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Take a deep breath before adopting new asthma guidelines

News briefs

Hold off before you follow new recommendations to treat mild, persistent asthma — or at least consult your doctor first. The updated guidelines from the National Institutes of Health, published online in the December 2020 issue of The Journal of Allergy and Clinical Immunology, say it's okay for people with mild, persistent asthma to stop daily use of inhaled corticosteroids and instead use them only as needed, along with short-acting beta agonists ("rescue" medications). That's considered a major shift in guidance. But that may not be a good idea for some older adults, notes Dr. Anna Wolfson, an allergist and immunologist at Harvard-affiliated Massachusetts General Hospital. "A lot of people have a harder time with the occasional use of medications than a routine practice of daily use," she says. "And you may not want to decrease your asthma regimen during the pandemic. Poorly controlled asthma could lead to a flare or an ER visit, and perhaps an increased risk for complications if you develop COVID-19." Dr. Wolfson says there are some people who might benefit from using inhaled corticosteroids only as needed, but she urges you to speak with your doctor before changing your medication regimen.

Image: Branimir/Getty Images

More older adults are not aware of hypertension

In the journals

Do you know if you have hypertension (high blood pressure)? And if you do, are you treating it effectively? Study findings published online Sept. 9, 2020, by JAMA found that people's awareness and control of their high blood pressure have both dropped in recent years, especially among older adults.

The study pulled data from the National Health and Nutrition Examination Survey. It found that the number of people who knew they had hypertension fell 8% from 2013 to 2018. Among those who were aware of their condition, more than half did not manage it adequately. In particular, adults ages 60 and older were less likely to control their high blood pressure than younger people. Lack of engagement could be a factor. Researchers noted that among people who hadn't been to their doctor in the past year, fewer than 10% had controlled their blood pressure.

Smell training can help fix distortions caused by viruses

In the journals

"Smell training" could help treat certain smell disorders, suggests a study published online Nov. 19, 2020, by the journal The Laryngoscope. Two common types of smell disorders are phantosmia, in which you smell an odor that isn't there, and parosmia, in which you smell strange and often unpleasant odors — for example, cinnamon smells rotten. Both disorders are believed to occur because of damage to the smell pathways (nerves that carry information from the nose to the brain), usually caused by a bacterial or viral infection. They also may result from a head injury or smoking.

The study enlisted 153 people who had experienced changes in their ability to smell after recovering from a viral infection, such as a cold or the flu. They were tested for how well they could smell a variety of odors. Smells related to phantosmia and parosmia also were identified. The people then received smell training kits that consisted of random odors as well as ones linked to their phantosmia or parosmia.

Choosing a home exercise machine

Treadmills and related fitness equipment can make aerobic workouts more convenient. Which type is best for you?

Even if you enjoy exercising outdoors, there are times when it's too cold, too hot, or otherwise uncomfortable or impractical to walk, jog, or cycle outside. And like many people, perhaps you've let your gym membership lapse. So how do you make sure you're getting an aerobic, heart-protecting workout most days of the week?

Maybe it's time to invest in a home exercise machine, such as a treadmill or elliptical machine. Not only can you exercise in the privacy of your home, you can also easily break up your workout into 10- to 15-minute stints throughout the day, whenever it's convenient for you. Current guidelines recommend getting at least 2.5 hours of heart rate–elevating (aerobic) exercise each week.

Did my diet cause my gout?

Ask the doctors

Q. I eat a lot of shellfish and recently developed gout in my knee. Did my diet cause the condition?

A. As you probably know, gout is a painful form of arthritis that occurs when high levels of a waste product called uric acid build up in the body. It can settle into joints, where it forms sharp crystals that can trigger inflammation, redness, and pain. Your diet may have aggravated the condition, but didn't cause it.

Am I too young for a knee replacement?

Ask the doctors

Q. I'm in my early 50s and am considering a knee replacement for severe arthritis. I've heard that doctors typically encourage people to wait until after age 60 to perform this procedure. Should I wait to have the surgery?

A. Doctors do sometimes recommend that people under age 60 wait to undergo a knee replacement procedure, because these artificial joints typically last only about 15 to 20 years. If someone younger gets the procedure, it's likely that the joint will need to be replaced again down the line. That said, the decision to have a joint replacement really depends more on your individual circumstances, such as how much pain you have, whether the problem is causing you significant disability, and your overall health, not just how old you are. Some people can safely wait until they are 60 to undergo the procedure without a problem. For others, waiting too long to have the knee replaced might not be advised. For example, if the knee joint deteriorates too much, that may make the surgery to replace it more challenging. Over all, most people (80% to 90%) who do opt for a knee replacement are happy with the results of the procedure, but it's best to discuss the pros and cons with your doctor.

Why won't some health care workers get vaccinated?

COVID-19 vaccination rates among health care workers in nursing homes and long-term care facilities have been lower than expected. Is this an information problem or does it stem from other issues –– and what can be done?

Avoiding the pain of kidney stones

If you've had a stone, the problem is likely to recur — but it doesn't have to. Use these strategies for prevention.

The pain associated with kidney stones has been described by some as more excruciating than childbirth. Kidney stones are small, hard stones, formed when high levels of minerals in your urine start to crystallize in your kidneys, forming a pebble-like mass. The pain comes when these stones migrate from your kidneys through the ureters, which are the narrow tubes that carry urine from your kidneys into your bladder.

"Kidney stone pain is not subtle," says Dr. Gary Curhan, a professor of epidemiology at the Harvard T.H. Chan School of Public Health. It typically starts in the flank, at the side of the lower back. Sometimes if the stone moves, the pain migrates to the front of the body.

Is fibromyalgia real?

Ask the doctors

Q. My friend was recently diagnosed with fibromyalgia, but it seems like she might be imagining her symptoms. Is fibromyalgia a real condition?

A. The short answer to your question is yes. Fibromyalgia is a real condition that affects some four million Americans. It's a chronic pain syndrome that experts believe may be caused by a malfunctioning nervous system. Researchers using magnetic resonance imaging to examine the brains of people with fibromyalgia have found abnormalities in the part of the brain that processes pain signals from the body. It appears that this part of the brain is essentially boosting the intensity of normal pain signals, potentially causing the body to feel pain without a physical cause.

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