Free Medical Articles

Asthma is the most common chronic condition in children. Nearly 3 million office visits are due to asthma each year in the United States. Asthma results in 200,000 hospitalizations each year. Asthma in children is often hidden by allergies or colds.

Parents are vital to good asthma care in children. It is not enough to recognize the symptoms of asthma and to administer treatment. If you have a child with asthma, good care means teaching the child how to take care of himself or herself. Children need to recognize the symptoms of asthma and to learn how to use the inhaler and peak flow meter properly. They need to learn when to get help.

A Message for Kids With Asthma

 

Did you just find out you have asthma, or have you had it for a while? Maybe you just have a nighttime cough. Sometimes, you might have trouble breathing.

Having trouble breathing can be scary. For some kids, finding out that they have asthma means feeling different from their classmates or friends. Sometimes, kids with asthma don't take their medicine when they need to because they don't want others to know they have asthma. But when they don't take their medicine, the wheezing or coughing gets worse. Here are some ideas about how to better deal with asthma so you can be active and have fun, just like everybody else.

• Triggers. Know your triggers and avoid them. Triggers are things that bring on your symptoms.

• Exercise. Being active is an important and fun part of life. If we sit around all the time, our muscles get weak and our lungs tire more easily. If exercise makes you tired and makes you start coughing, talk to your doctor about using your inhaler before exercising. Be sure to warm up. Walk around for several minutes before running. What about gym time at school? Can you exercise indoors when there is a lot of pollen (is that your trigger?), or is the gym a dusty place to be? Can you choose a sport that has some rest time -- like gymnastics, baseball, bowling or golf -- instead of constant running? Swimming is an excellent sport for people with asthma. Many Olympic athletes have asthma. Work with your doctor to find out how you can be active without flaring up your asthma.

• Medications. Understand what medications you need. Know the proper way and time to take them. This will put you, not your asthma, in control.

Parents  and Asthma

Your child has asthma. Maybe the only symptom has been coughing at night, or after exercise. Well, you are not alone. More than 20.3 million Americans have asthma. About 6 million of them are children. Asthma is the most common pediatric chronic illness, and one of the leading causes for hospital admissions.

Tips to gain better control over your child's asthma

Triggers. Know what triggers your child's asthma so that together you can work to avoid or minimize exposure.

Get the school and school nurse involved. Some daycare centers may be reluctant to administer the needed medication. Offer to teach all staff involved. Help them to understand that not offering medication in the early stages can lead to more severe symptoms, which become far more difficult to handle. Older children may be able to administer their medication via an inhaler by themselves. Check with your state school's policy on medication and self-treatment. Some schools only allow inhalers to be used in the nurse's office. This may be a dangerous policy because the rescue medicine MUST be readily available to the child. If your child is able to know when and how to take the medication, work with the school to allow him or her to carry the inhaler at all times, especially to gym class. This can avoid delay and progression of symptoms. Have a second inhaler on hand in the nurse's office as a backup. Keep track of doses used and replace the backup before it runs out.

Nebulizers. Children younger than 5 usually use a nebulizer instead of an inhaler. This machine creates a mist of the medication that can be easily inhaled using a mask. To make treatment time easier, keep a box of "special" toys that are only used at treatment time. Include cassette tapes, books, puzzles and videos that help to make this a special time.

Support groups and camps. Investigate support groups for children with asthma, as well as for parents through your local chapter of the American Lung Association, pulmonary rehabilitation programs or your pediatrician. Talk to them also about summer camps. These camps can provide wonderful, active experiences for kids with asthma in a setting designed for medical safety.

Preventive maintenance. Remember that asthma can be controlled. Don't accept school absenteeism, lack of an active lifestyle, hospital visits or sleepless nights as a reasonable trade-off for having a child with asthma. Being in good control of one's asthma means preventing symptoms from occurring in the first place, not dealing with them after they happen.

Seniors and Asthma

Asthma can begin at any age. While some seniors may have first gotten asthma as a child, or young adult, others are just encountering it for the first time. Environmental factors play a large role in this primarily because of outdoor and indoor (tightly sealed, energy-efficient homes) pollution. Adults with asthma should discuss getting vaccinated against pneumonia and influenza because respiratory infections are a trigger for asthma.

Co-existing  Health  Issues

Many people with asthma also suffer from other health conditions. If you see more than one physician to deal with other respiratory ailments such as Chronic Obstructive Pulmonary Disease (COPD) or emphysema (were you a smoker before getting asthma?), heart problems, diabetes or high blood pressure, it is important that each doctor be aware of all the medications (prescription, over-the-counter and herbal) that you take. Many over-the-counter medications, as well as herbal remedies, can have a significant effect on heart rate, respiratory rate and blood pressure. This could trigger an asthma flare-up or interact with your asthma medication and cause side effects. Also, as we age, our liver and kidney function slows down, changing the rate at which we metabolize medication. This could result in an increased level of a medication staying in the blood, leading to an overdose. It is best to stick to one pharmacy when filling your prescriptions so that potential drug interactions from prescriptions written by different doctors can be avoided.

Medical conditions such as arthritis and diabetes can affect one's hand strength. For someone with asthma, this can affect the ease of self-administering medication, such as an inhaler, or opening the top of a medicine bottle. Check with your pharmacist about "easy-open" bottle tops, especially designed for those with hand-strength problems. These tops, however, are not child-safe. So be careful about keeping them out of reach, especially when having young children in your home. The coordination necessary to use an inhaler properly is simplified by the use of a spacer. The inhaler attaches at one end of the chamber of the spacer, and has a mouthpiece at the other end. This allows you to press the inhaler, filling the chamber, then inhale the medication at your own pace. Check with your asthma physician about using a spacer.

A study reported in the American Journal of Respiratory and Critical Care Medicine found women who had been taking hormone replacement therapy (HRT) for 10 years or more had twice the likelihood of getting asthma than those not on HRT. Since HRT can be effective against osteoporosis and other diseases, be sure to discuss with your physician all the benefits, as well as the potential side effects, for you as an individual.

Surgery  and  Anesthesia

When undergoing surgery, anesthesia is a challenge for anyone, but poses particular challenges for someone with asthma. First, the medications used during surgery can interact with the asthma medications already in your system. For this reason, it is crucial to let your surgeon and anesthesiologist know of your asthma and the medications you take. The medications can become a trigger, since they can affect the airways as well as your breathing and heart rate. Secondly, if you undergo general anesthesia, a breathing tube will be inserted into your airway. The presence of a breathing tube also can act as a trigger. Even if your asthma is mild, or under good control so that you rarely experience symptoms, be sure to tell all the professionals involved with your surgery that you have asthma. Since surgery may be necessary on an emergency basis, it is best to wear a medic-alert bracelet for your asthma. Having a card in your wallet or purse may not be sufficient, since they may not be checked following an emergency.

Surgery itself is a stress to the body. There is the stress involved prior to the surgery; knowing that there is a problem necessitating surgery; then, the waiting, anticipating the surgery; then the surgery itself; and finally the healing process. All of these circumstances create an impact on the body.

Before surgery, make sure you have a thorough assessment, including a detailed history and physical exam. It will be important to be sure there is no sign of infection. If you have been taking oral corticosteroid medications for several months, your physician may decide to put you on temporary additional corticosteroids before and after your surgery. This is because the oral medication you have been taking suppresses the steroid production of the adrenal glands. When your body is in a stressful situation, such as surgery, it responds in part by secreting more steroid hormones to deal with the stress. Since this action has been suppressed, you will need extra medication to get you through the stress of the surgery safely.

To prevent or minimize respiratory complications following surgery, you will be required to sit up and get out of bed as soon as safely possible. It is important to use an incentive spirometer to encourage deep breathing and the clearing of secretions. A respiratory therapist will work with you in the hospital to help with this process.

Before surgery:

• Stop smoking for at least one week (perhaps this will allow more permanent smoking cessation).

• Get enough rest.

• Drink plenty of fluids, since inhaled anesthesia promotes drying of the airways.

• Avoid anyone with an infectious/contagious illness.

• Be vigilant about washing your hands.

• Practice whatever breathing and stress-reduction techniques you have learned.

Retirement

Many retirees who have asthma decide to move to another location. This may be family-related, or they may feel that their allergies will improve in another climate. A place that we visit on vacation may offer significant relief of allergy problems. However, relocation means living in a new place for time periods far beyond that of a vacation. After a period of time, our bodies can develop allergies to substances in this new environment. While you may no longer suffer from the allergies of your previous home, you may well acquire new ones over time. If you suffer from allergies, and your finances allow, spending shorter periods of time in different locations may prevent the formation of new allergies that develop as we are exposed to a substance repeatedly.

 

Treatments for Asthma

Medication is the cornerstone of asthma treatment and the main way asthma is controlled. Asthma medications can be divided into two basic categories:

1. Anti-inflammatories, also called long-term controller medications:
• Work slowly and last a long time.
• Reduce the inflammation that makes the bronchial tubes overly sensitive.
• Must be used on a regular basis to be effective. Those with persistent asthma will need to take anti-inflammatory medication daily.
• Are considered a first line of preventive care because they help to prevent asthma attacks from starting. However, they do not immediately stop asthma attacks once they've begun.

2. Bronchodilators, also called quick-reliever (rescue) medications:
• Work quickly and last for varying periods of time.
• Open narrowed airways and relieve bronchoconstriction (spasms of the airways).
• Do little to reduce the chronic inflammation that makes bronchial tubes overly sensitive.
• Help stop asthma attacks once they've begun, and are often used on an "as-needed" basis.

Your doctor will determine the type of medication that you will use based on your asthma classification. Generally, if you have intermittent asthma, you are only given quick-relief medication. If you have persistent asthma, your doctor will probably want you to use both long-term controller and quick-relief medications. People with exercise-induced asthma (EIA) may be told by their doctor to take either long-term controller or quick-relief medication right before they exercise to prevent symptoms.

Asthma medications come in all sorts of forms -- sprays, pills, powders, liquids and shots -- and are sold under many brand names. New medications frequently come on the market. So, if you have been on the same medications for five or more years, particularly if you do not have good control (frequent symptoms, nighttime asthma), check with your doctor to see if another type of medication might be better for you.

Medications that are swallowed in pill or liquid form usually have systemic, or total body, side effects. Inhaled medications go primarily to the lungs, decreasing the overall side effects. Medications vary as to "onset of action," or the amount of time it takes to feel the results. Another variable is when the peak, or maximal effect, occurs. If you are taking medication to prevent problems with nighttime asthma or with exercise-induced symptoms, you will want to coordinate the drug's effects with the timing of these activities. Unwanted side effects and cost are two other important factors in choosing which medications would be best for you.

Control medications (anti-inflammatories)

Once asthma has been diagnosed, many patients start on controller medicine, also called long-term preventative medication or maintenance medication. These medications are taken daily on an ongoing basis to calm the airways and control symptoms. The different types of medication in this category work by reducing inflammation, thereby opening the airways, and improving breathing ability.

Types of long-term control medications include inhaled corticosteroids, cromolyn sodium and nedocromil sodium, and long-acting beta-agonists (beta-adrenergic agonists).

Corticosteroids

Inhaled corticosteroids are the most effective medications to prevent swelling and irritation in the lining of inflamed airways. Dry powder or aerosol are the commonly prescribed forms.

Inhaled corticosteroids are used as daily controller medications in those with persistent asthma. They are a type of steroid medication that is related to cortisone, a hormone produced naturally by the adrenal glands. They block the chemicals in your body that cause inflammation and can take a week or more to start working fully. However, inhaled corticosteroids are not the same as anabolic steroids used illegally by some athletes. They are safe for long-term use since they are targeted directly at the lungs and do not affect the liver or cause sterility, as do the illegal anabolic steroids.

All corticosteroids can be used either as a short-term medication in severe, persistent asthma. They are effective in reducing bronchial inflammation and have minimal side effects when used for short periods of time. Patients switching from an oral steroid like prednisone, to an inhaled steroid need to be careful. While adjusting to the switch, one may not be able to handle major stress such as surgery or severe infection or trauma without additional systemic steroid. Discuss with your health care provider.

Brand Name	Generic Name
Beclovent® Vanceril® Vanceril DS® QVAR®	beclomethasone    dipropionate    Beclomethasone
Pulmicort Turbuhaler®	budesonide
AeroBid® AeroBid®-M	flunisolide
Flovent® Flovent Rotadisk®	fluticasone propionate
Azmacort®	triamcinalone acetonide

If taken as directed, inhaled corticosteroids do not cause the potentially serious side effects that can occur with the regular use of oral corticosteroids. Still, inhaled corticosteroids do have side effects (as does any medication): hoarseness can occur with increasing dosages and vocal stress; thrush (a yeast infection in the mouth) and mouth irritations are the most common. Use of a spacer (an attachment on the inhaler), and rinsing with water and spitting out after inhaling a dose can minimize the side effects. Some studies have suggested an increased risk of cataracts.

Women who take large doses of inhaled corticosteroids because of severe asthma may experience bone density loss after menopause. In the New England Journal of Medicine, researchers reported an increased risk of glaucoma formation with older adults using inhaled corticosteroids.

In addition, there has been some concern regarding possible growth retardation in children, which appeared to be dose related: The longer corticosteroids are used and the higher the dosage, the more likely growth stunting is to occur. However, results from two studies appearing in the New England Journal of Medicine independently concluded that inhaled corticosteroid use in children has no long-term impact on growth and that the potential risks were balanced by the benefits of improved asthma control.

Cromolyn and nedocromil

These medicines reduce inflammation by preventing the activation of messages in your body that tell the immune system to start acting up. They are less effective than inhaled steroids.

Cromolyn sodium and nedocromil are typically used as daily controller medications, but can also be used before exercise or exposure to an allergic asthma trigger. Cromolyn sodium is often the drug of choice for children because of minimal chance of side effects and its effectiveness for allergy-related asthma.

Brand Name	Generic Name
IntalR®	sodium cromoglycate
Tilade®	nedocromil sodium

Long-acting beta-agonist inhaler (beta-adrenergic agonist)

This medication prevents constriction by stimulating the messages to the smooth muscles in the airways that help relax the bronchial tubes. Long-acting beta-agonists are often used as a long-term control medication in moderate persistent or severe persistent asthma, particularly to prevent symptoms for those with nighttime symptoms and/or exercise-induced asthma. They are effective for up to 12 hours and are not for use as quick-relief medication.

Brand Name	Generic Name
Foradil®	Formoterol

Methylxanthines

This type of oral medication is a bronchodilator. Theophylline is rarely used in asthma treatment today and is noted for significant side effects, including nervousness, hyperactivity, upset stomach, and headaches. Tell your doctor if you are taking any other medicine with theophylline because side effects may occur.

Leukotriene modifiers

Antileukotrienes, also known as leukotriene inhibitors or modifiers, are among the newest oral anti-inflammatory medications. The body processes leukotrienes, chemicals that cause inflammation, as part of the reaction to an allergen. They may be useful as a primary treatment to control mild persistent asthma or as add-on therapy with moderate or severe persistent asthma. Two of these drugs, zafirlukast (Accolate®) and montelukast (Singulair®), block the action of leukotrienes in your lungs, while a third medication in this class, Zileuton® (Zyflo®), inhibits their production. All three drugs block the recognition of allergens, thereby avoiding the usual cascade of symptoms. The result is a decrease in the frequency of asthma flare-ups and a decreased need for quick-relief medications. These medications do not benefit every asthmatic. Side effects include headache and nausea, and the medications may interact negatively with other drugs, such as blood thinners.

Brand Name	Generic Name
Accolate®	Zafirlukast
Zyflo®	Zileuton
Singulair®	Montelukast

Quick-relief medications/bronchodilators

Called quick-relievers or rescue medicine, this type of medication works quickly to relieve flare-ups of asthma symptoms. They can "rescue" you and keep symptoms from getting worse. Most of this type of medicine comes in a canister and is inhaled.

Relievers work by opening airways and increasing airflow. They will stop the coughing, chest tightness, shortness of breath and wheezing associated with an asthma attack within 30 minutes.

Quick-relief medication is not meant to be used daily. Relievers are used at the moment you are having a flare-up of symptoms. No matter how light or severe your asthma is, your doctor will make sure that you have a reliever medication available. If you are using more than one canister of this medicine each month for relief, it may indicate that your long-term control medication needs to be adjusted. The two types, or classifications, of quick-relief medication are anticholinergics and short-acting beta-agonists.

Anticholinergics

Anticholinergics relax muscles around the airways to reverse airway narrowing and stop spasms in the bronchial muscles. Inhaled anticholinergics are generally not used as a first-line reliever medication for most patients with asthma as they may take several hours to take effect. They use a different mechanism than short-acting beta-agonists to make it easier to breathe and are usually used as an adjunct to inhaled Beta2-agonists (also known as B2-agonists) in patients who have severe asthma episodes. There is now an anticholinergic and short-acting beta-agonists combination available.

Brand Name	Generic Name
Atrovent®	ipratropium bromide
Combivent®	Ipratropium bromide and albuterol

Short-Acting Beta-Agonists

Beta2-agonists, or short-acting beta-agonists, are the most effective bronchodilators. When bronchial muscles tighten, the airway is narrowed and asthma symptoms occur. B2-agonists work rapidly and selectively on the B2 receptors in the muscles that surround the bronchial tubes to open the airways and improve breathing by reversing bronchoconstriction, allowing the muscles to relax. They also slow the release of histamines (part of the body's reaction to an allergen) and increase the body's ability to clear mucus from the airways. Their duration is about four hours. However, brands differ in potency, onset of action, and peak effective time.

B2-agonists are generally used on an as-needed basis during an asthma episode or prior to exercise for EIA. They are not intended for use every day, more than three times in any given day, or in excess of one canister per month. Excessive use indicates poor control and the need to add or increase long-term control medications. It could also mean that the inhaler isn't being used properly and the patient is not getting the proper dosage. Possible side effects are shakiness, jitteriness or rapid heartbeat, which should wear off after several weeks as the body adjusts to the medicine.

Brand Name	Generic Name
Proventil® Ventolin®	albuterol
Alupent®	metaproterenol
Maxair®	pirbuterol

Combination Therapy

The first combination anti-inflammatory and bronchodilator, fluticasone propionate and salmeterol inhalation powder, (Advair®, Diskus®) became available in the United States in 2001. The drug does not replace fast-acting inhalers for sudden symptoms. This medication is a controller medication or preventative medication and like Serevent or Foradil is not to be used as a reliever medication. While adjusting to the switch, one is not as able to heal after surgery, infection or serious injury.

Allergy Desensitization Shots

Certain sufferers of allergic asthma cannot easily control symptoms by avoiding triggers and using medication. In these cases, immunotherapy (allergy desensitization shots) may offer relief and even help prevent development of airway inflammation, resulting in chronic airway sensitivity.

According to the American Academy of Allergy, Asthma and Immunology (AAAAI), allergen immunotherapy works like a vaccination. Through exposure to small, injected amounts of a particular allergen, in gradually increasing doses, your body builds up immunity to the allergen(s) triggering an allergic reaction. This means that when you encounter these allergens in the future, you will have a reduced or very minor allergic response and fewer symptoms.

Immunotherapy appears to work best for allergies to pollen, mold, cat dander, insect stings, and dust mites. Potential side effects during treatment, according to the AAAAI, may include swelling at the site of the injection, and in rare instances, a more serious allergic reaction, resulting in asthma symptoms or an anaphylactic reaction. Asthma symptoms include cough, wheezing and shortness of breath. Symptoms of an anaphylactic reaction can include hives, sneezing, watery nasal discharge, itchy eyes, swelling in the throat, wheezing or a sensation of tightness in the chest, nausea, dizziness or other symptoms.

Anti-IgE

Omalizumab (Xolair®) is the first biotechnology product to treat patients with a type of asthma that is related to allergies. The drug, a monoclonal antibody, has been shown to be safe and effective to treat people 12 years of age and older with moderate to severe allergy-related asthma that is not well controlled with inhaled steroid treatments. In these patients, omalizumab decreases the number of asthma episodes of airway narrowing that result in wheezing, breathlessness and cough. The product is given as an injection under the skin.

For  more  information:  Please  consult  your  physician  on  your  next  visit.