[Allergy & Asthma Corner]

This patient has not missed a flu shot in over ten years.

“Dr. Thompson, I don’t want to get a flu shot. The last time I had one I got the flu”.

Someone says this to me almost every fall when it is time for a flu shot. My response is usually: “Did it kill you?”

Well, my point is the influenza vaccine is given in order to reduce the likelihood of having a severe, life-threatening flu syndrome. The vaccine may not prevent you from contracting the flu. If you still get sick with fever, headaches, sore throat and muscle aches, do not think this means the flu vaccine failed. You may have contracted another type of virus (and there are many) that may cause a flu-like illness. These viruses (flu-like) do not often carry as high a risk of respiratory failure, heart complications and pneumonia. It is possible to still become infected by the influenza virus but your chances of surviving it are much greater by having protective antibodies. The flu vaccine stimulates a protective antibody response.

Some FAQs:

(Information from the Centers For Disease Control website)

Who should get the flu vaccination?

-Anyone with chronic respiratory problems (asthma, chronic bronchitis) or other chronic medical problems (diabetes, kidney disease, heart disease)

-Anyone age 50 or older

-Children 6months to 5 years of age

-Anyone with immune system problems (HIV/AIDS)

-People who have undergone radiation and / or chemotherapy for cancer

-Children 6 months to 18 years on daily aspirin therapy (people at risk for Reye Syndrome)

-People traveling to the Southern Hemisphere between April and September or to the tropics or in an organized tourist group

-Anyone that desires protection against the flu syndrome (based on age guidelines with respect to the flu)

-Nursing home residents and people employed in such places

-Health care providers and any people who take care of children or the sick 

-Residents of dormitories or buildings where people are in close quarters

How long does it take to work?

A protective antibody response should be generated within 2-3 weeks.

How long are you protected?

The duration of protection should last through the flu season (November through March typically)

When should I get the flu shot?

Anytime after October 1st or when the updated vaccine becomes available. It is best to be vaccinated by or before December but the flu shot is administered throughout the flu season (usually up to March).

Who should not get the Flu vaccine?

-People under six months of age

-People with a history of allergic or severe reaction to the Flu vaccine

-People with a history of severe egg allergy

Will I get the flu from the flu shot?

The current vaccine given by injection does not contain any live virus. It contains inactivated virus particles (killed virus). Getting the full blown flu syndrome from the flu vaccine does not occur.

Are there any common side effects?

It is not uncommon to have some mild soreness at the site of the injection for two or three days.

Some may experience transient fever and muscle ache (but not a full blown flu syndrome).

Serious reactions to the flu vaccine are very uncommon.

How often should I get a flu vaccination?

Every year the vaccination is updated based on research on the flu virus from the previous year. An updated vaccine should be given every year, preferably by December.

What do you (Dr. Thompson) recommend to your patients?

I recommend that all my patients, especially those who have asthma or require inhalers get the flu vaccine (those six months or older).

Try to avoid being one of more than 100,000 people admitted to the hospital for flu syndrome. More importantly, avoid being one of more than 20,000 people that die from the flu each year.

To My Patients: GET YOUR SHOT PLEASE!

Where can I get more information?

www.cdc.gov/flu/

A patient with a BMI over 30.

Will losing weight help me breathe better?

Recent studies in the U.S., Canada and Europe have established a link between obesity and asthma.

Did you know?

-Both obesity and asthma prevalence have increased dramatically in the U. S. over the past twenty years.

-A 1998 Harvard Medical School study concluded that obese adults are three times more likely to develop asthma than slimmer people.

-A German study showed that the heaviest children were 77% more likely to have asthma in contrast to those children that were of normal weight.

-There is genetic research that links obesity and asthma.

-People that are obese or overweight more often have difficulty in controlling asthma.

-Other conditions brought on or made worse by excessive weight include: high blood pressure, diabetes, lipid disorders, certain cancers, degenerative joint disease, heart disease, sleep apnea, gall bladder disease, liver disease and irregular menstrual cycles.

How does obesity impact asthma?

Actually the mechanisms are not entirely clear but recent research has begun to develop some interesting concepts. Some reports have focused on the increased work of respiratory muscles associated with obesity. The chest wall tends to be less mobile in obese patients. It has also been reported that fat may compress airways within the lung, and cause increased sensitivity to cold air, viruses and some allergic triggers.

Weight loss is obviously not an easy task. Diet change and exercise is essential. You don’t have to stop eating or become a marathon runner. Modest changes in how much, and what you eat, along with regular aerobic exercise often lead to successful weight loss. Professional help by adequately trained doctors and dieticians may be very helpful.

It’s not a reach to deduct that losing weight will in turn, make exercising easier (less demand on muscles and joints, and less energy expenditure). The feeling of accomplishment as you succeed, may further fuel greater achievements. You may find it easier over time, to avoid the fatty, processed foods and rev yourself up for the next exercise routine. Look out! You may become addicted to good health, exercise and healthy meals.

In conclusion:

Recent research suggests that weight loss in situations of obesity (or being overweight) should lead to better asthma control, better breathing and better living.

Are you overweight? Do you know what determines whether you are obese? Do you know what your Body Mass Index (BMI) is, or what it should be?

Obesity is often based on the BMI. Although not always accurate in establishing risks to the above mentioned diseases, the BMI represents a useful tool that is most often used for assessment.

Figure out your BMI here: www.nhlbisupport.com/bmi/

Here are a couple of other sites to review: www.asthma.about.com/od/asthmaprevention/p/obesityasthma.htm.

AND: www.asthma.about.com/b/a/000141.htm.

“Horrible October” is less than a month away. Why is such a time when the leaves are changing colors, a/c finally going off, and holidays rapidly approaching, considered horrible? October is one of the busiest months of the year for allergists because of worsening asthma and sinus problems.

The set up is: school has been back in for a month, accompanied by the shared viral and bacterial upper respiratory infections; although a/c goes off, the heat comes on accompanied by the mobilization of dust (in the case of forced air heat); the temperature in the Chicago area goes from warm to cool (more associated with asthma symptoms); and although outdoor allergens soon come to a screeching halt (in the Midwest), indoor allergens and pollutants begin to play a much greater role.

Are you prepared?

An Asthma Action Plan is a written guide established between you and your doctor. The plan gives you steps to take if asthma becomes uncontrolled. Certain medications for asthma treatment are taken for relief of symptoms of cough, wheezing, shortness of breath or chest tightness. These are called reliever medications and include Albuterol. Other medicines help to prevent and control asthma. These are controller medications (for example Flovent, Qvar, Pulmicort, Advair, Symbicort etc.). The action plan usually details how to advance use of the reliever medications as well as increase or add certain controller meds.

Successful use of action plans may reduce the need for Emergency Department visits, unscheduled office visits, missed school, missed work and loss of sleep. Even if a sick visit is required, the asthma patient that has followed an action plan is often not as sick as one without an action plan.

In my experience October represents a time when asthma control is most likely challenged by a number of trigger factors discussed above. Preparation is the key to minimizing the negative impact of poor asthma control.

Talk to your doctor about an Asthma Action Plan. If you have one, see if it needs any revision. An important component of the action plan is the Maintenance Plan. This part of the plan reviews what you should be doing to maintain good asthma control.

Finally, some measure of asthma control may be helpful in determining whether symptoms reflect decreased lung function. The Peak Flow Meter allows you to measure lung function. A greater than 20% drop in Peak flow Rate (PFR) is usually considered significant. Green, Yellow and Red Zones may be established based on your PFR. Yellow and Red Zones require adjustment of your medications and identify warning signs which should prompt a call to your physician. A Peak Flow Meter may be prescribed by your asthma care provider.

A good site to check out is:

www.njc.org/disease-info/diseases/asthma/living/tools/action/index.aspx

Here is a link to a sample Action Plan:

www.aaaai.org/members/allied_health/tool_kit/handouts/my_action_plan.pdf

Park Forest Scenic 10 mile Run 2006. The rain helped to reduce the pollen and mold.

For many Chicago area students summer vacation is over and school has started. The warm, humid weather has allowed for many outdoor events (picnics, festivals and shows). If you have been following my seasonal tips you have prepared for the ragweed and mold exposure and hopefully have your allergy problems under control.

The fall schedule for many students in upper elementary grades and high school often includes running the mile. Many outdoor sports are already under way such as football, soccer, softball and others. People with asthma need to take extra precaution to prevent problems associated with aerobic activity, outdoors during September through October.

Exercise induced asthma (EIA) is a problem more than 75% of asthma patients experience at some point. It is believed that the cooling and drying of the airways of the lung lead to narrowing of the airways and excessive mucus production. These processes may result in symptoms of cough, wheezing, shortness of breath or chest tightness during activity or immediately after.

How do you determine whether shortness of breath is due to poor conditioning or stamina versus asthma?

A physician may need to address this issue when it is not clear. EIA often causes symptoms which persist more than five minutes after the activity is stopped. Wheezing and cough are not usually experienced as a result of poor conditioning alone. Peak Flow Rates (PFR) may be helpful in distinguishing asthma symptoms from conditioning. EIA often drops the PFR by 20 or more percent compared to pre-exercise values.

I have two major concerns when patients come in because of complaints of exercise related asthma symptoms.

1) Is the underlying asthma under good control? Some studies have shown that a third or more people with asthma under estimate their asthma control. A number of people have poor lung function according to breathing test but feel normal. These people would more likely have problems with aerobic activities.

2) Is the inhaler technique up to par? Many people do not fully respond to their controller and reliever medications simply because of poor inhaler technique (see my posting: March 1st.). It is imperative good inhaler technique be practiced for best results in managing asthma and EIA.

Assuming the above two concerns are not a factor, the first step in treating EIA usually includes taking 2 puffs (inhalations) of a reliever inhaler (for example Albuterol) 10 to 15 minutes before the activity. Most patients respond to this measure and experience protection from EIA for 2-4 hours. Occasionally other steps have to be taken in addition to the inhalations.

Warm ups and cool downs may also help to prevent EIA. A 5-10 minute pre-exercise, aerobic activity at a moderate level, followed by 5 minute cool down may better prepare the lungs for the full activity.

Don’t forget the other opponent you are up against with outdoor sports this time of the year. Mold spores and ragweed are hanging out and ready to further clog your nose and lungs. The nose filters and conditions the air in order to protect the lungs. Once the nose shuts down due to the allergy triggers mouth breathing follows. The lack of nasal function hastens the demise of the lungs which now take on the mold, pollen and pollutants directly.

What can you do?

By following tips covered previously (Postings on: August 5th, 25th) you may be better prepared for handling the exposure to allergy triggers. Taking your prescribed antihistamines and nasal steroid sprays is essential in order to keep your nose functioning well during outdoor activities. If the nose continues to filter and condition the air properly, the cooling and drying effect of exercise may be reduced (therefore reducing EIA).

Consult your doctor if you have been having any breathing problems associated with exercise or sports activities.

Here are some sites for your review:

www.mayoclinic.com/health/exercise-induced-asthma/HQ00560

and

www.aaaai.org/patients/publicedmat/tips/exerciseinducedasthma.stm