfunction syndrome, etc.
    Children, pregnant women, asthmatics & senior citizens are highly prone to these potentially harmful effects of Diwali smoke.
    Here is a list of precautions that need to be followed during Diwali celebrations.
    Precautions to be followed by asthmatics:
    1.      Stay away from people burning crackers.
    2.      Keep the inhalers and other medicines ready beforehand (both maintenance & reliever medications).
    3.      Consult your doctor and start maintenance dose of inhalers a few days before the festival & continue the same two days after Diwali.
    4.      In severe cases rescue medications need to be taken & if not relieved contact your doctor immediately.
    5.      Better do not venture out in the evening of Diwali. Stay in company of friends and family members in house.
    6.      If need to venture outside use masks (N95 masks have been technically recommended).
    7.      Consult your doctor regarding pulmonary vaccination in advance.
    8.      Stay away during colouring and white washing of house before Diwali because these also act as “triggers” of an asthma attack.
    9.      If possible plan a visit to some hill-station / ecoclean place (which is not much crowded) during Diwali festival.
    Precautions to be followed by every one of us during Diwali festival:
    1.      Avoid /decrease the firework celebrations & play “ecosafe” Diwali.
    2.      Enjoy Diwali with lamp, lanterns & diyas.
    3.      Fireworks if carried out should be done in open grounds, away from residential areas & during fixed time limits.
    We should remember that one person’s idea of fun could be an asthma patient’s nightmare. Asthma patients have as much right as us to stick around and enjoy Diwali. And ultimately for our own benefit we should not forget that “what we burn is what we breathe”, this Diwali.

    Green areas around homes reduce atopic sensitization in children!!!

    Green areas around homes reduce atopic sensitization in children

    Western lifestyle is associated with high prevalence of allergy, asthma and other chronic inflammatory disorders. ‘Biodiversity hypothesis’ suggests that reduced contact of children with environmental biodiversity, including environmental microbiota in natural habitats, has adverse consequences on the assembly of human commensal microbiota and its contribution to immune tolerance.

    This study analysed 4 cohorts from Finland and Estonia with 1,000 children and adolescents aged 0.5–20 yrs. The prevalence of atopic sensitization was assessed by measuring serum IgE specific to inhalant allergens. WProportion of 5 land-use types—forest, agricultural land, built areas, wetlands, and water bodies—in the landscape around the homes was calculated using the CORINE2006 classification.

    The cover of forest and agricultural land within 2–5 km from the home was inversely associated with atopic sensitization. This relationship was observed for children 6 years of age and older.

    Land-use pattern explained 20% of the variation in the relative abundance of Proteobacteria on the skin of healthy individuals, supporting the hypothesis of a strong environmental effect on the commensal microbiota.

    The amount of green environment (forest and agricultural land) around home was inversely associated with the risk of atopic sensitization in children. Early life exposure to green environments is especially important. The environmental effect may be mediated via the effect of environmental microbiota on the commensal microbiota influencing immunotolerance.


    Green areas around homes reduce atopic sensitization in children. Lasse Ruokolainen et al. Allergy, 2014, DOI: 10.1111/all.12545.

    Take care of your Asthma

    Here was this season of Diwali and our Asthmatic friends really passed a tough time.
    So here's this a comprehensive guideline for your care if you are an asthmatic.

    A Patient's Guide to Asthma Care


    If you need your quick relief (Reliever) medication as little as four times per week (not counting use for prevention of exercise-induced asthma), your asthma is probably not well-controlled.
    This may sound surprising, even shocking, but it's true. Up to 85% of people with asthma can live virtually symptom-free, or well-controlled, needing little or no quick relief at all! Most of the other 15% can be greatly aided by the information in this guide.


    You or your child's asthma is WELL-CONTROLLED if you:
    • have symptoms of coughing, wheezing, or shortness of breath 3 or fewer days per week;
    • can carry out most desired activities, work and play, without having asthma symptoms;
    • wake at night or early in the morning because of your asthma 1 or 0 nights per week;
    • have no sudden, severe or unpredictable flare-ups; and
    • need your quick relief medication 3 or fewer times per week.
    If this describes you, then you have asthma that is well-controlled. As with all asthma, however, you need to monitor your symptoms in case they worsen.

    Signs of Dangerous Asthma

    About 10-15% of asthmatics suffer more seriously from the disease and are at higher risk of having "out of control" asthma.
    IF YOU EVER...
    • get only temporary relief (1 to 4 hours) or none at all after using your quick relief medication or
    • have difficulty speaking normally because of your asthma


    Diagnosis of asthma should involve the following steps:
    • assessing symptoms of cough, wheeze, chest tightness and shortness of breath;
    • assessing severity of symptoms; do they
      • occur daytime and/or nighttime?
      • occur with physical activity?
      • occur frequently?
      • lead to missed play/school/work?
    • assessing family history of asthma, allergies;
    • assessing possible allergies to inhalants and/or food; other signs of allergy of the skin, nose and intestine;
    • referral for allergy testing (includes infants);
    • referral for breathing tests.


    Allergy/Asthma Information Association (AAIA)
    A national organization devoted to helping fellow asthma, allergy and anaphylaxis sufferers, the Allergy/Asthma Information Association (AAIA) publishes current information medically screened by the Canadian Society of Allergy and Clinical Immunology, holds support groups, provides telephone support and referrals and advocates at national and regional levels.
    Services are available through membership or donations. Call us at 1-800-611-7011 FREE


    Treatment of asthma should involve all of the following steps:
    • controlling symptoms as rapidly as possible by:
      • assessing home/school/work asthma triggers and
      • recommending avoidance; and
      • prescribing medication (steroids, inhaled or — if needed — oral, and a quick relief medication);
    • referral for asthma education;
    • checking inhaler technique;
    • scheduling a follow-up appointment; and
    • providing personalized instructions to keep track of quick relief puffs used per week and an Action Plan of what to do in case of a flare-up.
    At follow-up appointment(s):
    • redoing breathing tests;
    • rechecking inhaler technique;
    • reviewing medication; and
    • providing individualized instructions to keep track of quick relief puffs used per week and reviewing the Action Plan of what to do in case of a flare-up.
    This process of appointments and follow-ups continues until patients and caregivers:
    • know the signs of well-controlled and out-of-control asthma;
    • understand the need to avoid triggers whenever possible;
    • understand the need for anti-inflammatory medication;
    • learn how to adjust their medication quickly at the first signs of a flare-up; and
    • understand that an asthma educator and patient associations can help them learn all of the above.

    How Asthma puts the "Squeeze" on Breathing

    The inflamed lining of the breathing tubes causes the "squeeze" of muscles surrounding them, leading to feelings of chest tightness, shortness of breath, mucus production and coughing.





    Asthma is an immune system overreaction of the lining of the airways — the breathing tubes — in the lungs. If you were to accidentally spill hot liquid onto your hands, or if you could sunburn your airways, they would look scalded and swollen. In asthmatics, this is what the linings of the breathing tubes look like — red, swollen — inflamed.
    The following are the most common airborne triggers which can lead to inflammation and worsening asthma:

    • ALLERGENS, such as house dust mites, animal dander, moulds and cockroaches;
    • COLD VIRUSES and other infections;
    • IRRITANTS, such as cigarette smoke and outdoor air pollution.
    There are many others.


    • Temperature changes (bursts of cold or hot air, or seasons which bring colder or warmer air);
    • Perfumes and colognes; and
    • Strong toxic chemical smells, such as gasoline, marker pens or household cleaners.


    Once the airways are inflamed, a number of asthma symptoms may follow. A scald or burn begins to secrete fluid. Inflamed breathing tubes can secrete mucus which can clog them. But something else can happen, too. Surrounding the breathing tubes, there are bands of muscle whose natural purpose is to contract and relax depending on physical activity. When we breathe into inflamed tissue (which obviously cannot be avoided), the bands of muscle contract more than they would if the airways weren't inflamed. The muscles tense and tighten, squeezing the breathing tubes, so that less air can move in and out. Narrowing of the breathing tubes feels like shortness of breath or breathing discomfort. Finally, a whistling (wheezing) noise as an asthmatic breathes and coughing may follow.



    One contact with an allergen can lead to a series of immune system reactions that can go on for days or weeks, re-triggering airway inflammation long after the initial allergic exposure. This is how ongoing allergen exposure leads to ongoing inflammation and asthma. Presently there is no reliable way to calm down this immune system over-response except to prevent or reduce exposure to allergens. Scientifically proven ways to remove or reduce particular allergy triggers that can improve your asthma include:
    • buying dust mite-proof encasings for your pillows and mattresses (including the box spring);
    • removing carpeting from the bedroom of the allergic person;
    • removing carpeting everywhere in the home;
    • keeping household humidity below 50%;
    • removing pets from the home (washing will not reduce allergen levels enough);
    • avoiding outdoor activity in early to late morning during pollen seasons when you are allergic.


    Non-allergic triggers are less persistent in their effect on the immune system. They are considered irritants which, when removed, can lead to relatively rapid alleviation of asthma symptoms. Regular exposure, however, can lead to recurrent, chronic symptoms. Removing or avoiding irritants is generally easier than allergen avoidance. Unnecessary exposure to these should be avoided or eliminated altogether where possible.


    Young children have smaller, more delicate airways than adults. When exposed to passive smoke, many children develop sensitive airways, which make them more susceptible to a number of problems, including asthma. Research has shown that children who live with smokers have higher rates of asthma.


    Exercise triggers asthma symptoms in almost all asthmatics, mild to severe. Symptoms may be prevented by doing warm-up exercises and using your Reliever inhaler about 15 minutes before activity likely to bring on symptoms.


    Because our energy-efficient homes let less outdoor air in and less indoor air out, indoor allergens, such as house dust mite, animal dander or moulds, can accumulate in indoor air. In effect, we are continuously breathing in higher concentrations of allergens. There is a causal link between indoor air pollution and the onset of asthma.
    Solutions to this problem include:
    • reducing sources of indoor allergens (e.g. carpeting);
    • keeping humidity below 50%;
    • decontaminating mouldy places, such as basements, humidifiers, and bathroom tiles;
    • increasing ventilation throughout the home; and
    • seeking the advice of a professional indoor air quality expert (see resources section).
    Outdoor pollution worsens (but does not cause) asthma symptoms.
    • Exposure should be avoided when ground level ozone concentrations are highest — in late afternoon, especially on very sunny days which contribute to increased smog levels.
    • Observe smog alerts and stay indoors on these days.

    Second-hand Smoke: A contributor to Asthma and Indoor Air Pollution

    • Make your home and car smoke free;
    • Don't smoke or find a program and/or medication to help you stop;
    • Avoid smoky environments;
    • Don't let anyone smoke around you or your children; and
    • Work or go to school in a smoke-free environment



    The ideal asthma controller is avoidance of triggers. Learning to avoid them will, in the long run, minimize symptoms and the need for medication. On the other hand, medication should never be used as a way to cover up symptoms, for instance, to keep the cat.
    Unfortunately, total avoidance of triggers is not always possible. Since you have to breathe, you're likely to end up with some inflammation. With some unusual exceptions, this means medication will have to be part of having well-controlled asthma, even in mild cases.


    The most important asthma medication is an anti-inflammatory "Controller." When you take it daily as prescribed, you can control your asthma symptoms. Indeed, you may feel almost asthma-free.
    Here are some anti-inflammatory Controller-type drugs your doctor may prescribe:
    • non-steroidal inhaler;
    • low-dose inhaled steroid;
    • high-dose inhaled steroid;
    • steroid pill;
    • leukotriene receptor antagonist (LTRA) pill.
    Your pharmacist can be a good resource to help you understand the role of each type of asthma medication and how to use them.

    The Expanding Role of your Pharmacist

    Shoppers Drug Mart HEALTHWATCH® Pharmacists have been specially trained to help you better understand:
    • asthma and your asthma triggers;
    • the role of your medications and how to use them properly;
    • the need to use additional devices, such as spacers.
    In addition HEALTHWATCH® Pharmacists provide:
    • a personalized Asthma Plan;
    • instruction sheets on asthma devices; and
    • information and instruction sheets on Peak Flow Meters.


    Your quick relief medication is meant to work in 1 to 3 minutes and last 4 to 6 hours. Your goal is tonot need it, at least not more than 3 times a week. As you increase anti-inflammatory Controller medication, your need for a Reliever will decrease.


    Inhaled steroids offer the best option for the initial anti-inflammatory treatment of asthma. The initial dose in adults is usually 400 mcg daily of Beclovent/Becloforte (beclomethasone) or its equivalent in Pulmicort (budesonide) or Flovent (fluticasone). Ask your doctor. One to two inhalations are usually taken morning and evening. In more severe asthma, higher doses may be required.
    The initial dose in children is usually 200 to 1,000 mcg daily of Beclovent/Becloforte (beclomethasone) or its equivalent in Pulmicort (budesonide) or Flovent (fluticasone). Ask your doctor. One to two inhalations are usually taken morning and evening. Higher doses are rarely required.


    Children who consistently use high doses of Beclovent/ Becloforte (beclomethasone) or its equivalent in Pulmicort (budesonide) or Flovent (fluticasone) to maintain well-controlled asthma should:
    • always rinse and spit after using their inhaled steroid;
    • have their height measured regularly with a special instrument called a calibrated stadiometer; and
    • ask to be referred to a specialist for assessment.
    Adults who consistently use high doses of Becloforte (beclomethasone) or its equivalent in Pulmicort (budesonide) or Flovent (fluticasone) to maintain well-controlled asthma should:
    • always rinse and spit after using their inhaled steroid;
    • ask to be referred to a specialist for assessment;
    • have the pressure inside the eyeball checked on a regular basis, particularly if they have a family history of glaucoma; and
    • ask to be referred for a test to measure bone density, especially if there are other risk factors for osteoporosis.

    Add-On Medications

    If asthma is not adequately controlled with moderate doses of inhaled steroids, other "add-on" drugs may be tried. These include LTRAs including Accolate and Singulair (pill form), long-acting bronchodilating Controllers, such as Serevent (salmeterol), Advair (salmeteral / fluticasone combination) or Oxeze or Foradil (formoterol). Less often, theophylline (pills), ipratropium or nedocromil (inhalers) may be added.


    The newest class of anti-inflammatory Controller drugs is called leukotriene receptor antagonists (LTRAs). They are not steroids and are not inhaled but are in are pill form. These drugs may be combined with inhaled steroids as a means of keeping the dose of steroids as low as possible. For patients who choose not to use low doses of inhaled steroids for whatever reason, these drugs can be used alone as the best possible choice among other anti-inflammatory Controller drug options.
    There are currently two LTRAs available in Canada. One is called Accolate (zafirlukast), which is available for patients 12 years and older and is prescribed as one tablet twice a day for day and nighttime control. The other is Singulair (montelukast), which is available for adults and children as young as 6 years of age and is prescribed as one tablet taken daily at bedtime.


    Inhalation is the recommended way of using Relievers and steroid Controllers. These medications are available in an aerosol puffer (metered dose inhaler, MDI) or in a special device called a dry powder inhaler (DPI).
    For children under 5 years of age, aerosol puffers are recommended and must be used with a special tube and mask attachment called a spacer. The aerosol puffer, or MDI, remains a popular inhaler for children 6 and up and adults, with or without a spacer.
    The aerosol puffer, however, is changing. Inhalers contain a gas called chloroflurocarbon (or CFC) to help spray the medicine into your lungs. CFCs, while safe for you, harm the ozone layer, which protects us from the sun's burning rays.
    There is one CFC-free inhaler on the Canadian market, a Reliever medication (salbutamol) called Airomir. Since all aerosol puffers will become CFC-free in Canada by 2005, with a projected 60% phase-out of current MDI inhalers by 2001, CFC-free puffers are being prescribed increasingly over what you might be using now. Ask your doctor for a CFC-free version of your current salbutamol Reliever.
    Many people prefer the dry powder inhaler, which is already CFC-free. The action of breathing in with the inhaler in your mouth is how the medicine gets into the lungs. This kind of device may not be appropriate for children under 5 years of age because they may be unable to breathe in hard enough to actuate the drug.

    Action Plans

    Asthma is a variable disease. It can improve and worsen. Asthmatics need to learn to keep track of symptoms with a Peak Flow Meter so they can increase medication at the earliest sign of a flare-up, before asthma gets out of control.
    A Peak Flow Meter is a small blowing device. When your asthma flares, the meter readings drop. Your doctor's written Action Plan will indicate at what peak flow reading you should begin taking more Controller medication.


    Once well-controlled asthma is achieved (need for Reliever 3 or fewer times per week), your inhaled steroid should be reduced to the lowest possible dose needed to maintain control.

    A Final Word

    This article is intended as a basis for questions for your doctor, pharmacist, asthma educator, discussions with family, friends, teachers and coworkers who need to better understand asthma and for the individual or caregiver to take steps toward better control of the asthma they're living with.
    You control the road to better health!

    Reference: http://aaia.ca/en/patients_guide_to_asthma_care.htm