Influenza vaccine (flu shot) for the 2017-2018 season is available in all offices starting Monday, September 18. Call to schedule your flu shot as soon as possible!
FCAAIA Notes: The first national guidelines for the diagnosis and treatment of asthma were published in 1993, with updates and revisions more recently. Guidelines are just that-they are not rules or laws. But, they are evidence based recommendations to help physicians maintain control of asthma, use as little medication necessary to do so, and to decrease the risk of complications of asthma.
It is important for our patients to understand the basis and rationale for our treatment recommendations. They should ask any questions they have, but realize that “empowerment” is not just knowledge; it is in essence consent and agreement that comes from understanding. Continue reading
FCAAIA Notes: This study tells us that the best predictor of having a moderate or severe asthma exacerbation is a history of a previous such flare. Incorrect inhaler technique was also predictive. Of course, correct inhaler technique is a subset of using medications in the prescribed doses. If you do not use them, they will not work.
Inhaler technique is difficult to master; Continue reading
FCAAIA Notes: The best test for diagnosis of food allergy is a thorough history as to what happens with ingestion. Tests for food allergy can help confirm or refute a diagnostic suspicion (which means the physician needs to have a diagnostic suspicion before doing the test). The results are not “black and white” but require interpretation in the context of the patient’s history. A positive does not mean you have allergy. If you do not have symptoms with ingestion you are not allergic. Continue reading
FCAAIA Notes: In pregnancy, about 1/3 of mothers with asthma get worse, 1/3 get better, and 1/3 remain the same. The pattern tends to be the same from one pregnancy to the next. The control often improves in the last trimester. The health of the mother is paramount during pregnancy. Guidelines for the treatment of asthma in pregnancy have been around for a long time and are reviewed and updated regularly.
Poorly controlled asthma is more of a risk to the fetus than the medications used to treat it. Continue reading
FCAAIA Notes: There are old data showing that poorly controlled allergies have as much impact on school performance as diphenhydramine (Benadryl®). So do you want your child taking Benadryl before final exams? Allergies also have a great impact on health-related quality of life, work productivity, sleep quality, etc.
If you feel you are “good enough” with your allergies, ask yourself again. I also recommend you ask yourself, “Should I or could I be even better?”
We can help you achieve your best. Continue reading
FCAAIA Notes: Allergen immunotherapy (IT) is the only disease-modifying treatment and thus the only potential cure for allergies. People respond at different rates to different extents, but it is a highly effective treatment.
For IT to be helpful, you need to come regularly to build up to the top dose. High doses are more effective than lower doses. Continue reading
FCAAIA Notes: Weight loss and good physical conditioning are so important in virtually every aspect of health that we should not just concentrate on asthma. It is pretty clear that obesity contributes to diminished respiratory status with more shortness of breath and so on. My interpretation of the data are that at least some of that is because of other factors such as increased incidence of GE reflux, increased “work of breathing” because of the very thick and stiff chest wall, and overall de-conditioning resulting in worse exercise tolerance.
If you are overweight or obese, work hard to lose weight. Your ideal body mass index (BMI) should be 18.5-24.9. Curious? Continue reading
FCAAIA Notes: Restaurant employees are far more aware of food allergies now than they were 20-25 years ago, undoubtedly because of training by managers and owners. Nonetheless (as with most things) there is always room for improvement.
The burden remains on the patient to address his food allergies with wait staff and if unsure, ask to speak to the chef. When in doubt, don’t eat it.
Communication is a major problem. Continue reading
FCAAIA Notes: As I’ve written before, “The nose bone’s connected to the lung bone.” Asthma is part of “allergic airway disease” and control of the lower airway (lungs) always requires that we consider the upper air way (nose) as well. So, we treat nasal allergies even if the symptoms are relatively mild and not bothersome.
Here it also becomes clear that patients with asthma who also have sleep apnea (do you snore loudly, a lot, and sometimes startle awake gasping for a breath?) should address the apnea Continue reading