Expert: Marc Rubin, RPh Asthma Educator - 11/26/2008

Question
QUESTION: HI, IM JUST WONDERING IF YOU COULD ANSWER A FEW QUESTIONS, MY UNCLE IS 47, IS DIAGNOSED WITH ASTHMA, AND HAS BEEN TAKING PRIMATENE MIST FOR IT.  ON 11/13/08  HE WAS ADMITTED TO THE CRITICAL CARE UNIT AT OUR LOCAL HOSPITAL FOR A SEVERE ASTHMA ATTACK, THEY HAVE HIM ON A BREATHING MACHINE, AND HE IS SEDATED. HE ALSO HAD A MILD HEART ATTACK. HES BEEN IN FOR ABOUT A WEEK NOW, AND THEY KEEP SAYING NOT MUCH HAS CHANGED, LUNGS STILL SWOLLEN, ETC... AND I WAS WONDERING, WHAT IS THE AVERAGE STAY IN CCU FOR THIS?   HOW LONG SHOULD WE EXPECT HIM TO TAKE TO RECOVER??
WHAT QUESTIONS SHOULD WE ASK AND IS THERE ANYTHING WE CAN DO TO HELP SPEED UP HIS RECOVERY?  HES NEVER BEEN HOSPITALIZED FOR THIS BEFORE, AND WERE VERY WORRIED. ANY INFO YOU CAN GIVE WILL HELP, THANX

ANSWER: Hi Jade,

Was this the first time he was diagnosed with asthma? The use of Primatene Mist may have contributed to the heart attack. This is not considered to be a drug that should be used in asthma since, as compared to the other rescue inhalers, can dramatically increase blood pressure and heart rate. Was he under the care of a doctor for his asthma? Was he following the drug therapy instructions of the doctor? Is he over-weight? Was he using the Primatene rather than a prescription inhaler because he thought the prescription wuold be much more costly? (Up until 12/31/08, generic albuterol inhalers retail without insurance for ~ $22.00, versus Primatene at around $19.00. Starting January 1st, the generics will be off the market since the propellant in them destroys the ozone in our sky, and just the new brand name units will be available. There are coupon programs to get them for free with a prescription).

Regarding his recovery, he apparently has a significant degree of airway inflammation, and even with oral or injectable steroid therapy, it may take up to 14 days to get the swelling down to the point he can breath on his own. Of course, the heart attack will complicate this, and the degree of heart damage will determine the length of stay in the CCU. So the questions you need to ask will be in regards to his daily improvement, but addressing the heart and lung situation as separate but related problems. With his lung swelling, there is increased stress on the heart. I'll assume that, unless his oxygen levels are in the normal range (above 92%), that he is getting supplemental oxygen.

To help him recover, he needs to follow the doctors drug therapy program. Due to the serious nature of this episode, he should be treated by either an allergist or a pulmonologist. It will take up to 6 months for the lungs to reach a stable level of control. Even when under perfect control, asthmatics always have a low level of inflammation present. It is also extremely important for his to become educated about asthma. Knowledge is as important as drug therapy, since you must learn to take control by avoiding those things that irritate the lungs: pollens, molds, smoke, pollution,cold air, animal dander, viruses. The "triggers", those things that bring on an attack, are different for different people, so he must learn his. Smoke, pollution, mold,and viruses affect all asthmatics, beyond that, it is important to evaluate everything else.

To learn more about asthma, he, and you can go to the following links:
http://www.aaaai.org, http://www.acaai.org, http://www.lungusa.org, and http://www.chestnet.org
These medical sites each have patient education sections to learn about asthma.

Finally, if he does not have drug insurance, there are resources where you can get the very expensive medications at a very low price, and sometimes free. If this is the case, get back to me, and I'll give you contact information.

I wish you and your uncle well. If you have further questions, please get back to me.

Sincerely,

Marc



---------- FOLLOW-UP ----------

QUESTION: HE WAS DIAGNOSED WITH ASTHMA WHEN HE WAS LIKE 3 YRS OLD. HE WAS FINE FOR A LONG TIME BUT ABOUT 4 YRS AGO STARTED HAVING SYMPTOMS AGAIN. HE HASNT HAD A PRIMARY DR SO HE WAS TAKING THE PRIMATENE BECAUSE HE DIDNT HAVE A PRESCRIPTION OR INSURANCE. HES HAD INSURANCE NOW FOR MAYBE 3 MONTHS, AND ITS UP TO EXPIRE IN DEC. HES NOT OVER WEIGHT, AND HE IS USUALLY VERY HEALTHY, JUST THE ASTHMA WAS THE MAIN PROBLEM. HIS DRS AT THE HOSPITAL  SAID HE HAD PHNEMONIA YESTERDAY, SO IS THAT MAYBE SLOWING THE PROCESS?   ALSO IT WAS  MILD HEART ATTACK, THEY HAVENT SPOKEN ABOUT IT SINCE IT HAPPEND.  HE IS STILL ON THE VENTILATOR AND INTUBATED.  SO IS HE GOING TO HAVE TO STAY IN THE HOSPITAL FOR 6 MONTHS AS YOU SAID OR IS THAT INVOLVONG HOME TREATMENT??  AS FOR HIM GETTING OFF THE VENTILATOR THE KEEP SAYING A FEW DAYS MORE, AND THEN IT DOESNT HAPPEN. WELL LET ME KNOW IF YOU HAVE ANY MORE QUESTIONS, AND HOW MUCH LONGER YOU THINK HE MAY HAVE TO STAY HOSPITALIZED. THANK YOU SO MUCH....

ANSWER: Hi Jade,

He'll be removed from the ventilator probably in the next few days. It must have been a very severe attack, since we generally do not want to put an asthma patient on one except when very bad. There are two types of bacterial pneumonia which may cause a severe asthma attack mycoplasma pneumonia and chlamydial pneumonia. The other type of pneumonia causing this severe of a reaction is a viral pneumonia. IF he is on antibiotics right now, it would be one of the bacterial infections.

Once his lung function is back to ~ 70% of what they feel his should be, he'll be  discharged. I'd expect that to be under 3 weeks from admission, barring any complications. I'd hope that during this time, a staff member would begin giving him a course of asthma education.

Regarding the 6 months, that is just the period of time while on inhalation steroid therapy which is done at home, for the lungs to get to their lowest level of inflammation. The medication comes in inhalers just like the Primatene, so they are very portable.

Here are a couple of phone numbers for pharmaceutical assistance to contact: TogetherRx: 1-800-865-7211 ( http://www.togetherrx.com ), Helping Patients: 1-800-762-4636 (http://www.helpingpatients.org), and for Glaxo products, like Advair: 1-800-745-2967, ( http://www.gskforyou.com ).

Best wishes!

Sincerely,

Marc


---------- FOLLOW-UP ----------

QUESTION: OK HERES AN UPDATE, THEY REMOVED THE VENTILATOR AND MOVED HIM OUT OF CCU. HE IS AWAKE AND TRIES TO TALK BUT CANNOT TALK VERY LOUD OR MOVE MUCH, THEY ARE SAYING THAT HE WILL HAVE TO GO TO REHAB TO GET STRONGER.  BECAUSE THEY HAD HIM SEDATED FOR 12 DAYS HIS MUSCLES ARE REAL WEAK.  SO HOW MUCH TIME DO YOU THINK HE WILL TAKE TO GET BETTER FROM THIS INFO??

Answer
Hi Jade,

I so glad he is finally off the ventilator. He should refrain from talking for the next few days (the tube inserted in his throat is irritating, and he must allow it to heal). I'd expect him to be speaking more easily in about 4 days, and hopefully out of hospital in about 7 to 10 days. He can finish rehab as an outpatient. Now he will have plenty of time to learn about his asthma so he can be in control, rather than be controlled by it.

Best wishes! What a great way to start Thanksgiving!

Sincerely,

Marc