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November 3, 2005
Asthma treatments
Q: I have suffered from severe allergies and severe asthma since childhood. I take Advair, but it has had no noticeable effect on my nocturnal asthma, which is my main concern. Do you know any treatments that can ease nocturnal asthma?
A: Asthma is recurrent episodes of breathlessness, wheezing, chest tightness and coughing due to a sudden narrowing of the airways. Asthma attacks often strike during the night, and the reasons why aren't clear. Your first line of defence against night attacks is to allergy-proof the bedroom.
Frequent changing and washing of pillowcases, bed linen and sheets keep the dust-mite population in the bedroom to tolerably low levels. Dust mites are often responsible for asthma attacks. If there is carpet in your bedroom, it might serve you in good stead to remove it, if the expense is not prohibitive - another way to reduce the mite population. The same goes for any stuffed furniture in the room.
Keep bedroom humidity well under 50 percent to discourage the growth of molds, another cause of asthma attacks.
Acid reflux is the spouting up of gastric acid into the oesophagus, and it is the cause of heartburn. It can also bring on asthma attacks, and that can happen without having heartburn pain. Speak with your doctor about trying medicines that control reflux to see if it is playing a part in your attacks.
Your medicine, Advair, is a popular and effective asthma drug. It's inhaled twice daily through the mouth. It has two ingredients, fluticasone and salmeterol. Fluticasone is a cortisone medicine that soothes irritated airways. Salmeterol dilates airways. If the drug is not working for you, it might be more beneficial to take medicines that are not in a fixed combination in one pill. The doses of each can be varied to better fit your needs. Furthermore, there are many other asthma drugs. A change would be worth a try. Singulair, Accolate and Zyflo are a few examples. You are not chained to only one medicine.
For more information on asthma, readers can order the asthma booklet by writing: Dr Donohue - No. 602, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
Q: Could you explain what happens to a person in her 70s who might have water on the brain? I have never heard of someone that age as having it. I though it happened only in newborns. What causes it? Could her children get it?
A: Adult water on the brain is called normal pressure hydrocephalus. It happens mostly to people over 70 and results from a block in the reabsorption pathway of cerebrospinal fluid, the fluid that bathes the brain and spinal cord and circulates within the hollow brain caverns. The increased fluid volume compresses brain tissue and leads to three prominent symptoms: dementia, ataxia and urinary incontinence.
Dementia is a fall-off in mental function and memory. Ataxia is uncoordinated walking. People shuffle and stumble. They have a hard time lifting their feet off the ground. Urinary incontinence is the loss of bladder control.
The condition can result from a prior brain infection or from a blow to the head, or can arise without any identifiable cause.
Shunting of fluid from the brain to the abdomen though a very small-bore tube brings a reversal of symptoms to many.
Q: Do people without a gallbladder produce bile?
A: The gallbladder is the storage tank for bile made by the liver. People without a gallbladder still make bile. Instead of being stored in the gallbladder, which empties after a fatty meal, bile drips into the digestive tract from the liver on a constant basis. Bile aids in fat digestion. Without a gallbladder, people still digest fat.
Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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