REMEMBER TO ADVISE M.D. OF ALL MEDICINE OR FOOD ALLERGIES, AND OF ANY OTHER ALLERGIES.

1)   ABOVE ALL, STOP SMOKING!

2)   HYDRATION

(mainly water)  is very important: 2 quarts/day for adults.

A) INHALANTS

1. fast-acting, “rescue medications”:  Proventil / Ventolin / Xopenex / Albuterol - the generic, Albuterol, may not be as effective for some patients; Atrovent, Bronkosol.
2. extended duration (not rescue):  Serevent, Foradil, Spiriva

Preferrably use with an “extender” (aerochamber, inspirese).
Note: One cartridge must last at least one month!  Overuse is abuse, producing bronchial irritation, worsening symptoms, delay in seeking  proper treatment and EVEN DEATH.
Note:  Medihaler and Primitine are NO GOOD AND ARE DANGEROUS, except for acute laryngospasm - a different condition.

B) ORAL MEDICATIONS - Proventil, Terbutaline (Brethine), Theophyllin (theodur, uniphyll, etc)

A) ORAL INHALANTS:  Vanceril, Aerobid, Pulmocort, Flovent, Asmacort, Asmanex
B) NASAL INHALANTS:  Nasalide, Nasonex, Nasacort, Flonase, Nasarelle, Rhinocort, Beconase and Astelin, an anti-histamine.

Note:  Inhalant Steroid  medications are generally much safer than oral Steroids, even in children; and they should be part of the treatment of all but the most mild bronchial asthma.  They have generally little systemic effect ( through the “HPA Axis”).  But it should be remembered that their use is additive in these effects.  And in children their use in quantity and in time may produce short-term growth inhibition - although  a “catch-up” and long-term effects are still unclear.

C)  ORAL STEROIDS:  Prednisone, Deltasone, Medrol, Celestone, Decadron

Note:  Notify M.D. if you have a history diabetes, T.B., stomach ulcer or GERD, or Osteoporosis.

work to block the irritant or allergic reaction in spite of exposure - useful, partially effective.  Also useful for exercise - induced bronchospasm:  Intal (cromolyn sodium) inhaler, Tilade inhaler, Nasalcrom nasal spray.

Robitussin plain, Humibid, (glyceryl-guicaolate);  Duratuss G, Mucomyst (acetyl cystine) by inhalation; Mucinex, a tablet form of plain robitussin.

Note:  Especially with Mucomyst, safety and effectiveness require capability of a fairly good cough effort.

work to block inflamatory chemicals released by allergy, irritants, infection and other inflamation:  Singulair, Accolate.

Note:  Not for patients with liver disease;  liver function tests and  ESR should be taken periodically, the latter for the rare possibility of “vasculitis”.

inhibit or kill infectious agents; may be indirectly of help even in viral infections, especially in asthmatics and chronic bronchitics: Amoxycillin, Augmentin, Keflex,  Bactrim (a sulfa drug)  Macrolides (erythromycin, biaxin - ??zithromax, not very evffective in respiratory tract diseases), Tetracyclines (including vibramycin/doxycycline, Tequin (a Quinolone antibiotic)...

often needed in more advanced lung diseases, to delay complications and to improve quality of life, long before the current Medicare requirements for payment can be demonstrated.  Discuss this with your physician and with your legislator.

use only the second generation anti-histamines  (Claritin, Allegra, Zyrtec, Clarinex,Allevair); avoid the -D agents if hypertensive or over 40 years of age, in view of their effect on blood pressure.  Zyrtec is also in this class, and is best for itching, but may cause sedation in 10-15% of users.

Note: Any “sedating” medications may cause cognitive / reflex impairment even without recognized sedation.  This should be kept in mind with regard to driving, using machinery, or piloting a plane or boat.

Astelin, an antihistamine nasal spray, is useful for both irritational and allergic rhinitis,  as well as to abort sinus headaches.  It may produce sedation in a small number of users; thus, I do not use it as a first-line agent, but rather to augment other treatment when necessary.

Patanol, Optivar, Alocril, Crolom...

Note:  Many of these agents cannot be used in the presence of contact lenses, mainly because of the preservative.  But when allergic eye symptoms are active, contact lenses should not be used, anyway.

12) IMMUNOMODULATION: Allergy Immunotherapy; Tacrolimus (protopic and edicrel), Xolair (anti-IgE antibody).

13) INHALATION THERAPY UNITS (nebulizers,  like pulmoaid)

for use with inhalational agents like Proventil, Atrovent, Intal, Mucomyst, Xopenex, Pulmocort.

15) PULMONARY REHABILITATION PROGRAMS and other aerobic exercises.

Remember: IF YOU DON’T USE IT, YOU LOSE IT!

Watch out for "obstructive sleep apnea" (See the Category, Sleep Apnea), a serious condition, infrequently diagnosed, easily treated.

don’t try to hurtle through life, as you may have done until now.

AFFABILITY, AND AVAILABILITY - IN REVERSE ORDER OF IMPORTANCE.Always deal promptly with infections (mucus with “earth tones”, green, yellow, and/or a change in quantity and/or quality.  These usually require an antibiotic in this group of patients (asthmatics, chronic bronchitics, those with rrecurrent sinusitis), within 24 hours of onset, and taken for 10-14 days, until the mucus has completely cleared for 48 hours.

ASTHMA CAN BE REVERSED, EVEN “CURED”, WITH COMPREHENSIVE SPECIALTY TREATMENT, VERY OFTEN INCLUDING ALLERGY IMMUNOTHERAPY.

C.O.P.D. AT ALMOST ANY STAGE CAN BE STABILIZED; AND IT CAN OFTEN BE IMPROVED, ESPECIALLY IN THAT 30+% OF C.O.P.D. PATIENTS WHO HAVE A DIAGNOSABLE AND TREATABLE ALLERGIC / ASTHMATIC COMPONENT TO THEIR CONDITION.

Most patients do not have “Emphysema”, a word often used inappropriately, even by health professionals.

IF YOU NEVER SMOKED, DON’T START!
IF YOU SMOKE, STOP IMMEDIATELY, WITH THE HELP OF YOUR PHYSICIAN, WHO NOW HAS EFFECTIVE TREATMENT APPROACHES TO HELP YOU STOP.
AVOID SECONDARY SMOKE, WHICH CAN BE JUST AS HARMFUL TO YOUR HEALTH.  ESPECIALY WITH CHILDREN, SMOKING AROUND CHILDREN IN THE HOUSE IS A SERIOUS FORM OF CHILD ABUSE, SINCE IT HAS LONG-TERM, EVEN PERMANENT, EFFECTS ON THEIR LUNGS.

Avoid airborne particulates(dusts, fumes...) especially at work.  Only you can protect yourself.  And if your stone-age employer is giving you a choice between eating and breathing,  RUN FOR YOUR LIFE.

All this requires comprehensive medical and allergy treatment, with regular visits to your physician, with a good physician-patient relationship, and with good patieht understanding and compliance.  IT IS WORTH IT.

GS