Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Asthma is a disease in which there is a brief, temporary narrowing of the airways in the lungs, referred to as bronchospasm. This narrowing prevents air from moving in and out of the lungs easily. As a result, an asthmatic patient has episodes when breathing is difficult. An asthmatic episode can resolve spontaneously or may require treatment.
Asthmatic patients and their physicians may select from a wide variety of prescription medications. This is not true for over-the-counter (OTC) medicines, which are limited to epinephrine (adrenaline) and ephedrine. In addition, many asthmatic patients should not use epinephrine or ephedrine because of their relatively weak effectiveness or side effects.
To decide whether or not an OTC epinephrine or ephedrine product may be useful, viewers should understand (1) the abnormal conditions that exist in the airways of asthmatics, (2) the effects of epinephrine and ephedrine, (3) the specific factors that should be considered when choosing and using epinephrine and ephedrine, and (4) the side effects of these drugs.
The advantages of using OTC medications for asthma include their affordability and accessibility (lack of need for a prescription and/or health-insurance approval). Unfortunately, these medications are less effective at controlling asthma and sometimes can be more dangerous.
What is asthma?
The cause of asthma is unknown. More is known about the abnormal conditions
that occur in asthma. These conditions include (1) hyper-responsiveness
(contraction) of the muscles of the breathing airways in response to many
stimuli such as exercise or allergies (for example, drugs, food additives, dust mites,
animal fur, and mold), (2) inflammation of the airways, (3) shedding of the
tissue lining the airways, (4) increased secretion of mucus in the airways, and
(5) swelling of the walls of the airways with fluid. All of these conditions
narrow the airways and make breathing difficult. Symptoms of asthma include
wheezing (the hallmark of asthma), coughing, difficulty breathing, and
tightness of the chest. Asthma is diagnosed by the presence of wheezing, but
it can be confirmed by breathing tests (spirometry) that evaluate the movement of air into
and out of the lungs.
What medications are used to treat asthma?
Epinephrine and ephedrine once were the only effective medications for
treating asthma. Beginning in the 1980s, newer medications were
introduced that target more of the abnormal conditions in asthma and do so more
effectively than epinephrine or ephedrine. For example, prescription-inhaler
forms of beta2-agonists (albuterol and metaproterenol
[Proventil and
Alupent]), corticosteroids (beclomethasone and flunisolide [Beclovent and
Aerobid]), anticholinergics (ipratropium bromide [Atrovent]), and other
medicines are now widely used because of their greater effectiveness and fewer
side effects. The use of inhaled antiinflammatory medications that include steroid agents such as fluticasone, budesonide, beclomethasone, and flunisolide have become the mainstay of initial asthma therapy. Unfortunately, none of these medications are available without a prescription.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.
Biologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the day.
An asthma nebulizer, also known as a breathing machine, changes asthma medication from a liquid to a mist, so that it can be more easily inhaled into the lungs. Home nebulizer therapy is particularly effective in delivering asthma medications to infants and small children and to anyone who is unable to use asthma inhalers with spacers.
To obtain an asthma nebulizer, you need a prescription from your
physician. Home nebulizers vary in cost (approximately $200-250) and are
usually covered under the durable medical equipment portion of health insurance
policies. However, most insurance companies will require you to work with a
specified durable medical equipment supplier. Check with your insurance company
before purchasing or renting to ensure it will be covered. Your health care
provider should be able to assist you with these arrangements.
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