August - December 2005 Issue
Control Your Asthma: Don't Let It Control You
Joseph Hine, MDMedical College of Wisconsin Pulmonologist and Intensivist
Over the last 25 years, asthma has become more and more common in the United States. Joseph Hine, MD, of the Medical College of Wisconsin says the key to controlling the condition is monitoring your symptoms, avoiding triggers and keeping up with your medications.
Q. What is asthma?Asthma is a chronic lung condition characterized by inflammation and swelling of the airways (bronchial tubes) in the lungs, increased mucous production and tightening of the muscles around the airways causing them to narrow. We often describe the airways in people with asthma as hyper-responsive or oversensitive. The end result is difficulty moving air in and out of the lungs and trouble breathing.
Q. What are its symptoms? Asthma symptoms will vary from person to person. The symptoms range from something as simple as a recurring cough to more noticeable symptoms like wheezing, shortness of breath and tightness in the chest. Sometimes these symptoms will be more noticeable during certain times of the year.
Q. Do we know what causes the condition?We really don't know what causes asthma, but we don't think it's just one thing. Some people may have a genetic (hereditary) predisposition that results in allergies and ongoing inflammation in the airways of the lungs. We also think that exposure early in people's lives (infections, tobacco smoke, dusts, pollens and chemicals) may play a role in developing asthma. There is also evidence coming out now that obesity may contribute to certain people developing asthma.
Q. Who is most at risk of developing asthma?Asthma can develop at any age, from early childhood to people in their 70's and 80's. In young children, we see more males than females with asthma. By the time they become teenagers, that switches, with asthma occurring more frequently among females (this could be related to the hormones of puberty). Adult males and females have an equal chance of developing asthma.
Q. What triggers an asthma attackThere are many things that can trigger an asthma attack. These include pollen from grass, trees or weeds, certain animal secretions such as cat saliva or animal dander, molds, household dust mites and strong fumes such as household cleaning supplies or perfume. In addition, respiratory viral infections (such as the flu), cold air, ozone or air pollution, exercise and even emotional upsets, can all trigger asthma attacks. Tobacco smoke is notorious for causing people's asthma to worsen.
Q. How do you control asthma?There are many things people can do to control their asthma. First and foremost is to see you doctor on a regular basis because it's important to remember that asthma is a chronic disease.
Avoidance of those triggers that make your asthma worse is also important. The may mean that people have to wash their linens on a regular basis in hot water to get rid dust mites. If they have pets, it may mean removing the animal from the home or limiting the animal to the outside. We also don't recommend that people with asthma have a lot of carpeting in the house since it can collect dust, pollens, molds and animal dander. We also tell people with asthma that they should clean or replace their air filters on a regular basis as well as having the air ducts in your home cleaned periodically. Asthma sufferers may need to avoid outdoor activities on days when there is an ozone or smog alert. On those days, try to stay indoors with air conditioning. If you exercise, our general recommendation is to do a good warm-up beforehand and a good warm-down afterward – doing a gradual build-up helps increase circulation to the lungs, which is beneficial for asthma.
Even when people do all this, they still may not be able to control their asthma and their medications may need to be adjusted.
Q. What medications are available?There are different medications for the different stages or severities of asthma. All these medications are aimed at controlling the two main aspects of asthma, inflammation (swelling) and bronchoconstriction (narrowing of the airways). Most of these medications are inhaled through the mouth in either an aerosolized or powder form, these include medications such as long acting and short acting inhaled bronchodilators that work on relaxing the muscles and opening up the airways and inhaled corticosteroids that work at controlling the inflammation. Additional medications aimed at controlling inflammation can be taken in pill form.
For the most severe cases or exacerbations of asthma, we sometimes prescribe a steroid pill, a strong anti-inflammatory medication.
For people that have severe allergic asthma, there is a relatively new medication that requires people to get a shot every few weeks. These treatments may have side-effects which is another reason people with asthma should see their doctors on a regular basis.
Q. Are there any special programs for people with asthma? Two years ago, the Department of Internal Medicine and the Division of Pulmonary Medicine at the Medical College of Wisconsin started a comprehensive asthma program coordinated by Illeen Gilbert, MD. Her vision was to develop a clinic program that specializes in educating and treating people with asthma at various clinic sites around Milwaukee. The goal of any patient with asthma is to develop an Asthma Action Plan. It allows people to control their asthma in a way that is similar to how people with diabetes control their diabetes.
The most important thing for people to realize is that asthma is a completely treatable disease. Discipline in monitoring symptoms, controlling triggers and taking medications has been shown to greatly decrease hospital visits and decrease asthma symptoms which ultimately improve the quality of life of people that have asthma.
Author: Joseph Hine, MD
Source: Every Day
Date: August - December 2005