Asthma: Q and A

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Subject: Asthma: Q and A

Asthma is a chronic, life-threatening illness that kills more than 5,000 people each year and affects more than 12 million people in the United States. Though it cannot be cured, asthma is a chronic condition that can be controlled. It's important for asthma sufferers to work with their doctors to develop a treatment plan that prevents or relieves symptoms. The alternative is to risk a potentially fatal episode. It's a good idea to carry medical identification such as a medic alert bracelet or wallet card at all times.

Q. What is asthma?
A. Asthma is an upper respiratory condition caused by a tightening of the muscles and swelling of the lining in the small breathing tubes (bronchioles) of the lungs. This tightening, called bronchospasm, causes labored breathing as the airways become narrowed and restrict air flow. Also, the inflamed breathing tubes produce excess mucus, which further restricts breathing.

Q. What causes asthma?
A. Agents that a person is sensitive to usually triggers asthma symptoms. Common triggers include infections such as the common cold and influenza, things a person is allergic to (e.g., pollens, molds, dust, animal dander, certain foods), cold air, tobacco smoke, strenuous exercise, air pollution from industrial and auto emissions, pesticides, chemical fumes, drugs (e.g., aspirin, heart medications), and stress. Roach infestation also has been linked to asthma attacks.

Q. Who is at greatest risk for asthma?
A. Asthma is more common in children than adults, with about 30 percent of children outgrowing this problem before they reach adulthood. Also, asthma seems to run in families. The most important thing to remember is that asthma at any age is a serious health condition that requires a doctor's care.

Q. What are the common symptoms of asthma?
A. Symptoms of an asthma attack may start immediately or take a long time to develop. In turn, symptoms can be severe, moderate, or mild. Typical symptoms of mild to moderate asthma attacks include labored breathing (wheezing), shortness of breath, tightness in the chest, coughing, and spitting up mucus. When an attack happens it's important to take asthma medication and watch your symptoms. If symptoms do not clear up in the time your doctor has told you it should, or your symptoms get worse, call your doctor. In the case of a severe attack, symptoms may include the inability to catch your breath or feeling breathless, or having a hard time talking, bluish or grayish finger nails, tight neck muscles, and/or tight and sucked-in feeling in the chest muscles (between the ribs). If you experience these symptoms of a severe attack, it's important to take asthma medication immediately and seek emergency medical care as soon as possible. Approximately 12 to 15 percent of the general population experience exercise-induced asthma (EIA), a condition in which an increase in air resistance occurs after a few minutes of exercise. Common symptoms of EIA include tightness in the chest, shortness of breath, wheezing, coughing, fatigue, and difficulty recovering after exercise. However, EIA should not be a reason not to exercise since physical activity helps build and maintain lung function. In fact, many professional and Olympic athletes have EIA and with proper medical supervision have excelled in their respective sports.

Q. What do doctors mean by "the second wave"?
A. The second wave is a condition in which the air tubes continue to swell, even without symptoms for some people, after an initial asthma attack has eased. This reaction can last for days or for weeks and make the lungs more sensitive to triggers. A second-wave attack can be more severe and life threatening than the first attack. Medical supervision may be required in order to monitor the condition and avoid a more serious attack.

Q. How is a diagnosis made?
A. If you or a family member has any sign of an asthma attack, it's important that you see your doctor. Your doctor will take a medical history to see if you have another health problem that may mimic asthma, such as allergies or an upper respiratory infection. Other tests that usually are done include a physical exam with lung function tests that measure your "breathing efficiency." Lab tests might include chest X-rays, further pulmonary tests, blood work (e.g., complete blood count), urinalysis, sputum
test, or other evaluations such as allergy tests (if there's an indication of an allergic attack).

Q. How can an asthmatic monitor his or her condition?
A. Outside of symptoms, an asthma sufferer can tell if his or her airways are narrowing before an attack by using a peak flow meter. This hand-held device measures lung efficiency. By blowing into the device, a user can tell if his or her "lung power" is decreasing, thus signaling a potential asthma attack.

Q. What is available to treat asthma?
A. There is no cure, but day-to-day management can help prevent or reduce symptoms. It's important that individuals be under a doctor's care because asthmatic attacks can be life threatening if left untreated. Depending on the severity of symptoms, treatment options include:
1. You can reduce your exposure to agents that trigger asthmatic attacks. This may include allergens or environmental agents such as smoke, solvents, and air pollution.
2. Medications such as cromolyn and nedocromil or corticosteroids are anti-inflammatories and help prevent asthmatic attacks from occurring. These drugs are dispensed through inhalers, pills, or shots. Another class of drugs, bronchodilators, are used to help relax bronchial tubes after an asthma attack has begun, thus making breathing easier. These drugs are available as pills or inhalers or come in liquid form. For severe attacks your doctor may give you an injection of epinephrine
(adrenaline), which provides short-term relief. Your doctor may also teach you how to self-administer epinephrine at home in case of emergency.
3. Self-care practices, such as drinking plenty of water or breathing in warm, moist air, can relieve breathing problems. Regular aerobic exercise such as brisk walking and swimming can help build lung capacity. However, medications may need to be taken before exercising to help open up airways.
4. Allergy shots expose a person to certain allergens in small amounts over a number of years. The person's system becomes less sensitive to certain allergens, thus reducing the chances of an asthmatic attack.
5. Counseling and stress management techniques can help individuals whose asthmatic attacks are triggered or complicated by emotional triggers.Medication's can be prescribed to reduce agitation, anxiety, and unpredictable behavior as well as to improve sleep.

Q. If I have asthma, what's the best way to control it?
A. The American Lung Association recommends three things:
1. See your doctor on a regular basis. Share with him or her any changes in your symptoms, reactions to your medications, and any new triggers that cause symptoms.
2. Take your asthma medications as directed by your doctor. Don't stop taking them, even if you feel well.
3. Stay informed about asthma. Learn about asthma triggers and how you may avoid them. Also, be sure that your family understands what asthma is, what its symptoms are, and how to provide emergency care if you cannot do it yourself.

Questions to Keep in Mind:
* What agents or situations trigger my attacks?
* How can I avoid these triggers?
* What do I need to do when an asthma attack occurs?
* What medications should I carry at all times?
* Are my symptoms caused by certain allergens? What are they?
* If I'm allergic to certain things, should I consider allergy shots?
* What medications will I be taking? How should they be taken? What are the possible side effects? Will this drug affect the other drugs I take? How?
* How do I use a peak flow meter to monitor my condition? What are indication measures of a potential attack?
* How long does each drug take to relieve my symptoms? What should I do if my symptoms don't go away in the expected time?
* I hear that exercise is good for me, yet I have trouble breathing when I work out. What do I need to do in order to make exercise safe? For example, do I need to take medication before I start exercising?
* Where can I get information on how to make my home and environment safer for me (or my family member)?
* What support groups or organizations are available to help me (or the family) cope with asthma? How can I contact them?