Complex Care Plan
Choice of standing orders, or producing next requisition at each visit.
2003 Clinical Practice Guidelines
*Choice of standing orders, or producing next requisition at each visit.
Customize investigations on the basis of severity, changes in treatment or recent investigations, or need to monitor for stability. e.g. Repeat lipids in 3/12 if med changes, consider CK if myositis Sx but not routine
Annual CPx- annual labs (fasting); nurse, then doctor.
Every 6 months- doctor; BP and clinical status review including CCS every visit.
Labs annual or more often if required by other conditions.
Based on 2007 updated AHA guidelines, no Canadian equivalent
Grade I: Ordinary physical activity does not cause angina, such as walking and climbing stairs. Angina with strenuous or rapid or prolonged exertion at work or recreation
Grade II: Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, or in wind, or under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and in normal conditions
Grade III: Marked limitation of ordinary physical activity. Walking one or two blocks on the level and climbing one flight of stairs in normal conditions and at normal pace
Grade IV: Inability to carry on any physical activity without discomfort, anginal syndrome may be present at rest
The Healthy Heart Kit
Immunization: annual flu shot (fall), pneumovax once and repeat after 5 years if >65 years
Treatments to be considered: (AHA and SASK guidelines)
Customize blood work on the basis of severity, changes in treatment, or need to monitor for stability, e.g.
New York Heart Association Class
BC CHF Guidelines
The key target is prevent further worsening of CHF by preventing further events (ie AMI), control factors that require this (ie a fib), and optimize treatments to conserve or even enhance residual cardiac function.
Shortness of breath from COPD when hurrying on the level or walking up a slight hill.
Shortness of breath from COPD causing the patient to stop after walking approximately 100 m (or after a few minutes) on the level.
Shortness of breath from COPD resulting in the patient being too breathless to leave the house, breathless when dressing or undressing, or in the presence of chronic respiratory failure or clinical signs or right heart failure.
FEV1 > 80%predicted, FEV1/FVC < 0.7
50%<FEV1<80% predicted, FEV1/FVC<0.7
30%<FEV1<50% predicted, FEV1/FVC<0.7
FEV1<30% predicted, FEV1/FVC<0.7
Patient information adapted from MD consult
Coronary artery disease (CAD) or ischemic heart disease (IHD) is a type of heart disease. Your heart gets oxygen and nutrients from the blood that flows through the coronary arteries. In CAD, thick patches of fatty substances stick to the walls of the coronary arteries. These patches are called plaque. As the plaque thickens, the artery opening gets narrow and blood flow slows. This causes the heart to get less blood and oxygen. The plaque, or a blood clot that forms on the plaque, may completely block an artery and stop all blood flow. This narrowing or blockage of the arteries increases your risk for heart attack (death of some of the heart muscle) and sudden death.
Coronary artery disease is caused by gradual blockage of the coronary arteries. Several factors put you at risk for developing CAD:
There may be other factors we do not yet understand.
Coronary artery disease may have no symptoms. When there are symptoms, the most common one is chest pain, called angina. The symptoms of angina may include pain in the chest that lasts for more than 2 minutes, or that goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. There may be pain in other areas of the upper body, such as in one or both arms, the back, neck, jaw, or stomach. You may also be short of breath, break out in a cold sweat, or feel lightheaded or sick to your stomach. Angina tends to happen with activity, after a heavy meal, or with emotional stress. However, angina may also happen when you are resting. The pain happens more in cold weather.
Your healthcare provider will ask about your symptoms and then examine you. He or she will also ask about your personal and family medical history.
Blood samples may be tested in the lab to check the levels and types of fats (lipids) in your blood, your blood sugar and other tests if required. Your provider may order an electrocardiogram (ECG or EKG).
Your provider may want to know how your heart works when you exercise. You may have an exercise treadmill test. An echocardiogram (ultrasound images of the beating heart) may be done to check on your heart structure and function. Another test that may be done is a scan of the heart (MIBI). These scans are done before and after you exercise. They use a radioactive dye that is injected into one of your veins. If there is a problem with blood flow though an artery, the pictures will show that the dye is not getting to the heart muscle. A special kind of CT scan may also show coronary artery disease.
Heart catheterization and angiography may be needed. Angiography takes X-ray pictures of the coronary arteries. This allows the doctor to check the blood flow, including the number, location, and size of any blockages. This information will help determine the best treatment for you.
The goal of treatment is to prevent a first heart attack (damage to the heart muscle from loss of blood supply) or to prevent another heart attack if you have already had one and to optimize the function of your heart. In general terms it is also for you to resume or maintain a full and active lifestyle. Your treatment depends on many factors, such as your age, heart muscle function, and other health problems.
Treatment will include diet changes and an exercise program. Your healthcare provider will likely also prescribe medicine. Medications can help to keep the arteries open or even decrease the blockages in the arteries in some cases. They can also limit the chances of a narrowed artery developing a sudden blockage resulting in a heart attack. Your health care providers will help to choose the medications that are most suitable for accomplishing this considering your specific circumstances and can answer questions about the specific treatments recommended. If this treatment doesn't work, or if your coronary arteries are badly blocked, the blockages may need to be opened up or bypassed.
In balloon angioplasty, a small balloon is inserted into the artery to the blockage and then blown up to flatten the blockage against the artery wall. Angioplasty may be combined with inserting a stent. A stent is a device that keeps the artery open to improve blood flow.
If you have many blockages, or if they are bad, your healthcare provider may recommend coronary artery bypass surgery. Arteries from the chest or veins from the legs or arms are used to make a path around blocked areas in the heart artery.
Many people do well after balloon angioplasty or bypass surgery and return to very active lives, sometimes more active than before their diagnosis. People who already have advanced heart disease with complications when they are diagnosed and those who do not change to a healthier lifestyle are least likely to do well.
Eating a healthy diet, staying fit with the right kind of exercise, and not smoking are the best ways to prevent CAD. Talk to your healthcare provider about your personal and family medical history and your lifestyle habits. This will help you know your risks for coronary artery disease.
If you have a strong family history of CAD, a healthy lifestyle may slow the start of the disease and maybe even keep you from getting it. However, you must have regular checkups to keep a close watch on the health of your heart.
If you ever have chest pain symptoms, get medical attention right away. If you are concerned that you are having a heart attack, call 911 and get taken directly to the emergency department for urgent assessment and treatment.
An excellent web site for more information; http://www.canadian-health-network.ca;
Follow the links under groups and topics "cardiovascular disease and stroke" and then under disease prevention to "How can I reduce my risks of cardiovascular disease". There are links to numerous other web sites including the Canada Food Guide, the Canadian Heart and Stroke Foundation, "Women's Unique Risk Factors", etc
Nitroglycerin is one of the oldest medications available for the treatment of angina and heart disease. Nitroglycerin dilates blood vessels reducing the workload of the heart and improves blood flow to the heart. Nitroglycerin is used under the tongue to treat attacks of angina. Follow these directions for the use of Nitroglycerin.
Stop what you are doing. If the discomfort does not subside within several minutes, take a Nitroglycerin under your tongue(spray or tablet). Avoid swallowing while the tablet dissolves. When doing so you should ensure that you are sitting or lying. Nitroglycerin can lower the blood pressure and cause dizziness. Avoid standing after taking the medications for approximately 20 minutes.
There are two different sizes of Nitroglycerin tablets, 0.3 mg and 0.6 mg. Nitroglycerin is also available in spray form (0.4 mg). You may take one 0.3 mg tablet or one 0.4 mg spray every five minutes up to a total of four doses or one 0.6 mg every 10 minutes up to a total of two to three doses. You should never use Nitroglycerin while driving.
It is not possible to take too many Nitroglycerins; however, if your angina has not subsided after 20 to 30 minutes, then there is a chance you may be having a heart attack and you should either contact your physician immediately or have someone take you to the nearest hospital or best of all, call 911. This will be the quickest way to get the critical emergency care if you are having a heart attack.
Nitroglycerin tablets must be fresh to be effective. Cap the bottle quickly and tightly after each use. Replace unopened bottle after three months even if there are tablets left. Protect tablets from light. If you are using spray, check the expiry date on the bottle.
MOST IMPORTANTLY, IF YOU NITROGLYCERIN DOES NOT QUICKLY RELIEVE YOUR SYMPTOMS, CALL FOR HELP AND DO NOT ATTEMPT TO DRIVE YOURSELF TO THE HOSPITAL!
Often, it is not easy to tell. But there are symptoms people may have. These are: an uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back; discomfort in other areas of the upper body, which may be felt in one or both arms, the back, neck, jaw, or stomach; shortness of breath, which often occurs with or before chest discomfort; and other symptoms such as breaking out in a cold sweat, nausea, or light-headedness. When in doubt, check it out! Call 9-1-1. Don't wait more than a few minutes-5 at most. Call right away!
An episode of angina is NOT a heart attack. However, people with angina report having a hard time telling the difference between angina symptoms and heart attack symptoms. Angina is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood temporarily. A person may notice it during exertion (such as in climbing stairs). It is usually relieved within a few minutes by resting or by taking prescribed angina medicine. People who have been diagnosed with angina have a greater risk of a heart attack than do other people.
Clot-busting drugs and other artery-opening treatments work best when given within the first hour after a heart attack starts. The first hour also is the most risky time during a heart attack-it's when your heart might stop suddenly. Responding fast to your symptoms really increases your chance of surviving.
If you have any heart attack symptoms, call 9-1-1 immediately. Don't wait for more than a few minutes-5 at most-to call 9-1-1.
That's not true. There is something that can be done about a heart attack. Doctors have clot-busting drugs and other artery-opening procedures that can stop or reverse a heart attack, if given quickly. These drugs can limit the damage to the heart muscle by removing the blockage and restoring blood flow. Less heart damage means a better quality of life after a heart attack.
Given that these new therapies are available, it's very sad to know that so many people cannot receive these treatments because they delay too long before seeking care. The greatest benefits of these therapies are gained when patients come in early (preferably within the first hour of the start of their symptoms).
Emergency medical personnel-also called EMS, for emergency medical services-bring medical care to you. For example, they bring oxygen and medications. And they can actually restart someone's heart if it stops after they arrive. Your wife/husband/friend/coworker can't do that, or help you at all if they are driving. In the ambulance, there are enough people to give you the help you need and get you to the hospital right away.
You can make a plan and discuss it in advance with your family, your friends, your coworkers and, of course, your doctor. Then you can rehearse this plan, just like a fire drill. Keep it simple. Know the warning signs. Keep information-such as what medications you're taking-in one place. If you have any symptoms of a heart attack for a few minutes (no more than 5), call the EMS by dialing 9-1-1 right away.
Yes, if your doctor has prescribed nitroglycerin pills, you should follow your doctor's orders. If you are not sure about how to take your nitroglycerin when you get chest pain, check with your doctor.
You should not delay calling 9-1-1 to take an aspirin. Studies have shown that people sometimes delay seeking help if they take an aspirin (or other medicine). Emergency department personnel will give people experiencing a heart attack an aspirin as soon as they arrive. So, the best thing to do is to call 9-1-1 immediately and let the professionals give the aspirin.
Adapted from "http://www.nhlbi.nih.gov/actintime/faq/faq.htm"
Nutrition is often said to be the cornerstone of diabetes care. The nutritional management of diabetes can affect long term health and quality of life. The goal for nutritional management is optimal metabolic control through a balance between food intake, physical activity, and if necessary, medication to avoid complications.
All people with diabetes should receive individual advice on nutrition from a registered dietitian (RD). The registered dietitian can apply the nutrition guidelines while considering current intake, individual energy needs, lifestage, lifestyle, and any medical conditions of the individual with diabetes.
In type 2 diabetes, nutritional goals aim for improved glycemic and lipid levels and weight loss when required. In type 1 diabetes, the goal of nutritional intervention is improved glycemic control through coordination of food, especially carbohydrates, doses of insulin, and physical activity.
A healthy diet for a person with diabetes, as for a person without diabetes, follows the principles of Canada's Food Guide to Healthy Eating.
The following summary highlights the Canadian Diabetes Association National Nutrition Committee revised nutrition guidelines for people with diabetes (1999).
Recommendations for the Nutritional Management of Diabetes Mellitus:
Sometimes, we unknowingly send messages to patients through the words we use. For example: Don't say: "Your sugars are bad so I'm sending you to the dietitian." Say instead: "Making changes in eating habits is not easy. I think it would be very helpful if you could make an appointment with a registered dietitian and discuss your diet changes."
Registered dietitians work in area hospitals, community health centres, and privately in clinics. Many are Certified Diabetes Educators (CDE) and teach at various Diabetes Education Programs. The hospitals which have programs include the Ottawa Hospital: Riverside, General, and Civic campuses, as well as the Queensway-Carleton Hospital. A list of these Diabetes Education Programs is available from the Ottawa and District Branch of the Canadian Diabetes Association (613) 521-1902.
Usually, there is a waiting period (on average one month) to see a registered dietitian in a hospital, either for individual or group counselling. There are several registered dietitians, who are also Certified Diabetes Educators, who work in private practice and are able to see individuals sooner but for a fee. Some third party health care plans cover this fee. For further information, please contact: Sue Ann Ray-Spicer RD, CDE at (613) 727-0924
Adapted from http://www.cvtoolbox.com/cvtoolbox1/diabetes/di_2.html
Kidneys are as important to your health as your heart or lungs. Shaped like kidney beans and about the size of your fist, your kidneys are located on either side of your spine under the lower ribs. Their main task is to remove waste products and excess fluids from the body through the urine. The kidneys also ensure that the blood supply to your body's tissues has the proper balance of water, minerals (sodium, potassium, phosphate, calcium, and magnesium) and other substances that the body needs to work properly. They produce important hormones that help control blood pressure and stimulate the bone marrow to produce red blood cells. Your kidneys help keep your bones strong and muscles functioning properly by producing the Vitamin D that you need in order absorb calcium from the foods you eat.
You may be confused by the many different names used to describe kidney disease. Until recently, kidney disease was referred to as "renal" disease. These days, the term "kidney" is preferred. However, you may still hear terms such as "chronic renal insufficiency", "renal disease" and "end stage renal disease". Most people now use the term "chronic kidney disease" rather than "chronic renal insufficiency". However, you may still hear both "end stage renal disease" and "end stage kidney disease". Just remember that "renal" means kidney.
Chronic kidney disease (CKD) refers to the condition where the kidney's filtering ability is damaged over the course of many years due to a disease or other medical conditions. CKD is often called a "silent disease" because you may experience few symptoms until the disease has seriously progressed. To be diagnosed with CKD, you must have some type of kidney abnormality or "marker" such as protein in the urine and have decreased kidney function for three months or longer.
If diagnosed and treated early, kidney disease may be slowed down or stopped. However, if it keeps getting worse, wastes can build up in your blood and make you feel sick. CKD can lead to complications such as high blood pressure, anemia, weak bones, poor nutrition and nerve damage. It also increases your risk of developing heart and blood vessel disease. CKD may eventually lead to kidney failure (see End Stage Kidney Disease) - this is the point at which life-saving measures such as dialysis or kidney transplant are needed.
There is no cure for CKD - the goal of treatment is to keep the kidneys functioning as long as possible.
The two leading causes of chronic kidney disease (CKD) are diabetes and hypertension.
Diabetes is the leading cause of CKD. Insulin is a hormone that helps the body use the sugar (glucose) found in the foods we eat. Diabetes is a chronic medical condition where the body does not make enough insulin or does not use insulin properly. As a result, the amount of glucose in the blood stays high. High glucose acts like a poison, damaging the kidney's blood vessels and filters. If you have diabetes, talk with your doctor about how to keep your blood glucose as close to normal as possible to ensure your diabetes is under control.
Hypertension, or high blood pressure, is the second leading cause of CKD. High blood pressure damages the kidney's small blood vessels and filters, causing kidney function to deteriorate more quickly. Blood pressure greater than 130/80 mm/Hg is considered high and poses many risks to your health, including kidney disease, heart attack and stroke. If you have been diagnosed with CKD, it is important that you work with your doctor to keep your blood pressure under control.
While anyone at any age can develop chronic kidney disease (CKD), a number of risk factors have been identified that may lead to possible problems with your kidneys. These include:
If you fall into one of these groups, ask your doctor about getting tested for CKD.
Chronic kidney disease is usually a silent disease. Most people do not have any symptoms in the early stages. Symptoms that may show up as your kidney function deteriorates include:
As kidney disease worsens, the body is unable to get rid of waste products and excess water. This condition is called uremia. In addition to earlier symptoms, you may experience:
Because there are few symptoms in the early stages of kidney disease, diagnosis depends on laboratory tests. A diagnosis of chronic kidney disease requires some type of kidney abnormality or "marker" such as protein in the urine and decreased kidney function for three months or longer. A number of diagnostic tests are used to determine how well your kidneys are functioning. Some tests that may be performed include:
If these simple blood and urine tests indicate reduced kidney function, your doctor may request other tests to help determine the cause of the problem. For instance, a kidney ultrasound may be used to identify polycystic kidney disease, cancer, kidney stones or other obstructions. It can also help identify reversible conditions.
As chronic kidney disease (CKD) progresses, the following complications may develop:
End Stage Kidney Disease, also known as end stage renal disease (ESRD), is a complete or near complete failure of the kidneys to function to excrete wastes, concentrate urine, and regulate electrolytes. When this happens, the body begins to fill up with waste products and excess water. This condition is called uremia and its symptoms include swelling of the hands and feet, fatigue and weakness. If uremia is not treated it usually leads to seizures or coma, and ultimately death. However, it is important to remember that End Stage Kidney Disease refers to the end of your kidney function, not the end of your life. End Stage Kidney Disease can be treated by dialysis or through a kidney transplant. However, preparing for these treatments takes time. It is important to discuss your treatment options with your doctor well before your kidneys fail.
Dialysis is a treatment that substitutes a machine for usual kidney function. Dialysis removes waste products from the blood, eliminate excess fluid from the body, and helps maintain the right balance of electrolytes. Dialysis does not cure End Stage Kidney Disease - it is a life-saving procedure that can extend life. Some people have lived from 10 to 20 years longer as a result of dialysis treatment.
There are two types of dialysis:
If you need dialysis, decide with your doctor which type of dialysis is best for you. Your lifestyle, body size and shape, and other medical conditions will be considered when making this decision. Early referral to a nephrologist (kidney specialist) is very important.
Kidney transplant is an option only for people who have End Stage Kidney Disease that cannot be treated with medication. In addition, kidney transplants are not performed if there is active infection or cancer.
When the decision to proceed with a transplant has been made, a transplant surgeon will place a healthy kidney (donor kidney) from another person into your body. The new kidney is called a "donor kidney"; it will do the work that your failing kidneys can no longer perform. Possible kidney donors include:
Matching Kidney: There is a chance that the body will reject the new kidney. Having a donor kidney that matches your tissue and blood type reduces the likelihood of rejection. Prior to the transplant surgery, tests are done to make sure the donor kidney is a good match.
Surgery: During the transplant surgery, the surgeon will place the donor kidney in your lower abdomen. The blood vessels from the donor kidney will be connected to the arteries and veins in your body. The tube that carries urine to the bladder (ureter) from the donor kidney will be connected to your ureter. This connection enables blood to flow through the new kidney.
After Surgery: It may take time for your new kidney to produce urine. During this time, you may have to have dialysis and take drugs (such as diuretics) to help your new kidney eliminate excess fluid and salt from your body. You will also have to take drugs that help prevent your body from rejecting your new kidney (immuno-suppressive drugs). You will need to take these drugs as long as the new kidney is working, perhaps for the rest of your life. Your body may still reject your new kidney, despite taking these drugs.
Adapted from http://www.healthservices.gov.bc.ca/cdm/patients/ckd/
A number of pain relieving non-prescription drugs can have an adverse effect on your kidneys. If you are taking painkillers you should ask your doctor if, and how, they can affect your kidneys. Your doctor may be able to recommend a safer alternative. The following OTC drugs are known to cause damage to kidneys with prolonged and frequent use:
Be aware that taking aspirin or ibuprofen in combination with acetaminophen is especially harmful to your kidneys.
The best way to manage chronic kidney disease is to develop an effective working partnership with your doctor. Your doctor's role in this partnership is to provide medical advice, suggest treatment options and recommend resources. Your role is to monitor your symptoms, report them accurately, and do what you can to manage your disease on a day-to-day basis.
If you or someone you care for has congestive heart failure (CHF), this Web site may help you learn more about the illness. It has been designed to provide basic information and tips for managing your condition. In addition, you will find other Web sites and resources that will give you more detailed information on managing CHF.
The heart is made of specialized muscle and acts as a powerful pump that sends blood flowing throughout the body. Our blood contains the oxygen and nutrients that the body needs in order to function. When the heart muscle is not pumping blood as strongly as it should, the body does not receive enough oxygen and nutrients to function properly. This poor pumping action by the heart is known as congestive heart failure.
The heart's weakened pumping action causes body fluid (water) to back-up into the lungs, kidneys, and other parts of the body such as the arms, legs, ankles, and feet. This congestion, combined with a poor supply of oxygen, causes you to feel very tired, short of breath, and to experience swelling. Everyday activities such as walking, household chores, and climbing stairs become difficult.
Congestive heart failure is a common illness among those 65 years and older. About 40,000 British Columbians have been diagnosed this condition.
Congestive heart failure has no cure. With proper care, including medication and a healthy lifestyle, you should be able to manage the symptoms and improve your health and quality of life.
If you think you may have congestive heart failure, you must visit your doctor for a diagnosis. Some common symptoms you may experience if you have CHF are described below.
Depending on how weak your heart is, these symptoms can range from moderate to severe. You may experience one or all of them, or possibly none of the symptoms. The number of symptoms you experience is not an indication of how weak your heart is.
Congestive heart failure develops gradually over time and results from underlying conditions. These conditions may include:
To determine whether your symptoms are actually a sign of congestive heart failure, your doctor will need to conduct a number of tests. In addition to taking your history and conducting a physical examination, your doctor will likely request the following tests and procedures:
The results of these tests and procedures will help your doctor determine if you have congestive heart disease and decide which treatment is best for you.
Adapted from http://www.health.gov.bc.ca/cdm/patients/chf/index.html
Adapted from: http://www.cvtoolbox.com/cvtoolbox1/heart_failure/hf_5.html
Your doctor or other members of your health care team can recommend the type and amount activity that is right for you.
Physical activities that cause shortness of breath or dizziness are not recommended. These include:
Medications are very important in the treatment of congestive heart failure. Their function is to remove excess body fluid, improve your blood circulation, improve the heart's ability to pump, and maintain proper heart rhythm.
Your doctor may suggest that you stop smoking or lose weight to help reduce the workload on the heart before prescribing medications. These lifestyle changes can help reduce risks associated with high blood pressure and coronary artery disease - two recognized causes of congestive heart failure.
The following types of medications are used in treating congestive heart failure:
Side effects may include weakness, dizziness or light-headedness, skin rash, and dry cough. If you experience swelling of the face, tongue, hands or feet, seek medical help immediately. Please note that this side effect is very rare.
Side effects may include weakness, dizziness, muscle cramps, nausea, dry mouth and increased thirst. Contact your doctor if you develop a skin rash.
Side effects may include fatigue.
Side effects may include weakness, dizziness, muscle cramps, nausea, vomiting, diarrhea, blurred vision, confusion, major appetite loss, and weakness. Contact your doctor if these side effects cannot be explained by another cause, such as the flu.
Always speak with your doctor if the side effects bother you. Never stop taking your medications without first discussing it with your doctor. Never skip a dose, even if you are feeling better.
If you plan to take over-the-counter medications such as antacids, laxatives, cough or cold medications, ibuprofen and other anti-inflammatory drugs, ask your pharmacist to help you find an over-the-counter medication that does not make your symptoms worse or make your prescription medicines less effective.
Remember that the medications do not cure congestive heart failure; they only improve your symptoms. If you stop taking your medications, your symptoms will return.
A stroke is damage to the brain usually from a problem with the blood supply. This damage may be permanent and so it is important to recognize the stroke early on and take the appropriate steps.
http://www.heartandstroke.bc.ca (this links to an excellent description including the various types of strokes)
The following information is from the Canadian Heart and Stroke Foundation website.
Stroke is a medical emergency. Recognizing and responding immediately to the warning signs of stroke by calling 9-1-1 or your local emergency number can significantly improve survival and recovery. If a person arrives at a hospital emergency immediately after experiencing any or all of the stroke warning signs, and if the patient is diagnosed with a stroke caused by a blood clot, then doctors can administer a clot-busting drug called tPA - but only within three hours of initial symptoms. Thrombolytic drugs like tPA can effectively improve the outcome of a stroke by potentially minimizing the physical and mental damage. Yet only 20% to 25% of those who have a stroke actually get emergency care and treatment within three hours of the onset of symptoms the critical time frame during which clot-busting drugs are most effective.
Stroke can be treated. That's why it is so important to recognize and respond to the warning signs.
If you experience any of these symptoms, CALL 9-1-1 or your local emergency number immediately. The important thing is to recognize this early and take the necessary action!!
Stroke is a "brain attack" cutting off vital blood and oxygen to the brain cells that control everything we do - from speaking, to walking, to breathing. Most strokes occur when arteries are blocked by blood clots or by the gradual build-up of plaque and other fatty deposits. Some strokes can be caused by arteries rupturing when weak spots on the blood vessel wall break.
Every year, stroke strikes approximately 750,000 Americans - killing 160,000 and forever changing the lives of many who survive. The good news is that many strokes can be prevented. If you do have a stroke, new treatments can help stop the brain damage and disability, if you know the symptoms and get immediate attention.
Everyone has some stroke risk. A few stroke risk factors are beyond your control, such as being over age 55, being a male, being an African-American, having diabetes, and having a family history of stroke. If you have one of these risk factors, it is even more important that you learn about the lifestyle and medical changes you can make to prevent a stroke.
Previous stroke, previous episode of transient ischemic attack or "TIA," high cholesterol, high blood pressure, heart disease, atrial fibrillation and carotid artery disease. These medical risk factors can be controlled. Talk with your doctor about what will work best for you.
Smoking, being overweight and drinking too much alcohol. You can control these lifestyle risk factors by quitting smoking, exercising regularly, watching what and how much you eat and limiting alcohol consumption.
Few Americans know the symptoms of stroke. Learning them - and knowing what to do when they occur - could save your life.
Common stroke symptoms include:
Call 911 if you see or have any of these symptoms. Treatment can be more effective if given early on. Every minute counts!
Special note: If symptoms appear for only a very short period of time and then disappear, it could mean a Transient Ischemic Attack or TIA. It's important to call 911 whenever you experience any stroke symptom. While TIA's are not strokes, they indicate serious underlying stroke risks and are a powerful warning that a full stroke may soon follow.
Getting emergency medical treatment is important for several reasons: Only a doctor can tell for sure if you are having a stroke or a TIA. And, if you are having a stroke, emergency medical treatment could save your life and greatly improve your chances for successful rehabilitation and recovery. If you are having a TIA, your doctor will evaluate and treat the underlying causes. Following you doctor's orders for medication and treatment can help reduce your risk of having a stroke.
COPD stands for Chronic Obstructive Pulmonary Disease. COPD is a long-term lung disease usually caused by smoking.
COPD includes a few lung diseases: the most common are chronic bronchitis and emphysema. Many people with COPD have both of these diseases.
COPD symptoms include shortness of breath, increased mucus and coughing. Some people with COPD say it feels like they're breathing through a straw.
COPD can't be cured, but it can be treated. With the right treatment, people with COPD can lead active lives and live for many years. People can learn strategies for living with COPD.
COPD slowly damages your airways - the tubes that go in and out of your lungs. People with COPD have swollen and partly blocked airways. They can also have damage in the air sacs at the tips of their airways.
COPD makes it hard to breathe because:
Many people with COPD have emphysema and chronic bronchitis.
The emphysema part of COPD means you have damage to the air sacs at the tips of your airways. This makes it hard for your body to take in the oxygen it needs.
The chronic bronchitis part of COPD means your airways are irritated, red, and make too much sticky mucous. The walls of your airways are swollen and partly block the air from passing through.
Smoking cigarettes causes about 90 percent of COPD cases. Other things that can cause COPD are:
Anyone who smokes or who smoked in the past can get COPD. People with Alpha-1 antitrypsin deficiency, exposure to second-hand smoke or pollution, or many childhood chest infections, can also get it.
People usually notice COPD symptoms when they're in their 40s, 50s or 60s. Often people think their COPD symptoms - feeling short of breath, wheezing or coughing- are a normal part of getting older. They're not.
The sooner COPD is diagnosed, the easier it is to treat. That's why it's important to catch symptoms early. If you are a smoker or a former smoker, take the Canadian Lung Health Test to see if you're at risk for COPD.
Yes. Most of the time, COPD can be prevented. Since most cases of COPD are caused by smoking, people can prevent COPD by not smoking. Smokers can reduce their chance of getting COPD by quitting as soon as possible - it's never too late to quit.
Yes. If you have COPD and smoke, you can slow down the COPD by quitting smoking. Quitting smoking is the best thing you can do to feel better.
People with COPD eventually die from it, or from a complication of it.
Complications of COPD:
People with COPD can live for a long time after they are diagnosed. If you have COPD, how long you'll live depends on many things:
If you have COPD and you smoke, it's important to quit smoking. Work with your doctor to get proper care and treatment for COPD, so that you'll live as long and as comfortable a life as possible. Many people with COPD find ways to enjoy a happy and productive life despite their disease.
It's also important to talk to your doctor and family about what kind of care you will need in future years, and what you can do now to get ready for the future.
A recent report commissioned by The Lung Association shows that 1.5 million Canadians have been diagnosed with COPD. Another 1.6 million Canadians may have COPD but haven't yet been diagnosed. Doctors and public health officials agree that COPD is dramatically under-diagnosed and under-treated.
COPD is on the rise. Doctors project that COPD will be the third leading cause of death around the world (and in Canada) by the year 2020. Today, many people with COPD are women. More and more women who started smoking in the 1960s are getting diagnosed with COPD.
Adapted from: ? http://www.lung.ca/diseases-maladies/copd-mpoc/what-quoi/index_e.php?print=1
COPD can't be cured, but there are safe, effective medicines that can help control your symptoms. You'll need a doctor's prescription to get these medicines.
Because COPD symptoms are variable- they can change or get worse - it's important that you know how to adjust your medicine depending on how you feel.
Many people get confused by COPD medicines; they aren't sure what to take, or when to take it. With a little bit practice, people can learn to adjust their medicine to control their symptoms.
This website explains the basics of COPD medications. It also explains how to use inhalers and nebulisers. If you have any questions, be sure to ask someone on your COPD healthcare team. It can also help to have your son, daughter, spouse or friend sit in on your appointment when the doctor is explaining your medicines. They can take notes and help you remember the details.
Bronchodilators help reduce your breathing effort. They open up the airways in your lungs to relieve or reduce shortness of breath and wheezing.
The three main groups of bronchodilators are:
They come in two varieties: short- and long-acting.
Short-acting beta2-agonists are often used as a "rescue" medication to open airways quickly. They can also be taken on a regular basis.
Examples of short-acting beta2-agonists are:
If you need many doses of a short-acting bronchodilator to control your symptoms, your doctor may also prescribe a long-acting beta2-agonist, for you to take regularily regularly.
Examples of long-acting beta2-agonists are:
Anticholinergics also work to relieve breathlessness, but in a different way than beta2-agonists. Anticholinergics seem to be effective in treating COPD - especially if they are taken on a regular basis.
An example of an anticholinergic is:
A long-acting anticholinergic bronchodilator called tiotropium (Spiriva®) is also available.
A short-acting beta2-agonist and an anticholinergic can be combined in a single inhaler. For some COPD sufferers, this combination can provide better relief of breathlessness than if the drugs are used separately. For others, the effect is the same, but the combination medication is more convenient. They can be used both regularly and on an "as needed" basis.
An example of a short-acting beta2-agonist and anticholinergic combination is:
Xanthines are tablets that may help relieve breathlessness.
Depending on the person, xanthines can also improve the function of breathing muscles and perhaps reduce inflammation. Your doctor will be careful about prescribing xanthines: this medication is likely to cause side-effects such as nausea and heartburn, and can also interact with food and other drugs.
Examples of xanthines are:
Anti-inflammatories are corticosteroids, usually taken in an inhaled form. Corticosteroids are not the same thing as anabolic steroids, which some athletes take to build muscles.
Corticosteroids work over the long term, to reduce cough and inflammation in your airways.
New medical evidence shows that people with COPD who take corticosteroids at the first sign of a flare-up have fewer complications than those who do not take corticostroids.
Your doctor may put you on corticosteroids for a short while as a test to see if they help your breathing. A typical trial (test) lasts two to three weeks.
Examples of inhaled corticosteroids are:
Corticosteroids in tablet form (e.g. prednisone) are often prescibed to people with COPD flare-ups or a bad lung infection.
Corticosteroid tablets can cause more side effects than inhaled steroids. Your doctor will explain the side effects of oral corticosteroids, and explain that you have to slowly taper off this medication: you can't quit taking corticosteroid tablets all of a sudden, or you could feel sick.
Some medications combine anti-inflammatories with long-acting beta2-agonists to reduce inflammation, relieve breathlessness and decrease the number of COPD flare-ups.
Two such combinations are:
When you have COPD, your lungs' natural defence systems are not as effective as they normally would be. You are very susceptible tohave a higher risk of lung infections.
You'll need antibiotics to protect your lungs: even a mild infection can turn out to be very serious when your lungs cannot protect themselves.
If you notice any of the warning signs of worsening COPD, you should call your doctor. Your doctor may prescribe antibiotics. Be sure to follow the doctor's instructions exactly, and take all the antibiotics in your prescription.
Oxygen is a medicine that your doctor may prescribe. Not everyone with COPD needs oxygen. Many people believe that being "put on oxygen" is a sign that they're desperately sick. This isn't always true. For some people, oxygen is an important part of regular therapy. For others, it may be a short-term treatment.
Generally, oxygen therapy can benefit people with:
Only people who suffer from significant low blood-oxygen levels will benefit from oxygen. Ask your doctor to test to see if oxygen might help you.
If your doctor says oxygen is right for you, you can enjoy these benefits:
How does oxygen therapy work? Oxygen therapy is generally delivered as a gas from an oxygen source like a cylinder or concentrator. You breathe in the oxygen through small nasal "prongs" that fit into the nostrils, or through a mask, that covers the mouth and nose. Breathing in this extra oxygen raises low blood-oxygen levels, easing the strain on your body and making breathing easier.
Because your body can't store oxygen, the therapy works only while you use it. If you take off your oxygen mask or remove the prongs, your blood-oxygen level will drop within a few minutes.
Like any other prescription medicine, oxygen must be used carefully. You need to follow instructions and follow all the safety precautions. Your doctor will tailor your oxygen prescription to your individual needs. Be sure you get instruction on how to use your oxygen, and how to clean your equipment.
How long do people use oxygen therapy? You may be on oxygen therapy for a few weeks or months, or for the rest of your life. It all depends on why you need it.
If you have a respiratory infection, you may need to be on oxygen only until the infection clears and your blood-oxygen levels return to normal. If you have chronically low blood-oxygen levels because of lung damage from COPD, you may need to be on oxygen permanently. If you are prescribed oxygen on around-the-clock, usually you need to use the oxygen for a minimum of 15 hours a day for the best results.
You can't use oxygen if you smoke. No one can smoke within 10 feet (3 meters) of oxygen tanks, because of the risk of fire. You can't use oxygen anywhere near an open flame (candle, fireplace, etc).
Ask how to use the equipment. Learning how to use and care for the oxygen equipment may seem complicated. Have Ask the oxygen supply company to give you a demonstration. If you're not clear on something, keep asking until you feel confident. For more support, have a family member or caregiver learn about your equipment as well.
Keep your equipment clean. Clean equipment works more effectively. Keeping your equipment clean also helps prevent infections. Always wash your hands before cleaning or handling your oxygen equipment.
Have your doctor check your prescription at least once each year, or if your symptoms change, to see if your oxygen prescription still meets your needs.
Ask about funding. Oxygen therapy can be expensive, especially over the long term. You may qualify for government funding for oxygen therapy - ask your doctor if you're eligible. Funding, which varies from province to province, may cover basic oxygen needs.
You can travel with oxygen. With some extra help and planning, you can travel by car, plane, boat or train with your oxygen tank. Contact your home oxygen supply company well in advance of your trip to allow them to arrange for oxygen while traveling and at your destination.
People with COPD are very vulnerable to lung infections. A healthy person with the flu or pneumonia usually recovers in a couple of weeks. But a person with COPD who gets the flu or pneumonia can be very sick, go to the hospital, or even die.
It's important to prevent lung infections. If you already have an infection, it's important to get it treated right away.
Adapted from: http://www.lung.ca/diseases-maladies/copd-mpoc/treatment-traitement/medications-medicaments_e.php?print=1
If you have COPD, you have to learn to get the most out of your breath.
A great place to learn about breathing techniques is in a respiratory rehabilitation program. Respiratory rehabilitation programs are specially designed for people with COPD. They teach breathing techniques, as well as how to exercise, and they give you a chance to practice with the group. Learn more about respiratory rehabilitation programs, and how to find one in your area.
How to cough up phlegm: controlled coughing
Comfortable positions if you're short of breath
If you know how to control your breathing, you can stay calm when you're short of breath. Pursed-lip breathing and diaphragmatic breathing will both help. These breathing methods prevent or reduce the trapped air in your lungs, and allow you to breathe in more fresh air.
Pursed Lip Breathing
People with COPD usually have extra phlegm (mucus) in their lungs. If you have phlegm, cough it up. If the phlegm stays in your lungs, it can clog your smaller airways, making it hard to breathe. The phlegm could also become infected. It's important to get the phlegm out.
Controlled coughing helps you clear the phlegm from your lungs. Here's how to do it:
Adapted from: http://www.lung.ca/diseases-maladies/copd-mpoc/breathing-respiration/index_e.php?print=1#todo
A COPD flare-up happens when COPD symptoms (shortness of breath, cough, spitting up mucus) get worse, or when new symptoms develop.
A flare-up is often brought on by a lung infection. Flare-ups are one of the biggest reasons why people with COPD become disabled or have to be hospitalized.
Learning how to avoid flare-ups is an important part of managing your COPD. There are many ways to prevent COPD flare-ups.
It's also important to know what to do when you do get a flare-up. If you get treatment as soon as you notice the warning signs of a flare-up, you'll have a better chance of avoiding a serious illness or a hospital stay.
Sometimes flare-ups still happen, despite your best efforts to prevent them. Early treatment of flare-ups can prevent you from becoming seriously ill or having to go to the hospital. This is why it's so important to know the warning signs of a potential flare-up. These warning signs include:
If you notice any of these signs call your doctor right away. Go to the hospital emergency department if you can't reach your doctor.
The action plan that you create with the help of your doctor is a great starting point for knowing what to do to prevent flare-ups and when to seek medical treatment. Don't be afraid to ask for help.
Some things can irritate your lungs and make your COPD symptoms worse. For example:
Avoid breathing in the fumes from perfume, paints and cleaning products. Try to buy household products that are unscented. When cooking, turn on your kitchen fan, which should be vented outdoors. Avoid smoke from fireplaces or woodstoves. Avoid second-hand smoke anywhere: in homes, in cars, in restaurants.
If cold air and strong winds bother you, try covering your nose and mouth with a scarf (wrapped loosely) and breathe through your nose. The scarf will help warm the air before it gets to your lungs. On hot humid days, or days of smog, stay indoors in an air-conditioned room.
Things that trigger COPD are often the same things that trigger asthma. In our asthma section, you can read more about triggers and how to avoid them.
Adapted from: http://www.lung.ca/diseases-maladies/copd-mpoc/flareups-pousseesactives/index_e.php?print=1
When it comes to understanding all of the new asthma treatments available, it's natural to feel a little confused.
The important thing to remember is that asthma is a "variable" disease. In other words, the symptoms can vary from person to person, and even the same person's condition may fluctuate throughout the year.
If you have asthma, your doctor will:
In order to minimize possible side effects, your doctor will prescribe the lowest dose of medication needed to control your symptoms. It may take some experimenting to find out what that dose is. You and your doctor might have to try a few different doses or a few different medications before you find what works best for you. Over time, your medication needs may change.
Most people with asthma take two kinds of medication. That's because each asthma medication treats only one aspect of the condition:
Relievers are used to quickly alleviate asthma symptoms. They do this by relaxing the bands of muscle that surround the airways. However, they do not reduce inflammation in the airways - to treat inflammation, you will need to take a controller medication.
Relievers have a number of different names. You may hear them called:
Examples of reliever medications include:
Relievers are safe but, as with any medication, you should never take more than you need. Possible side effects of relievers include:
Only take your reliever medication when you're experiencing asthma symptoms or if prescribed, before you exercise. Since you can never be sure when symptoms will happen, keep your reliever medication with you at all times. That way you won't be caught off-guard.
If you find you're using your reliever medication four or more times a week (not counting before exercising), it means your asthma is not well-controlled. Talk to your doctor to see about a controller medication adjustment.
While relievers help you treat the symptoms of asthma, controller medications help to treat the underlying inflammation of the airways in a person with asthma. By controlling the inflammation, asthma symptoms will diminish and attacks prevented.
When you start taking controller medications, you may not notice a difference right away. It may take a few weeks before the inflammation in your airways is reduced. Even if you do not feel better right away, do not stop taking your controller medication unless your doctor tells you to.
Remember, controllers do not immediately relieve wheezing, coughing or chest tightness, and should not be used to treat a severe asthma attack. Make sure you understand the difference between your reliever medication, which provides quick relief during an asthma episode, and your controller medication, which controls your underlying inflammation so that you're less likely to experience these symptoms in the first place.
Inhaled steroids, also called inhaled corticosteroids, are considered to be the most effective medications for controlling asthma when taken regularly. They work continuously to reduce swelling of the airways.
Inhaled steroids include:
If you're taking inhaled steroids and start to feel better, do not stop taking them. You must take them regularly and for as long as your doctor advises if you want to properly control your asthma.
Inhaled corticosteroids are the most effective prescribed medication for most patients with asthma. Inhaled corticosteroids at the dose they are currently recommending for asthma have not been shown to cause weak bones, growth suppression, weight gain and cataracts.
The dose of the corticosteroid inhaler is in micrograms, which is one millionth of a gram. Corticosteroids in a tablet form (e.g. Predisone) are in grams, a much higher dose than in the inhaler. Where ever possible, the least amount of medication is used to maintain asthma control. Corticosteroid tablets or liquid are used when a larger dose is needed to get the asthma under control.
Taking inhaled steroids can have a few side effects, but they are generally not serious. They include:
You can minimize these side effects by rinsing your mouth after every dose of inhaled steroids and by using a spacer device with a pressurized MDI (pMDI).
There are a number of misconceptions about inhaled corticosteroids. For example, some people mistakenly believe that they are the same as the anabolic steroids that are sometimes abused by athletes. You can find out the truth about inhaled steroids here.
Adapted from http://www.asthma.ca
Sometimes, moderate doses of inhaled steroids alone do not fully control asthma symptoms. You may find that, even though you're taking inhaled steroids regularly, you still experience asthma symptoms, for example, at night or when you exercise.
Long-acting beta-agonists(LABAs) dilate the airway for up to 12 hours and are to be taken along with your inhaled steroids. Currently, researchers do not think that long-acting bronchodilators can reduce inflammation on their own, but they may help the inhaled steroids to work better.
There are several different kinds of long-acting bronchodilators. If you are given the inhaled corticosteroid and LABA in two separate inhalers, make sure you use them both. LABAs are not intended to be used alone for the treatment of asthma. Like any medication, a long-acting bronchodilator should be used only as your doctor advises.
Examples of long-acting bronchodilators are:
Possible side effects of long-acting bronchodilators include:
Some pharmaceutical manufacturers have combined two controller medications into one inhaler. These inhalers are referred to as "Combination Medications".
Combination medications contain both an inhaled long-acting bronchodilator (LABA) and an inhaled corticosteroid. This means that two areas of asthma can be effectively treated at the same time: (1) the bronchodilator works by widening your airways, making it easier for you to breathe, and (2) the inhaled steroid reduces and prevents inflammation of your airways.
Recent studies show that many people with asthma find that combination medications give them better control and are convenient to use.
Examples of combination medications are:
Possible side effects of combination medications include:
Leukotriene receptor antagonists, called LTRAs for short, are a class of oral medication that is non-steroidal. They may also be referred to as anti-inflammatory bronchoconstriction preventors. LTRAs work by blocking a chemical reaction that can lead to inflammation in the airways. Although not preferred first choice therapy, LTRAs can be tried when an inhaled steroid can not, or will not, be used, or if the dose cannot be increased.
If you've been taking inhaled steroids and your asthma still isn't well-controlled, your doctor may prescribe LTRAs instead of increasing the dosage of your inhaled steroids.
LTRAs do not contain steroids, come in a chewable tablet form and have few side effects. If there is no improvement in your symptoms after 4 weeks of use, your doctor will change your treatment.
Examples of LTRAs include:
The side effects of LTRAs include:
Anti-IgE treatment might be recommended if you have allergic asthma and you keep experiencing persistent symptoms despite taking your controller medications.
If you have allergic asthma (about 60% of asthma is caused by allergy), your symptoms are triggered when you inhale certain allergens in the air. These allergens cause a chain reaction that leads to inflammation in the lungs.
While inhaled steroids work by treating and reducing the inflammation, anti-IgE therapy works by keeping inflammation from developing in the first place. It does so by blocking immunoglobulin E, a substance in the body that is one of the underlying causes of inflammation in allergic asthma.
Anti-IgE therapy is only available by prescription. Unlike other asthma medications, it is not administered by pill or by inhaler. It needs to be injected once every two or four weeks by a doctor or other trained healthcare professional.
The only anti-IgE therapy available in Canada is omalizumab (Xolair®).
The most common side effects of anti-IgE therapy are: skin irritation or reaction at the site of the injection, and respiratory tract infections (e.g., common cold).
Q: Who is Anti-IgE therapy for?
A: Anti-IgE therapy with omalizumab is for adults and adolescents (12 years of age and above) with moderate-to-severe, persistent allergic asthma who continue to have asthma symptoms even though they are taking inhaled steroids.
Q: How quickly does anti-IgE therapy work?
A: It does take time for the IgE blocking to start working. It is normal not to feel a difference right away. It is important to keep getting your injections until your doctor tells you otherwise. In scientific studies testing omalizumab, the benefits of IgE therapy were shown in most patients by three months.
Q: Does omalizumab (Xolair®) have any serious side effects?
A: In scientific studies, cancer was seen in a small number of patients receiving omalizumab, as well as in those receiving placebo injections. The rate was higher in patients treated with omalizumab than placebo (0.5% vs. 0.2%). This difference has not been conclusively linked to the omalizumab. Some patients in the studies had a serious allergic reaction called anaphylaxis. This was rare, occurring in less than 0.1% of patients. Doctors have been advised to observe patients for a period after omalizumab injection to make sure that no anaphylaxis develops. If it does, it can be treated.
Q: Will I still need to keep taking my inhalers?
A: Yes. Anti-IgE therapy is meant to complement, not replace, your existing medications. Although many patients taking IgE therapy have been able to have the dose of their inhaled steroid decreased over time, you will still need to keep taking your other asthma medications as directed by your doctor.
Q: How often is omalizumab given?
A: Depending on your body's IgE level and your body weight, omalizumab will be given once every two or four weeks.
Q: Who will administer the injection?
A: Omalizumab needs to be injected by a trained healthcare professional. You may be able to have it done at your usual doctor's office. In some cases, your doctor will refer you to another location to have the injection given. There are specialty clinics in many Canadian cities that have been especially set up to give injections of omalizumab.
Occasionally, doctors will prescribe oral (tablet or liquid) corticosteroids for more severe or troublesome asthma symptoms.
Oral corticosteroids can have serious side effects if used for a long time. However, they also have significant benefits that outweigh their side effects. Your doctor can explain the pros and cons of using oral corticosteroids.
Examples of oral corticosteroids are:
Possible side effects of long-term oral corticosteroid use include:
Theophyllines are occasionally used to treat asthma. However, their anti-inflammatory properties haven't yet been conclusively proven and they're known to have a number of side effects.
Examples of theophyllines are:
Possible side effects of theophyllines include:
A metered-dose inhaler, called an MDI for short, is a pressurized inhaler that delivers medication by using a propellant spray.
If you need a second puff, wait 30 seconds, shake your inhaler again, and repeat steps 3-6. After you've used your MDI, rinse out your mouth and record the number of doses taken.
Store all puffers at room temperature
To clean your MDI, follow the instructions that came with it. In most cases, they will advise you to:
Always follow the instructions that come with your MDI.
Also known as aerosol-holding chambers, add-on devices and spacing devices, spacers are long tubes that slow the delivery of medication from pressurized MDIs.
Spacers should always be used with MDIs that deliver inhaled corticosteroids. Spacers can make it easier for medication to reach the lungs, and also mean less medication gets deposited in the mouth and throat, where it can lead to irritation and mild infections. The Asthma Society of Canada recommends that anyone, of any age, using a puffer, consider using a spacer.
While a spacer can make it easier to co-ordinate breathing in and activating an MDI, it can also make the MDI less portable because a spacer takes up extra space in a purse or a bag. However, inhaled corticosteroids are usually prescribed to be taken twice a day, so the spacer can be left at home for morning and evening use.
To clean your spacer, follow the instructions that come with it. In most cases, they will advise you to:
Always follow the instructions that come with your spacer. As well:
For more information about spacers and available spacer products click here.
A DISKUS® is a dry-powder inhaler that holds 60 doses. It features a built-in counter, so that you always know how many doses you have left in it.
To use your DISKUS®:
If you drop your DISKUS® or breathe into it after its dose has been loaded, you may cause the dose to be lost. If either of these things happens, reload the device before using it.
A Turbuhaler® is a dry-powder inhaler available in an easy-to-use format.
Some Turbuhalers® feature a dose counter that shows the exact amount of medication left. If your Turbuhaler® doesn't have a dose counter, then check for a red indicator in the windows on the side of the device. When you see red in the window, there are approximately 20 doses left and it's time to order a refill.
If you drop your Turbuhaler® or breathe into it after its dose has been loaded, you may cause the dose to be lost. If either of these things happens, reload the device before using it.
Clean your Turbuhaler® as needed. To do this, first wipe the mouthpiece with a dry tissue or cloth. Never wash the mouthpiece or any other part of the Turbuhaler® - if it gets wet, it won't work properly.
A Diskhaler® is a dry-powder inhaler that holds small pouches (or blisters), each containing a dose of medication, on a disk. The Diskhaler® punctures each blister so that its medication can be inhaled.
If you drop your Diskhaler® or breathe into it after its dose has been loaded, you may cause the dose to be lost. If either of these things happens, reload the device before using it.
Your Diskhaler® should always be cleaned according to its instructions and before you insert a new medication disk into it.
Having asthma does not mean that you cannot exercise. However, if you have any limitations in your ability to exercise because of your asthma, your asthma is not being controlled properly.
If your asthma is not controlled and you exercise, you may experience worsening symptoms. If this it the case, you need to take steps to first regain total asthma control prior to resuming your exercise program. The inability to exercise without symptoms is a sign of poor asthma control. Talk to your doctor about this. Once you have total control, you will be able to exercise without asthma symptoms.
If your asthma is under control and you experience asthma symptoms five or 10 minutes after exercising, this is probably due to exercise-induced asthma.
Exercise-induced asthma occurs because the airways are sensitive to temperature and humidity changes, especially when breathing in cold, dry air through the mouth. Air that passes through the mouth is bypassing the nose, which normally humidifies and warms the air prior to its reaching the lungs.
The diagnosis of exercise-induced asthma is made by performing a breathing test (spirometry) at rest and then again following exercise. If there is a measured decrease in the speed of air that can be breathed out following exercise, this indicates exercise-induced asthma, or EIA, is present.
Contributing factors to exercise-induced asthma include:
It's important to note that the benefits of regular exercise almost always outweigh the risks associated with exercise-induced asthma.
These benefits include:
If you're unsure whether your symptoms are due to exercise induced asthma, or are the signs of worsening asthma control, talk to your doctor.
Once you and your doctor have established what your exercise regimen should be, keep the following in mind:
If your doctor has given you a physical examination and determined that you have exercise-induced asthma he or she may recommend that you use your reliever medication 10 to 20 minutes before you begin exercising. This can help reduce the likelihood that symptoms associated with exercise-induced asthma will flare up.
Unfortunately, pets can make asthma worse if you're allergic to them. Animals that can act as asthma triggers include:
Often, people think that fur or feathers are what trigger symptoms in people with asthma. But in fact, if you have asthma, you could be sensitive to an animal's:
If you have an animal in your home and your family doctor or allergist determines that it is a trigger for your symptoms, it is highly recommended that you remove the animal from your home. Removal of a pet from the home is the single most effective environmental avoidance strategy for optimal asthma control.
If you decide to keep the pet even though you are allergic, you will be increasing the severity of your asthma over time. There is no such thing as an allergy-free dog or cat. All furred animals shed dander. Reducing your exposure to pet allergens is the most effective way to help your asthma.
If you are unable to remove the pet from the home, try these things to minimize exposure:
Everyone knows that smoking isn't healthy. But when you have asthma, it can be even more dangerous. Tobacco smoke is frequently responsible for the onset of asthma symptoms and must be avoided.
Tobacco smoke, even secondhand, can trigger asthma symptoms. If you have asthma, do not allow any smoking in your home, your car or anywhere else where you spend a lot of time. As well, stay out of smoky places like bars and cafés.
If you do not smoke, recognize that secondhand smoke should be avoided at all times. If you do smoke, try to quit.
If you wish to quit, there are many options available to assist you. Talk to your doctor or asthma educator about how nicotine-replacement therapy, counseling and other treatments can help you butt out for good.
You'll find lots of other useful information about quitting smoking on the Web, including this special online program that shows you great ways to kick the habit.
When you're outdoors, you have less control over the triggers you encounter. You can't, for example, vacuum the lawn if pollen is bothering you, and there's no air cleaner large enough to clean a city's air pollution.
Still, there are things you can do to help reduce you exposure to outdoor triggers. By making a few adjustments, and by taking your medication as directed, you can breathe easier when you're outside.
Moulds are asthma triggers for many people. A type of fungus, their spores float in the air where they're easily inhaled and can lead to coughing, sneezing, wheezing and chest tightness.
You'll find moulds wherever it's damp. This includes piles of vegetation, stagnant water, and garbage containers.
If you're sensitive to mould spores, try the following:
Pollens are a very common trigger for asthma symptoms. Generated by trees, grasses and weeds, airborne pollens are easily inhaled, especially during warm-weather months.
If you're allergic to pollen, there are a number of things you can do to stay healthy:
Cold air, or sudden changes in the weather, can also trigger asthma symptoms. If you're affected by the cold, the following tips can help:
While air pollution as a cause of asthma has not been verified, there is good evidence that pollution causes the symptoms of many people with asthma to get worse on days when the air-quality index is high.
If you find your symptoms become worse on these days, try to:
With smog, pollen and severe weather changes, you might think that you're more likely to encounter more triggers outdoors than indoors. In fact, the opposite is true. Canadians spend 90% of their time indoors. This, along with changes in how our homes are built, is has lead to poor indoor air quality and more triggers, in our homes.
Fortunately, a great deal has been learned about asthma triggers that exist inside. By educating yourself about indoor hazards, you'll discover simple ways to reduce their levels.
Dust mite allergy is a common problem for people with asthma. The excretions and body parts of these tiny, spider-like creatures can be a powerful trigger of asthma symptoms.
Dust mites congregate in soft-surfaced places where there is an abundant food supply. Dust mites feed off shed human skin and are thus found in bedding, mattresses, pillows, sofas and carpets.
Effective strategies for minimizing dust mites are:
Cockroaches are one of most hated household pests, and for good reason. Not only are they a terrible nuisance, their feces have been shown to trigger symptoms in individuals with asthma.
If your home has cockroaches, make sure that food and water are never left where they can get at them. To ensure they leave and never come back, call a professional exterminator.
Moulds are fungus that can be found just about anywhere it's damp and where air flow is minimal, like basements and bathrooms. Their airborne spores can trigger asthma symptoms, but there are many ways to avoid them. The best way is to keep your home dry and clean.
Many people with asthma are affected by airborne chemicals. They may be exposed to them in the home, or even at work.
At home, chemicals are reasonably easy to control. If you have paints or other volatile products in your house, you can get rid of them or seal them carefully and place them in a garage or shed. If you're sensitive to heavy perfumes, try not to use products that use them.
If you have any of the following jobs, you may be at risk for occupational asthma:
To determine whether you've developed occupational asthma, ask yourself the following questions:
If you suspect you have occupational asthma, talk to your doctor, who may refer you to a respirologist for further assessment.
If your employer has taken every preventive measure possible and your symptoms are still severe, you may have to consider switching careers. Remember, you can always talk to your doctor or asthma educator if you think your job is making you sick.