It's good that the guidelines are reflecting what we've come to learn about asthma over the past few years that much of it is eosinophil-driven (driven by the immune-system), meaning that it responds to immune suppression much more than we had appreciated before. It's not just a handful of people with high eosinophil counts who get the specialty drugs, but patients more broadly who can benefit. This is a good thing for patients. As Dr. Seheult rightly points out, the severe exacerbations can be fatal. This will save lives. Thank you, Doctor, for the clear and succinct update.
What an amazing presentation on the new Asthma guidelines. It had visuals, it had evidence based medicine and it had a great narration. Thank you so much for providing such an amazing video!!!
Concise as well highly informative and will be useful for all the clinicians who have background knowledge of Asthma and COPD. With a few slides you explained the treatment so well.Thanks
Excellent video Doc! My wife has Asthma & has been taking Advair daily for quite some time now. She also takes Albuterol as a rescue inhaler. I will have her watch this video. Thanks for this important medical information! Hope that all is well with you & your family.
So do I. But I'm wondering, how does one go to the doctor and ask him to make changes based on, "I saw this medical video on You Tube that you should watch and it said....."
Got diagnosed with asthma this summer at the ripe old age of 68. Got put on Advair. I did not realize how bad my breathing had gotten until taking this. No more out of breath at the top of the stairs or walking uphill. Way less fatigue.
I was diagnosed with asthma last year and use an albuterol inhaler PRN. I am not having actual “I Can’t Breathe” attacks more than twice a year but my daily shortness of breath is getting much worse, especially since my last round of COVID last fall. If it hadn’t been for my inhaler I probably would have been hospitalized. I appreciated this video because it gives me more of an understanding about future medications my doctor might prescribe to manage my asthma and to look at possible COPD. That’s not paranoia, I was a heavy smoker for 20 years. I quit 20 years ago but somehow it doesn’t seem to matter.
The irreversible damage has already been done, unfortunately. After being a HEAVY smoker, my dad stopped but as he got older the damage was done. It contracted the veins in his legs. Walking became a real problem and then swelling. His lungs were not affected to any degree. Some people smoke in their 90s. How many I know who had lung cancer and NEVER touched tobacco. When the ships were out in the harbor and supply lines were effected, the cigarettes tasted HORRIBLE! Chemicals. Even loose tobacco tastes nasty with the chemicals. They were beyond stale 😅 Maybe the chemicals are what's keeping us alive. Kudos for your quitting! Three times I have effectively stopped smoking but went back. The effects are in Gods' hands and , as I continue to 🚬 , 🙏🏻🙏🏽🙏 and Blessings
This is super helpful, thank you! Now I know why my insurance is suddenly denying coverage for my Ventolin, and all generics. Time to have a chat with the pulmonologist.
Thank you for your informative video. I have had athsma for many years. I have found the reformulated version of Abuterol with the new inhaler barely effective, when the old version was effective for decades.
I'm so glad I caught this. I've moved and need to find a doctor. I want to have this info handy. Now, if only I could find a doctor who doesn't try to treat my asthma like an allergy problem. They always start with that and don't usually listen to me... even when armed with my records. It has never been an allergy issue, and I've known about my asthma since my first major attack in 1976.
People with asthma really need to look into their vitamin D levels. As a kid, I only had mild asthma around cats and dogs. But when I got closer to 40, I began having persistent mild asthma and was put on a HFA twice daily maintenance plan (two puffs in the morning, two at night). I was working night shift in the Pacific Northwest, getting virtually no sunlight for years. I was taking a multivitamin, but it only had 1000 IU's of vitamin D3. I recently started taking more vitamin D3 (5000 IU's at breakfast, 5000's at dinner) and now I only have to use ONE puff of HFA per day. It was a huge difference. Sometimes I don't even need HFA at all. Obviously this is anecdotal, but there are some studies out there showing vitamin D deficiency can affect asthma. Hope this helps someone.
I'm definitely thank you all for putting this on TH-cam for people to learn about asthma I have asthma and I am learning a lot by looking at your TH-cam I know what to ask my doctor once again I thank you and I thank you so much for putting this out for people to learn and educate them
I've never had asthma, so I knew nothing about these medicines...until covid. Lung clotting was a major cause of death for covid. Nebulized albuterol treatments knocked out covid in my 80 year old mother and myself (60 y/o male) 3 years ago. I'm talking 6 treatments, 3-4 hours apart, and the next day we were not just better...we were cured...it was a huge improvement).... so THANK YOU to everyone who keeps trying to figure out what does work and what works even better on these medical issues...and then shares it with the world. We may not need it right now, but who knows what's next....
People who don't have asthma, or have a minor case of it, don't realize how bad it can get. About 4k people die from asthma attacks every year in the USA. I used to go to emergency about every 6 months, until I got on Advair too. I don't think I have ever been to emergency since using Advair. If you have a child who gets severe asthma, check with their school to see if they are allowed to carry their inhaler on them. About a year ago, a student died in Riverside, Ca, because he was playing soccer during recess, and his rescue inhaler was in the Nurses office. He may have been so low on oxygen, he may not even had been able to tell someone to go get it from the Nurse, or call 911. He may have had to try and use hand signals. I think a child should be able to keep a nebulizer and albuterol liquid in their home room class too, in case he can't get to the nurse, or they not in their office.
We use iv magnesium for asthma exacerbations. It's a smooth muscle relaxer. It's a really good adjunct therapy. Very effective, cheap, hardly any side effects. Makes sense an oral supplement would have similar effect
That’s interesting I have added magnesium as a supplement on advice from my chiropractor who also has training as a nutritionalist to reduce cramping and the accompanying result of nerve pinches in my neck. But now that you mention it my asthma has improved and I haven’t been on asthma medication in several years.
please make a video about myofascial pain (it's not taken seriously even though it prevents millions of people from sleeping (e.g. more than 20 minutes or 1h in a row, for years). There are a lot of misconceptions and misinformation about it and the way to treat it (such as "correct your posture" or "stretch your muscles" etc.).
I was able to stop all inhalers a couple years ago when I discovered Red Light Therapy. Specifically daily NIR directly on my chest areas which alleviates my asthma entirely. I was on inhalers for over 45 years so this was a BIG surprise. Unsure if this would work for others, but given that inhalers come with their own side effects, perhaps someone needs to study Red Light Therapy for asthmatics.
This is needed more than ever. Long Covid has triggered so much lung inflammation. Is it asthma after acute covid is declared over? It often responds to inhaled steroids.
So are insurers going to evaluate what they're covering? I work in asthma and spend ridiculous amounts of time on Prior auths for combination inhalers. Insurance is always wheeling and dealing with drug manufacturers to make their formulary. One year, a patient is stable on generic advair. Next year that's not preferred on the insurers formulary so gotta switch or pay 500 a month to breathe. I hate the way we do things in the US.
Dr.: this is interesting. Thank you for posting! I have more serious asthma now. 20 years ago when it was more mild, when I was sick I was sometimes given inhaled steroid two to three times a day plus continue albuterol daily until the illness resolved. I imagine the above is somewhat similar. This makes sense and I still get good results, now that I am on a biologic when I have an exacerbation, I do that combo approach still, and it resolves more quickly, as long as I am not very ill, and then I drop it. Asthma Tx is also an art. An excellent doctor who understands human and asthma variability is a must.
This is interesting and very helpful information. I appreciate the GINA assessment of asthma control. As I've aged my asthma is worse than the mild it was for years. A Dr. Rx Symbicort b.i.d when wheezing became obnoxious. I could not tolerate it because of suspected allergy to it with increased mucous, worsened throat clearing symptoms. Now I'm on a break from Flovent with occasional use of Albuterol. Finally, is there any known (nonitchy) rash associated with inhaled corticosteroids?
My asthma doc presecribed Dulera for me in 2012, and I have not needed the rescue inhaier albuterol since. Also only have to take the Dulera as needed. This study seems to confirm he knew what he was doing back then. I am still taking the Dulera, although my insurance doesn't normally cover it, and we have to get pre authorization for Dulera every year.
Sir- my wife and I are physicians. We just listened to a lecture on this from Harvard that was as clear as mud. THANK YOU for making this easy to understand. Will you do one on the 2024 guidelines or are they the same?
A new and powerful study done in the UK (30 years long, and multiple 1000s of participants) shows that keto people live SHORTEST. There were 4 groups: normal diet healthy; normal diet unhealthy; keto healthy; keto unhealthy. ALL KETO PEOPLE DIED SOONER.
My husband has suffered for many many years with asthma. He used an inhaler quite frequently especially before exercising. He started a Carnivore diet and within two weeks, he said he could finally breathe without thinking about it!! He also stopped snoring! If he cheats, the wheezing immediately comes back. I would recommend everyone with asthma to change your diet!!!
@@galaxia4709what a load of rubbish, they have NOT followed thousands of people on keto diets for 30 years. Give us the exact details of this supposed study so we can look it up ourselves, or we can conclude it does not exist.
As your friendly neighborhood Respiratory Therapist, please use your spacers with inhalers! Not all inhalers need them, but things like Albuterol inhalers MUST have them. You're not doing anything wrong by using one, nor are they just for kids. Without the spacer holding the medicine for you, the vast majority of the medicine gets squirted out into the back of your throat and doesn't really get down to your lungs.
Cigarette smoking I believe is the greatest cause of COPD. My father gave up a life time of cigarette smoking in his late 30s. He was a fit strong man till his late 70s. Then he got COPD as a result of his history of smoking. He could barely walk to the toilet and was on O2 nasal feed where ever he tried to go. Pneumonia killed him in his late 80s. Damn cigarettes. Don't smoke folks
I have had severe asthma since childhood.. many icu admissions. Finally got onto laba/ics (Pulmicort/Oxis.. like symbicort but I have them in separate inhalers as I can’t get the right combo in symbicort.. have used these for approx 25 years now.. it has been the only thing that has treated it effectively.. I increase the dose when I get asthma symptoms eg when I get a cold and it stops it most times without any other meds.. it’s the business! Of course every new GP I’ve had tries to get me back on other inhalers.. but I have managed to stand firm.. have not had any hospital admissions and rarely take corticosteroids now.. as a young person I ended up with a tricky prednisone addiction as I couldn’t get any meds that actually worked until I found Pulmicort/Oxis.. I agree completely with what you are saying.. thanks for the info!
i was always taking symbicort as needed even though the doctors always said i should take it every morning/evening, it seemed to work fine for me just taking it sometimes, interesting it has been validated now
I was told I had asthma as an elderly person, and given inhalers including that combination inhaler. All I can tell you is the inhalers made the problem MUCH worse; the inhalers turned the problem from an occasional one into a constant daily one, and greatly increased the severity. I could not get enough air because I could not breathe OUT when I used the inhalers. I really felt like I was going to suffocate and die. No, I have never smoked, and no, per the lung function tests I don't have COPD. I couldn't walk a couple hundred feet uphill to my garden without stopping to pant for air. Finally in desperation I threw them all in the trash and started using a Chinese traditional asthma tea, and only when having problems. The whole shortness-of-breath problem just disappeared except for very mild symptoms a couple of weeks a year (allergies???) and then I take the tea. After all of this, I really question how "asthma" is diagnosed, and I think way too many drugs are prescribed for "mild" asthma without regard to side effects on different people. I have read for example that these treatments work very poorly for many black patients, which seems to point at genetics having a lot of influence on their effectiveness/safety. At any rate, their effects frightened me enough that I'll never use them again.
This is devastating for me, I can take albuterol and it really helps. I literally cannot take inhaled corticosteroids without a giant Candida flare up, that in the past has caused 60 pounds of weight gain in 3 months. Forcing me on a corticosteroid steroid will cause me harm. I'm really glad I got the heads up from you here, because I now have a mountain of research to do to figure out how to avoid being forced on a corticosteroid steroid.
4:33 That's how I deal with my asthma as well, I only use it if I feel some trouble breathing or in case of an exacerbation like coughing and stuff.. Thankfully I almost never use it, perhaps a couple times a month... sometimes I go months without needing it.
I didn't hear anything about vitamin d. Is there any mention of vitamin d levels in the studies? You should look for the studies of vitamin d and asthma. Checking vitamin d levels seems to be anathema in asthma. I wonder why.
@@marysmith7765 I don't have any one study in mind. This is from my years of reading studies. Vitamin d among other things. Any study of drugs should be normalized at least for vitamin d levels.
My son has asthma since childhood and during his 30 years he has had the same medication. I have wondered why nothing has changed, but maybe it will now.
Any estimate on costs involved for the inhaler with ICS/Formoterol? I ask because my insurance isn’t covering the inhaler that works for me. My out of pocket cost for it is $880. This is not sustainable.
What about side effects of a corticosteroid. I took it for years and had significant problems with throat irritation, and I’m wondering if it would increase the chance of getting respiratory infections in the long term?
We encourage patients to rinse after using their inhalers. Some are still sensitive to yeast development so we sometimes give them an antifungal rinse and swallow medication. Did you try it?
For so much of my life, I was warned about the risks of inhaled corticosteroids. It was always made clear to me to do the lowest dose necessary to control asthma. Now it's being used "as needed' - are there enough studies showing taking ICS as needed doesn't have long term side effects? Asthma patients can over medicate with prn treatment when asthma is out of control - what risks are there in changing from super high administration of Albuterol to the same frequency of ICS? I also find it *very* interesting that this whole paradigm shift seems to be largely based on one study. In that study, the groups tested were: Albuterol as needed, ICS maintenance protocol, or ICS+Fomoterol as needed. I find it interesting that they didn't include a group doing what has been the gold standard protocol: ICS+Fomoterol maintenance combined with Albuterol as needed. I can't help but wonder if this study was meant to "prove" that people need to take their ICS+Fomoterol more frequently than they already do. Especially since the study *happened* to be partially funded by Astrazeneca, which interestingly enough makes Symbicort, an ICS+Fomoterol.
Wow, I have been doing this without even knowing there was a research and it does work. This is because the ICS affected my eyesight so i only take it when I'm using my albuterol pump
Yeah I’ve kind of noticed that if I do my steroid and the albuterol at the same time, I get better long-term results. However for long-term steroid users please please make sure you get regular eye exams. And add in some nasal washes to prevent asthma if post-nasal drip is a trigger (exercise-induced.)
SYMBICORT can also cause other serious side effects, such as increased blood pressure, increases in heart rate, and changes in heart rhythm. These are not all the possible side effects of SYMBICORT - there is a number of them. Ventolin was very effective, but it was being over used and was less efficient with controlling chronic symptoms. An asthmatic should ALWAYS have Ventolin (Salbutamol) for a back up reliever because it is VERY efficient at relieving mild attacks. Just a note: Symbicort is unpleasant to take. I've written this as an long-term chronic asthmatic and a lay person.
Yesss my 7 year old son was just put on symbicort and right away started complaining of heart palpitations and fluttering so I immediately took him off
Is ICS-Formoterol also recommended for exercise-induced asthma, and if so, can it be given hours before (rather than 5-20 minutes in SABA) because it has LABA? (Formoterol half life is 7 hours).
I am so thrilled I have managed my asthma with herbs and homeopathy. My gf has been off her inhaler for 4 months using the same remedies. My inhaler was making me worse and it had terrible side effects for me. I now feel much better and breathe so much better and have very little episodes; and when I do have one, it is quite mild (compared to before) and the remedies work fast for me. I was talking to my gf one day and she happened to mention her inhaler was making her worse too so I told her about the remedies. She got on them and said they have been life changing. Too bad more people do not know about these.
I love homeopathy. Which remedies did you take. I had a blood clot in my leg and homeopathic remedies resolved it despite me expecting to need to visit the ER. It was severe and very painful as well.
Asthma and copd are caused by right side vegophaty ,neurophaty witch is due to exotoxins ,chemotoxis ,biotoxins and poor detoxification or lack of hot climate . Despite cigarette ,allegens and toxins here in hottest place on earth ,afar ,Ethiopia no asthama and copd case .even those patient who come from cold climate in ethiopia ,they recover the atack within few hours .thanks to near infrared radiation ! The best detox and antiinflammatory !
0:05: 📚 The video discusses the treatment of asthma and COPD, with a focus on the new guidelines for asthma treatment. 2:58: ✅ A study published in the New England Journal of Medicine found that combining an inhaled corticosteroid and a long-acting beta agonist as routine treatments, or using an inhaled corticosteroid alone as routine treatment, can be effective for managing mild asthma. 5:27: 💡 Using an inhaler with an inhaled corticosteroid as a rescue inhaler is more effective in reducing urgent medical care usage and systemic glucocorticoid use compared to using albuterol alone. 8:20: 💨 New asthma guidelines recommend combining short-acting beta Agonists with inhaled corticosteroids for rescue inhalers. 11:05: 📚 Risk factors for asthma flare-ups and exacerbations include obesity, food allergies, smoking, and other medical conditions. Recap by Tammy AI
So, if I understand correctly, the Netherlands currently uses the old paradigm? I use ventolin as needed, and when it gets worse, for example, once a year, I get perscribed fluticasone, a corticosteroid, to take twice a day. Now I'm wondering whether to bring this up with my doctor? My asthma was controlled for years but became partially controlled to sometimes uncontrolled recently.
GINA 2019 already suggested using ICS-formeterol or ICS single inhaler + SABA as needed for treatment in mild asthma instead of using just SABA as needed. This was revolutionary for clinical pracitce at least in EU as we never prescribe SABA as only asthma treatment anymore since then. Over the years another problem occured as many patients don’t feel the decline in lung function especially if the symptoms appear gradually and they don’t know when to use ICS-formeterol inhaler that is only perscribed to be used as needed. This approach is therefore appropriate only for a small number of patients. I believe this is the main issue for GINA to address in the future.
@oumaymen6773 for who? I haven't found any physical therapy that helps with my asthma, not to mention that not all asthma is the same. The only thing that held me is playing a very large wind instrument, but as soon as it's super humid or I get sick again, I'm back to having problems.
what if you are using it for exercise to prevent exacerbation?? i would think the combination drug is still probably better but nothing was said during the video.
I am suffering from GAD with breathing difficulties and my doctor put me on budesonide 200ug twice a day. Still have chest tightness and and shortness of breath and starting to wonder if diagnosis was correct. How can I know if it’s asthma or anxiety?
Is there a link to updated official guidelines that are layperson friendly? In the UK my daughter still takes daily ICS but I'd really like to present some information to her care team, it's been bothering me if she really still needs it. She's really mild and was diagnosed only resulting from some chest infections years ago.
I have been trying to teach this to patients, but when they see the price tag of the combination inhaler, I inevitably get a call to please switch it back to albuterol only.
That’s fine so long as you just let them know that whenever they take their albuterol rescue inhaler that the guidelines suggest them also taking inhaled corticosteroid along with it.
This is awesome information. Question, my 6 y/o has multiple food allergies, and have had to give albuterol for cough from food allergies.. He occasionally has exercise induced coughing. Does this also sound like asthma, how would I get him tested?
could be cough variant asthma, which is a milder form of asthma. But it is important to see a doctor for this either way! There are lung specialists that can help with the diagnosis and treatment of symptoms
as an asthmatic i can attest to the importance of saba and ics treatment, ive had flareups that felt like breathing thru a pen tube, maybe worse, always at times ive forgotten my inhaler at home.
My wife has the most severe form of asthma. She's been in the ICU, on a ventilator, in a medically-induced coma, 8 times. She crashes if she gets a respiratory infection. She lives on Albuterol on a nebulizer, with 20 treatments per day. It's life altering.
uhm, you need to include what c 1 9er did to our lungs on top of these issues. since i got the original c 1 9er back in 2019 (last week of) before THEY said it was started to spread in late jan/feb, i have to have asthma and copd inhaler's and i take primatene tabs on top, to me the primetabs work great sometimes better than the inhalers but not alone, i have to have all 3 every day and night. all i can say is that the o.g. c 1 9 er ravaged my lungs and i have a harder time breathing now, before that, i was fine with just a saba and or prime tabs seasonally or couple of times a year.
Alright, this is based on my own life experience... and I know that medicine/science can evolve over time... but: I've always associated "asthma" as having the need of having an inhaler with you at all times in case of flair-ups. My daughter was born in 2001 and suffered greatly as a child due to seasonal allergies from spring to fall. Her symptoms would be red, itchy, watery eyes, runny nose, irritated throat, etc. and many times severe enough that she needed to stay home indoors for a few days to alleviate her symptoms. Maybe once a year it would be severe enough that she would also be prescribed albuteral to help the symptoms. So here's my issue: I've grown to understand that there was a difference between having asthma-like "symptoms" from a condition/sickness and having "asthma" AS a condition in its own that COULD be aggravated by external conditions (air impurities) and/or internal conditions (stress). Although my daughter still suffers from seasonal allergies, sometimes badly, in general it's nowhere near as bad as when she was younger. She was prescribed albuteral maybe once in the past 8 years as opposed to 1 to 2 times a year when she was little. The problem arose when she was in high school and needed a yearly physical exam before being allowed to join athletic teams at her schools. The doctors would say she "has" asthma and that she needs to have a rescue breather just because she "used" albuteral in her past. It was always a yearly issue arguing with the doctor and school nurse about how the albuteral was only for the severe allergy attacks when she was younger. It's like saying if I were ever sick enough to need hospital care and if they gave me oxygen either through a canula or mask, then that means I have COPD. That simply does not make any sense and quite frankly would sound like the doctor for his credentials from a cereal box. Isn't there a clear distinction of having a sign/symptom of asthma due to having your airways restricted from a sickness/severe-allergic reaction as opposed to "having" asthma AS a condition in and of itself that COULD be exasperated from other factors? Again, if I ever needed oxygen in my past, that DOESN'T mean I have COPD type disease... so WHY are every pediatrician nowadays declaring that if a child EVER needed albuteral, than it means the child HAS asthma for life and SHOULD always have a rescue breather??? It seems to me that many doctors blindly go through medical literature without any critical thinking. Kinda brings to mind my past benadryl use... the active ingredient is also very common for sleep aid. In my younger years I needed over the counter antihistamines to help my seasonal allergies. I also have always had insomnia issues. And whenever I mentioned to a doctor that I took a benadryl to help me sleep because I ran out of my unisom, they'd be completely puzzled and question the action and say, "but that's for allergies, not for sleeping" and then if have to educate the doctors that benadryl's active ingredient IS the new norm in over the counter sleep aids... to which they'd still give a disbelief reaction to. I simply can't understand how the medical community can be so narrow-minded sometimes. Side note... benadryl never worked well enough for me, and as a sleep aid was terrible for me. For allergies I now use daily types such as Claritin, and only sleep aids (as needed) with the older more useful doxylamine succinate as the active ingredient. TL:DR Isn't there a difference of having asthma symptoms from an underlying condition as opposed to having asthma as a condition??
I get what you are saying but I suppose they are taking the 'better to be safe, than sorry' . approach. Once they see "rescue inhler" was used then the red flags go up, which is understandable. I suppose the fault is with the Dr's prescribing a rescue inhaler when there was obviously no need for it. The only time they shud be prescribed is for breathing difficulties or when the lungs are effected in any way by triggers. But in your case, looks like your daughter had everything but her lungs effected!!! So yes, this is annoying alright but unfortunately you can't turn back time.!!
Thanks you very much for this information doc. If you have the time, I have a couple of questions: 1/ I'm an RN and one of my doctors told me to advise patients to use their short acting albuterol inhalers prior to their Symbicort to help get the latter in. I have noted that this does raise their heart rate, sometime into the tachycardic zone. What do you think of this practice? 2/ There used to be a warning in this literature that comes with the Symbicort of sudden death if used more than BID. Can their be any truth to this if we are now using it PRN as a rescue?
Respiratory Therapist here. Part of the advice that the provider may be wanting to stress is that patients need to make sure they are doing well enough breathing wise before taking their maintenance medications otherwise they don't get nearly as much. If their lungs are already tight, then starting with their SABA will open them up a bit so they get more of their maintenance. Not everyone needs to do it, but it's important to try to open your lungs up first before taking your maintenance if your lungs are a bit tight.
I am suffering from inhaler induced eczema (like topical steroid withdrawal). All symptoms are the same as I have already been through 4.5 years of topical steroid withdrawal, and am aware of the symptoms - its not eczema. I was assured that inhalers with steroid in would not cause the same red skin syndrome/tsw like side effects. I dont really have anywhere to turn as i need the long acting inhaler (which contains the steroid), yet i am suffering so much from the side effects on my skin.
Are long term ICS side effects a concern? My 6 y/o is starting symbicort, I worry about long term effects (osteoporosis, growth suppression, infections)
When I was working in the ER as an RT about a decade ago we would do an 2mg budesonide neb with high dose albuterol for acute exacerbations. Don't know if they still do that.
You want the short acting bronchodilator component in a resq inhaler. The risk of using a pure long acting, especially with multiple doses in a short period of time, is you fill up the receptors with a med that takes a long time to reach peak effect and stays on the receptor for a long period of time, preventing subsequent short acting doses from working as well as there are fewer available receptors. I'd stay away from a pure laba in acuity. Formoterol is a unique case as it has both saba and laba action. My gut would say a saba and ics would be best, but idk that that combo therapy exists in an inhaler, and 2 inhalers is more cumbersome. So budesonide/formoterol is the best option for now
You never want to use a Advair as a rescue inhaler. The beta agonist in Advair is a long acting beta agonist and not a short acting beta agonist like formoterol is.
Does pre-exericse SABA use to prevent exericse-induced asthma symptoms, count toward the total weekly "count" of determining intermitent vs persistant asthma? Or is it only rescue uses?
Thanks for posting. We are trying to nail down whether my shortness of breath and feelings of chest pressure is due to my mild Pulmonary Hypertension (40 on echo / 40/25 RHC) or if COPD or Asthma. My doc wants everything to be about COPD - I am pushing back because my DLCO score is normal (86) and so is my FEV1. Doc is pushing for COPD because FEF increased by 16 points from 5.01 Since everything else was normal, shouldn't the diagnosis lead more to Asthma? And... even with that - are my symptoms more of a Pulmonary Hypertension nature ? They classify my PH as being in class 3 based on my docs interpretation leading to COPD. Any help understanding this would be appreciated.
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Is it the same recommendation for an asthmatic reaction to dust, where a patient already take albuterol when reacting to an exposure?
It's good that the guidelines are reflecting what we've come to learn about asthma over the past few years that much of it is eosinophil-driven (driven by the immune-system), meaning that it responds to immune suppression much more than we had appreciated before. It's not just a handful of people with high eosinophil counts who get the specialty drugs, but patients more broadly who can benefit. This is a good thing for patients. As Dr. Seheult rightly points out, the severe exacerbations can be fatal. This will save lives. Thank you, Doctor, for the clear and succinct update.
I have RA and asthma. I never thought of the similarities. Now I'll have to look into that.
What an amazing presentation on the new Asthma guidelines. It had visuals, it had evidence based medicine and it had a great narration. Thank you so much for providing such an amazing video!!!
Our pleasure!
Concise as well highly informative and will be useful for all the clinicians who have background knowledge of Asthma and COPD.
With a few slides you explained the treatment so well.Thanks
Thank you.
I have 9/11 COPD/Asthma/GERDs/Cancer(s) and your synthesis of GINA Report and research articles extremely well done. Sent to my physicians.
Excellent video Doc! My wife has Asthma & has been taking Advair daily for quite some time now. She also takes Albuterol as a rescue inhaler. I will have her watch this video. Thanks for this important medical information! Hope that all is well with you & your family.
Yes, thank you very much
So do I. But I'm wondering, how does one go to the doctor and ask him to make changes based on, "I saw this medical video on You Tube that you should watch and it said....."
As always, Dr Seheult is pure gold. Succinct, clear, and a wealth of information. Thank you.
Got diagnosed with asthma this summer at the ripe old age of 68. Got put on Advair. I did not realize how bad my breathing had gotten until taking this. No more out of breath at the top of the stairs or walking uphill. Way less fatigue.
I was diagnosed with asthma last year and use an albuterol inhaler PRN. I am not having actual “I Can’t Breathe” attacks more than twice a year but my daily shortness of breath is getting much worse, especially since my last round of COVID last fall. If it hadn’t been for my inhaler I probably would have been hospitalized.
I appreciated this video because it gives me more of an understanding about future medications my doctor might prescribe to manage my asthma and to look at possible COPD. That’s not paranoia, I was a heavy smoker for 20 years. I quit 20 years ago but somehow it doesn’t seem to matter.
The irreversible
damage has already been done, unfortunately. After being a HEAVY smoker, my dad stopped but as he got older the damage was done. It contracted the veins in his legs. Walking became a real problem and then swelling. His lungs were not affected to any degree. Some people smoke in their 90s. How many I know who had lung cancer and NEVER touched tobacco. When the ships were out in the harbor and supply lines were effected, the cigarettes tasted HORRIBLE! Chemicals. Even loose tobacco tastes nasty with the chemicals. They were beyond stale 😅 Maybe the chemicals are what's keeping us alive.
Kudos for your quitting! Three times I have effectively stopped smoking but went back. The effects are in Gods' hands and , as I continue to 🚬 , 🙏🏻🙏🏽🙏 and
Blessings
This is super helpful, thank you! Now I know why my insurance is suddenly denying coverage for my Ventolin, and all generics. Time to have a chat with the pulmonologist.
Thank you for your informative video. I have had athsma for many years. I have found the reformulated version of Abuterol with the new inhaler barely effective, when the old version was effective for decades.
A spacer or holding chamber is very helpful. I think this helps because the medicine is there, but the modern actuators don't seem to be as good.
I'm so glad I caught this. I've moved and need to find a doctor. I want to have this info handy.
Now, if only I could find a doctor who doesn't try to treat my asthma like an allergy problem. They always start with that and don't usually listen to me... even when armed with my records. It has never been an allergy issue, and I've known about my asthma since my first major attack in 1976.
I have an excellent, tested and successful natural recipe for asthma
People with asthma really need to look into their vitamin D levels. As a kid, I only had mild asthma around cats and dogs. But when I got closer to 40, I began having persistent mild asthma and was put on a HFA twice daily maintenance plan (two puffs in the morning, two at night). I was working night shift in the Pacific Northwest, getting virtually no sunlight for years. I was taking a multivitamin, but it only had 1000 IU's of vitamin D3. I recently started taking more vitamin D3 (5000 IU's at breakfast, 5000's at dinner) and now I only have to use ONE puff of HFA per day. It was a huge difference. Sometimes I don't even need HFA at all. Obviously this is anecdotal, but there are some studies out there showing vitamin D deficiency can affect asthma. Hope this helps someone.
Sunlight may have larger effect (and also increase vit D levels)
Very precise content
Very interesting. My doc gave me different meds for my last asthma flare. No explanation for why. Would be nice if it was explained. Thank you.
I'm definitely thank you all for putting this on TH-cam for people to learn about asthma I have asthma and I am learning a lot by looking at your TH-cam I know what to ask my doctor once again I thank you and I thank you so much for putting this out for people to learn and educate them
Our pleasure!
This is needed more than ever, now that the air has been inundated with particulates from all these fires.
I've never had asthma, so I knew nothing about these medicines...until covid. Lung clotting was a major cause of death for covid. Nebulized albuterol treatments knocked out covid in my 80 year old mother and myself (60 y/o male) 3 years ago. I'm talking 6 treatments, 3-4 hours apart, and the next day we were not just better...we were cured...it was a huge improvement).... so THANK YOU to everyone who keeps trying to figure out what does work and what works even better on these medical issues...and then shares it with the world. We may not need it right now, but who knows what's next....
Albuterol won't cure a virus, but it is an effective treatment to deal with breathing difficulties related to a virus.
Thank you for this video, its the most informative video on asthma I've ever watched.
Wow, thank you!
People who don't have asthma, or have a minor case of it, don't realize how bad it can get. About 4k people die from asthma attacks every year in the USA. I used to go to emergency about every 6 months, until I got on Advair too. I don't think I have ever been to emergency since using Advair. If you have a child who gets severe asthma, check with their school to see if they are allowed to carry their inhaler on them. About a year ago, a student died in Riverside, Ca, because he was playing soccer during recess, and his rescue inhaler was in the Nurses office. He may have been so low on oxygen, he may not even had been able to tell someone to go get it from the Nurse, or call 911. He may have had to try and use hand signals. I think a child should be able to keep a nebulizer and albuterol liquid in their home room class too, in case he can't get to the nurse, or they not in their office.
My wife was helped by Advair for about a year, but it doesn't work anymore.
Physical therapy exists, has been tested, and is 100% successful
Great info!! I’ve been hitting the albuterol more than usual with this smoke in the PNW. So this will be helpful! Thanks!
nice thank you very much I have mild asthma so this is very helpful
thanks for the info
So informative, thank you!
Super helpful video, thanks.
Adding magnesium to my daily supplements has radically improved my asthma. Just an FYI for anyone watching.
This does make sense, if the asthma is muscular constriction of the bronchial tubes, just as magnesium (in many people) reduces leg and other cramps.
We use iv magnesium for asthma exacerbations. It's a smooth muscle relaxer. It's a really good adjunct therapy. Very effective, cheap, hardly any side effects. Makes sense an oral supplement would have similar effect
Same here. Plus I took two table spoons of golden Seamoss for two years post Covid and it worked wonders for my asthma.
@@sarahobaka8354Did you have additional problems after covid. I know that I have some mild damage after covid. I can still feel it from time to time.
That’s interesting I have added magnesium as a supplement on advice from my chiropractor who also has training as a nutritionalist to reduce cramping and the accompanying result of nerve pinches in my neck. But now that you mention it my asthma has improved and I haven’t been on asthma medication in several years.
please make a video about myofascial pain (it's not taken seriously even though it prevents millions of people from sleeping (e.g. more than 20 minutes or 1h in a row, for years). There are a lot of misconceptions and misinformation about it and the way to treat it (such as "correct your posture" or "stretch your muscles" etc.).
Yes, also Fibromyalgia and Costochondritis. They are Very REAL and PAINFUL.
I was able to stop all inhalers a couple years ago when I discovered Red Light Therapy. Specifically daily NIR directly on my chest areas which alleviates my asthma entirely. I was on inhalers for over 45 years so this was a BIG surprise. Unsure if this would work for others, but given that inhalers come with their own side effects, perhaps someone needs to study Red Light Therapy for asthmatics.
Thank you so much for this informative video.
Excellent video (as always!), thank you. AG FNP
This is needed more than ever. Long Covid has triggered so much lung inflammation. Is it asthma after acute covid is declared over? It often responds to inhaled steroids.
Thank you. This is very good information.
So are insurers going to evaluate what they're covering? I work in asthma and spend ridiculous amounts of time on Prior auths for combination inhalers. Insurance is always wheeling and dealing with drug manufacturers to make their formulary. One year, a patient is stable on generic advair. Next year that's not preferred on the insurers formulary so gotta switch or pay 500 a month to breathe. I hate the way we do things in the US.
I totally hear you. This is a major frustration from myself as well.
Pure gold doc
Dr.: this is interesting. Thank you for posting! I have more serious asthma now. 20 years ago when it was more mild, when I was sick I was sometimes given inhaled steroid two to three times a day plus continue albuterol daily until the illness resolved. I imagine the above is somewhat similar.
This makes sense and I still get good results, now that I am on a biologic when I have an exacerbation, I do that combo approach still, and it resolves more quickly, as long as I am not very ill, and then I drop it. Asthma Tx is also an art. An excellent doctor who understands human and asthma variability is a must.
Excellent video thank you..
You are welcome!
Thanks for t his. This is quite interesting.
This is interesting and very helpful information. I appreciate the GINA assessment of asthma control. As I've aged my asthma is worse than the mild it was for years. A Dr. Rx Symbicort b.i.d when wheezing became obnoxious. I could not tolerate it because of suspected allergy to it with increased mucous, worsened throat clearing symptoms. Now I'm on a break from Flovent with occasional use of Albuterol. Finally, is there any known (nonitchy) rash associated with inhaled corticosteroids?
Please can you do a video on red light, collagen, exercise and diet recommendations/research for osteoarthritis?
My asthma doc presecribed Dulera for me in 2012, and I have not needed the rescue inhaier albuterol since. Also only have to take the Dulera as needed. This study seems to confirm he knew what he was doing back then. I am still taking the Dulera, although my insurance doesn't normally cover it, and we have to get pre authorization for Dulera every year.
Sir- my wife and I are physicians. We just listened to a lecture on this from Harvard that was as clear as mud. THANK YOU for making this easy to understand. Will you do one on the 2024 guidelines or are they the same?
Glad it was helpful!
Very similar
It will be interesting to see how long it takes for this to impact practice
I LOVE the lectures....love medicine....thank u Dr!
Thank you
I had asthma for nearly 50 years. It has disappeared completely since I started following a keto diet 4 years ago.
A new and powerful study done in the UK (30 years long, and multiple 1000s of participants) shows that keto people live SHORTEST. There were 4 groups: normal diet healthy; normal diet unhealthy; keto healthy; keto unhealthy. ALL KETO PEOPLE DIED SOONER.
You likely had allergies that caused the asthma flare. Good for you that you found them 👍
@@galaxia4709 if that study existed it would be the most comprehensive diet study ever performed, I wish we had good diet studies, link?
My husband has suffered for many many years with asthma. He used an inhaler quite frequently especially before exercising.
He started a Carnivore diet and within two weeks, he said he could finally breathe without thinking about it!!
He also stopped snoring! If he cheats, the wheezing immediately comes back. I would recommend everyone with asthma to change your diet!!!
@@galaxia4709what a load of rubbish, they have NOT followed thousands of people on keto diets for 30 years. Give us the exact details of this supposed study so we can look it up ourselves, or we can conclude it does not exist.
What do you think about patients who use a SABA prophylactically before exercise? Should they also use an inhaled steroid at that time?
That’s a great question. I don’t know if they tested that.
I have severe asthma and moderate COPD. I use albuterol before exercise with ICS/LABA and LAMA maintenance inhalers. Very interested in your question.
As your friendly neighborhood Respiratory Therapist, please use your spacers with inhalers! Not all inhalers need them, but things like Albuterol inhalers MUST have them.
You're not doing anything wrong by using one, nor are they just for kids. Without the spacer holding the medicine for you, the vast majority of the medicine gets squirted out into the back of your throat and doesn't really get down to your lungs.
Thank you!
Most use poor technique anyway! Def need to rinse mouth after steroid inhalation! Retired respiratory therapist/RPFT as well.
Cigarette smoking I believe is the greatest cause of COPD. My father gave up a life time of cigarette smoking in his late 30s. He was a fit strong man till his late 70s. Then he got COPD as a result of his history of smoking. He could barely walk to the toilet and was on O2 nasal feed where ever he tried to go. Pneumonia killed him in his late 80s. Damn cigarettes. Don't smoke folks
very helpful , thanks sir
Learning this for my abim boards haha. Thanks!
Good luck!
I have had severe asthma since childhood.. many icu admissions. Finally got onto laba/ics (Pulmicort/Oxis.. like symbicort but I have them in separate inhalers as I can’t get the right combo in symbicort.. have used these for approx 25 years now.. it has been the only thing that has treated it effectively.. I increase the dose when I get asthma symptoms eg when I get a cold and it stops it most times without any other meds.. it’s the business! Of course every new GP I’ve had tries to get me back on other inhalers.. but I have managed to stand firm.. have not had any hospital admissions and rarely take corticosteroids now.. as a young person I ended up with a tricky prednisone addiction as I couldn’t get any meds that actually worked until I found Pulmicort/Oxis.. I agree completely with what you are saying.. thanks for the info!
With a natural recipe, I was cured of asthma and threw away all medications and sprays
i was always taking symbicort as needed even though the doctors always said i should take it every morning/evening, it seemed to work fine for me just taking it sometimes, interesting it has been validated now
I was told I had asthma as an elderly person, and given inhalers including that combination inhaler. All I can tell you is the inhalers made the problem MUCH worse; the inhalers turned the problem from an occasional one into a constant daily one, and greatly increased the severity. I could not get enough air because I could not breathe OUT when I used the inhalers. I really felt like I was going to suffocate and die. No, I have never smoked, and no, per the lung function tests I don't have COPD. I couldn't walk a couple hundred feet uphill to my garden without stopping to pant for air. Finally in desperation I threw them all in the trash and started using a Chinese traditional asthma tea, and only when having problems. The whole shortness-of-breath problem just disappeared except for very mild symptoms a couple of weeks a year (allergies???) and then I take the tea. After all of this, I really question how "asthma" is diagnosed, and I think way too many drugs are prescribed for "mild" asthma without regard to side effects on different people. I have read for example that these treatments work very poorly for many black patients, which seems to point at genetics having a lot of influence on their effectiveness/safety. At any rate, their effects frightened me enough that I'll never use them again.
Which tea do you use ?
Natural and definitive treatment for asthma exists
This is devastating for me, I can take albuterol and it really helps. I literally cannot take inhaled corticosteroids without a giant Candida flare up, that in the past has caused 60 pounds of weight gain in 3 months. Forcing me on a corticosteroid steroid will cause me harm. I'm really glad I got the heads up from you here, because I now have a mountain of research to do to figure out how to avoid being forced on a corticosteroid steroid.
They won’t force you. It’s a guideline. I’d be surprised if your doctor even knows about it.
With a natural recipe, I was cured of asthma and threw away all medications and sprays
@@Medcram
Most of us are forced into changes by our insurance coverage.
4:33 That's how I deal with my asthma as well, I only use it if I feel some trouble breathing or in case of an exacerbation like coughing and stuff.. Thankfully I almost never use it, perhaps a couple times a month... sometimes I go months without needing it.
Physical therapy exists, has been tested, and is 100% successful
I didn't hear anything about vitamin d.
Is there any mention of vitamin d levels in the studies?
You should look for the studies of vitamin d and asthma.
Checking vitamin d levels seems to be anathema in asthma.
I wonder why.
Are you talking about the NIH study?
@@marysmith7765
I don't have any one study in mind.
This is from my years of reading studies.
Vitamin d among other things.
Any study of drugs should be normalized at least for vitamin d levels.
We cover that.
th-cam.com/video/ezuyfGLph4Q/w-d-xo.html
My son has asthma since childhood and during his 30 years he has had the same medication. I have wondered why nothing has changed, but maybe it will now.
There is a very excellent and 100% successful natural treatment for asthma
Any estimate on costs involved for the inhaler with ICS/Formoterol? I ask because my insurance isn’t covering the inhaler that works for me. My out of pocket cost for it is $880. This is not sustainable.
Generic drugs are much cheaper in India, and hospitals too
What about side effects of a corticosteroid. I took it for years and had significant problems with throat irritation, and I’m wondering if it would increase the chance of getting respiratory infections in the long term?
We encourage patients to rinse after using their inhalers. Some are still sensitive to yeast development so we sometimes give them an antifungal rinse and swallow medication. Did you try it?
For so much of my life, I was warned about the risks of inhaled corticosteroids. It was always made clear to me to do the lowest dose necessary to control asthma.
Now it's being used "as needed' - are there enough studies showing taking ICS as needed doesn't have long term side effects? Asthma patients can over medicate with prn treatment when asthma is out of control - what risks are there in changing from super high administration of Albuterol to the same frequency of ICS?
I also find it *very* interesting that this whole paradigm shift seems to be largely based on one study. In that study, the groups tested were: Albuterol as needed, ICS maintenance protocol, or ICS+Fomoterol as needed. I find it interesting that they didn't include a group doing what has been the gold standard protocol: ICS+Fomoterol maintenance combined with Albuterol as needed. I can't help but wonder if this study was meant to "prove" that people need to take their ICS+Fomoterol more frequently than they already do. Especially since the study *happened* to be partially funded by Astrazeneca, which interestingly enough makes Symbicort, an ICS+Fomoterol.
There were a few studies - not just one.
Wow, I have been doing this without even knowing there was a research and it does work. This is because the ICS affected my eyesight so i only take it when I'm using my albuterol pump
Hopefully Kaiser will put this medication back on their formulary!
Do you know if these new protocols are coming to the UK?
Yeah I’ve kind of noticed that if I do my steroid and the albuterol at the same time, I get better long-term results. However for long-term steroid users please please make sure you get regular eye exams. And add in some nasal washes to prevent asthma if post-nasal drip is a trigger (exercise-induced.)
SYMBICORT can also cause other serious side effects, such as increased blood pressure, increases in heart rate, and changes in heart rhythm. These are not all the possible side effects of SYMBICORT - there is a number of them. Ventolin was very effective, but it was being over used and was less efficient with controlling chronic symptoms. An asthmatic should ALWAYS have Ventolin (Salbutamol) for a back up reliever because it is VERY efficient at relieving mild attacks. Just a note: Symbicort is unpleasant to take. I've written this as an long-term chronic asthmatic and a lay person.
Smoking is a serious negative.
Yesss my 7 year old son was just put on symbicort and right away started complaining of heart palpitations and fluttering so I immediately took him off
@@sarahlynne4528 he probably need a smaller dose
Is ICS-Formoterol also recommended for exercise-induced asthma, and if so, can it be given hours before (rather than 5-20 minutes in SABA) because it has LABA? (Formoterol half life is 7 hours).
I am so thrilled I have managed my asthma with herbs and homeopathy. My gf has been off her inhaler for 4 months using the same remedies. My inhaler was making me worse and it had terrible side effects for me. I now feel much better and breathe so much better and have very little episodes; and when I do have one, it is quite mild (compared to before) and the remedies work fast for me. I was talking to my gf one day and she happened to mention her inhaler was making her worse too so I told her about the remedies. She got on them and said they have been life changing. Too bad more people do not know about these.
I love homeopathy. Which remedies did you take. I had a blood clot in my leg and homeopathic remedies resolved it despite me expecting to need to visit the ER. It was severe and very painful as well.
@@wildhorses6817 I just responded. Please let me know if it doesn't show up. I often have posts that never get seen.
Asthma and copd are caused by right side vegophaty ,neurophaty witch is due to exotoxins ,chemotoxis ,biotoxins and poor detoxification or lack of hot climate .
Despite cigarette ,allegens and toxins here in hottest place on earth ,afar ,Ethiopia no asthama and copd case .even those patient who come from cold climate in ethiopia ,they recover the atack within few hours .thanks to near infrared radiation ! The best detox and antiinflammatory !
0:05: 📚 The video discusses the treatment of asthma and COPD, with a focus on the new guidelines for asthma treatment.
2:58: ✅ A study published in the New England Journal of Medicine found that combining an inhaled corticosteroid and a long-acting beta agonist as routine treatments, or using an inhaled corticosteroid alone as routine treatment, can be effective for managing mild asthma.
5:27: 💡 Using an inhaler with an inhaled corticosteroid as a rescue inhaler is more effective in reducing urgent medical care usage and systemic glucocorticoid use compared to using albuterol alone.
8:20: 💨 New asthma guidelines recommend combining short-acting beta Agonists with inhaled corticosteroids for rescue inhalers.
11:05: 📚 Risk factors for asthma flare-ups and exacerbations include obesity, food allergies, smoking, and other medical conditions.
Recap by Tammy AI
The ultimate treatment for asthma exists, has been tested, and is 100% successful
So, if I understand correctly, the Netherlands currently uses the old paradigm? I use ventolin as needed, and when it gets worse, for example, once a year, I get perscribed fluticasone, a corticosteroid, to take twice a day. Now I'm wondering whether to bring this up with my doctor? My asthma was controlled for years but became partially controlled to sometimes uncontrolled recently.
GINA 2019 already suggested using ICS-formeterol or ICS single inhaler + SABA as needed for treatment in mild asthma instead of using just SABA as needed. This was revolutionary for clinical pracitce at least in EU as we never prescribe SABA as only asthma treatment anymore since then. Over the years another problem occured as many patients don’t feel the decline in lung function especially if the symptoms appear gradually and they don’t know when to use ICS-formeterol inhaler that is only perscribed to be used as needed. This approach is therefore appropriate only for a small number of patients. I believe this is the main issue for GINA to address in the future.
Yes but in 2019 “other reliever option” was SABA only.
Unfortunately, there are still doctors who haven't caught up.
Physical therapy exists, has been tested, and is 100% successful
@oumaymen6773 for who? I haven't found any physical therapy that helps with my asthma, not to mention that not all asthma is the same. The only thing that held me is playing a very large wind instrument, but as soon as it's super humid or I get sick again, I'm back to having problems.
what if you are using it for exercise to prevent exacerbation?? i would think the combination drug is still probably better but nothing was said during the video.
I am suffering from GAD with breathing difficulties and my doctor put me on budesonide 200ug twice a day. Still have chest tightness and and shortness of breath and starting to wonder if diagnosis was correct. How can I know if it’s asthma or anxiety?
What is OCS? As in avoid maintenance OCS. Does that refer to occasional chronic systems, and using a rescue inhaler when occasionally needed?
He I see you are in California I always wanted to take a trip out there see the redwood trees
Is there a link to updated official guidelines that are layperson friendly? In the UK my daughter still takes daily ICS but I'd really like to present some information to her care team, it's been bothering me if she really still needs it. She's really mild and was diagnosed only resulting from some chest infections years ago.
If you look up GINA and asthma that should get you to the right place.
@@Medcram awesome, thank you. 🙏
I have been trying to teach this to patients, but when they see the price tag of the combination inhaler, I inevitably get a call to please switch it back to albuterol only.
That’s fine so long as you just let them know that whenever they take their albuterol rescue inhaler that the guidelines suggest them also taking inhaled corticosteroid along with it.
This is awesome information. Question, my 6 y/o has multiple food allergies, and have had to give albuterol for cough from food allergies.. He occasionally has exercise induced coughing. Does this also sound like asthma, how would I get him tested?
could be cough variant asthma, which is a milder form of asthma. But it is important to see a doctor for this either way! There are lung specialists that can help with the diagnosis and treatment of symptoms
@@HybridHumaan Thank you, you are right. We did end up seeing the pulmonologist who dx him with asthma.
How about Leukotriene inhibitors
as an asthmatic i can attest to the importance of saba and ics treatment, ive had flareups that felt like breathing thru a pen tube, maybe worse, always at times ive forgotten my inhaler at home.
I was completely free of asthma years ago
My wife has the most severe form of asthma. She's been in the ICU, on a ventilator, in a medically-induced coma, 8 times. She crashes if she gets a respiratory infection.
She lives on Albuterol on a nebulizer, with 20 treatments per day. It's life altering.
The ultimate treatment for asthma exists, has been tested, and is 100% successful
Carnivore diet with plenty of salt! Many testimonies of folk resolving their asthma!
uhm, you need to include what c 1 9er did to our lungs on top of these issues. since i got the original c 1 9er back in 2019 (last week of) before THEY said it was started to spread in late jan/feb, i have to have asthma and copd inhaler's and i take primatene tabs on top, to me the primetabs work great sometimes better than the inhalers but not alone, i have to have all 3 every day and night. all i can say is that the o.g. c 1 9 er ravaged my lungs and i have a harder time breathing now, before that, i was fine with just a saba and or prime tabs seasonally or couple of times a year.
"Having asthma is like trying to breathe through a thick pillow
ㅇㅋ Andrew(Arlo)
todas que su hablar es correctamente a mi, enfemeria Jessica🤗
Alright, this is based on my own life experience... and I know that medicine/science can evolve over time... but:
I've always associated "asthma" as having the need of having an inhaler with you at all times in case of flair-ups.
My daughter was born in 2001 and suffered greatly as a child due to seasonal allergies from spring to fall. Her symptoms would be red, itchy, watery eyes, runny nose, irritated throat, etc. and many times severe enough that she needed to stay home indoors for a few days to alleviate her symptoms. Maybe once a year it would be severe enough that she would also be prescribed albuteral to help the symptoms.
So here's my issue: I've grown to understand that there was a difference between having asthma-like "symptoms" from a condition/sickness and having "asthma" AS a condition in its own that COULD be aggravated by external conditions (air impurities) and/or internal conditions (stress).
Although my daughter still suffers from seasonal allergies, sometimes badly, in general it's nowhere near as bad as when she was younger. She was prescribed albuteral maybe once in the past 8 years as opposed to 1 to 2 times a year when she was little.
The problem arose when she was in high school and needed a yearly physical exam before being allowed to join athletic teams at her schools. The doctors would say she "has" asthma and that she needs to have a rescue breather just because she "used" albuteral in her past. It was always a yearly issue arguing with the doctor and school nurse about how the albuteral was only for the severe allergy attacks when she was younger. It's like saying if I were ever sick enough to need hospital care and if they gave me oxygen either through a canula or mask, then that means I have COPD. That simply does not make any sense and quite frankly would sound like the doctor for his credentials from a cereal box.
Isn't there a clear distinction of having a sign/symptom of asthma due to having your airways restricted from a sickness/severe-allergic reaction as opposed to "having" asthma AS a condition in and of itself that COULD be exasperated from other factors?
Again, if I ever needed oxygen in my past, that DOESN'T mean I have COPD type disease... so WHY are every pediatrician nowadays declaring that if a child EVER needed albuteral, than it means the child HAS asthma for life and SHOULD always have a rescue breather???
It seems to me that many doctors blindly go through medical literature without any critical thinking. Kinda brings to mind my past benadryl use... the active ingredient is also very common for sleep aid. In my younger years I needed over the counter antihistamines to help my seasonal allergies. I also have always had insomnia issues. And whenever I mentioned to a doctor that I took a benadryl to help me sleep because I ran out of my unisom, they'd be completely puzzled and question the action and say, "but that's for allergies, not for sleeping" and then if have to educate the doctors that benadryl's active ingredient IS the new norm in over the counter sleep aids... to which they'd still give a disbelief reaction to.
I simply can't understand how the medical community can be so narrow-minded sometimes.
Side note... benadryl never worked well enough for me, and as a sleep aid was terrible for me. For allergies I now use daily types such as Claritin, and only sleep aids (as needed) with the older more useful doxylamine succinate as the active ingredient.
TL:DR Isn't there a difference of having asthma symptoms from an underlying condition as opposed to having asthma as a condition??
Boy do I agree with you!
I get what you are saying but I suppose they are taking the 'better to be safe, than sorry' . approach. Once they see "rescue inhler" was used then the red flags go up, which is understandable.
I suppose the fault is with the Dr's prescribing a rescue inhaler when there was obviously no need for it. The only time they shud be prescribed is for breathing difficulties or when the lungs are effected in any way by triggers. But in your case, looks like your daughter had everything but her lungs effected!!! So yes, this is annoying alright but unfortunately you can't turn back time.!!
I used to use an inhaler, but my breathing only got better in the short run, and it got worse in the long run.
What about daily magnesium/potassium?
i find it helpful
Thanks you very much for this information doc. If you have the time, I have a couple of questions:
1/ I'm an RN and one of my doctors told me to advise patients to use their short acting albuterol inhalers prior to their Symbicort to help get the latter in. I have noted that this does raise their heart rate, sometime into the tachycardic zone. What do you think of this practice?
2/ There used to be a warning in this literature that comes with the Symbicort of sudden death if used more than BID. Can their be any truth to this if we are now using it PRN as a rescue?
Respiratory Therapist here.
Part of the advice that the provider may be wanting to stress is that patients need to make sure they are doing well enough breathing wise before taking their maintenance medications otherwise they don't get nearly as much. If their lungs are already tight, then starting with their SABA will open them up a bit so they get more of their maintenance.
Not everyone needs to do it, but it's important to try to open your lungs up first before taking your maintenance if your lungs are a bit tight.
Just make sure they're not taking SABA just before LABA, since the SABA latches onto the same receptors and the LABA will not work.
Natural and definitive treatment for asthma exists, has been tested, and is 100% successful
Duoneb always seems to be on back order. We are still using albuterol in our urgent care.
I wonder if you can order ipatropium only solution for neb and mix it with the albuterol or tandem admin?
I am suffering from inhaler induced eczema (like topical steroid withdrawal). All symptoms are the same as I have already been through 4.5 years of topical steroid withdrawal, and am aware of the symptoms - its not eczema. I was assured that inhalers with steroid in would not cause the same red skin syndrome/tsw like side effects.
I dont really have anywhere to turn as i need the long acting inhaler (which contains the steroid), yet i am suffering so much from the side effects on my skin.
Are long term ICS side effects a concern? My 6 y/o is starting symbicort, I worry about long term effects (osteoporosis, growth suppression, infections)
This is probably a dumb question but what would be some of the brand names of the inhalers that are ICS/Formoterol combination?
Dulera, symbicort.
Albuterol never did a thing for my asthma, but maybe I'll talk to my doctor about this to see if it helps!
Natural and definitive treatment for asthma exists and is proven
So if Symbicort is too expensive, a combo of taking fluticasone and and salbutamol would be a good affordable alternative?
Have to admit I had not heard faba until today. Had to turn my phone over and look
When I was working in the ER as an RT about a decade ago we would do an 2mg budesonide neb with high dose albuterol for acute exacerbations. Don't know if they still do that.
Yes
Just to clarify, is correct that Advair (ICS + LAMA) may be used under the new guidelines as and as-needed reliever? Thanks.
You want the short acting bronchodilator component in a resq inhaler. The risk of using a pure long acting, especially with multiple doses in a short period of time, is you fill up the receptors with a med that takes a long time to reach peak effect and stays on the receptor for a long period of time, preventing subsequent short acting doses from working as well as there are fewer available receptors.
I'd stay away from a pure laba in acuity. Formoterol is a unique case as it has both saba and laba action.
My gut would say a saba and ics would be best, but idk that that combo therapy exists in an inhaler, and 2 inhalers is more cumbersome. So budesonide/formoterol is the best option for now
Exactly. Good answer.
You never want to use a Advair as a rescue inhaler. The beta agonist in Advair is a long acting beta agonist and not a short acting beta agonist like formoterol is.
Does pre-exericse SABA use to prevent exericse-induced asthma symptoms, count toward the total weekly "count" of determining intermitent vs persistant asthma? Or is it only rescue uses?
Only rescue doses
@@Medcram Thank you so much!
Thanks for posting. We are trying to nail down whether my shortness of breath and feelings of chest pressure is due to my mild Pulmonary Hypertension (40 on echo / 40/25 RHC) or if COPD or Asthma. My doc wants everything to be about COPD - I am pushing back because my DLCO score is normal (86) and so is my FEV1. Doc is pushing for COPD because FEF increased by 16 points from 5.01 Since everything else was normal, shouldn't the diagnosis lead more to Asthma? And... even with that - are my symptoms more of a Pulmonary Hypertension nature ? They classify my PH as being in class 3 based on my docs interpretation leading to COPD. Any help understanding this would be appreciated.
8:36 isnt Formoterol a LABA ??
Yes, but it’s also short acting