What is dry powder inhaler (DPI)?

Dry powder inhalers (DPI) are an alternative to the aerosol-based inhalers commonly called metered-dose inhalers (or MDI). The medication is commonly held either in a capsule for manual loading or a proprietary form inside the inhaler. Once loaded or actuated, put the mouthpiece of the inhaler into your mouth and take a fast, deep inhalation and hold your breath for 5 to 10 seconds. Most DPIs rely on the force of inhalation to allow the powder to go from the device and break into aerosol particles that are small enough to reach the lungs. Insufficient inhalation flow rates may lead to reduced dose delivery. DPIs are normally used in older children and adults. Some powder inhalers use lactose to aid in powder uptake from the device during inhalation. The amount of lactose delivered by dry powder inhalers is typically less than a few milligrams and such small doses do not lead to clinically relevant concerns of adverse effects in lactose intolerant patients. DPI medication must be stored in a dry place or sealed packaging, since exposure of the powder to moisture degrades the ability of the device to disperse its medication as an aerosol upon inhalation.

I have been told that I need skin testing. Will it hurt?

Skin testing is a very quick, convenient and accurate way of assessing whether someone has allergies. The testing is done on the forearms or on the back. Small plastic devices with a sharp tip are dipped in the testing fluid, pressed onto your skin and then removed. There is no needle insertion, and usually minimal discomfort. Most people are pleasantly surprised at the speed and ease of the test. If your child will be skin tested, you can try to approximate how it might feel by using a bristly hairbrush and pushing it down on his or her back. A positive skin test looks like a mosquito bite and does itch. The reactions begin to resolve after they are wiped off about 20 minutes after they are applied.

I have been told I have acid reflux. What should I include/avoid in my diet?

People who have gastro-esophaghageal reflux disease (GERD) may need to avoid certain foods to help improve their symptoms. The following foods/beverages may trigger reflux and should be avoided if possible: caffeinated drinks, alcohol, carbonated drinks, chocolate, mint, spicy foods, tomato products, onions and citrus fruit.

What are the pollen seasons in Willamette Valley?

Cedar and pine can begin to pollinate as early as December. Starting in January, many other trees begin to pollinate, such as hazelnut, juniper, cypress and spruce. The next group begins in February: alder, birch and elm. The last group to pollinate in March/April includes oak, sweet gum, sycamore, cottonwood, maple, ash, hickory-pecan, beech, locust and walnut. The next pollinators are grasses. Usually the grass season is at its peak from Memorial Day (end of May) to Fourth of July, but depending on the climate can shift a little earlier or a little later. The Willamette Valley has very high grass pollen due to nearly 500,000 acres of land used for commercial production of grass seed. The last group of pollinators is weeds. Typically, these pollinate toward the end of summer and into fall, until first frost. People who have allergies to perennial allergens such as feathers, animal dander, dust mites or mold may have symptoms year-round. Symptoms may be worse during colder weather with increased indoor exposure.

I was told to use saline nasal rinses. Can I make these myself?

Pre-made saline packets are available over the counter, or can be homemade using the following ingredients. To mix daily: ¼ to ½ teaspoon table salt (adjust to your comfort, using less if it stings) plus ½ teaspoon baking soda added to a pint of warm water (water does not need to be sterile). To mix and store dry: 1 part salt and 1 part baking soda. When mixing with warm water, use ½ to 1 teaspoon of salt/baking soda mixture per cup of water.

I have all the symptoms of hay fever, but I was told I am not allergic. What is the cause of my symptoms?

Allergic symptoms can be caused by irritants such as strong odors/fumes (perfumes, detergents, cleaning products, paints, gasoline), diesel particulates, smoke (for example, cigarettes, smoke from field burning or wood stoves), alcoholic drinks, aspirin, and even some medications such as beta-blockers, which are taken for high blood pressure. We cannot skin for test irritants like we can allergens, but avoidance of these things may help reduce symptoms.

I can't drink milk. Does this mean I am allergic to milk, or is it lactose intolerance?

The answer to this question comes down to the difference between an allergy and intolerance. An allergy is an immune hypersensitivity to a particular allergen, and usually causes an immediate reaction that typically includes itching and may include other symptoms, such as difficulty breathing, swelling, low blood pressure, and hives. People who are allergic to a food cannot ingest even small amounts of the food without risking an allergic reaction. Those who are allergic often will have a positive skin or blood test when given a small amount of the food. This type of person will need to be careful to avoid all forms of such food. This is different from intolerance, which means your body does not easily or effectively process the food. Intolerance can lead to gastrointestinal symptoms, such as bloating, abdominal pain and sometimes vomiting or diarrhea. People who have lactose intolerance will have a negative skin test to milk and often can tolerate small amounts of dairy products and normal amounts of lactose-free dairy products. They are not at increased risk of having a severe allergic reaction with eating dairy, but simply may not feel good.

I don't have allergies, so why do I have asthma?

Allergies, asthma and eczema are genetically linked diseases. It is possible to have one, two, or all three.

I have very allergic skin. Should I use "natural" products?

Many individuals with allergic-skin conditions have the misperception that natural skin products will be better and cause less itching or rash. However, many natural products contain proteins from plants that can be recognized by your immune system and cause a hypersensitivity reaction. Aloe vera is a commonly added plant product that can cause a contact dermatitis (itchy red rash) with frequent use. Many over-the-counter hydrocortisone creams contain aloe vera. For those with sensitive skin, eczema or hives, aloe vera should be avoided. Also know that skin products that contain food oils or proteins might potentially cause sensitization to food, leading to a food allergy. For instance, many over-the-counter (OTC) creams contain nut oils, and these may not be the best choice for infants with eczema who are at risk of developing food allergies. Two OTC creams that do not contain botanicals or food oils/proteins are Aquaphor and Vanicream. Skin reactions can occur not only with new products, but also from products you may have been using for some time.

How do I know when my inhaler is out?

Unless your inhaler has a counter, it can be difficult to know when your inhaler is empty. Shaking it to listen for the sound can be misleading, as there may still be propellant without medication. Using the “float test” is no longer recommended and may damage your inhaler. The easiest way to tell how many puffs you have left is to put a sticker on your inhaler and simply mark it each time you use it. Your inhaler will be labeled with the number of puffs it contains.

How do I clean a metered-dose inhaler?

About once a week, remove the metallic canister from the plastic container and run warm water through the container, and let it air dry. This will remove any clogs from the nozzle, so that the inhaler will work well when you need it.

How do I use a metered-dose inhaler (MDI)?

1. Shake the inhaler.
2. Remove the cap.
3. Breathe out normally.
4. Open your mouth wide and place your lips firmly around the inhaler. Keep your tongue relaxed and down. Another technique is to hold the inhaler 1-2 inches in front of your open mouth.
5. Begin to take a slow, deep breath through your mouth as you squeeze (activate) the inhaler as you continue to breathe in.
6. Continue to breathe in until your lungs are full, and then hold your breath for 10 seconds, if possible.
7. Breathe out normally.
8. Wait one minute then take a second puff in the same manner.
9. Be sure to re-cap the mouthpiece when finished.
10. If the medicine you took was steroid-based, be sure to rinse your mouth out and gargle after use.

How can I tell if this sinus pressure is from allergies, a cold or a sinus infection?

Allergies: Sinus pressure, nasal congestion and runny nose may occur during an allergy flare. The nasal discharge in allergies is usually clear and watery. The symptoms can be treated with an increase in allergy medications.

Colds: An upper respiratory infection, commonly known as a cold, usually last about 10-14 days, and is often accompanied by other symptoms of illness such as a sore throat, thick, colored nasal discharge, fever and muscle aches. Decongestant medications and sinus washes are helpful in relieving symptoms of a cold or a sinus infection.

Sinus Infections: Sinus infections can cause a headache and pressure in the forehead or around and under the eyes. Nasal congestion and colored discharge is also a common symptom. A virus or bacteria can cause a sinus infection. Many sinus infections are over-treated and resolve in the same amount of time without an antibiotic. Viral infections do not respond to antibiotics. Decongestant medications and sinus washes are helpful in relieving symptoms of a cold or a sinus infection. A physician can do a nasal smear, a microscopic examination a sample of nasal mucous to help determine the cause and recommend a course of treatment.

How can I tell whether my symptoms are due to allergies or a cold?

Allergies and colds cause very similar symptoms. Colds are caused by a viral infection, and symptoms often last up to two weeks while your body’s immune system tries to defeat the virus. Sometimes, the nasal mucous color starts out clear, but then it often turns cloudy and/or discolored before it eventually goes away. Sometimes a virus is accompanied by a fever, headache and muscle aches. Allergies are genetic hypersensitivity that causes a reaction when a person is exposed to something. As a person breathes in the allergen, the immune system over-reacts and causes symptoms of itchy eyes, such as sneezing, congestion, or runny nose. Allergy symptoms can last for several weeks or months, and in some people can occur year-round. Typically, the nasal discharge is thin and watery and allergies do not cause fevers. Fortunately, allergies can be easily diagnosed with skin tests and can be treated with allergen avoidance and/or medications, including immunotherapy, a series of desensitization injections.