A lecture at the The Fit Lab of First Health Associates April 2011

1. Asthma-attacking the cause,not the effects Enrique Saguil, M.D. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

3. Cares what I have to say

4. Doesn’t Keep Me Waiting

5. Gives Me OptionsWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

6. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

7. Your Community of Care Ric Saguil, MD Jason Gruss, MD Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Nick Nowicki, DC Emery Paredes, PT Courtney Day, EP Yu Zhu, MD China Mike Blumberg, LCPC You

8. Basic anatomy Upper airway Lower airway

10. Upper respiratory tract Lower Bronchospasm We didn’t invent the practice of medicine…. we’re just changing the way it’s provided. Asthma anatomy

11. Post Bronchospasm Hyperinflation

12. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided. Allergy mediated

13. Bronchial smooth muscle

14. Bronchodilators and Anti-inflammatories

15. Bronchodilators Inhaled steroids Singulair Nedocromil Ipatropium bromide Allergy control antihistamines Oral steroids We didn’t invent the practice of medicine…. we’re just changing the way it’s provided. Standard prescription treatment

16. Pharmacologic control of bronchospasm and inflammationworks for treating the effects!

17. …back to inflammation again!

18. Airway obstruction PFT’s

19. Pre and post albuterol PFT’s

20. Education Always Wins

21. The perfect balance Short term rescue- fast acting albuterol, oral steroids Long term control- long acting albuterol, inhaled steroids Lifetime control- environmental modification, nutrition, exercise, behavioral modification, herbal supplementation, posture/ alignment

22. Many allergic responses are cumulative!!

23. Why so many allergies?

25. How Integrative Medicine can help: Naturopathic medicine!!! TCM (“lung meridia”) Yoga/posture/alignment Behavioral stress response control Nutritional education (anti-inflammatory diet) Alternative testing (allergies, toxin, deficiency)

26. Hx-Px A comes in with persistent cough for last 12 hours since going to bed. No sick contacts but usually gets sick this time of year. Low grade fever and usual medicines are not helping (nebulizer every 2 hours last one 1 hour ago). Nasal turbinates swollen, PND, chest clear no accessory muscle use, no other sign of infection. Tx=Continue with bronchodilator, add steroids, consider antibiotics and follow up in 1-2 days. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided. Scenario patient A

27. Hx-Px B comes in for check up and has used an inhaler few times a week for the last year. No big flare ups but hesitant on stopping for fear of attack. Obese with occasional cigarette with going out and has a cat. Tx-Suggested group therapy for tabacco cessation and diet changes/exercise. Also restrict cat to rooms and vacuum dust 2-3x week in addition to hard wood flooring. Reeval in few weeks after changes but refill meds until then and add steroid inhaler. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided. Scenario patient B

28. Hx-Px C comes in for check up and has used inhaler a few times a week for the last year. Avid exercise with weight training (pretraining inhaler) BMI 23, diet is mostly fast food or fast restaurant, works 60 hours a week and high stress position. No supplements Tx-counseling and meditation, dietary evaluation, naturopath evaluation, herbal treatment and cut back on weekly inhaler, keep preexercise puffs. Exercise phys for interval running program/farlek. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided. Scenario patient C

29. History for cues on if symtoms are truly reactive airway, stress level, environmental triggers, genetics, diet, use of inhaler, asthma action plan, supplements MD/DO, naturopath, homeopath, dietary, behavioral, acupuncture TCM, exercise phys, physical therapy, yoga (careful articulation between disciplines) Tests for allergies, deficiencies, methacoline challenge, chest xrays We didn’t invent the practice of medicine…. we’re just changing the way it’s provided. At First Health Associates:

30. Asthma:Attacking the cause, not just the effects. QUESTIONS? COMMENTS? CONCERNS? 2010 South Arlington Heights Road Arlington Heights, IL Phone: 847-593-3330www.FirstHealthAssociates.com