What is Asthma?
Asthma is a long-standing (chronic) inflammatory disease of the airways with episodic bronchospasms. Asthma affects 20 million people and 9 patients die from asthma every day in the United States. Asthma is serious. Even asthma diagnosed as mild, could at times turn deadly
Asthma is often misdiagnosed as acute bronchitis or pneumonia.
Patients with asthma have “hyper-responsive” airways which mean that their airways react to triggers such as cigarette smoke and exercise faster and more intensely than people whose airways are normal.
During an asthma episode:
- The lining of the airways swells and produces more mucus
- The muscles around the airways tighten making the opening in the airways smaller
A trigger is any object, act or event that causes the airways to become inflamed. Some common triggers are:
- Virus infection
- Pollution like cigarette smoke, smoke from a wood stove or perfume
- Allergens, such as cats, dogs, mites, cockroaches, grass, mold and pollen
- Cold air, coughing, yelling and laughing
- Some medicines and chemicals
Triggers add up
Signs of Asthma
- Breathing faster than usual
- Sucking in of the chest wall (retractions)
You can control your asthma by teaming up with your doctor to create a personalized treatment plan which will enable you to:
- Run as fast and long as your peers
- Attend work or school daily
- Sleep through the night without coughing or wheezing
- Avoid urgent visits to the doctor
- Avoid hospitalization for asthma
Bronchial Asthma is diagnosed by:
- Pulmonary Function Testing \ Spirometry - pre and post bronchodilator administration.
- Exhaled Nitric Oxide ( Fe NO )
Asthma Medications \ Management:
Asthma has a ‘quiet phase’ (inflammation, mucus production and swelling of the airways) and a ‘noisy phase’ (cough, wheeze). The management of asthma should address both the quiet and noisy phase of asthma.
Asthma management in patients with persistent asthma should include:
- Controller Medications: For long term positive outcome. This group of medications includes inhaled corticosteroids, long acting beta agonists (LABA), leukotriene modifiers, cromolyn sodium and theophylline.
- Quick relief medications: Are used to treat asthma flare ups and to prevent exercise induced bronchospasm, such as short acting beta agonist (SABA) and ipratropium bromide.
- Oral corticosteroids are in a class of their own. This medication will reduce inflammation of the airways during acute episodes.
- Anti Ig E monoclonal antibodies (Xolair) to treat difficult to control allergic asthma.
- Acid reflux and other triggers should be addressed.
- Allergen immunotherapy in allergic asthma.
Assess, Individualize, and Monitor (AIM) for optimal control your asthma.
Assess Asthma Control: Asthma is not well–controlled, if:
- The patient uses SABA ( quick relief inhaler ) more than twice a week
- Having day time symptoms more than twice a week
- Nighttime asthma symptoms more than twice a month.
- Refilling more than two SABA inhalers in one year.
- Limitations in activity due to asthma.
- Abnormal lung functions for patients over 5 year of age
Individualize therapy based on:
- The patient’s response to therapy.
- Formulary preference and adherence issues.
- Possible adverse effects to therapy.
- Patient’s life style—activity level, hobbies or school environment.
Monitor control of asthma by:
- Communicating with your physician.
- Follow up at regular intervals with spirogram\ breathing test and \ or Exhaled Nitric Oxide and a questionnaire Asthma Control Test (ACT).