Insurance Update
May 2016
Issue No. 68
In this issue

What is asthma?



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Church of the Brethren Insurance Services provides the following products: dental, vision, basic life and accidental death & dismemberment, supplemental life and AD&D, dependent life and AD&D, retiree life, long-term disability, short-term disability, and Medicare supplement for eligible Church of the Brethren employees.
Dental, vision, retiree life, and Medicare supplement coverage may also be available for eligible retired Church of the Brethren employees.
For eligibility information, call Connie Sandman at 800-746-1505, ext. 366, or contact your human resources representative.
Medical and ancillary plans (named above) may be available to Brethren-affiliated employer groups.
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Dear (Contact First Name),

Spring is here! Remember the old adage "April showers bring May flowers." We hope flowers are blooming in the yards and gardens where you live, and that you are enjoying mild breezes, warm sunshine, the smell of freshly turned earth, and the many subtle shades of green as the buds on the trees burst into leaves. There is a glorious sense of new life. And the smells! Of all the seasons, spring has the most fragrance.
But to enjoy the many fragrances of spring we have to breathe, and that can bring complications. If you have allergies or suffer from asthma, you will know what we mean. Perhaps that is why May is designated each year as Asthma and Allergy Awareness Month, and May 5 is World Asthma Day.
The focus of this month's issue is asthma. We hope you will come to understand it better and know why it is such a difficult and puzzling disease. By restricting the ability to breathe, asthma causes great and immediate suffering and anxiety. With the information and stories in this issue, it is our hope that you may better understand that there are ways to manage the disease.
May this be a good May for you, and may you never take for granted the gift of breath.

Asthma: a dramatic, enigmatic illness
Suddenly you cannot breathe. Your breath becomes shallow and labored. You simply cannot get enough oxygen. Your chest tightens and begins to hurt. The little bit of air that is moving in and out makes a high wheezing sound. Your shoulders hunch forward. Your chest heaves as you gasp for breath. Your whole body tenses as it fights desperately to keep you alive. Fear rises and tension deepens; your chest tightens even more. You begin to go into oxygen debt. Your skin takes on a bluish cast.
This is a full-blown asthma attack, something millions of people suffer. An inhaler or an injection can bring some relief. Sometimes the victim is rushed to the emergency room. More than 25 million people suffer from asthma in the U.S.; each year about 3,600 people die from acute attacks.
The disease is not this severe for everyone who has asthma, but any asthmatic can tell you that even a mild attack is uncomfortable and frightening, and makes physical activity and mental concentration difficult. Half of all children with asthma miss school because of the disease. And a third of all adults with asthma miss work regularly.
Asthma is a condition at least as old as recorded history. There is reference to a respiratory condition described as "noisy breathing" as early as 2,600 B.C. in China. Hippocrates (circa 400 B.C.) was the first to use the term asthma. It comes from a Greek verb, aazein, which means to pant, to exhale with open mouth, to take a sharp breath. Doctors in Roman times described the condition. Moses Maimonides, 12th-century Jewish rabbi, scholar, and physician, wrote a treatise on it. By the end of the 19th century, physicians came to view asthma as a distinct disease with a specific set of causes and treatment requirements. But it was not until the late 1960s that significant therapeutic advances were made.
Asthma is a chronic (meaning long-term) disease of the respiratory passages, making it hard to move air in and out of the lungs. Two things create this difficulty. First, the airways themselves narrow as the tissue becomes inflamed, swells, and produces mucus. Second, the muscles around the airways tense and tighten causing further constriction. The result is the cascading flow of symptoms - tightness in the chest, labored breathing, wheezing, pain, tenseness, and shortage of oxygen.
Asthma often starts during childhood. According to the Asthma and Allergy Foundation of America, 6.3 million U.S. asthmatics are under 18 years of age. Asthma is more common in boys than girls, but more common in adult women than adult men; almost 65 percent of those who die from asthma are women. Asthma is more prevalent among African-Americans and Hispanics, especially Puerto Ricans; 16 percent of African-American children have asthma. The overall asthma death rate is highest for people 65 years or older. In rare instances, childhood asthma can diminish and even disappear in adulthood, but this is so unlikely that the disease is considered "chronic."
At present, no one has identified a "cause" for asthma. Researchers know about the chemical activity during the swelling of the air passages and the mucus production. But there is no bacterium or virus known to produce the symptoms. Instead, physicians and medical researchers have identified triggers -- substances and events that precipitate an attack. The triggers are sometimes used to differentiate between different types of asthma.
In exercise-induced asthma, the attack is triggered by physical activity, often exacerbated by air temperature and air quality. Cold, dry air seems to worsen the attack. Occupational asthma is triggered by exposure to chemicals or dusts in the workplace, which can cause an allergic reaction that irritates the airways. Allergic asthma is set off by many different allergens. Among them are cockroaches, dust mites, indoor mold, pets, pet dander, pollen and outdoor mold, strong odors, sprays, smoke -- especially tobacco smoke, and various foods. As already noted, weather and air quality can be triggers as well as colds and respiratory infections. Further, stress can set off asthma, usually along with other triggers.
Finally, some researchers identify still another type they call nocturnal asthma, because symptoms often worsen during the night. There are a number of possible reasons: exposure to allergens in the bedroom, particularly dust mites; delayed allergic response, which may occur three to eight hours after exposure; chronic sinus problems and/or post-nasal drip; gastroesophageal reflux; airway cooling from a drop in body temperature; decreased effect of medications during early morning hours; or sleep apnea.
In a basic way, asthma is simple; the reality is that the victim cannot get enough air. But because of the interconnection of physical and environmental factors, the difficulty in identifying actual causes, and the profusion of triggers, asthma becomes a highly complex phenomenon -- a reality compounded by the widely accepted view that asthma can be inherited. Though the gene or genes involved have not been identified, it is well known that asthma is found within families.
One of the most curious and perhaps even perverse characteristics of asthma is that it may result from an immune system that works too well. It may be that the immune system itself overreacts to everyday substances such as dust, pollens, mold, cat dander, etc. In shutting down the airways to keep the allergen out and protect the victim, it blocks the very air that keeps the victim alive. Research is proceeding on many fronts to understand better the role of genetics, infection, exposure, and the immune system in the etiology of asthma.
Though doctors are no closer to finding the root cause of asthma, they have made strides in treatment and management. There are many medications, some to reduce inflammation of the airways, others to relieve constriction. Some are designed for quick relief. Some are taken long term as the doctor deems necessary.
The quick-relief medicines are called bronchodilators, and they relax the muscles around the airways. They are used to reduce symptoms and are generally delivered with an inhaler. This is a pressurized tube with a small delivery chute that you place in your mouth. When you press on the metal tube, an atomized burst of medicine is sent into the chute, at which time you take a deep breath and inhale the medication, holding it in your lungs as long as possible.
The longer-term asthma medications are taken daily, whether there are symptoms or not. They are anti-inflammatories, which means they reduce the inflammation in the airways of the lungs. These are used for prevention and control, not for immediate relief. One frequently used medication to combat inflammation is a corticosteroid, taken daily with an inhaler. For asthmatics for whom corticosteroids are not enough, there are monthly injections of an immunomodulator, which inhibits the antibodies released by the immune system.
Sometimes a medication combines a corticosteroid for long-term, anti-inflammatory relief with a bronchodilator. This combination is delivered by an inhaler and is used daily to prevent symptoms, not to give quick relief.
But for people with asthma, medications are only part of the effort. They benefit from careful management through an asthma action plan. This might include:
  1. Monitoring lung capacity daily with a Peak Flow Meter; taking action when it drops
  2. Ridding the home of triggers
  3. Staying away from places in the community and workplace where there is smoke or other irritants.
  4. Keeping an asthma diary to track symptoms and medications
  5. Knowing when and how to use both emergency and daily medications
  6. Exercising daily to maximize aerobic fitness
  7. Using medication to prevent exercise-induced asthma.
  8. Eating nutritious foods and maintaining a normal weight
  9. Knowing when to call the doctor/health care provider
  10. Knowing when to go to the emergency room and where it is
  11. When travelling, doing research on the external and internal environments of the destination
  12. Being sure to have a full supply of medications
At the foremost respiratory hospital in the country, National Jewish Health, in Denver, Colorado, where patients with severe asthma often go for treatment, a comprehensive, multidisciplinary approach includes sophisticated testing not found elsewhere, psychological assessment and treatment, nutrition counselling, patient education, physical rehabilitation, and assistance in developing a management plan.
Research seems to indicate that asthma rates are rising across the world. Some say that the increased pollutants in the atmosphere are acting as triggers. Another theory called "The Hygiene Hypothesis" suggests that asthma is the perverse result of a more hygienic environment in the developed countries. In the critical time after birth, the immune response is derailed by a clean household. An article from the  U.S. Food and Drug Administration states, "The problem with extremely clean environments is that they fail to provide the necessary exposure to germs required to 'educate' the immune system so it can learn to launch its defense responses to infectious organisms. Instead, its defense responses end up being so inadequate that they actually contribute to the development of asthma." There is data in support of this hypothesis, but the research is not conclusive. 
In the end, asthma is something of a puzzle. Humans have suffered from it for at least four millennia, but we still don't know why. It is a debilitating condition and can be frightening to the person having an attack. If you are its victim, it robs you of breath, movement, activity, and even speech as you gasp for breath. There are modern medications that bring relief and help control symptoms, and alternative approaches that may be helpful. Still asthma can kill, and in a particularly unpleasant way. Your own body suffocates you.
So, asthma is a serious disease. If you have it, your condition may improve, but you can never get away from it. At best it's inconvenient. At worst it's dangerous. You have to find a way to live with it, and there is nothing funny about it. Yet there are websites with asthma humor and cartoons. A life-long asthmatic named Joe Bottrell lists "The Seven Benefits of Having Asthma." They are perspective, vulnerability, religiosity, empathy, intelligence, sharing, and cleanliness.

One of the most interesting claims is that having asthma can increase your intelligence. The reasoning is that asthma limits activity and forces you to use and develop your mind and imagination. There is no hard evidence for this, but the point is that a disabling condition can be regarded as an opportunity. And it may be that doing so is the best way of treating and managing asthma.
So during Asthma Awareness month, we take this occasion to understand this curious disease, to sympathize with its victims, and to celebrate those who live and thrive in spite of it. 
Emotion and distress: Two asthma stories
Though asthma is a chronic disease, which means it is always present, it can manifest itself in overwhelming attacks that can come on unexpectedly. Many asthmatics live with anxiety and feel they must be prepared. You could say that asthma is a dramatic disease - an asthma attack is full of high emotion and great physical distress. Here are some first-person accounts:
My near-fatal asthma attack

I had been trying to exercise more and had taken up in-line skating in an effort to bolster my lung capacity as my asthma was getting worse. I was just beginning to get the hang of it and thought I could stay in control without overdoing it and causing an asthma attack.
It was a beautiful spring day, but I had had a stressful day at work. After dinner, I decided to unwind and don the skates for a short trip. Normally, I would go a mile or so and then return. Fortunately, that day I decided just to circle the block and not go my usual route.
On my second lap, my asthma started kicking in, and I tried using a few puffs from my inhaler. As I slowed down, I realized the asthma was not letting up. My lungs started slowly to shut down from being clogged with the mucus produced by the asthma attack. I contemplated sitting down and seeing if it would let up while I rested, but I thank God that I kept slowly rolling that last half block home, so I could bang on the front door of our house. When my wife came to the door, I told her I was having trouble breathing, but as this had happened numerous times before, I wasn't greatly concerned.
She went to put on a pot of coffee, which usually seemed to help when my asthma bothered me. By the time she put the pot on, I had only wrestled off one of my skates, and my breathing was starting to get critical. The inhalers weren't helping at all. I beat on the door again and told her that something was wrong. She called 911 and stayed on the phone with the dispatcher; I was in terrible agony. Imagine someone putting a piece of plastic wrap over your face, and no air getting in at all. It's a feeling that I cannot describe. It was so horrible. In my mind, I was afraid I wasn't going to make it this time. My body and chest ached from gasping for air.
The last sounds I remember were sirens way off in the distance. Then it was like a volume control being turned down. Things got quieter as I collapsed on the porch. My wife says I turned a bluish purple. Several minutes later, the fire department arrived and started administering CPR. Then the paramedics came, and they intubated me and used the defibrillator paddles to shock me and restart my heart.
The next thing I remember was lying in a hospital bed very relaxed but unable to open my eyes or move any part of my body. My mind was totally alert and I could hear the nurses talking. One of them even said "Don't worry, he can't hear us," and I remember thinking that was funny.
I faded out, back to sleep, and a little while later I heard my wife. The stuff they had given me to immobilize me was starting to wear off and I was able to open my eyes.
The paramedics and EMT's did a terrific job bringing me back. I used to work on an ambulance and did CPR on people numerous times, but never thought I would be a recipient. The EMT who was doing CPR kept talking to me the whole time I was out and coaxing me back.

Will, a nine-year-old with asthma
Will was diagnosed with asthma when he was five years old. Ear infections, colds, sinus problems, and upper respiratory problems were so common that the pediatrician would prescribe an antibiotic for him without an office visit.
When Will entered kindergarten, he complained about Physical Education class. His parents assumed this was because he wasn't used to going to school and running around. They thought he would get used to it eventually. About two months into the school year, his eyes were swollen and they itched. The doctor thought he had rubbed his eyes with something to which he was allergic. That same weekend, he woke up coughing, and his breathing was shallow. His parents took him to the doctor, who immediately gave him a nebulizer treatment with albuterol.
After that, Will's parents worked very hard to find answers from doctors about their son's condition. When they received the information and all of the necessary equipment to treat an asthma attack, they came to feel much more capable of handling Will's asthma problems. His parents believe that if they had been given all of the information they needed from the beginning, Will would not have had such frequent absences from school in his primary grades.
Will had his worst asthma attack when he was nine. The weather was cool and dry, and he was playing outside. He went in the house gasping for breath with his shoulders up, making an attempt to open his lungs. Will was panicked, but his mother, knowing exactly what to do, was not. She gave him a breathing treatment and medication.
Naturally, Will wants to know why he was born with asthma and if he will have it forever. This is the hardest part of having a child with asthma induced by exercise and allergies. It's also frustrating for parents. In Will's case, allergy skin testing proved that all of the things he is allergic to are in the public school he attends. His parents can only keep an eye on him and give him the medicine he needs. They also use a Peak Flow Meter every day to check Will's lung capacity. When his asthma is on the rise, he is irritable and doesn't do well in school. Although they wish there was more information to help children with asthma understand their condition, Will's parents feel that as far as they know, they have all the information they need to keep their son's asthma under control.
Asthma capitals
Back on World Asthma Day, May 5, 2015, the Asthma and Allergy Foundation of America (AAFA) released the 2015 Asthma Capitals report, which ranks the 100 most challenging United States cities to live in if you have asthma. The report looks at 13 critical factors related to asthma prevalence, environmental conditions, and healthcare utilization. Here are the top 25. Click here for the full list and a chart of the factors considered.

1. Memphis, Tenn.14. Providence, R.I.
2. Richmond, Va.15. Tulsa, Okla.
3. Philadelphia, Pa.16. Atlanta, Ga.
4. Detroit, Mich.17. McAllen, Texas
5. Oklahoma City, Okla.18. Dayton, Ohio
6. Augusta, Ga.19. Allentown, Pa.
7. Knoxville, Tenn.20. Cleveland, Ohio
8. Chattanooga, Tenn.21. Louisville, Ky.
9. New Orleans, La.22. Milwaukee, Wis.
10. Chicago, Ill.23. Springfield, Mass.
11. Indianapolis, Ind.24. Toledo, Ohio
12. New Haven, Conn.25. Jacksonville, Fla.
13. Fresno, Calif.
NEW! Brain Puzzles
The staff of Insurance Update is excited to bring you a new, regular monthly feature -- BRAIN PUZZLES!

Classic Attention Experiment
(1-minute video by SharpBrains)
Try this experiment, conceived by Simons and Chabris for their classic study on sustained inattentional blindness.
Watch this brief video clip. Your challenge is to count how many times the basketball is passed by a player in white.

Click on the link and follow the instructions.

Can you figure out the phrases?

  1. 26 L of the A
  2. 7 D of the W
  3. 7 W of the W
  4. 12 S of the Z
  5. 66 B of the B
  6. 52 C in a D (W J)
  7. 13 S in the U S F
  8. 18 H on a G C
  9. 39 B of the O T
  10. 5 T on a F
  11. 90 D in a R A
  12. 3 B M (S H T R)
  13. 32 is the T in D F at which W F
  14. 15 P in a R T
  15. 3 W on a T
  16. 100 C in a D
  17. 11 P in a F (S) T
  18. 12 M in a Y
  19. 8 T on an O
  20. 29 D in F in a L Y
  21. 27 B in the N T
  22. 365 D in a Y
  23. 13 L in a B D
  24. 52 W in a Y
  25. 9 L of a C
  26. 60 M in an H
  27. 23 P of C in the H B
  28. 64 S on a C B
  29. 9 P in S A
  30. 1000 Y in a M
Click here for the answers.
 LTCILong-Term Care Insurance
Think about long-term care insurance
Asthma and other respiratory diseases can be debilitating. They are among the many conditions that can impair your ability to make a living and care for yourself. This is a reason to think about long-term care insurance.
Despite your best efforts, there is always the chance you could suffer a debilitating illness or a disabling accident. And, of course, if you live long enough, the time may come when you just can't do everything on your own anymore. Long-Term Care Insurance makes sure that you will get the care you need. It assures that your medical bills will not eat up your savings. Finally, and this is one of the best things about LTCI, it protects your children and other relatives from having to use their resources to care for you.
Brethren Insurance Services offers Long-Term Care Insurance for all members and employees of the Church of the Brethren and their family and friends; and also for employees of Church of the Brethren-affiliated agencies, organizations, colleges, and retirement communities and their families and friends.
If you are interested in obtaining this coverage, contact Brethren Insurance Services at or 800-746-1505 for a free, no-obligation proposal or click here to request more information.