Expert: Marc Rubin, RPh Asthma Educator - 2/26/2009

Question
Hi!

A friend of mine recently told me she has asthma. I've seen her wheezing and unable to catch her breath before, and it scared me. I don't know what to do for her. She fights taking her rescue inhaler....says that it makes her really really shaky and she feels like she's going to pass out. But i don't like hanging out with her because I'm afraid something's going to happen and she'll suddenly have one, and I don't know what to do.

She lives in Chillicothe, Ohio and I live in Frankfort Ohio, out in the country. She lives in town. She doesn't take any medicines other than her rescue inhaler, when she does take that.

Answer
Your friend is playing with fire...literally. The symptoms of asthma are due to inflammation in the airways and tissues of the lungs. Although only a small percentage of asthma patients die of their asthma during an attack, her behavior is leading in that direction.

Medication wise..she can ask her doctor to prescribe Xopenex rather than plain albuterol-HFA for her rescue inhaler. It has a lower level of stimulation that what she is using. Also, it sounds as if she has not been taking her controller (daily) medication, out of fear of side effects. Asthma is a medical condition which the patient has a LOT of control on quality of life. But it is essential that she educates herself about it.

It is great for you to be so concerned about your friend. It may be of benefit for both of you to learn together so as to discuss issues and work them out, where she ignores reality and can pay the ultimate price.

If you are with her when she has an attack, work to calm her, since emotions worsen a flare-up. Also, she should not lay down, but sit down and lean forward to open the rib cage to ease the pressure.

Does she see a specialist? Asthma doctors have staff that teach the patients about their disease. In addition, they should also teach proper technique in using the rescue medication and other inhaler devices. A large number of patients do not use them correctly, and do not achieve full benefit.

She also needs to understand that controlling asthma is only partially done with medication. Again back to the education point, but she must learn what brings on attacks so that she can a) if at all possible, avoid those triggers, and b) if she knows she is going where she has had prior problems, pre-treat with the appropriate medication to minimize her body reacting.

Below are some links to follow to help educate her, as well as a monitoring tool for self-evaluation.

Asthma Control Test: http://www.asthmacontrol.com/

Asthma Action Plan: http://tinyurl.com/q5j2v

AAAAI Patient Site: http://www.aaaai.org/patients.stm  (Also review the link on the left side of this site for  "Disease 101"

AANMA: http://www.aanma.org/   view the Asthma Basics 50 in the right column.

This is a good starting place for you to help her.

Feel free to get back to me when necessary.

Sincerely,

Marc