Managing Your Asthma

The first thing to do about controlling asthma is to understand it. Asthma is an inflammatory lung disease. Even if there seems to be no symptoms, the asthmatic airway has inflammation. During an asthma episode your airways become narrow from smooth muscle constriction, excess mucous, bronchial wall edema and bronchial hyperresponsive. The lung is reacting to triggers which can be allergens or irritants. It becomes harder to breathe. Damage from chronic airway inflammation leads to airway remodeling and contributes to diminished lung function. With treatment the narrowing for the most part can be reversed so it is considered a reversible airway disease.

Controlling these episodes of asthma attacks are of the utmost importance. It is a commitment to health. Your lifestyle will not be the same as someone who does not have breathing problems. Just popping pills will not control it, ignoring it will not control it but extra effort and changes in behavior will.

Classification of Asthma

Mild Intermittent
Daytime symptoms less than than twice a week. Nighttime symptoms less than twice a month. Peak flow 80% or more of baseline.

Mild persistent
Daytime symptoms more than twice a week, but less than once a day. Nighttime symptoms more than twice a month. Peak flow 80% or more of baseline.

Moderate persistent
Daytime symptoms every day. Nighttime symptoms more than once a week. Peak flow between 60% to 80% of baseline.

Severe persistent
Daytime symptoms are continuous. Frequent nighttime symptoms. Peak flow is 60% or less than baseline.

Some clinicians prefer to use the management method based on asthma control

Levels Of Asthma Control

Controlled
Daytime symptoms two times or less, no nighttime symptoms,no limitation of activities and no exacerbations. There will be two times or less need for rescue medications per week. Maintain at lowest treatment level.

Partly Controlled
Daytime symptoms more than twice a week, some nighttime symptoms, some limitation of activities and one or more exacerbation a year. There will be two times or more need for rescue medications per week. Step up treatment until controlled.

Uncontrolled
Three or more features of partly controlled in one week. Need to step up treatment until asthma is controlled.

You must know what your triggers are so you can try and avoid or eliminate them. It is suggested you keep a diary of your symptoms and what caused them

ALLERGENS- Animal Dander, Dust Mites, Insect Waste, Pollen, Mold, Food

IRRITANTS- Perfume, Cigarette smoke, Chemicals including cleaning products and Pesticides, Dust, Air Pollution, candles, fire place, gas stoves, grilling smoke.

INFECTIONS- Colds, flu, sinus

PHYSICAL- exercise, laughing, crying

MEDICINE- Aspirin, NSAIDS

There are long term controller medications and short term relief or rescue medications. All medications have side effects. But the ultimate side effect of not breathing is death. If you are able to manage your asthma naturally with lifestyle changes, then you are doing good. Many asthmatics are not able to because of the severity of their symptoms. They have to take the medicines with the lifestyle changes in order to manage their disease. Just because Aunt Betty was able to maintain her asthma naturally doesn't mean Cousin Sue can do the same. Her disease process might be different and more complicated. Everyone is different.

The long term controller medications are to be taken daily. They are for keeping control of the inflamed airway by reducing the inflammation that already is there and preventing further inflammation and bronchodilation. These are not rescue medications for immediate relief of an asthma attack. Taking these medications should be done at the same time every day and become a part of everyday routine like combing hair or brushing teeth.

Unfortunately some asthmatics are non-compliant with the medication. Asthma can be a long term chronic illness and medication nonadherence can be lessened due to the seemingly non emergency factor. They might promise themselves that they will follow doctors orders at a later date. The problem of course is the over reliance on the emergency bronchodilators after an attack instead of preventing the attack. One study found that people who regularly took herbal medicines were less compliant with their preventive medications and this gave them negative outcomes. The more medicines that a person has to take the more likely they will not take them all. Economics can be a factor if there is no money to buy all the medicines

Inhaled steroids -Anti-inflammatory
beclomethasone
budesonide
flunisolide
fluticasone

Mast cell stabilizers
cromolyn
nedocromil

Long- acting beta 2 agonist- Used with the inhaled steroid for bronchodilation, or opening the airway.
salmeterol
formoterol

Leukotriene modifiers
montelukast
zileuton
zafirlukast

The short term medication is for quick relief from shortness of breath and other symptoms. .

Short-acting beta 2 agonist- These are the rescue medications you use for quickly reversing airway obstruction. These are also the ones that are most over used by asthmatics.

albuterol sulfate
pirbuterol
metaproterenol
bitolterol
levalbuterol

might be combined with an anticholenergic.

anticholenergic- Usually given with a short acting beta-2 agonist. They are believed to work better together. They are slower acting than the beta-2.

ipratropium bromide

Oral steroid - Used during moderate to severe asthma attacks on a short term or long term basis. Less organ specific than inhaled and more side effects but does offer in lessening the inflammation.

prednisone
prednisolone

A peak flow meter is a very easy way to determine if you are having problems with breathing and every asthmatic should have one. It is hard for some asthmatics to determine that they are in trouble. This portable device can help you monitor your breathing on a daily basis. You blow into it as hard as you can and see what the number is. The numbers are divided into zones. Green means your airway is good, yellow means you have a little problem and need to treat it. Red means you are having problems that need immediate medical attention.

Exercise can be an asthma trigger and make symptoms worse. When you do vigorous activities your need for oxygen goes up, you then start breathing fast and deep from your mouth. This cools and dries your airway. In 80 to 90% of asthmatics this causes problems with their breathing. Approximately 50% of hay fever sufferers or those with allergic rhinitis get short of breath during exercise also. In some people this is the only time they have breathing problems. In this case they might not know what is happening. All they can tell is that they start coughing or wheezing, feel chest tightness and may not be able to keep up with their peers. They might think they are just out of shape and need to get conditioned.

It seems to be worst in the winter when the air is cold and dry and can irritate the lung. Summer is best when it is warm and somewhat humid.

In the instance of the known asthmatic, they need to talk to their doctor about how to monitor the symptoms. If there in difficulty in breathing at the beginning they should not start exercising with breathing difficulties. They might have to warm up longer, hydrate more or pre-medicate.

For those not diagnosed with asthma they need to find out. Sometimes the symptoms are mild and go away after hydration. If they continue to present themselves you need to find out what is the problem and if it is EIA of something else.

The type of exercise or activity might need to be changed. Certain ones cause more symptoms than others. It can be a personal choice of picking one that fits you and one that you are able to do without too many symptoms.

Swimming indoors is good because of the warm moist environment. Walking rather than running is preferable because it is less symptomatic. Bicycling is good as is golf, volleyball baseball and other sports. Activities with intermittent periods of rest are good because it lets the person normalize their breathing. The high intensity activities like aerobics can cause more symptoms but that might mean the person starts off slow and gradually intensifies as much as possible with periods of rest.

Do not start intense activities if you feel symptoms.

Treating and monitoring the problem can help prevent halting favorite activities and sports. Everyone, with asthma or without need to be active and physically fit.

A simple thing to do is to cover the mouth and nose to prevent drying and to keep warm. For more serious instances relief can be gotten by using medication before your activities. The medication is often taken about 10 to 15 minutes before exercise starts and can help prevent the onset of symptoms.

Supplemental oxygen is used in acute severe asthma attacks. While in the hospital If oxygen levels in the blood are significantly low (hypoxemia) because of the attack, oxygen can help bring them back up. It will not stop or shorten the asthma attack and medication will be needed for that purpose.

People who find they have breathing problems, thinking it's from COPD, asthma and other lung diseases might have Alpha-1 antitrypsin deficiency and not know it. It is a genetic disorder that sometimes is misdiagnosed as uncontrolled asthma. Alpha-1 lung disease is considered an atypical COPD. It confuses doctors because the symptoms present themselves earlier than regular COPD and has no cigarette connection. Because of the young age of those it affects means it may be confused with asthma and treated as such.

It is now recommended by the American Thoracic Society and the European Respiratory Society to test sufferers with COPD, asthma, other lung and certain kidney diseases for this genetic disorder. It is a relatively eastest and can be done with routine blood tests.

People in the U.S. spend a vast majority of their life indoors. And indoor pollution is a big problem whether its in your home or other indoor environments. The level of indoor pollutants is much higher than outdoors due in part to the concentrated nature of being inside. We find pet dander, cockroach residue, tobacco smoke, fireplace smoke, cooking gas, perfumes, rodent droppings, mold and mildew, dust and dust mites. Learning that indoor pollution can come from many everyday things and that these can be triggers and exposure to them can be problematic.

Dust mites are the most common cause of allergic symptoms that can cause breathing problems in 90% of allergic asthmatics.They live in our homes, in our beds, pillows, upholstered furniture, carpeting and other places that don't get sunlight and are humid. They thrive on dead skin of people and animals, and it is their protein and waste matter that causes reactions to those who are allergic. They live in house dust which in itself can also be a irritant to the asthmatic.

In New York City there is new legislation that was introduced called the Asthma-Free Housing Act, Intro 750. Once alerted about indoor triggers like mold or vermin. Landlords would have 21 days to address and rectify the problems. This is one small way to help in lessening dangerous exposure.

The body goes through a 24 hour circadian cycle. The lungs will narrow or expand during the course of a day. This is a part of diurnal variation and it is normal. People who have no disease and people who do have problems are effected. In those who do have illnesses like asthma the variation is more pronounced and it produces symptoms like shortness of breath.

Many asthmatics experience nighttime sleep disturbances. They have a hard time
getting to sleep and will wake up during the night feeling breathless. Having daytime sleepiness can be an end result of this. With the increase in melatonin and histamine level there is an increase in inflammation. Breathing worsens around 12 a.m. It is believed the worst time is around 4 a.m. and the best time for lung function is around 4 p.m. The suggestion is to use chronotherapy in order to work with the natural cycle. Medication is given according to the body's circadian rhythm in order for it to be more effective to the asthmatic. Making sure that the early morning hours are covered with medication in order to allow a more restful night.

Holidays are times for friends and family to get together. For the person with asthma it can be filled with danger. Hospitals notice an increase in admissions from asthma triggers around the holidays. So care needs to be taken in order to have an enjoyable holiday.

Food allergies is one of the asthma triggers. With certain foods the allergic asthmatic can either have an asthma attack or the anaphylactic reaction. Some asthmatics are prone to both. The treatment for anaphylaxis is an emergency epi-pen that can be self administered. It slows down the attack but doesn't stop it, only quick medical attention can stop it. If there is a reaction and it is not clear if it is asthma or anaphylaxis always use the epi-pen, it works on both.

Allergic items can be found in the food that is eaten by way of obvious or hidden ingredients. During the holiday asthmatics might find that they are eating outside their home more often which increases the potential of accidentally ingesting forbidden foods.

Make sure you continue to keep to your schedule and take your medications. Always remember to have your rescue medication with you and don't be embarrassed to take it if you feel symptoms coming on. If you feel sick you might have to go home or to the doctor, remember you need to take care of yourself so you can return an party another day.

Being social is a part of human nature but you have to be careful of people with colds and other respiratory symptoms. Try to avoid people who are coughing and sneezing and delicately try to avoid too much kissing and hand shaking. Always wash your hands before any food contact and carry and use your personal hand sanitizers.

You have more control over your environment if you are at home and receive visitors but if you are visiting someone else you need to discuss things with your host and hostess. If you get reactions from scents like candles, perfumes and potpourri. If you get sick around pets or smoke you can discuss those with them. It is better if you had been there before to see how you react to the environment.

There are some homes that you need to stay away from or at least don't stay long and don't spend the night because of pets, dust and other allergens and irritants. You can visit them by the free videoconferencing or someplace neutral like a restaurant or a trigger free home.

One of the good reasons for joining a local support group is that there are like minded people there and you can socialize with them in comfort. Or make friends with people who are allergic, have asthma or COPD and will be living similar to you.