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Asthma

The National Heart, Lung and Blood Institute defines asthma as "a chronic inflammatory disease of the airways (which causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night and early morning) usually associated with widespread but variable airflow obstruction that is often reversible, either spontaneously or with treatment."

Risk Factors

The cause of asthma is unknown. Studies suggest a strong link between asthma and the hereditary presence of antibodies associated with allergic reactions. Exposure to environmental allergens can trigger asthma symptoms. Among the most common allergens are microscopic dust mite and cockroach droppings, airborne pollens and molds, plants and plant proteins, enzymes and pet dander (tiny scales of hair, feathers or skin). Also, vapors, dust, gases, fumes, tobacco smoke and air pollution can worsen or cause asthma.

Certain medications may trigger asthma symptoms. These include beta-blockers, used to treat high blood pressure and glaucoma (in eye drops). About 5 - 20 percent of adults with asthma have attacks triggered by sensitivities or allergies to medications such as aspirin, ibuprofen, indomethacin and naproxen. Others react to sulfites (chemicals commonly used to preserve foods such as tuna, salads, dried apples and raisins and beverages such as lemon juice, grape juice and wine).

Signs and Symptoms
  • Coughing from asthma is often worse at night or early in the morning, making it hard to sleep.
  • Chest tightness can feel like something is squeezing or sitting on your chest.
  • Shortness of breath - some people say they can't catch their breath or they feel out of breath. You may feel like you can't get enough air in or out of your lungs.
  • Faster breathing or noisy breathing.

Inflammation causes airways to become constricted and narrow. Narrowing of the airways, called bronchoconstriction, produces shortness of breath, tightness in the chest, coughing and wheezing.

Diagnosis

A diagnosis of asthma usually is based on the following:

  • Patient's symptoms
  • Medical history
  • Physical exam
  • Spirometry - a test that measures air entering and leaving the lungs
  • Peak expiratory flow - the patient's maximum ability to exhale; usually measured twice a day for a few weeks, after which it is reviewed by your health care provider.
  • Chest X-ray - a picture of the chest that shows your heart, lungs, airway, blood vessels and lymph nodes.
  • Allergy testing - either by skin test or by blood test to measure antibodies in the blood.

Asthma cannot be cured. Most people with asthma can manage it, so they have fewer and less frequent symptoms and can live active lives.

Treatment

Four classifications of asthma based on frequency and duration of symptoms are used to develop a treatment plan: (1) mild intermittent asthma, (2) mild persistent asthma, (3) moderate persistent asthma and (4) severe persistent asthma. Patients often move from one classification to another and the treatment is adjusted as a result.

Drug Therapy has several goals, they include:

  • prevention of chronic symptoms
  • prevention of recurrent exacerbations
  • prevention of emergency room visits
  • prevention of hospitalization
  • maintenance of normal lung function
  • normal activity levels

There are two broad classes of medications used in the treatment of asthma:

Quick-relief medications include short-acting inhaled beta2 agonists, oral beta2 agonists, inhaled anticholinergics and oral corticosteroids or rescue medications; and long-term control medications.

  • beta2 agonists produce relief almost immediately and may continue doing so for as long as 6 hours.
  • The inhaled anticholinergics presently are limited to ipratropium bromide (Atrovent).

Long-term control medications include oral corticosteroids, inhaled corticosteroids, cromolyn sodium, and nedocromil, long-acting beta2 agonists, leukotriene modifiers and theophylline.

  • Corticosteroid medications for long-term control can be taken orally or inhaled.
  • Cromolyn sodium and nedocromil are anti-inflammatory agents and are delivered by inhalation, found to work best in children.
  • Leukotriene modifiers, ( e.g., Singulair®, Accolate®) are a class of drugs that block part of the inflammatory cascade that typically occurs in asthma. For use in adults and children over 2 years.
  • Metered-dose inhalers (MDIs) are the most common delivery systems used. They are relatively easy to use, but children under age five often have difficulty using them effectively. Dry powder inhalers are used in patients under five years of age.
  • Nebulizers can be used with all classes of inhaled medications but are most commonly used with short-acting beta2 agonists and ipratropium bromide.
What Can You Do?

Remember: Taking care of your asthma is an important part of your life.

Self-Management

A written self-management or Asthma Action Plan is useful for asthma patients. The health care provider prepares the plan detailing the adjustments to patients' medications based on their asthma symptoms and peak flow meter readings. This plan can assist greatly in knowing what to do during an acute increase in symptoms (an acute exacerbation). If there is any doubt about what to do during an acute asthma exacerbation, you should contact your healthcare provider.

Tobacco Cessation

The use of tobacco in any form is a great health concern. Even if you don't smoke, reduce your exposure to secondhand smoke. If you use tobacco products, prepare yourself to quit as soon as possible.

  • Set a date to stop and mark it on your calendar. Twenty-four hours before the start date make everyone aware of your goal to stop.
  • Remove the smell of tobacco by cleaning your house and car. Remember to get rid of lighters, ashtrays and matches.
  • You can use over-the-counter aids such as nicotine patches and gum. Contact your health insurance provider to see if Nicotine replacement therapy is a covered service.
  • Know what your triggers are that make you want to use tobacco products and be prepared with chewing gum, celery or carrot sticks.
  • Kentucky has a free Quit Now program that helps you quit using tobacco products. You can contact the Quit Now program at (800) 784-8669.

Control Your Environment

An important part of asthma control therapy is the control of contributing environmental factors. Common asthma triggers found in the environment include pets, molds, perfumes, dust mites and medications. Be aware of your asthma and symptoms, so that you can take action quickly at the sign(s) of an attack.

Working with your health care provider

  • Learn about your asthma and how to control it. Work closely with your health care provider.
  • Use medicines as directed by your health care provider, to prevent or stop attacks.
  • Get regular checkups from your health care provider.
  • Stay away from things that make your asthma worse, as much as possible.
  • Follow your Asthma Action Plan and work with your health care provider on your Asthma Action plan.

 

Last Updated 9/28/2012
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