Posts Tagged ‘asthma’

Asthma News: Parents Underestimate Children’s Symptoms, Placebos Effective in Improving Patient’s Subjective Improvement but Not Objective Health

Monday, July 25th, 2011

image from consumerreports.org

A couple of months ago, one of my colleagues, Jon Stefanuca, wrote a post for Eye Opener entitled Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem. In that article, he explained the importance of patients proactively knowing and explaining their asthma symptoms to healthcare providers. He focused on some of the key features of asthma and the unique symptoms that each individual may experience. If you have not already read that article, I highly recommend it as a great way to become a better advocate for yourself or someone in your life that suffers from asthma.

Over the last few months, I have been thinking about Jon’s advice in relation to some work I have been doing. It makes good sense and hopefully will help people receive better care when they are having exacerbations of their asthma. However, I was disheartened to read a recent article from Reuters about how frequently parents underestimate their children’s asthma symptoms.

Parents Underestimate Their Children’s Asthma Symptoms

I am always a little leery of studies that are drugmaker-funded, particularly when the study suggests that perhaps more medications are needed to combat a problem. However, taken at face value, this is a pretty frightening idea given how many children now suffer from asthma and how serious a condition it can be for those children and families. The article points to a disconnect between the parents’ description of their child’s asthma and whether the asthma was actually being adequately treated:

While more than seven out of every 10 parents interviewed described their child’s asthma as “mild” or “intermittent,” the disease was adequately treated in only six in 10 kids.

A doctor who was not involved in the study explained it this way:

“Parents are only aware of asthma when the child is more severely ill,” Dr. Gordon Bloomberg…

“Physicians cannot just ask the parent ‘how is your child doing?’ The physician will get a global answer that doesn’t reflect the child’s quality of life,” said Bloomberg, of Washington University in St. Louis.

Poor treatment may influence asthmatic children’s quality of life, as well as that of their families.

In the survey, more than four in 10 parents reported missing work because of their child’s asthma, and similar numbers of parents regularly lost sleep for the same reason.

Children are Better Reporters Than Their Parents of Symptoms

Interestingly, “[t]he study also found children tended to be better than their parents at determining how well their asthma was being treated.” So, clearly, doctors must take the time to discuss the asthma symptoms and treatments not only with parents but also in a sensitive and appropriate way with the children patients themselves in order to receive a better indication of the disease status. The doctors interviewed for the Reuter’s article had different opinions on what this means for asthma treatment:

According to a new report, this suggests parents need more education about asthma medications.

But one expert said more medication is not the be-all and end-all for children.

“The idea of total control…is not where we should be putting our energy,” Dr. Barbara Yawn from Olmstead Medical Center in Rochester, Minnesota, told Reuters Health in an email.

Instead of just giving children with stubborn breathing problems more medication, she said better communication is needed to determine how children’s lives are affected, and what it will take to prevent their symptoms.

New Study Shows Receiving Treatment, Even with Placebo, Important for Asthma Patients – But Does not Improve Objective Health

image from 123rf.com

In another recent study, reported in the New England Journal of Medicine, researchers looked at how asthma patients responded to a medication (bronchodilator), two different types of placebos (fake inhaler or fake acupuncture), or no intervention at all. An objective measure was taken of the patient’s ability to exhale after each intervention (or lack of intervention) and the patient’s own rating of improvement was noted. What was so interesting about this study were the different outcomes between the objective (spirometry) and subjective (patient’s self-reporting) measurements of improvement.

The bronchodilator provided markedly better objective treatment over the placebos or no treatment – a 20% improvement rather than 7% for the placebos or no treatment. However, the subjective measure of improvement found that patients were almost the same, 45-50% improvement, whether the patients received the actual bronchodilator (50%), the placebo inhaler (45%) or the sham acupuncture (46%).  All of which were higher than the 21% improvement reported by those who did not receive intervention.

An article about the study in medicalnewstoday.com explains the outcome this way:

Now a study of asthma patients examining the impact of two different placebo treatments versus standard medical treatment with an albuterol bronchodilator has reached two important conclusions: while placebos had no effect on lung function (one of the key objective measures that physicians depend on in treating asthma patients) when it came to patient-reported outcomes, placebos were equally as effective as albuterol in helping to relieve patients’ discomfort and their self-described asthma symptoms.

The study’s senior author, Ted Kaptchuk, Director of the Program in Placebo Studies at Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School explained it this way in the article:

“It’s clear that for the patient, the ritual of treatment can be very powerful…This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson.”

However, I wonder if it cannot also be understood another way – which is that patients are likely to feel like their symptoms have been improved after a visit to a doctor, even if objectively their airway is still compromised.

How Should this Impact Asthma Treatment?

So what can be done with this new information? I think that Jon’s advice about patient’s knowing their own symptoms and expressing them clearly to their doctors is critical. I also agree completely with his advice that patients should ask for an objective measure of their respiratory improvement before leaving a health care facility. These two steps seem key to making sure that patients objective health is being improved – not just their subjective opinion of improvement. Finally, I think that it is critical that parents act as the best advocates possible for their children – which may include making sure that the children are heard on their own symptoms since parents are not the most reliable reporters.

What do you think? Are there other tips for asthma patients and their parents out there? How do respond to these new studies?

Related Videos:

Videos about Asthma

Related Articles:

Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem

Asthma – How to Protect Your Child When the Steroid Inhaler Fails

Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children

Week in Review (May 2 – 6, 2011): The Eye Opener Health, Law and Just Interesting Stuff Blog

Saturday, May 7th, 2011

From Brian Nash (Editor)

We appreciate your stopping by to see what this past week’s posts covered in the world of law, medicine, health and safety – and then some.

You’ve been told you need to undergo treatment. The doctor tells you (hopefully) the risks and benefits of what’s being proposed. You’re wondering – “Is this my only choice?” In a non-emergency situation you usually have a choice you may not have considered – a second opinion. Theresa Neumann’s piece this past week addresses this usually available but very under-utilized resource for patient’s facing this situation.

Sarah Keogh writes about a topic that makes a lot of sense – when you stop and think about it. Who are the people on a hospital’s medical team that are with you more than anyone else? Your nurses, of course. Just how does a nurse’s working conditions not only affect him or her – how does it affect your health? Read Sarah’s piece and find out.

Asthma affects the lives of 20 million people in America. It does not discriminate since it affects the young, the old and all in between. This past week, Jon Stefanuca, who has been immersed in a case involving a young man who tragically died as a result of asthma shortly after being discharged from a local hospital, shared his “4 tips” to make sure you get the health care you need when you have an asthma problem. If you or someone close to you has asthma, take the time to consider Jon’s suggestions. As always, if there are some suggestions you could share with others, please do in the comments section.

Recently our firm started using QR Codes on our business cards. I’d heard about them but wasn’t quite sure what they were all about. After a little bit of study and discussion, I was amazed at what they can do – you will be too. So many now use their phones and mobile devices as their primary means for connecting with the world via the internet. Just download a free mobile application, snap a picture using the app and the QR Code will whisk (at a blazingly fast speed) you away to more information than you can imagine. Jason Penn, who was the first to get his QR Code business card, was apparently fascinated by this new technology, so he wrote a post this week about it and shares with you some interesting information about some others who have been using it for some time now.

Our Posts of the Past Week

Medical Second Opinions: An Under-utilized Option for Patients

By: Theresa Neumann

Today’s medical world is vast with various technologies, treatments and options.  So, if a patient is diagnosed with a medical condition, and doctor A recommends treatment A, what keeps the patient from seeking a second opinion? This is an interesting phenomenon.  After performing intake summaries and client interviews for quite a while now, it still amazes me how many people have bad outcomes from surgery simply because they never requested a second opinion. Second opinions are not simply reserved for surgery, though; cancer treatment options, medical therapies for chronic conditions like rheumatoid arthritis or inflammatory bowel disease….read more

 

Working Conditions for Nurses Impact Patient Health

By: Sarah Keogh

I suspect that anyone who has spent even as much as one day or night in a hospital knows just how critical the nursing staff is in the , health, care and comfort of a patient. A compassionate and personable nurse can put a patient at ease and help them feel better in ways that go beyond just medicine.

Recently, I wrote about how different schedules impact nurses’ lives and how they cope with shifting from day to night schedules. This week, I was drawn to write about nurses again after seeing an article on medicalnewstoday.com that spoke about a study done by the University of Maryland School of Nursing.  Read more

Having an Asthma Problem: 4 Tips for you to use to get the medical care you need

By: Jon Stefanuca

Did you know that approximately 20 million Americans suffer from asthma?  Every day, about 40,000 of them miss school or work because of this condition. Each day, approximately 30, 000 experience an asthma attack.  About 5000 patients end up in the emergency room. Asthma is also the most common chronic condition among children. Can there by any doubt it is a very serious and potentially deadly medical condition that needs equally serious understanding and attention? The good news is that with proper education and treatment, most asthmatics have active and productive lives.

Bronchospasm and inflammation: the key features of asthma

This chronic airway disease has two primary features: bronchospasm and inflammation. Bronchospasm refers to the mechanism by which airways become narrower. In asthmatic patients, the muscle within the wall of the airway contracts, thus narrowing the lumen (a cavity or channel within a tubular structure) of the airway and causing respiratory obstruction. Inflammation refers to the process by which the wall of the airway becomes thicker in response to inflammation, which also causes the lumen to narrow and produce respiratory obstruction. Bronchospasm is usually treated with….read more

Bar Codes, QR Codes and More: The Intersection of Life and Technology

By: Jason Penn

The business cards I ordered arrived yesterday.  I tore into the package to do the usual inspection.  Is my name spelled correctly?  Is the card stock heavy enough?  Did they use the desired typeface?  Yes. Yes. And Yes.  But I needed to ask one additional question: Does the QR code link correctly?   I know what you are thinking:  What is a QR Code and why is it on your business card?  Let’s try an experiment. Read more…

Don’t forget, however – you can learn about Jason but just using your QR Code reader right now….

Sneak Peak of the Week Ahead

That was it for last week. What’s coming in the week ahead? Here you go -

  • Mike Sanders has a piece about our wonderful canine friends and how they are being used for those with special needs.
  • Sarah Keogh will be investigate the role and responsibility of our schools to warn parents about potential health problems involving their children
  • Jon Stefanuca will be taking a look at ovarian cancer and suggesting some key issues to discuss with your physician
  • Jason Penn will be telling us more about stroke and a very interesting problem that his research has revealed
  • I will be writing about a brand new project we are starting to take our social networking to a whole new level – stay tuned.

Again – many thanks to all who stopped by. Take a few minutes, read our posts and maybe have some interesting topics for discussion this weekend after reading last week’s Eye Opener.

Have a great weekend, Everyone!



Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem

Wednesday, May 4th, 2011

Did you know that approximately 20 million Americans suffer from asthma?  Every day, about 40,000 of them miss school or work because of this condition. Each day, approximately 30, 000 experience an asthma attack.  About 5000 patients end up in the emergency room. Asthma is also the most common chronic condition among children. Can there by any doubt it is a very serious and potentially deadly medical condition that needs equally serious understanding and attention? The good news is that with proper education and treatment, most asthmatics have active and productive lives.

Bronchospasm and inflammation: the key features of asthma

This chronic airway disease has two primary features: bronchospasm and inflammation. Bronchospasm refers to the mechanism by which airways become narrower. In asthmatic patients, the muscle within the wall of the airway contracts, thus narrowing the lumen (a cavity or channel within a tubular structure) of the airway and causing respiratory obstruction. Inflammation refers to the process by which the wall of the airway becomes thicker in response to inflammation, which also causes the lumen to narrow and produce respiratory obstruction. Bronchospasm is usually treated with bronchodilators such as Albuterol; whereas, airway inflammation is treated with corticosteroids. These two characteristics vary from patient to patient. Most asthma patients have elements of both bronchospasm and inflammation.

If you suffer from asthma, keep in mind that you are the one who best understands just how your problem manifests. You alone are in the best position to provide information to health care providers in order to alert them about a possible asthma exacerbation. This is particularly true when one considers that a physician may have relatively poor knowledge regarding management practices, social background and trigger factors of asthma, among other things.  In part, the difficulty in diagnosing asthma stems from the wide variability in its presentation. Any given patient with this condition can have some or all of the classic asthma symptoms. Asthmatics can have mild deterioration or a severe attack and anything in between.  Therefore, if you have asthma, you must be proactive and communicate all the information you can to your health care provider. To help you have “talking points” when you are having this discussion, you may want to consider including the following topics the next time you see a doctor about your asthma:

1. Appreciate  Your Unique Symptoms

Asthmatic patients will often present with a cough, chest congestion/chest tightness, wheezing, and shortness of breath. Some of these symptoms may be more pronounced than others. The symptoms can change or get worse over time. Some patients may present with only a cough. Depending on the severity of the asthmatic attack, some patients may even present with normal vital signs. On other occasions, some patients could have normal breath sounds and no wheezing or shortness of breath.  For these reasons, you must carefully identify those symptoms, which are characteristic of your asthma exacerbation.

2. Give Your Physician a Complete History

Once you have identified what defines your asthma attacks, make sure to communicate the complete history of your symptoms to nurses and physicians taking care of you.  Tell them when you began to experience symptoms. If you think you are having an asthma attack, say so.  If you had been experiencing asthma symptoms, but which happen to be gone at the time of your doctor’s visit, talk about your recent problems as well. If you are taking asthma medications, identify all medications, the dosage, and the method by which you administer those medications (inhaler vs. nebulizer), your frequency of use, and most importantly, advise your doctor if your symptoms are relieved when you use those  medications. Talk about each of your symptoms, identifying their pattern, triggers, severity, and whether they are relieved by any medications.  Tell your doctor if the quality of your life is impacted by your asthma symptoms.  You may also want to inform your doctor about previous asthma exacerbation, how they presented, and whether you sought medical attention. Whatever you do, don’t assume that the nurse or the doctor will spend the time to question you extensively and get this very important information from you. Take the time and the initiative to tell them yourself.

3. If You Are Concerned About Your Condition, Ask For a Peak Flow Measurement

If you present with symptoms and your doctor rules out asthma without utilizing some objective measure of your respiratory ability, you should be very concerned. Remember that many of the symptoms of asthma can be associated with other non-asthma medical conditions. For example, a cough can be associated with asthma, but it can also be indicative of a cold. To avoid any ambiguity in what you may be suffering from, your doctor should perform a peak flow test. This test is performed with a peak flow meter, which measures a person’s maximum speed of expiration (breathing out).  It is a non-invasive test extremely easy to perform.  The test can objectively identify a respiratory obstruction. Demand this test if you are concerned about your condition! It could save your life.

4. If You Are Found to Have a Respiratory Obstruction, Don’t Leave Without Getting Treatment

If you are found to have a respiratory obstruction of any kind, do not leave your doctor’s office or the emergency department without receiving medical attention.  Generally speaking, you should be given albuterol, which is a bronchodilator. Your peak flow should then be reassessed after each albuterol treatment. Frequently, Albuterol is administered several times per hour with peak flow measurements taken after each treatment to determine your response to the medication. If you continue with a respiratory obstruction, corticosteroids should be considered and administered where indicated.  If you persist with a respiratory obstruction, additional steroids and bronchodilators may also be needed. You may even need to be hospitalized. Whatever you do, don’t leave your doctor or the emergency room if you continue to have a respiratory obstruction.

What’s your story?

If you have asthma, share with our readers the unique pattern of your symptoms.  Your information may well help others who suffer from this condition. Remember, there is not a uniform pattern of signs and symptoms with asthma. They can very widely from patient to patient.

If you would like to learn more about asthma, I strongly recommend reading the Asthma Prevention Guidelines published by the National Heart Lung and Blood Institute.  This publication is comprehensive and very informative. As we always say- the more informed you are about your own health, the better your chances will be in getting the right care.

 

Image from morningsundesigns.com

Asthma – How to Protect Your Child When the Steroid Inhaler Fails

Sunday, March 21st, 2010

According to an article published by WebMD, a new study by the National Institute of Health examined the effectiveness of step-up asthma treatment among children who continue to experience asthma attack on steroid inhalers.

Researchers concluded that the success of the step-up treatment varies depending on the population of children. The study focused on 182 children between the ages 6 and 17. All of the children enrolled in the study experienced asthma attacks despite regular steroid treatment. In this population, the following drugs were used: long-acting beta-agonists (LABAs), leukotriene-receptor antagonist (LTRA), and increased doses of inhaled steroids. According to the article:

The drugs with the best chance of success – 45% – are long-acting beta-agonists (LABAs)… . But safety concerns limit the use of these agents, the best known of which are Serevent and Foradil and the combination products Advair and Symbicort. About 30% of kids, the study found, do best either with a leukotriene-receptor antagonist (LTRA, brands include Accolate, Singulair, and Zyflo) or by doubling the dose of the child’s current inhaled steroid medication.

Although the study did not reveal a clear winner, researchers were able to identify the following correlations:

Hispanic and non-Hispanic white children were most likely to have the best response to LABA and least likely to have the best response to doubling inhaled steroid dosage. Black children were equally likely to have the best response to LABA or doubling inhaled steroids and less likely to have the best response to LTRA. Children who did not have eczema were most likely to have the best response to LABA.

Contributing author: Jon Stefanuca