WHAT IS ASTHMA?

Asthma is a chronic but treatable lung condition.  It is not known why certain people develop asthma, but it is more common among those with history of  “overly-responsive” immune systems.  Often, asthmatic individuals also have prior history of eczema or “sensitive skin” and of sinus allergies.  Asthma seems to be at least partially hereditary in nature.  When a person with asthma is exposed to certain “triggers,” they respond by: tightening the muscles that surround the airways (bronchospasm)

• swelling of the airway lining (edema)

• producing thicker mucus into the airways 

All of these things make the passage of air into the lungs more difficult.  When this happens, people may have feelings of chest tightness, shortness of breath, wheezing, exercise intolerance, fatigue, or cough.  It is important to realize that all people with asthma do not wheeze. 

WHAT CAN I DO ABOUT IT?

It is crucial to keep asthma under control, as without effective treatment, asthma tends to get worse.  If not treated properly, asthma can be fatal.  There is also evidence that, even though asthma is considered “reversible,” with long term undermanagement, asthma can lead to cellular changes in the airways including buildup of thicker cell linings, and eventually may lead to irreversible lung diseases in later life, otherwise known as COPD or chronic obstructive pulmonary disease. 

Different people have different triggers for asthma.  It is helpful for you to know what your triggers are so that you can reduce your exposure to those triggers if possible.  Common triggers include:

• Allergens (i.e. pollen, dust, mold, cat/dog/bird dander)

• Irritants (i.e. wood or cigarette smoke, perfumes, air pollution, paint odors, cooking odors, cleaning products)

• Exercise

• Colds, flu or other respiratory infections

• Cold, dry air

• Stress

• Laughing or crying hard

• Certain medications (i.e. aspirin, ibuprofen, and other related anti-inflammatories, some blood pressure medicines called Beta blockers)

Obviously, if you can reduce the exposure to known triggers, you are less likely to have asthmatic exacerbations.  Keep the following measures in mind:

• If cold dry air is a trigger:  wrap your mouth and nose in a scarf or ski mask when going out in very cold weather.

To reduce exposure to indoor triggers such as dust mites and mold:

1. Encase mattresses and pillows in allergen-proof zippered covers.

2. Wash bed linens at least weekly in hot water and use hot dryer setting.

3. Wash comforters and blankets monthly.  Avoid wool and down bedding. 

4. Keep living areas well ventilated and dry.  Dust mites and molds love humidity.  Do not use a humidifier; use a dehumidifier in the summer months.  Radiator or baseboard heat is preferred.  Apply a HEPA filter to your heat pump and change it regularly.

5. Vacuum with a HEPA (high efficiency particulate air) filter.

6. Invest in a HEPA air cleaner for your sleeping quarters.

7. Avoid dust collectors such as stuffed animals, heavy curtains and blinds, books, flowers and plants (natural or artificial), knickknacks, upholstered furniture, rugs/carpets especially in your sleeping space.  If carpeting is unavoidable, apply a special solution or powder that inactivates allergens and/or kills dust mites.

8. Keep clothing in closed closets, drawers, and hampers.

9. Keep dogs, cats, and birds out of the bedroom, if you must have a pet.

1. Plan outdoor activities for later in the day.  Pollen counts are usually highest in the mornings.

2. Keep doors and windows closed during periods with high pollen counts.  Use air conditioners with HEPA filters.

3. Minimize yard work or wear a protective mask if you must mow or rake leaves.

4. Pollen counts are usually higher during warm, dry weather and lowest right after a prolonged rain. 

5. If you have been outside during the day, wash your hair and change clothing before bedtime.  Pollen will cling to hair and then will deposit on pillowcase and bedding where you can inhale it all night long.

6. If you take medications to control seasonal sinus allergies, plan to begin them at least one week prior to when you usually develop symptoms.  It is easier to avoid the allergic response than to turn it off once it has been turned on.  

To reduce chances of colds, flu and other respiratory illnesses:

1. Wash your hands before eating or touching your face. 

2. Consider getting yearly flu shots in the fall, and pneumonia vaccines every 10 years.  (The pneumonia vaccine is helpful in preventing one type of pneumonia). 

***A note to those who have exercise induced asthma:  This does not mean you have to avoid exercise!!  Warming up before and cooling down after exercise helps the airways adjust better.  Often, by using an inhaled bronchodilator ½ to 1 hour before expected activities, people with asthma are able to fully participate in exercise and sports activities.  Always keep your inhaler with you during activities in case you need it!!!  

WHAT ABOUT MEDICATIONS?

Medications used to treat asthma fall into two broad groups.  The first group of medications is called bronchodilators.  They give relief of symptoms by relaxing the smooth muscles that surround the airways, thereby reducing the bronchospasm.  Bronchodilators may be the only type of medication you need if your asthma is mild and intermittent.  Often these are referred to as your “rescue inhaler.”  

Other medications are designed to prevent asthmatic occurrences.  These are sometimes referred to as your “maintenance” medications.  This is because you should take them regularly to achieve maximum benefit.  They do not act quickly, and sometimes take up to a week to obtain maximal benefit.  They work on the immune system to reduce its reactivity to triggers.  Preventative medications are added to a treatment regimen if bronchodilators alone are not controlling symptoms well enough, or before or during anticipated peak allergy seasons. Preventative medications include corticosteroids (which reduce swelling and inflammation) and leukotriene inhibitors (which reduce the release of histamine from certain cells). 

These medications are used, alone or in combination, to control the symptoms of asthma.  It is common to adjust the medication regimen, either “stepping up” when symptoms worsen, or “stepping down” when symptoms are better.  In general, your asthma is considered under fairly good control if you are having symptoms two or less times a week and nighttime symptoms less than 2 times a month.  If your symptoms are more often, schedule an appointment with your health care provider.  Also, talk to your healthcare practitioner about establishing baseline peak flow meter measurements.  This can provide information about your personal best measurement of airflow, and serve as a warning signal for intervention if it drops below 80% of your personal best. 

WHEN DO I GET IMMEDIATE HELP?

If you are having trouble with any of the following, you need to be seen by health care providers immediately.  Call 911 if:

• Despite using your medications and giving it sufficient time to work, your symptoms are worsening.  (Your short-acting bronchodilators, such as albuterol, normally should take 5-15 minutes).

• You have trouble walking or talking.

• You need to hunch over or struggle to breathe, or are using your neck or chest muscles to draw breaths in.

• Your peak flow meter shows a drop of 50% or less of your personal best.

• Your lips or fingernails look gray or bluish.