* e-Asthma is category of severe asthma

* Patients with e-Asthma have difficulty getting asthma control with usual treatment

* e-Asthma responds well to a new type of injected medicine

* In such patients, this new medicine can decrease their asthma attacks and allow them to use less oral steroid.

     e-Asthma is a type of severe asthma that responds well to a new kind of control medicine that you inject under skin, usually monthly.

     Severe Asthma means:

1. You’ve been on a high dose of inhaled corticosteroid (ICS) and a long-acting bronchodilator or theophylline for in the past year; and/or
2. You’ve been treated with steroids (like Prednisone) by mouth for more than half of the past year.

Wondering what “high dose” ICS means?

This new type of injectable asthma medicine has been shown to dramatically:

1. Reduce the number of asthma attacks you will have

2. Reduce how much oral steroid (like Prednisone) and ICS you need to stay controlled.

How do we know if your asthma is the type that will respond to this medicine?  You would be likely to get a good response to this new medicine if:

1. Your eosinophils are elevated in your bloodstream, and
2. Your allergy testing shows that you are triggered by seasonal allergens.

So, let’s review:

If 

You have been on high dose ICS (see above) or oral steroid for more than half of the year,

AND

You have skin allergy tests that show a problem

THEN

I would recommend having your blood drawn to measure your eosinophil count.

If your eosinophil count is elevated (35-700 IU/mL), you would be a good candidate to try this new type of medicine.

What medications would be considered?

Here is a list of subcutaneous medications that can be ordered for e-Asthma:

Omallzumab (Xolair) injected every 2 or 4 weeks depending on your eosinophil count and age

Dupilumab (Dupixent) injected every 2 weeks

Mepolizumab (Nucala) injected every 4 weeks

Benralizumab (Fasenra) injected every 4 weeks for 3 doses, then every 8 weeks.

Tezepelumab (Tezspire) injected every 4 weeks.  This medicine does not require any history of elevated eosinophils or prior testing for allergic asthma.

These medications are quite new and it will take some time for general practitioners to become educated about prescribing them.

But, they are available RIGHT NOW and if you are suffering from severe asthma, they could be a really good solution for getting your severe asthma under control.

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Remember our hashtag: #asthmacarenow! And keep Breathing Easy!

#asthmacontrolnow
#telemedicineasthmacare
#backpocketasthmadoc
#asthmaactionplan
#asthmacontroltest
#asthmacontroller
#rescueinhaler
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* Finding your inhaler empty when the tightness starts IS NOT A GOOD FEELING!

..You need your rescue inhaler

..When you need it!

..Without it, it is probably a trip to the ER and

..a few days of having messed up breathing.

* Asthmaniac offers $50 doctor visits for inhaler refills and

*sends all orders for prescription medication to the pharmacy of your choice.

Asthma is one disease that cannot be controlled without medication.

When your wheezing kicks in, you need a rescue inhaler NOW!

And to keep your wheezing suppressed, you need a controller medication.

Since these medications are so important to keeping you breathing well, I have designed a online ‘clinic’ that makes it possible for you to never run out!

Running out is usually from:

… The discouraging cost of the medicine

…  The discouraging inconvenience of finding a doctor appointment to get the medicine ordered

… The discouraging cost of the doctor appointment.

Well, I have good news!

1. Albuterol (your usual rescue inhaler) is now generic, and priced as low as $20/inhaler in some pharmacies!
2. You have already ‘found’ the doctor that will take care of you (that’s me!).
3. You can ‘see’ me online (on your phone) to get your refill ordered for $50! 

I send your prescriptions electronically to your preferred pharmacy.

That doesn’t matter where you are or where I am.

All electronic.

No paper prescription to lose,

Even better: now that Amazon is in the pharmacy game, there’s a pretty good chance you can get more affordable inhalers delivered right to your door!

Ok, to be sure, getting your asthma under control is not ONLY about getting your inhalers.

But making sure you have your rescue medicine is my First priority.

Affordable

Convenient

Inhaler Refills.

A CORE philosophy of Asthmaniac!

Complete the subscription form on the right if you’d like to get an email when I post a new podcast and blog entry.

Remember our hashtag: asthmacarenow! And keep Breathing Easy!

#asthmacontrolnow
#telemedicineasthmacare
#backpocketasthmadoc
#asthmaactionplan
#asthmacontroltest
#asthmacontroller
#rescueinhaler
#asthmacovid19
#childrenandasthma
#eprescription
#easthma
#peakexpiratoryflow
#peakflowmeter
#asthmaniac

* Electronic prescriptions mean:

..More accuracy in the order, 

..More convenience for you,

..No paper to lose, and

..It’s FAST!

* Asthmaniac sends all orders for prescription medication to the pharmacy of your choice.

Asthma is one disease that cannot be controlled without medication.

When your wheezing kicks in, you need a rescue inhaler NOW!

And to keep your wheezing suppressed, you need a controller medication.

Most asthma patients are sensitive to environment allergens like pollen, dust and smoke.  For them, a trigger control medication protects their airways from ever getting started with narrowing, swelling, and the breathing struggle that follows.

Since these medications are so important to keeping your breathing well, I have designed a clinic that makes prescribing them more efficient.

I send your prescriptions electronically to your preferred pharmacy.

No paper prescription to lose,

And since I send the prescription as part of our scheduled appointments, you can go to the pharmacy with a single goal: pick up your prescribed medication!

Even better: now that Amazon is in the pharmacy game, there’s a pretty good chance you can get more affordable inhalers delivered right to your door!

Asthmaniac is designed to minimize your contact with sick people and make more time for LIFE!

Electronic prescriptions: another key convenience of Asthmaniac!

Complete the subscription form on the right if you’d like to get an email when I post a new podcast and blog entry.

#asthmacontrolnow
#telemedicineasthmacare
#backpocketasthmadoc
#asthmaactionplan
#asthmacontroltest
#asthmacontroller
#rescueinhaler
#asthmacovid19
#childrenandasthma
#eprescription
#easthma
#peakexpiratoryflow
#peakflowmeter
#asthmaniac

* The National Institutes of Health, National Heart, Lung, and Blood Institute coordinated this update

* Recommendations were published on December 1, 2020.

* It Focuses on six areas:

….Fractional Exhaled Nitric Oxide Testing

….Indoor Allergen Mitigation

….Intermittent Inhaled Corticosteroids

….Immunotherapy in the Treatment of Allergic Asthma

….Bronchial Thermoplasty

* Only four of these six areas have immediate implications for asthma disease management in primary care.

* I’ll review the recommendations briefly here.

Major Points:

• These guidelines are not as wide-ranging as those developed and released in 2007.
• The new recommendations are based on reviews of the scientific literature and the use of the GRADE methodology for assigning a level of certainty (Low, Moderate, or High) for each recommendation.
• Of the six areas, only numbers 2, 3, 5, & 6 have practical implications for primary asthma care.

• The full guidelines:  2020 Focused Updates to the Asthma Management Guidelines:…
• I have put together a quick-read summary of the recommendations.  I have only included recommendations that have moderate or high certainty of benefit for patients.

Indoor Allergens: Pillow covers and mattress bags to seal in allergens are recommended if you have symptoms.  (Moderate Certainty)

Allergy Shots: SCIT (Subcutaneous Immunotherapy) is recommended for adults and children (>5 yr) with mild to moderate allergic asthma as long as they have lab or skin testing data to support the allergy. (Moderate Certainty).

Wheezing in Kids: Children from ages 0-4 yr with recurrent wheezing (3 x /year), triggered by colds and URI’s should have a short course (7-10 days) of inhaled corticosteroid at the onset of a new wheezing episode. (High Certainty).

In ages 4+ with moderate to severe-persistent asthma, a combination inhaler containing formoterol and steroid can be used as both a daily controller and as a rescue medicine. (Moderate to High Certainty).

In ages 12 + with mild persistent asthma, inhaled corticosteroids should be used daily, either along with rescue albuterol or in a combination inhaler that includes  albuterol. (Moderate Certainty).

This approach to wheezing is referred to as Single Maintenance And Reliever Therapy (SMART).  

UPDATE (3/17/22): Today, the FDA approved a generic inhaler containing formeterol and budesonide (the components of Symbicort)!  This will put SMART inhaler use within the price reach of asthma sufferers 5 years of age and older.

In age 12 + yr with uncontrolled, persistent asthma, Long Acting Muscarinic Antagonist (LAMA) medicine can be added to Inhaled Corticosteroid (ICS) for better control. (Moderate Certainty).

I have devoted a full page to discuss how these recommendations will affect my asthma care plans in further detail.

If you have questions about asthma management or want to update your asthma action plan and medication prescriptions, grab an appointment and let’s talk!

Complete the subscription form on the right if you’d like to get an email when I post a new podcast and blog entry.

#asthmacontrolnow
#telemedicineasthmacare
#backpocketasthmadoc
#asthmaactionplan
#asthmacontroltest
#asthmacontroller
#rescueinhaler
#asthmacovid19
#childrenandasthma
#eprescription
#easthma
#peakexpiratoryflow
#peakflowmeter
#asthmaniac