Asthma

Definition of Asthma

Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial susceptibility to spasm and constriction, as well as an underlying inflammation of the airways. The interaction of these features of asthma determines the clinical manifestations and severity of asthma and the response to treatment. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.

Environmental Factors

Two major environmental factors have emerged as the most important in the development, persistence, and possibly severity of asthma: airborne allergens and viral respiratory infections. Tobacco smoke, air pollution, occupations, and diet have also been associated with an increased risk for the onset of asthma, although the association has not been as clearly established as with allergens and respiratory infections.

Control and Treatment

Current therapeutic approaches allow most people who have asthma to participate fully in activities they choose. 

Understanding what triggers your asthma as well as how your medications work is extremely important in the treatment of your asthma.

Treatment with anti-inflammatory drugs can, to a large extent, reverse some of the processes involved which cause asthma symptoms; however, the successful response to therapy often requires weeks to achieve.

Medications

Medications for asthma are categorized into two general classes: long-term control medications used to achieve and maintain control of persistent asthma and quick-relief medications used to treat acute symptoms and exacerbations.

Long Term Control Medications:

Corticosteroids: (Usually inhaled): Block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation. They are the most potent and effective anti-inflammatory medication currently available.

Long Acting Beta Agonists: Salmeterol and formoterol are bronchodilators that have a duration of at least 12 hours after a single dose. Long acting beta agonists are not to be used alone for long term control of asthma, but are used in combination with inhaled corticosteroids for long-term control and prevention of symptoms in moderate or severe persistent asthma.

Combinations of Inhaled Corticosteroids and Long Acting Beta Agonists: These combinations make it a bit easier to take medications for long term control of asthma. Brands include Advair, (fluticasone, an inhaled corticosteroid, plus Salmeterol, a long acting beta agonist) and Symbicort, (budesonide, an inhaled corticosteroid, plus formoterol, a long acting beta agonist).

Cromolyn sodium and nedocromil: Are used as alternative, but not preferred, medication for the treatment of mild persistent asthma. They can also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens.

Leukotriene modifiers: Montelukast and zafirlukast, as well as zileuton are available. LTRAs are alternative or adjunctive therapy for asthma that is not controlled with an inhaled corticosteroid. LTRAs are not first line treatment for mild persistent asthma.

Methylxanthines: Sustained-release theophylline is a mild to moderate bronchodilator used as alternative, not preferred, adjunctive therapy with inhaled corticosteroids.

Quick Relief Medications:

Short acting beta agonists: Albuterol, levalbuterol, and pirbuterol are bronchodilators that relax smooth muscle. These medications are the therapy of choice for relief of acute symptoms and prevention of Exercise-Induced Asthma.

Systemic corticosteroids: Although not short acting, oral systemic corticosteroids are used for moderate and severe exacerbations as adjunct to short acting beta agonists to speed recovery and prevent recurrence of exacerbations.

Anticholinergics: Ipratropium bromide provides additive benefit to short acting beta agonists in moderate-to-severe asthma exacerbations. This medication may also be used as an alternative bronchodilator for patients who do not tolerate short acting beta agonists.

KNOW HOW TO TAKE YOUR INHALED MEDICATIONS EFFECTIVELY! Check with your practitioner to review how to take your inhalers so that they work the best they can.

HOW TO CONTROL THINGS THAT MAY MAKE YOUR ASTHMA WORSE:

The following is a list of things, (in bold print), that may make your asthma worse. Not everyone is sensitive to everything, but if you feel your symptoms are made worse by any of the following, take a moment to put the recommended steps into place in order to limit your exposure.

  • Tobacco Smoke
    • If you smoke, ask your doctor for ways to help you quit. Ask family members or those you live with to quit smoking, too.
    • Do not allow smoking in your home or around you.
    • Be sure no one smokes at a child’s day care center.
  • Dust Mites
    • Many people with asthma are allergic to dust mites. Dust mites are like tiny “bugs” you cannot see that live in cloth or carpet.
    • Encase your mattress in a special dust-proof cover or wash the pillow each week in hot water. Water must be hotter than 130 degrees to kill the mites.
    • Wash the sheets and blankets on your bed each week in hot water.
    • Reduce indoor humidity to less than 50 percent. Dehumidifiers or central air conditioners can do this.
    • Try not to sleep or lie on cloth-covered cushions or furniture.
    • Remove carpets from your bedroom and those laid on concrete, if you can.
    • Keep stuffed toys out of the bed or wash the toys weekly in hot water.
  • Animal Dander
    • Some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers.
    • The best thing to do is to keep furry or feathered pets out of your home.
    • If you can’t keep the pet outdoors, then keep the pet out of your bedroom and keep the bedroom door closed.
    • Cover the air vents in your bedroom with heavy material to filter the air.
    • Remove carpets and furniture covered with cloth from your home. If that is not possible, keep the pet out of the rooms where these are.
  • Cockroach
    • Many people with asthma are allergic to the dried droppings and remains of cockroaches.
    • Keep all food out of your bedroom.
    • Keep food and garbage in closed containers (never leave food out).
    • Use poison baits, powders, gels or paste (for example, boric acid). You can also use traps.
    • If a spray is used to kill roaches, stay out of the room until the odor goes away.
  • Vacuum Cleaning
    • Try to get someone else to vacuum for you once or twice a week, if you can. Stay out of rooms while they are being vacuumed and for a short while afterward.
    • If you vacuum, use a dust mask (from a hardware store), a double layered or microfilter vacuum cleaner bag, or a vacuum with a HEPA filter.
  • Indoor Mold
    • Fix leaky faucets, pipes, or other sources of water.
    • Clean moldy surfaces with a cleaner that has bleach in it.
  • Pollen and Outdoor Mold
    • What to do during allergy season (when pollen counts are high):
    • Try to keep your windows closed. 
    • Stay indoors with windows closed during the midday and afternoon, if you can. Pollen and some mold spore counts are highest at that time. 
    • Ask your doctor whether you need to take or increase anti-inflammatory medicine before your allergy season starts. 
  • Smoke, Strong Odors, and Sprays
    • If possible, do not use a wood-burning stove, kerosene heater, or fireplace. 
    • Try to stay away from strong odors and sprays, such as perfume, talcum powder, hair spray, and paints. 
  • Exercise, Sports, Work or Play
    • You should be able to be active without symptoms. See your doctor if you have asthma symptoms when you are active—like when you exercise, do sports, play, or work hard. 
    • Ask your doctor about taking medicine before you exercise to prevent symptoms.  
    • Warm up for about 6 to 10 minutes before you exercise. 
    • Try not to work or play hard outside when the air pollution or pollen levels (if you are allergic to the pollen), are high.
  • Other Things That Can Make Asthma Worse
    • Flu: Get a flu shot every year.
    • Sulfites in foods: Do not drink beer or wine or eat shrimp, dried fruit, or processed potatoes if they cause asthma symptoms.
    • Cold air: Cover your nose and mouth with a scarf on cold or windy days.
    • Other medicines: tell your doctor about all the medicines you may take. Include cold medicines, aspirin, and even eye drops.
    • For further information on asthma, visit:  www.aafa.org
    • Pollen.com - pollen count