Archive for May, 2012

Asthma Action Plan Necessary

May is National Asthma Awareness Month. It is estimated that more than 8 percent of the U.S. population suffers from asthma, and the numbers are rising yearly.

This translates into 18 million adults and 7 million children with the disease.

Asthma causes more than 3,000 deaths yearly, along with 500,000 hospitalizations, 2 million emergency room visits and 9 million doctor’s office visits.

The disease costs the U.S. economy $56 billion per year. It has a tremendous financial impact on our families, our nation and our health care system.

Asthma occurs when the small airways deep in the lung tissue become swollen and narrowed. This makes it difficult for air to pass through, causing the usual symptoms of wheezing and shortness of breath. Asthma can be deadly if not treated promptly and properly.

It is unclear why asthma affects some people and not others. The difference is probably due to both environmental and genetic factors.

For some people, asthma symptoms flare up under certain circumstances.

Allergy-induced asthma is triggered by such things as pollen, grasses, pet dander, and dust. Exercise-induced asthma is triggered by exercise or exertion. Occupational asthma results from exposure to chemical fumes, dust or gases.

A number of factors have been identified as increasing one’s chance of developing asthma:

– Having a close relative — a parent or a sibling — with asthma.

– Having any other allergic condition, such as hay fever or eczema.

– Being overweight or a smoker.

– Experiencing exposure to secondhand smoke or other airborne pollution.

Treatment of asthma can be broken down into two categories.

First, for quick relief, a drug called albuterol is the mainstay of treating an acute attack — one that is happening now. The drug is breathed into the affected lung airways using either a handheld inhaler or a tabletop device called a nebulizer.

Second, for longer-term treatment, inhaled corticosteroids, such as Flovent, have revolutionized the treatment of asthma by helping prevent attacks and also helping in the treatment of an acute attack.

I can’t emphasize enough how important it is to have an asthma action plan worked out with a doctor. Asthma is an ongoing condition that needs constant monitoring and treatment.

In spite of reports of increasing rates of asthma in the population, I have been a witness to fewer patients coming into my practice for treatment of acute symptoms. This has been in large part due to the use of the inhaled corticosteroids, as well as patients working closely with their doctors.

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Depression is a true medical illness, just like having diabetes or high blood pressure. It’s not a weakness, having the blues or something one can just snap out of. Fortunately, like most illnesses, it is treatable through medication and psychotherapy.

Common symptoms of depression include feeling sad, unhappy, irritable or frustrated; a loss of interest in things that usually bring pleasure; feeling worthless; fatigue, excessive sleeping or insomnia; indecisiveness and decreased concentration; and in some cases, thoughts of death, dying or suicide.

Many of us may briefly experience any of the above symptoms, but the person with true depression lives with these symptoms day in and day out.

Some risk factors of depression are having biological relatives who have depression or who have committed suicide and experiencing stressful events, such as the death or loss of a loved one. Women are also at risk, especially after a pregnancy. Other risk factors are serious, chronic illness and abuse of alcohol, drugs or nicotine.

In general, the most effective treatment for depression is a combination of medication and psychotherapy.

There are many types of antidepressant drugs available, and finding the right one may take some trial and error. Antidepressant drugs may take several weeks to take effect.

A patient who experiences undesired side effects should not stop taking the medication without consulting the prescribing doctor. In many cases, one must taper off the drug to avoid withdrawal.

Psychotherapy is provided by a trained and licensed professional, who can help one to understand one’s thoughts and behaviors and guide one in making effective changes. Ideally, this treatment can also provide a regained feeling of hope, happiness and control.

If someone you know is having suicidal thoughts, help is needed immediately. Here’s what needs to be done:

– Contact a family member, friend or clergy member for help.

– Call a suicide hotline number. Our local number is 877-663-5433.

– Seek professional consultation from a doctor or a mental health provider.

If someone you know is on the verge of, or has attempted, suicide, call 911 immediately for professional and rapid help.

Depression is not a weakness; it is a treatable illness. A doctor can help.

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Allergic rhinitis, commonly called hay fever, affects as much as 40 percent of children and 10 to 30 percent of adults in the United States. It is “seasonal” if symptoms occur at particular times of the year and “perennial” if they remain year round.

Common symptoms include sneezing, itchy eyes, nasal congestion with a decreased sense of smell, headache and fatigue.

These symptoms can tremendously impair one’s quality of life, as well as productivity. American workers lose an estimated 6 million work days yearly to this disorder and incur costs of several billion dollars in evaluation and treatment.

Seasonal rhinitis usually occurs from spring to early fall and is due to pollens from trees, grass and weeds. Perennial rhinitis, lasting throughout most of the year, is caused by indoor factors, such as dust mites, animal dander and mold.

Nasal stuffiness from allergic rhinitis can cause swelling and obstruction of the sinuses which can cause a sinus infection.

There is a strong association between allergic rhinitis and asthma. As much as 50 percent of patients with asthma have allergic rhinitis. Sleep disorders in adults and a high proportion of ear infections in children are also associated with allergic rhinitis.

Treatment for people who think they have allergic rhinitis can begin with an over-the-counter antihistamine, such as Benadryl or Chlor-Trimeton. However, these are often associated with the bothersome side effects of drowsiness. They should be avoided in children younger than 2 years and in elderly patients.

Newer antihistamines, such as Claritin and Zyrtec, are now available without a prescription and cause significantly fewer side effects than the older antihistamines. They are also more conveniently dosed, at once or twice a day.

Intranasal steroids have been shown to be very effective in relieving the symptoms of allergic rhinitis with minimal side effects in recommended doses. These nasal sprays are available by prescription from a doctor.

n Terry Hollenbeck, M.D., is an urgent-care physician at Palo Alto Medical Foundation Santa Cruz in Scotts Valley. Readers can view previous columns on his website, https://valleydoctor.wordpress.com, or email him at valleydoctor@sbcglobal.net. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor.

Allergy treatment at a glance

– Avoid substances and situations that cause your reaction.

– If symptomatic, try over-the-counter, nondrowsy antihistamines, such as Claritin or Zyrtec.

– If still symptomatic, see your doctor for prescription intranasal steroid sprays.

– If none of the above is helpful, ask your doctor for a referral to an allergy specialist.

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