PERC to Rule out Pulmonary Embolism

Having a clot in the lungs (AKA pulmonary embolism [PE]), can be fatal. Hence we take serious considerations not to miss the diagnosis by ruling out with investigations (such as D-dimer testing or CT pulmonary angiography) if a patient presents with non-specific symptoms (e.g. chest pain, shortness of breath).  But there are also concerns with expensive resources used to investigate in patients who have low probability of presenting with a PE. The PERC rule has been developed to identify these individuals in hope to spare them from additional investigations without compromising safety or care.

Continue reading PERC to Rule out Pulmonary Embolism


Steroid Phobia in Asthma

It has been a long-standing challenge to improve the adherence of asthma medications in paediatric patients.  Parents are often concerned about the side effects of inhaled corticosteroids.  There are valid side effects to be noted, such as oral candidiasis which is preventable, and possible reduction in growth and final height by about 1 cm.  But the benefits of long term use of inhaled corticosteroids are still greater because it can prevent future asthma attacks.

Continue reading Steroid Phobia in Asthma

The Politics Behind Smoking Cessation Products

It has taken us a long time to realize how the tobacco industry is creating a lot of public health concerns, from increasing the risk of lung cancer and the prevalence of COPD, to recognizing it as a risk factor in cardiovascular diseases.  But while we now recognize  vehemently the harm of smoking, do we realize, understand or appreciate all the benefits and harms of available smoking cessation products? Do we?

Continue reading The Politics Behind Smoking Cessation Products

The Cardiovascular Risk Associated with the Use of Long Acting Bronchodilators

It seems the pendulum is always swinging back and forth with the management of COPD. Few years ago, we have pulled away from the use of high dose inhaled corticosteroids when we found its association with increased risk of pneumonia and related mortalities. Here’s my post on this topic. And thus, the treatment strategy has shifted to using more long acting bronchodilators. These bronchodilators include LABA (long acting beta agonist) and LAMA (long acting muscarinic antagonist).

Continue reading The Cardiovascular Risk Associated with the Use of Long Acting Bronchodilators

To Promote Antibiotic Stewardship – how about a glimpse of my daughters’ antibiotic use?

I realize there is so much talk and education on how we should prescribe antibiotic more appropriately. A discussion on antibiotic stewardship may sound very sexy but the public may not be able to connect to such term. In essence, antibiotic stewardship is an initiative to promote appropriate antibiotic prescribing, to improve patient outcomes and to reduce antibiotic resistance. Maybe making it personal will help – and I mean let’s look at my daughters’ antibiotic use.

Continue reading To Promote Antibiotic Stewardship – how about a glimpse of my daughters’ antibiotic use?

Drug Shortage of Essential Medicines

Are you kidding me? We don’t have salbutamol nebules during the peak season where many people are experiencing shortness of breath due to pneumonia, respiratory infections or COPD/asthma exacerbation? Salbutamol is a quick acting bronchodilator medication which is often prescribed to relieve shortness of breath by opening up the airways to the lungs. It is an essential medicine.

Continue reading Drug Shortage of Essential Medicines

Prevention with Tamiflu During Influenza Outbreak

The influenza season usually runs between November and April of every year.  During this time, it can be busy for long term care facilities. Flu vaccines are administered to residents. Staff members are encouraged to receive their flu vaccines. All residents are verified to have an active antiviral prescription on file to treat or prevent the influenza infection if needed. Education on proper hand hygiene is provided. These activities are all done in the hope to prevent any influenza outbreak or to be able to manage the outbreak in a somewhat organized manner.

So what happens if front line staff members do not receive their flu vaccines?

Continue reading Prevention with Tamiflu During Influenza Outbreak