“Doc, I’ll be out of the country in a week and I’ve have been having attack recently despite my meds! What do I do” ®v2010 2024 By Dr. Mac
First - are you in remission before you left? Never assume mild attacks before your intended travel will subside without your doctor’s follow-up care. When it occurs while you are in a far away place, not much can be done by your MD back home, and your local prescription may not even be honored in a foreign land. So, include the pre-travel pulmonary check-up in your list of priorities.
Check your peak flow pattern. What was your best blow? And do you have a recent one? Was it 15% or more lower than your best? If it is so, SEE YOUR DOCTOR before your fly.
Second, when you travel, find out first How’s the weather. The sad thing about checking today’s weather is that it is becoming as unpredictable as today’s typhoons and floods! Get weather update as travel date nears, even the date before flight date!
Check natural turmoil / local epidemics. Remember, majority of asthma attacks are caused by respiratory infections and if you decide to pursue your travel, you should be ready for its exacerbation – even for confinement!
Third, ask "What should you avoid? Whatever makes you worse locally is probably what can also make you worse in other places, plus the extra triggers over there that we don’t have here – like extremes of temperature A very common and almost certain observation is that going to less polluted areas relieve patients of their symptoms , at times they are able to taper their medications. (Reminder: if you do so, you must put them back about few days before traveling back to a densely populated place where pollution is a problem.) Don’t forget to ask your doctor what to take before you arrive back.
For my patients, there is a Travel Prescription being issued – go get a check-up BEFORE your travel date Fourth, know what your doctor can do before you fly/cruise. What I do to my patients is provide them an extended prescription of their maintenance medications (assuming they may extend their travel plans).
Under these prescriptions are Optional meds that include:[a] acute relieversfor acute attack’ [b] 2 sets of broad-spectrum antibiotics; [c] anti-inflammatory meds like steroid tablets;[d] a pack of anti-flu like Oseltamivir – among other meds – with explicit notes on what those meds are for , and advice to see local MD if symptoms persist. Buying these medicines before travel is not cheap – but having to go to an Emergency Room and get slapped Euro 300 or more is certainly more expensive!
Fifth, now comes your problem – you have asthma attacks despite your meds! What are your options? If internet signal is not a problem, get a teleconsult with your pulmo MD – assuming of course you have your meds choices with you, and it’s only a matter of knowing which meds to start when.
Meanwhile, DO NOT FORGET - DO NOT PANIC! Why? because if patients with obstructive airways problem (like asthmatics and COPDs) breathe fast during attacks, they will TRAP MORE air, and will worsen their symptoms. Breathing out should be looonnnger than breathing in – this should minimize air trapping. How do you it? Try it with a pursed lip. SIT UP , BEND FORWARD, with ELBOWS ON YOUR KNEES. Do not lie down. Why? From our middle chest bone structure, we have a long muscle called Rectus Abdominis that stretches all the way down to our lower belly area , and this muscle aids the chest muscle in breathing out – like a bellows system. For a muscle to work best, it should be allowed to contract or shorten in the most optimum position. Lying down prevents this muscle from shortening at its best.
Also, use the doctor-prescribed acute relievers - those airways maintenance meds are generally NOT rapid relievers and are therefore NOT for acute attacks. Some long-acting meds though like formoterol are also rapid relievers!
Better bring a portable nebulizer. With today’s technology, in your palm will fit a portable battery-operated / rechargeable unit, neb kit and mouthpiece included. IF you opt to bring the old reliable AC-plugged nebulizer - Check your hotel socket requirement because they vary in configuration depending on the countries.
Get that multiple adapter from the local home depot, or find them at the airport duty-free shops before heading for your hotel. Note that before you can use this, you may also need another adapter for your nebulizer which was converted to local applicability. Remember as well that some adapters allow you to use US or European equipments in Asia, but not necessarily vice-versa.
If your machine has a 220-110-volt option, you’ve may have no problem about power supply needs. (But, if it needs to be reset every time you change places of stay, recheck setting before plugging while abroad. Also, do not forget to reset the machine to local applicability when you bring it back!). Fortunately, most gadgets today though are auto-volt.
If you are to use a nebulizer in-flight, some preferred/de luxe regular seats have AC sockets, and you may have to consider that too. (Some airlines however, a patient shared to me, do not allow nebulization inflight!)
NOW, ANTIBIOTICS. You may have to bring some. In most countries, you cannot get over-the-counter antibiotics other than erythromycins, (and apart from paracetamols and some decongestants). The rest needs at least a hundred-fifty dollar consult (make it three or more times if you’re in a hotel). Your doctor will prescribe which will suit your needs. Just a reminder, asthmatics have mucus oversecretion already as part of the nature of the disease – so DON’T try any mucolytics (and any other pahabol pabaon cough meds by anyone). Same for expectorants - they will worsen the coughing in asthmatics.
If in case, you happen to be so short of breath despite your meds, remember the Emergency Numbers:
911 in US,
120 in China,
119 in Japan,
112 in Europe
999 or 112 in UK.
Also, remember that if you’re using a cellphone (at least for Motorola) in USA, pressing “1” for a few seconds automatically connects you to 911 service. (I was told it’s two thousand green bucks per 911 service, wheww!!!!).
Finally, Do you have a comprehensive health insurance coverage? There are local insurance companies that offer reimbursement types, in case you got confined but make sure it includes health, not just accident. Others are more comprehensive. (Schengen states require a Euro30,000 health insurance cover for each trip).
Watch out for Pre-existing conditions? Be prepared. There is no substitute for getting ready of cash or plastic money - just in case.
AND Don't forget to have those flu vaccine shots, and the pneumonia shots too! They are best received two weeks before the travel date.
Other than the above, enjoy your stay.
Have fun!
(Oh,, by the way , your doctor loves Music CDs , cap, Tshirt, ha ha.) Joke
Preparing Home 0xygen Set-Ups
Generally patient home oxygen needs are tapered to minimum required, and those patients who are short of breath and 02-requiring are better cared in a medical facility.
For home oxygen use, remember the set up - there are 2 types – one with usual oxygen tanks and the one with oxygen concentrators.
Oxygen tanks are heavily pressurized and are connected to a gauge – THIS GAUGE MUST BE CLOSED or OFF BEFORE opening the oxygen tank. Let’s repeat that statement – THE GAUGE MUST BE IN THE ‘CLOSED’ POSITION BEFORE THE OXYGEN TANK IS OPENED.
When having an oxygen tank at home, the tank preferably must have a stand to keep it secure -better yet if it is buckle-belted (not snap-on) to a post of the bed – turning an oxygenated patient connected to a nasal cannula/mask on may tilt the tank – any tall slim equipment has a narrow center of gravity and is prone to fall. Also, oxygen tanks cannot be tried on carpeted floor.
Don’t forget the floor where patient will stay – without lifters, bringing 02 tanks to higher floors will be challenging. Back pains for lifters and damage to wooden floors when rolling the tanks are other concerns.
Oxygen tank users should not be near ovens or lighted candles. (In other countries, having an 02 concentrators at home may need fire department clearance!!)
The second type of home oxygen set-up is the concentrator type – it is simpler and portable. Depending on versions, there are those that run on AC only. There are also AC/DC versions that patients can use in bedroom, or bring in the sala or dining – even in the vehicle.
And if the price is not an issue, there are those that can be carried on the waist like the old Walkmann with battery pack and be worn anywhere, even on planes.( For air travel use – have such concerns be discussed with your pulmo MD)
20 July 2024