Vinegar for GERD?

An interesting question from the message board:

Q: I have read in several publications that a person should take a couple of spoon fulls of vinegar for their heartburn instead of meds...Is this true or is there more to this then I have read?

A: I believe that one should take no more medicine than necessary to treat most diseases. The best drug-free GERD therapies are to lose weight, don't eat or drink during the two hours prior to bedtime, and raise the head of your bed by six inches.

The next cheapest and safest GERD therapy is to take antacids. If those therapies don't work, then the first generation acid blockers are a good next choice. If those aren't effective, then the relatively new PPI drugs block almost all production of stomach acid for more than 24 hours. However, daily use of PPIs for months to years is expensive and does slightly increase the risk of getting pneumonia.

Related Topics: Heartburn Drugs May Cause Diarrhea, Barrett's Esophagus: More Patients?

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Adult Onset Asthma and Exercise

Q: I had asthma as a child but "outgrew it". I've recently started running for exercise and am having a lot of trouble breathing. Has my asthma come back or is it something else? Should I lay off the running and give my lungs a break?

A: Most folks with asthma as children also have asthma as adults, but they may have learned to avoid the factors which trigger their asthma. About half of adults with asthma have allergic triggers, but the vast majority have exercise-induced bronchospasm (EIB) when they exercise vigorously in cold or dry air. Your symptoms shortly after a bout of exercise sound just like EIB (not poor conditioning).

Are you currently taking any asthma medications? Consider going to an allergist or pulmonary doc and asking for a new asthma evaluation, which will probably include spirometry. Once asthma is confirmed as the cause of your exercise symptoms, the doctor will probably prescribe an inhaled corticosteroid and an albuterol (rescue) inhaler. Using the albuterol 5-20 minutes BEFORE you begin your exercise is highly likely to prevent EIB. If not, there are several other approaches to prevent it (see my FAQs). Please let us know the results.

Related Topics: Worst 100 Cities for Asthma, Everyday Pain Relief with Asthma

Technorati Tags: asthma, outgrowingasthma, asthmainhalers

Primatene Mist or Albuterol?

I've always been told that Primatene Mist -- an over-the counter (OTC) epinephrine (adrenaline) metered-dose inhaler (MDI) -- was less effective and more dangerous than Albuterol as an asthma rescue inhaler. However, a new multi-center study [Hendeles L] funded by the National Institutes of Health proves that I was wrong (at least for young adults with asthma).

For nighttime asthma attacks, lung function and symptoms improved just as fast, improved the same average amount, and the improvement lasted just as long after patients took several puffs of Primatene Mist as when they took several puffs of albuterol on a different night. Unexpectedly, average pulse rates went down after Primatene Mist, but up after albuterol. Blood potassium levels fell lower after albuterol than after Primatene Mist, further evidence that the adrenaline inhalers were safer than the albuterol inhalers. Similar studies have not been done in children or older adults, but should be.

If you have mild asthma and have run out of your prescription albuterol and can't afford to see a doctor for a new prescription, then now may be the time to buy a few canisters of Primatene Mist or generic epinephrine inhalers, because an FDA committee voted 11 to 7 a couple of months ago to recommend that it be taken off the market. About 5 million were sold last year for about 12 dollars each.

Note that there was also a recent shortage of albuterol (Proventil, Ventolin, or generic 6 dollar) inhalers, which may again occur because the FDA has announced that traditional MDIs which use CFC propellants must no longer be sold in the United States after December 2008, so apparently companies are reducing their inventories.

I think that the rationale, "CFCs reduce the ozone layer" is ridiculous because the total effect of medicinal inhalers on ozone is probably one millionth of that due to military and industrial activities.

I am concerned that somebody is planning to "put the squeeze" on folks with asthma during the next couple of years by forcing them to get a prescription for the new HFA inhalers. This action will both reduce ready availability and cost much, much more than Primatene Mist does now.

Who will benefit? Write your congressman and local newspaper if you are one of those who will suffer. While you are at it, ask why no generic corticosteroid inhalers are available yet for poor folks with moderate to severe asthma.

Related Topics: 2-Drug Strategy May Improve Asthma, New Warnings for 3 Asthma Drugs

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Singulair for Hayfever?

Singulair has become a popular choice for those who would otherwise suffer from asthma most of the time, probably because it is a convenient, once-a-day pill instead of another inhaler. It is also perceived by patients and parents as safer than corticosteroid and bronchodilator asthma inhalers.

During the past couple of years, Singulair has also been marketed for hay fever (allergic rhinitis). However, a study published last month, authored by ENT specialists from Chicago, demonstrated that Singulair, a which costs 3 dollars a day by prescription, was no more effective than sustained-release 240mg Sudafed, an over-the-counter decongestant capsule which costs less than one dollar.

Sudafed was slightly more effective at reducing nasal congestion during the September allergy season in Chicago, and was no more likely to cause side-effects than Singulair.

Homeopathic treatments (equivalent to a placebo) also work rather well for hayfever (allergic rhinitis, sinusitis, and conjunctivitis). A Merck-funded study published in December 2005 [Patel P] showed that 6 weeks of a placebo pill substantially reduced hayfever symptoms in 53% of 1000 adult patients while Singulair did the same for 58% of the other 1000 patients, randomized at 122 medical centers in the United States and Europe. While the difference between 53% and 58% was "statistically significant," the much higher cost of Singulair doesn't seem to me to justify the slightly improved chance of effectiveness. Placebos are also much less likely to cause worrisome dreams than is Singulair.

Patients in the U.S. spend more than 6 billion dollars each year on prescription medicines for hayfever [Yawn, Medscape 2006]. Most of this money is probably spent on non-sedating antihistamines, such as Zyrtec, Clarinex, or Allegra; and for nasal corticosteroid sprays, such as Beconase, Rhinocort, Nasalide, Flonase, Nasonex, or Nasacort. These all cost somebody (patient or insurance) about 75 dollars per month.

However, non-prescription generic Claritin is usually just as effective as the prescription antihistamines and only costs about 3 dollars a month. Rinsing the nose with salt water, such as Sinus Rinse, is even less expensive, often effective at relieving nasal congestion, and has no side-effects. Long-acting nasal decongestant sprays, such as Afrin and generics, can also be used safely for up to ten days, and cost less than 6 dollars for a bottle without a prescription.

In my opinion, people like me with allergic rhinitis should first try the low cost, non-prescription treatments, starting with allergen avoidance, then saline rinses, then generic Claritin, before asking their doctor for an expensive medication.

Related Topics: Plagued by Pollen, Allergy Proof Home Guide

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Adult-Onset Asthma

Adult-onset asthma is rather common, and often initially misdiagnosed as recurrent attacks of bronchitis. Asthma and bronchitis share most of the same symptoms, except that shortness of breath is not due to simple bronchitis.

Since asthma therapy usually works very well at relieving shortness of breath, it's worthwhile going for a diagnosis. In the meantime, ask a local pharmacist about a Primatene Mist inhaler (which does not require a prescription). If using it quickly relieves your respiratory symptoms, then they were probably due to asthma. If you are a smoker, be sure to ask for help to stop, as this will improve both bronchitis and asthma.

If problems breathing occur during a meal it could be due to acid reflux, inhaling some food into your lungs, or a food allergy (rare).

Get an evaluation by a pulmonary specialist or allergist, who will confirm the diagnosis, and probably place you on a good asthma controller (such as an inhaled corticosteroid). Keep asking lots of questions until the cause of your symptoms is confirmed and you are treated effectively.

Related Topics: Dust Mites Elude High End Vacuums, 100 Worst US Cities for Asthma

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