Asthma Coalition of Texas

BUSTING MYTHS ABOUT ASTHMA AND ALLERGIES

Mon, 10 Nov 2008 04:00:00 GMT

* MYTH: Children outgrow asthma in their teens. Once they hit puberty their asthma disappears, they don’t have the disease anymore so they don’t need to use asthma medications. FALSE! Asthma is a chronic disease. The symptoms of the disease (cough, wheezing, shortness of breath, chest tightness) may disappear or improve because the patient is following their medication plan (in compliance) or has eliminated their asthma triggers which cause their symptoms to occur, but the disease is always there. For an unknown reason, probably hormonal, asthma symptoms do lessen or stop during puberty making teens think they no longer have asthma, but this isn’t true. They still have the disease but symptoms decrease. There is no cure for asthma yet -but it can be controlled.
* MYTH: An asthma diagnosis means a patient’s quality of life changes for the worse. Asthma patients have to restrict their lives or suffer with symptoms. FALSE! With a proper diagnosis and the right management plan asthma patients can live normal lives. A management plan includes identifying and using the correct medications for that individual patient, eliminating and avoiding environmental allergens that trigger symptoms (if the patient has allergy triggered asthma) and learning everything they can about the disease so they can control asthma.
* MYTH: Exercise can trigger an anaphylactic reaction. TRUE AND FALSE! A few people are really allergic to exercise but exercise-induced anaphylaxis is rare. It can cause hives, fainting, vomiting and difficulty breathing during a workout with symptoms lasting up to 4 hours. But in most of these cases, the anaphylactic reaction is triggered by a food such as peanuts, shellfish, eggs, or in 2 reported cases, celery. And in order to have this exercise induced anaphylactic reaction, they had to have eaten these foods right before strenuous exercise. If you eat a peanut butter sandwich then go watch TV, nothing. Eat the peanut butter sandwich and jog on the treadmill, it may be bad news for someone affected by this syndrome. The reason for this is exercise increases heart rate, causing blood to circulate faster in the body, picking up food allergens along the way. Jogging and running are most likely to trigger the anaphylaxis but dancing, skiing, volleyball, even raking leaves or mowing can also cause this reaction. Extremely rare, there have only been 1000 cases of documented exercise-induced anaphylaxis since 1970, with 1 death. If you have an anaphylactic allergy to exercise, the reactions can be controlled by waiting a few hours after eating before exercise plus always using a warm-up, cool-down period when exercising.
* MYTH: If you have a stuffy head, sore throat and sneezing, you only have a cold. FALSE! If these symptoms, which can even lead to a migraine headache, occur at the same time each year, they might be allergy symptoms instead of a cold. How can you tell the difference between a cold and an allergy? One way is the quickness symptoms appear. Colds take a day or more to show symptoms and the symptoms gradually get worse, adding loss of appetite and perhaps headache to the list. These symptoms lessen and disappear within 7-10 days. Normal treatment for colds is to treat the symptoms, wash hands frequently, get plenty of rest and drink lots of fluids. Allergy symptoms, though, begin hard and fast. Sneezing is sudden and strong. Congestion is immediate. And symptoms can disappear almost immediately too, when the offending allergen is no longer provoking symptoms. Allergies almost always cause itchy eyes, nose and throat but colds usually don’t. Someone with a cold may have a fever, body aches and colored mucus but these symptoms normally don’t occur with allergy. Allergies are treated in a variety of ways including antihistamines, decongestants, and immunotherapy. The most effective way to treat an allergy is to identify then eliminate or avoid the trigger or allergen for the symptoms. If in doubt about your symptoms always talk with your healthcare provider.
* MYTH: Taking corticosteroids to treat asthma is potentially dangerous, can cause weight gain and should be avoided. FALSE! Asthma corticosteroid medications are not the same as the steroids taken by athletes to improve performance. Oral (taken by mouth) corticosteroids can increase weight but these are only prescribed for the most severe asthma. Inhaled corticosteroid medications are one of the safest and most effective treatments for mild or moderate persistent asthma according to most specialists. The drugs don’t become less effective the longer you use them, either. If inhaled corticosteroid medications aren’t as effective for you this year as they were last year, it’s not the fault of the medication. It means your asthma is getting worse or changing. Make an appointment with your physician to discuss the progress of your disease and whether you need to “step-up” (increase) or change your medications.
* MYTH: Epinephrine (adrenaline) is sometimes used as asthma medication. TRUE! Asthma patients usually require 2 types of medications commonly referred to as “relievers” and “controllers.” Adrenaline is one of the earliest inhaled and injected drugs used to treat asthma as a quick-acting reliever drug. Adrenaline does more than open up the bronchial tubes to make breathing easier, though: it increases heart rate and blood pressure which is not desirable. New medications don’t have this negative side-effect so epinephrine is seldom used anymore to stop sudden symptoms.

Upcoming AAFA-TX programs: 1) Nov. 5 “Tools To Manage Your Asthma & Allergies” McKesson Corp., Eric Schmitt, MD, instructor 2) Nov. 8 “”Walk for Food Allergy: Moving toward a Cure” Bob Woodruff Park, Plano, reg. begins 9 am. Sponsored by FAAN and partnered with AAFA-TX. 3) Nov. 12, 7 pm, SAFERHouston Food Allergy Support Group open meeting, ”Managing Food Allergies During the Holidays” Montgomery Cty. S. Regional Library in the Woodlands, Houston 4) Nov. 19, 1:30-4:30 pm “Asthma Management & Education” a continuing ed. program worth 3 contact hours for nurses, 2 ARCE for registered therapists and 3 ACPE for pharmacists. Albuquerque, NM, Jan Tippett, instructor. Pre-registration required. A small fee for pharmacists, register with Julie, 505-265-8729. Contact info@aafatexas.org or check our website www.aafatexas.org for more information on activities.

9-Nov-08 10:00 PM

Texas Health Care 2008

Mon, 10 Nov 2008 03:00:00 GMT

Click this link to view article Texas Health Care 2008: What Has Happened and What Work Remains

9-Nov-08 9:00 PM

Homeland Defense Journal Training Workshops™ Crisis Management & Emergency Preparedness Training Courses 2008-2009

noemail@texasasthma.org — Tue, 21 Oct 2008 17:00:00 GMT

Courses presented in multiple cities in U.S. See below for details.

Homeland Defense Journal produces over 150 course presentations each year. Our instructors are the "best of the best". For details on these courses and the full range of security training, go to http://www.homelanddefensejournal.com/.

Risk and Crisis Communication in the 21st Century - A Thought Leaders Forum on the Trends and Innovations Shaping Communication in Times of Crisis
Nov 3, 2008 Washington, DC

Crisis Management Plan Writing: An Interactive Workshop on Expanding and Enhancing Local Crisis Management Capabilities
Dec 2-3, 2008 Arlington, VA    ?    March TBD, 2009 Arlington, VA    ?    June TBD, 2009 San Antonio, TX    ?    September TBD, 2009 Washington, DC    ?    December TBD, Los Angeles, CA

Crisis Management Teaming Workshop: Strategically Selecting, Training, and Evaluating Your Team
Dec 4-5, 2008 Arlington, VA    ?    March TBD, 2009 Arlington, VA    ?    June TBD, 2009 San Antonio, TX    ?    September TBD, 2009 Washington, DC    ?    December TBD, Los Angeles, CA

Disability and Special Needs Technical Assistance Conference: Understanding the Four Phases of Emergency Management
Dec 9-10, 2008 San Diego, CA    ?    June TBD, 2009 Washington, DC

Fundamentals of Medical Planning - A Two-Day Workshop in Support of Emergency Response in a Medical Environment
Jan 14-15, 2009 Arlington, VA    ?    Mar 4-5, 2009 San Diego, CA

Disaster Logistics A Workshop on Managing Logistics for Emergency Situations
Jan 21-22, 2009 Houston, TX

How to Mitigate and Manage a Disaster A Workshop on Case Study Examples for the Risk Management Professional
Jan 21-22, 2009 Arlington, VA    ?    May TBD, 2009 Arlington, VA    ?    October TBD, 2009 Arlington, VA

How to Develop a Continuity of Operations/Continuity of Government Plans that Really Work
February TBD, 2009 Scottsdale, AZ    ?    March TBD, 2009 Arlington, VA    ?    August TBD, 2009 Arlington, VA    ?    December TBD, 2009 Arlington, VA

Mass Casualty Preparedness & Response Forum Mission Integration and Megacommunity Approaches in an All Hazards Environment
Feb 23, 2008 Washington, DC

Unable to travel to Washington, D.C or other cities where this training is presented?

Please contact Brian Lake at blake@HomelandDefenseJournal.com to discus your special needs and he will work with you to deliver a course or series of courses to your key personnel.

Registration Options:

[1] Online with your credit card using our online booking system at www.HomelandDefenseJournal.com
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21-Oct-08 12:00 PM

Vendor Drug Rx Update Newsletter

noemail@texasasthma.org — Mon, 20 Oct 2008 20:00:00 GMT

Click the link below to read Rx Update October 2008 issue.

Texas Health and Human Services Commission Newsletter, October 2008

20-Oct-08 3:00 PM

Tx DSHS Immunization Requirements: Provisional Enrollment Extension for Students Displaced by Hurricane Ike

noemail@texasasthma.org — Wed, 15 Oct 2008 16:00:00 GMT

Click on the link below for letter from the Texas Department of State Health Services on Immunization Requirements: Provisional Enrollment Extension for Students Displaced by Hurrican Ike

/attachments/wysiwyg/539/ImmReqs_Hurricane_Ike_10-10-08.pdf

15-Oct-08 11:00 AM

DISCIPLINE, BEHAVIOR, MEDICATIONS: PARENTS CAN COPE WITH CHILDHOOD ASTHMA

noemail@texasasthma.org — Wed, 15 Oct 2008 15:00:00 GMT

* Asthma is the most widespread chronic disease in children; it affects not only the patient but the whole family. Asthma can result in family friction, stress, irritation, financial worries, resentment in siblings, or, it can strengthen the family unit as everyone works together to support and control the disease.
* Sometimes, asthma, like any chronic illness, can blow family problems out of proportion and tensions within the family can ran high. Asthma and family problems can aggravate each other making each worse and hurting the family unit and quality of life for all. If you feel this is happening in your family, speak to your healthcare provider about seeking family counseling to resolve these problems.
* But there are ways to cope with having an asthmatic child, ways to improve the quality of family life while handling asthma, especially when it comes to discipline, behavior and teaching a child to be responsible for their own medications.
* Behavior: Asthma isn’t psychosomatic; it’s not a disease caused by emotions. It is a physical disease yet emotions, including stress, tension, fear, anger, even extreme laughter can trigger asthma symptoms. But when a child has had severe or persistent asthma most of their life, the stress of the disease can cause psychosomatic behavior problems for some children. If your child exhibits self-destructive behavior, uses asthma as a reason for not going to school or to manipulate the family, or deliberately doesn’t take their medications, then it’s time to talk about this with your physician and perhaps seek psychological help. The worst a parent can do is to excuse or ignore this behavior.
* Discipline: Stress, high emotions (whether happy or sad), fear, anger, frustrations can all trigger an asthma flare in many children and adults but that isn’t a reason to avoid disciplining a child when they are breaking family, school or society’s rules. It’s more harmful to let an asthmatic child break the rules and have their own way then to provide appropriate discipline even if it does result in an asthma flare. It’s also harmful for other children in the family or in the classroom to see a sibling or friend “get away” with breaking the rules just because they have asthma. This can result in resentment or even stronger feelings. If it’s necessary to discipline your child, discipline appropriately and follow the child’s asthma action plan if they do have a flare-up or exacerbation. Don’t feel guilty for playing the role of a parent.
* Medications: If a child is very young when diagnosed with asthma naturally it’s the parents or caregiver that have the responsibility for administering medications when needed as needed, eliminating asthma triggers from the child’s environment and generally protecting the child from exacerbations. As the child grows older, they should assume more responsibility for their own health but this responsibility should always be age and maturity appropriate to the individual child. How can you teach your child the way to use their medications independently?
* As a parent you and your physician will be the best judge as to when your child is ready to assume this responsibility. Some might be ready to start by age 5, others not until they’re 8 or older. The older the child, the more responsibility they should have. There are some steps to make this learning process happen more easily.
1.       Learn how to use a spacer and inhaler yourself so you can instruct your child in how to use it properly. Spacers ensure more medicine is inhaled and not lost in the air. They are highly recommended to get the most out of medications.
2.       Teach your child one step at a time. It may take months or longer before your child is ready to take medications alone each time, depending on their age. Perform each step yourself and explain what you’re doing and why.
3.       Smile. Be patient. Give praise for trying as well as succeeding. Don’t yell or berate failure even if frustrated.
4.       Help your child do it the right way if they make a mistake. Create a reward system when they get it right (stars on a chart for younger kids, extra game time for older kids, etc.) but don’t punish if they don’t do it right.
5.       As the child takes over, have them do each step as an adult watches. Praise and help as needed.
6.       Build routine. Take medications at the same time daily and put the container(s) back in the same place each time.
7.       Show the child how to wash the spacer container when needed and how to check the medicine every week to see when you need to buy more. NOTE: You can’t test HFA propelled inhalers by floating in water. If you don’t have an automatic dose meter on your inhalers, then mark a calendar to keep track of doses. Most hold 200 doses.
8.       Once the child can take the medicine alone, ask your child to tell you when they have used the med so you can write it down and keep track of remaining doses
Hints: Some medications leave a bad taste or a dry mouth after using them. Follow manufacturer’s instructions, but usually the child can rinse their mouth out with a little water after using the meds. Don’t store dry powder inhalers in the bathroom, they collect moisture and gum-up. All medications have side effects. Discuss your child’s concerns about these (I feel funny, I feel jumpy, I feel sleepy, I feel dopey) and work with your physician to find the medications with the least side-effects for your child. You can teach your child how to control their asthma!
* For more information on asthma and allergies, contact us at info@aafatexas.org or www.aafatexas.org

15-Oct-08 10:00 AM

Childhood Wheezing With Rhinovirus Can Increase Asthma Odds 10-fold

noemail@texasasthma.org — Thu, 09 Oct 2008 16:00:00 GMT

Infants who experience viral respiratory illnesses with wheezing are known to be at increased risk for developing asthma later during childhood. It is not known, however, whether every type of respiratory virus that produces wheezing presents similar risk. Using new molecular techniques to identify different viruses, researchers now believe they have pinpointed the biggest culprit: rhinovirus (RV).

"We have found that rhinovirus, the most common cause of colds, contributes a disproportionate amount towards future asthma development in comparison to other viruses that also cause childhood wheezing," said principle investigator, Robert F. Lemanske, Jr., M.D., head of the Division of Pediatric Allergy, Immunology, and Rheumatology and Professor of Pediatrics and Medicine at the University of Wisconsin School of Medicine and Public Health.

The results were reported in the first issue for October of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

From November 1998 to May 2000, researchers at the University of Wisconsin recruited nearly 300 newborns at high risk for asthma (with one or both parents having had allergies or asthma) to take part in their prospective cohort study on the etiology of asthma, the Childhood Origins of Asthma (COAST) study. The children were followed from birth to six years and evaluated for the presence of specific viruses during wheezing illnesses.

At six years, 28 percent of the kids had asthma— and those who had wheezed with rhinovirus were disproportionately among them. Children who wheezed with RV during the first year of life were nearly three times as likely to have asthma at age six, whereas children who wheezed with respiratory syncytial virus (RSV), another common respiratory ailment that has been linked to asthma risk in children, did not have an increased asthma risk.

The older the children were, the greater the effect. Children who had wheezed with RV in their second year of life were more than six times as likely to have asthma. Wheezing with RV at three increased asthma odds by more than 30-fold.

The study confirmed previous findings that wheezing with RSV any time during the first three years led to a nearly three-fold increased asthma risk. However, the novel finding is that "wheezing RV illnesses occurring at any time during the first three years of life were associated with a nearly 10-fold increase in asthma risk at six years, making them the most significant predictor of asthma development in the high risk COAST cohort," wrote Daniel J. Jackson, M.D., Allergy and Immunology Fellow at the University of Wisconsin, lead author of the article.

"Indeed, nearly 90% of the children wheezing with RV during year three subsequently developed asthma at age six," he wrote.

Whether RV causes asthma to develop, or simply reveals children who are already predisposed to the disease (host-related factors) remains an open question. Alternatively, "In genetically susceptible children, RV wheezing illnesses could cause airway damage as well as subsequent asthma (virus-related factors)," stated Dr. Jackson, pointing out that the possibilities are not mutually exclusive and that additional research would be required to resolve the question.

These findings mark a shift in medical knowledge on the topic of virus-induced wheezing and subsequent asthma development. John E. Heffner, M.D., past president of the ATS, stated that "the results of this study represent important advances in our understanding of childhood asthma because the investigators studied infants in an outpatient setting. Prior studies examined more seriously ill, hospitalized infants— mild viral illnesses may be just as important for later asthma as more severe infections. Also, the elegant technique used to identify specific viruses provides a foothold for understanding the unique viral attributes that cause wheezing and— potentially— lead to asthma."

Adapted from materials provided by American Thoracic Society, via EurekAlert!, a service of AAAS.

9-Oct-08 11:00 AM

Ike Victims to Get More Food Stamp Benefits in October

noemail@texasasthma.org — Thu, 02 Oct 2008 02:00:00 GMT

AUSTIN – The Texas Health and Human Services Commission (HHSC) has received federal approval to increase the amount of emergency food stamps that many Ike victims will receive in October.

The new policy applies to low-income households eligible for food stamps in the 29 counties declared federal disaster areas after Hurricane Ike. It doesn’t change the income limits for the program, but it does provide eligible families with additional food stamp assistance in October.

“I want to thank the Health and Human Services Commission for recognizing the needs of the residents of these 29 counties and moving promptly on our request for extra help,” said Rep. Garnet F. Coleman of Houston.

HHSC has approved more than 130,000 applications for special disaster food stamps since Hurricane Ike struck the Texas coast. On average, these individuals and families received $226 in food stamps for October. The amounts range from a low of $14 to maximums that vary based on the size of the family. For instance, a family of four can get a maximum of $588 in food stamps per month.

“Our offices have been seeing many low-income families who aren’t currently receiving food stamps,” said Texas Health and Human Services Executive Commissioner Albert Hawkins. “In many cases, these families lost food because of power outages or flooding, and they’re also facing other financial pressures this month. This special disaster supplement will help them feed their families while they continue to rebuild and recover after Hurricane Ike.”

The amount of food stamps a family gets is based on income and household size, and the new policy doesn’t change the maximum benefits allowed for the program. That means that households already approved for the maximum allotment level in October aren’t eligible for additional food stamps. Other food stamp recipients in the 29 counties declared disaster areas will automatically receive higher food stamp allotments for October. This includes households approved for food stamps before Hurricane Ike.

The new policy is expected to increase food stamp benefits in October for more than 240,000 families, and the amount of the increase will vary according to the family’s size and income level. For example, a family of three with an income of $1,143 will receive $451 in food stamps in October – an increase of $331 over the standard allotment of $120. An individual with income of $870 in October will get $170 – an increase of $156 over the standard allotment of $14.

The new policy is being applied to all eligible food stamp cases in the disaster area. Food stamp recipients do not need to visit an office or reapply. They will begin receiving the supplements early next week when the amounts are added to their Lone Star Cards.

Food stamp cases approved for benefits on or after Sept. 26 were processed using the new policy, and those families were notified of the amount of their October benefits when their cases were approved. Individuals and families with cases approved before Sept. 26 who are eligible for the higher amounts will get a letter notifying them of the increase in their October food stamp benefits.

1-Oct-08 9:00 PM

Nancy Otto, PharmD; Mark T. O'Hollaren, MD
Author Information

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Educate colleagues about resistant pathogens and intervention strategies
Show us how you would construct a presentation to educate your colleagues about resistant pathogens and intervention strategies. Participate in this interactive program

Editor’s Note:

The National Institutes of Health (NIH) released the 2007 NAEPP EPR-3 [National Asthma Education and Prevention Program Expert Panel Report 3] over a year ago. Since then, clinicians have continued to face challenges in assessing and managing asthma. What are some ways to overcome these challenges? How can practitioners involve their patients more in asthma management? To discuss these and other issues, Nancy Otto, PharmD, Editorial Director of Medscape Pulmonary Medicine, interviewed Mark T. O'Hollaren, MD, Associate Professor of Medicine, Oregon Health & Science University, Portland, Oregon, and Director, Clinical Outreach, Oregon Health & Science University, Portland, Oregon.

Medscape: We're here today with Dr. Mark T. O'Hollaren, Associate Professor of Medicine at Oregon Health and Science University and Director of Clinical Outreach for OHSU Healthcare. Today we'll discuss practical insights into assessing asthma and maintenance therapy in light of the 2007 NAEPP EPR-3 Guidelines for the Diagnosis and Management of Asthma. This is the first of a 2-part series. Welcome Dr. O'Hollaren.

Dr. O'Hollaren: Thank you.

Medscape: Today we're going to explore the topic of asthma control and management. Our first question is, how reliable is the patient's perception of asthma control?

Dr. O'Hollaren: This is a very interesting question, because one would believe that an asthmatic would be able to tell when they're experiencing increasing airway obstruction. In other words, you would think that if increasing inflammation was narrowing airway diameter, that patients would experience increasing dyspnea, shortness of breath, cough, wheezing, chest tightness, etcetera. Interestingly, the data would not back up that fact. If you look at studies which correlate a patient's perception of dyspnea with actual measured airflow using spirometry, specifically FEV1 [forced expiratory volume in 1 second], there is very little correlation between actual measured lung function and perception of dyspnea. Nearly all asthmatics can tell if they're acutely worse with their asthma, or if they need to go to the emergency room in a crisis situation. We're not referring to that particular situation, but rather the other 99% of the time when asthmatics are just living their daily lives.

We recently did a study of several hundred asthmatics in which we measured lung function, specifically FEV1 using spirometry, and had patients rate their perceived dyspnea using a Borg Scale, which is a validated tool to measure dyspnea. Interestingly, we found essentially no correlation between measured lung function and perceived level of shortness of breath in patients with asthma. This has significant clinical implications. If a patient is unable to determine their level of airway obstruction, then they may not appreciate the importance of the need to adhere to the medication program prescribed by their physician. Much like patients with hypertension, who may not comply with their antihypertensive medications because they don't experience acute symptoms, patients with asthma who do not perceive dyspnea may not feel that it's important to comply with their chronic controller medication. Because patients with asthma may also alter (ie, decrease) their activity level to accommodate their asthma, they may not exercise enough to provoke dyspnea and provide clues to recognize that their airflow obstruction is becoming progressively worse.

If a patient, for example, experiences a 1% fall in their FEV1 every week, there is no way that the majority of patients with asthma will perceive any change in their asthma control on a week-to-week basis. However, if that process continues unabated, that can amount to a 50% fall in lung function over one year while the patient has not recognized that they're getting worse. Therefore, it is important to realize that when a patient goes to the doctor to be seen, despite their best intentions, they may not give an accurate portrayal of their level of asthma control.

Medscape: So, what are reliable tools to follow a patient's level of asthma control?

Dr. O'Hollaren: There are a number of different tools that have been validated to allow the physician or healthcare provider to more accurately assess asthma control. As per the NIH guidelines, spirometry continues to be extremely helpful in providing an objective guideline for the level of airway obstruction in an asthmatic. Exhaled nitric oxide (eNO) is also being increasingly evaluated as an auxiliary tool to follow airway inflammation. The cost of the equipment to measure exhaled NO has been falling, and may soon be more widely within reach of physicians involved in the care of patients with asthma. In addition, there are several key questions that can be asked to tease out the specific level of asthma control. For example, a general question such as "How are you doing with your asthma?" is next to useless in getting meaningful information regarding a patient's functional status. When a patient is asked such a question, the typical reflex answer would be, "Fine." On the other hand, specific questions such as "Is your asthma waking you up from sleep at night?" or "How often do you need your albuterol during an average week?" or "How much are you able to exercise before needing albuterol or before experiencing shortness of breath?" Those specific questions tend to give far more information about the real level of asthma control.

There have been validated tools developed to assess the level of asthma control for a given patient. One of the most commonly used tools in this category is the Asthma Control Test. This is a 5-question validated questionnaire that allows a patient to score from 1 to 5 on each of 5 questions. So, the maximum score would be 25; the minimum score would be 5. A score of 19 or less on this simplified questionnaire correlates with asthma that is not well controlled when compared with specialist-assessed asthma control, and it also correlates with an FEV1 of less than 80% predicted. This is a simple questionnaire that can be done in a physician's office while the patient is waiting to see the physician.

If the medical assistant or nurse both checks spirometry and has the patient fill out an Asthma Control Test while they're waiting to see the physician, then as the physician enters the room, they have 2 validated tools to accurately assess how a patient is actually doing with their asthma. The Asthma Control Test also provides a quantifiable score for following a chronic disease, which is helpful in the various quality measures that are now being brought forth by Medicare, etcetera. Some physicians choose to ask these specific questions as a part of the history; others use a tool such as the Asthma Control Test. The important point is to go beyond the basic questions such as "How are you doing with your asthma?" and delve into issues such as sleep disturbance, exercise tolerance, and albuterol use. These specific questions are best used in tandem with objective measures of lung function, such as spirometry.

In summary, in order to reliably assess asthma control in an office visit, the physician ideally would like to use an objective measure of lung function such as spirometry and also use specific questions regarding the level of asthma control, as noted above. The combination of both of these approaches will help physicians to more accurately assess asthma control. The level of asthma control has been shown to correlate with subsequent healthcare utilization by asthmatics in the emergency room, hospital, or urgent care setting.

Medscape: What can clinicians do about monitoring the use of rescue medication in asthma?

Dr. O'Hollaren: Frequently there is someone in a medical office who is assigned to handle pharmacy requests for medication refills. One of the simple refill requests for patients with asthma is albuterol. In speaking with groups of pharmacists, it's alarming to me how often they tell me that patients are requesting and receiving 3 and 4 albuterol inhalers at a time, and refilling that number of inhalers every 1 to 2 months. The NIH guidelines suggest that patients whose asthma is well controlled should not need albuterol for treatment of spontaneous dyspnea more than twice weekly. This does not include albuterol taken before exercise.

A typical albuterol canister contains approximately 200 puffs of medication. If the NIH guidelines state that you shouldn't be using more than 2 puffs of albuterol twice per week, or 4 puffs in a week, or roughly one 200 puff canister in a 52-week year. Put another way, if a typical inhaler of albuterol contains 200 puffs, excluding pretreatment for exercise, an albuterol inhaler should last about a year. When you account for exercise pretreatment and the fact that the new HFA [hydrofluoroalkane] albuterol inhalers may not have as long of a shelf life, the average asthmatic should not be needing more than 2 to 3 albuterol inhalers per year. It is alarming if a patient is requesting 2 or 3 albuterol inhalers in a 1- to 2-month period.

It is very helpful if those reviewing requests for albuterol refills note whether or not inhaled corticosteroids or typical controller medications are being refilled at the same time as albuterol. If a patient is refilling only albuterol despite the fact that an inhaled corticosteroid has been prescribed, then the patient has "fallen off the wagon" as far as medication compliance with their controller inhaler. These patients should be contacted or brought in for assessment and education regarding the importance of medication compliance. The NIH guidelines clearly state that if someone needs albuterol more than twice per week (excluding exercise pretreatment) that they should be on a long-term asthma controller such as an inhaled corticosteroid.

In summary, being mindful of how many times a patient with asthma is requesting albuterol refills is important for every medical office, so that indicators of poor asthma control can be recognized and addressed.

Medscape: What do you see as the role of the pharmacist in appropriate asthma management?

Dr. O'Hollaren: I think the pharmacist can play a critical role in helping to identify patients whose albuterol use is spiraling out of control. Frequently, albuterol prescriptions are written with PRN [as needed] refills for a period of 1 year. Albuterol prescriptions, in my view, should never be written in this manner. They should be written for a single or at most 2 albuterol inhalers, with a limited number of refills so that it would trigger a call to the physician's office when those refills are exhausted. This allows some control over the process, so that patients are not going and getting unlimited albuterol refills without knowledge of the treating physician. If the pharmacist sees a pattern of excess albuterol use, I believe that it's very helpful for the pharmacist to call and alert the prescribing physician regarding the number of refills of albuterol that a patient is requesting. The pharmacist can also assess whether or not that patient has been prescribed an inhaled steroid or a controller medication, and whether or not the patient is refilling that prescription.

I sense hesitation on the part of some pharmacists to call a physician's office to alert them in such a situation. However, when I receive such a call, I thank the pharmacist and believe they're playing a critical part in the care of these patients by helping to identify early deterioration in asthma control, often prior to it coming to the attention of the treating physician. In addition, some pharmacies have begun to use the Asthma Control Test to assess the level of asthma control and report those results back to the treating physician. As pharmacists tend to become more involved in helping to maintain the complete health of patients, I think having them as a part of the asthma care team will only improve the quality of care for patients with asthma.

Medscape: Thank you Dr. O'Hollaren for your insights today into asthma control and management. We will continue this discussion in Part 2 of this series.

1-Oct-08 9:00 AM

IN THE NEWS: ASTHMA & ALLERGY

noemail@texasasthma.org — Wed, 01 Oct 2008 14:00:00 GMT

* Researchers have discovered a link between menopause and Adult Onset Asthma. The link is estrogen, a hormone protective of lungs and actively produced in young women of child-bearing years. Menopause reduces or stops the production of estrogen and this estrogen reduction could lead to asthma, especially for thin women. Women that are underweight are four times likely to develop asthma or allergies then women who are in the upper normal weight range. Obesity or being overweight is linked to an increased likelihood of asthma, though. Heavy women have more estrogen which some might think makes them protected from asthma, but obesity is linked to insulin resistance which hurts lung function. Suggestion: remain (become) active, maintain weight levels and discuss hormone replacement options if at risk for asthma.
* Every year approximately 150 people die from anaphylaxis caused by food allergy. The 12 million people with diagnosed food allergies know they have to avoid their food allergens. They must read labels and be vigilant in restaurants yet sometimes food allergens pop-up in unexpected places. Many street food vendors, a common sight at carnivals, state fairs and community celebrations are now using peanut or soybean oil in their fryers instead of trans fats. Vendors are trying to improve health by eliminating the bad fats, yet they’re unknowingly exposing some to serious food allergens that could lead to anaphylaxis. Suggestion: ask vendors at the State Fair and other activities the kind of oil they’re using to fry their wings, corn dogs or snowballs.
* The Journal of Allergy and Clinical Immunology reported that if you had (have) eczema as a child, this might lead to hay fever and/or asthma. Studies of people ages 8 to age 44 who had childhood eczema had twice the incidence of asthma then those who never had eczema. Many physicians aren’t surprised by these findings since they support the “atopic march” theory: a child begins with a food allergy then gets eczema and goes on to hay fever or asthma or both. This is the first study which definitely links eczema to asthma. Treating eczema aggressively may not prevent asthma but usually treating hay fever does reduce asthma risk.
* Are you bothered by sinusitis? Traditional treatments include prescription corticosteroid sprays, nasal sprays or saline irrigation, all effective methods to open clogged sinus cavities so they can drain properly and not become infected. If these methods fail, surgery may be necessary to open sinus cavities by removing bone and nasal tissue, surgery performed under anesthesia and requiring several days to recover. There may be another treatment for some using technology borrowed from methods used to unclog heart arteries. A minimally invasive surgical procedure, a tiny snip under the lip allows the surgeon to place a balloon catheter into the nasal cavity. This balloon expands the passageway and allows excess mucus to drain from the sinuses. The procedure, which is approved by the FDA, is done in a physician’s office under local anesthetic. But don’t rush to your doctor’s office yet. There is a question by many physicians that this procedure could cause nerve and tooth root damage. Most physicians would prefer to wait longer to see what long term effects might be for the 5% of patients who might benefit from this procedure. Suggestion: if you have chronic sinusitis, speak with your healthcare provider to determine the best option for you to open your sinuses and prevent infection.
* Are you trying to be kind to your body, to exercise more and loose weight but every time you venture outdoors to run, jog or walk your allergies go into attack mode and you feel miserable? You’re not alone. In Texas, pollens and molds are active 11 months of the year. Tree pollens thrive January through June, grass pollen season overlaps from April to September, weed pollen season is July to November – just in time for the ragweed season which lasts from August into November or our first heavy frost. Besides pollens, many parts of Texas have very poor air quality and this causes breathing problems and allergy symptoms for many who are chemically sensitive. Suggestion: If you can exercise indoors in a controlled air environment, do so. (gyms, at home, Mall walking, etc). If not, try to exercise outdoors in the evenings when pollen and mold spore counts are much lower. Select an exercise activity that requires shorter bursts of energy rather than sustained activity. Avoid working out or exercising on carpeted or grassy surfaces, instead use mats indoors and look for paved paths away from wooded areas when running. Breathe through your nose rather then your mouth. Nose-breathing helps to filter the air before it gets to the lungs. Warm up at least 10 minutes to allow your lungs and bronchial tubes to also warm up and prevent constriction or tightening. Don’t be afraid to stop exercising if you feel faint or have trouble breathing. If you have a cold or bronchial infection, postpone exercising until you’re over these illnesses. If you have allergies and/or asthma, always discuss your exercise program with your healthcare provider.

Upcoming AAFA-TX programs: 1) Oct. 3, 9-noon, “Asthma Management & Education” a continuing ed. program worth 3 contact hours for nurses, Oklahoma City, OK, Kathleen Conboy-Ellis, instructor. 2) Oct. 4, 9-noon, “Asthma & Allergy Essentials for Childcare Providers” First Baptist Church of Melissa, Mudpies & Lullabies sponsor, Melissa, TX, Darla Theis, instructor 3) October 10 “Asthma & Allergy Essentials for Childcare Providers” Holy Family of Nazareth, Irving, Patty Carlton, instructor. 4) Oct. 13, 8:30 am-11:30 am “Asthma Management & Education” a continuing ed. program worth 3 contact hours for nurses, Corpus Christi, Gwen Carlton, instructor. 5) Nov. 8 “”Walk for Food Allergy: Moving toward a Cure” Bob Woodruff Park, Plano, reg. begins 9 am. Sponsored by FAAN and partnered with AAFA-TX. 6) Nov. 19, 1:30-4:30 pm “Asthma Management & Education” a continuing ed. program worth 3 contact hours for nurses, Albuquerque, NM. Jan Tippett, instructor. Pre-registration required for each nursing program. Contact info@aafatexas.org for more information.

Information contained in this publication should not be used as a substitute for responsible professional care to diagnose and treat specific symptoms and illness. Any reference to products and procedures is not an endorsement. AAFA-TX and all parties associated with this Bulletin will not be held responsible for any action taken by readers as a result of this Newsletter.

1-Oct-08 9:00 AM

Updated - Healthcare Services for Ike Evacuees

noemail@texasasthma.org — Mon, 29 Sep 2008 17:00:00 GMT

Healthcare Services for Ike Evacuees

The Texas Health and Human Services Commission (HHSC) anticipates that federal legislation will be filed to provide relief for uninsured Hurricane Ike evacuees who seek medical care. While HHSC awaits Congressional action, providers should be aware of information that may be necessary to process claims for services provided to uninsured Ike evacuees.
It is important to understand that unless Congress authorizes funds, there is no guarantee that reimbursement will be made available for the treatment of uninsured evacuees. However, in the event that Congress does not authorize funds, HHSC will still need to track the cost of uncompensated care. If an evacuee seeks services, providers should collect the following information:

      Name and Social Security number.
      Citizen status.
        County and Zip Code where evacuee resided before the hurricane
         (see attachment for counties/Zip Codes covered).
      Monthly income.
      Evacuee attestation that they are uninsured.
      Demographics, including:
      Age
      Gender
      Race.
      Household composition, including the following information about people in the
      client’s household:
      Names of others in the household
      Ages of others in the household
      Relationship to client
      FEMA Registration ID Number
      Signature of client.

HHSC will provide more information about when to file claims; what period of time will be covered and other important details regarding reimbursement for providers as soon as Congress acts. Thank you for your ongoing efforts to provide services to the victims of Hurricane Ike and for the work you do to support clients of the Texas Medicaid program.

You can view or update your subscriptions, password or e-mail address at any time on your User Profile Page. All you will need are your e-mail address and your password (if you selected one).
This service is provided to you at no charge by Texas Health and Human Services Commission.
Visit us on the web at http://www.hhsc.state.tx.us/.

P.S. If you have any questions or problems e-mail support@govdelivery.com for assistance.

GovDelivery, Inc. sending on behalf of the Texas Health and Human Services Commission · 4900 North Lamar Blvd · Austin TX 78751 · 1-800-439-1420

29-Sep-08 12:00 PM

Separate Billing for Outpatient Prescriptions and DME

noemail@texasasthma.org — Mon, 29 Sep 2008 17:00:00 GMT

The Vendor Drug Program reimburses providers for outpatient prescription drugs only. Drugs administered in the doctor’s office, inpatient hospital, outpatient hospital, or any location other than the client’s home, nursing facility, or extended care facility are not a covered Vendor Drug Program benefit. Physician-administered drugs must be provided by the medical provider at the time of administration.
Pharmacies also may provide durable medical equipment (DME) and medical supplies to Medicaid clients as appropriate. Reimbursement for DME is different from drug claims; pharmacy providers must enter into a separate written agreement with HHSC, through the Texas Medicaid & Healthcare Partnership (TMHP). Download the TMHP Provider Enrollment Application at
www.tmhp.com. Some clients are enrolled in Medicaid managed care health plans and, for those clients, pharmacies must enter into a contract with their individual health plans to be reimbursed for DME and medical supplies.
To learn more about the Vendor Drug Program, please visit:
http://www.txvendordrug.com
You can view or update your subscriptions, password or e-mail address at any time on your User Profile Page. All you will need are your e-mail address and your password (if you selected one).
This service is provided to you at no charge by Texas Health and Human Services Commission.
Visit us on the web at http://www.hhsc.state.tx.us/.

29-Sep-08 12:00 PM

Asthma Coalition of Texas

BUSTING MYTHS ABOUT ASTHMA AND ALLERGIES

Texas Health Care 2008

Homeland Defense Journal Training Workshops™ Crisis Management & Emergency Preparedness Training Courses 2008-2009

Vendor Drug Rx Update Newsletter

Tx DSHS Immunization Requirements: Provisional Enrollment Extension for Students Displaced by Hurricane Ike

DISCIPLINE, BEHAVIOR, MEDICATIONS: PARENTS CAN COPE WITH CHILDHOOD ASTHMA

Childhood Wheezing With Rhinovirus Can Increase Asthma Odds 10-fold

Ike Victims to Get More Food Stamp Benefits in October

Recently Updated National Institutes of Health Asthma Treatment Guidelines: Important Clinical Applications: Part 1

Nancy Otto, PharmD; Mark T. O'Hollaren, MD Author Information

Information from Industry

IN THE NEWS: ASTHMA & ALLERGY

Updated - Healthcare Services for Ike Evacuees

Separate Billing for Outpatient Prescriptions and DME

Nancy Otto, PharmD; Mark T. O'Hollaren, MD
Author Information