About Dexamethasone, a steroid, for the Treatment of COVID-19

https://www.covid19treatmentguidelines.nih.gov/…/corticost…/

KEY QUOTE from ARTICLE…….. “Panel recommends against using dexamethasone for the treatment of COVID-19 in patients who don’t require supplemental oxygen (AI). If dexamethasone isn’t available, the Panel recommends using alternative glucocorticoids such as prednisone, methylprednisolone, or hydrocortisone.”…….

EXPERIMENT “I have #COPD & #asthma. I take #prednisone & Advair among many other medicines. Do you think those two drugs would help me from having a severe attack of #coronavirus if I caught it? I use #oxygen after a long walk.”

P.S. This suggestion has some implications. Could I miss the endangered list for bad lung patients? I’m not automatically suggesting that dexamethasone/prednisone plus oxygen necessarily be the treatment in a hospital. Furthermore, other daily medications could boost the immune system and be a confounding variable, and they may work on heart/blood pressure and or fat/obesity problems. Magnesium and CoQ10 are are great!

By the way, I tested negative at the Tyler Care Clinic Quick COVID-19 test on Friday, August 28. Previously, I tested negative at St. Louis Baptist Church on Wednesday, June 17.

Review results from studies evaluating corticosteroids for the treatment of COVID-19.

 

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My Illnesses & Pills: Strengthening the Immune System–One Way to Battle the COVID-19/Coronavirus Pandemic, by J. D. Meyer (2nd Edition)

Dang, I’ve been feeling good for four years! But I fit the stereotype of someone that ought to be “fixin’ to get sick”—lungs illness, namely COPD (since 2005) and asthma (since 1986). I got on the combination of SSDI, Medicare, and Medicaid by 2012. I’m writing this article about my illnesses and pills because medical professionals may find clues to finding a way to battle the COVID-19/coronavirus pandemic. Dealing with the pandemic takes three routes in the medical community: building the immune system, finding antibodies, and discovering a vaccination. My article represents the way for educated laymen to contribute.

I take at least 15 pills per day (11 different pills)—a motley mix of prescription drugs, vitamins/minerals, and OTC drugs. I have more health issues than Asthma-COPD Overlap Syndrome (ACOS). Quitting cigarettes was important as was quitting snuff tobacco. Nowadays, I occasionally indulge with Smoky Mountain Herbal Snuff (Wintergreen Flavor). It’s made from corn husks and molasses; it’s made in Sandy Hook, CT.

Here are the rest of my diagnoses: Mixed hyperlipidemia E 78.2, Essential (primary) hypertension I10, atherosclerosis heart disease of native coronary artery without angina pectoris I25.10, and macular degeneration. Furthermore, I get monthly allergy shots for Bermuda and Johnson grass, and I have sleep apnea.

Now let’s check out my daily pills. Prescriptions: Daliresp, Montelukast, Dilacor (DILT), Omega 3 Acid Ethyl Esters (4, Take two twice daily), and Prednisone. Vitamins/Minerals: Magnesium, CoQ10, Vitamin D (2), Ocuvite (Vision Health). That last pill is a mix of Vitamins A, C, E and Zinc, Selenium, Copper, and Lutein. Over the Counter Medicine (OTC): Vitamin B-Complex with C (general health)& Loratadine (non-drowsy generic pill for allergies).

Here are the drugs that I inhale. Obviously, I have a rescue inhaler, and it’s Combivent (albuterol + ipratropium). I graduated from the albuterol inhalers a while back. But my nebulizer fluid is albuterol only. Then I take Advair twice daily, an anti-inflammatory.

Here are the occasional OTC drugs and vitamins/minerals: Sudafed (nasal congestion), Mucinex–aka. Guaifenesin (chest congestion/bronchitis). , Milk Thistle (liver health) and rarest of all—Turmeric Curcumin (anti-inflammation). Before I got health insurance, Mucinex and Sudafed were very frequent companions. I’ve become a member of the Chris Cuomo Fan Club and explained the joy of Mucinex on his website.

Let’s hope that my list of medicines and illnesses helps medical researchers during our pandemic crisis. I was invited to join the local Community Health Workers (CHW) coalition several years ago because of my explanation of lung health issues for the layman. I used to be a teacher–mostly Developmental English/Writing (college level), ESOL (English for Speakers of Other Languages)for all levels, and all-level/ most subjects substitute teacher.

Some of those drugs and whatnot represent a journey! Magnesium is a new friend. First I was put on statins and developed heart issues. Then I found CoQ10 and that helped. Then I had a phase of Red Yeast Rice–a more organic, mellow statin. Then I read a couple of journal articles against it and stumbled onto Magnesium. Magnesium is the super mineral. It’s good for excess fat, arthritis, COPD, and even more issues!

My most recent drug is prednisone—previously som’n just for acute attacks. I passed a recent chest X-ray, but my pulmonologist felt that I needed prednisone. After all, I’ve had a low moderate Forced Exhale Volume (FEV) for years. I may be 6’2” and 61 years old, but my FEV is comparable to a short elderly lady’s lungs, or just one lung, or a very short child’s lungs. Stop smoking, stay indoors, or wear a mask/bandanna when shopping.

SOL18: Assisting a Local Journalist: Future Story About Coping with Obstacles to Success Faced by Locals

I received a Facebook message from our star local newspaper’s photojournalist that she was in the process of co-authoring an article about obstacles to success faced by locals: poverty, medical/mental disabilities, incarceration, and lack of housing. I was flattered that she wanted my input; she’s been a favorite acquaintance and neighbor for a few years. You’ll notice that I added “coping” to this article.

I’m a former teacher who is disabled with COPD and asthma. To get on SSDI, I went for tests at a local hospital–East Texas Medical Center. Later I got on Medicare and became connected with the East Texas Council for independent Living (ETCIL) and entered a nursing home for eight months. I got two overdue surgeries while I was there. However, I couldn’t get discharged until I got on Medicaid and was turned down the first time. So I went to the Records Department of ETMC and got a complete list of my Emergency Room visits for the previous four years. Most of y’all have probably heard that Texas is the largest state not to have Medicaid expansion. It’s so wonderful to have Cigna health care. I get maintenance medicine, have a pulmonologist and a G.P. that are really great and nice, and discovered what else was wrong with me health-wise. I study my Asthma-COPD Overlap Syndrome and have a binder and a couple of folders on the illness; some articles are by me on my Word Press.

I mentioned that I went to the City of Tyler Neighborhood Services to get an apartment rental discount through the Department of Housing and Urban Development (HUD). The local center for independent living relocation specialist facilitated the process. Later when I moved across town, I did it all myself. Before I got on Meals on Wheels and SNAP Food Stamps, I went to a couple of local food pantries once per month.

Besides specifically telling her to call Neighborhood Services and ETCIL, I told her about my main volunteer activity: East Texas Human Needs Network (ETHNN). We have five committees: Education, Employment, Healthcare, Housing, & Transportation. Transportation is my main focus because I ride the bus regularly, as I quit driving several years ago. I’ve arranged field trips with lunch for all five lines. We went to both shopping centers, two grocery stores, and Neighborhood Services. I also attend Education and Healthcare committee meetings.If more people rode the bus, we’d have less traffic, pollution, and more bus routes.

Just between us for now, I’ve really been trying to advertise the importance of finding a match between personality and college major choice/vocation. The local university wants to improve its graduation rate, so I sent my article on the topic to a couple of friends who work there. Furthermore, career counseling centers should advertise the free online Myers-Briggs Type Indicator (MBTI) instruments.

To conclude for now, I told the photojournalist that I may not make much money, but I don’t spend much either. Just because one may be a retired teacher (prematurely, in my case), a teacher never quits teaching.

Questions to Ask Someone with COPD (2nd Edition), by J.D. Meyer

1. What inhalers do you use? A rescue inhaler, like Pro-Air, was my first. Now, I usually take Combivent.

2. Do you use a nebulizer with albuterol or albuterol-ipratropium? Nebulizer fluid is an extra strength version of rescue inhalers with the same chemicals.

3. Do you use a twice daily inhaled corticosteroid, such as Advair or Symbicort?

4. Do you have a pulmonologist? I go to Pulmonary Specialists of Tyler on Fleishel, behind ETMC. Dr. Luis Destarac is my doctor. I get allergy shots there too. I’m allergic to Bermuda & Johnson grass.

5. Do you have lots of phlegm sometimes? Take Mucinex, and you can get the generic version at Family Dollar that’s cheaper.

6. Have you ever been to the ER for an exacerbation? Have you been there lately? More often or less often over the years?

7. Do you have sleep apnea? Do you have a C-PAP?

8. Do you have an oxygen machine with nasal canula?

9. Do you still smoke cigarettes? I quit a few years ago.

10. Have you ever had asthma? Child asthma can go away, & it’s more common. I developed asthma at age 28 & COPD at age 46. Asthma-COPD Overlap Syndrome (ACOS) is characterized by more dyspnea (breathlessness), more phlegm, but better response to inhaled corticosteroids (such as Advair). Some COPD inhalers, like Onoro, can be fatal to those with asthma also!!

http://www.healthcommunities.com/copd/early-stage-copd.shtml Early COPD.

https://bohemiotx.wordpress.com/2017/02/05/dealing-with-a-bad-copd-exacerbation-maybe-dodging-an-e-r-visit/ On reducing ER Trips.

Budget ACA: 3-10 Essential Benefits, 2nd Edition, by J.D. Meyer

1. Ambulatory patient services. [Outpatient care]
2. Emergency services.
3. Hospitalization. [Inpatient care]
4. Maternity and newborn care
5.Mental health and substance use disorder services, including behavioral health treatment.
6. Prescription drugs.
7. Rehabilitative and habilitative services and devices.
8. Laboratory services
9. Preventive and wellness services and chronic disease management;
10. Pediatric services, including oral and vision care.

Health insurance plans must cover these benefits https://en.wikipedia.org/wiki/Essential_health_benefits

Right now, it’s all ten or none. Pay a fine if you choose none……. How about a budget version: (2) Emergency Services, (6) Prescription Drugs, & (1) Ambulatory patient services [Outpatient care]? Limit eligible clients to those who make $20K/year or less.

Let’s change the paradigm from younger healthy people would rather pay a fine than go for all ten. My new proposed paradigm is let the poor choose the three most important!

I know what it’s like to work over 40 hours/week with three part-time jobs and no insurance: adjunct instructor at a community college, construction assistant, and substitute teacher. This was my career from 1994-1999. I’d developed asthma in 1987. Trust me, summer is construction asst. only, and that faded out of the picture after I got a full-time teaching job (2001-2006), followed by COPD (2005).

Why did I choose those three benefits? Emergency Room visits are very expensive, and in the USA, we let the sickly get help and hopefully pay later. I got on Medicaid by showing my record of ER visits from 2008-2012 to social workers, despite living in Texas—the largest state not to expand Medicaid.

I could afford an inhaler and nebulizer fluid, but not Advair. Fortunately, I learned about botanicas from living in a predominantly Mexican-American neighborhood and got gordolobo (mullein leaves) and eucalyptus.

I went to clinics that generally served the poorer part of the population. Through “Ambulatory patient care [Outpatient care],” more would be able to afford the office visits themselves and have a regular doctor.

I hope my “Budget ACA: 3-10” brings a helpful new angle to American Health Care. It’s such a hotly debated topic, and we seem to have more difficulties than most OECD nations. My first edition was mistaken in choosing 9. Preventive and Wellness Services and Chronic Disease Management over 1. Ambulatory Patient Services [Outpatient care]. Outpatient care is more basic.I bet plenty of poor people would rather buy “Budget ACA: 3-10” than pay a fine–looking forward to feedback.

COPD Dude Goes to a Chiropractor with the Impulse Adjusting Instrument, by J.D. Meyer

I taught for 20 years, especially Developmental English/Writing & ESOL–before my COPD got too bad. Now I’m on SSDI with Medicare, Medicaid, and Cigna Health Spring insurance. I have gone to chiropractors on a regular basis twice in my life–after my asthma diagnosis and need for an albuterol nebulizer, but before the COPD verdict: emphysema and bronchitis.

Bratcher Chiropractic is a father-son team and the only Cigna-approved chiropractors in Tyler, Texas. The chiropractic science has really changed in the last fourteen years! There’s no more roller ball on a table kneading your back like bread dough, followed by the doc popping you with his hands in the three regions of your back. Nowadays, there’s a wild little machine that looks like a home construction tool called the Impulse Adjustment Instrument, and it is wonderful! The pamphlet describes the benefits as (1) Extreme Speed, (2) Controlled Force, and (3) Frequency Tuned Waveform.

The Extreme Speed refers to the Impulse being “twice as fast as other adjusting instruments, and 100x faster than manual adjustments. The gentle thrust is faster than the body’s tendency to tighten up and resist the adjustment.” Believe me, my neck used to be very resistant to popping by hand! Controlled Force describes the “three different force settings for different parts of the body and to treat patients of all ages.” Frequency Tuned Waveform shows that the “Impulse is specifically tuned to the natural frequency of the body that joints, muscles, and nerves respond.” The impulse is “controlled by micro-computer circuitry housed within the device.”The Impulse Adjusting Instrument is patented and an FDA (Food & Drug Administration) registered device.

So far (three visits), my doctor has commented that I only have 50% movement in my neck and a dislocated rib cage! It turns out that the bad lung crowd is vulnerable to such rib cage issues. The sessions are really faster than chiropractic treatments of yesteryear.

By the way, I quit driving a car several years ago, and have become a recognized authority on the the Tyler Transit. It’s a journey starting with Purple South (or Red South), followed by Yellow SW. This time on the way back, I just took one bus to the second hub–Bergfeld Center and walked the 1.3 miles home.

When I got home, I happily made the following announcement, “I just overcame a mental block. For the first time, I walked home from Bergfeld Center (actually the CVS to be exact). I walked down Broadway to beautiful Charnwood, then crossed over to Houston from tiny Niblack. I had just been to Bratcher Chiropractic. My FEV (Forced Exhale Volume–peak flow meter) was a staggeringly high (for me) 350 upon entering my place!!….Many times I’ve walked home from La Michoacana and Downtown–roughly the same distance. …Ready for the I have a Dream event Downtown at 6:30.”

I will be going to Bratcher Chiropractic twice a week for several weeks. While I wait for the Yellow SW to return, I’ve gone to a Wal-Mart grocery store in search of strong cheap red wine and beer, granola bars, and spicy Taki snacks. My backpack contains reading and writing material, along with my lined canvas bag for groceries–and even lunch. So my adventure is more than medical, it’s travel to an unfamiliar part of the city for me.

I’m keeping my G.P. and pulmonologist updated on my progress–a practice that reveals my love of teaching and research. Remember those middle back vertebrae are connected to your lungs. Consider getting chiropractic treatment if you have asthma or COPD.

SOL17: World Asthma Day, Publicizing Dr. Tedros of Ethiopia for Director of WHO, etc.

I’m a retired teacher, disabled due to asthma and COPD. I developed asthma in 1987 and COPD in 2005. I got on SSDI in 2010. By 2012, I was on Medicare and Medicaid and had moved to the Hospital District, aka. Midtown, in Tyler, Texas–my third neighborhood in the largest city in East Texas.

Nowadays, I spend much of my time on Twitter and Facebook. I was happy to see that World Asthma Day fell on Slice of Life Tuesday today. One of the best articles that I read today was about the reasons for the rise in inhaler prices–a chilling indictment of “Big Pharma.” http://www.motherjones.com/environment/2011/07/cost-increase-asthma-inhalers-expensiveWhy You’re Paying More to Breathe

The happiest pack of articles that I’ve encountered lately is about Dr. Tedros of Ethiopia–the leading candidate for Director of the World Health Organization (WHO). http://www.huffingtonpost.com/entry/dr-tedros-is-the-leader-the-who-needs_us_59075cd2e4b03b105b44ba96?ncid=engmodushpmg00000004 Dr. Tedros is the Leader that WHO Needs

A sad article that I read was about Trump ending Michelle Obama’s program, “Let Girls Learn.” http://www.dailykos.com/story/2017/5/1/1657898/-Trump-administration-ends-Michelle-Obama-program-to-educate-girls-and-lift-them-out-of-povertyTrump administration ends Michelle Obama program to educate girls and lift them out of poverty Then I had a great idea. What if Dr. Tudros is able to revive Mrs. Obama’s program if he’s elected Director of WHO!

A different type of sad article shows that pollution causes lung disease. India is the most polluted country in the world with 13 of the 20 worst cities. Anti-asthma medicine has increased a staggering 43% in the past four years. Furthermore, it’s harder to measure the effects of air pollution in rural areas. Climate change is a big issue in political debate, despite its near unanimous recognition by science. However, how can pollution be denied at all? http://www.hindustantimes.com/health/world-asthma-day-india-chokes-sales-of-medicines-rise-43-in-4-years/story-mt5V9Kdqv4yGF062ZOmC6I.html World Asthma Day: India chokes, sales of medicines rise 43% in 4 years

To conclude, I started with the reasons for the rising cost of asthma inhalers, a graphic view of the actions of “Big Pharma.” Then I lamented the end of Michelle Obama’s project, “Let Girls Learn. ” Educated girls are more likely to be healthy and maybe wealthy. Then I campaigned for Dr. Turkos of Ethiopia for Director of the World Health Organization (WHO). Ethiopia has experienced dramatic health improvement through his guidance. I speculated that he may be able to save Mr. Obama’s project. Finally, I ended with the increase in asthma in India due to its air pollution. Nobody tries to deny that pollution can cause health problems. To conclude, improving health not only involves medical advances, but sound political decisions and cleaning up the planet!

Dealing with a Bad COPD Exacerbation & Maybe Dodging an E.R. Visit (4th Edition)

By J.D. (“Joffre”) Meyer
Those of us with COPD (Chronic Obstructive Pulmonary Disorder) live with the strong risk of an exacerbation that is severe enough to go to the Emergency Room by way of ambulance. I developed asthma 18 years before COPD too. We face a mix of lung spasms, excess chest phlegm, and a low FEV (Forced Exhale Volume). Asthma-COPD Overlap Syndrome (ACOS) is known for increased breathlessness and sputum–but a better response to inhaled corticosteroids.

It’s typical for me to have some coughing and wheezing when I awake, and sometimes after a walk. Choice #1 is using an asthma rescue inhaler, such as Combivent or Pro-Air. It’s like a “Bud Light” version of the nebulizer, as both use albuterol. Combivent is stronger, and it also has ipratropium. But the likelihood of its effectiveness goes downhill if our attack is more than simply mild. Rule #2 is not to take the long-term inhalers during an acute attack, such as Advair or Symbicort, and Singulair.

So we go for our dear friend, the nebulizer, and pour a vial of albuterol or albuterol-ipratropium in the receptacle. We get “Albut-Iprat” when our condition becomes worse. I just started getting Combivent, the stronger “Albut-Iprat” inhaler. Our next choice is mask or “pipe.” Most say the pipe-like hose is better because we get more of the medicine. So here’s my first original suggestion. If you wear the mask, put your oxygen canula up your nose (assuming you own one). Really tired COPD sufferers may have difficulties with the pipe. Lately, I’ve switched back to the pipe-like breathing tube. Furthermore, I’ve started holding a lozenge in my mouth while I inhale my albuterol from the nebulizer. The lozenge is menthol and maybe eucalyptus too. That way, the cooling anti-inflammatory elements of the lozenge shoot directly to your lungs, as opposed to staying in your mouth and keeping you from coughing phlegm. My guess has been approved by real doctors!

Speaking of phlegm, keep a plastic can with a lid handy, such as my old Folger’s coffee can, the regular 10.3 oz. size. Don’t even consider swallowing that phlegm. I’m not trying to be funny because it’s not. Don’t expect to be able to run to spit in the nearest toilet or sink either. Make sure you drink enough water too–a likely weak area for most people. 1.5 liters daily should be enough since other fluids are okay; vegetables and fruits are full of water too. I use an attractive purple jug for my water, so I’ll notice it better! I can keep the squirt cap on when I take my many morning pills. Then I remove the cap for water guzzling! Now I’m exploring fruit-flavored water to increase my likelihood of really hydrating. Furthermore, local water systems have been breaking down lately!

Now let’s look at the OTC (over-the-counter) medicines. For your chest congestion, take some guaifenesin; that is, Mucinex or a generic version. COPD is a mix of emphysema and bronchitis. Bronchitis is like having a perpetual chest cold while emphysema is a destruction of the lung sacs and a lack of elasticity in the lungs.

What if you have nasal congestion? A saline nasal spray will open a constricted nose. Later I submitted this article to COPD Breathing Buddies of Facebook, and I was warned about Sudafed. This drug may reduce nasal congestion, but Sudafed can raise your blood pressure, which may happen anyway during a COPD attack. In the past, I added Mullein leaves (gordolobo), eucalyptus leaves to my morning coffee drip bin before I got health insurance but lived next door to a Mexican botanica. My goal is to reduce inflammation. Garlic pieces and ginger slices work too.

If you have severe or moderate COPD, take your Daliresp pill. I have allergies to Bermuda & Johnson Grass, so I have allergy pills to take–an OTC generic equivalent of Claritin called Loratadine, a non-drowsy tablet and now Montelukast, my newest prescription. Montelukast is actually the pill version of Singulair, and one of the cheaper lung-related prescriptions. I keep a daily pill reminder box by my bed, as I have a total of six per day–not all bad lungs related. By the way, since you’re taking all these pills have a water bottle next to your bed. The more water you drink, the more the mucus will be thinned.
Here’s my second original tip. If you have a C-PAP machine for sleep apnea, you can use it when you’re wide awake to force air into your inelastic, sagging emphysema-ridden lungs! Don’t overuse your nebulizer; try a wide range of strategies to stop the COPD attack.
Lately, I started taking Vitamin D and magnesium. I read a wonderful booklet about the benefits of magnesium for the lungs after my move of February 2018.

Please check out my methods for battling severe COPD exacerbations! Maybe I have a higher tolerance for pain than many, or a fear of walking home from the E.R. before sunrise? I wrote this article after coping with a severe attack lasted for 1 hour & 40 minutes; editing followed the intial blog!!
And when you quit choking, take those long-lasting spray/powders: Advair or Symbicort and Singulair or whatever.

Consider calling your G.P. M.D. later for an office visit. After this epic COPD attack, I got a shot of Salumedrol, a steroid, at her office. Then I got prescriptions for prednisone pills and a Z-Pac antibiotic.

“Asthma-COPD Overlap Syndrome (ACOS),” Footnotes & a Commentary from a Patient (6th Edition), by J.D. Meyer

 

“Asthma-COPD Overlap Syndrome (ACOS): A diagnostic challenge,” was a Top 100 WebxMD article for 2015. http://onlinelibrary.wiley.com/doi/10.1111/resp.12653/full It caught my attention because I’ve had this condition for ten years; however, I never heard the two described as a unit in this manner! Three symptoms stood out on my first reading: increased sputum, more dyspnea (breathlessness), but better response to inhaled corticosteroids. At once, I told all my local health connections about ACOS. This article was written by three doctors in the Far East: Vietnam, Korea, and Japan. “Tho, N. V., Park, H. Y. and Nakano, Y. (2015), Asthma–COPD overlap syndrome (ACOS): A diagnostic challenge. Respirology. doi: 10.1111/resp.12653.”

Furthermore, a Google search for ACOS yielded nothing unless I entered the complete term. So the breakthroughs didn’t happen around here—adding to this disabled Developmental English/Writing—ESOL teacher’s sense of urgency!

Definition of Terms

I printed this article and started highlighting and making notes. Fortunately for me, many of these technical terms corresponded to familiar brand names for my many ACOS drugs. Symbicort is a Long-Acting Beta2-Agonist (LABA) and an Inhaled Corticosteroid (ICS). A LABA is a long-term brochodilator while an ICS decreases inflammation. Rinse your mouth with water after each use, and don’t swallow the water; spit it out. I was switched back to Advair (another LABA +ICS drug), which has bee my usual inhaled corticosteroid. Both drugs are used for asthma &COPD. A Muscarinic Antagonist is also a bronchodilator, such as tiotropium (Spiriva) and aclidinium.

Spiriva, an inhaled capsule, is used for COPD, including emphysema and chronic bronchitis. Later, I was switched to Montelukast, the pill version of Singulair.

There is only one PDE4 inhibitor—Daliresp (roflumilast), and it works against excess bronchitis and phlegm. Daliresp decreases the number of exacerbations in severe COPD, and it’s not a bronchodilator. Daliresp decreases lung inflammation and prevents COPD flare-ups. Don’t use Symbicort, Spiriva, or Daliresp for an acute attack.

For an acute attack, use your “inhaler,” such as ProAir and Proventil; they’re examples of Short-Acting Beta2-Agonists (SABA); both are albuterol. Proair will open the airways and prevent a bronchospasm. You could go for your nebulizer for an acute attack, especially a bad attack. Our albuterol vials for the nebulizer could be called an”extra-strength” SABA. Iprat-Albut (Albuterol & Ipratropium) are two bronchodilators for the COPD patients’ nebulizer. For two decades, I was on pure Albuterol for my nebulizer. Now my inhaler is Combivent–a stronger ipratropium-albuterol inhaler.

Atopic is an allergic reaction, often hereditary. Atopy is a feature of ACOS and associated with a higher prevalence of chronic cough and sputum production, according to Tho, Park, and Nakano. Eosinophilic airway inflammation means there’s a higher than average number of white blood cells. It can be detected in mucus if it’s tissue eosinophilia. Tho, Park, and Nakano note that ACOS patients have higher sputum eosinophil counts than those with COPD alone, but sputum count profiles may change over time. Blood eosinophilia is over 500 in a microliter of blood. I found these definitions at Medicine Net and the Mayo Clinic websites too.  Much of the drug definitions came from the pharmacy’s medicine sheets themselves.

Economic Burden & Disability

Tho, Park, & Nakano note that the percentage of ACOS patients visiting the ER or admitted to hospitals is significantly higher than COPD alone in South Korea. A United States Medicaid population reports that ACOS patients have a higher rate of utilizing any service versus asthma or COPD alone. Moreover, the average annual medical cost for an ACOS patient in the US is $14, 914–much higher than asthma, $2307 or COPD,  $4879. ACOS is common in the elderly. It features more dyspnea (breathlessness), wheezing, and more frequent exacerbations. The respiratory quality of life and amount of physical activity for those with COPD alone.

Addendum to Tho, Park, & Nakano

Using my peak flow meter to check my forced exhale volume (FEV) always has been one of my strong points in managing my ACOS. I check my peak flow meter before I go for a walk, and if I’m under my usual low moderate level of impairment, I head for the albuterol nebulizer. Check my article https://www.newscastic.com/news/forced-exhale-volume-fev-lung-disease-your-peak-flow-meter-1155949/ The “whole story” includes a link to an About.com article on Pulmonary Function tests, by Deborah Leader, RN, COPD Expert.

Returning to the Tho, Park, and Nakano article, we see that a staggering 49% of smokers develop chronic bronchitis and 24% get emphysema or COPD. “Smoker’s cough” is worst upon arising. Dyspnea increases as the disease worsens. Quit smoking or else!

Guaifenesin (Mucinex) has been one of my favorite OTC medicines for years because it’s an expectorant. You can find a cheaper generic version in the dollar store too. Warn the doctor if you smoke, or have asthma or emphysema. It thins the mucus, so it’s less sticky and easier to cough up, according to www.drugs.com/mucinex.html  Take guaifenesin when you have a cold, bronchitis, flu, or allergies–whatever got your chest full of phlegm. Still drink plenty of fluids. www.webmd.com/drugs/2/drug-63818/mucinex-oral/details I’ve been told by my doctor to take a larger than average dose of guaifenesin during an ACOS attack.

I also take an over-the-counter allergy pill, for I’m allergic to Bermuda and Johnson grass. My choice is non-drowsy Loratadine Tablets, an antihistamine that’s another find at Family Dollar. Loratadine is a generic form of Claritin.

Beware of drinks with carbon dioxide (CO2) also, such as beer and soda. http://respiratorytherapycave.blogspot.com/2008/06/asthmacopders-should-avoid-pop-beer.html The ability to exhale carbon dioxide is vastly impaired for the bad lung crowd. “The normal human body breathes to eliminate CO2, producing 200 cc./minute. However, one can of soda has up to 1000 cc. of dissolved CO2. Most is absorbed by into the blood stream by the intestines.” This can lead to more dyspnea (breathlessness) in those with lung disease. Furthermore, beer can cause dehydration too–another cause of dyspnea. Maybe gas pills help; time will tell.

On the other hand, if you like alcoholic drinks and wish to be more careful, then try red wine. First of all, you won’t have to worry about bubbles. Red wine increases antioxidant status and decreases oxidative stress in circulation, mainly because of glutathione (GSH). The “French Paradox” is explained by their love of red wine lessening coronary heart disease despite a fatty diet. https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-6-27

In closing, there’s a rich amount of literature on asthma, bronchitis, and COPD. Learn to manage your illness before you continue to deteriorate, and get a pulmonologist if you don’t have one already.