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Turn Off Mute Mode and Talk to Your Allergist

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Plenty of people suffer from “white coat syndrome” aka anxiety about talking to their doctor. A new study revealed that asthma sufferers often experience this anxiety about approaching their allergist.

A study in the Annals of Allergy, Asthma and Immunology revealed that asthmatics are often afraid to ask their allergist questions or speak up when they have a problem. Stanley Fineman, allergist and past president of the American College of Allergy, Asthma and Immunology (ACAAI), found that only 8 to 13 percent of asthma patients keep refilling prescriptions for inhaled corticosteroids after a year. Patients may not realize that managing their allergies in a proactive, consistent way will have a big impact on their asthma symptoms.

 If you’re still experiencing white coat syndrome but know it’s time to talk to your allergist, try these tips to help you keep your cool before you visit your doctor. First identify what’s worrying you; if you identify what specifically is making you uncomfortable, it’ll be easier to address the issue head on. Consider taking a friend or spouse with you to help you relax in the waiting room. Finally, if you simply don’t have a great relationship with your doctor, ask friends and family for a recommendation for a different doctor.


What Asthmatics Should Know about Ozone Forecast Season

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Ozone: Photo from Pexels.

Photo from Pexels.

Before heading out into the sunshine, we know to lather up with sunscreen and pack plenty of water. But another important step is to check the ozone forecast; this is especially important for children, the elderly, those with respiratory diseases or heart disease, and asthmatics.

Ground-level Ozone

There are two types of ozone, but ground-level ozone is the one you should be concerned about. Ozone occurs naturally in the stratosphere, but ground-level ozone is created when nitrogen oxide (NOx) and volatile organic compounds (VOCs) chemically react in the sunlight. Ground-level ozone comes from sources like cars and smokestacks.

Ozone Forecast

Ground-level ozone can exacerbate asthma symptoms, but asthmatics can monitor the ozone forecast each day to know if it’s OK to participate in outdoor activities. Elaine Loyack is the program coordinator for Triangle Air Awareness, an organization that helps Triangle-area residents and businesses stay informed about and help improve local air quality. Each summer, she reminds folks about the importance of keeping tabs on the local ozone forecast and to plan their outdoor activity level accordingly.

“Ozone forecast season is the time of the year when the risk for unhealthy levels of ground-level ozone formation is highest,” says Elaine. “In North Carolina, ozone forecast season runs from April 1-October 31.”

What the Ozone Forecast Means for Asthmatics

On unhealthy air quality days, asthmatics should limit time outdoors to the morning and early to late evening. Severe asthma sufferers should avoid the outdoors completely. Asthmatics should also reduce their level of activity, so if you normally run outside, choose a walk instead.

  • Code Yellow (Moderate)–dangerous for those suffering extreme asthma.
  • Code Orange (Unhealthy for Sensitive Groups), Code Red (Unhealthy), and Code Purple (Very Unhealthy)–dangerous for all asthma sufferers.

 

Ozone Forecast Resources

Asthmatics can monitor ozone levels by email, phone, the Internet, social media, and through a mobile app. Each day at 3pm, the ozone forecast is published for the following day so folks can plan ahead. Click here to sign up to receive the ozone forecast.


Part II: How to Lessen Asthma Symptoms by Addressing Indoor Air Quality

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Part I: How to Lessen Asthma Symptoms by Addressing Indoor Air Quality, I explained how improving indoor air quality with the right air filters is key to managing asthma symptoms. In Part II of this series, you’ll learn how to manage indoor humidity levels to prevent mold growth.

Checking  Humidity Levels

Air filters are great at capturing particulates that can exacerbate asthma symptoms, but asthmatics can also be sensitive to heat and humidity. Since high humidity can encourage mold growth, it’s best to maintain 30-50 percent (% RH) humidity levels year-round. Humidity levels are higher at night and first thing in the morning during the summer, so leaving the windows open at night can actually raise the humidity levels in your home. It’s best to leave windows closed in the summer unless the outdoor RH is about 50 percent.

Smart Thermostats

Some thermostats, like Sensi from Emerson Climate Technologies, will tell you your home’s humidity level both on the thermostat and through the companion smartphone app. Although use of air conditioning can help with dehumidification, there are times when it may not be sufficient and a whole-home dehumidifier will help close the gap.

Bath and Kitchen Fans

Kitchen and bath fans are also important for keeping humidity in check. Today’s modern fans are equipped with automation and controls to run the fan at the most optimal times. Controls or use methods can also be adapted to older installations. Be sure to run your bath fan for a half hour after taking a shower.

If you’re unsure about the humidity levels in your home, consult with your trusted HVAC technician or an indoor air quality specialist. They can help you determine if your current fans, thermostat and air conditioning unit are working efficiently or if there is a benefit to install new equipment.


Part I: How to Lessen Asthma Symptoms by Addressing Indoor Air Quality

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Vacuuming with a HEPA vacuum cleaner, dusting, and regularly changing bedding are all important steps to take care of allergens in your home. Asthma sufferers should also frequently change return air filters in their HVAC system to capture particulates; monitoring humidity levels in the home to manage mold is also beneficial.

Selecting the Right Air Filter

There are a few key components to look for in an air filter to make sure you’re getting the most bang for your buck. Peter Kusterer, of Air Comfort for Homes, which specializes in indoor air quality (IAQ), recommends better performing 1″ traditional filters designed with low pressure drop (LPD) for your system. Select a pleated filter with a minimum efficiency reporting value (MERV) of 8, or better. Aprilaire and Honeywell are two brands that manufacture whole-home media air filters with a minimum MERV 11 rating that require less frequent replacement; in some cases, only once a year.

If you’re still experiencing discomfort after cleaning your home and changing your air filters, consider installing a whole-home media air cleaner that attaches to your HVAC system. Unlike a more traditional 1″ filter, a whole-home media air filter  cleans the air across a greater surface area. You can also move up to an electronic media air cleaner for an even higher MERV rating and efficiency. These filters will seem more expensive when compared to the traditional 1″ filter. Consult with your trusted HVAC technician or an indoor air quality specialist to determine if there is a benefit for you to install a whole-home media air cleaner.

Changing the Air Filter

Traditional 1″ filters will capture larger particulates and should be changed every 30 days. Follow the manufacturer’s recommendation of when to change the air filter.  When air filters aren’t changed regularly, your HVAC system has to work harder since particulate matter has built up on the filter and may restrict airflow. Set a reminder on your smartphone or calendar so you can easily remember when it’s time to change the air filter. Another quick tip is to write the “change by” date on the filter itself. Also consider running your system with just the fan on during high pollen count periods or when you have guests over. Using the fan, only, requires only the blower motor to capture particulates and can save energy when compared to running heating or cooling; you also capture airborne particulate that may have otherwise settled and is no longer capable of being trapped by the filter.

 In Part II of this series, I’ll explain how humidity levels can be monitored and managed to lessen asthma symptoms.


What’s in Your Mattress?

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There’s a lot more than stuffing and springs in your mattress, it can also be home to dust mites and other allergens like pet dander and mold. Although dust mites are invisible to the naked eye, these critters can exacerbate asthma symptoms and shouldn’t be ignored. About a quarter of Americans have allergies, and two-thirds of that group have dust mite allergies, according to allergist Dr. James Sublett.

What are Dust Mites?

Dust mites thrive in humid climates, and eat flakes of human skin, which settle in your mattress. They can also live in bedding, carpets, curtains and upholstered furniture.

Symptoms of Dust Mite Allergies

Individuals with dust mite allergies are allergic to the protein in dust mite feces and body remnants. Indicators of dust mite allergies are frequent nasal drip, sinus headaches, sneezing in the morning, and waking up with itchy eyes. If you’re not sure if you have a dust mite allergy, you can contact your allergist about taking an allergy test for confirmation.

Protection Against Dust Mites

Before you toss out your mattress and opt for a hammock, you can rest easy knowing there are a few simple ways to avoid irritation from dust mites. Wash your bedding weekly and consider investing in mattress and pillow covers that protect against dust mites. Hypoallergenic bedding can protect against pet dander, pollen, mold, dust mites, and other allergens. If you’re allergies are severe, you may also need to frequently clean curtains, carpets, and other upholstered furniture to minimize dust mite exposure.


Don’t Wheeze Your Way Through Exercise-Induced Asthma

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Photo courtesy of American Lung Association

Photo courtesy of American Lung Association

It’s often tough to work up the motivation to make a trip to the gym, but it’s even harder for those who experience asthma symptoms triggered by exercising. Post-workout, individuals with exercise-induced asthma, or exercise-induced bronchospasm (EIB), may experience wheezing, coughing, and difficulty catching their breath. Active Healthcare Account Representative Janice Stewart shared with me her own experience with EIB, and explained which treatment was effective for her.

Ten years ago, Janice was diagnosed with pneumonia and her doctor gave her an inhaler as part of her treatment. Since then, she noticed that she would periodically have trouble with wheezing, usually after using the treadmill or sometimes when her daily allergy medicine wore off. Janice got relief by using her inhaler after her workout, but she remained curious as to the root cause of her symptoms. Several months ago over lunch, I happened to be chatting with Janice about exercise-induced asthma and she realized that EIB might be the cause of her post-workout breathing problems.

Janice met with her doctor who confirmed that her symptoms sounded like a case of EIB. Janice’s doctor prescribed a new inhaler and an additional allergy medication to go with her daily Zyrtec. She now has a more proactive approach to managing her exercise-induced asthma. Thirty minutes before working out, Janice uses her new inhaler and now only experiences issues if she’s doing an advanced cardio workout.

“With my new medication regimen I am able to now do exercises that increase my heart rate without having to sit down afterwards to wait for the wheezing to clear,” says Janice. “I can recoup a lot quicker.  I have also noticed that with the additional medications that my allergy symptoms have been more manageable as well.”

Janice’s advice for individuals who have trouble breathing after exercise is to pay close attention to what your body is telling you—don’t ignore your symptoms. Janice wishes she had seen her doctor sooner for treatment so she could have spent less time suffering through her workouts. ­


Traveling with Asthma: Part II

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Packing Suitcase for TravelTraveling with Asthma—Part I explained how to pack and prepare for trips out of town if you have asthma. Now that you’ve done a little homework on how to get ready for your trip, check your packing list against this one to make sure you have everything you need. Need some suggestions for lightweight, small products that are great for traveling? I’ve also included some recommendations as part of this list.

*Packing List

  • Inhaler
  • Spacer—The Vortex valved holding chamber and mask delivers medicine quickly and efficiently, and is great for travel because of its lightweight design.
  • Peak Flow Meter—The TruZone PFM is also lightweight and the slim design makes it easy to pack.
  • Nebulizer—pack a portable nebulizer that’s battery charged or can be plugged into the cigarrette lighter in your car. If you’re traveling abroad and using a chargeable nebulizer, make sure you have an adapter. If you’re flying, check that the airline permits the use of a nebulizer while in the air. The PARI Trek S and OMRON nebulizers are great for traveling; both are lightweight and portable.
  • Health insurance cards and information
  • Asthma diaryclick here to find out more about what type of information to include in your asthma diary. The diary is useful in monitoring asthma triggers and medications, so you can recognize oncoming asthma attacks.
  • Hypoallergenic bedding—if you’re allergic to dust mites, consider bringing your own pillow and sheets if you have space in your bag.

*Note: You may not need all of these items, but this is a comprehensive list for your reference.

Remember to keep all medication handy. If you’re driving, don’t leave the medicine in a hard-to-reach corner of the trunk; if you’re flying, pack medicine in your carry-on luggage. With your careful planning, you’re on your way to a fun and healthy vacation!


Traveling with Asthma: Part 1

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It’s summer vacation time, but before you’re able to hit the road, there’s the dreaded chore of packing. Next to your sunscreen, flip-flops and stylish sunglasses, don’t forget to pack your asthma medication. Smart packing and a little research on your destination will go a long way in making your trip smooth and enjoyable.

Make a Packing List

Taking your medication with you is especially important if you’re in a foreign country. Brand names of drugs are sometimes different in other countries and it could be tricky to communicate with a doctor who speaks a foreign language; it’s best to avoid any issues by taking your medication with you. Pack spares of your medication so you have a backup in the event of lost medication.

If you’re traveling by plane, check with the airline about any packing constraints. Check packing guidelines from the Transportation Security Administration (855-787-2227), and visit the “Special Travel Needs” section on the airline’s website. Leave your medication in the original container and in your carry-on for easy access; if you’re checked baggage gets lost, you’ll be glad your medication is in your carry-on luggage. Some airlines even make oxygen available to passengers, so ask before your flight if that’s an option.

Research your Destination

Check the weather for your destination, and look for information about pollution levels at online new sites. That way, you can prepare for the type of air quality you’ll encounter.

You may also need to call your insurance company to verify that you’re covered while traveling. If you plan to go abroad, you could need travel insurance. If you have a smartphone, check to see if it works internationally as it could come in handy if you need to look up a hospital.

Assess your Hotel Room

Hotel rooms can be a hot spot for cleaning and smoking fumes, and dust mites. If you’re sensitive to harsh cleaning chemicals, avoid a room near a pool where those chemicals are used. Also check that your room is in a non-smoking area. If dust mites cause you trouble, consider bringing your own bedding or ask the hotel if they use impervious mattress covers.

With a little preparation, you can avoid navigating a foreign healthcare system and have a fun, relaxing and healthy trip.


Fact or Fiction? Spring Allergy Myths Debunked

Lisa Feierstein Allergies, Asthma Leave a comment  
Six sneezing people sm

Photo from Shutterstock

No sooner does cold season end that allergy season begins. It’s easy to get cold and allergy symptoms confused, and finding the right tools to treat allergies can be a challenge. Take a look at these answers to allergy myths for tips on how to keep pesky symptoms in check.

1. Allergies and colds have the same symptoms.

Not exactly. Allergy symptoms may include itchy nose, eyes and throat; clear mucus; and symptoms that persist from as little as a few days to a few months. Colds typically end after two weeks; usually occur in the winter; and can cause coughs, aches, fatigue, a sore throat, and a runny nose with yellow mucus. Allergies rarely cause coughs and never cause aches or fever, which are occasional cold symptoms.
2. An air purifier will stop allergy symptoms.

An air purifier will remove airborne allergens, but doesn’t take care of allergens that have settled on clothing or furniture. Wash clothes and shower to remove pollen at night, and try an impervious mattress cover as a shield against dust mites.

3. All allergy medicines cause drowsiness.

Some antihistamines like diphenhydramine (Benadryl) and doxylamine succinate (Nyquil) can cause drowsiness. Newer antihistamines like loratadine (Claritin) and Fexofenadine (Allegra) are less likely to make patients drowsy. Benadryl may be a better solution for nighttime allergy relief, whereas Claritin is better for the daytime.

4. Moving to the Southwest will cure allergies.

Allergens are everywhere, and there are plenty of plants in the desert that produce pollen. Offenders include sagebrush, cottonwood, ash and olive trees. Moving to the desert may offer temporary relief, but new allergies can develop after a few months.

5. People with pet allergies are allergic to the pet’s fur.

The pet allergen is a protein produced in pet skin and, to a lesser extent, its urine and saliva. There aren’t any non-allergenic breeds, but pets with shorter hair shed less and send less dander into the air. These breeds are a better option to the pet lover with pet allergies.


How to manage asthma’s annual nemesis: pollen

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment  

In early spring I don’t even bother washing my car; I’ve given up on the fight with the yellow-green pine pollen. Although few people are allergic to pine pollen, it’s a visible reminder of other invisible pollen that trigger allergic reactions. Thirty-five million Americans suffer through hay fever each year, but it can be an even tougher time for those with asthma.

If spring allergies increase your asthma symptoms, keep this list of springtime pollinators and allergy tips on hand to help you prepare for the worst.

Springtime pollinators:

Tree Pollination Period Peak Pollination Count
Cedar January to February Early January
Elm January to April Early March
Pine February to April Early March
Oak February to May Late March
Ash February to April Mid February to Mid March
Hackberry March Early March
Pecan April to May Late April to Early May

 

How to lessen allergy symptoms:

  • Close windows and doors.
  • Change clothes and shower at night to keep pollen from lingering indoors.
  • Reduce time spent outdoors when pollen counts are high. Pollen counts are highest before sunrise and after sunset.
  • Replace indoor air filters at home each month.
  • Dry laundry inside so pollen won’t settle on clean clothes.
  • See an allergist to determine which allergens affect you.
  • Keep antihistamines on hand. Nasal steroid sprays and neti pots can also offer relief.

President Obama Signs New EpiPen Law to Protect Children with Asthma and Severe Allergies

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President Barack Obama signs H.R. 2094, the School Access to Emergency Epinephrine Act, during a signing ceremony in the Oval Office, Nov. 13, 2013. (Official White House Photo by Pete Souza)
This photograph is provided by THE WHITE HOUSE as a courtesy and may be printed by the subject(s) in the photograph for personal use only. The photograph may not be manipulated in any way and may not otherwise be reproduced, disseminated or broadcast, without the written permission of the White House Photo Office. This photograph may not be used in any commercial or political materials, advertisements, emails, products, promotions that in any way suggests approval or endorsement of the President, the First Family, or the White House.Ê

On November 13th, President Obama signed into law the School Access of Emergency Epinephrine Act, legislation that helps protect schoolchildren who experience anaphylaxis, a life -threatening allergic reaction. The new law provides funding incentive to states that enact laws allowing schools to stock and administer emergency supplies of epinephrine auto-injectors. Food allergies are prolific in the United States. The potentially life-threatening disease is a growing public health issue, and a concern among those with asthma, as allergies can trigger asthma symptoms such as coughing and wheezing. The first line of treatment for anaphylaxis, epinephrine narrows blood vessels and aids lung passages that are more susceptible to inflammation and swelling, which leads to shortness of breath, coughing and wheezing. The epinephrine auto-injector is used to deliver measured doses of epinephrine by a spring-loaded syringe.
 
The new legislation will help save lives of children who may experience an anaphylactic reaction for the first time at school or don’t have an epinephrine auto-injector available when anaphylaxis occurs. There are states which have legislation either requiring or allowing schools to stock and administer emergency supplies of epinephrine auto-injectors, North Carolina is among the 22. The state of North Carolina recently made Asthma and Allergy Foundation of America’s Honor Roll by meeting several of their core policy standards. Of the core standards met, providing emergency protocols for asthma and anaphylaxis are among many standards upheld by the state.


Tis’ the Season for Allergies and Asthma Triggers

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A season normally filled with joy can turn miserable quickly. Seasonal allergic rhinitis and asthma sufferers can breathe relief as most outdoor allergens disappear until spring, but holiday gatherings and increased time spent indoors means more exposure to different allergen triggers. In an effort to help you avoid the hazards of the holidays, we’ve compiled some tips to keep you from wheezing and sneezing.
 
Oh, Christmas tree: It’s not just the live trees that can trigger symptoms; the artificial variety can, too! To avoid allergic triggers use a leaf blower to blow any pollen, mold spores or terpene on the tree. You can also wash the tree off with a garden hose. Letting the tree sit to dry in an open place like your garage will definitely help. For artificial trees, we recommend taking them outside and washing also as they, too, can harbor dust and mold.
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Use of Acid-Suppressive Drugs during Pregnancy linked to Increased Risk of Childhood Asthma

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Asthma is a prevalent disease among children, accounting for numerous emergency room visits, and unfortunately, a significant cause of morbidity. Although asthma incidence has increased over the past few decades, variations between countries, environmental factors and the use of certain medications have created a flurry of research dedicated to the disease and the understanding of its etiology.

Epidemiological studies have suggested that they key time period for childhood allergies and asthma development occurs between conception and early childhood, and prenatal drug use has also been implicated. In a letter to the Editor in The Journal of Allergy & Clinical Immunology, Mulder and colleagues assessed the association between the use of acid-suppressive drugs during pregnancy and the risk of developing childhood asthma using a crossover study. As gastrointestinal symptoms in pregnancy are fairly common, proton pump inhibitors (PPIs), histamine 2 receptor antagonists (H2ra) and other antacids have been known to be effective. Understanding that the development of asthma is a complex interaction between genetic and environmental factors, researchers used a general practitioners research database to identify children with a drug-treated asthma diagnosis between the years 2006 and 2010 that were matched with a sibling without asthma. Researchers conducted analyses based on exposure of anti-suppressive drugs, drug class (e.g. PPIs, H2ra) and trimester.

Of the 3,748 children studied, half with asthma and the other used as a control group, 22% of the children with asthma had mothers who were exposed to an acid-suppressive drug during their pregnancy compared to 20% in the control group. This data suggests that exposure to acid-suppressive drugs during pregnancy presents an increased chance in developing childhood asthma. Upon further analyses, mothers who used acid-suppressive drugs during the third trimester increased the odds of their child developing childhood asthma. These findings support evidence that exposure to acid-suppressive drugs during pregnancy is associated with childhood asthma. Although more research is needed to understand the exact mechanisms, one hypothesis suggests that neutralized gastric levels prevent adequate digestion of antigens in the mother’s stomach. The antigens, if not degraded can create sensitization of the immune system and cross the placenta creating likelihood for allergic sensitization of the fetus.


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