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Medical Messages

Welcome to our Medical Director message section. From time to time, I will post topically relevant issues concerning asthma and other respiratory diseases. While the focus will often relate to high-risk populations, it is my hope these messages will be of value for the general population of individuals with respiratory disease and the providers who care for them. I will also invite notable thought leaders in various areas to utilize this section as well from time to time.

If you are new to the NOML website, I thank you for your interest. NOML is a 501c3 organization dedicated to addressing disparities in morbidity and mortality attributable to asthma and other respiratory diseases among high-risk populations to include minorities, the poor and children. In addition to the information and educational materials you will find on our website, NOML also provides free live programs of education, screening, counseling, referral and follow up case management in partnership with local communities of faith in metropolitan Atlanta. NOML also travels to other cities around the US to train local teams to replicate this model. NOML has screened over 5000 participants in 140 programs offered in our Atlanta base and now has 13 expansion cities around the US where local teams have been trained to replicate our innovative model.

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It Just Might Be Asthma

Medical Message by: Dr. LeRoy Graham
Date: January 1, 2012

One of the greatest challenges to changing outcomes in asthma is the misconception about the how common asthma is and how serious it may become if not managed properly. These misconceptions are not limited to the public but are far too often found among primary care providers who treat the vast majority of patients with asthma. Asthma must first be diagnosed to initiate effective treatment. Far too often, children and adults with repeated episodes of coughing and wheezing are diagnosed as having acute or chronic bronchitis or recurrent pneumonia. Acute bronchitis is often associated with a productive cough (often discolored mucous “coming up” while coughing), an occasional fever. While this may occur in children, it a relatively rare diagnosis in that population. Chronic bronchitis is almost never seen in children without underlying medical problems and should be a diagnosis made by a specialist after a thorough evaluation. Even in adults, chronic bronchitis is most typically seen in smokers. Recurrent pneumonia, in anyone, is a rare diagnosis. Pneumonia should always be confirmed by a chest x-ray. If proven pneumonias do indeed occur frequently in a patient, a thorough evaluation by a specialist is required to determine the underlying cause.

Recurrent episodes of coughing and wheezing associated with the common cold, exercise or exposure to strong odors, dust, dirty environments, cigarette smoking or exercise are often signs of asthma. While a rescue inhaler such as albuterol (Pro-Air, Ventolin or Proventil) may provide welcome but temporary relief, it is not suitable therapy for recurrent asthma episodes. A controller that treats the underlying inflammation in the air passages will decrease and in most cases eliminate these episodes and the unscheduled doctor visits, ER visits, hospitalizations and even deaths that result from inadequate treatment limited to albuterol alone. The most effective controller is an inhaled steroid (Flovent, QVAR, Pulmicort, Alvesco) which is the only agent ever proved scientifically to prevent death from asthma. If abluterol is required more than twice weekly on a regular basis, asthma is uncontrolled and the risk of hospitalization and death continues to increase until control is established.

Patients must know these simple facts and should speak up when seeing their doctors about these symptoms. Patients should become active participants with their primary care providers to ensure they get the best care. Patients should also learn how to recognize and avoid triggers that bring on asthma attacks. Patients must also know how to use their inhalers in the proper fashion to ensure the medication gets deep into their lungs where it needs to be to work effectively. Finally, primary care providers must provide each and every asthma patient an easily understood and written asthma action plan which tells the patient what medications to take each and every day and a step by step plan of what to do when they have an asthma attack. Most importantly, this plan must also tell a patient when to seek care if the plan is not working which may, in severe cases, mean a trip to the emergency room or calling 911.

It’s not rocket science but good asthma care resulting from active teamwork between a patient and their primary care provider can often be far too rare!