One Minute Asthma
One Minute Asthma
One Doctor’s Way of Handling Your Disease
Some doctors will never give up on trying to find curative measures for illnesses, scouring the earth for cures, methods of treatment or new approaches for treating them. This pretty much describes renowned Massachusetts physician Dr. Thomas Plaut, an asthma consultant, nationwide lecturer and author of several books about asthma.
Plaut, who sees a small number of patients himself, believes asthma can be controlled, and he is willing to talk to anyone who will listen.
“Most asthmatics I can help. One out of twenty, I cannot. Those people I refer to pulmonologists,” he said. “But for the most part, if they use my One Minute Asthma book and an asthma diary, that is all they need.”
With 15 million asthmatics in America, Plaut believes the key to controlling asthma is understanding its mechanisms and knowing when and how to use tools readily available. In One Minute Asthma, first published in the early 1990s, Plaut first began telling patients they could control their disease and avoid costly hospitalizations.
“You can stay out of the emergency room and out of the hospital,” he said. “But first you must learn the basics of asthma and the medicines used to treat it. Second, you need to monitor your asthma using a peak flow or asthma sign score. After that, you and your doctor can work out a clear, diary-based plan for treating your asthma at home.”
Know The Signs
Controlling asthma begins by understanding and recognizing the signs of trouble, he noted. Notable signs include cough, wheezes, sternal or chest retractions and tachypnea. If those signs are present, the patient is in trouble and may need to use asthma medications prescribed by a physician. Noticing the signs and symptoms is much easier if the patient keeps an asthma diary, he said. But it is difficult for physicians to accept the use of a diary as part of an asthma regimen.
“My diary has been out for nine years, and I would say 1/10 of 1 percent actually use it,” he told ADVANCE. “Unfortunately, doctors and patients just don’t take the time to understand it.”
The top portion of his asthma diary asks patients to keep a record of asthma triggers or events that might cause their airways to constrict. One Minute Asthma lists potential triggers: Exercise or exposure to animals, chemicals, pollutants and dust, for example. Additionally, if the patient takes regular medications for conditions like high blood pressure, migraine headaches or angina pectoris, asthmatic symptoms may worsen. Often, it takes time for patients to pinpoint precisely what triggers their asthma, so a careful, detailed use of the diary can help them make the necessary deductions.
Plaut’s asthma diary also urges patients to keep track of peak flow values–long held to be of great value to asthmatics. Plaut said it is important for asthmatics to note their “personal best” scores, even though that concept seems to fly in the face of tradition.
“Some physicians say to take an average, but this doesn’t work,” he said. “Do they take your average score at the Olympics? No. They take your personal best, and this is what I want. I want to know what the patient can do in his best state of health, which means his airways are completely clear.”
Peak Flow Values
The peak flow portion of the asthma diary consists of four color-coded sections: Green is indicative of excellent pulmonary health; high yellow is a sign of a mild asthma episode requiring the patient to look for triggers, use medications and slow down; low yellow indicates the patient should start using oral prednisone and/or cease work activity; and red indicates a full-blown attack which may require hospitalization.
In another book, The Asthma Guide for People of All Ages, Plaut discusses the seriousness of hitting the red zone. “If you can barely blow a peak flow and your respiratory muscles are exhausted from the work of breathing through blocked airways…you are in serious trouble and need medical help immediately, even though your symptoms may be improving,” he noted.
His asthma diary also has a section for medications, tailored specifically to each patient’s needs. Like most pulmonologists, Plaut advocates the use of inhaled steroids to clear inflamed airways.
There are favorites in his medicine chest. “I like using Flovent, because it comes in varying doses,” he said. “The idea is to clear the airways completely. Sometimes I have to start with a high dose; then I can reduce it by 25 percent. If the peak flow stays high, I can continue tapering off the inhaled steroids.”
Other medications are beta 2 agonists–both short- and long-acting ipatropium, oral steroids, and cromolyn sodium. They are adjusted to fit each patient’s reaction.
As a primary beta agonist, he prefers albuterol consisting of two parts: Levalbuterol, a pure isomer which opens the airways, and S-albuterol, although the latter can cause adverse side effects in some patients.
Numerous HMOs, including Kaiser Permanente, have consulted with him regarding his asthma plan, believing that if asthmatics use his One Minute Asthma, they can considerably reduce hospitalizations and emergency department visits.
Despite the HMO level of support, Plaut believes many health care professionals individually are resistant to adopting his plan. The people most likely to put his plan into practice are school nurses and hospitals where staff are interested in reducing costly admissions, he explained.
He recommends anyone suffering from asthma to read his One Minute Asthma and Asthma Guide for People of All Ages. Both are available through Amazon.com or www.pedipress.com.
Katherine Lesperance is an ADVANCE assistant editor.