Dealing With Asthma When The SHTF, by A.C.

HJL Notes: There are quite a few links in this article. Some are to procedures performed on YouTube. The reader should be warned that while SurvivalBlog made a “best-effort” to verify every link for the medical information, some also contained references to homeopathic and eastern medicine with some eastern religious gestures honoring a false god.

When I was about 14, my younger brother, who was 10 at the time, became seriously ill with pneumonia. It started out as a “chest cold”, but after a couple of weeks developed into a deep, body wracking cough along with a high fever. He went to the doctor, was diagnosed with a lower respiratory infection, and was administered antibiotics. He was told to stay in bed, drink lots of fluids, and take acetaminophen to control his fever, like anyone with pneumonia. Everyone expected that the medications would take effect and that he would bounce back. Instead, a few days later, he ended up in the hospital with a collapsed lung and a chest tube. He almost died. Over the next few months, he was plagued with lung infection after lung infection, as well as breathing problems, and he landed in the hospital several times for breathing treatments and oxygen. One of my earliest memories of this time was of visiting him in the hospital when he was lying face down with the lower half of his body propped up while the nurse was giving him a “percussion” treatment http://www.youtube.com/watch?v=nc3bK7i3FAM . (Percussion is a technique that helps loosen mucus and other secretions so they can be coughed up. It is usually used for pneumonia or cystic fibrosis.) The pneumonia and subsequent lung infections had taken their toll on his lungs, and ever since he has had to deal with asthma.

Fast forward to 1993. My son was born completely normal– normal weight, normal apgar, normal everything. Like all babies, my son usually would get fussy and want to eat when he woke up in the morning. However, one morning, when he was about two months old, I got up to check on him because he hadn’t made any noise. I found him with his eyes bulging, struggling to breathe. His breaths were so labored that I could see all of his ribs when he took a breath. (These are called retractions.) I grabbed him up, rushed him to the emergency room where he was diagnosed with RSV (Respiratory Syncytial Virus http://www.webmd.com/lung/tc/respiratory-syncytial-virus-rsv-infection-topic-overview), and put in an oxygen tent because his O2 level was so low. He stayed in the tent for over a week. When he was finally able to emerge from the tent, he was put on nebulizer treatments of albuterol (a bronchodilator) three times daily and a steroid inhalant to control his lung inflammation, plus weekly evaluations by a pulmonologist. He remained on these nebulizer treatments until he was old enough to use an inhaler. He was also diagnosed with severe environmental allergies. Since then, he also has had asthma. –

Today, both my brother and my son lead healthy, active lives. Both use a metered dose combination steroid and bronchodilator inhaler, and both take allergy medications on a daily basis. Neither have had a serious asthma attacks in years. They are able to exercise and participate in the same activities as other “normal” people, provided they use their respective inhalers morning and night to prevent lung inflammation and provided they avoid the allergens that trigger their asthma attacks. Both are allergic to cats, dogs, and birds. Both are allergic to dust and molds and have hay fever. Both also have other things that they are sensitive to, such as perfumes and certain chemical odors. Both have to take additional allergy medication to control their body’s reaction to allergens in the environment. However, in a situation where they couldn’t obtain their medications, they would quickly have allergic reactions, develop lung inflammations, which would lead to asthma attacks, and they would likely both die.

Even though I have lifelong experience with asthma as well as medical training, this article is written as information only. It does not constitute medical advice. You should always have a discussion with your medical practitioner and educate yourself about your personal health problems. Finding a medical practitioner who has a preparedness mindset is not always easy, but there are many out there. With the knowledge you accumulate by learning about your or your loved one’s health problem, you will more easily be able to have an intelligent and productive conversation about what you need to do to prepare.

Asthma is a lung disease where the lungs become inflamed and the air passages narrow, making it difficult to breathe. Since 2011, one in 12 people are diagnosed with asthma. This adds up to more than 25,000,000 people in the U.S. that suffer from the disease. http://www.cdc.gov/vitalsigns/asthma/. Internationally, about 300,000,000 people have asthma http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx, and many more don’t even know they have it. Of these people, about 3,500 people in the U.S. die from asthma every year, and 250,000 die internationally every year. Many deaths are due to people’s mismanagement of their disease, due to lack of medication or lack of medical care. However, in the U.S., once medications to control allergies and asthma run out, in a SHTF situation, people with asthma will not be able to survive.

There are a number of different categories of breathing problems. Most of them can fit into the following four categories:

• Inflammation lung diseases which include asthma, cystic fibrosis, emphysema, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS),
• Obstructive lung diseases, which include COPD and asthma,
• Restrictive lung diseases, which include pulmonary fibrosis and infant respiratory distress syndrome (IRDS), and
• Lung infections (both bacterial and viral), such as the common cold, bronchitis, and pneumonia.

Note that asthma fits into both inflammation and obstructive categories. http://en.wikipedia.org/wiki/Respiratory_disease . For the purposes of this article, I will focus only on asthma, which is usually a long-term, manageable problem. If you have other breathing problems, you will want to make sure you have a conversation with your medical professional about how to prepare for emergencies and extend their recommendations to cover you for longer lengths of time. Some of what this article covers will apply to all people who have breathing problems, but every individual is different with different needs. Make sure that a thorough conversation is had with your medical practitioner about your particular illness, and then do what you can to plan.

A note on infections: Most upper respiratory infections and about half of all lower respiratory infections (bronchitis and pneumonia) are caused by viruses. (The rest are caused by bacteria, and in the case of lower respiratory infections, you can add fungi and parasites as possible causes.) The treatment for these is usually bed rest, lots of liquids, an over-the-counter decongestant, acetaminophen or ibuprofen to control fever, time, and/or allergy medication. In a healthy adult with a healthy immune system, the illness is usually resolved within a couple of weeks. On occasion, especially if the patient becomes dehydrated, they are hospitalized. However, there is no “medication” that is effective against viral infections. (Occasionally, if the pneumonia is caused by a flu virus, an antiviral may be prescribed, but they only work against flu and not all viruses.) Using an antibiotic every time people have a cough (along with the routine antibiotic dosing of animals used for food) is what has led to some antibiotic resistant infections. http://www.cdc.gov/features/getsmart/ Of course antibiotics have their place, and we should prepare for bacterial infections, including respiratory infections, by acquiring them; however, they are not a cure-all. The often-prescribed Amoxicillin does not treat all infections, and simply dosing oneself with an antibiotic every time an illness occurs will not necessarily treat that disease. Learning how to diagnose disease, when to use antibiotics, and which antibiotics are used to treat specific bacterial infections is something that takes years of study. There are books that can be purchased that can help recognize certain symptoms, but often similar symptoms can indicate either a viral or bacterial infection. Antibiotics can also cause other serious problems if misused. http://www.livestrong.com/article/276230-side-effects-of-taking-too-many-antibiotics/ Make a concerted effort to include a medical professional in your preparedness group, and always consult with them before taking antibiotics, if at all possible. Additionally, do not self-treat with antibiotics unless it is a true SHTF situation, and you know what the illness is and what antibiotic to take for the illness. There are serious side effects that can occur with improper use of antibiotics, never mind allergies to antibiotics (which would open a brand new can of worms). Do your research and make a list of what antibiotics to use and what infections they will treat. Antibiotics are a crucial part of SHTF preparedness, however, it is also imperative that you know how and when to use them. http://infectiousdiseases.about.com/od/treatment/a/ant_choice.htm

Diagnosing asthma is not always easy. Most doctors will take a medical history and listen for several key factors, such as a family history of asthma and whether the patient has had breathing problems in the past. They will also listen to the lungs, have the person blow into a peak flow meter, have the patient breathe into a spirometer, obtain an arterial blood gas (ABG), and/or put a pulse-oximeter on one of the patients fingers to measure oxygen in their blood http://www.wikihow.com/Measure-Blood-Oxygen . They may also take a chest X-ray to see what might be visible in the lungs. They might also run a battery of allergy tests which include pricking or scratching the skin and inserting typical allergens into the wound. If there is a reaction, it means the patient is allergic, and that particular allergen could be an asthma trigger for them.

There are also telltale physical signs of asthma that the doctor will also look for:

• chronic cough (usually worse at night and in the morning),
• wheezing,
• chest tightness,
• shortness of breath, and
• breathing difficulties, brought on by a variety of things.

In a SHTF, a medical practitioner would not have access to X-rays, however, a preparedness group should purchase several pulse-oximeters and several peak flow meters. These are inexpensive and can help with diagnosis. Related to why there are more and more asthma diagnoses every year, some medical professionals have suggested that it is our ultra-clean living that is preventing our bodies from developing strong immune systems. Some have posited that there was less asthma when most people lived on farms and raised animals, thereby coming into contact with bacteria and developing resistance to infection. http://www.ncbi.nlm.nih.gov/pubmed/17263280 ; http://now.tufts.edu/articles/why-are-asthma-rates-higher-among-children-now . In a SHTF situation, there likely would be more outdoor work, which might reduce the incidence of new cases of asthma. It wouldn’t be prudent, however, to assume so.

No one really knows why some people get asthma and others don’t. However, once a person has asthma, it usually is life long and has no cure, although some seem to think they can “grow out” of it. http://www.pamf.org/asthma/overview/facts.html Most often asthma is associated with environmental allergies, and there is also evidence that it could be genetic. http://www.webmd.com/asthma/guide/asthma-triggers . Asthma usually starts in childhood, and it is often preceded by a lung infection or allergies. Once the damage occurs, the person will have asthma for the rest of their life. Managing the disease with medication makes it possible for the person with asthma to live a normal life.

Asthma causes chest tightness and wheezing when the person has trouble moving air in and out of their lungs. People with asthma often tend to be sensitive to dust and pollen, and they also tend to have allergies that trigger asthma symptoms. Asthma triggers can be a variety of things from dust to mites, smoke to illnesses, and even cold or exercise. http://www.cdc.gov/asthma/triggers.html . When the person with asthma encounters a trigger, the lungs react by becoming inflamed and producing mucus. Mucus production often occurs simultaneously with swelling and lung muscle tightening. Airways in the lungs are surrounded by small muscles, which become constricted and narrow the airway when a trigger is encountered. These three cause extreme breathing difficulties for the person suffering with asthma. Wheezing can be heard as whistling– the air gets blocked by swelling and mucus in the small airways. Symptoms of an asthma attack are wheezing, shortness of breath, coughing and chest tightness.

All people with asthma should have an asthma care plan that they set up with their doctor. This would include steps to prevent worsening of symptoms during an asthma attack. Most asthma care plans have three components:

1. Measure the person’s peak flow rate. This is measured by a peak flow meter, which has a mouthpiece the person with asthma blows into to raise a movable indicator of air flowing out of a person’s lungs. For information about using a peak flow meter, visit the following website: http://www.lung.org/lung-disease/asthma/living-with-asthma/take-control-of-your-asthma/measuring-your-peak-flow-rate.html. The person with asthma should periodically measure their peak flow rate, so they can know what their average is and then compare that to their measurement when they are having an asthma attack.
2. Identify the person’s asthma triggers. Learn how to avoid or manage these triggers.
3. Treat the asthma. This treatment will be something the patient and his or her doctor will set up, based on the symptoms and the peak flow meter measurement.

Often, there are early warning signs to an asthma attack. Maybe the person came into contact with a known allergen. Maybe an environmental trigger was present. Regardless of the cause, the person with asthma should recognize differences in their breathing to gauge whether the trigger is affecting them and whether they need to use an inhaler to prevent worsening of symptoms. Additionally, many asthma sufferers will begin to panic once they start experiencing shortness of breath, which itself can worsen symptoms. Imagine suffocation caused by one’s own body. Keep in mind that asthma (and all breathing problems) can be fatal, if not treated. The warning and danger signs are described here: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000062.htm

There are several treatments for asthma, which are outlined here: http://www.on.lung.ca/page.aspx?pid=404

Anti-inflammatory drugs are usually in the form of inhaled steroids. The person with asthma inhales the drug morning and night (or based on a treatment plan set up by a doctor) to help to control the inflammation in their lungs. With the inflammation under control, the person with asthma is less likely to react to asthma triggers. http://www.webmd.com/asthma/guide/asthma-control-with-anti-inflammatory-drugs Injectable and pill form corticosteroids are also used and should be discussed with your doctor.

Bronchodilators are medications that “open the airway”. There are long-term bronchodilators that keep lung muscles from contracting, thereby keeping the airway open. There are also short-term bronchodilators, which react quickly to help contracted muscles in the lungs relax to open the airway. These are used for asthma attacks. http://my.clevelandclinic.org/disorders/asthma/hic_treating_asthma_with_bronchodilators.aspx Combination medications are combination anti-inflammatory drugs and bronchodilators. http://www.webmd.com/asthma/guide/medications-trigger-asthma

An asthma attack should not be confused with anaphylactic shock, which is usually a result of coming in contact with a potent allergen. Some people with asthma do have allergies that will cause anaphylaxis. Anaphylaxis is usually treated with epinephrine, usually in the form of an epi-pen. If you have allergies that are this severe, it is a twofold issue: treating the life threatening allergy and treating the asthma attack that the allergy may cause. Ensure that you discuss allergies with your healthcare practitioner and that you have a treatment plan that you can administer yourself. http://www.anaphylaxis.org.uk/what-is-anaphylaxis/signs-and-symptoms . Untreated anaphylactic shock can cause death. Make sure that you discuss your particular needs with your preparedness group and stock up on anything you need to both prevent and treat your allergies. https://www.resus.org.uk/pages/reaction.pdf

Accumulating medications for people with asthma is a priority when preparing for a SHTF event. Explore all avenues to obtain the medication necessary. Make sure you keep in mind that you should have several backups in case of equipment malfunction. Additionally, keeping medication dry, dark, and cool is best for obtaining the longest shelf life. Alternative medications and herbs could also be explored, but they usually can’t be substituted for actual medication. The medications and equipment I would recommend to store are the following:

1. Obtain several peak flow meters and record the measurements. http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=peak+flow+meter&rh=i%3Aaps%2Ck%3Apeak+flow+meter
2. Purchase several pulse-oximeters and batteries for those meters. This will help you to monitor the amount of O2 that is in your or your loved one’s blood. http://www.aacn.org/WD/Practice/Docs/ch_14_PO.pdf http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=pulse%20oximeter&sprefix=pulse%2Caps&rh=i%3Aaps%2Ck%3Apulse%20oximeter
3. Purchase several nebulizers and nebulizer medications, particularly those that are “rescue medications” for asthma attacks. Combivent is one example of a short acting rescue medication that can be administered with a nebulizer. Talk to your doctor about which one is best for you. http://www.medicinenet.com/nebulizer_for_asthma/article.htm
4. Purchase oxygen concentrators and masks or cannulas for emergency treatment. You can often buy these used. http://easyoxygen.com.au/should-i-use-a-nasal-cannula-or-oxygen-mask-with-my-oxygen-concentrator/ http://asthmamomlife.blogspot.in/2012/05/oxygen-concentrators.html
5. Obtain enough of your beta2 adrenergic agonist medication to last for the SHTF event you are planning for. These are the medications that will help relax the muscles in your lungs, thereby opening your airway. An example of this is albuterol; however, there are a number of other medications. http://en.wikipedia.org/wiki/Beta2-adrenergic_agonist There is always a concern about expiration dates. However, my son has used expired albuterol inhalers, and they have worked fine. Often, people with asthma have several inhalers lying around and will grab one within reach if they start wheezing. My son has said that “old ones” (presumably out of date) work fine, but they “taste skunky”. I would hazard a guess that if inhalers are kept cool and vacuum packed they will be fresher than those that are found under the bed and out of date. http://www.healthcentral.com/asthma/c/52325/137060/expired-medicines/
6. Obtain enough corticosteroid medication. This is the medication that reduces inflammation in the airways. There are a number of these medications, but an example of this is Flovent. http://www.webmd.com/asthma/inhaled-corticosteroids-for-long-term-control-of-asthma . Again, keep your stockpiled medication cool, dry, and dark for maximum shelf life.
7. Talk to your doctor about obtaining anticholinergic combination medications, as either an inhaler or nebulizer medication. These are usually reserved as rescue medication in severe asthma attacks, and for asthma are combined with another medication, such as albuterol (a Beta2 agonist). An example of an anticholinergic is ipratropium. http://www.webmd.com/asthma/anticholinergics-for-asthma
8. If you use a combination medication, such as Advair, obtain enough medication to last for a SHTF event. Again, read the article about using expired medications and use your judgment,
9. Purchase several inhaler spacers. A spacer helps to “hold” the medication longer, which makes it easier to breathe more of it into your lungs. This is especially helpful for children. http://en.wikipedia.org/wiki/Asthma_spacer
10. Obtain enough steroids in tablet form and/or in injectable form. Make sure you talk to your doctor about which options are best for you. These could be as emergency backup or used for asthma that needs supplemental corticosteroids. Tablet form steroids, particularly if you vacuum pack them, likely could last much longer than inhaled or injectable corticosteroids.
11. Obtain enough allergy medications and antihistamines that you use consistently or frequently. Obtain prescription medications, but also their over-the-counter counterparts. Often it’s just a matter of strength. You can always double up, if it’s the exact same medication. (Check with your doctor.) Also, talk to your doctor about other medication options. If one can’t be obtained, what others could be used? Again in regards to storage, vacuum packing and keeping medication dark, dry, and cool is the key for preserving potency.
12. Obtain several epi-pens in the case of severe allergy. There has been a study done about the effectiveness of epinephrine used past its expiration date. http://www.ncbi.nlm.nih.gov/pubmed/10808186 The conclusion is that as long as there is no precipitate (floaty stuff or cloudiness) in the liquid, it can be used. However, try to ensure you consistently obtain epi-pens, and keep them in date by rotating them. Don’t throw out the ones that are out of date though, and make sure you refill your prescriptions, even if you don’t use them so you have a stockpile. Check that the liquid is clear, and keep the pens cool. Always store epi pens in their carrier tubes. Just make sure you check them frequently.
13. Ensure that everyone in your preparedness group is trained in CPR. On occasion, an asthma attack can worsen and the person with asthma can stop breathing.
14. Obtain additional emergency equipment, such as blood pressure monitors (or sphygmomanometer and stethoscope), IV fluids, and sets, as well as emergency breathing equipment and the training to administer them. (There are some serious risks with using these things inappropriately.) There are a number of medical preparedness trainers around the country, as well as community colleges that can give you medical training. If you or your loved one has a medical condition that might require specialized knowledge, now is the time to get it.
15. I recommend Asthmanefrin, with reservations. It is a bronchodilator that helps to open the airway. It is fast, acting in five minutes or less, so it can be helpful in an asthma attack, but is not recommended for long-term use. It is actually not the drug of choice for asthma. If there is nothing else available, having this “inhaler” might be better than nothing, but it is quite expensive, and the plastic parts have had a tendency to break. There have also been other serious medical issues associated with this product. http://www.fda.gov/drugs/drugsafety/ucm370483.htm . If you decide to stock up on this drug, educate yourself on when and how it should be used.

Make sure you are familiar with the side effects that asthma medications can have, as well as medications to avoid when you are using asthma medications. Side effects of some asthma medications can include rapid heartbeat, shakiness, nervousness, dizziness, headaches (in the case of bronchodilators http://www.ventolin.com/risks-and-sideeffects/index.html), and bone density issues, weight gain, thrush, and others with corticosteroids http://www.asthma.partners.org/newfiles/BoFAChapter44.html . There are also some over-the-counter medications that are not recommended for people with asthma. My brother and son have not had any problems with their medications, but they have been told to avoid aspirin and ibuprofen. Just remember that not all medications affect all people the same way. Make sure you talk to your doctor about any side affects you may experience now or in a SHTF situation, and know how to deal with them. You should also talk to your doctor about how to deal with a serious side effect, if normal medical services are interrupted. Bring up weather issues such as Katrina and Sandy as well as the flooding in Colorado to help start the conversation about what to do if you can’t get to a medical facility.

Alternative asthma treatments are often sought by asthma sufferers. The thought of having to take lifelong medications, some that cause side effects, is not appealing to many. In a SHTF situation, alternative medication could be something that compliments and possibly extends prescription medications. http://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-treatment/art-20044554 . My brother swears by yoga and meditation, which help him relax. He also says that drinking strong coffee has helped lessen his symptoms, especially if he wakes up wheezing. He fixes himself a pot of strong brewed coffee and says that by the time he is done drinking two cups, his wheezing is nearly gone. My son prefers caffeinated sodas, though I prefer him to not have the sugar and chemicals. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010864/ Some people have looked at herbal remedies such as ephedra as well as special diets. Page three of this article offers some solutions from the kitchen cupboard, refrigerator, drawer, and spice rack: http://health.howstuffworks.com/wellness/natural-medicine/home-remedies/home-remedies-for-asthma.htm. Also, there are some herbal/homeopathic solutions offered here, but physician or herbalist supervision is recommended: http://life.gaiam.com/article/7-nondrug-asthma-treatments-5-herbal-remedies . Do your own research and work with a medical practitioner while trying them. You or your loved one may be sensitive to some of the treatments and may need allopathic care, if you have an asthma attack. There are also some over-the-counter as well as alternative medications that some people with asthma are sensitive to and, therefore, should never use. Keep in mind that some medications will affect some people, yet not affect others. Make sure you recognize the ones that you or your family members are sensitive to and talk to your doctor about what over-the-counter medications are safe for you to use.

In a SHTF situation, an asthma attack would be life threatening. If the person with asthma recognizes the symptoms and treats them with his or her quick-acting inhaler and they are still experiencing worsening breathing difficulties, the usual procedure is to call an ambulance and be transported to the nearest emergency room. There are things the hospital can do to that are not available at home: http://www.asthmaaustralia.org.au/About_asthma/What_happens_in_hospital.aspx

So, what if emergency services are not available? Having emergency treatment equipment, such as O2 concentrators and nebulizers with a fast-acting combination medication as well as additional medication and equipment, might make the difference between life and death in a SHTF situation. Sometimes, a person suffering from an asthma attack might need additional breathing support. Speak with your medical practitioner about potential emergencies. Talk to them about what you could do at home, if there was a weather situation that prevented you from getting to a hospital in the event of an asthma attack. If you approach your doctor this way, even if they don’t have a preparedness mindset, they won’t think you are a whack job. Be calm and logical with your concerns. Using weather events and their after effects as a starting point to obtain additional medication will usually make a difference with how your doctor perceives your concerns. Concrete facts about overwhelmed hospitals and clinics after Katrina and Sandy or impassible roads during snowstorms or floods should be how you begin the conversation. Talk to them about how you can effectively treat a full-blown asthma attack during these times, particularly because these times will be extremely stressful, which could bring on an asthma attack in itself. You might also consider talking to your doctor about obtaining additional supplies saying that you are going to take a trip overseas. You could also ask what you can do if you are not able to obtain emergency treatment in a foreign country without adequate medical facilities. Their answers could help you start developing your own emergency plan for SHTF situations. If you talk to them about a short-term emergency situation, you can take their advice and extend it for a longer period of time to plan for longer events.

Equipment, such as oxygen concentrators, pulse oximeters, and nebulizers, can easily be purchased online. The medications needed for a nebulizer would need to be prescribed by a medical practitioner, but using the above suggestions to have the conversation about at home emergency treatment would be a good way to talk to them about obtaining additional supplies. Looking at ways of producing electricity to run this equipment will also be vital in a grid down situation. An easy way is to purchase a generator and store fuel for it, but alternative means of generating electricity should also be explored, such as purchasing a solar array.

It is also extremely important that a person with asthma take charge of their condition and prepare for long-term SHTF issues. Staying as healthy as possible– eating a proper diet, developing an exercise program, and building their general health– should be a priority for asthma sufferers. Ultimately though, if the person has not taken stock of their health, in a long-term SHTF situation the outcome is dire. Do what you can to prepare, and stockpile all the medication you or your loved ones need to lead as healthy of a life as possible.