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   Dr. Bralow’s Bulletin
September 3rd, 2021
Edition #131 – est 3/2020

Enjoy Labor Day weekend!

This week’s Bulletin discusses Asthma, along with the latest updates on COVID-19:


Asthma is a chronic (long-term) lung disease. With asthma, the lining of the airways tend to always be in a hypersensitive state characterized by redness and swelling (inflammation). It’s similar to how your skin becomes red, irritated and sensitive after a sunburn. Researchers have started to look deeper at the role that inflammation plays in asthma. They believe that all people with asthma have some degree of inflammation of the airways.

The hypersensitive state of the lungs makes asthmatics react to everyday exposures – a common cold, stress, changes in the weather, or things in the environment, such as dust, pollen, chemicals, smoke and pet dander. This reaction or “trigger” causes the insides of the airways to swell, narrowing the space where air moves in and out of the lungs causing these symptoms:

  • Wheezing. You may notice a whistling sound when you breathe. Sometimes this happens only when you exercise or have a cold.
  • Frequent cough. This may be more common at night. You may or may not cough up mucus.
  • Shortness of breath. This is the feeling that you can’t get enough air into your lungs. It may occur only once in a while, or often.
  • Chest tightness. Your chest may feel tight, especially during cold weather or exercise. This can also be the first sign of a flare-up.

Asthma is often categorized into different types based on triggers that cause breathing problems and make asthma symptoms worse. They include:

  • Allergic asthma – Allergens may include dust mites, pet dander, pollen, or mold.
  • Aspirin-induced asthma – hyprsensitivity to aspirin and nsaids accompanied by nasal polyps
  • Cough-variant asthma presents solely with cough and is one of the most common causes of chronic cough. More importantly, 30 to 40% of adult patients with CVA, unless adequately treated, may progress to classic asthma.
  • Exercise-induced asthma – Coughing and wheezing are the most common symptoms with airway narrowing causing wheezing when the exercise begins, making it difficult to catch breath. The symptoms peak or worsen a few minutes after stopping the exercise.
  • Nighttime asthma – This may be because of increased nighttime exposure to allergens (asthma triggers), cooling of the airways, reclining position, or even hormone cycles at night. Sometimes, normal heartburn can trigger asthma symptoms at night.
  • Occupational asthma– due to patients’ occupation (paint, metal, or gas); hence, patients may require knowing the exact trigger

The most common risk factors for developing asthma is having a parent with asthma, having a severe respiratory infection as a child, smoking cigarettes, having an allergic condition, second-hand tobacco smoke exposure or being exposed to certain chemical irritants or industrial dusts in the workplace. Obesity is also a risk factor and this is thought to be due to the low-grade inflammation in the body that occurs with extra weight.

Although we cannot cure asthma, we can control it. There are three changes in the airways when you have asthma:

  1. Swelling inside the airways
  2. Excess mucus that clogs the airways
  3. Muscles tighten and squeeze around the airways

This swelling, clogging, and muscle tightening makes your airways smaller or narrower. This makes it harder for air to flow easily through your airways, and it becomes harder to breathe. There are asthma medicines that target these three changes.

  • Inhaled corticosteroids are the most effective long-term control medicines. These aren’t the same as anabolic steroids that people use to grow muscle. They include beclomethasone (Qvar RediHaler), budesonide (Pulmicort Flexhaler), ciclesonide (Alvesco), fluticasone (Flovent HFA), and mometasone (Asmanex Twisthaler).
  • Inhaled long-acting beta-agonists open your airways by relaxing the smooth muscles around them. You’ll take this medication along with an inhaled corticosteroid. They include formoterol, salmeterol, and vilanterol.
  • Combination inhaled medicines have an inhaled corticosteroid along with a long-acting beta-agonist. This is an easy way to take them together. They include Advair, Breo, Dulera, and Symbicort.
  • Biologics target a cell or protein in your body to prevent airway inflammation. They may be shots or infusions you get every few weeks. They can be expensive, so you usually get them if other medications don’t work. Biologics include benralizumab (Fasenra), dupilumab (Dupixent), mepolizumab (Nucala), omalizumab (Xolair), and reslizumab (Cinqair).
  • Leukotriene modifiers relax the smooth muscles around your airways and ease swelling. You can take them as pills or liquids. These include montelukast (Singular), zafirlukast (Accolate), and zileuton (Zyflo).
  • Cromolyn prevents your airways from swelling when they come into contact with an asthma trigger. It’s a non-steroid medicine that comes in an inhaler.
  • Theophylline (Theo-24, TheoDur) relaxes the smooth muscles that narrow your airways. It comes as a tablet, capsule, solution, or syrup.
  • Long-acting bronchodilators. You might use tiotropium (Spiriva) along with corticosteroids if you have ongoing asthma symptoms even though you take a daily inhaled steroid. Never use long-acting bronchodilators alone as a long-term asthma treatment.
  • Corticosteroids. If no other medicine can get your asthma attacks under control, your doctor might have you take these medications for a couple of weeks. They come in pills or liquids.

Asthma inhalers are the most common and effective way to deliver asthma medicine to your lungs.

  • A metered-dose inhaler, which uses a small aerosol canister to push out a short burst of medication through a plastic mouthpiece
  • A dry powder inhaler, which releases the medicine only when you take a deep breath

A nebulizer is used If you’re having trouble using small inhalers. This machine changes asthma medications from a liquid to a mist so it’s easier to get the medicine into your lungs using a mouthpiece or mask. It’s a good option for anyone who has trouble using inhalers or whose lungs are so tight they cannot inhale deeply.

Most people with asthma can manage their condition and get rid of most of their symptoms. The key is to work with your doctor to come up with a treatment strategy, called an asthma action plan. It should identify your triggers, list your daily medications, and outline what to do when you have a flare-up. You can revisit your plan and adjust it when you need to.



  • Masks will be required in all Pennsylvania K-12 schools, Gov. Tom Wolf announced Tuesday (watch live here), reversing course amid a statewide COVID-19 resurgence that is filling hospital beds just as students return to class. The Department of Health order will take effect Tuesday, Sept. 7 — the day after Labor Day — and will require students, teachers and staff to wear masks when inside. The order applies to private as well as public schools and will also apply to child care facilities.


  • Federal officials said they are prepared to start administering booster shots as early as Sept. 20, pending approval by the U.S. Food and Drug Administration.  The CDC also released three studies Wednesday that suggest the Pfizer and Moderna vaccines remain highly effective at preventing COVID-19 hospitalizations, but that their abilities to prevent infection have weakened. “Nearly all the cases of severe disease, hospitalization and death continue to occur among those not yet vaccinated at all,” the federal officials added in their statement.


  • White House COVID-⁠19 Response Coordinator Jeff Zients on Tuesday also spoke to the increasing vaccination pace, citing an 80% increase since mid-July in the average number of daily vaccinations, climbing from about 500,000 to 900,000. Last week, the country logged over 6 million vaccinations, translating to the largest weekly total since July 5, Zients said. The nationwide pace of first vaccinations has also accelerated, with over 14 million shots administered in August, or nearly 4 million more initial shots since July.


  • Half of American workers are in favor of vaccine requirements at their workplaces, according to a new poll, at a time when such mandates gain traction following the federal government’s full approval of Pfizer’s COVID-19 vaccine. The poll from The Associated Press-NORC Center for Public Affairs Research shows that about 59% of remote workers favor vaccine requirements in their own workplaces, compared with 47% of those who are currently working in person. About one-quarter of workers — in person and remote — are opposed.


  • Your ride on SEPTA could be slower than normal due to a lack of bus drivers. The Philadelphia-area transit agency tweeted out more than 20 bus routes that were “operating with delays due to an operator shortage.” The impacted routes are 14, 20, 24, 25, 28, 29, 33, 4, 47, 49, 5, 56, 57, 58, 60, 64, 66, 67, 7, 70, 9, G and K, according to SEPTA.. It is unclear when bus service on those routes will return to normal, so give yourself some extra time.


  • Before you lace up your sneakers for the 2021 Blue Cross Broad Street Run be sure to get vaccinated against COVID-19. This year’s Blue Cross Broad Street Run in Philadelphia will require proof of vaccine for all participating runners while spectators will not be allowed at the start of the race or the finish line due to the recent rise in COVID-19 cases. The 10-mile race will take place on Sunday, Oct. 10. All registered participants who want to run in-person must have their COVID-19 vaccination series completed by Sunday, Sept. 26 while proof of vaccination must be provided to the race’s organizers by Friday, Oct. 8.


  • A prior infection from COVID-19 was more protective than vaccine-induced immunity in reducing the risk of infection and symptomatic illness from the Delta variant, according to a retrospective observational study from Israel. Among people with prior infection, a single dose of the vaccine conferred more protection against reinfection compared with no vaccination at all. But experts cautioned that these results shouldn’t encourage people to go out and get infected.  Robert Schooley, MD, of the University of California San Diego, told MedPage Today that “Putting yourself at risk of dying to have ‘natural’ immunity is not a great tradeoff.”. 


  • Individuals infected with the coronavirus disease 2019 (COVID-19) are most contagious 2 days before, and 3 days after they develop symptoms, according to a study published in JAMA Internal Medicine.


  • Taking children and teenagers into account, more than 55 percent of the overall E.U. population has been fully vaccinated (this means 250 million people in the EU have been fully vaccinated.). This is compared with 52 percent in the United States, 61 percent in Israel and 64 percent in Britain. While more than 80 percent of adults have been fully inoculated in Belgium, Denmark and Portugal, and more than 75 percent in Spain and the Netherlands, the figure falls to 45 percent in Latvia, 31 percent in Romania and only 20 percent in Bulgaria where disinformation, poor trust in institutions and a lack of a communication strategy have plagued efforts,


  • Under N.F.L. rules, unvaccinated players must be tested every day for the virus, as opposed to once a week for vaccinated players, and they cannot move around the team facility or mix with teammates as freely as vaccinated players.

  • The latest Axios-Ipsos Coronavirus Index, released Tuesday, finds only one in five Americans say they’re not likely to get vaccinated, the lowest level since the start of the index. The percentage of Americans who stand in hard opposition to getting the vaccine has also dropped to its lowest reported levels at 14% of U.S. adults. The changes are particularly noteworthy among parents: 68% now say they’re likely to get their children vaccinated and 31% oppose vaccinating their children.


  • Kiss frontman Paul Stanley tested positive Thursday, forcing the band to postpone a string of shows over subsequent days. On Tuesday, the band announced that bassist Gene Simmons, too, has tested positive for COVID-19.


  • Google is once again postponing a return to the office for most workers until mid-January, in addition to requiring all employees to be vaccinated once its sprawling campuses are fully reopened.


  • Alabama, Georgia, Texas, Florida and Arkansas have less than 10% left of their ICU bed capacity, according to data from the Department of Health and Human Services. In Georgia, the CEO of Northeast Georgia Health Systems said it had 287 Covid patients Monday morning, which is more than the hospital has had since January. And it’s not just the South now. On Tuesday, Idaho had just four ICU beds available out of the 400 beds total in the state, Gov. Brad Little said.”Yesterday evening I toured a nearly full ICU wing in Boise. What I saw was heartbreaking. Among the Covid-positive patients all of them were unvaccinated,” Little said.


  • New York Mayor Bill de Blasio issued a vaccine mandate for “high-risk” public school sports. The mandate applies to roughly 20,000 students and staff participating in football, basketball, wrestling, lacrosse, stunt, rugby, and bowling, according to a statement from the NYC Department of Education. New York Gov. Kathy Hochul plans to require mandatory weekly Covid-19 testing for school staff in the state who are not vaccinated, she said Tuesday.


  • Athletes in Fairfax County Public Schools (Virginia’s largest public school system) will have to be vaccinated in order to compete in winter and spring sports, according to a letter from the superintendent. “Proof of full COVID-19 vaccination will also be required for participation in any other activity that requires a physical,” Superintendent Scott S. Brabrand wrote in a letter to the community Monday. “This includes dance team and step team, as well as out-of-season practices and workouts.” The requirement kicks on November 8.


  • Nearly 300,000 Americans in rural areas completed a COVID-19 vaccination series last week, translating to the largest weekly gain since mid-July, per data published by the nonprofit Center for Rural Strategies. While rural counties logged about 150,000 weekly vaccinations by late July, the figure has since climbed to 292,898, according to the report. Also, the weekly number of residents in rural areas rolling their sleeves to receive a first dose increased by over two-thirds in the last three weeks, and 39 of 47 states with rural counties saw an uptick in initial shots administered last week compared to two weeks prior.



Bralow Medical Group Office Information
We have resumed our regularly scheduled hours
Our first priority is your health and safety

If you are my patient then you know to contact me directly on my cell phone 24/7 if you have any  medical concerns. You can also email me at with general questions.

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Please stay safe and be smart,
Dr Bralow

Dr. Vicki Bralow
834 South Street
Philadelphia, Pa 19147


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