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.

COVID-19/Coronavirus Annotated Link Page, by J.D. Meyer (2nd Edition)

1. Q & A on Coronavirus (COVID-19) by WHO (World Health Organization). Answers to 23 questions, two information links, subscribe to WHO newsletter. https://www.who.int/news-room/q-a-detail/q-a-coronaviruses?fbclid=IwAR0cSHcLD8YtFmTG8sq-w8E3p4BVui6L41CieOoR0C1fu_9fbROHjcUcaHQ

2. Oxford COVID-19 Evidence Service. By Centre for Evidence-Based Medicine. Updates began on March 17, 2020. Click for Questions under Review. Top 3 Most Viewed: COVID-19 Signs & Symptoms Tracker, Assessing dyspnea, Global Covid-19 Case Fatality Rates, TRIP database COVID-19 updates. https://www.cebm.net/oxford-covid-19/

3. How the Novel Coronavirus and the Flu are Alike…and Different
Symptoms, Transmission, Degree of Mild vs. Severe Cases, Length of Hospitalization, What % of the Population Will Get Each Virus, Death Rate, Treatment, Vaccines, Impact of Seasonal Weather. https://www.npr.org/sections/goatsandsoda/2020/03/20/815408287/how-the-novel-coronavirus-and-the-flu-are-alike-and-different?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social&fbclid=IwAR0-_S-NHB2OHGoJs6EHu-OBPDp8Qh6xYB6BPxB11ePdN_519YgFeIheNCE

4. Why ‘Death Rates’ from Coronavirus Can Be Deceiving. “The answer involves how many people are tested, the age of an infected population and factors such as whether the health care system is overwhelmed, scientists say.”
https://www.npr.org/sections/goatsandsoda/2020/03/27/821958435/why-death-rates-from-coronavirus-can-be-deceiving?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social&fbclid=IwAR1P6Dzb5ug-mG-CAY3rfsrl2dJ1c-1YPu2KitdIXl9e4ruNHVP858JqAfE

5. Can a Supplement Protect Me Against the New Coronavirus? “Doctors say there’s limited evidence on how any supplements may or may not affect coronavirus spread and the resulting disease. Here’s what we know right now.” The following supplements are analyzed: elderberry, Vitamin C, Vitamin D, apple cider vinegar, turmeric. https://www.everydayhealth.com/infectious-diseases/can-a-supplement-protect-me-against-the-new-coronavirus/

6. Faces of Coronavirus: One Woman’s Road to Recovery. “…the first signs that she had the disease caused by the novel coronavirus were some aches and a dry cough. Her symptoms quickly escalated to difficulty breathing and fever.” This interview was reviewed by an M.D. https://www.everydayhealth.com/coronavirus/faces-of-coronavirus-one-womans-road-to-recovery/

7. Loss of smell and taste could be the strongest symptom of Coronavirus, experts believe. Loss of smell and taste are stronger predictors than fever and cough—triple other symptoms. The Covid Symptom Tracker App has created a model that also lists new continuous cough, fever, fatigue, diarrhea, abdominal pain and loss of appetite. https://www.manchestereveningnews.co.uk/news/uk-news/loss-smell-taste-could-strongest-18019703

8. COVID-19, Asthma, Allergies: You’ve Got Questions….(Video with Transcript). “Allergy & Asthma Network compiled a list of questions regarding COVID-19 (novel coronavirus) that people asked during our “Distinguishing the Difference: COVID-19 vs. Allergies vs. Flu” webinar on March 17. The webinar was hosted by Allergy & Asthma Network President and CEO Tonya Winders and board-certified allergist and immunologist Purvi Parikh, MD.” https://www.allergyasthmanetwork.org/covid-asthma-and-allergies-frequently-asked-questions/ General Questions (25), Asthma Management Questions (13), School Questions (3).

9. COVID-19 COMPARISON: Coronavirus vs. Cold vs. Flu vs. Allergies (Chart comparing 12 symptoms among 4 Illnesses) https://coronavirus.health.ok.gov/sites/g/files/gmc786/f/fb-covid-comparison-8.5×11-eng.jpg

10. Coronavirus is not the flu. It’s worse. This 6 ½ minute YouTube video is from the CDC (Center for Disease Control). Twice as contagious , longer incubation period, no shot or immunity, 25% hospitalized > 2%. At least 10 times the fatality rate. Older and compromised people are more vulnerable. https://www.youtube.com/watch?v=FVIGhz3uwuQ&feature=youtu.be&fbclid=IwAR2oMqPwP76ZMdL_U8GTRjXy4LNaONjc-c_6oHaZ9XnkKOJykpZDo8UnOH4

“Skillful Teaching through Facilitating Discussion—Teaching skills is an essential pillar of a competent CHW and CHWI,” a lecture by Dr. Shannon Cox-Kelley, summarized by J.D. Meyer

This was the first lecture at the 2018 Community Health Workers Conference for the NE TX CHW Coalition, July 13, 2018.

The NE TX CHW Coalition Conference featured two main lectures and three breakout sessions. The first main lecture was by Dr. Shannon Cox-Kelley –Dean of Health Science–who teaches in the Community & Public Health degree program at NE TX Community College. She received all of her degrees at Texas A&M at Commerce and is a noted online distance educator.

Dr. Cox-Kelly cited four occasions to use discussion: (1) Evaluate evidence. (2) Formulate application of principles. (3) Foster motivation for further learning. (4) Articulate what has been already learned—theory behind the discussion.

Memory is linked to how deeply we think about something. A research interest cited in Dr. Cox-Kelley’s biography really clicked with me: “the impact of educational attainment on health outcomes in diverse communities.” My disabling condition is COPD, but as a Master’s degree holder and former all-level teacher (mainly Developmental English/Writing: the Pre-College Composition course), I’ve learned to study my conditions. (Yes, I have other health issues). I write Word Press articles on health and make binders full of info on medicine, ER reports, and journal articles.

Returning to Dr. Cox-Kelley, she notes that relationships are key, and we have a need to know why and how information is needed. The CHW Instructor could start with controversy like a “devil’s advocate,” but one should announce it in advance to maintain trust. Uncertainty arouses curiosity; switch sides. Focus on solving problems rather than the solution.

Many students are passive and quiet since we’re taught to memorize in secondary education. An increasingly popular practice is to flip the class and have the lecture at night on You Tube or something like it. Then the classroom becomes a place for total discussion. This flip improved passing rates at Dr. Cox-Kelley’s junior college. Think, don’t memorize.

How to start with questions means to start with desired outcomes. Factual questions increase problem-solving. Application and interpretation questions find connections. Problem questions can induce critical thinking. Comparison questions can evaluate readings.

Dr. Cox-Kelley cites principles behind case studies: (1) Increase focus. (2) Break cases into sub-problems. (3) Socratic questioning, and (4) Lead students toward intended outcomes. Once again, passive students can be a possible barrier, as well as failure for students to see value.

Dr. Cox-Kelley cited Discussions as a Way of Teaching, by S.D. Brookfield and S. Breskill (1999) as a fine relevant book. Students can experience a fear of looking stupid and the inability to consider alternative sides because of emotional attachment. Are they trying to find a correct answer or explore? Helping emotional reactions includes asserting the value of discussion and keeping opinions and verbalization in perspective. To conclude, collaboration is better than competition.

“Skillful Teaching through Facilitating Discussion” lived up to its subtitle of teaching skills being an essential pillar of both the Community Health Worker (CHW) and CHW Instructor (CHWI). Furthermore, Dr. Cox-Kelley’s lecture reached out to teachers looking for a second career or a stimulating cause in retirement.

2017 NE TX Community Health Worker Coalition Conference, By J.D. Meyer

The 2017 Northeast Texas Community Health Worker (CHW) Coalition Conference was held on July 14th at TJC West. According to the official booklet, the CHW conference addresses “the role CHW Workers/Instructors play in creating access to care, reducing care costs, and promoting health and happy communities.” The Conference stressed “the importance of CHW(I)’s reducing health disparities; return on investment; and methods of overcoming barriers to CHW(I) program success.” Participants who attended the entire conference received six CEU (Continuing Education Units). “Presentations can be downloaded after the conference at the following link: http://tinyurl.com/y7brtht7

There were three main presentations. “The CHW and Public Health: The UT Health NE Experience,” was delivered by Jeffrey L. Levin, M.D. “Creating and Maintaining Health Workplace Environments,” was given by Terrence Ates, M.ED and Detective John Ragland. “CHW Self-Care—Focusing on You While Giving to the Community,” was presented by LaShonda Malrey-Horne, MPH.
The CHW of the Year was presented to the late Cynthia Keppard, the former director of the NE TX CHW Coalition. Several of her family members were in attendance.
There were three Breakout Sessions also—a choice of 18 sessions. First, I attended “Helping Clients Self Manage Chronic Disease,” by Marcus Wade, LMSW & CHWI. Then I went to “A Community Health Worker’s Guide to Texercise Classic,” by Jeanie Gallegly, MS & CHWI. The last breakout session for me was “Tobacco Danger,” by Lana Herriman, BS.
There were several organizations serving as vendors and sponsors. For example, I was able to pick up the Cigna Health Spring Provider Directory and Over-the-Counter Products Catalog in the lobby. Lunch was from Jason’s Subs; snacks were available too. Once again, the annual NE TX CHW Coalition Conference was a success that drew a huge crowd.

SOL Tuesday: Shopping at Family Dollar for a Low-Fat/Low-Sodium Cardiac Diet (2nd Edition)

I spent a half week at the East Texas Medical Center (ETMC) Cardiac floor for COPD & hypertension. I’m on disability for COPD and asthma. Usually, my blood pressure isn’t bad, but it was high in mid-September 2016. It was my first overnight stay in a hospital in five years. Previously, I’d assumed my diet was okay because I eat a balanced diet. I’m no carnivore, for I like grain, vegetables/fruits, and dairy. My diet is if I see food, I eat it. Recently, I’d become aware of anti-inflammatory foods to cope with my Asthma-COPD Overlap Syndrome (ACOS). http://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation Foods that Fight Inflammation Later at the annual Northeast Texas Community Health Worker (CHW) Coalition conference in July 2019, we heard that grocery store tours–including how to shop at a dollar store–are available in some sectors. That lecture was “Meeting your clients where they are to promote healthy changes,” by Ardis Reed.

So I’ve been shopping with memories of the Cardiac Diet in my mind. Now, I check all foods for saturated fat, cholesterol, and sodium. I made sure I bought Mrs. Dash, the salt substitute, for starters. Texas Pete, a Louisiana type hot sauce, makes the cut with only 3% sodium per tsp. Texas Pete is the hot sauce for Church’s Chicken too.

Cheese was on the not-there list at the hospital. So I surveyed all the cheese at Family Dollar. Much to my amusement, the lowest fat/lowest sodium cheese is the cheapest generic cheese in Family Dollar! It’s simply called, Singles, an “imitation pasteurized process cheese food.” Saturated fat is 5% and sodium is 9% per slice, and the package has 16 slices for a mere $1.25! However, it didn’t melt well, so I’ve tried Shredded Velveeta at 10% saturated fat, and it tastes way better. Then I found delicious, generic shredded Mexican 4 Cheese Blend with a comparable low-level of saturated fat; the four cheeses are Monterrey Jack, cheddar, asadero,and queso quesadilla. But the winner of the low saturated fat award for cheese goes to Family Dollar’s Salsa con Queso with only 4% saturated fat in a 2 tablespoon serving. Plus it’s ready for dipping whether you heat it or not.

Unfortunately, that delicious slab of generic dark chocolate is off-the-scale for saturated fat at 41%! Hershey’s with Almonds has a staggering 71% saturated fat for the day. But all is not lost, Family Dollar chocolate syrup has no saturated fat! Here’s a pleasant surprise. Snack-Pack Chocolate Caramel Pudding has only 8% saturated fat and 5% sodium per cup. Furthermore, a four cup package only costs $1 at Family Dollar.

My beloved Family Dollar Sweet & Salty Peanut Granola Bars are OK at 10% saturated fat and 7% sodium per bar. Those peanut granola bars are so good with beer! Another generic granola bar favorite is Dark Chocolate-Peanut Butter Protein Chewy Bars. They’re a bit high in fat at 15% saturated fat, together with 7% sodium per bar. Snicker’s Ice Cream has only 15% saturated fat and 3% sodium for a half-cup–another mega-relief! I had to indulge myself on Halloween but within reason. So I bought a package of 6 “Fun-Size” Snickers bars. Two bars have 15% saturated fat and 3% sodium

Margaret Holmes Seasoned Collard Greens have 16% sodium per half cup, but a staggering 130% of your daily Vitamin A, and of course, no saturated fat. Family Dollar Diced Tomatoes have no fat and 8% sodium per half cup. Both are considered anti-inflammatory foods.

Dean’s Zesty Guacamole Dip from Brookshire’s–Tyler, Texas’s major grocery store– has 15% saturated fat and 8% sodium per 2 tbsp serving. Speaking of other favorite grocery stores, Granvita Ganola from La Michoacana only has 4% saturated fat and 1% sodium per serving. I also mix horchata (cinnamon rice milk powder) with low-fat milk from Meals-on-Wheels. Horchata only contains 3% saturated fat per 4 ounces, and I only need a tablespoon, as I mix the half-pint of milk with a half-pint of water. La Michoacana is the leading chain Mexican grocery store in Texas. Hey, sometimes I catch the bus instead of walking a block.

Sardines–my favorite seafood in a can–tomato, mustard, plain; which is the healthiest choice? Pampa Sardines in Tomato Sauce wins with 5% saturated fat, 11% sodium, and 15% cholesterol. Furthermore, a serving has 20% of daily Vitamin A. A 15 ounce sardines-&-tomatoes can has seven servings, and it’s only $1.75! Our sardines are a product of China that’s distributed by a Miami company. I love globalization. Alas, sardines in mustard sauce–my former favorite–finishes last in my health measures with 15% saturated fat, 17% sodium, and 20% cholesterol.

Peanut butter is a mandatory fixture in my pantry, so let’s check it out. Value Time Creamy Peanut Butter (a generic) has 15% sat. fat & 6% sodium in a 2 tbsp serving size. Total fat is far higher at 25%, not a common large gap between total fat and saturated fat. Gold Emblem Crunchy Peanut Butter has 12% sat. fat & 6% sodium per 2 tbsp serving size with 23% total fat. I bought my crunchy peanut butter at CVS Pharmacy. Did you hear CVS bought out Medicine Chest? Peanuts show a range of saturated fat/sodium, depending on the seasonings. Japanese peanuts win with only 11% saturated fat & 9% sodium. Honey peanuts contain 17% saturated fat and 5% sodium. Meanwhile, the two spicy peanuts clock in at 20% saturated fat & 15% sodium and 17% saturated fat and 14% sodium.

CONCLUSION: Hopefully, you liked my analysis of some key favorite foods–mostly from Family Dollar. I’m no health professional, just a disabled Developmental English and ESOL (mostly)teacher. However, I’m certainly going to research what I eat from now on, and I seem to be improving. Furthermore, I can guarantee another revision with a sat.fat/sodium analysis of more food. Moreover, I no longer buy generic CoQ10 at the dollar store, but get the CVS Pharmacy choices– such as gummies and Qunol CoQ10. I was glad to pass this article to a Family Dollar employee, who had some heart issues about a month before I got sick. Don’t you feel sorry for those who live in food deserts? Some apartment complexes in town aren’t close to any stores–let alone hospitals, pharmacy, and a pulmonology clinic. We’re really happy to have a dollar store–Family Dollar–in this neighborhood: Midtown (aka. Hospital District), Tyler, Texas. Technically, most would consider a grocery store to be a far more valid dodge of food desert classification than a mere dollar store. But a dollar store is way better than nothing or mere snacks at a gas station.

2016 Northeast Texas Community Health Worker (CHW) Coalition Conference

The Northeast Texas Community Health Worker (CHW) Coalition held its second conference at Tyler Junior College West on Friday June 15, 2016. The Keynote Speakers were David L. Lakey, M.D.; Paul McGaha, M.D.; and Ardis Green, MPH. To begin the conference, Dr. Lakey presented, “Improving Health in Northeast Texas.” After lunch, we heard Dr. McGaha speak about the “Zika Virus: Implications for East Texas and CHWs.” The final talk was by Ms. Green, and it was entitled, “The New Diabetes Educator Paraprofessional Competencies.”

We chose three Breakout Sessions from a choice of eight. My choices were “Hypertension,” by Debbie Warren–a CHW Instructor; “It Takes a Village–The importance of Partnerships,” by Lori Arteaga, M.Ed.; and “Helping Clients Self-Manage Chronic Disease,” by Marcus Wade, LMSW & CHW Instructor.

The other Breakout Sessions were “Suicide Prevention in Youth: Part 1 & 2,” by Carolyn Harvey, Ph.D.; “Preconception, Pregnancy, and Tobacco,” by Jeanie Gallegly, MS & CHW Instructor; “Compliance: Confidentiality/HIPAA/PHI,” by Christie M. Cofer, BS & CHW Instructor; and “Chosen–The True Story of America’s Trafficked Teens,” by LaJuan Scott, MPA and Dreka Strickland, BS & CHW.

My choice of Breakout Sessions reflect that I have a chronic disease-Asthma and COPD-that got me on SSDI, and Medicaid/Medicare; furthermore, sometimes I get hypertension. As you can surmise, I see plenty of medical personnel and volunteer, so I know the importance of partnerships.

Improving Health in Northeast Texas

This presentation by Dr. Lakey was the ideal opener because of its broad focus and a call for action because our area’s health fairs poorly. Like all the other talks, we saw a Power Point and received a handout of those Power Points. Dr. Lakey defined Population Health as examining the overall health of an area–together with groups based on gender,age, and ethnicity. The Triple Aim is to improve the individual experience of care (quality and personal satisfaction), improve the health of the populations, and reduce the per capita cost of health care.

Despite spending more money on heath care than any country in the world, the U.S. only ranks #34 in Life Expectancy and #42 in Infant Mortality. Coincidentally, Texas ranks #34 among the states. Lack of health insurance is the major problem. Senior health for Texas is just #41. Moreover, Northeast Texas health is clearly among the worst in the state. So it keeps getting worse as you narrow the territory from nation to state to region.

 

 

 

 

“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.