ASTHMA

WHAT IS ASTHMA

Asthma is characterized by the narrowing of airway passages that is recurrent and reversible. The narrowing causes wheezing, shortness of breath, cough and a tight feeling in the chest. Secretions of mucus into the airway and swelling of the airway lining also occurs during an asthma attach along with constriction of the smooth muscles surrounding the airways.

Asthma is not uncommon. It frequently occurs in individuals with hayfever, eczema, or a family history of allergy. In most cases, normal growth and development occur and the lungs are not permanently damaged as a result of asthma if it is properly cared for.

WHAT CAUSES ASTHMA

Causes of asthma are: Allergy, infection, temperature or environmental changes in humidity and barometric pressure, environmental irritants (cigarette smoke, air pollution, dust, chemical odors), exercise and emotional upsets.

HOW IS THE DIAGNOSIS OF ASTHMA ESTABLISHED?

Other causes of wheezing and coughing are ruled out by the history, physical examination, and chest x-ray. Pulmonary Function Tests are performed because they reflect how sensitive the airways are. They determine if narrowing or obstruction to the breathing tubes is present. The Pulmonary Function Test will also reflect response to medication and judge the severity of asthma. Even though medications seem to have symptoms of asthma under control, a Pulmonary Function Test (PFT) can still be residually abnormal and therefore they are an invaluable tool in regulating medication. A Pulmonary Function Test is to asthma as a blood pressure determination is to hypertension.

Dr. Bray will take a comprehensive history from you about the pattern of your asthma. If indicated by your history, allergy skin testing is done to determine which allergens may be causing the asthma.

WHAT ARE THE SYMPTOMS AND TREATMENT OF AN ACUTE ASTHMA ATTACK?

Symptoms of an attack are coughing, wheezing, shortness of breath with a tight feeling chest and difficulty breathing. When this occurs, the individual should:

  1. Stay calm and quiet
  2. Breathe with slow, deep breaths and exhale slowly
  3. Take your medication as you have been instructed
  4. Control fever with acetaminophen (Tylenol) in appropriate amounts. Do not use aspirin, as in 10-15% of cases aspirin will aggravate symptoms.

If these measures do not ease the difficulties - call Dr. Bray's office so he can begin early intervention to avoid a worsening of the attack and slow recovery.

WHAT ARE THE LONG-TERM TREATMENTS FOR ASTHMA?

The goal of treatment is to control the asthma symptoms and normalize lung function. The individual should avoid substances or situations which precipitate an attack. Knowing one's own pattern is extremely important in developing a medical program to head off problems. This can be the key to successful control. This is another reason why Dr. Bray takes time to get a thorough history from each patient.

In the problem of exercise-induced asthma, medication need to be taken prior to exercise. Physical fitness is encouraged for all asthmatics. The key to making exercise tolerable is to premedicate in an expert manner before physical activity.

Several types of medications are used to treat asthma. They are taken orally, by inhalation or by injection. The right dosage, combination, and type of medication must be determined in each individual situation.

CLASSES OF INHALED MEDICATION

Primary asthma medications available in inhaled form include:

  • Inhaled corticosteroids, also referred to as topical corticosteroids or glucocorticosteroids, are effective anti-inflammatory medications used successfully to treat asthma for more than 50 years. These types of steroids are different from the anabolic steroids misused by some athletes to increase performance. These inhaled steroid medications decrease airway inflammation, mucus production, hypersensitivity, swelling and constriction of the bronchial tubes. It is important to continue to take inhaled corticosteroids as prescribed even if you feel well, because the inflammation is constant even when you do not feel it and the medication helps to prevent asthma exacerbations. Examples of inhaled corticosteroids are beclomethasone, budesonide, flunisolide, fluticasone and triamcinolone. It is important to rinse, gargle and spit with water after each dose of inhaled steroids.
  • Bronchodilators, also called beta2agonists, are non-steroid medications related to adrenalin and used as "rescue" medications to immediately relieve asthma symptoms. These include albuterol and levalbuterol, pirbuterol, and terbutaline. Sometimes these inhaled medications are overutilized. Using more than one canister per month or needing it more than 2 times per week during the day is cause for concern. It indicates that underlying inflammation is not adequately controlled, and that you should see your physician for adjustment of your treatment. Salmeterol and formoterol are long-acting beta2agonist bronchodilators that are ordinarily intended to be used together with anti-inflammatory medication on a regular (daily) rather than as-needed basis.
  • Non-steroid anti-inflammatory medications, such as cromolyn or nedocromil, reduce inflammation and can help prevent asthma symptoms. These drugs are extremely safe but are less effective than inhaled corticosteroids.

TYPES OF INHALATION DEVICES

There are three basic types of devices used to deliver inhaled medications. The most common is the metered dose inhaler (MDI), which uses a chemical propellant to push the medication out of the inhaler. Chlorofluorocarbon (CFCs), are used in many MDIs but are being replaced gradually by other propellants. Nebulizers deliver fine liquid mists of medication through a tube or a "mask" that fits over the nose and mouth, using air or oxygen under pressure. Rotary inhalers and other dry powder inhalers deliver medication without using chemical propellants.

Regardless of the type of inhalation device, effective delivery of medication to the lower airways is critical for the medication to work. For all devices, education and training of patients, and family or professional caregivers who administer these medications to patients, for the proper and effective use of these devices is an essential component of inhalation therapy. It is so important, in fact, that proper inhalation technique should be constantly ensured with re-education and re-training as necessary.

Coordination of inhalation from inhalational devices varies from extremely easy with some devices (for example, nebulizers) to extremely difficult for some patients (for example, MDIs) and poor response to therapy can be due simply to such poor coordination with inhalational delivery that little or no drug reaches the airways. A device called a spacer can improve delivery of inhaled medication from MDIs.

Spacers help deliver a greater amount of medication directly into the lower airways, where it is intended to go, rather than into the throat. Many spacers fit on the end of an inhaler; for some, the canister of medication fits into the device. Some devices come with built-in spacers. Many people with asthma, especially young children, may have difficulties coordinating inhalation with using a metered dose inhaler. For these patients the use of a spacer is particularly recommended.

MDIs from which drug is dispensed automatically when the patient breathes in from the inhaler also are available. Technique for inhalation from dry powder inhalers is different and may feel more "natural" than with MDIs. Spacers are not needed for dry powder devices.

Nebulizer use
Nebulizers effectively deliver asthma medications in a fine mist through mouthpieces, through masks sized differently to fit infants through adults, or through T-tubes. Their use tends to be particularly easy, requiring only usual inspiration and expiration through the connection to the nebulizer. Nebulized asthma medication is especially useful for infants, young children and some elderly patients who are unable to use an MDI. Use of a nebulizer can be more time-consuming and is much less effective if an infant or child is crying.

Appropriate medication use
Dr. Bray will prescribe inhaled medication that is most appropriate for you. If you have any questions about your prescribed inhaled medications or their proper use, make sure to contact Dr. Bray. Many inhaled asthma medications are intended to be used on a daily basis to keep your airways open, even if you are not experiencing symptoms. It is important to follow Dr. Bray's instructions to ensure that you are optimally managing your asthma.

When to see an allergy/asthma specialist
Dr. Bray can provide information to assist patients in determining when a patient may need consultation or ongoing specialty care. Patients should schedule a visit if they:

  • Need education regarding inhaler technique.
  • Need education on asthma and guidance in techniques for self-management.
  • Need daily asthma reliever medications.
  • Have persistent asthma, particularly moderate-severe persistent asthma.
  • Have uncontrolled asthma.
  • Are not using medications as prescribed, and this is limiting their ability to control their asthma.

Dr. Bray can provide you with more information on using inhaled asthma medications.

Non-steroid anti-inflammatory medications, such as cromolyn or nedocromil, reduce inflammation and can help prevent asthma symptoms. These drugs are extremely safe but are less effective than inhaled corticosteroids.

Asthma is not curable but it can be controlled with education, medication, and allergy therapy if indicated. A personalized, workable, effective program can be accomplished with cooperation between you, Dr. Bray and his staff. Please learn your individual asthma pattern and know your medication. Consistency and compliance will pay off in better health.

 

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use of inhaled asthma medications