(515) 224-1777 Pulmonary and Infectious Disease

(515) 224-3948 Sleep Medicine

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Frequently Asked Questions

Q: What should I do if I cannot keep my appointment?

A: If you cannot keep an appointment, you should call the office as soon as you know that you are going to miss it. Too frequently we are notified of a cancellation after the appointment time has passed, or worse, not notified at all. This courtesy on your part and makes it possible for us to give an appointment to another patient who needs to see the doctor.

Q: Will there be a lot of questions to answer at my appointment?

A: You will be asked for information that is necessary to provide your care. Your address and phone number are needed in case the doctor writes prescriptions for you. Information concerning your occupation, age, and other statistics is important because it has a bearing on your health and physical status. This information is also required for insurance claims made by this office. This information must be regularly updated.

Q: How do you determine which patients get called in first?

A: You may be disturbed to see patients called in ahead of you, even though you have been in the waiting room longer than they were. These are patients the nurse is taking care of under the doctor's supervision. They may be getting blood pressure checks, laboratory examination, injections, or x-rays.

Q: My child always seems to have a cough. It never goes away and lingers even if treated with antibiotics. What's wrong?

A: A cough may be an indication of a simple cold due to a viral or a bacterial infection (bronchitis). A cough that persists may be due to some other condition such as sinusitis, postnasal drip, or acid reflux from the stomach. Persistent or recurring cough may also be a reflection of bronchospasm (swelling and constriction of the bronchial tubes). This process may occur intermittently or in patients with asthma. Any persistent cough should be evaluated so that a correct diagnosis can be made and proper treatment started to minimize or prevent long-term complications. An accurate diagnosis can be made in one or two visits with or without some simple breathing tests.

Q: I'm new to Iowa, 28 years old, and have been recently diagnosed with asthma. Who should take care of me?

A: Asthma afflicts 15 million people in this country and produces symptoms in all age groups. Although effective, readily available therapy is consistent with its results, many asthmatics suffer needlessly. Family physicians, internists, and pediatricians, as well as pulmonologists and allergists, care for patients with asthma. Training and experience in asthma management are uneven. Asthmatics should have at least an initial evaluation by a physician trained to diagnosis and manage the spectrum of asthma from mild to life threatening.

Asthma care must be individualized to be effective. Patient education regarding medications, monitoring devices, environmental control measures, exercise, and warning signals for worsening asthma is critical. Patient phone calls and urgent office visits must be readily accepted by a comprehensive asthma-oriented office. Effective treatment comes from a detail-oriented physician who has the time, interest, and training to sort out unusual exposures, occupational risks, and psychosocial factors that can play key roles in asthma.

Q: What does asthma feel like?

A: You can get an idea of what asthma feels like by trying the following. Put one end of a straw in your mouth and curl your lips tightly around it. Then totally clamp off your nose with your fingers and breathe. This is what a person experiences when asthma is not controlled.

With an asthma attack, the airways become swollen and reduce the hollow space inside where the air you breathe flows through. This inflammation causes the airways to become hyper-responsive or to overreact. There are also excessive contractions of muscles that surround the airways, literally choking these tubes and making it difficult to breathe.

Excess mucus can also build up in airways during an attack. Special cells called goblet cells keep the tubes constantly "oiled" with mucus, which makes it easy to clear out debris. However, when asthmatic inflammation develops, too much mucus is secreted, plugging smaller airway tubes.

Q: I have asthma. Should I be concerned about my lungs getting worse as I get older?

A: The best answer to that question is to cite recent medical literature regarding the natural history of lung function in asthma. A study that appeared in The New England Journal of Medicine in October 1998 refers to a 15-year study of 17,000 adults in Denmark. This study found that asthmatic patients had a greater drop in the one second forced expiratory volume than non-asthmatic subjects, yet this amounted to only a decrease of an additional 16 cc per year. However, for a 20-year-old who has asthma until age 70, that can result in about 800 cc of lost volume. This study also showed increased loss of lung function in patients with asthma who smoked or who had excess secretion of mucus from their airways amounting to about a quart in 60-year-old men over their lifetime.

This information suggests long-standing asthma may cause irreversible lung injury. We do not know whether the medications used for the treatment of asthma reduce this decline, but we do know that it helps maintain lung function to its optimal level, at least in short-term. It will take long-term studies to answer your important question.

Q: How significant is a concern of secondhand smoke to an individual with asthma?

A: Although an emotional issue, this form of air pollution is a relevant factor to people with asthma as a documented trigger in making their asthma worse. This is especially worrisome in children whose lung size is smaller, thus making the concentration of exposure greater. Significant medical data has accumulated to support the conclusion that secondhand smoke offers real harm to patients with this form of lung disease and adds to the burden of airway inflammation that characterizes asthma. Fortunately, this message is reaching more of the community with the help of various media resources.

Q: I have asthma and am using several inhalers and sometimes need courses of oral steroids. Are there any new treatments for asthma?

A: Yes there are. These medications are leukotriene modifiers and are the first new class of asthma treatment available in the past 20 years. Leukotrienes are substances that cause airway smooth muscle constriction, inflammatory cell recruitment, tissue swelling, and mucus secretion in the lung. There are currently three leukotriene modifiers available. These medicines have been shown to reduce asthma symptoms and bronchodilator inhaler use, block exercise- and cold air-induced wheezing, reduce the frequency of asthma attacks by 60 to 80%, and nearly double symptom-free days, while cutting in half absences from school and work.

Leukotriene modifiers have been recommended as an alternative therapy for long-term control in patients with mild, persistent or more severe asthma. These medications are not recommended for quick relief of asthma.

Q: I have several friends with asthma—some do well with attacks and some end up in the hospital often. Why the difference?

A: Despite recent advances in understanding the cause of asthma and in developing better therapies, mortality has continued to rise since 1980. Many risk factors have been identified, but there is agreement that most asthma deaths could be prevented if patients were treated adequately. Available evidence suggests that patients and physicians continue to underestimate the severity of asthma attacks. A study recently published from the University of California, San Francisco, identified seven reasons for treatment delay: (1) Uncertainty or the inability to know how severe the episode was or what to do about it; (2) disruption or interference with the stream of everyday activities; (3) minimization or refusal to believe an episode is serious; (4) fear of taking steroids; (5) fear of going to a hospital ER; (6) a need to "tough it out alone"; and (7) lack of economic resources. Some of these reasons are modifiable. Clear directions from health professionals to guide patients responding to acute asthma episodes are needed. Asthma action plans written by the physician may be a positive agent of change for those who delay.

Q: Why is it that 3 to 4 times per year, a routine cold results in several days to weeks of a productive cough and shortness of breath on exertion? My family places blame on smoking.

A: Your complaint is a common one in the context of an individual who may be showing signs of overt toxicity to the lungs from ongoing smoking. If this has been occurring for the past 2 to 3 years, then you may fit the definition of chronic bronchitis, a well-known sequelae of cigarette smoking and a compelling reason to quit. Further evaluation of this problem allows for a specific diagnosis and treatment plan.

Q: Does anyone get better with emphysema or it is progressive—keeps getting worse? Is there any exercise you can do for lungs?

A: The natural history of emphysema is one of slow progression as a reflection of the aging process that robs all of us of minor portions of our lung function. This is of greater significance in someone with chronic lung disease. One key feature that will aggravate this issue of progression is inactivity, and thus a comprehensive pulmonary rehabilitation program that provides education and advice on an appropriate exercise program could be of great value. Walking has proven to be a most useful exercise for this illness with the proviso that the possible need for supplemental oxygen is assessed before embarking on such a program.

Q: Are such interventions as a flu shot or pneumonia vaccine a waste of time for people with chronic lung disease?

A: The opportunity to lessen the severity of influenza, bronchitis, or pneumonia is most effectively achieved via vaccination. Certainly, anyone with chronic lung disease has the potential for deriving benefit. The flu shot does not guarantee that you won't catch the flu, but for people with compromised lung function, it can often make the difference between suffering a severe illness requiring hospitalization and suffering a less severe illness at home. Occasionally, vaccinations make the difference between living and dying for people with this illness. The same may be true for the pneumococcal vaccine, which is likely more under used than the flu vaccine. The pneumococcal vaccine helps reduce the severity of illness of the most common bacterial pneumonia encountered in the community and the elderly. It requires a booster injection every five years. The influenza vaccine requires annual administration for effectiveness and is directed towards a virus.

Q: I am traveling to Costa Rica and Brazil in two months. What health precautions do I have to take?

A: Traveling to other parts of the world can be a fun and rewarding experience. It can also expose you to physical and biological threats to your well-being. Travel medicine consultants are well versed in helping you deal with these potential threats.

Brazil and Costa Rica post unique and complex physical and biological threats. The infectious diseases you would be potentially exposed to include typhoid fever, yellow fever, schistosomiasis, and Chagas' disease. The physical threats include heat, humidity, the sun, pollution, and any underlying medical conditions of your own. Various prophylactic medications and vaccinations are required.

Specific issues related to your travel, valuable knowledge about your health risks, and how to ameliorate these risks when you travel abroad should be discussed individually.

Q: I am leaving on a trip to Mexico. I plan on visiting many of the famous archaeological sites. What precautions do I need to take?

A: Mexico presents a higher risk than the United States in terms of acquiring tropical and subtropical diseases. By far the highest risk is for traveler's diarrhea. Traveler's diarrhea is best avoided by taking meticulous food and water precautions.

Insects borne diseases are also high on the list. Malaria is a major concern. The rural areas of Oaxaca, Chiapas, Guerrero, Campeche, Quintana Roo, Sinaloa, Michoacan, Nayarit, Colma, and Tabasco provinces have a high risk for malaria transmission. Visitors to these areas require malaria prophylaxis and personal protection against insect bites. Many archaeological sites are in these risky areas. Other insect borne diseases to be aware of include cutaneous and visceral leishmaniasis and dengue fever.

Q: Recently, my sister was diagnosed with pulmonary hypertension. Do I need to be screened?

A: Yes. There is potential for pulmonary hypertension to cluster in family members. There are many causes of pulmonary hypertension that can lead to breathlessness, chest pressure, and even fainting. A thorough evaluation should be conducted for pulmonary hypertension on anyone, particularly those under 40 years of age and who complain of breathlessness.