Asthma

Asthma can affect people of all ages. Here is some information that we provide to patients in the office.

Asthma Overview
Asthma is a very common disease, about 15 million people suffer from asthma at some point in their lives. Asthma often starts in childhood, but can also start in adulthood. The word “asthma” is derived from a Greek word meaning “to pant”. Read more...
It is a chronic obstructive lung disease in which the muscles lining the bronchial tubes contract in response to inhaled irritants. When these muscles contract, the bronchial tubes become too narrow and are more easily irritated. Fortunately, the muscle contractions are temporary and improve with avoidance of irritants or with treatment.

Triggers
Many irritants can trigger or worsen asthma. Some patients with asthma are allergic to various dusts, pollens, and other environmental irritants. Chest infections, cigarette smoke, cold air, anxiety, or exercise can also cause an asthma episode. Patient may have more episodes during the spring and fall months. Asthma may be inherited; however, it also occurs later in life without any definite allergy or family history of it.

Symptoms
The most common symptom of asthma is wheezing. This is musical, high-pitched sound caused by air passing through the narrowed bronchial tubes. During an asthma episode, patients usually become short of breath and wheeze. However, some patients’ only symptoms of asthma may be an intermittent dry, hacking cough. Patients with asthma may bring up yellow phlegm. This does not always mean there is a lung infection; often the asthma alone will cause this problem, but it is important to treat a lung infection promptly if one is present.

Treatment

Of all the chronic lung diseases, asthma responds the best to certain medications called bronchodilators. These medications cause the muscles lining the bronchial tubes to relax and lesson muscle spasm. The following medications may be indicated to treat asthma:
  • “Short Acting Rescue inhalers” - Maxair, Ventolin, or Proventil inhalers: These drugs are breathed directly into the lung through the mouth and often are very effective with minimal or no side effects. The inhaler may be taken regularly or as necessary.
  • “Controller medications e.g. before exercise Steroid inhalers” – Azmacort, Advair, Flovent, AeroBid, Pulmicort inhalers: These inhalers provide direct application of steroids to the lungs. Avoids most side effects. Can be used after one of the “rescue inhalers” to prevent wheezing. Should be taken as directed and will not help with sudden wheezing. Rinse mouth after using to avoid yeast infection.
  • Leukotriene antagonist – Singulair or Accolate: These medicines are pills that can block inflammation and airway narrowing. They have to be taken regularly and will not stop an asthma attack that has already begun. While very convenient, this has not been an effective treatment in most patients.
  • Steroids - Prednisone: This medication and similar “steroids” are very effective for asthma but have more unwanted side-effects than other drugs. This is sometimes necessary as a temporary medication in cases of severe, persistent asthma.
Like the other chronic lung diseases, there is more treatment than just using medications. Stopping smoking and avoiding known irritants are important. In some allergic patients, desensitization (allergy shots) may help. It is important to get flu vaccine each year.

Identify & Avoid Triggers Of Asthma
Allergy to allergens and irritants are important causes of allergic/asthma symptoms. When exposure to irritants can be avoided, symptoms and attacks can be prevented and medications reduced. Read more...
Common Triggers And How To Avoid Them:
  • DUST MITES: Microscopic insect like creatures which are found primarily in pillows and mattresses, carpets and upholstered furniture. They thrive in humid, warm conditions.
    How To Avoid:
    Emphasis is placed on the bedroom since people spend a large portion of each day there. The mattress, pillows, and box springs should be encased in zippered, allergen-impermeable covers. Bed linen should be washed frequently in hot water. Remove all carpeting if possible. Allergen-impermeable covers may be found at stores that carry bedding and linen supplies.
  • ANIMAL ALLERGY: Cat/animal allergy is not the hair but a problem present in the dander and saliva in cats. The microscopic particles become airborne and are inhaled. The length of hair has no relationship to allergen production.
    How To Avoid: The best way to avoid exposure is to remove animals from the home, although this is not easy, it is the most beneficial. If unable to remove animal from the home, at least remove it from the sleeping area.
  • MOLD: Mold is a microscopic fungi. Many molds reproduce by releasing spores into the air. When these spores are inhaled, they can cause allergic symptoms.
    How To Avoid: Allow adequate ventilation. Avoid over excessive humidity. Use an air conditioner or dehumidifier in order to sustain a low humidity environment. Use HEPA-filtered air cleaners. Use an exhaust fan following showers. Use mold killing and mold preventing cleaning solutions. Use disposable ventilation filters.
  • TOBACCO SMOKE: Exposure to smoke can be from smoking or breathing in secondhand smoke (the smoke of others).
    How To Avoid: Stay away from all kinds of smoke. Patients and household members should not smoke.
  • COCK ROACH ALLERGENS:
    How To Avoid: Clean the home thoroughly and often. Use pesticide sprays.
  • PHYSICAL ACTIVITY: Physical activity should not be avoided. Speak to your physician about medications that may be used prior to exercise.

Inhalers
Inhalers are most commonly used to treat asthma, bronchitis, or emphysema. When inhaled properly into the lungs, they cause the muscles lining the airways to relax, thereby improving shortness of breath or wheezing. They act quickly (within 2-5 minutes) and usually last 4 hours. Read more...
Side Effects
Side effects from these inhalers are uncommon. Occasional rapid heartbeat, nervousness or tremor may occur. Occasionally, these inhaled drugs may cause coughing or make shortness of breath or wheezing worse. If this happens, the drug should be stopped.

Dose
Your provider will instruct you on the proper dose for each inhaler.

Proper Usage
These drugs need to be inhaled into the lungs to be effective. The inhaler should be shaken before each puff. Then follow these steps for each puff of the drug:
  • Step 1: Breathe out through the mouth.
  • Step 2: Place the mouthpiece in front of your mouth. Begin a slow, deep breath and, at the same time, press the container firmly down into the mouthpiece. This will release one puff of the drug. Continue to breathe in as deeply as possible 
  • Step 3: Hold your breath for a few seconds. Wait about 1 minute before the next puff and repeat the above steps.
  • You should wait at least 1 minute between puffs and 5 minutes between medications. A plastic spacer device may be used between the inhaler and your mouth to enhance the amount of medication that reaches your lungs.