Advertisement Knuffman, who joined Gundersen Lutheran Medical Center seven months ago as an adult allergist and clinical immunologist, said he has an arsenal of treatments and medications today to help people control their asthma and stay out of the hospital.
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Dr. Jason Knuffman of Gundersen Lutheran Medical Center said the compliance rate of patients taking their asthma medication properly is only 30 percent to 40 percent. Dick Riniker photo |
The problem: Patients don’t take their asthma medications regularly, or they misuse them, he said.
“Some patients take the medications for a couple weeks like antibiotics and stop them because they feel better,” Knuffman said. “Then they start having trouble because they no longer are taking the medications.”
He said patients say they take their medication every day, but then he finds they have refilled their medication only three or four times that year.
The compliance rate for patients taking medication is only 30 percent to 40 percent, Knuffman said.
“It’s hard to get control of your asthma if you’re taking the medication once in a while,” he said.
Too many patients rely too much on rescue inhalers — beta-agonist short-acting medicines such as Albuterol — for asthma control when these medicines are only supposed to be used for emergency relief, he said.
“People with asthma need to be on a long-acting medication for good control,” Knuffman said. “If you’re using a rescue inhaler more than two to three times a week, you need to see your doctor and be placed on another medication.
“Overusing your rescue inhaler will catch up to you,” he said.
Asthma is a chronic lung disease that affects about 20 million Americans and is characterized by inflammation of the airways. The inflammation makes the airways smaller, making it more difficult for air to move in and out of the lungs.
Asthma and allergies often go together, Knuffman said.
“Many people with asthma are in denial, or they don’t have access to health care and these medications,” Knuffman said. “We should be able to treat anyone with asthma so they can have good control.
“The longer people wait to get help, the worse the asthma will be,” he said.
Knuffman, who served an allergy fellowship at the University of Wisconsin-Madison Hospitals, said people need to see a doctor if asthma and allergies are interfering with their ability to carry on day-to-day activities and they are struggling to catch their breath, wheezing or coughing often, especially at night or after exercise, or being frequently short of breath or feeling tightness in the chest.
He said he will determine the severity of lung function and choose a medicine and dosage based on that severity and other factors. He said he also will evaluate patients for allergies, reflux disease and sleep apnea, too, and ask smokers to stop smoking.
Knuffman said inhaled corticosteroids are the first line of treatment for asthma — Pulmicort, Symbicort, QVAR, Aerobid, Flovent, Advair and Azmacort.
In the United States, inhaled corticosteroids are approved for chronic control of asthma symptoms. Knuffman said they are known to reduce inflammation in the airways to prevent an asthma attack.
“These drugs were a great leap forward in preventing symptoms,” Knuffman said.
He said he has many patients taking one medication, but some patients need more than inhaled corticosteroids.
Knuffman said he also will prescribe leukotriene modifiers such as Singulair, Accolate or Zyflo Filmtab for some patients. These medications reduce the effect of leukotrienes, which are responsible for the swelling and constriction of the bronchial tubes and cell activities related to asthma.
People with asthma who are ill or have severe symptoms are often prescribed oral corticosteroids such as prednisone, the most potent and effective anti-inflammatory medicines, to gain rapid control over asthma symptoms.
Knuffman said people with severe asthma and allergies can be prescribed a new injection called Xolair, which has been effective. He said he has a half-dozen patients using the injection, but it costs at least $10,000 a year.
“It is a major advancement in the treatment of allergies,” Knuffman said.
Xolair’s approach treats asthma as more of a systematic disease, he said.
“Fifty years from now, we may be treating asthma and allergies more as a whole-body issue,” Knuffman said.
TAKE CONTROL OF YOUR ASTHMA
Source: American Lung Association
Terry Rindfleisch can be reached at trindfleisch@lacrossetribune.com or (608) 791-8227.
