Refills on Albuterol Inhalers

Each albuterol inhaler has 200 puffs. And since we advised patient to give themselves TWO puffs per treatments. There are about 100 "treatments" in one inhaler. Knowing this, I rarely give out more than 1 inhaler at a time (and I rarely give refills). The reason is that I can use the patient's refill history to give me a rough estimate of the patient's asthma control. If the patient is requesting a refill of their albuterol inhaler every three months, that means they are using their inhaler on the average 1 to 2 times a day (definitely not in control). And if they are requesting their refill only after one month, that means that they are using their inhaler at least three times a day! Yikes!

Imaging for Chronic Sinusitis

Do you have a patient with "chronic sinusitis" and you want to order some imaging?

• Order a limited CT scan of sinuses (without contrast)
• This costs about the same as a sinus x-ray
• But it gives way better images!

Women's Health Screening Recommendations

The Florida Academy of Family Medicine published a Women's Health Screening Recommendations (last edited 4/23/12). It's an interesting read that summarizes the recommendations made by various organizations such as the USPSTF. Here is the official New Release.  (NOTE: Don't click on the image below to see the recommendations—you will only see the first page of the recommendations—click on the link above instead).

Testing for Celiac Disease (Celiac Sprue)

Here are some tips regarding Celiac Disease:

• All patients with history of "irritable bowel syndrome" should be tested for celiac disease
• Testing should be done on a HIGH gluten diet
• These test have the highest diagnostic accuracy (better than IgG):
• Endomysial IgA 
• Tissue transglutaminase IgA 
• Diagnosis needs to be confirmed with small bowel biopsy

ASPIRIN Use: A Simple Reminder

Here are the USPSTF guidelines on aspirin use for protection against cardiovascular disease: 

Here are the original recommendation:

The USPSTF recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage.
Grade: A recommendation.

The USPSTF recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.
Grade: A recommendation.

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older.
Grade: I statement.

The USPSTF recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years. 
Grade: D recommendation.