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Asthma Solution Guide
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Affecting up to one in four urban children and causing approximately 21
million missed school days per year, asthma is the most prevalent chronic disease among children. There is no cure, but asthma can be controlled with asthma education, asthma medication, environmental trigger
avoidance, and peak flow monitoring. Common asthma triggers
include dust mites, pet
dander, mold, and pollen.
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 Helpful Information for Asthma Sufferers |
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What is Asthma? |
Asthma is a disease of the lungs that causes the airways narrow and tighten, often in response to a trigger such as exposure to an allergen, exercise, or
emotional stress. As with allergies, an over-sensitive immune response leads asthma symptoms, with the main symptom being difficulty breathing. All asthma
sufferers have chronic inflammation and excessive airway sensitivity to various triggers. The prevalence of asthma in our society is rapidly
increasing. Asthma affects up to one in four urban children.
Asthma is a form of chronic obstructive pulmonary disease (COPD) since it obstructs the airways. Chronic bronchitis and emphysema are other forms
of COPD. There is no cure for asthma, but it can be controlled with proper treatment including medication and avoidance of triggers.
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What Causes Asthma? |
Scientists do not know exactly what causes asthma. Most likely, several factors contribute the development of the disease. Some people have a genetic
predisposition to developing asthma. If one parent has asthma, each child has a 1 in 3 chance of developing asthma. If both parents have asthma, chances
rise to 7 in 10. Researchers are still looking for the genes involved. People who have hay fever (allergic rhinitis) or eczema are also at higher risk for
developing asthma.
The environment plays a role in the development of asthma, too. Asthma attacks are reactions to triggers like environmental irritants or allergens. Asthma
prevalence is increasing in the United States and many other parts of the world, perhaps because people are spending more time indoors, breathing in more
indoor allergens. The hygiene hypothesis (applicable to the rise in prevalence of both allergies and asthma) posits that these diseases are increasing
because people in modern societies grow up with less exposure to infectious agents, which makes their immune systems more sensitive to normally harmless
substances. Furthermore, modern air is much more polluted than the air our ancestors breathed. Some evidence also suggests a link between asthma
and obesity.
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Asthma Triggers |
Common asthma triggers include:
- tobacco or wood smoke
- polluted air
- allergens like mold, dust, & animal dander
- respiratory infections
- cold weather
- emotional stress
- physical exercise
- stomach acid reflux (GERD)
- sulfites (additives in some foods and wines)
- menstruation (in some, not all, women)
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Asthma Prevalence |
Asthma affects more than 20 million adults in the United States. Over 9 million U.S. children have been diagnosed with asthma, and it's the most prevalent
chronic condition among children. The prevalence of asthma increased 75% from 1980-1994. Asthma prevalence is 39% higher in African Americans. Asthma is a
major cause of missed work and school days.
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Asthma Symptoms |
Asthma symptoms include coughing, wheezing, chest tightness, difficulty breathing, and difficulty speaking.
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Asthma Attacks |
An asthma attack is much like an allergic reaction, and so asthma is sometimes referred to as reactive airway disease. When immune cells mistake an asthma trigger for an invader, a series of reactions produce the
mucus and bronchospasms characteristic of an asthma attack. Bronchioles (airways) swell, and the muscles tighten, making it harder to breathe.
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Asthma Treatment |
You should not take cough medicine to treat asthma; it will not help and may cause side effects. Do not take non-prescription medicines or natural or
herbal remedies without first consulting your physician; some of these remedies may interfere with your medicines. Take your medication exactly as
directed. If your medication is not working, do not take more than you have been prescribed, as overuse can be dangerous.
Successful asthma treatment revolves around taking asthma medication as directed and avoiding environmental asthma triggers.
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Asthma Medications |
Some asthma medications are for long-term relief, while others are for quick relief.
Long-term asthma medications are normally taken every day and include corticosteroids (usually inhaled) to reduce swelling and mucus
production. Corticosteroids are the most effective medicine for the treatment of asthma. However, inhaled corticosteroids may affect the growth of some
children and increase the risk of bruising.
Please note: When using corticosteroids in a metered dose inhaler, it is very important to use a spacer,
or
holding chamber, and gargle with water afterward. Spit out the water to
reduce the amount of the drug that's accidentally swallowed. If you don't use a holding chamber, you increase the risk of side effects like mouth and
throat irritation and oral thrush (oral yeast infection). Examples of inhaled corticosteroids include Flovent, Pulmicort, Azmacort, Aerobid, and
Qvar. Advair is an inhaler that combines a corticosteroid with a long-acting beta-agonist.
Long-acting beta-agonists are bronchodilators that help relax the muscles of the airways. In 2005, the FDA issued a public health advisory for Advair
Diskus, Foradil Aerolizer, and Serevent Diskus, warning that these medications may increase the risk of severe asthma episodes and possibly death from an
asthma attack. Long-acting beta-agonists should never be used for quick relief.
Leukotriene modifiers come in tablet form and serve as an alternative or supplement to corticosteroids. They are anti-inflammatory in nature, and
examples include Singulair, Accolate, and Zyflo.
Theophylline, another bronchodilator, helps prevent nighttime symptoms and may cause side effects like nausea, vomiting, abdominal pain, diarrhea, acid
reflux, confusion, irregular heartbeat, and nervousness. Theophylline prescriptions are less common now than in the past.
Nedocromil and cromolyn have anti-inflammatory effects and may be used to treat mild asthma. Cromolyn is available for use in a nebulizer and therefore
often used in treating young children.
Quick relief asthma medications, also known as rescue medications, provide relief of asthma attack symptoms and include short-acting
beta-agonists, which work as bronchodilators and relax the muslces around the bronchial tubes (airways). Albuterol is the most common short-acting
beta-agonist and is the active ingredient in Airet, Proventil, and Ventolin. Levalbuterol is a new, purer form of albuterol available as Xopenex. Other
short-acting beta-agonists include Tornalate, Maxair, and Brethaire.
Ipratropium bromide, an anticholinergic and also a bronchodilator, is used by people who cannot tolerate short-acting beta-agonists; it's also used
among those whose asthma is triggered by beta-blocker heart medication. Atrovent is an example of ipratropium bromide.
Systemic steroids (oral or intravenous) take longer to act but help prevent additional attacks. Examples include prednisone as Deltasone and
Orasone, Prelone, Pediapred, and Medrol. Long-term use of systemic corticosteroids could cause serious side effects like cataracts, osteoporosis, muscle
weakness, decreased immune function, and high blood pressure.
Asthma medications are either taken orally or inhaled using a metered dose inhaler (MDI), dry powder inhaler (DPI), or nebulizer.
Xolair, a new medication for allergy-induced asthma, is given by injection under the skin every two to four weeks. Xolair is an anti-IgE monoclonal
antibody that blocks the antibodies which lead to inflammation. Xolair risks include the possibility of a severe reaction soon after getting the shot,
blood-clotting problems, and a possible link to cancer.
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Nebulizers for Asthma Medications |
Nebulizers are devices that administer medication in the form of a liquid mist
into the airways. Nebulizers pump oxygen through liquid medicine, turning it into a vapor which can be inhaled. As with inhalers, if nebulizers are used
to administer an inhaled corticosteroid, you should rinse out your mouth with water to avoid oral thrush.
Different types of nebulizers include the standard PARI Proned Ultra
Nebulizer, the small, lightweight PARI TREK Nebulizer, and the convenient and
cordless Omron MicroAir Portable Ultrasonic Nebulizer. Some nebulizers are made
specially for children, like the quiet and easy-to-use MedQuip Pediatric
Nebulizer. The Bubbles Fish Mask is also made specially for children to use with
nebulizers to minimize aerosol loss and make treatment time more fun.
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Holding Chambers or Spacers for Asthma Medications |
As stated above, you should always use a
holding chamber or spacer for inhaled
corticosteroids. Holding chambers are tubes that increase the effectiveness of inhalers by slowing down the delivery of the medication. Using a spacer also
reduces the risk of side effects from corticosteroid residue in the mouth. Young children who don't understand the timing of inhalers normally use holding
chambers.
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Asthma MDI Inhaler Changes |
MDIs traditionally used chlorofluorocarbons (CFCs) to propel drugs like albuterol into the lungs. However, CFCs harm the ozone layer. After
December 31, 2008, you will be required to use a hydrofluoroalkane (HFA) inhaler instead of a CFC inhaler. HFA inhalers have been available since 1996, and
they may feel or taste a bit different than CFC inhalers.
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Peak Flow Monitoring |
Peak flow meters help you detect subtle increases in airway obstruction. A low reading
may be a sign of an oncoming asthma attack or that control medications need to be changed. Discuss peak flow monitoring in more detail with your doctor, and
don't forget to keep you peak flow meter clean using hot water and soap.
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Asthma Trigger Avoidance - Asthma Prevention |
The best way to prevent an asthma attack is to identify all of your triggers and avoid them. See our allergy solution guides and learn how to avoid the
following common asthma triggers: dust
mites, mold, pet dander,
and pollen.
Allergy bedding is the most effective first line of defense against
allergens. Air purifiers eliminate allergens as well as airborne toxins like cigarette smoke
and chemical fumes. Window, furnace, & vent filters also trap allergens in the air, as
do allergy relief masks. Cold weather masks help
prevent asthma attacks triggered by cold weather. Dehumidifiers curb mold and
dust mite growth, and HEPA filtered vacuum cleaners pick up allergens in carpet and
upholstery.
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Childhood Asthma |
Asthma is one of the most prevalent chronic diseases among children and affects up to one in four urban children. Asthma is the most common cause of missed
school due to chronic disease. Approximately 80% of childhood asthma sufferers develop symptoms before the age of five. If you think your child may have
asthma, look for coughing, wheezing, chest tightness, and shortness of breath, and see your doctor for a diagnosis. All children with asthma should have
asthma management plans and know what to do in case of an emergency.
"Planning is the key to overcoming panic," says James Li, M.D., an asthma and allergy specialist at the Mayo Clinic. "A written plan can give you and your
child the confidence to treat asthma signs and symptoms promptly."
A recent study showed that only about 20 percent of children with asthma are
receiving optimal care, meaning that 80 percent could be receiving better care with more consistent use of medication, less exposure to environmental
triggers, and more education about asthma.
See Disarming Asthma - A Mother's Perspective for more information about childhood asthma.
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Asthma Emergency |
You should go to a hospital if you have an asthma attack with severe shortness of breath. To learn more about what to do during an asthma
emergency, see Are You Prepared for an Asthma Emergency? for expert advice from a
certified paramedic.
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