Asthma Exacerbation Case Study 1 - Treatment (Asthma Flare / Attack)
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- เผยแพร่เมื่อ 9 ส.ค. 2022
- Acute asthma exacerbation treatment with illustrations by pulmonologist Dr. Seheult. See all Dr. Seheult's videos at: www.medcram.com/?Y...
(This video was updated on August 10, 2022)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.com/?Y...
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
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#asthma #ventilation #casestudy
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Sir no words to say .Thank you you are teaching us (physicians ) residing in rural Africa. I feel very much lucky to get this
this is exactly the problem I have from 9/11 as a paramedic
Love this. Thank you so much for teaching us.
I was diagnosed with asthma at age 8. I used many meds over the years including theophylline, albuterol, flovent, advair ,etc. it was well controlled and I was never hospitalized. If I stopped taking my meds, I'd have the typical tightness, cough, mucus. I started the keto diet about 5 years ago and my asthma has gone away....totally away. I am 49 now and don't take meds. I have no flares or issues. Docs need to start looking closer at food allergies and recommending new ways, other than meds to control, and possibly cure, this debilitating disease.
Thank you for sharing that experience.
Asthma seems to be almost as slippery as it was a couple generations ago when our family went mano a mano with it. In our case the big allergen was mold... and that was in Phoenix.
I'm glad you are med and flare free! Our son estimates he will live into his 50s, and my retired nurse wife and I sadly agree. Lots of damage from prednisone but it kept him alive.
I mean that's good for you but we need some RCTs to test your belief that keto cures asthma. I'd rather have asthma than to do keto, but that's me. Fun fact, we have largely prevented many asthma related hospital admissions and most deaths with the use of inhaled corticosteroids and bronchodilators. Not so much for keto. Yay science!
Yes, It's fascinating... persons come for MEDICAL treatment.....but really need diet care.
YES! THIS IS MY STORY ALSO! people think I'm crazy when I tell them. I can remember running out of albuterol inhalers and paying people to go to the emergency room for me. Buying them from people on the street. Now like you I'm cured! And I'm also 49. 50 next month. Would love someone to create a group for people like us to talk. When I tell people I swear they say I'm lying, or that my asthma was faked all these years. I don't talk about it anymore. I feel vindicated. Thank you!
Thank you so much for sharing.🙏🙏
One of our sons was diagnosed with moderately severe asthma as a young child. He was prednisone dependent from age 6 to age 13, which has caused serious lifelong problems. Do not underestimate the dangers of poorly controlled asthma!
He spent 3 months in National Jewish Hospital, finally resulting in being prednisone free except for flares; his daily medications dropped from 17 to three. (His hometown allergist knew many of them were not helping but he was too brittle to try backing any of them off in an outpatient setting. It was there, in family education, that they introduced the concept of an "allergy bucket." We may not show identifiable symptoms from air pollution, pollens, or whatever but they all go in the bucket. When the bucket is full asthma symptoms appear. That has been one of the most useful learnings we took back from the education.
Obviously, the technical side of this presentation does not guide our treatment protocol (he is living with us because of the extensive prednisone damage) but it gives us more information and that is never a bad thing.
The bucket makes sense, actually, at least for me. Thanks!
That makes so much sense wow, thank you
Such a great explanation. My wife's asthma crises are more understandable now.
I sent my wife a link and she appreciated it. She sees her pulmonologist every three or four months.
You're an amazing teacher, thank you
He has a gift for teaching
Thank you for explaining asthma...I am a severe asthmatic and have been intubated 10+time and in ICU more times than I can remember.
Most persons have no understanding of the problem ...that we can not empty our lungs.
Due to repeated i tubation I also have V.C.D,vocal cord dysfunction so my attacks start in both the throat and lungs.
I am seen by a renowned Pulmonologist but remain uncontrolled.
Please continue to educate others
Thanks Dr S🇨🇦
Dr. S., Thank you! With a new baby she probably isn't getting enough sleep, fluids or sunlight. Glad you saved her life. If she is breastfeeding she might be limiting her meds. I try to avoid albuterol but sometimes need it. I have bad side effects. I try menthol cough drops, coffee, theobromine, vitamin c, magnesium and bromlain daily to keep from needing the inhaler. I also sometimes place a heating pad on my chest. This seems to abate it. It is a horrible condition to have and it is so exhausting. Also, noticed that with exercise induced asthma you need to try to exercise despite it.
Fascinating
I watched this video with great interest. I've had asthma since I was three. Any cold exacerbates my asthma. (Unfortunately, I typically need a week's course of prednisone to recover.) I'm very fortunate to be under the care of an excellent pulmonologist. A decade ago, I suffered from the flu (despite having received the inoculation for that year). The hospital attempted to place me on a breathing device that pumped air into me while I was conscious. Thank goodness, when I spat the hose out (almost immediately) the nurses didn't shove the thing in and sedate me. I fear the incompetence of staff almost as much as I do catching a cold. (And yes, I was a guinea pig for a certain pharma company's v study, because I wanted to be as protected as possible as quickly as possible - not that such seems, in retrospect, to be much of a safeguard)
Life long Asthmatic and the only Doctor that did any good for me retired several years ago. Can you please list the diff.meds you spoke of so I can try to talk to a new doctor about getting these on my maintenance scripts? Thank you.
I'll have to look for your videos about how to PREVENT getting into the situation where the ventilator is needed! As 1 comment below points out there are many items that combine into an individual's "allergy/asthma bucket"
Very interesting case study Doc! I am going to assume that the patient responded well to treatment and was released from the hospital. I hope that you do a follow up on this case. Thanks and hope that all is well with you! 👍👍
Yes. Concluding video to be released soon
So...are smooth muscle relaxants used to help ease constriction?
(Sorry if this is a silly question...)
Is this information generalizable to the twice-daily exacerbations that occur with chronic bronchitis / bronchiectasis?
Thank you. My son would so regularly have asthma attacks when he got the flu that we learned the triggers and fine tuned the response. Though we also learned the hard way, if you go into emergency and say “he’s having another croup attack”, he’d be given a steroid and sent home. However if you said “he’s having another asthma attack” he’d get proper Athsma treatment.
Adding Magnesium infusion and SQ Epinephrine should help this prior to intubation
I stopped eating meat and dairy asthma went away completely after being asthmatic from the age of 13.
Please what is the medicine for broncial asthma
I know some of these words.
My wife has severe asthma and there seems no cure, just treatment. She's been intubated, but has survived each time, but it is touch and go. And she's avoided the ECMO so far. This is profound ICU territory, and it is stressful on family. 10 infusion pumps at once. We need a cure!!!
Check for sulfites in your diet (preservatives)
Check for GERD and treat it
Check for post nasal drip and treat it
Check with your physician to see if LABA/LAMA/ICS combination inhaler is right.
Consider singular
Consider xolair
Consider nucala
Consider bronchothermoplasty
It sounds serious. Check with your physician of course.
@@Medcram Thank you. She has a pulmonologist at UC Davis. She has tried what you mentioned, and been on two clinical trials. What gets her in trouble is a respiratory infection. Since we have avoided people because of Covid, she's not been in the hospital. (Silver lining)
The last time I insisted on Albuterol in the hospital, constantly. Prior to that they were doing breathing treatments every four hours, and she ended up in the ICU each time. This last time I insisted on the constant Albuterol and a BiPap, and she avoided the ICU.
I will mention these things to her. She goes through 8-10 vials of Albuterol each day. And she has nebulizers in house, car, my car.
I really enjoy your channel.
Also, I tried to get her to go to the asthma center in Denver, but she's afraid to leave home.
I'm not a doctor, but just sharing my experience. I've had asthma since I was diagnosed at 6yrs, about 37 years now. I used to have asthma attacks a couple times a week and would go to the hospital about once a month. 22 years ago the doctors put me on advair- a long acting beta agonist or LABA. It is a combination of salmeterol and fluticasone.(I think there are a few different brands of LABA with a few different medicines.) Prescribed to take every 12 hours. Since I started taking that medicine I haven't had an asthma attack in 22 years. I also carry a rescue inhaler, albuterol. I have severe allergies and for that I take fluticasone nose spray at night and allegra (regular not allegra D) once a day in the daytime. If my allergies get really bad i might pop an extra allegra once in a while.
If she has allergies, they need to be under control. Look into the LABA medicines with her doctor. (LABAs usually take a couple of weeks or so to really kick in and start to work, but its worked wonders for me.)
@@TheArgos12 Thank you. My wife developed asthma as an adult. She can't use an inhaler because she can't breathe in deeply enough anymore. She uses a nebulizer a dozen times a day, day and night. She moved into the spare room so her frequent treatments during the nighttime wouldn't wake me.
When she was in the ICU two years ago they said she was the sickest patient they had.
She can deal with it, as long as she does not get a respiratory infection, like a cold or the flu. We stopped going to church or seeing family except outdoors. On top of that she had a cardiac arrest in January. My CPU training saved her life.
@@scottslotterbeck3796 - I, too, have asthma which is set off by even a mild cold. I've avoided people due to Covid and have not had an attack in three years. No nebulizer treatments, no steroids, no ER visits. What a relief!
Been watching your videos and great explanation of copd and asthma. In the last year or so I have had wheezing on exhalation it has gotten worse the last month my GP told me I have allergies and perscribed Montelukast sodium 10mg. Not any better I have no history of any allergies copd or asthma am a non smoker and79yo. How can I get tested for what is going on???
Pulmonary function testing
History, physical exam (mental, aucultate wheeze/RR), vitals, ABG, steroids and Nebulization and repeat.
Intubation.
Xray = hyperexpansion hypotenison
Incorrect ventilation=dynamic
Resp viral infections = astham exacerbaiton
Hx:
Vitals
Mental status
Pex: auscultate
ABG
Steroid oxygen nebulizers
Bipap
Repeat ABG
Beta receptor = musuclar relaxaiton
Need to be activated
Msucarinic need to be blocked
Ipratropium
Albuterol
Resp acidosis
Dt co2 acxumulation rather than change in bicarb
Xray after bipap
DHI dynamic hyperinflation
Why didn't the patient was started on IV mgso4 or sc bricanyl?
Lower AC than 20, less tidal volume?
Can nitrates help asthma?
Doc...why do so many doctors and pulmonary specialty doctors miss telling patients to eliminate all dairy even cheese? I took Florent 225mcg 2 puffs twice a day for years and carried an emergency albuteral inhaler. I went Carnivore to reverse T2 DM, hypothyroidism, hypertension and ckd. All of which I successfully cured. I then dropped dairy in an effort to loose a few pounds. Rather shockingly my allergies and chronic, severe asthma complete with a cough and wheezing went away in a week. Recently, one of my employees was really suffering with sinus pain, asthma, sniffing and even migrains she's been seeing a specialist for weekly. She is in her 60's speaks very little English..I told her NO MORE LECHE!!! She was eating lots of cheese and drinking a glass of milk at bedtime each night. 1 week in she is shocked..report's no more sinus issues or asthma, not using allergy meds anymore and Flovent is actually working now as it wasn't working for her recently. She is so happy as am I that it's working. Why do doctors not analyze what people are eating?
I would slow the control rate, increase sedation, and drop O2 to a level to maintain a reasonable O2 sat.
Paralytic, short I time to increase e time.
@@imgadgetmanjim they have put my wife in paralytics the ladt four times she's been intubated. Problem is, waking up paralyzed is not pleasant. My wife cried the first time it happened. Some people are partially paralyzed for life afterwards. So far, my wife has fully recovered, thank God.
@@scottslotterbeck3796 Paralytic should not be given without proper sedation. Sorry to hear that.
@@imgadgetmanjim oh, she was sedated. This was at a University of California hospital. This was about five years ago?
Is she on a maintenance inhaler?
I have asthma. Is there any way to create pressure to aid exhalation? I remember attacks so severe my lung muscles were actually fatigued and could barely help with exaltation. I had to lay my chest on a table to exhale.
Need to get help before that happens. Try a peak flow meter daily so you know how you are doing before you get bad.
@@Medcram Using the peak flow meter gives my wife an asthma attack. She tracks her attacks using a pulse oximeter.
Why is Duoneb the go to treatment? Duoneb dries out asthmatics. We need just regular Albuterol. I demand only Albuterol whenever I'm in the hospital along with steroid. I'm now steroid dependent because of my asthma and diabetic because of the Prednisone. Damn if you don't, damn if you do. My doctor gave me Duoneb for home use but it is too drying, not to mention the antihistamine when I do take it.
Doctors please understand that the anticholinergic drug will cause a mucus plug and increased difficulty breathing. Repeat Albuterol TX and hydration works wonders along with steroids of course.
Around the 5 minute mark he explains the mechanism of action of the combination in Duoneb. The ipratropium opens the airway by blocking the muscarinic receptor. It does dry up the mucus, also.
@@stevepottschmidt2903 my question was really a statement, not a question per se. Ipatropium is not a good drug for asthmatics as it dries up the mucus. We need that mucus loose and thin so we can cough it up and expel it. I had a horrible week using Duoneb. Ughh. I'll stick to plain old Albuterol.
Welcome to the Severe Asthma club. Not fun!
@@prettyyoungthingpyt5015 good to know. My wife uses Albuterol 8-10 a day with a nebulizer. She agrees she needs to cough up stuff. She used Mucinex for a long time.
Well that freaks me out a little bit. Especially during a pandemic. But regardless. I really don't like asthma. It is not fun. I pray frequently that my death someday will not involve not being able to breathe. Ah just ignore my negative attitudes. We just had two more family deaths this week, and it's affecting my attitude temporarily. Seven in less than a year, some with covid. I'll cheer up later. But I still really dislike having asthma and most of my relatives have it too. It's a family thing.🙄 We take it in stride. For some reason I found the video both informative and upsetting. Excellent video though.
My wife says it's like breathing through a straw. Very scary!
@@scottslotterbeck3796 It can be yes. Once I sat on my husband's chest to help him understand. When he commented how hard it was to breathe in with my weight on his chest, I told him, That's what it feels like.
Good to finally see a video that's not about the WuFlu. We can only go over the intricacies of a cold for so long. Welcome back!
Regardless of your opinion of the disease, the COVID-19 pandemic has been by far the most heavily studied pandemic in history and is immensely interesting from an epidemiological standpoint, so it's well worth studying in great detail even though the disease seems to be mutating to be less damaging.
Covid is still killing people. Stop making light of this killer. Over 5 million dead. It is not a hoax.
Dr. Seheult is a God send for me! I'm a cancer survivor at high risk of death, and his video #59 (?) is a life saver!!!
I believe my daughter got asthma through a childhood Vv@×ination.
I didn't expect all the pseudo science comments from non medical professionals here.
You'd be amazed what too many MDs don't understand.
Hi. Retired medical doctor here. 95% of adult asthma is allergy mediated. The problem is, the insurance industry has taken over health Care and doctors are not allowed enough time to figure out what is wrong with people. I graduated medical school around 1980. By the time I retired, 30 years later, I had to do five times as much work for an hour's pay and my pay was 60% lower than it was 17 years earlier. Doctors are overworked, nurses are overworked, you can't get lab results at night anymore, and you spend unpaid hours, literally hours, I mean like I once spent 4 hours on the phone trying to get life saving care for patient. The insurance company denied it. Another doctor was on the phone next to me and we both finally had to get off the phone from the insurance company about the same time. We just gave each other a hug and cried for about 3 or 4 minutes.
The United States for profit healthcare system has made magnificent salaries for insurance company and hospital corporation ceos. Dollar bill Maguire, over the 10 years he was at United healthcare, took 10 billion in compensation. You have to deny a lot of healthcare to give that much money to one man.
So is it any surprise that the United States has some of the worst healthcare outcomes in the developed world, the shortest life expectancy in the developed world?
@@Madronaxyz I'm saving your valuable text here, thank you for this. The authoritarian abuse of MD's and patients in HC appears essentially coordinated, also with Pharma, where the legal meeting of standard of care is sufficed with agents labeled for the diagnosis. Once the legal standard is met, the system can defend itself; to Hell with anything else.
@@Madronaxyz The USA has the best healthcare system in the world, but it is too bureaucratic, too expensive, and making obscene money is evil. I agree.
But government-run health care is far worse. I have incurable cancer, but I'm still here after 23+ years because I researched doctors specializing in my cancer, and found a dictor who was an expert in that cancer, a published researcher, and have been on five clinical trials. Also, of course, by the grace of God.
I would be dead if I lived in a country with socialized medicine. Zero question. A doctor from the UK laughed when I asked him and he said yes, I would be. They simply do not have access to the latest drugs.