Kids and Asthma Twitter Party: Recap!

Our Friday night Twitter party for kids and asthma was an informative hour and we’re really looking forward to our next chat on May 18th!

Quite a bit of the hour was spent discussing the nitty gritty of when to (and how to) contact an allergy and asthma specialist.

Dr. A noted that he often encounters families who have pushed for some time to get their physician to refer their case to an asthma or allergy specialist. There are many times when a trip to the allergist merely confirms what the parents already knew: Their child has asthma.

Once you’ve made the decision to see an allergist and asthma specialist, there’s much more work ahead! Finding the right doctor for you and your family can be very challenging. Some of the great advice shared included:

We’re really looking forward to our next chat! Have ideas for a topic? Let us know!

Asthma treatment: LABA’s should not be used alone!

Study: Asthma drugs raise risk of complications in children

When used alone, the asthma medications known as long-acting beta-agonists are associated with an increased risk of serious complications, new research indicates.

*This headline appeared in USA Today Online over the past several days. Similar headlines have recently appeared elsewhere in the media.

Should you be frightened?

I don’t think so, and here’s why.

First of all, this is not really “new research”, not in the purest sense. It is a statistical review of a lot of clinical trials (research studies) using asthma medications that have all been done in the past. The “researchers” are looking at many trial results that were obtained in the past and trying to increase the power of conclusions that may be drawn from combining a lot of diverse data. It (meta-analysis) can be helpful, but, in this case it does not really tell us anything new.

Why?

Well, the standard of care in treating asthma for at least the past 3-5 years has been to not use LABA (long acting bronchodilators or beta agonists) alone as the sole treatment agent for asthma because of the increased risk of complications when this is done. (these LABA drugs are salmeterol and formoterol)

In this same article a physician from Children’s Hospital of Pittsburgh really sums it up well when she states:

“It looks like LABA alone may not be the right treatment for the pediatric population, and we don’t use it alone.” said Dr. Allyson Larkin, an assistant professor of pediatrics in the division of pulmonary medicine, allergy and immunology at Children’s Hospital of Pittsburgh.* (emphasis added)

So, what is my point to all this?

Good question! I have a few points.

Here they are:

First, while headlines are sometimes intended to make it appear that the sky is falling, more often than not there is little reason to run for shelter! It is essential to learn more before drawing conclusions from a sensational headline.

Second, as always, I also think it is wise to never make any sudden unilateral decisions about changing your medication regimen without speaking to your physician partner in care first!

And, lastly, if you are being treated by a physician who has you using LABA alone, find an allergist (an asthma specialist) for evaluation!**

Be kind to yourself!

Controlled asthma always makes me smile!

I love what I get to do every day as a physician. I would do it all again if I had to choose.

Surgeons get to see the results of their work rather quickly. The appendix is inflammed, the patient is in pain, they remove the appendix and the patient is healed (most often). Quick, right? As a medical specialist, the results of my interactions take time, and multiple steps must take place, from correct diagnosis, correct treatment and my patients following the treatment plan we develop together.

When successful, it feels good, especially for those who have been suffering, sometimes for long periods of time.

So, today I wanted to share a success story with you.
I have been taking care of someone for several months now who has had a troubling cough for over 10 years. It annoyed him (and his wife!). Sleep interrupted by a spouse coughing is troublesome for both parties. We treated some infection in the sinuses, the cough persisted. We then started him on a combination inhaler, Dulera, which is used for the treatment of asthma.

Well, I saw him today for a follow-up office visit. Great news. The cough is gone for 2 months now! Sleeping well, no need for ‘cough medicine’. He is very happy and so is his wife. He thanked me for my help, and as he was leaving, he shook his head and said, “doc, thanks, for 10 years I was coughing like that”. As you probably know, not all asthma wheezes, and cough may be the only way it is manifested. He is a good example of that lesson.

As he left the office both he and I had big smiles on our faces. Controlled asthma always makes me smile!

Collaboration between asthma patient and physician

The old paternalistic model in medicine is slowly being replaced these days by a collaborative physician-patient relationship model, in which equality reigns. I believe most allergists successfully use this model, especially when working with patients suffering from asthma.

What do I mean by “equality reigns”? When it comes to dealing with a chronic disease like that of asthma, the ideal relationship is one in which both patient and physician bring their own strengths and expertise to bear on the problem. As an allergist, I bring my knowledge and experience as an asthma expert. As a patient, you bring expertise in yourself, your history, and your observations of your illness. Each of us has an equally important role to play in this relationship.

This is a big shift from the old paternalistic model. (Physician: “I’m going to tell you what to do.” Patient: “Can I ask you a

question?” Physician: “No, just do it.”)—A shift that you, as a patient, may likely welcome.

What might you expect in such a collaborative relationship, beyond the fact that your physician should have a strong foundation of knowledge of asthma? What are the characteristics that you and your physician bring into a relationship that is collaborative in nature? What will this new relationship look like, feel like, work like? Where will it take you?

Good food for thoughts!

Be kind to yourself!

The Allergist as Asthma Expert, How Are They Made?

Allergists certified by the American Board Of Allergy & Immunology (ABAI) are considered to be experts in asthma as well as allergic diseases and immunology. It takes a minimum of 5 years of training after attending medical school with an MD or DO degree to be eligible to take the ABAI board certification examination.

How does that training occur? First, these physicians complete training as an internist or pediatrician (3 years of training). They then spend an additional 2-3 years of training in the areas of asthma, allergy, and immunology. Following this, it is only after successfully completing a comprehensive board examination that they are able to identify themselves as Board-certified Allergists. There are currently an estimated 3500 full time board-certified allergists practicing in America.[1]

[1] Allergist Report, p15. Accessed at www.acaai.org/press/Documents/AllergistReport08Final.pdf 18 July 2011.

We

What are the characteristics of a good patient-physician relationship?

It depends.

It depends?

Yes, it depends on what you need from that relationship, on your personal ‘style’, on your temperament, on the physician’s style and temperament.

A good place to start is by asking yourself some questions, such as: What do I envision as the perfect relationship with my asthma physician? What will it look like to me? How will it feel to be in that relationship? Do I just ‘need the facts’ and not the ‘warm and fuzzies’? Do I need the ‘warm and fuzzies’ along with the facts?

If your current physician is a good match for you, that’s great! No need to change.

If you find the relationship does not stack up well after you have decided what the ideal looks like for you, then you have work to do. Having a frank discussion with your physician related to your expectations is a good place to start. Giving feedback on what works and what doesn’t can be quite powerful in effecting change. Good physicians usually welcome the chance to become better physicians. Sometimes, though, change is simply not possible, in which case you need to search for a physician who is a better match for you.

For what it’s worth, many Allergists, myself included, work best in a collaborative relationship with the people we care for. It is important for us to first LISTEN to the patient history and concerns BEFORE we decide on a diagnosis and plan of action.

There was a study done some time ago that found that, on average, physicians let the patient talk for something less than 30 seconds before interrupting them with questions. I believe that, especially when dealing with a chronic problem such as asthma, this is simply unacceptable.

Physicians bring their medical (asthma) expertise to the encounter and patients bring observations of their symptoms, severity and timing. Together a powerful alliance is created. By using the strengths of physicians and patients, in many cases, the correct diagnosis of the problem can be quickly made, and a treatment plan mapped out. We work together to diagnose a problem. We work together to make a treatment plan. WE… WE… WE!

It is true that in emergent or life threatening situations rapid action on the part of the physician and medical team is needed to safe life or limb. There may be less time for a collaborative relationship. This makes sense here, but, in the long term management of chronic medical problems such as asthma, it is more often the ‘We’ attitude that is the most helpful, the most satisfying, and the most efficient at bringing about true change over time.

Be kind to yourself!

Category Archives: physician-patient relationship

Kids and Asthma Twitter Party: Recap!

Our Friday night Twitter party for kids and asthma was an informative hour and we’re really looking forward to our next chat on May 18th!

Quite a bit of the hour was spent discussing the nitty gritty of when to (and how to) contact an allergy and asthma specialist.

Dr. A noted that he often encounters families who have pushed for some time to get their physician to refer their case to an asthma or allergy specialist. There are many times when a trip to the allergist merely confirms what the parents already knew: Their child has asthma.

Once you’ve made the decision to see an allergist and asthma specialist, there’s much more work ahead! Finding the right doctor for you and your family can be very challenging. Some of the great advice shared included:

We’re really looking forward to our next chat! Have ideas for a topic? Let us know!

Posted in asthma, physician-patient relationship, Twitter Chats | Comments Off on Kids and Asthma Twitter Party: Recap!

Asthma treatment: LABA’s should not be used alone!

Study: Asthma drugs raise risk of complications in children

When used alone, the asthma medications known as long-acting beta-agonists are associated with an increased risk of serious complications, new research indicates.

*This headline appeared in USA Today Online over the past several days. Similar headlines have recently appeared elsewhere in the media.

Should you be frightened?

I don’t think so, and here’s why.

First of all, this is not really “new research”, not in the purest sense. It is a statistical review of a lot of clinical trials (research studies) using asthma medications that have all been done in the past. The “researchers” are looking at many trial results that were obtained in the past and trying to increase the power of conclusions that may be drawn from combining a lot of diverse data. It (meta-analysis) can be helpful, but, in this case it does not really tell us anything new.

Why?

Well, the standard of care in treating asthma for at least the past 3-5 years has been to not use LABA (long acting bronchodilators or beta agonists) alone as the sole treatment agent for asthma because of the increased risk of complications when this is done. (these LABA drugs are salmeterol and formoterol)

In this same article a physician from Children’s Hospital of Pittsburgh really sums it up well when she states:

“It looks like LABA alone may not be the right treatment for the pediatric population, and we don’t use it alone.” said Dr. Allyson Larkin, an assistant professor of pediatrics in the division of pulmonary medicine, allergy and immunology at Children’s Hospital of Pittsburgh.* (emphasis added)

So, what is my point to all this?

Good question! I have a few points.

Here they are:

First, while headlines are sometimes intended to make it appear that the sky is falling, more often than not there is little reason to run for shelter! It is essential to learn more before drawing conclusions from a sensational headline.

Second, as always, I also think it is wise to never make any sudden unilateral decisions about changing your medication regimen without speaking to your physician partner in care first!

And, lastly, if you are being treated by a physician who has you using LABA alone, find an allergist (an asthma specialist) for evaluation!**

Be kind to yourself!

Posted in asthma, Breaking news, physician-patient relationship, Uncategorized | Tagged , , , | Leave a comment

Controlled asthma always makes me smile!

I love what I get to do every day as a physician. I would do it all again if I had to choose.

Surgeons get to see the results of their work rather quickly. The appendix is inflammed, the patient is in pain, they remove the appendix and the patient is healed (most often). Quick, right? As a medical specialist, the results of my interactions take time, and multiple steps must take place, from correct diagnosis, correct treatment and my patients following the treatment plan we develop together.

When successful, it feels good, especially for those who have been suffering, sometimes for long periods of time.

So, today I wanted to share a success story with you.
I have been taking care of someone for several months now who has had a troubling cough for over 10 years. It annoyed him (and his wife!). Sleep interrupted by a spouse coughing is troublesome for both parties. We treated some infection in the sinuses, the cough persisted. We then started him on a combination inhaler, Dulera, which is used for the treatment of asthma.

Well, I saw him today for a follow-up office visit. Great news. The cough is gone for 2 months now! Sleeping well, no need for ‘cough medicine’. He is very happy and so is his wife. He thanked me for my help, and as he was leaving, he shook his head and said, “doc, thanks, for 10 years I was coughing like that”. As you probably know, not all asthma wheezes, and cough may be the only way it is manifested. He is a good example of that lesson.

As he left the office both he and I had big smiles on our faces. Controlled asthma always makes me smile!

Posted in asthma, physician-patient relationship, Uncategorized | Tagged , , , | Leave a comment