Archive for Asthma

Summer Vacations And Asthma

Summer is the time of year when most of us relax and take vacations.   My patients often ask me, other than taking their asthma medication with them when traveling, what other tips can I recommend to avoid asthma attacks.
If one is staying in the city or heading out to the country, I tell them to be cognizant of the weather reports each day.  The EPA recommends checking the Air Quality Index.  Most simply, this is done by checking televised weather reports or by logging on the EPA’s website,  The AQI measures the amount of air mixed with pollutants as well as pollens.
In an interesting article by the American Lung Association (ALA),  when flying, it  recommends taking a carry-on bag packed with the following: copies of your asthma action plan; extra written prescriptions; insurance cards; medicines such as  quick-relief and controller medications; a spacer; and a peak flow meter.
The ALA also has a free app, the State of the Air, for your smartphone which is free.  You punch in the zip code your are traveling to or use the geo-location  function.
Also when flying, the TSA allows you to bring a nebulizer on board or as checked baggage.
Before you arrive at your destination, you should have in mind the following to reduce the chances of an asthma attack:  request a hotel or  an inn with a smoke free room; wood floors instead of carpeting if available; ask for fragrance free toiletries; even bring your own bedding to reduce dust mite exposure.
Remember, each vacation environment poses its own challenges for asthmatics.  For beach-goers, bring fragrance-free sunscreen, pack plenty of water and pain relievers that won’t exacerbate your asthma–consult your physician.  When traveling to countryside, avoid animal hair and bird feathers which produce dander, and are asthma triggers.  When swimming in pools, make sure these areas do not have a strong smell of  chlorine and that the pools are well ventilated, to prevent an allergic reaction.
Following these tips should make your vacation more enjoyable.


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School Asthma Management Plan Act

School Asthma Management Plan Act

The most common chronic disorder in children, ASTHMA affects nearly seven million children. Over half of these children suffered with an asthma attack or episode in 2014 to their poorly controlled condition. As well as the health risk involved, these asthma attacks resulted in 10.5 million missed school days and U.S. $56 billion in healthcare expenditures. A good number of these costs are preventable when a prescribed Asthma Plan is implemented correctly.

On April 22, 2015 Senator Kirsten Gillibrand (D-NY) introduced the Asthma Management Plan Act with Senators Mazie Hirono (D-HI) and Bob Casey (D-PA).


The School Asthma Management Plan Act allows schools to apply for grants that help them: 1) develop asthma management plans, and 2) purchase medication and equipment necessary to treat students affected by asthma.

Bill Summary
• Develop and implement school asthma management plan—Schools shall use grant money to develop asthma management plans based on national guidelines that include, among other provisions, methods for identifying all students with asthma diagnoses, implementing asthma education for all staff, providing access to medication and methods to administer medication for all affected students, and developing medication and emergency policies specific to each school.

• Purchase asthma medications and devices—Schools shall also use grant funds to purchase asthma inhalers, spacers, air purifiers, asthma education materials, and other supplies necessary for the relief and treatment of affected students.

• Improve communication and coordination—Schools receiving grants shall find ways to encourage bidirectional communication between schools and physicians, and improve adherence to asthma treatment my students. Schools shall also utilize existing systems and resources when possible.

The AAAAI is on the record as a supporter of the bill, having submitted an official letter of support to Senator Gillibrand. In it, AAAAI President Robert F. Lemanske, Jr., MD, FAAAAI, states: “As the current president of the AAAAI, this bill is of great interest to me personally since my major presidential initiative focuses on the creation of the Office of School-based Management of Asthma and Allergic/Immunologic Diseases within the AAAAI to serve as a resource for the creation of programs to establish optimal clinician-school nurse-family communications to better care for children with asthma in the school setting.”

If you have questions about Asthma or how to control asthma with an Asthma Treatment Plan, please contact an allergist. Live in NYC or tri-state area, please feel free to contact my office for a consultation. The first step to Asthma control, is adhering to your prescribed Asthma Treatment Plan.

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Asthma Triggers

It is estimated that 25 million people in the United States are currently living with asthma. That equals out to one in every 12 people or about 8% of the population. That’s a lot of people. But for a disease that is so common, symptoms and triggers can be confusing. Let’s shed some light on asthma.

Asthma Symptoms

inhalerThe symptoms of asthma can be vast and varied but typically include shortness of breath, wheezing while breathing, tightness in the chest and excessive or painful coughing. If you experience any of these symptoms, be sure to visit your allergist to determine causes and triggers. Left untreated, allergies can also develop into asthma. Be safe and consult your allergist early on.

Symptoms of an asthma attack are caused by constriction (tightening of the muscles) and inflammation (swelling and irritation) of the airways. During an attack the muscles around the airways spasm,  the mucosal membrane lining the airways gets inflamed, and excessive amounts of mucus flow in the airways all contributing to the narrowing of the airway. This increases constriction and makes breathing very difficult.

Types of Asthma and Causes

Depending on each person, asthma attacks can be caused by either internal and/or external triggers. Asthma is commonly categorized by symptom triggers. These categories include:

Allergic Asthma triggered by allergic reactions to allergens such as pet dander, dust or dust mites, mold or pollen.

Seasonal Asthma triggered by seasonal allergic reactions to allergens such as trees, grasses, or weeds.

Non-Allergic Asthma triggered by irritants in the air that you breathe such as tobacco smoke, wood smoke, room deodorizers, fresh paint, and perfume.

Exercise-Induced Asthma triggered by exercise or physical activity.

Nocturnal Asthma can occur in a patient with any of the aforementioned types of asthma, though the asthma symptoms will increase or worsen at night.

Asthma is the most common chronic illness among children. If a child’s asthma is left untreated, it can result in loss of sleep, exercise limitations, absenteeism, emergency room visits and, in a few cases, death. Asthma in both adults and children can be effectively managed with medications and “trigger” avoidance.

Receiving medical help for asthma is essential. If you’re concerned that you or a loved one is showing signs of asthma, please consult your allergist.  Live in the NYC area, call my office to arrange a consultation,  (212) 247-7447

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The Dangers Of Raw Milk

As a doctor, I am interesting in preventing disease as well as treating it. So I try to encourage my patients that having a healthy lifestyle is key is lessening their frequency of having allergies and asthma.

What concerns me is that in the public’s quest to eat healthy, some may have gone overboard. Many people who promote organic food–because it has less additives and pesticides, which is a good thing– are now promoting a food that has potential dangers in its so-call pure state: that is raw milk.

Under the mistaken belief that raw milk is better for your health, the American Academy of Pediatrics issued a statement that “substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections.”

Pasteurization is the term in which heating milk to a high enough temperature for a long time period to kill disease-causing bacteria has been used safely for over 100 years. And states the New York State Department of health that “pasteurization is the only way to ensure that milk products do not contain harmful bacteria such as salmonella, E. coli, Campylobacter, Staphylococcus aureus, Yersinia, Brucella, Coxiella and Listeria.”

In an interesting article by the FDA, it stated that CDC reported between 1993 and 2006 more than 1500 people in the US became ill due to drinking raw milk or eating cheese made from raw milk. Also the CDC stated that “unpasteurized milk is 150 times more likely to cause food borne illness and results in 13 times more hospitalizations. It is especially dangerous to people with weakened immune systems, children, older adults and pregnant women.”

Symptoms of people becoming ill from raw milk include: vomiting, diarrhea (sometimes bloody), abdominal pain, fever headaches and body aches. More serious reactions such as blood-stream inflections, kidney failure and inflammation of the nervous system can occur. Consult a physician in you or your children exhibit these systems.

When shopping for milk or milk products, make sure to check the package to see it its states pasteurized.

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Non-Allergic Asthma. Causes And Treatment

A big part of my practice is seeing patients with asthma. They often ask me, “Dr. Lubitz, what triggers my asthma and how can I control it?”

I tell them first that I have to determine whether they have allergic asthma or non-allergic (intrinsic asthma). The Asthma and Allergy Foundation of America (AAFA) states both types of asthma exhibit the same symptoms: coughing, wheezing, shortness of breath or rapid breating and chest tightness. However where allergic asthma is triggered by allergies such as food, pollen and other allergens, non-allergic asthma does not involve an immune-system response (like intrinsic asthma) but is triggered by other factors.

The Asthma Center Education and Research Fund states that symptoms that provoke non-allergic asthma include “weather changes, cold air, exercise, indoor pollutants (household cleaners and chemicals cigarette smoke, perfumes), outdoor pollutants (ozone, sulfur dioxide, carbon monoxide) and strong odors (perfumes, scented sprays, fresh pain, moth balls).”

Also, I read an interesting article in the Wall Street Journal that stated that New York’s Columbia University Medical Center commissioned a study on asthma that found “an association between asthma rates and phtalates, chemicals used in many plastic products that have raised concerns.” Though more research needs to be done.

There are a variety of drugs that treat non-allergic asthma. Corticosteriods, such as prednisone, administered with an inhaler, works well for allergic asthma because it “dampens the body’s immune response to an allergen, but is less effective on nonallergic asthma. Instead, these patients might be given another type of drug called a beta-agonist, such as albuterol and levalbuterol, which works by relaxing lung muscles.”

If you exhibit any symptoms of asthma, it is important to see a medical professional immediately.

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What You Should Know About COPD

A lot of my practice deals with allergies and asthma. But I also deal with a disease that can be confused with asthma, COPD.

Chronic obstructive pulmonary disease (COPD), according to the Mayo Clinic, is a group of lung diseases that block airflow and make breathing difficult. The two primary examples of COPD are emphysema and chronic bronchitis.

States the Mayo Clinic website, “in chronic bronchitis, there is an inflammation of the lining your bronchial tubes, which carry air to and from your lungs. Emphysema occurs when the air saces (alveoli) at the end of the smallest air passages (bronchioles) in the lungs are gradually destroyed.

Now there are similarities between COPD and asthma. In an interesting article in the Medscape Journal, the publication characterizes the commonality of symptoms: It states “both are characterized by a reduced rate of pulmonary airflow from increased inflammation. Airway obstruction is typically fully or nearly fully reversible in patients with asthma, whereas COPD is characterized by airway obstruction that is not fully reversible.”

However, the causes of asthma and COPD are different. Asthmatics may have a genetic predisposition to their illness, which tends to run in families. However, not all predisposed family members may get asthma. Some experts theorize that respiratory infections in infancy or early childhood may play a major role in the disease.

COPD on the other hand, has a more definitive cause. Smoking constitutes a majority of cases in 85 to 90 percent of COPD deaths. Moreover, exposure to air pollution, chemicals, and secondhand smoke can also cause it. In rare cases, says the American Lung Association, there is a genetic defect called alpha-1 antitrypsin deficiency, constituting 2 to 3 percent of all COPD cases.

COPD is often not diagnosed in people until they reach 40 years of age. Asthma cases are diagnosed very early; children often exhibit symptoms at the age of 5. COPD is a progressive disease, unlike asthma, where is some cases some children may even outgrow the condition as they get older.

While medical treatment for COPD may not repair structural changes in already damaged lung tissue, it can slow down the progression of the disease.


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Fish Allergies

In recent years, the conventional wisdom is that the Americans consume too much meat in their diet. Public health officials have said that we should diversify our diet with dairy, vegetables and fish. Yet some Americans are allergic to fish and may be allergic to products that contain fish.

WebMD states that food products containing fish ingredients are: “Worcestershire sauce, barbecue sauces made with Worcestershire; Caesar salad and Caesar dressing, caponata (Sicilian eggplant relish), caviar and fish roe; artificial fish like imitation crabmeat, and fish sauce, oils, and gelatin.”

I tell my patients that those who are allergic to fish, may only be allergic to only a certain type of fish. Some allergists feel that a fish allergic person should avoid fish altogether, but that person may feel that he or she should be allowed to eat other types of fish in their diet. They can ask their allergist to test them for their specific fish allergy.

The American College of Allergy, Asthma and Immunology (ACAAI) website states that after your allergist tests you for your particular fish allergy “take extra precautions to avoid cross-contact (when two foods come into contact with each other and their proteins mix) when purchasing fish from a market or when dining out.”

Typical symptoms of fish allergies, like other food allergies, may include: nausea, stomach cramps, indigestion, vomiting, diarrhea, stuffy/runny nose, sneezing, headaches, and asthma. Yet some people are so sensitive to fish allergies, that merely touching fish or being in an area where it is being cooked can provoke a severe anaphylactic response. People that are so allergic adverse are advised to carry an epien (epinephrine injector) with them and to avoid fish contaminated areas.

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Dirty Kids, Allergies And The Amish

Many of my female patients who have kids feel that dirt is the ultimate “evil” that their little ones can bring home. Those mothers are real “germaphobes.” They think dirt and kids don’t mix and are obsessed with their children’s cleanliness.

Yet according to various studies, a little dirt may be a good thing for kids.

In an interesting 2012 study, Dr. Mark Holbreich, an allergist with Allergy and Asthma Consultants found that children growing up in the Amish culture in Switzerland have significantly less asthma and allergies than Swiss children who didn’t grow upon a farm.

In an article on the website Health Day, the results of this study stated “Amish children had about the half the prevalence of asthma compared to their non-farm-dwelling counterparts (about 5 percent vs 11 percent). Swiss farm children had a rate of asthma of nearly 7 percent. The rate of allergic sensitization followed similar patterns. Non-farm children had the highest rates, at about 44 percent, compared with 25 percent in the Swiss farm children and just above 7 percent among the Amish children.”

Dr. Hobreich said in the American Academy of Allergy, Asthma and Immunology (AAAAI) annual meeting that the study ” supports the hygiene hypothesis …that early life farm exposures are protective against developing allergies and asthma.” He went on to say that “our next goal is figuring out of the farm life factors that are protecting the children we studied…Early exposure to farm animals and drinking milk directly from the farm, which is neither pasteurized nor homogenized, may be key factors.”

Coming on the heels of the Amish study, prior research indicates that exposure to ordinary dirt activates the neurons that produce serotonin–a key chemical in many bodily functions, as well as being a natural anit-depressant. Also, dirt is a boom to the immune system. Early exposure to naturally occurring microbes can help building stronger, more disease-resistant children.

Parents should encourage their children to spend more times outdoors and expose them to soil rich environments. Creating an outdoor garden for your child to tend, or even taking them in the woods for hikes or nature collection–such as studying insects or plants– can create an allergy-resistant and happier child.

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Allergies, Asthma and Pregnancy

Allergy season is in full swing, so the question that I am often asked by my female patients who are pregnant is “Dr. Lubitz, what type of medications can I take for my allergies that are safe for my unborn child.” Well, there are a variety of modalities I can recommend.

An interesting article on the Mayo Clinic website recommends an approach that is the least invasive for pregnant mothers. It states:

“*Avoid triggers. Limit your exposure to anything that triggers your allergy symptoms.

“*Try saline nasal. Over-the-counter saline nasal spray can help ease nasal dryness, bleeding and congestion. It can be used as often as needed.

“*Rinse your nasal cavity with a neti pot. Once or twice a day, fill the neti pot with an over-the-counter saline nasal solution. Then tilt your head over the sink, place the spout of the neti pot in your upper nostril and gently pour in the saline solution.

“*Include physical activity in your daily routine. Exercise helps reduce nasal inflammation.

“*Use nasal strips at night. Over-the-counter adhesive nasal strips–such as Breathe Right–can help keep our nasal passages open while you sleep.”

Now if these approaches do not alleviate allergy symptoms, there are prescription medications available. To know which medications are suitable, a physician gives his patient a Immunocap blood test. This test can diagnose pollen an food allergies during pregnancy. It’s considered safer than a regular allergy skin prick test for pregnant women which may effect the fetus.

The FDA classifies drugs that are safe for pregnant women with allergies and asthma on a scale of A, B, C, D and X. Category A is the safest shown through studies on pregnant women in the first trimester but for which there are relatively few drugs available at present. Category X which is the least desirable category shows clear evidence of birth defects in animals/and or human studies, and should not be used in cases of pregnancy.

Many doctors recommend the use of Category B medications for their allergic pregnant patients. This means that medications have been used in studies in pregnant animals and are considered relatively safe in humans, but no human studies are available.

The website lists medications classified in three categories. They include: “antihistamines, such as Chlor-Trimeton, Benadryl, Claritin and Zyrtec (generic forms) are considered Class B; decongestants, including Pseudoephedrine (Sudafed) are considered Class C and should be avoided by female patients during the entire first trimester; medicated nasal sprays such as NasalCrom and Rhinocort Aqua are used in treating allergic rhinitis and are classified as Class B. Other medicated nasal sprays such as Flonase are considered Class C.

Concerning the use of asthma drugs in pregnant women, Pulmicort is a Class B drug most often prescribed to treat asthma in pregnancy. It is estimated that 1% of all pregnant women are asthmatic and controlling their asthma symptoms is a priority. To do this, doctors often use a variety of asthma drugs that may be from other FDA classifications of medications that are not in the B class. Their use depends on what types of symptoms their female pregnant patients manifest.

When contemplating the use of any medication for your allergies or asthma, a qualified allergist should be consulted.

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No Quick Fix For Asthma Treatment

One of the things my mother taught me growing up in Brooklyn was to be disciplined. Whether it be my homework, career goals or life in general. And that’s my view in treating diseases like allergies and asthma, especially asthma. You have approach it in a disciplined way; have a plan and take logical steps to deal with it. Really, there are no quick fixes for treating asthma.

Let me tell you a story. Recently, a young, 24-year old very bright woman, walked into my office. She complained of having asthma and after I asked her a few questions, she told me “all I want is a new inhaler with refills. That’s all I want.” I tried to explain to her that having asthma is complicated and requires a plan to successfully deal with the symptoms in order to lead a normal life. She responded, “I don’t need to hear all that! All I want is an inhaler with a few refills! I’ll be back in a year.”

So her response is like a number of patients who are in a hurry to get a quick fix for their problem. Sometimes a physician can’t give patients what they want. I told her, “Listen. Obviously you think you’re the doctor and telling me what I should do! When in reality I have 30 years experience treating asthma patients and you should listen to me!” With that statement she got angry and walked out.

I am very concerned about the well-being of all my patients. I tell them using an inhaler for sudden asthma attacks is no panacea for long- term asthma treatment. You need a well, thought-out, asthma action plan in writing, with your healthcare provider.

Here are some steps I advise my patients to note in their action plan when treating their asthma:

Step 1. General information: Include your name, emergency contact information, your asthma classification number and a list of triggers that my cause an asthma attack.

Step 2. An asthma action plan is divided up into three color-coded zones. 1) The green zone is the optimal zone where you want to be on a daily basis. That means you have no asthma symptoms so you continue taking long-term medications even if you are feeling well; 2 ) the yellow zone is defined as one who is experiencing symptoms and need the use of quick-relief medications to prevent the worsening of asthma symptoms; and 3) the red zone is when you experience severe asthma symptoms and should get immediate medical treatment if your symptoms do not improve.

Step 3. Use a peak flow meter. This is a device that monitors your peak flow rate–whether your asthma is getting worse, even before symptoms occur. Your best peak flow rate is the highest peak flow number you have maintained in a two to three week period. Your physician can help you to calculate it.

Step 4. Symptoms – Monitoring your symptoms is another way to use your asthma plan. They may vary during day and nighttime hours. They include: daytime symptoms (cough, wheeze or chest tightness); movement or activity level (working, exercising or playing); and nighttime symptoms (like dayttime symptoms).

Step 5. Medications. Discuss with your doctor what short-term and long-term medications are right for you depending on your symptoms.

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