Asthma

Asthma is inflammation of the tubes of the lungs which causes them to be obstructed, and therefore air passes though them less easily. Asthma frequently runs in families and is closely associated with hayfever and eczema. Sometimes other members of the family will have asthma, hayfever, or eczema, or combinations of these. It is essentially caused by an allergic type of reaction of the immune system. Sometimes the irritants which set off the reaction are not strictly allergens but chemical irritants eg smoke, some fumes.

SYMPTOMS

The main symptoms are:

• Difficulty breathing or "shortness of breath", associated with a "tight" feeling. This may be associated with exercise, come on at night, or on exposure to various external stimuli.
• Audible wheeze is often present.
• Cough may be the main symptom in some children.
  

DIAGNOSIS

Your doctor will want to demonstrate that your air flow is significantly limited at times and that this is reversible. He may do this by asking you to use a peak flow meter which measures the fastest rate at which air comes out of your lungs when you blow into it as hard as you can. You will probably be tested in the office and then be given a prescription to get a meter of your own and asked to record regular readings. The doctor may also order pulmonary function tests, which measure lung capacity and can tell if you will respond to medications.

TREATMENT

As with most conditions you can treat Asthma with drugs from your doctor and by trying to prevent the symptoms of Asthma. For example avoiding dust and other irritants, which trigger Asthma, is an example of treating your Asthma by preventing it occurring in the first place.

Controlling your asthma may seem like a lot of work, but taking steps now can help you live a normal life.

• Find ways to control your asthma triggers.
• Keep your asthma diary up to date and follow your asthma action plan.
• Take your long-term control medicines properly.
• Always carry your quick-relief medicine with you.

All of these steps together can greatly reduce your chances of having asthma attacks. Prevention is the key. All it takes is good information and a working partnership with your doctor.

There are two main types of drugs used for treating Asthma, and these are most commonly taken using an aerosol inhaler.

Long Term Control Medications: There are preventers that are taken every day, even if you feel well. They help to control the air-way inflammation and prevent asthma attacks from starting. These medicines reduce the swelling in your air tubes and decrease the mucus, They reduce the sensitivity of the cells in the lungs to house dust mites and other allergens. Some of these do not contain steroids eg sodium cromoglycate (Cromlyn), and others which tend to be more effective, especially in moderate to severe asthma, contain steroids eg beclomethasone, budesonide, and fluticasone. Leukotriene Modifiers (such as ) can be used instead of inhaled corticosteroids for people with mild asthma.

They must be used regularly to be effective, usually every day.

In the usual doses prescribed the total steroid dose to the body from these inhalers is not enough to cause significant adverse effects. It is wise, however, to rinse the mouth and throat by gargling with water after use of inhaled steroids. Any steroid that is left on the mouth and throat will not do any good to your asthma and may predispose you to infections in the throat and a hoarse voice. Alternatively, with young children encourage them to brush their teeth after using their preventer inhaler. (This should also please the dentist!)

Quick Relief Medications: Bronchodilators are medicines that help to stop asthma attacks after they've started and can help prevent expected attacks, as from exercise. These medicines give you relief during an asthma attack. Bronchodilators work to relax the muscles in your air tubes. As this happens, your air tubes open up, making it easier for you to breathe.
Be Careful! You can use quick-relief medicines too often. They make you feel better for a little while, but will not help if you need to use them every day. If you use your quick-relief medicines every day, you may need long-term control medicines. With good control, you should not need quick-relief medicines very often.

No matter what kind of quick-relief medicine you use, always carry it with you. Never leave home without it! Make sure you know how to use it the correct way.

Allergy shots: There is another kind of treatment that may be helpful to you if your asthma attacks get started by allergies. This treatment is called hyposensitization therapy or allergy shots. These shots may be helpful to you in preventing your asthma attacks.

The medications for asthma can be inhaled through an aerosol spray or a fine powder. You may need a “spacer” between the aerosol and your mouth. You may need to take pills. The anti-inflammatory medications may be given by tablet form.
Sometimes you may have some side effects, such as a sore throat, nervousness, nausea, rapid heartbeat, loss of appetite, or staying awake. Tell a doctor if you feel this way. The doctor may want to change your dose, or try a different asthma medicine.

MONITORING ASTHMA

The patients themselves develop a very good idea of the severity of their asthma on a day to day basis, but it helps both them and the doctor to have an objective measure of the condition. Listening to the lungs is not very helpful, but peak expiratory flow meters (peak flow meters) give a very accurate idea of how tight the airways are.

These measure the fastest rate at which air comes out of your mouth when you blow as fast as you can. The measurement relies on maximum effort, but assuming that this is achieved, the muscle power of the muscles involved in blowing will not vary from day to day, and so changes in the reading are a result of change in the diameter of the airways. (A small change in diameter causes a fairly large change in air flow and thus the reading is very sensitive.)

ASTHMA ATTACKS CAN BE DANGEROUS

It helps to know when an asthma attack may be starting. You may be able to prevent it before it starts.

Know Your Signs

• Coughing, sneezing, itchy throat
• Tight chest, wheeze
• Shortness of breath
• Wake up at night
• Fast heartbeat and breathing
• Headache
  

Danger Signs

• Can't talk well or walk/gasping for air
• Lips or fingernails turn blue

YOU ARE HAVING A MAJOR ATTACK. IF YOU HAVE THESE SIGNS, GO TO THE EMERGENCY ROOM OR CALL 911 IMMEDIATELY!

Take Action

• Work with your doctor to develop an action plan.
• Learn what your warning signs are.
• When you feel an attack coming:
  • Get away from the trigger that started your attack.
  • Take a quick-relief medicine (such as Albuterol inhaler) up to 3
  • treatments of 2 to 4 puffs, 20 minutes apart.
  • If you still have wheezing and shortness of breath, get emergency help from your doctor.

WHAT IS A PEAK FLOW METER?

A Peak Flow Meter measures your ability to push air out of your lungs.

WHO CAN BENEFIT FROM USING A PEAK FLOW METER?

Many doctors believe that people who have asthma can benefit from the use of a Peak Flow Meter. If you need to adjust your daily medication for asthma, a Peak Flow Meter can be an important part of your asthma management plan.

Many doctors believe a Peak Flow Meter may be of most help for people with moderate and severe asthma. If your asthma is mild or you do not use daily medication, a Peak Flow Meter may not be useful for asthma management.

WHY SHOULD I MEASURE MY PEAK FLOW RATE?

A Peak Flow Meter can show you that you may need to change the way you are using your medicines. For example, Peak Flow readings may help be a signal for you to implement the medication plan you and your doctor have developed for worsening asthma. On the other hand, if you are doing well, then measuring your Peak Flow may be helpful as you and your doctor try to lower the level of your medicines.

A Peak Flow Meter can help you when your asthma is getting worse. Asthma sometimes changes gradually. Your Peak Flow may show changes before you feel them. It can allow your doctor to adjust your treatment to prevent urgent calls to the doctor, emergency room visits or hospitalizations.

A Peak Flow Meter may help you and your doctor identify causes of your asthma at work, home or play. It may help parents to determine what might be triggering their child's asthma.

A Peak Flow Meter can also be used during an asthma episode. It can help you determine the severity of the episode; decide when to use your rescue medication; and decide when to seek emergency care.

Knowing your "personal" Peak Flow Rate allows you to elevate your readings. Being at your "best" can provide reassurance and make you feel more self-confident.

HOW DO YOU USE A PEAK FLOW METER?

Step 1: Before each use, make sure the sliding marker or arrow on the Peak Flow Meter is at the bottom of the numbered scale (zero or the lowest number on the scale).

Step 2: Stand up straight. Remove gum or any food from your mouth. Take a deep breath (as deep as you can). Put the mouthpiece of the Peak Flow Meter into your mouth. Close your lips tightly around the mouthpiece. Be sure to keep your tongue away from the mouthpiece. In one breath blow out as hard and as quickly as possible. Blow a "fast hard blast" rather than "slowly blowing" until you have emptied out nearly all of the air from your lungs.

Step 3: The force of the air coming out of your lungs causes the marker to move along the numbered scale. Note the number on a piece of paper.

Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.)

Step 5: Record the highest of the three ratings. Do not calculate an average. This is very important.

You can't breathe out too much when using your Peak Flow Meter but you can breathe out too little. Record your highest reading.

Step 6: Measure your Peak Flow Rate close to the same time each day. You and your doctor can determine the best times. One suggestion is to measure your Peak Flow Rate twice daily between 7and 9 a.m. and between 6 and 8 p.m.

You may want to measure your Peak Flow Rate before or after using your medicine. Some people measure Peak Flow both before and after taking medication. Try to do it the same way each time.

Step 7: Keep a chart of your Peak Flow Rates. Discuss the readings with your doctor.

HOW DO I CHART MY PEAK FLOW RATES?

Chart the HIGHEST of the three readings. The chart could include the date at the top of the page with AM and PM listed. The left margin could list a scale, starting with zero (0) liters per minute (L/min) at the bottom of the page and ending with 600 L/min at the top.

You could leave room at the bottom of the page for notes to describe how you are feeling or to list any other thoughts you may have.

HOW CAN I DETERMINE A "NORMAL" PEAK FLOW RATE FOR ME?

Three zones of measurement are commonly used to interpret Peak Flow Rates. It is easy to relate the three zones to the traffic light colors: green, yellow, and red. In general, a normal Peak Flow Rate can vary as much as 20 percent.

Be aware of the following general guidelines. Keep in mind that recognizing changes from "normal" is important. Your doctor may suggest other zones to follow.

Green Zone:
80 to 100 percent of your usual or "normal" Peak Flow Rate signals all clear. A reading in this zone means that your asthma is under reasonably good control. It would be advisable to continue your prescribed program of management.

Yellow Zone:
50 to 80 percent of your usual or "normal" Peak Flow Rate signals caution. It is a time for decisions. Your airways are narrowing and may require extra treatment. Your symptoms can get better or worse depending on what you do, or how and when you use your prescribed medication. You and your doctor should have a plan for yellow zone readings.

Red Zone:
Less than 50 percent of your usual or "normal" Peak Flow Rate signals a Medical Alert. Immediate decisions and actions need to be taken. Severe airway narrowing may be occurring. Take your rescue medications right away. Contact your doctor now and follow the plan he has given you for red zone readings.

Some doctors may suggest zones with a smaller range such as 90 to 100 percent. Always follow your doctor's suggestions about your Peak Flow Rate.

MANAGEMENT PLAN BASED ON PEAK FLOW READINGS

It is important to know your Peak Flow reading, but it is even more important to know what you will do based upon that reading. Work with your doctor to develop an asthma management plan that follows your green-yellow-red zone guidelines.

Record the Peak Flow readings that your doctor recommends for your green zone, yellow zone, and red zone. Then work out with your doctor what you plan to do when your Peak Flow falls in each of those zones.

OUTDOOR AIR, INDOOR AIR AND AIR-CONDITIONING

Controlling your exposure to triggers outdoors is hard. You may have to avoid outdoor air pollution, pollen, and mold spores. Any time air pollution and pollen levels are high, it's a good idea to stay indoors.

The air at home is easier to control. Some people with asthma and allergies notice that their symptoms get worse at night. Trigger controls in the bedroom or wherever you sleep need the most care.

Air-conditioning can help. It allows windows and doors to stay closed. This keeps some pollen and mold spores outside. It also lowers indoor humidity. Low humidity helps to control mold and dust mites.

Avoid too much air-conditioning or too much heat. Room air temperature should be comfortable for someone with allergies or asthma. Some people can't tolerate a big change in temperature, particularly from warm to cold air.

There are some devices that effectively remove particles from air. Their usefulness in reducing allergy symptoms is under study.

TRIGGER CONTROLS

Here are some common triggers and some ways to help control them at home:

House Dust Mites

Dust mites are tiny insects found in house dust in almost all parts of the United States. They live on human dander (skin flakes shed by all people) and moisture in the air. Dust mites are plentiful on mattresses, pillows, carpets, bed covers and upholstered furniture.

Solution

• You can control dust mites by washing the bed pillows, sheets and covers every week in hot water.
• Use special dust-proof mattress and pillow covers.
• Get rid of carpets, extra pillows and upholstered furniture, especially in the bedroom.
• Limit stuffed animals in children's rooms, and wash them often in hot water.
• Dust and vacuum often.
• Use a dehumidifier - Dust mites need moist air to live.

Animals

All warm-blooded animals, including birds and small rodents, produce dander (shedded skin, fur and feathers) and urine, saliva and droppings that you may be sensitive to.

Solution

• Give away your pets. If that's not an option, keep pets out of your bedroom and living areas as much as possible.
• Keep your bedroom door closed and consider using dense filters over forced-air outlets.
• Keep the pet away from carpet and upholstered furniture.

Molds

Molds can grow in many homes and apartments, especially if you have a dampness problem.

Solution:

• When humidity is high, molds can be a problem in bathrooms, kitchens, and basements. Make sure these areas have good air circulation and are cleaned often. The basement in particular may need a dehumidifier. And remember, the water in the dehumidifier must be emptied and the container cleaned often to prevent forming mildew.

Wood Smoke

Wood smoke is a problem for children and adults with asthma and allergies.

Solution:

• Avoid wood stoves and fireplaces.

Cockroach Droppings

You can breathe in the droppings of cockroaches and become sensitive to it. This is a concern in big cities and areas of the country with cockroach problems.

Solution:

• Use traps and poison baits instead of chemical sprays to control cockroaches. Sprays can also be irritating to your airways. If spraying is necessary, people with asthma must leave the home until the odor has cleared. Like humans, roaches need food and water and a place to live. Help keep your home roach free by storing food in sealable containers and keeping crumbs, dirty dishes and other sources of food waste cleaned up; fixing leacks and wiping up standing water; and cleaning up clutter where roaches find shelter.

Outdoor Triggers

Tree, grass and weed pollens and outdoor mold can also be a problem. Air pollution, smoke and car exhaust can affect you as well.

Solution:

• Stay inside during the time of year when blossoms are producing pollen.
• Keep your doors and windows shut during those times.
• Avoid the outdoors when air pollution is high.

Strong Smells

Strong smells from painting, spraying, cleaning fluids, garden chemicals, perfumes, lotions, hair sprays and deodorants can trigger asthma problems.

Solution:

• People with asthma should stay away from the house or apartment when these chemicals and sprays are in use, and stay away until the smell clears.

Smoking

Cigarette, pipe and cigar smoke are triggers that can affect asthma severely. Children in homes with adults that smoke are far more likely to have asthma problems.

Solution:

• If possible, smokers in families with asthma should quit. At the very least, smokers should never smoke indoors and never around people with asthma.

Food, Medicine, and Cosmetic Allergies

Many people with asthma report problems with eating certain types of food, especially those that contain sulfites, and also with some medicines,especially aspirin.

Solution:

• Be careful to avoid eating foods that contain sulfites.
• Read food labels and use medicines such as Tylenol or Advil instead of aspirin.
• Stay away from any food or medicine that makes your asthma worse.

Drainage From Colds and Sinus Problems

Sinus drainage from colds and other problems can make asthma worse.

Solution:

• Don't ignore a drippy nose.
• Talk to your doctor about medicines you can take to reduce the drainage.

Infections

Viruses and infections of the sinuses can also make asthma worse.

Solution:

• See your doctor for proper treatment. Often you will need medicine to fight the infection and more of your regular asthma medicines until the infection clears.

Weather Changes

Weather changes can affect the lungs and airways of people with asthma-usually very hot, humid weather or very cold, dry weather.

Solution:

• Avoid doing much outdoors when the weather is very hot or cold.
• Wear a scarf around your mouth and nose to protect your airways when you must be out in cold, dry weather.

Exercise and Stress

Many people with asthma can have attacks during exercise or during times of high stress.

Solution:

• If exercise is one of your triggers, your doctor can provide medicine to take just before exercising to prevent an asthma attack.
  Remember
  • Even though asthma can affect exercise, you should not avoid it. Regular exercise can improve your lungs and overall health. It's an important part of controlling your asthma. Ask your doctor to help you plan a safe exercise program.
  • Controlling your asthma triggers is the first important step in keeping your airways open and in controlling your asthma.