What You Need to Know About Adult Asthma
Chances are, you know someone who has asthma -- or even have it yourself. More than 23 million Americans have been diagnosed with asthma, according to the National Center for Health Statistics. Asthma is a condition in which the bronchi and bronchioles, the tubes that carry air to and from the lungs, become chronically inflamed and abnormally sensitive to certain substances that make the inflammation worse. Asthma cannot be cured, but it can be controlled by limiting exposure to those substances -- called triggers -- and, if needed, taking medication.
An asthma attack occurs when the immune system in the lungs reacts to a trigger. When the immune system encounters a trigger, it causes airway linings to swell and become more inflamed. Mucus forms and clogs airways. Muscles around the airways tighten, causing the airways to narrow, obstructing the flow of air and making breathing difficult. Symptoms include shortness of breath, chest tightness, coughing, wheezing, and excess mucus. Asthma attacks can range from mild to severe and can result in hospitalization or even death.
The most common trigger is an allergy, usually to dust, dust mites, pollens, mold, animal dander, cockroaches, or certain foods.
These are other common triggers:
Irritants in the air, including smoke from cigarettes, wood fires and charcoal fires; air pollution; and fumes or odors from household sprays, paint, gasoline, perfumes, and scented soaps.
Colds and other respiratory infections.
Exercise or other activities that cause you to breathe heavily.
Cold air or dry wind.
Expressing strong emotions, such as anger, fear or excitement.
The sulfites used as preservatives in foods and beverages.
Sensitivity to aspirin; other non-steroidal anti-inflammatory drugs, such as ibuprofen; or beta-blockers. People with asthma should consult their doctors or pharmacists before taking any medication, especially over-the-counter products.
Each person reacts differently to the factors that may trigger asthma.
Although there's no cure for asthma, people with asthma can lead normal lives by managing the disease. The most effective management methods are measuring peak flows, controlling environmental triggers and taking the right medications the right way. A daily treatment plan developed with your health care provider should include ways to avoid triggers, how to measure your peak flow and how to use medications.
These are the goals of treatment:
To allow you to do normal activities without symptoms
To prevent most asthma attacks
To decrease the need to use quick-relief medications to prevent symptoms
Measuring peak flows
Health care providers recommend the use of a peak-flow meter to measure and monitor the strength of your breathing. When you blow into this small device, it can detect narrowing in the airways hours or days before asthma symptoms appear. The meter provides an early warning that an asthma episode is approaching, so you can treat the attack before it occurs. Your health care provider should show you how to use the peak-flow meter and watch you use it to make sure you are doing it correctly.
Controlling environmental triggers
To avoid exposure to triggers, you must first know what they are. If you have allergies to substances such as dust, pollen, animal dander or mold, you can take preventive measures to avoid the allergens. For instance, you can put a dust-proof casing on mattresses and pillows. You can vacuum frequently, using a vacuum cleaner with a HEPA filter. You can remove carpets or clean carpets, drapes and rugs frequently to decrease the amount of dust and animal dander.
If you are allergic to pollen, keep the windows closed and use an air conditioner to reduce symptoms during allergy season. Stay indoors during high pollen counts and the early morning. Keep pets out of the house or out of the bedroom. Clear out damp areas around and outside the home to prevent mold. If you live in a humid climate, use a dehumidifier to make your home less friendly to dust mites and mold.
Taking the right medications
Treatment depends on the frequency and severity of symptoms, which can vary widely from person to person. Asthma experts classify symptoms by their severity:
In mild, intermittent asthma, symptoms come and go. Symptoms during the day occur twice a week or less often, and symptoms at night occur twice a month or less. In between episodes of symptoms, lung function is normal.
In mild, persistent asthma, symptoms occur during the day more than twice a week, but not more than once in a single day; symptoms occur at night more than twice a month.
In moderate, persistent asthma, symptoms occur every day during the day, and nighttime symptoms occur more than once a week.
In severe, persistent asthma, symptoms occur throughout the day on most days, and nighttime symptoms occur often.
Asthma medications usually are taken orally or inhaled. Two types of medications are used to treat asthma: quick-relief medications and long-term control medications.
Quick-relief medications are taken when asthma symptoms first occur and provide relief within minutes. According to the National Heart, Lung, and Blood Institute (NHLBI), everyone with asthma needs to have a quick-relief medicine. The preferred quick-relief medicines are short-acting inhaled beta-agonists. These medicines, called bronchodilators, relax the muscles around the airways so they can expand and allow more air to pass through. Albuterol (Proventil, Ventolin) is an example of a short-acting inhaled beta-agonist. Another type of quick-relief medications is an inhaled anticholinergic. Like short-acting beta-agonists, they open the breathing passages. They take slightly longer than beta-agonists to work, but they last longer. Often, the two types of drugs are used together to provide greater relief. Ipratropium bromide (Atrovent) is an inhaled anticholinergic drug most often prescribed as an asthma quick-relief medication.
Long-term control medications are taken every day. They decrease swelling in the airways caused by inflammation. These medications need to be taken for a period of weeks before they are fully effective. The most effective, according to the NHLBI, are corticosteroids. They come in tablets, liquids or an inhaled form. The inhaled form is the most effective for long-term control because the medicine gets directly to where it is needed and does not cause many side effects. The oral forms (Prednisone) are usually used for short periods of time to control severe symptoms. Beclomethasone (Vancenase, Beclovent) and triamcinolone (Nasacort, Atolone) are examples of inhaled corticosteroids.
These are other long-term medications:
Inhaled long-acting beta-agonists -- Like short-acting beta-agonists, these relax the muscles of the airways, but they are not anti-inflammatory drugs. They usually are used with inhaled corticosteroid medicines. Salmeterol (Serevent) and formoterol (Foradil) are long-acting beta-agonists.
Leukotriene modifiers (montelukast, zafirlukast and zileuton) -- These prevent the effects of one of the chemicals the immune system releases during inflammation. These drugs are used either alone or with inhaled corticosteroids to decrease inflammation in the airways. Zileuton (Zyflo), zafirlukast (Accolate) and montelukast (Singulair) are examples of leukotriene inhibitors.
Cromolyn and nedocromil -- These prevent the release of chemicals that cause inflammation in the airways.
Theophylline and aminophylline -- These work as long-acting bronchodilators. They are used alone or with inhaled corticosteroids. These drugs are related to caffeine.
Metered dose inhalers
Most medications that are inhaled come in metered dose inhalers (MDIs). It's important to use and store your MDI properly to get the correct dose of medication. Your health care provider should show you how to use an MDI and should watch you use it to be certain you are doing it correctly.
MDIs come in two forms: pressurized (wet) and dry powder. The pressurized MDIs are small canisters that contain the medicine and a propellant. After they are attached to a mouthpiece, they form an L shape. These MDIs must be shaken and primed before they are first used and may require an additional tube, called a spacer. It is important to count the number of times you use a pressurized MDI to make sure you don't run out of medicine. Throw it away when you have reached the number of doses of medicine it contains. An MDI can still contain propellant and appear full even after the medication is used up.
Dry powder MDIs are disc- or tube-shaped and do not require priming, shaking or a spacer. They do not use a propellant to push the medication into your lungs. The medicine is drawn into your lungs by taking a quick, deep breath. They usually have dose counters to help you know how many times the MDI has been used.
Immunotherapy (allergy shots)
Omalizumab, a monoclonal antibody that attacks an immunoglobulin associated with allergic reactions, can be used for severe asthma attacks in adults and children age 12 and over. A mixture of the various pollens, mold spores, animal danders, and dust mites to which the patient is allergic is formulated. This mixture is called an allergy extract (vaccine). By administering increasing doses of the allergy extract, the person's natural immune system is enhanced and learns to fight off the allergens. This extract contains no medication such as antihistamines or corticosteroids.
The shots are given once a week or twice weekly until the maximum dose is tolerated.