Health Line
You Take My Breath Away 2
YOU’RE running fast as you climb the stairs to the second floor; then sprint back downstairs; then up again to the third. As your heart pounds, with lungs gasping for breath, pinch your nose. Breathe through a soft drink straw. How long will you last?
Empathize with the asthmatics. That is how they feel during ‘attacks’ or a exacerbation. A non-asthmatic would just frees one’s nose and opens the mouth in order to breath normally. However, the asthmatics are stricken by the disturbing emotional ‘flavor’, the darkest fear that they might not breath normally and would die.
Life and Death
The patient uses a nebulizer, with its magical ‘smoke’ hoping to restore one’s normal breath. The lucky ones experience improvement while the unfortunate ones are only a few breaths away from acute severe asthma, a life and death situation that may require a life-saving intubation.
Telltale Signs
Watch out if an asthmatic: Cannot finish his sentence, pants in between words or phrases; cannot lie down; breathes fast at more than 30 per minute; pulls his ‘stomach’ in instead of ‘ballooning’ it out while inhaling air; has fast heart/pulse beats of 120 and above per minute; turns pale or ‘blue’ and looks panic-stricken. No time to waste. Follow your doctor’s action plans (found on your prescription pad) in this critical moment e.g. puff the ‘rescuers’, take the tablet or liquid steroids, and go quickly to the nearest hospital.
Home Nebulizer: Friend Or Foe?
For asthmatics who have signs of impending doom, unsupervised nebulization at home could spell catastrophe. The air tubes may be so tight and closed during severe attack that no amount of nebulized drug could enter the airways.
Worse, most nebulized drugs called B2 agonists can lower blood potassium level (Bone, Pulmonary and Critical Care Medicine Vol. 1 Chapter 3: 8) that may cause muscle and heart weakness.
Red Blood That Is Hungry For Oxygen
During nebulization with B2 agonists (e.g. salbutamol or terbutaline), blood may lack more oxygen because its capillaries (filled with oxygen-hungry venous blood) that surround the lungs open first before the air tubes could do the same. There is a delay in the entry of oxygen (ventilation/perfusion mismatch), thus venous blood flows back to the body from the lungs with less oxygen. More danger ensues.
Simultaneous oxygen inhalation is usually needed during nebulization (medically- supervised in an emergency room setting).
Home nebulizers? I have seen patients dying at the ER with those machines at home. It’s like putting our dearly beloved’s life into our hands that despite the tell tale signs of impending doom, we still try to gamble with the nebulizer, delaying those badly needed emergency procedures.
The Triggers
These are agents causing asthma attacks. More common are house dust mites that look like hybrid ‘hippo’ and hairy cockroach on a microscope. They usually stay in pillows and bed sheets. Oh how they love to eat our ‘dead’ skin (“buling”) and scalp flaking (dandruffs)! When their wastes are inhaled, asthma attack occurs.
Others are cockroaches, cats/dogs dander, fumes, food additives as artificial colorings (check for FDC yellow color # 5 in junk foods) and sulfite found in french fries, salads, and wines. Sulfite, when mixed with stomach acid, produces sulfur dioxide gas. If burped and inhaled back, sulfur dioxide gas causes asthma attacks. Even weather changes as ‘low-pressure’ status provoke asthma. Don’t forget the rice pollens (‘tis harvest season now) and the molds as the palays are stored inside the house.
The Other ‘Tube Of Life’
Severity of asthma attacks can be unpredictable: from mild to severe. Patients’ difficulty in sensing real seriousness (so used to their usual breathlessness, they underestimate the real score) can be deadly. Thus, patient needs objective evidence to assess his actual breathing force.
A peak flow meter answers that need. It is a small tube (resembles an elongated toilet paper’s inner cardboard) with a piston marker that moves forward when blown forcefully. An asthmatic measures his force and lists the results twice a day (morning /evening). Any obvious lowering from the usual ‘best’ or sudden variation from usual trend serves as warning for a looming worse scenario. Ask your doctor about it.
A Patient Informed Is A Patient Alive
The importance of education to an asthmatic patient cannot be overemphasized. He or she should take his or her maintenance ‘preventer’ drugs to control inflammation inside the airways thus preventing ‘attacks’ can be life saving. Please see last week’s “You Take My Breath Away (1)”.
Many consider patient education program as their advocacy (Health Line is one of them).
Asthma Pharmacoeconomics
When an asthmatic dies because he or she cannot afford medications, it is the worst price a Third World or Developing Country has to pay. When a company like GSK and others with notable corporate social responsibility heed this sorry state, pledges to sell ISO certified asthma products (at half the price) even before a losing VP candidate’s Cheaper Medicine Law came into action, then we see a brighter hope.
Year after year, asthma cases go up, so with deaths and sufferings. When somebody helps curb this problem, then he conveys, literally, Emerson’s lines: “If you could have made one life breathe easier just because you have lived, then you must have succeeded.”
Happy breath-day dear asthmatic!
(Comments to dryapjr@yahoo.com)
(Our writer is a member of the The Kapisanan ng Mga Brodkasters sa Pilipinas. You can catch Dr. Yap every Sunday morning at Bombo Good Morning Philippines 900 MHz, and Fridays at “Health Line” Wesfardell Budyong Kapihan TV Show simulcast with dyjj with Rexam Laguda. Saturdays at Pulso sang Banwa with Glenn Beup channel 5 Alto Cable 8 am. reactions are welcome at dryapjr@yahoo.com. Dr. Yap’s book “Joyful Life & Sex? GO TO HEALTH!” is now available at all National Book Stores outlets nationwide.)
