Asthma

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is asthma?

Asthma is a condition in which the lining of the airways supplying the lungs swells, restricting air flow and making it hard to breathe. During an asthma attack the airways become narrower; often sticky mucus or phlegm is produced. Sufferers have hypersensitive airways, which are almost always red and slightly inflamed. This means that their lungs are vulnerable to any of a wide range of irritants, including pollen, feathered and furred animals (particularly cats), aspirin and some other drugs, the droppings of house-dust mites, changes in temperature (for example, breathing in very cold air) and cigarette smoke. Some asthma attacks are triggered by non-environmental factors such as respiratory infections, stress, anxiety or exercise.

Who is at risk for asthma?

About one-third of those with the disease have asthma in their family. About half of all cases start in children under age 10, but asthma can occur at any age. Patterns vary greatly from one person to the next, so it’s important to learn what your triggers are and how your body reacts to them.

Treatment for asthma

There is no cure for asthma. It’s important to understand that this is a chronic disease. Untreated, it can be fatal. You must be under a doctor’s care for this condition. But most people with asthma can keep their symptoms in check with a combination of self-monitoring, inhalers, prescription drugs, and lifestyle changes and by avoiding common triggers.

Medications for asthma

If you have asthma, you will probably will need at least a couple of different prescription medications. Drugs such as bronchodilators relieve symptoms. Others, such as inhaled steroids, prevent new asthma attacks. Knowing which drugs you’re taking for what reasons’and how to take them properly’is absolutely crucial to managing asthma.

For immediate relief for an asthma attack, your best bet is a bronchodilator inhaler, which opens constricted airways. It includes short-acting beta2-agonists, such as albuterol, bitolterol, pirbuterol, and terbutaline. An anticholinergic drug that relaxes lung muscle spasms, such as ipratropium bromide (Atrovent), may also be beneficial. For a severe asthma attack, you may need oral or even intravenous corticosteroids, such as prednisone, prednisolone, or methylprednisolone to decrease the inflammation. Oral corticosteroids are typically prescribed for short-term use. They can cause side effects if taken at high doses for an extended period of time.

For long-term asthma management, the first line of defense is inhaled corticosteroids, which reduce inflammation in nasal passages and bronchial tissues. Familiar examples include fluticasone (Flovent), flunisolide (AeroBid), triamcinolone (Azmacort), and budesonide (Pulmicort). Inhaled corticosteroids are considered safe and rarely cause the more serious side effects reported with the oral forms. The new leukotriene modifiers also reduce bronchial inflammation. They work differently than inhaled corticosteroids, and many people find combining the two works better than either one alone. These drugs, including zafirlukast (Accolate), montelukast (Singulair), and zileuton (Zyflo), counteract leukotrienes’potent chemicals that constrict airways and increase mucus production. They can also soothe symptoms of nasal allergies.

Other useful asthma therapies include sustained-release bronchodilators such as salmeterol (Serevent); combined medication inhalers, like fluticasone/salmeterol (Advair Diskus) and ipratropium/albuterol (Combivent); nonsteroidal inhalers like cromolyn (Intal) and nedo-cromil (Tilade); and the oral bronchodilator theophylline. Just remember: Asthma medications affect people differently, so it’s important to work with your doctor to find the right drug or drug combination for you. Also, because respiratory infections can trigger or worsen asthma, make sure you get an annual flu shot and are vaccinated against pneumonia.

Lifestyle changes

Though you will probably need prescription medications to help manage your asthma, there’s a lot you can do to help yourself.

‘ Have a plan. Develop an asthma action plan with your doctor. Make sure you share the information with your family. List the drugs you take for maintenance and prevention, those you’ll take for specific symptoms, how you’ll handle an attack, when to call the doctor, and where to go during a serious episode.
‘ Identify your triggers. Keep a diary of asthma attacks, noting what seems to cause them. Besides animal dander (particularly that of cats), pollen, cold air, exercise, dust mites, and cockroach droppings, other common triggers include aspirin, chocolate, milk, nuts, and fish.
‘ Slim down. Obese women, defined as those with a Body Mass Index of 30 or higher, have almost double the risk of developing asthma as other women, according to one Canadian study. Another study that tracked a group of nurses found that those who gained more than 55 pounds after age 18 were almost five times as likely to develop asthma as those who kept their weight down.
‘ Drink lots of water. Here’s another reason to down at least eight glasses of water daily: It loosens mucus to keep airways clearer.
‘ Keep indoor air dry. Reduce humidity below 50%. Using a dehumidifier or air conditioner also keeps the dust mite population down. Be sure to change or clean filters often.
‘ Don’t smoke. And stay away from people who do. Secondhand smoke can trigger asthma attacks. It also increases the risk of getting asthma. One Swedish study of 8,000 adults found asthma in 7.6% of those exposed to secondhand smoke as children, compared to 5.9% of those who grew up smoke-free.
‘ Bundle up. Wintry air can trigger asthma. So cover your nose and mouth with a scarf. It’ll help warm the air you’re breathing.

Alternative therapies for asthma

Stress and extreme emotions can trigger asthma, so it’s important to find ways to remain calm. One interesting study suggested that yoga meditation may help the effectiveness of asthma drugs. A group of people with asthma, who continued to experience symptoms while taking preventive medication, improved after practicing Sahaja yoga for four months. This form of Indian meditation teaches practitioners to attain ‘mental silence,’ a state of being alert without specific, focused thoughts. Lung tests showed that the yoga students were less susceptible to asthma triggers than those who practiced other relaxation techniques. Two months after they stopped practicing yoga, the benefits disappeared. Acupuncture may help improve short-term lung function, although the scientific evidence is less than conclusive. In one controlled study, nearly 50% of the asthma patients who practiced guided imagery were able to decrease, or even discontinue, their medication, compared to just 18% of the control group.
Certain foods can help you control your asthma. Researchers in the UK found that people who ate at least two apples a week had up to a 32% lower asthma risk than those who ate fewer. They also discovered that those who had at least 55 mcg of the mineral selenium each day’the daily value’were about half as likely to have asthma as those who consumed only 30 mcg or less. Selenium is found in such foods as Brazil nuts, fish, oysters, and sunflower seeds. Researchers believe that antioxidants like vitamin C boost lung health and may help lower the risk for asthma.

Questions for your doctor

‘ Would you help me prepare an asthma action plan?
‘ Should I bring my peak flow readings to my next appointment?
‘ Is it dangerous for me to exercise?
‘ Should I consider moving to a different climate?
‘ Will allergy shots help me?
‘ Should I see a specialist?

Living with asthma

If you live with Asthma, here are a few tips to stay in control of your condition:

Perform at your peak. A peak flow meter can help you head off an asthma attack before it becomes serious. This simple and inexpensive plastic gadget measures how fast you can exhale air from your lungs. People with untreated asthma have low ‘peak flow,’ which increases (often dramatically) a few minutes after they take medication. Measure your peak flow twice a day when your asthma is under control. You’ll know what’s normal for you. When these baseline readings begin to fall, you’ll know you might be about to have an attack.

Give yourself a spacer. A metered-dose inhaler lets out a burst of medication when you press down on it, but this most common type of inhaler can be tricky to time correctly. A special device called a spacer may help. This long plastic tube attaches to one end of the inhaler. The other end goes into your mouth. Once the inhaler is activated, the medication remains in the spacer until you inhale it. With some of these inhalers, like Advair Diskus, the metered dose is released only when you breathe in.

Clean house. Up to 90% of people with asthma react badly to dust mites. These tiny insects cling to carpets, mattresses, bedding, upholstered furniture, and even clothing. Solutions include banishing carpets, dusting religiously with a wet or oiled cloth, and using a vacuum with a microfiltration bag. Wash all bedding in hot water (130°F or higher) once a week, and consider replacing dust-catching blinds or curtains with shades.