Monday, May 12, 2008

Asthma

Asthma

Asthma occurs when the main air passages of your lungs, the bronchial tubes, become inflamed. The muscles of the bronchial walls tighten, and cells in the lungs produce extra mucus further narrowing your airways. This can cause minor wheezing to severe difficulty in breathing. In some cases, your breathing may be so labored that an asthma attack becomes life-threatening.
Asthma is a chronic but treatable condition
Signs and symptoms
Asthma signs and symptoms can range from mild to severe. You may have only occasional asthma episodes with mild, short-lived symptoms such as wheezing. In between episodes you may feel normal and have no difficulty breathing. Some people with asthma have chronic coughing and wheezing punctuated by severe asthma attacks.
Warning signs and symptoms of asthma in adults may include:
§ Increased shortness of breath or wheezing
§ Disturbed sleep caused by shortness of breath, coughing or wheezing
§ Chest tightness or pain
§ Increased need to use bronchodilators — medications that open up airways by relaxing the surrounding muscles
§ A fall in peak flow rates as measured by a peak flow meter, a simple and inexpensive device that allows you to monitor your own lung function
Children often have an audible whistling or wheezing sound when exhaling and frequent coughing spasms.
Exposure to various allergens and irritants may trigger your asthma symptoms. The following are common things that trigger asthma symptoms:
Allergens, such as pollen, animal dander or mold
Cockroaches and dust mites
Air pollutants and irritants.
Smoke
Strong odors or scented products or chemicals
Respiratory infections, including the common cold
Physical exertion, including exercise
Strong emotions and stress
Cold air
Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs
Sulfites, preservatives added to some perishable foods
Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your esophagus. GERD may trigger an asthma attack or make an attack worse.
Sinusitis
Treatment
There are several types of medications available for treating asthma. Most people use a combination of long-term control medications and quick relief medications. Your doctor can help you decide which option is best for you based on your age and the severity of your symptoms. In general, the main types of asthma medications are:
1-Long-term-control medications. These are used regularly to control chronic symptoms and prevent asthma attacks.
2-Quick-relief medications. You use these as needed for rapid, short-term relief of symptoms during an asthma attack.
3-Medications for allergy-induced asthma. These decrease your body's sensitivity to a particular allergen and your immune system from reacting to allergens.
Long-term control medicationsThese medications are usually taken every day on a long-term basis, to control persistent asthma.
Inhaled corticosteroids. These anti-inflammatory drugs are the most effective medications for asthma. They reduce inflammation in your airways and prevent blood vessels from leaking fluid into your airway tissues.
Corticosteroids help decrease the frequency of your attacks and reduce the need for other medications you may use to control your symptoms. Because inhaled corticosteroids control most forms of asthma by delivering medication directly to your airways, they have a lower risk of side effects than are associated with oral corticosteroids.
Side effects associated with inhaled corticosteroids can include hoarseness or loss of voice, oral yeast infections (thrush), and cough. Long-term use of inhaled corticosteroids may slightly increase the risk of skin thinning, bruising, osteoporosis, eye pressure and cataracts. In children, inhaled corticosteroids may slow growth.
Long-acting beta-2 agonists (LABAs). These medications are part of a group of medications called bronchodilators, which open up constricted airways. Long-acting beta-2 agonists, such as salmeterol and formoterol , last at least 12 hours. They're used to control moderate and severe asthma and to prevent nighttime symptoms. Salmeterol or formoterol are used on a regular schedule along with inhaled corticosteroids and should not be used as the main treatment for asthma.
Leukotriene modifiers. These drugs reduce the production or block the action of leukotrienes — substances released by cells in your lungs during an asthma attack.
Cromolyn and nedocromil. Although they're not effective for everyone, daily use of inhalant may help prevent attacks of mild to moderate asthma. They may also be used to help prevent asthma triggered by exercise.
Theophylline. You take this bronchodilator in pill form every day. It may be helpful for relieving your nighttime symptoms of asthma. But theophylline may cause side effects, such as nausea and vomiting, severe abdominal pain, diarrhea, acid reflux, confusion, fast or irregular heartbeat, and nervousness. If you're taking theophylline, get regular blood tests to make sure you're getting the correct dosage.
Quick-relief medications Short-acting bronchodilators — often called "rescue" or "quick-relief" medications —stop the symptoms of an asthma attack in progress. You take these medications when you begin to have symptoms, such as coughing, wheezing, chest tightness or shortness of breath. You may also use short-acting bronchodilators to prevent an asthma attack when your peak flow meter shows that your readings are lower than normal.
Short-acting beta-2 agonists. These bronchodilators begin working within minutes and last four to six hours. But they can't keep symptoms from coming back. The most commonly used short-acting bronchodilator for asthma is albuterol.
Ipratropium (Atrovent). Your doctor might prescribe this anticholinergic for the immediate relief of your asthma symptoms.
Oral and intravenous corticosteroids for asthma attacks. These corticosteroids — including prednisone, methylprednisolone, hydrocortisone and others — may be taken to treat acute asthma attacks or very severe asthma. They may take a few hours or a few days to be fully effective. Long-term use of these medications can cause serious side effects, including cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin. Asthma attacks can be life-threatening and should be managed by a doctor.
Medications for asthma triggered by allergiesOther medications focus on treating allergy triggers for asthma and include:
Immunotherapy. Allergy-desensitization shots (immunotherapy) may help if you have allergic asthma that can't be easily controlled by avoiding triggers. You'll begin with skin tests to determine which allergens trigger your asthma symptoms, followed by a series of therapeutic injections containing small doses of those allergens. You generally receive injections once a week for a few months, then once a month for a period of three to five years. Over time, you should lose your sensitivity to the allergens. Immunotherapy isn't for everyone, though. You're most likely to benefit if it's clear you have allergic asthma. In addition, immunotherapy carries the risk of an allergic reaction to the shot. Life-threatening reactions are rare but possible.
Anti-IgE monoclonal antibodies. If you have allergies, your immune system produces allergy-causing IgE antibodies to attack substances that generally cause no harm, such as pollen, dust mites and pet dander. If you have allergic asthma that's difficult to control, omalizumab may reduce the number of asthma attacks you experience by blocking the action of these antibodies. That way your immune system isn't prompted to react and cause the inflammation that makes breathing difficult.
It is used in children over 12 years old and adults with moderate to severe asthma caused by an allergy, if all other treatments have failed.
It is delivered by injection every two to four weeks. Risks include the possibility of a severe reaction within two hours of receiving the shot, blood-clotting problems, and a possible link to cancer. That link is currently being studied. Also, if you're pregnant or breast-feeding, tell your doctor beforehand.
Treatment by severity for better controlTreatment based on asthma severity can help you control your asthma. According to guidelines from the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology, asthma therapy should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly.
For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma is not well controlled or getting worse, your doctor may increase your medication and recommend more frequent visits.
Prevention
The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants. That's easier said than done because thousands of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger your attacks. A number of indoor allergens, including dust mites, cockroaches, pet dander and mold, can do the same. A common asthma irritant is tobacco smoke.
Even if you reduce indoor and outdoor allergens and irritants, managing asthma can be challenging. It often takes ongoing communication and teamwork with your doctor. But by working together, you and your doctor can design a step-by-step plan for living with your condition. In addition to knowing and avoiding your triggers, develop an action plan, monitor your breathing and treat attacks early.

1-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 impending 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.
Although many people with asthma rely on medications to relieve symptoms and control inflammation, you can do several things on your own to maintain overall health and lessen the possibility of attacks:
2-Exercise. You don't have to be sedentary if you have asthma. Regular exercise can strengthen your heart and lungs so that they don't have to work so hard. Aim for 30 minutes of exercise on most days. If you've been inactive, start slowly and try to gradually increase your activity over time. Keep in mind that exercising in cold temperatures may trigger symptoms. If you do exercise in cold temperatures, wear a face mask to warm the air you breathe. And don't exercise in temperatures below zero. Activities such as golf, walking and swimming are less likely to trigger attacks, but be sure to discuss any exercise program with your doctor.
3-Use your air conditioner. Air conditioning helps reduce 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.
4-Decontaminate your decor. Minimize dust that may aggravate nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dust-proof covers. Remove carpeting and install hardwood or linoleum flooring. Use washable curtains and blinds.
5-Maintain optimal humidity. Keep humidity low in your home and office. If you live in a damp climate, talk to your doctor about using a dehumidifier.
6-Keep indoor air clean. Have a utility company check your air conditioner and furnace once a year. Change the filters in your furnace and air conditioner according to the manufacturer's instructions. Also consider installing a small-particle filter in your ventilation system. If you use a humidifier, change the water daily.
7-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.
8-Clean regularly. Clean your home at least once a week. Because cleaning stirs up dust, however, wear a mask or, if you can, have someone else clean.
9-Limit use of contact lenses. Try substituting eyeglasses for your contact lenses when the pollen count is high. Pollen grains can become trapped under the lenses.
10-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.

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