ASTHMA

DEFINITION :

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This
can make breathing difficult and trigger coughing, wheezing and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem that
interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can't be cured, but its symptoms can be controlled. Because asthma often changes
over time, it's important that you work with your doctor to track your signs and symptoms
and adjust treatment as needed.

CAUSES

It isn't clear why some people get asthma and others don't, but it's probably due to a
combination of environmental and genetic (inherited) factors.

Asthma triggers

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs
and symptoms of asthma. Asthma triggers are different from person to person and can
include:

 Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles
of cockroach waste

 Respiratory infections, such as the common cold

 Physical activity (exercise-induced asthma)

 Cold air

 Air pollutants and irritants, such as smoke

 Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB,
others) and naproxen (Aleve)

 Strong emotions and stress

 Sulfites and preservatives added to some types of foods and beverages, including
shrimp, dried fruit, processed potatoes, beer and wine
  Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up
into your throat

Risk factors

A number of factors are thought to increase your chances of developing asthma. These
include:

 Having a blood relative (such as a parent or sibling) with asthma

 Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay
fever)

 Being overweight

 Being a smoker

 Exposure to secondhand smoke

 Exposure to exhaust fumes or other types of pollution

 Exposure to occupational triggers, such as chemicals used in farming, hairdressing

and manufacturing

SYMPTOMS

Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have
symptoms only at certain times — such as when exercising — or have symptoms all the time.

Asthma signs and symptoms include:

 Shortness of breath

 Chest tightness or pain

 Trouble sleeping caused by shortness of breath, coughing or wheezing

 A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma

in children)

 Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold
or the flu
Signs that your asthma is probably worsening include:

 Asthma signs and symptoms that are more frequent and bothersome

 Increasing difficulty breathing (measurable with a peak flow meter, a device used to
check how well your lungs are working)

 The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:

 Exercise-induced asthma, which may be worse when the air is cold and dry

 Occupational asthma, triggered by workplace irritants such as chemical fumes, gases

or dust

 Allergy-induced asthma, triggered by airborne substances, such as pollen, mold

spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)

TREATMENT

Prevention and long-term control are key in stopping asthma attacks before they start.
Treatment usually involves learning to recognize your triggers, taking steps to avoid them
and tracking your breathing to make sure your daily asthma medications are keeping
symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief
inhaler, such as albuterol.

Medications

The right medications for you depend on a number of things — your age, symptoms, asthma
triggers and what works best to keep your asthma under control.

Preventive, long-term control medications reduce the inflammation in your airways that leads
to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are
limiting breathing. In some cases, allergy medications are necessary.

Long-term asthma control medications, generally taken daily, are the cornerstone of
asthma treatment. These medications keep asthma under control on a day-to-day basis and
make it less likely you'll have an asthma attack. Types of long-term control medications
include:
  Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flonase,
Flovent HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan
HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar),
mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta).

You may need to use these medications for several days to weeks before they reach their
maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a
relatively low risk of side effects and are generally safe for long-term use.

 Leukotriene modifiers. These oral medications — including montelukast (Singulair),

zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to
24 hours.

In rare cases, these medications have been linked to psychological reactions, such as
agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical
advice right away for any unusual reaction.

 Long-acting beta agonists. These inhaled medications, which include salmeterol

(Serevent) and formoterol (Foradil, Perforomist), open the airways.

Some research shows that they may increase the risk of a severe asthma attack, so take
them only in combination with an inhaled corticosteroid. And because these drugs can
mask asthma deterioration, don't use them for an acute asthma attack.

 Combination inhalers. These medications — such as fluticasone-salmeterol (Advair

Diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (Dulera) —
contain a long-acting beta agonist along with a corticosteroid. Because these
combination inhalers contain long-acting beta agonists, they may increase your risk of
having a severe asthma attack.

 Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps

keep the airways open (bronchodilator) by relaxing the muscles around the airways. It's
not used as often now as in past years.

Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief
during an asthma attack — or before exercise if your doctor recommends it. Types of quick-
relief medications include:

 Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within

minutes to rapidly ease symptoms during an asthma attack. They include albuterol
(ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex).
 Short-acting beta agonists can be taken using a portable, hand-held inhaler or a
nebulizer — a machine that converts asthma medications to a fine mist — so that they
can be inhaled through a face mask or a mouthpiece.

 Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to

immediately relax your airways, making it easier to breathe. Ipratropium is mostly used
for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks.

 Oral and intravenous corticosteroids. These medications — which include

prednisone and methylprednisolone — relieve airway inflammation caused by severe
asthma. They can cause serious side effects when used long term, so they're used only
on a short-term basis to treat severe asthma symptoms.

If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But
if your long-term control medications are working properly, you shouldn't need to use your
quick-relief inhaler very often.

Keep a record of how many puffs you use each week. If you need to use your quick-relief
inhaler more often than your doctor recommends, see your doctor. You probably need to
adjust your long-term control medication.

Allergy medications may help if your asthma is triggered or worsened by allergies. These
include:

 Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your
immune system reaction to specific allergens. You generally receive shots once a week
for a few months, then once a month for a period of three to five years.

 Omalizumab (Xolair). This medication, given as an injection every two to four

weeks, is specifically for people who have allergies and severe asthma. It acts by
altering the immune system.

Bronchial thermoplasty

This treatment — which isn't widely available nor right for everyone — is used for severe
asthma that doesn't improve with inhaled corticosteroids or other long-term asthma
medications.

Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of
the airways in the lungs with an electrode, reducing the smooth muscle inside the airways.
This limits the ability of the airways to tighten, making breathing easier and possibly
reducing asthma attacks.

Treat by severity for better control: A stepwise approach

Your treatment should be flexible and based on changes in your symptoms, which should be
assessed thoroughly each time you see your doctor. Then your doctor can adjust your
treatment accordingly.

For example, if your asthma is well-controlled, your doctor may prescribe less medicine. If
your asthma isn't well-controlled or is getting worse, your doctor may increase your
medication and recommend more-frequent visits.

Asthma action plan

Work with your doctor to create an asthma action plan that outlines in writing when to take
certain medications or when to increase or decrease the dose of your medications based on
your symptoms. Also include a list of your triggers and the steps you need to take to avoid
them.

Your doctor may also recommend tracking your asthma symptoms or using a peak flow meter
on a regular basis to monitor how well your treatment is controlling your asthma.

Lifestyle and home remedies

Although many people with asthma rely on medications to prevent and relieve symptoms,
you can do several things on your own to maintain your health and lessen the possibility of
asthma attacks.

Avoid your triggers

Taking steps to reduce your exposure asthma triggers is a key part of asthma control,
including:

 Use your air conditioner. Air conditioning reduces the amount of airborne pollen
from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers
indoor humidity and can reduce your exposure to dust mites. If you don't have air
conditioning, try to keep your windows closed during pollen season.
  Decontaminate your decor. Minimize dust that may worsen nighttime symptoms by
replacing certain items in your bedroom. For example, encase pillows, mattresses and
box springs in dustproof covers. Remove carpeting and install hardwood or linoleum
flooring. Use washable curtains and blinds.

 Maintain optimal humidity. If you live in a damp climate, talk to your doctor about
using a dehumidifier.

 Prevent mold spores. Clean damp areas in the bath, kitchen and around the house to
keep mold spores from developing. Get rid of moldy leaves or damp firewood in the
yard.

 Reduce pet dander. If you're allergic to dander, avoid pets with fur or feathers.
Having pets regularly bathed or groomed also may reduce the amount of dander in your
surroundings.

 Clean regularly. Clean your home at least once a week. If you're likely to stir up
dust, wear a mask or have someone else do the cleaning.

 Cover your nose and mouth if it's cold out. If your asthma is worsened by cold or
dry air, wearing a face mask can help.

Stay healthy

Taking care of yourself can help keep your symptoms under control, including:

 Get regular exercise. Having asthma doesn't mean you have to be less active.
Treatment can prevent asthma attacks and control symptoms during activity.

Regular exercise can strengthen your heart and lungs, which helps relieve asthma
symptoms. If you exercise in cold temperatures, wear a face mask to warm the air you
breathe.

 Maintain a healthy weight. Being overweight can worsen asthma symptoms, and it
puts you at higher risk of other health problems.

 Control heartburn and gastroesophageal reflux disease (GERD). It's possible that
the acid reflux that causes heartburn may damage lung airways and worsen asthma
symptoms. If you have frequent or constant heartburn, talk to your doctor about
treatment options. You may need treatment for GERD before your asthma symptoms
improve.

Alternative medicine
Certain alternative treatments may help with asthma symptoms. However, keep in mind that
these treatments are not a replacement for medical treatment — especially if you have severe
asthma. Talk to your doctor before taking any herbs or supplements, as some may interact
with medications you take.

While some alternative remedies are used for asthma, in most cases more research is needed
to see how well they work and to measure the extent of possible side effects. Alternative
asthma treatments include:

 Breathing exercises. These exercises may reduce the amount of medication you need
to keep your asthma symptoms under control.

 Herbal and natural remedies. A few herbal and natural remedies that may help
improve asthma symptoms include black seed, caffeine, choline and pycnogenol.

Coping and support

Asthma can be challenging and stressful. You may sometimes become frustrated, angry or
depressed because you need to cut back on your usual activities to avoid environmental
triggers. You may also feel limited or embarrassed by the symptoms of the disease and by
complicated management routines.

But asthma doesn't have to be a limiting condition. The best way to overcome anxiety and a
feeling of helplessness is to understand your condition and take control of your treatment.
Here are some suggestions that may help:

 Pace yourself. Take breaks between tasks and avoid activities that make your
symptoms worse.

 Make a daily to-do list. This may help you avoid feeling overwhelmed. Reward
yourself for accomplishing simple goals.

 Talk to others with your condition. Chat rooms and message boards on the Internet
or support groups in your area can connect you with people facing similar challenges
and let you know you're not alone.

 If your child has asthma, be encouraging. Focus attention on the things your child
can do, not on the things he or she can't. Involve teachers, school nurses, coaches,
friends and relatives in helping your child manage asthma.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, when
you call to set up an appointment, you may be referred to an allergist or a pulmonologist.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a
good idea to be well-prepared. Here's some information to help you get ready for your
appointment, as well as what to expect from your doctor.

What you can do

These steps can help you make the most of your appointment:

 Write down any symptoms you're having, including any that may seem unrelated to
the reason for which you scheduled the appointment.

 Note when your symptoms bother you most — for example, if your symptoms tend
to get worse at certain times of the day, during certain seasons, or when you're exposed
to cold air, pollen or other triggers.

 Write down key personal information, including any major stresses or recent life
changes.

 Make a list of all medications, vitamins and supplements that you're taking.

 Take a family member or friend along, if possible. Sometimes it can be difficult to

recall all the information provided to you during an appointment. Someone who
accompanies you may remember something that you missed or forgot.

PREVENTION

While there's no way to prevent asthma, by working together, you and your doctor can design
a step-by-step plan for living with your condition and preventing asthma attacks.

 Follow your asthma action plan. With your doctor and health care team, write a
detailed plan for taking medications and managing an asthma attack. Then be sure to
follow your plan.
 Asthma is an ongoing condition that needs regular monitoring and treatment. Taking
control of your treatment can make you feel more in control of your life in general.

 Get vaccinated for influenza and pneumonia. Staying current with vaccinations can
prevent flu and pneumonia from triggering asthma flare-ups.

 Identify and avoid asthma triggers. A number of outdoor allergens and irritants —
ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks.
Find out what causes or worsens your asthma, and take steps to avoid those triggers.

 Monitor your breathing. You may learn to recognize warning signs of an impending
attack, such as slight coughing, wheezing or shortness of breath. But because your lung
function may decrease before you notice any signs or symptoms, regularly measure and
record your peak airflow with a home peak flow meter.

 Identify and treat attacks early. If you act quickly, you're less likely to have a
severe attack. You also won't need as much medication to control your symptoms.

When your peak flow measurements decrease and alert you to an oncoming attack, take
your medication as instructed and immediately stop any activity that may have triggered
the attack. If your symptoms don't improve, get medical help as directed in your action
plan.

 Take your medication as prescribed. Just because your asthma seems to be

improving, don't change anything without first talking to your doctor. It's a good idea to
bring your medications with you to each doctor visit, so your doctor can double-check
that you're using your medications correctly and taking the right dose.

 Pay attention to increasing quick-relief inhaler use. If you find yourself relying on
your quick-relief inhaler, such as albuterol, your asthma isn't under control. See your
doctor about adjusting your treatment.