Helping yourself
You are one of many people who have asthma. This book will help you take charge of your treatment and learn how to manage your asthma.
The best way to do this is with an asthma action plan made just for you. This book will help you and your health care provider: know what triggers (causes) your asthma flare-ups learn how to prevent and treat your flare-ups set up an asthma action plan that works for you
Diagnosing asthma
There are two common methods used to diagnose asthma:
Spirometry is the measurement of airflow. Since asthma is an airflow-limiting disease, your doctor will confirm your lung function levels with this simple test. You will be asked to "blast" your air out as hard, fast, and long as possible. This will generate an image and values to help your doctor confirm a diagnosis and understand how to best treat your asthma.
FeNo (Fraction of Exhaled Nitric Oxide) is another simple test to manage your asthma. It tells your doctor about inflammation levels in your airways since they can change without you knowing it. As with spirometry, you will be asked to exhale at a steady rate for several seconds. This value will also help your doctor to know what kind of controller medication may be best for you.
What is asthma?
Asthma is a chronic (long-term) disease of the airways in the lungs. It’s not catching, but it tends to run in families.
You may go for several weeks, months or even years with no symptoms or signs of asthma. Then you may have a flare-up of coughing, wheezing or shortness of breath. Even when you’re not having symptoms, you still have asthma. So continue to follow your treatment plan.
Normal breathing
When you breathe, air flows through the windpipe (trachea) into large air tubes (bronchi), then into smaller tubes (bronchioles), then to tiny air sacs (alveoli) in your lungs.
trachea bronchi
bronchioles
alveoli
Asthma flare-ups
With asthma, your airways become inflamed and swollen and make extra mucus. These changes make your airways smaller. This makes it harder for air to flow in and out of your lungs.
During a flare-up (attack or episode), you may:
cough be short of breath have chest tightness
bronchial tube
alveoli
wheeze (make a high-pitched whistling sound caused by air trying to move in and out of your airways)
What causes a flare-up?
Things that cause asthma flare-ups are called triggers. Some triggers bother everyone who has asthma. These are called general irritants.
Other things, especially allergic triggers, bother some people and don’t bother others. These are different for each person. Ask your doctor to help you find out what makes your asthma worse. This is not always easy, because a flare-up may be triggered hours or even days before you get symptoms. Use the checklist on page 5 to record your triggers. inflamed, swollen airway mucus trapped air
My Triggers
general irritants
(should be avoided by everyone with asthma)
smoke from tobacco, vapes, marijuana
spray deodorants, hair sprays, insect sprays, cleaning sprays
fragrances, perfume, cologne, scented candles, incense, Plugins® room freshener
chalk dust, odors from markers
car and truck exhaust
smog and other air pollution
changes in temperature, humidity or air pressure
odors from cleaning fluids, paints, furniture polish
smoke from burning wood or leaves
allergic triggers
(avoid if you are allergic to them)
dust mites (see pages 7–8)
cats, dogs and other furry pets
cockroaches
mold, mildew
some foods (rarely)
sulfites (such as in wine)
pollens, grass, trees, ragweed
others
colds, flu, sinus problems
exercise
bursts of emotion that affect breathing (such as crying, laughing, etc.)
some medicines
Avoiding triggers
Avoid smoke and smoky places. Do not smoke or let anyone else smoke in your home or car.
Avoid air pollution when you can. Use air-conditioning, not fans, at home. Keep your car windows closed when you can. If you have air-conditioning in your car, recirculate the air, especially during traffic rush hours.
Try to avoid air that is very hot, cold or humid. Use unscented liquid or solid products, not sprays.
Use a stove vent to get rid of cooking fumes.
Keep your house as dust-free as you can. Use an air cleaning device with a HEPA filter in the bedroom.
Avoid dust mites if you are allergic to them. (See pages 7–8.)
If you are allergic to furry pets, try to keep them outdoors. Never let them in your bedroom. Wash bedding every week.
Avoid mold (such as in wet leaves, damp basements and plant soil). Clean moldy surfaces with a cleaner that has bleach in it. Fix leaky faucets, pipes or other sources of water buildup.
Use poison bait or traps to control roaches. Do not leave food or garbage out uncovered.
Don’t buy foods or over-the-counter medicines that may cause a flare-up for you. Read labels.
Record your triggers in your asthma diary (page 28). This will help you know what to avoid.
Dust mites are tiny insects that live in house dust. They are very common, and are so small that you can’t see them. If you are allergic to them, they can trigger flare-ups when breathed into your lungs.
It’s very important to control dust mites in your house (especially your bedroom). Make your house as dust-free as you can.
Make sure your house gets a good cleaning every three months. (All surfaces should be dusted with a damp mop or sponge.) Have someone else do the cleaning, and try to be out of the house during that time. If you must be there, wear a dust mask (the heavy-duty kind you can buy from a hardware store).
Wash bed linens in hot water (130°F) each week.
Make sure your bedroom is cleaned every week. If you are the person who cleans it, wear a dust mask.
Put airtight, allergy-proof, zippered covers on your pillow, box spring and mattress.
Hardwood floors with rugs that can be washed are better for you than carpet. If you have carpet, vacuum each week, and shampoo or steam clean it every 3 to 4 months.
Use shades instead of curtains, or wash curtains in hot water (130°F) every month.
Use your bedroom closet only for shoes and clothes that you wear at least once a week. Move all other items to another closet.
other ways to avoid dust mites:
Use a vacuum with one or more of the following:
HEPA (high-efficiency particulate arrester) filter
double-layered bag
microfilter bag
If possible, have someone else vacuum.
Get rid of clutter that collects dust.
Use a dehumidifier to keep indoor humidity below 50%. (Do not use a vaporizer daily. This will increase humidity.)
Change furnace filters often (at least every three months). Change them every month during the winter. Cover heat vents with an air filter or cheese cloth.
plain lampshade (not pleated)
non-fabric headboard
airtight, allergy-proof pillow and mattress covers dehumidifier shades instead of curtains
non-fabric furniture
hot waterwashable bed linens
hot waterwashable throw rugs
exercise
Exercise is important to your health. Even if exercise is a trigger for you, don’t avoid it. Being in good shape will help you manage your asthma. And if you are overweight, losing weight may make it easier to control your asthma.
To help prevent a flare-up:
warm up for at least 5–10 minutes before you exercise in cold weather, cover your mouth and nose with a scarf, muffler or ski mask (helps warm the air before it reaches your lungs)
use your quick relief medicine 15 minutes before exercise. If needed, you can use it again during the exercise. If it’s needed a 3rd time during that same activity, you probably need to stop and rest. if you feel a flare-up coming on, stop and rest when air pollution levels are high, try not to exercise outside
Walking is very good exercise. You may need to walk indoors (at a fitness center or mall) to avoid triggers such as cold and smog.
allergens
Over 80% of people with asthma also have allergies to things like dust mites, molds, pollen or animals (saliva and flaking skin). These things are called allergens. When a person is exposed to some allergens (especially dust mites), he may have an asthma flare-up.
If you think you may be allergic to something, talk with your doctor.
germs and infections
One of the most common triggers is an infection of the airways— like a cold or the flu (influenza). Flu shots are recommended for people with asthma*. Ask your doctor about any vaccines you need to get.
People pass many germs to each other by coughing, sneezing and sharing things like spoons or cups. Wash your hands often and always cough into your elbow to avoid spreading germs.
* Source: CDC, National Center for Infectious Diseases, ACIP.
My Warning Signs
An asthma flare-up begins slowly. Most people feel warning signs when a flare-up is starting. But everyone’s warning signs are different. Learning yours can help you and your doctor make a plan to keep a flare-up from becoming severe. Check the warning signs you have had before a flare-up:
dry cough
stuffy nose, runny nose, watery eyes
sneezing, itchy throat (or throat that "tickles")
feeling tired
feeling sad, angry, moody or restless
fast heartbeat headache
stomach ache
ear pain
tight chest
wheezing
shortness of breath or fast breathing
trouble sleeping because of coughing, wheezing or shortness of breath
drop in peak flow meter scores
Write in any signs you have had:
There are many free apps to help you track your asthma symptoms. Check the App Store or Google Play.
Monitoring your asthma
There are many apps available to help track your asthma. Some count inhaler use, set reminders, and track symptoms. Many allow sharing with your healthcare team. Ask your nurse or respiratory therapist or which app would work best for you. Most are available at the App Store or Google Play.
If you prefer, you can use a peak flow meter. If you do, make sure to use it:
every morning when you wake up, but before you take your medicines (consistent daily tracking is important to monitor changes over time.)
when you are having asthma symptoms or a flare-up, and then again after taking medicine for the flare-up
any other time your doctor suggests
Keeping track of your peak flow meter scores will help you manage your asthma. You can do this by writing them in your asthma diary (page 28).
To use a peak flow meter:
1. Stand.
2. Remove any gum or food from your mouth.
3. Slide the arrow to the bottom of the numbered scale.
4. Take a slow, deep breath and blow into the peak flow meter as hard and fast as you can. (Stop if you begin to cough or wheeze. Do not write that number down. Try again in a few minutes.)
5. Write down the number reached by the arrow.
6. Repeat steps 3–5 two more times.
7. Write down your highest score in your asthma diary on page 28. (Don’t average the numbers.)
Make sure the peak flow meter is level. Don’t blow down.
personal best peak flow number
To use daily peak flow meter scores to check your breathing, you need to have something to “check” them against. This “check” is your personal best peak flow number. This is the highest peak flow meter score you can reach when your asthma is under good control.
For a 2–3 week period when your asthma is under good control, write down your peak flow score each day. To find your personal best peak flow number, take your score as close as possible to the same time each day:
in the morning and afternoon (before any inhalers are used) each day
any other time your doctor suggests
Use the asthma diary on page 28 to record your scores. Your highest score during this period is your personal best peak flow number. Write this number on your asthma dairy and on your asthma action plan (page 30).
your breathing zones
Using your warning signs and your personal best peak flow numbers, you will be able to tell what breathing zone you are in: green, yellow or red.
Treating asthma
Asthma causes more hospital stays than any other chronic disease. It causes more visits to the emergency room than any other disease. You can prevent most of these scary events. Asthma does not have to cause you to miss activities. Work with your doctor to set up a written asthma action plan. This may include:
learning your warning signs
avoiding triggers (see pages 5–6)
learning what medicines to take and how to take them
With a good asthma action plan, you should:
be able to keep up with your usual activities (including exercise, sports and work)
be free of flare-ups
sleep through the night without waking (due to asthma)
use a quick-relief inhaler less than 2 times a week
have no visits to the hospital or emergency room (due to asthma) have few side effects from asthma medicines
* ACT/GINA guideline
* Rule of 2 for Asthma Control-
1. Use Rescue inhaler 2 times or fewer each week.
2. Wake up from asthma symptoms two times or fewer per month.
3. Refill your quickrelief inhaler fewer than twice a year.
Medicines
There are two main types of asthma medicines:
long-term control (preventive)
quick-relief (rescue)
long-term control medicines
These are taken to prevent asthma flare-ups. You may have to take these for a long time. You will not become addicted even if you use them for several years.
anti-inflammatory medicines
Most preventive medicines are antiinflammatory. They help reduce swelling in the airways. Anti-inflammatories come in 2 forms: inhaled steroid and non-steroid.
Quick relief medicines work on the outside
Preventive medicine works on the inside
Steroid medicines are the most common type of preventive medicine. These are not the muscle-building steroids taken by some athletes. Preventive steroids are taken as a fine mist from an inhaler or a nebulizer (pages 21 and 26).
Inhaled steroids are strong medicines but are also the best medicines for long-term control of asthma. As a rule they are safe, but you should ask your doctor about the risk of side effects. Your doctor will closely watch the use of these medicines.
To prevent side effects (such as a sore mouth and throat or bad taste), use with a spacer and rinse your mouth (with something other than water) or brush your teeth and spit after each use of the inhaler.
Take your medicine regularly even if you feel better.
combination medicines*
Some drugs are a combination of a steroid and a long acting bronchodilator. These are usually given as an inhaler in cases of moderate to severe asthma.
This medicine is NOT a rescue inhaler!
Combination medicines include:
Symbicort®
Advair® Dulera®
The non-steroid medicines include:
antihistamines (Claritin®, loratadine, Zyrtec®)
leukotriene modifiers immunomodulators
cromolyn sodium
Some of these are used with an inhaler or a nebulizer and some come in pill or liquid form, or as a shot.
Make a note…
1. Long-term control medicines prevent symptoms or flare-ups by decreasing inflammation in the airways. They will not give relief for symptoms (such as wheezing, coughing, shortness of breath) already showing.
2. You should continue taking long-term control medicines even when you have not had any signs of asthma for several weeks or months. After your asthma has been under control for a while, your doctor may have you slowly decrease the amount of these medicines.
3. Take your inhaler to each doctor visit. Ask the doctor, respiratory therapist or nurse to watch you use it and check your technique.
* GINA guidelines/SMART therapy
quick-relief medicines
When you have an asthma flare-up, the muscle bands that open and close your airways tighten up. Quick-relief (rescue) medicines relax these muscles so that air can move in and out easier.
quick-acting inhaled bronchodilators*
These are the medicines that work best for relieving coughing, wheezing and shortness of breath. You should begin to breathe easier within 10 - 30 minutes of taking quick-relief medicine.
Quick relief medicines work as muscle relaxers
Quick-acting bronchodilators are breathed in (inhaled) from a hand-held inhaler (page 21) or a nebulizer (page 26). They may cause a headache, fast heart rate, trouble sleeping or jittery feeling. Most of the time, these side effects go away or get better after you have been using the medicine for a while. If they bother you or don’t improve, tell your doctor.
If exercise is one of your triggers, your doctor may tell you to take one of these medicines 15 to 30 minutes before you start to exercise.
NOTE: There may be times when you will need to take these medicines every day for several days along with your preventive medicines.
spacer/ holding chamber
CAUTION:
Never take any medicines (including over-the-counter
nebulizer
* Some quick relief medicines may include inhaled steroids per GINA guidelines
Make a note...
1. Always keep your quick-relief medicines with you at work, at home and on vacations.
2. Wait at least 15 to 30 seconds between puffs.
3. If you have to use quick-relief medicine more than 2 times a week, your asthma is not in good control. Your asthma action plan is not working. Talk to your doctor about this.
steroids (taken by pill or liquid)
Most steroids are inhaled as long-term medicines to prevent flare-ups. But if you are in your yellow or red breathing zone, the doctor may have you take steroids as pills or liquid for several days. These are very helpful in controlling a severe flare-up. They may take about 4–12 hours to begin working and should be taken with food.
When taking steroids by pill or liquid, you should continue using your inhaled preventive medicines. You should also keep using your quick-relief medicines for fast relief of symptoms. You should never stop taking steroids without your doctor’s advice.
Side effects and what to do about them your name
What to do if you forget to take
When you will feel it working
How long to take
How to take
When to take
Name Type (preventive or quick-relief) What it does
Ask the doctor to help you fill in this chart.
Medicines
This page may be copied for your use. ©Pritchett & Hull Associates, Inc.
Ways to take asthma medicines
Your doctor may have you take your asthma medicine as a pill or liquid, by inhaling it or by injection.
inhaler
A metered dose inhaler (MDI) is a small hand-held device that lets you breathe in a fine mist of medicine. The inhaler is set to give a pre-measured dose of medicine with each puff. Your doctor will tell you how many puffs you should take.
Not all MDI’s are the same. Read the instructions with your package to find out exactly how your inhaler works. To use an inhaler the right way, you need to have a spacer/holding chamber. This will help you get the right amount of medicine into your lungs and not just into your mouth. A spacer/holding chamber can also help you avoid some side effects.
inhaler
mouthpiece
cap
medicine can holder
inhaler with spacer
mouthpiece holder
medicine can spacer/ holding chamber
Some asthma medicines come in a dry powder inhaler that releases the powder into your mouth. A deep breath pulls the medicine into your lungs. These medicines look just like an inhaler, but do not need a spacer. Ask your doctor which type of inhaler you have.
Not all inhalers or spacers are the same. Read the instructions with your package to find out exactly how your inhaler and spacer/holding chamber work. For all inhalers, make sure you:
1. Shake the inhaler well (at least 15 seconds) right before each puff.
2. Remove the caps. With the inhaler in the upright position, insert the mouthpiece of the inhaler into the spacer or holding chamber.
3. Stand or sit up straight and, when ready, gently breathe out.
4. Put the mouthpiece of the spacer/holding chamber into your mouth—over the tongue and between the teeth. Seal your lips around the mouthpiece.
5. Start to slowly breathe in, then press down on the metal can to release 1 puff of the medicine.
6. Breathe in slowly and deeply to fill the lungs. (Many spacers will whistle if you are breathing in too fast.)
7. Hold your breath for 10 seconds and then breathe out slowly while keeping your lips sealed on the mouthpiece.
8. If you are supposed to take more than one puff, repeat steps 4–8. For the quick-relief meds, wait 15 to 30 seconds between puffs to let the first puff begin working. Make sure to take only one puff at a time.
9. When finished, brush your teeth or rinse your mouth and spit (ICS [steroid] inhalers only).
10. Follow the directions on the package to clean and store the inhaler and spacer.
Make sure you prime your inhaler the first time you use it and again if you haven’t used it for several days.
To prime your inhaler:
Take the cap off and shake the inhaler.
Spray a puff of medicine away from your face.
Shake and spray the inhaler like this 2-4 more times.
Different medicines have different priming instructions.
Check with your pharmacist or on the package label for exact priming instructions for your device.
don’t run out
It’s hard to tell when an inhaler is empty. All inhalers will continue to spray air (propellant) after the medicine is gone.
If your inhaler does not have a counter, one way to tell if the inhaler is to keep up with the puffs you’ve taken. Follow these steps:
1. Put a piece of masking tape on the side of the plastic cover that holds your MDI.
2. Mark the tape with a tally mark each time you take a puff (include “puffs” used for priming).
3. Keep up with the tally marks to see how close you are to the total number of puffs in the inhaler.
You can also use an inhaler counter to keep track of the number of puffs. You can find these at asthma and allergy supply centers.
dry powder inhalers
Follow these steps when you use a dry powder inhaler:
1. Read the product insert page that comes with the inhaler.
2. Hold the inhaler in one hand and load a dose of medicine as directed.
3. Breathe out through your mouth. Push as much air from your lungs as you can.
4. Put the mouth piece in your mouth. Close your lips around it. Make sure that your lips or fingers are not covering any vents on the inhaler.
5. Breathe in deeply through your mouth. You should do this until your lungs feel completely full of air. This will deliver the medicine to your lungs.
6. Hold your breath for 10 seconds. Then breathe out slowly.
7. Remove the inhaler from your mouth. Check the dose counter on the back to make sure you received the dose.
8. If you need another dose, follow steps 2 through 7.
9. Brush your teeth or rinse your mouth after each dose (steroid inhalers only). Then spit. Do not swallow.
10. Follow the directions on the package to clean and store the inhaler.
nebulizer
With a nebulizer, you breathe a fine mist of medicine into your lungs. The medicine is breathed in through a mask or mouthpiece.
A nebulizer may be used: during a severe flare-up when you have trouble using the inhaler
When you use a nebulizer:
nebulizer
mouthpiece
compressor
tube cup for medicine
Make sure the doctor or company that supplies you with the nebulizer shows you how to use it.
Follow the doctor’s orders when adding medicine. Clean the parts of the nebulizer according to the directions that come with the machine. Replace the air filter every 6 months.
Write down the name and phone number of the company that sold you the nebulizer in case you have a problem or need to order supplies.
Asthma diary: putting it all together
The asthma diary on the next page will help you and your doctor: learn what makes your asthma worse decide if your asthma action plan is working know when to add or stop a medicine decide when to get emergency help
To make the diary most useful:
1. Fill it in every day. It’s hard to remember what happened if you skip 2 or 3 days.
2. Take it to every doctor visit.
3. Remind the doctor that you would like to talk about it.
4. Save the completed diaries for several months. These will help you know what’s needed for long-term asthma control.
‘s Asthma Diary
‘s Asthma Diary
How to use Fill in the blocks under “Asthma Signs” by using numbers in the key at the bottom of this diary. Fill in the names of your medicines, and write in the number of times a day you take them.
Working with your doctor
You and your doctor must work together to find the asthma action plan that is best for you. Ask your doctor how often you should visit. To get the most from these visits:
Take your inhaler, peak flow meter, spacer/holding chamber and asthma diary with you. Show the doctor how you use them.
Ask questions. Write down your questions before each visit. Be sure you understand your doctor’s answers.
Give information. Tell your doctor how you’ve felt since your last visit. Share your diary and peak flow meter scores. Talk about how and when you take your medicines.
Follow directions. Write down everything your doctor tells you. Follow your written asthma action plan closely.
Questions for your doctor:
your name Personal Best Peak Flow Meter
Green Zone:
You are breathing your best.
You:
have peak flow meter scores greater than _________ (80% of your personal best peak flow number)
sleep through the night without coughing or wheezing
have no early warning signs of an asthma flare-up can do usual activities
‘s Asthma Action Plan
Yellow Zone:
You are not breathing your best.
You may:
have a peak flow meter score between ______–______ (50%–80% of your personal best peak flow number)
be coughing or wheezing at night
have early warning signs of a flare-up
have trouble doing your usual activities (work, exercise)
Red Zone:
You need help now.
You may:
have a peak flow meter score less than_________ (50% of your personal best peak flow number)
be coughing, short of breath, wheezing
suck in skin between ribs, above your breastbone and collarbone when breathing have trouble walking or talking
Take preventive medicines:
Continue to avoid triggers.
Take quick-relief medicines 15 minutes before exercise.
Take quick-relief medicines:
Emergency Medicine Plan:
take quick-relief medicine
Continue or increase preventive medicines.
Call your doctor if:
you stay in the yellow zone for more than _________ hours your symptoms are getting worse you use quick-relief medicine more often than every 4 hours or _________ times a day
Take the Asthma Control Test (ACT): Google “asthma control test” for various examples.
Call your doctor or emergency room and ask what to do.
Call 911 if:
your nails or lips are blue you have trouble walking or talking you cannot stop coughing
This page may be copied for your use. ©Pritchett & Hull Associates, Inc.
When to call your doctor
Ask your doctor to check the signs below that tell you when to call him or her.
wheezing that does not get better after using quick-relief medicines
low peak flow meter scores that do not improve after taking quick-relief medicine
using quick-relief medicines more than every 4 hours or 4 times a day
shortness of breath
hard coughing, persistent coughing or too much mucus
trouble exercising
rapid breathing
chest tightness
missing sleep because of cough or asthma
missing work often because of asthma
medication side effects cannot stop coughing
other:
Asthma on the go
In your daily life, it’s important to keep your preventive inhaler and quick-relief medicines nearby. If you go on a trip, you must be even more prepared. If traveling by air, take medicines and supplies on the plane.
When to stay home
It may not be a good idea to travel when you are having asthma problems. Stay home if you feel very tired or have:
low peak flow meter readings trouble breathing, or other symptoms of a flare-up
a fever over 100°F (38°C)
With asthma, you need a special plan for traveling. Use this checklist to be sure you are ready before you leave.
My Travel Checklist
Medicines
enough medicine for vacation, plus some extra
a list of all medicines
labels from pharmacy bottles (for emergency refills)
medicines and inhalers with spacer
Equipment
peak flow meter
nebulizer and supplies, if needed
anti-dust mite items, if needed (pillow and mattress covers)
medical alert bracelet or necklace, if needed
©Pritchett & Hull Associates, Inc. This page may be copied for your use.
Records
asthma action plan
asthma diary with peak flow meter numbers
medical insurance card(s) your doctor’s phone number
the names of asthma specialists where you are going
Reserve non-smoking rooms at hotels.
Resources
These groups want to help you manage your asthma. They can answer your questions and send you information. Most of the information is free.
American Academy of Allergy, Asthma and Immunology aaaai.org
American College of Allergy, Asthma and Immunology 1-847-427-1200 acaai.org
American Lung Association 1-800-586-4872 lung.org
Reviewers and contributors for this book:
Current review:
Amanda Clark, RRT Lexington, SC
Previous reviewers:
Jo Ann G. Bedore, RN, BS, AE-C Akron, OH
Renee K. Bergner, MD Burlington, VT
The Asthma and Allergy Foundation of America (AAFA)
1-800-7-ASTHMA aafa.org
Lung Line, National Jewish Medical & Research Center
1-800-222-LUNG nationaljewish.org
Asthma Control Test (ACT) Google “asthma control test”
J. Michael Halwig, MD, FAAAI Atlanta, GA
Sally Crim Tibbals, RN, MS, CS Oklahoma City, OK
Marjan Torbati, BS, RRT, CPFT Norman, OK
Special thanks to A. A. Marie Singletary-Schuster, RN, for her contributions to an earlier edition of this book.
We believe that you have the right to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.
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