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ASTHMA

Asthma symptoms affect an estimated 21.9 million Americans and are one of the leading causes of work and school absences. The cost in direct medical care and indirect expenses totals more than $16.1 billion each year. Although the exact cause of asthma remains unknown, many treatment options are available to control and reverse this chronic inflammation of the lungs’ airways.

Although no cure exists for asthma, effective treatments are available. We learn more about asthma every year and newer, more effective drugs are being developed. As a result, most people with asthma live normal, productive lives. Research is continuing, and the outlook is bright.

Asthma

Types of Asthma


Types of Asthma

In addition to the stereotpyical asthma with symptoms such as shortness of breath or wheezing with changes in temperature, infections, or allergies, there are also subtypes of asthma:

  • Occupational Asthma
  • Exercise Induced Bronchoconstriction

Occupational Asthma

Do you have wheezing, coughing or shortness of breath at work? If so, you could have occupational asthma.

Is your asthma caused by your work?

The answer to this question may be very difficult. It begins with you, yourself, answering many questions about your asthma and your work. For instance:

Did your asthma start when you changed jobs? Does your asthma improve when you are away from your job? Do you suspect anything at work is causing your problem? Is anything at work triggering your asthma?

Asthma caused by work is called occupational asthma. Asthma due to other causes (non-occupational asthma) also sometimes can be worsened by the workplace environment.

Proving it is occupational asthma

Some experts suspect that exposures in the workplace may be the cause of 5 percent to 10 percent of asthma, and occupational asthma can cause long-term problems. If work-related asthma is suspected, then that possibility should be evaluated. We will need to ask you many questions about your asthma, your work and how they may be related.

Prepare yourself to answer these questions accurately. You should be able to describe your current and past jobs and whether/how they seem to relate to your asthma. You should be able to explain your job and job conditions exactly, including any exposure to fumes, gases, smoke, irritants, chemicals, potential allergens or excessive environmental conditions, such as heat, cold or dryness, as well as many manufacturing or processing conditions to which you are exposed.

Spray painting is one of the most common workplace hazards linked to occupational asthma, but there are hundreds of possible irritants or allergens that could cause your problem. You can usually obtain exact details of your potential work exposures from your work supervisor, who may give you Occupational Safety and Health Administration (OSHA) safety literature that describes potential work-related problems. Review and make available to your treating physician the Material Safety Data Sheets (MSDS) for all chemicals that you are exposed to at work (So far, about 250 potential causes of occupational asthma are known.)

Doctor may prescribe tests

Suspecting that you may have work-related asthma and knowing that you are exposed to a potential cause of asthma does not prove that you have occupational asthma. To do this, you must take notes on how your work seems to affect your asthma. Proof may require medical examinations and testing at work and away from work. Further specific tests, such as challenge tests, which observe your body's reaction when exposed to potentially problematic substances, or blood tests, may be necessary to prove the suspected occupational asthma and its cause. Any asthma evaluation must also consider non-occupational causes of asthma since these are more common and require different treatment.

Treating occupational asthma

Therapy for occupational asthma stresses avoiding whatever causes the asthma. This often means quitting the job or making changes in the workplace to avoid the cause. This is particularly difficult with occupational asthma, since having to leave your job or avoid certain types of work can greatly influence the quality of your life. In addition, trying to change the workplace to avoid causes of asthma often can be difficult and expensive.

Breathing Problems During Exercise

If your chest feels tight, you have trouble catching your breath or you cough during or after exercise, you might have exercise-induced bronchoconstriction. That's EIB for short, and it simply means breathing problems brought on by exercise. Most people with asthma have EIB. But, it's also possible to have EIB and not have asthma. The good news is you can exercise control when you exercise.

No matter what sport or exercise activities you do, we can work with you to keep your condition under control.
  • To help you manage your EIB, keep track of your exercise and symptoms with a Journal.
What happens if I have EIB?

When you exercise hard and do things such as running, skiing, biking or an aerobics class, you breathe more rapidly. This fast breathing can make the airways inside your lungs dry and irritated. As a result, the airways actually get smaller, and it's hard to get air in and out of your lungs. This is more likely to happen when you exercise in cold, dry air, or when there is a sudden change in temperature or humidity.

Asthma Symptoms


Asthma Symptoms

Many people do not know they have asthma, especially if their symptoms aren't severe. But any asthma symptom is serious and can become deadly.

The most common asthma symptoms are:
  • Coughing, especially at night, with exercise, or when laughing
  • Trouble breathing
  • A tight feeling in the chest
  • Wheezing – a squeaky or whistling sound
Sometimes a cough that won't go away is the only symptom of asthma. Asthma symptoms often happen at night and in the morning, but they can happen any time. They get worse when you are around your asthma triggers.

Is asthma a psychological disorder?

Asthma is not a psychological or emotional disorder, but sometimes a physical display of strong emotion – such as shouting, crying, laughing or rapid breathing – may contribute to an asthma episode. Panic can prevent a person with asthma from relaxing and following instructions properly, which is essential during an attack. Medical scientists have found that behaviors associated with strong emotions can cause bronchial tubes to constrict, which may provoke or worsen an attack.

A chronic disease, such as asthma, can cause emotional strain. Depression may set in when those with asthma believe they cannot participate in normal activities. As a leading cause of work and school absences, asthma can have a significant effect on livelihood, education and emotional well-being.

Is asthma life-threatening?

In severe and poorly controlled cases, asthma can be life-threatening, and the death rate and prevalence of asthma has increased significantly since the late 1970s. Deaths occur more frequently in adults. If there is a single factor leading to severe or fatal asthma attacks, it appears to be a delay in administering appropriate drug therapy.

Symptoms of an Asthma Attack

What happens in an asthma attack?

Because of asthma’s chronic, low-grade inflammation and irritation of the bronchial tube lining, airways can become "twitchy" and narrowed in response to certain triggers. During an asthma attack, the muscles that surround the bronchial tubes contract, further narrowing the air passages.

With worsening of asthma, inflammation of the lining of the airways increases and produces swelling and further reduces airway size. In addition, glands in the lining of the air passages secrete excess mucus that accumulates in the already narrowed air passages. Air is trapped behind the narrowed bronchial tubes and there is a decrease in the oxygen available to the body. The result is that breathing, especially exhaling, becomes extremely noisy.

How long does an asthma attack last?

The duration of an asthma attack can vary according to the type of trigger that caused it and how long the airways have been inflamed. While mild episodes may last only a few minutes, more severe episodes can last from hours to days. Mild attacks can resolve spontaneously or may require medication. More severe attacks can be shortened with appropriate asthma treatment.

What should be done during an attack?

Always follow the instructions of a physician. People with asthma should have an action plan for dealing with an acute attack. In general, it is important to stay calm and take prescribed medications. Quick-relief medications, including short-acting, rapid-onset inhaled beta2-agonist bronchodilators, anticholinergics and systemic corticosteroids are used to treat asthma attacks and are taken on an as-needed basis. They relieve symptoms rapidly by relaxing the muscles surrounding the airways, helping to open the bronchial tubes.

Asthma Diagnosis


How Asthma Is Diagnosed

Diagnosis of Asthma requires evaluation and testing. During your consultation, we will:
  • Take a medical history that reviews if any members of your family have asthma or allergies, such as hay fever, hives or eczema
  • Ask you about your attacks, how often they happen and what seems to trigger them
  • Perform a physical exam
  • Measure airflow entering and leaving the lungs
Other tests such as chest X-rays, blood tests or allergy tests, may also be needed.

Asthma Medication


Proper Use of Asthma Medication

Today, there are many effective medicines to treat asthma. Most people with asthma need two kinds.

Quick-relief medicines — taken at the first sign of any asthma symptoms for immediate relief:
  • Short-acting inhaled beta2-agonists
  • Anticholinergics
Quick-relief medicines can stop asthma symptoms, but they do not control airway inflammation that causes the symptoms. If you find that you need your quick-relief medicine to treat asthma symptoms more than twice a week, or two or more nights a month, then your asthma is not well controlled. Be sure to tell you doctor.

Long-term control medicines — taken every day to prevent symptoms and attacks:
  • Antileukotrienes or leukotriene modifiers
  • Cromolyn sodium and nedocromil
  • Inhaled corticosteroids
  • Long-acting inhaled beta2-agonists (never taken alone)
  • Methylxanthines
  • Oral corticosteroids
  • Immunomodulators
These medicines are taken every day even if you do not have symptoms. The most effective long-term control medicines reduce airway inflammation and help improve asthma control. The goal of asthma treatment is to have you feel your best with the least amount of medicine.

Asthma Management


Asthma Management

Many of the 22 million Americans who have asthma limit their activities and miss work or school. The disease also can kill. Almost 4,000 people die from asthma each year and most of these deaths are preventable. Uncontrolled asthma and asthma deaths happen when the disease is not treated correctly or sometimes because people do not know they have asthma.

Effective asthma control begins with the right diagnosis early in the disease. Delays can lead to permanent lung damage.

During your visits, we will review your symptoms, activities and medicines. Between visits, it is important for you to monitor your asthma by keeping an asthma diary to track your symptoms or using a peak flow meter to measure the air flow from your lungs. With either method, you also should keep track of your medication use. This information will help you and your doctor decide if any changes in your treatment plan are needed.

Why does physical exertion sometimes cause an asthma attack?

During exercise, rapid breathing occurs through the mouth. As a result, the air that reaches the bronchial tubes has not been warmed and humidified by passing through the nose. This cold, dry air can trigger asthma symptoms. It usually takes six to eight minutes of sustained aerobic exercise to bring out asthma symptoms, which may then occur for several minutes after the exercise has been completed.

If asthma symptoms begin after fewer than six to eight minutes of hard exercise or during or after very mild exercise, a person’s asthma may be out of control and these symptoms should be discussed with a physician. More than 70 percent of all people with asthma suffer some degree of exercise-induced asthma, which is usually preventable.

Should persons with asthma avoid sports and exercise?

By taking preventive measures, people with asthma should be able to compete in sports. However, not all sports are tolerated equally well. In general, exercise and most sports that involve prolonged periods of running are more likely to provoke asthma attacks than nonaerobic ones.

Swimming is one of the best-tolerated sports. In most instances, pre-exercise medications and warm-up exercises enable participation. Many Olympic athletes, including several gold medal winners, have had asthma.

Asthma Shots


Who Should Consider Allergy Shots for Asthma

If you cannot avoid an allergic asthma trigger and you have asthma symptoms three days a week and more than two nights a month, you should consider allergy shots. Also known as immunotherapy, the shots are especially helpful when symptoms occur year-round or are not easily controlled by medicine.