Free trade for better health Free trade for better health By Philip Stevens, Director, Health ProgrammeInternational Policy Network (IPN) is a charity based inthe UK, and a non-profit (501c3) organisation in the US. It is a non-governmental, educational and non-partisanorganization which relies on charitable donations fromindividuals, foundations and businesses to carry out itswork.
Ww.pembrokecenter.orgAsthma Management and Prevention
P A T I E N T E D U C A T I O N S E R I E S
What is asthma?
What Triggers set off asthma attacks and
You can get asthma at any age. Approximately 5% exacerbations?
of the general population in the U.S. has asthma. Triggers can be animals with fur, cigarette smoke, Often there is a history of allergies and/or asthma dust, feather or down bedding, perfumes, pollen, cold air, upper respiratory infections, exercise and acid reflux. It is important to note which triggers Asthma is caused by spasm and inflammation of may be causing your asthma symptoms.
the airways in the lungs. Like branches of a tree, the airways get smaller and smaller until they Controlling or Avoiding triggers
reach the air sacs that make up the lungs.
Taking your medication as directed and avoiding triggers that can set off your asthma is the best When asthma is under control, the airways are way of preventing attacks. Your medical provider clear and air flows in and out of your chest easily. can help you determine which steps to take to help When asthma is not under control, the airways be- come constricted and inflamed, with increased mu- cus production that further obstructs the airways. Dust/dust mite allergy
Remove rugs, carpet and extra pillows. Use mat- During an asthma attack, less air can get in and tress and pillow coverings to avoid dust mites. out of the lungs, causing coughing, wheezing, and Do not use down comforters or pillows. Wash shortness of breath. Coughing for more than 10 sheets and blankets in hot water weekly. Vacu- days after a cold can also be a symptom of asthma. Sometimes prolonged coughing is the only symptom Allergies/hay fever
Take antihistamines and other allergy medica- How is asthma diagnosed?
tions as prescribed to control symptoms. Your Your medical provider can often diagnose asthma in medical provider may suggest an evaluation by the office. Using a peak flow meter is a quick and an allergist if the allergies are a significant trig- easy method of measuring the degree of obstruction to airflow though you airways. If your asthma is moderate to severe, your provider may have you re- Upper respiratory infections
peat this breathing measurement at home to help Discuss with your medical provider whether or not a flu shot is appropriate. Careful hand washing can help to prevent frequent colds. Do Asthma can vary in severity.
not directly share food, drinks or eating utensils. With intermittent asthma, symptoms occur spo- Start your bronchodilator inhaler (e.g., Albuterol) radically in response to a trigger, and there are no asthma inhaler at the first sign of shortness of breath or wheezing, or as directed by your pro- In cases of mild persistent asthma, there maybe symptoms less than 2 times per week, and night Smoke or odors
Avoid smoke-filled places; use unscented soaps and detergents. Do not use perfumes or colognes.
Moderate persistent asthma occurs when there are symptoms present daily, a peak flow 60% to 80% Wear a scarf over your mouth and nose to warm of the predicted norm and night coughing greater With severe persistent asthma, there are daily Animal fur
symptoms with limited physical activity, night Avoid animals with fur. Keep pets outside if you wakening daily or very frequently, and a peak flow of less than 60% of the predicted norm.
BROWN UNIVERSITY HEALTH SERVICES | www.brown.edu/health | 401.863-3953
2. Long-acting inhaled broncnodilators
Use any medicines prescribed by your medical provider before exercising to help prevent at- These medications have the same action on the tacks. Always carry medication with you while airways as short-acting bronchodilators but deliver exercising, and be prepared to stop at the first that effect over a prolonged period, often making them useful for people with nighttime symptoms. They are not to be used for quick relief of asthma Measure your peak flow regularly
symptoms and should never be used more often This will help you assess your own level of asth- ma control and identify when you are in trouble. Peak flow readings provide an objective measure 3. Inhaled Steriods
to help your medical provider evaluate your sta- (e.g., Flovent, Beclovent, Vanceril, Aerobid, Pul- tus and give you the right treatment advice. These medicines reverse the inflammation in the Which medicines are used to control
airways which is present in patients with persistent asthma symptoms. Inhaled steroids need to be used While avoiding triggers is the first approach to regularly on a ongoing basis to be effective. They asthma management, medicines will help keep your have no effect on acute shortness of breath and symptoms under control. It is very important
should not be used intermittently. Remember to that you use the medicines correctly, and at
rinse out your mouth with water after each use of the correct intervals as prescribed.
Four classes of medicines are most commonly used 4. Oral steroids
to treat asthma symptoms. Your medical provider In some cases, your asthma symptoms may be severe will choose one or more of these medicines based on enough to require a short course of oral steroids to the causes and severity of your asthma symptoms. decrease inflammation. Oral steroids are best taken Most of the medicines are inhaled so that the maxi- in the morning; be sure to take it exactly as prescribed.
mum effects go straight to the airways. To improve the dose of the inhaled medicine that gets to your 5. Combination asthma medication
lungs, your medical provider may prescribe a spacer Inhaled steroids are sometimes prescribed in combination with long-acting bronchodilators. It is 1. Short-acting inhaled bronchodilator
important not to use these more often than prescribed (e.g., Proair,Ventolin, Albuterol, Proventil) by your provider, as excessive doses of long-acting These rescue or quick-relief medicines act on the agents can have serious side effects.
smooth muscle lining the airways to help reverse the spasm and narrowing of the airways. The 6. Leukotriene receptor antagonists
effects are felt immediately. This medicine may be prescribed on a regular basis, or as needed for These oral medicines are sometimes additionally used symptoms which are intermittent. You may feel a to improve asthma control, and for exercise-induced little jittery, light-headed or racy after starting this medicine. These symptoms usually diminish with 7. Cromlyn products
If your symptoms are not relieved with the pre- This class of medications is sometimes used for scribed inhalations, call your medical provider. Do prevention of exercise-induced asthma symptoms or not exceed the prescribed number of inhalations. If predictable allergic exposures (e.g.,visiting a home you need this rescue medicine more than 6 times in one day to control asthma attacks, you need imme- diate help from your medical provider.
Act fast if an asthma attack starts
• Know that coughing, wheezing, tight chest, Sometimes short-acting bronchodilators are pre- and waking up at night are signs of an asthma scribed for use 20 minutes before exercise to control BROWN UNIVERSITY HEALTH SERVICES | www.brown.edu/health | 401.863-3953
• Move away from the thing that started the • Stay calm for 1 hour to be sure breathing Call EMS at 863-4111 if you experience any
of these asthma danger signs
• If your rescue medicine does not help for very • Breathing is still fast and hard.
• Your lips or fingernails turn gray or blue.
• Your heartbeat or pulse is very fast.
• You can see the skin around your ribs pulling BROWN UNIVERSITY HEALTH SERVICES | www.brown.edu/health | 401.863-3953
FACULTY OF MEDICINE UNIVERSITY OF SYDNEY MEDICAL PROGRAM YEAR 3 MED 3 SUMMATIVE MEQ PAPER 1 QUESTION COPY Thomas Werner is a 50 year old man with insulin requiring Type 2 diabetes who presents to the Emergency Department with severe left loin pain and high fevers of 24 hours duration. He looks very unwell and his temperature is 39°C. His blood pressure is 80/50 mmHg and his heart rat