Thursday, May 9, 2013

Asthma - What You Need to Know

Do you ever find yourself gasping for air or have trouble catching your breath, especially after exercise? Perhaps you may want to talk with your doctor about asthma.

So what is asthma, and why should you make sure you make it a priority to get it under control?

Asthma is a lung problem involving the tubes that bring air in and out of your body.  When these airways get inflamed and swollen, the tube get smaller and narrows the outlet of small airways (bronchioles) which are inside your lungs. As a result, air has a more difficult time flowing through the lungs.

Imagine you had a regular tube to push air through, but when it got inflamed it became a tiny coffee swizzle stick with just a small hole to get air through.

 This problem is why air for asthmatics can get in but has a super difficult time getting out (and why we call it an obstructive lung disorder.) So asthma has inflammation (which results in thickened moist tissues) and smaller tubes to let air out.

For these reasons, individuals with asthma often experience episodes of shortness of breath and wheezing.

Other symptoms include pressure or tightness in the chest area, coughing spells, excessive throat clearing or sighing of fatigue that comes and goes (aka - I walked these stairs yesterday but today I'm pooped!) 

Allergies  can trigger asthma attacks. These include dust, pollens, molds (soon we will be in Ragweed season!) and pet dander. Other common triggers are irritants like cigarette smoke, strong fumes, harsh chemicals with strong odors, or particles in car exhaust or other pollution, for example. Triggers can often be infections like colds or influenza. Some people get triggered with exercise or when exposed to cold air. Sometimes, in some people, food or medicines can trigger flares (like chemicals in wine, aspirin or ibuprofen.) Lastly, stress, extreme crying or laughing can also trigger flares in some people.

ASTHMA AS A CHRONIC ILLNESS - Some people are confused about the fact that symptoms of asthma come and go. One day you can feel fine and another really tired or coughing or wheezing. The disease of asthma is referred to as 'reversible airway disease' - which in one way is a good thing as it can get better. We know that if people with asthma don't use anti inflammatory medicine (like inhalers) on a regular basis, the inflamed airway tissue with moist membranes can, in essence, 'scar down' over years and become fixed (or irreversible) disease - that's then known as chronic bronchitis. We know that we can avoid this with regular use of medicines.

MEDICINES - Medicines for asthma work in one of three ways (although many people know of the most common two types.)

First - we focus on the inflammation. For this we use anti inflammatory medicines that are delivered in aerosol form (these are known as steroid or corticosteroid inhalers.) These are very effective but don't work immediately (if you need to go to an ER and get them by IV they can work faster, but we try to avoid that!) These medicines work gradually (takes a couple of days to have the effect we want) - so it is important to take them every day! After taking a puff, you need to rinse your mouth so you don't leave any medicine in your throat.

The second medicine focuses on the narrowing of the air tube - that happens as muscles around the tube clamped down. For this we use muscle relaxants (specifically air tube or bronchial muscle relaxers.) These medicines are, cousins, if you will,  of epinephrine - so they often cause jitteriness after taking them. They are referred to as Beta agonist medicines. These medicines are used for flares and to prevent attacks. In excess they can results in extra heart beats (palpitations) and even heart attacks! There are combination medicines that have the first and second type together.

The third type of medicine is a anti inflammation (not steroid) type of medicine and focuses on calming down one of the cells that gets irritated in asthma (mast cells) or preventing inflammation chemicals (leukotrienes) from getting released. The first group are inhalers are known as cromolyn or nedocromil. The second is  in pill form (montelukast) Here is a listing of types of medicines used.

Not everyone can tell if their asthma is 'acting up' and our goal in care of asthma is to avoid flares (and ER visits!) and then keep inflammation under control.

So, patients are encourage to get and use a peak flow meter and record their breaths on a regular basis. Here is a place to get directions on using your meter.

If you think you have asthma - see a doctor and get checked out! If you know that you do, find out if you are controlling it as well as you think you are. If you keep on winding up the ER with asthma - you need to spend some time on yourself to get things under control.

Everyone with asthma should have there Personal Action Plan. Click HERE to see one.

If you are suffering from asthma, it is important to realize that even though your symptoms come and go - you have a chronic illness. Although there is no cure for asthma, it can be controlled. A long-term control medication, along with a quick relief medication (inhaler) as a rescue or back up are often used. These medications will minimize any symptoms and help individuals with asthma function without any restrictions.

Asthma is a serious illness - it reducing lung function at faster rates (if untreated.) Uncontrolled asthma may prevent vital organs, such as your brain, from getting enough oxygen.  Uncontrolled asthma puts you at risk for lung infections and can, if untreated result in death! Pregnant women must be especially dedicated to controlling their asthma. Uncontrolled disease can result in harm to the mother (preeclampsia, prolonged labor) as well as to the fetus (preterm birth, oxygen deprivation to the brain and even death.) By working with your clinician, you can get asthma under control and have a safe and healthy pregnancy.

For some people, the best thing they can do for their lungs is QUIT SMOKING! Although it easy to say and hard to do, every day - people are successfully quitting and helping their lungs. Asthma and smoking is an unhealthy combination. If you smoke - get tips to quit HERE and make an appointment with your clinician to develop a smoke ending plan.

Here's what you should expect in a 15 minute asthma visit.
For more information, visit the Asthma and Allergy Foundation of America website ( or the National Heart Lung and Blood Institute website ( and the American Lung Association Take Action sites.

The CDC also has audio and videopodcasts HERE

Contributing Blogger  - J.Woloski

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