All you need to know about the most common chronic childhood disease.
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What is Asthma?
Asthma is a chronic disease that causes the air passageways in the lungs to become blocked or narrowed, making it more difficult to move air into and out of the lungs. Inflammation causes the airway tubes to swell, limiting the available space for air to move through. If you have asthma, you have it all the time but your symptoms may vary from none at all to mild breathing impairment to extreme difficulty breathing, as happens during a severe "asthma attack." When symptoms occur, treatment may be required to restore normal breathing.
An estimated 20 million adults and children in America have asthma. It is the most common chronic childhood disease and, according to the Centers for Disease Control and Prevention (CDC), nearly one in every five pediatric emergency room visits is related to asthma.
What is an Asthma Attack?
An asthma attack (or "episode") occurs when something bothers the lung airways, and makes asthma symptoms worse than usual. The airways of the lungs are like tree branches, starting out with a big diameter in the throat and near the entrance to lungs but subdividing into numerous smaller tubes as they progress deeper into the lungs. Near the ends of these airways, the smallest branches (called bronchioles) end in cul-de-sacs called alveoli and this is where air is exchanged with the blood. When the airways become irritated, muscles that surround each bronchiole tighten, narrowing the pathway for air flow and making it difficult to get fresh air into the alveoli. Irritation of the airways also causes increased inflammation, which makes the bronchiole tissue swell and release mucus, making it even more difficult to get air into the lungs. When the airways become very narrow and inflamed like this, it results in the symptoms of an asthma attack: coughing, wheezing, chest tightness, and shortness of breath. Some people report that an asthma attack feels like trying to breathe though a very narrow straw.
Asthma attacks are not all the same. A mild attack may cause some discomfort and may resolve over time or go away after treatment with a fast-acting inhaler. A severe asthma attack can cause the airways to close to a point where there is not enough oxygen getting into the lungs to supply the body's vital organs. A severe asthma attack is a medical emergency that can result in death without treatment.
What Triggers Asthma Attacks?
There are two basic types of asthma: allergic (extrinsic) asthma and non-allergic (intrinsic) asthma. While the two types have similar symptoms, their triggers are different.
Allergic asthma is caused by an allergic reaction in the lungs. An allergic reaction involves the inappropriate activation of the immune system toward a substance that does not normally cause disease (called an allergen). This common form of asthma is often triggered by inhaling an airborne allergen, such as mold or pollen, which causes the immune system of the lung airways to react, making the tissue swollen and inflamed. In people with allergic asthma, allergens cause the release of several natural chemicals (such as histamine) in the cells of the lung airways. These constrict the air passageways which results in the wheezing, coughing, chest tightness, and shortness of breath that accompany an asthma attack. Some common allergic asthma triggers include both inhaled and ingested substances such as:
-- Tree and plant pollen
-- Animal dander
-- Dust mites
-- Mold spores
-- Foods, such as peanuts, milk, and shellfish
Non-allergic asthma causes symptoms very similar to allergic asthma, but the triggers are different. Instead of inhaled allergens causing an inappropriate activation of the immune system, in non-allergic asthma something in the environment triggers inflammation that does not involve the immune system. The airways become inflamed, swell, and release mucus, obstructing air flow and leading to similar symptoms of coughing, wheezing, chest tightness, and shortness of breath. Some common triggers for non-allergic asthma include:
-- Environmental irritants, such as smoke, smog, perfumes, gasoline, and household cleaners
-- Respiratory infections, such as colds, flu, and sinus infections
-- Changes in breathing including exercise or laughter
-- Weather, such as dry wind or cold air
-- Strong emotions like anger, fear, stress, and excitement
-- Certain medications like aspirin
People with asthma have chronic inflammation of their lung airways, which may noticeably affect their breathing all the time or it may only become noticeable during an asthma attack.
Asthma is marked by hypersensitivity of the lung airways to irritants. During an asthma attack, an irritant causes three major changes to the lung airways: swelling of the airway lining, release of mucus that impedes air flow, and bronchoconstriction, a tightening of the muscles that surround the airways of the lungs. These symptoms all narrow the airways and obstruct the flow of air into and out of the lungs, making it harder to breathe. The result is the symptoms of asthma: coughing, wheezing, chest tightness, and shortness of breath.
A severe asthma attack can cause the airways to close to a point where there is not enough oxygen getting into the lungs to supply the body's vital organs; without treatment it can lead to death. During a severe asthma attack, symptoms often may not respond to medication. The symptoms of a severe asthma attack include:
-- Severe wheezing, when breathing both in and out
-- Using neck and /or chest muscles to assist breathing
-- Coughing that just doesn't stop
-- Severe chest tightness or pressure
-- Shortness of breath
-- Feeling anxious or panicky
-- Blue skin coloration (cyanosis)
Who is at Risk for Asthma?
Researchers have uncovered a lot about what occurs during an asthma attack. Unfortunately, the exact reason why one person gets asthma while another does not remains unknown. One thing is certain: genetics play a big role. Like allergies, asthma tends to run in families. According to the Asthma and Allergy Foundation of America, if only one parent has asthma, the chances are nearly 1 in 3 that their child will have asthma. If both parents have asthma, the chances of their child having asthma increase to 7 in 10. However, the genes involved in developing asthma remain mostly unknown.
While genetics are a factor, it is clear that they are not the whole story. The genes involved likely confer a susceptibility to developing asthma instead of causing the disease directly. Many people who have asthma also have allergies and it is thought that certain genes may cause susceptibility to both diseases. Even so, just having the genes is not enough. In addition, you also need to come into contact with the right allergens or irritants that trigger a reaction in your lungs. Also, several environmental factors are known to increase the likelihood of developing asthma, including poor air quality, exposure to irritants, childhood exposure to secondhand smoke, and others.
In the United States, nearly half of the people who have been diagnosed with asthma are children. Asthma is the leading cause of chronic illness in children. Although asthma can develop at any age, it most often starts in childhood. Recently, the prevalence of asthma in American adults and children has been increasing for unknown reasons. Interestingly, asthma is more common in boys than in girls, but after about age 20 it becomes more common in women than men.
Several studies have demonstrated that the time of gestation (i.e. during pregnancy) and the first few years of a child's life are critical to determining whether or not a person will develop asthma in childhood. Premature birth or low birth weight both make an infant more susceptible to respiratory problems and increase the likelihood of developing asthma. Frequent respiratory infections in the early years can also make asthma more likely. Exposure to secondhand smoke also appears to increase asthma risk.
When asthma is diagnosed for the first time in someone older than 20, it is known as adult-onset asthma. Women are more likely than men to develop asthma as adults. A person can develop asthma at any time during life. Exposure to irritants on a long-term basis, such as secondhand smoke in the home, is a major risk factor for developing asthma later in life. Other factors include exposure to things like household chemicals and air pollution.
Main risk factors for asthma:
To summarize, the main risk factors for developing asthma include:
-- Family history of asthma or allergies
-- Having allergies yourself
-- Frequent respiratory infections in childhood or certain other illnesses in adulthood
-- African American or Hispanic/Latino ethnicity
-- Growing up in a low-income environment
-- Living in a large urban area
-- Women who are pregnant or are experiencing menopause
-- Gastroesophageal reflux disease (GERD)
-- Exposure to tobacco smoke before birth, in childhood, or as an adult
-- Exposure to environmental irritants, mold, dust, feather beds, or perfume
-- Exposure to occupational triggers, such as chemicals used in manufacturing
Exercise-induced asthma / bronchospas
Some people only experience their asthma symptoms during or after exercise. However, exercise-induced asthma / bronchospasm should be anticipated in all asthmatics as exercise might trigger asthma symptoms in all sensitive people. If you suspect that you have exercise-related asthma you should discuss this and your symptoms with your doctor.
How do I know if I have Asthma?
If you notice that you have trouble breathing periodically or you find yourself wheezing, especially at night or in the early morning, you may want to be tested for asthma. Since asthma occurs frequently in children, if you are a parent you should look for signs of breathing problems in your child and tell your doctor if they occur. You should be especially concerned if you or your child has risk factors for asthma like allergies or a family history of asthma. The symptoms of asthma can be scary. See a doctor as soon as possible if you or your child has an episode of difficult breathing that lasts more than a few minutes.
Asthma symptoms are often brought on or made worse by a "trigger." A trigger can be an allergen (a substance you are allergic to) if you have allergies or some other factor like smoke, chemicals, stress, cold weather, or even (for women) menstrual cycles. If you notice that it becomes more difficult to breathe when you are exposed to certain triggers, you may want to see a doctor to be tested for asthma.
If you experience difficulty breathing or other asthma symptoms such as those mentioned above it is important to see a doctor. However, symptoms alone are not enough to diagnose asthma. Only a doctor can confirm that you have asthma and rule out other problems. An asthma diagnosis usually involves the following steps:
Medical History and Physical Exam
During your visit, the doctor will first ask you detailed questions about your health history, your family's medical history and your symptoms. Then you will be given a physical exam. This will most likely involve listening to your lungs with a stethoscope and examining your nose and throat for signs of inflammation. The doctor may also ask to examine your body for signs of allergic conditions (such as eczema) on your skin.
Lung function tests
If your exam does not rule out asthma, the doctor will likely perform tests of your lung function. You cannot be diagnosed with asthma without showing signs of reduced lung function on one or more of these tests. Most lung function tests are non-invasive and can be performed in the doctor's office using a medical instrument called a spirometer. Spirometry findings that indicate asthma are needed to make a definitive diagnosis of asthma. The spirometer records the amount of air you exhale and is used for two key lung function measurements:
-- Forced vital capacity (FVC) is the maximum amount of air you can exhale after inhaling as deeply as possible. This is a measure of the total usable capacity of your lungs.
-- Forced expiratory volume (FEV-1) is the maximum amount of air you can exhale in one second. This measures how well you can move air out of your lungs.
Your results on these tests will be compared to the expected values for someone of your age, height, and sex. If these numbers are lower than normal, there is reason to suspect you have asthma. Even so, your doctor may have you repeat the lung function tests after having you inhale a small amount of a drug that improves lung function in asthmatics by dilating the bronchioles. If your lung function numbers improve after inhaling the drug, you likely have asthma.
Even if your lung function tests are initially normal, the doctor may ask you to inhale a common trigger substance that tends to bring on asthma attacks in many asthmatics and then repeat the spirometry measurements. This is called a challenge test and if your lung function values decline after the challenge, it is likely that you have asthma.
Tests for exercise-induced asthma / bronchospasm
If your asthma symptoms occur only during exercise, your doctor may decide to give you an exercise challenge test (where you perform lung function tests at 5 minutes intervals while exercising in between) to make the diagnosis. If you do have exercise-induced bronchospasm, it shouldn't interfere with your ability to be active and participate in vigorous exercise if you a have good asthma action plan.
Tests to rule out other problems
If your lung function tests indicate that you have reduced lung function, the doctor may want to do a few more tests to rule out other conditions that can cause similar symptoms as asthma. Some of these include: pneumonia, chronic obstructive pulmonary disease (COPD), tumors, congestive heart failure, and bronchitis. The tests to exclude these and other conditions may include a chest X-ray or CT scan of the lungs, a complete blood count (CBC), and an examination of respiratory mucus (sputum).
If your doctor concludes that you do indeed have asthma, he or she may refer you to an allergy specialist to be tested for allergies. More than half of asthma cases are caused by allergic reactions in the lung airways, so allergy testing can help you determine the things that may trigger or worsen your asthma symptoms so you can avoid them in the future.
Based on the results from your tests, the doctor may give you a diagnosis of asthma with a specific classification. The classification is based on how severe and persistent your symptoms are. It can also help you better prepare for the symptoms you are likely to experience and provide a guide for treatment. The four main classifications of untreated asthma:
-- Intermittent asthma is the mildest form of asthma, with symptoms up to twice a week.
-- Mild persistent asthma is accompanied by symptoms more than twice a week, but no more than once in a single day.
-- Moderate persistent asthma symptoms occur once a day.
-- Severe persistent asthma is the most severe form, causing symptoms throughout the day on most days.
The classification of asthma is presently undergoing changes in the clinical and research communities. There is a new school of thought that asthma severity should be based on how severe the asthma is when it is controlled, or how much medical treatment it takes to control the symptoms. One new classification scheme from the Global Institute for Asthma uses the following classification of how well-controlled your symptoms are with medications:
-- Controlled asthma means there are no daytime or nighttime symptoms, infrequent need for quick-relief medicines (no more than twice a week) and peak flow is normal with no asthma attacks.
-- Partly controlled asthma involves daytime symptoms more than twice a week and sometimes at night with use of quick-relief medicine more than twice a week. Peak flow rate is less than 80 percent of your normal and asthma attacks occur at least once a year but not weekly.
-- Uncontrolled asthma is when you have three or more of the features of partially controlled asthma at least 3 times a week, and asthma attacks are occurring weekly.
If you have asthma, controlling your asthma requires you to consider three basic aspects of care. These are:
1. Education about your condition and participation in your own care so that you can monitor your asthma symptoms more effectively;
2. Proper medication;
3. Controlling or managing environmental or other health factors (e.g. obesity, infections, stress) which affect your asthma. There is no cure for asthma, but several treatments are available to alleviate asthma symptoms. The most effective treatment is avoiding asthma triggers, but when that is not enough several types of medications may help.
Participate in and get educated about your asthma care
Together with your doctor you can develop an asthma action plan with appropriate treatments. Developing an asthma action plan should be a collaborative effort between the asthma sufferer and a doctor or other health care professional (those with young children that have asthma should participate in the plan for their child). Ask questions of your doctor when the plan is being designed and make sure your concerns are addressed. Your input is important for a successful plan. The plan should include:
-- Recommended doses and frequencies of daily medications
-- How to monitor symptoms
-- How to adjust medicines at home in response to particular signs, symptoms, and peak flow measurements that indicate worsening asthma
-- Patient peak flow levels, including their personal best and calculated zones based on personal best that can indicate when reductions require treatment
-- Symptoms to watch out for that may require use or fast-acting medications
-- Conditions or symptoms that warrant seeking more urgent medical care
-- Telephone numbers for the doctor, emergency, and family/friends for support
-- List of asthma triggers to avoid and how to cut down the risks of exposure to them
-- Daily lifestyle modifications that can improve your symptoms
You can also learn self-management skills necessary to control your asthma. Self-management education improves your quality of life while living with asthma by reducing your need for of urgent care visits, hospitalizations, and limitations on activities and it can also save you time, money and worry in the long-run.
As an asthma patient or the parent of a child with asthma, you should have the doctor or another health care professional instruct you on how to use an inhaler. There are different types of inhaled medications that are used under different circumstances so be sure that you know how to use each of them and what the differences are among them. The doctor should have you demonstrate your technique before you attempt to use the medication on your own. The doctor should also instruct you how to use other medical devices you are prescribed including spacers, nebulizers, and peak flow meters.
If you are thinking about using alternative therapies such as herbs or homeopathic remedies, most doctors will be able to educate you on safe use of these as well. Many of these alternative therapies have limited medical evidence to indicate whether they work or not, but most doctors can tell you about their experiences with these treatments and if they are considered safe for you in combination with your other treatments.
You can also learn about how best to identify your asthma triggers. The doctor may refer you for allergy testing, which can help you determine some of your triggers and he or she can educate you about avoiding environmental exposures that may worsen your asthma such as tobacco smoke, cold air, and other irritants.
One of the most important things you can educate yourself about is how to monitor your own asthma symptoms. This helps you assess how controlled your asthma really is, helps you determine when to use fast-acting medications or when to limit your activity, and will also allow you to recognize the warning signs of an impending asthma attack.
Monitoring your asthma symptoms:
You can effectively monitor your own asthma symptoms using an inexpensive handheld medical device called a peak flow meter. A peak flow meter measures the maximum airflow you can generate during a quick forced exhalation (a fast blast) and this can be compared to your normal peak flow rate. This measurement is a reasonably accurate indicator of how well air can flow through your lung airways. Changes in your peak flow rate indicate changes in your airways: a lower peak flow rate means the bronchioles are constricted and can foretell asthma symptoms.
Monitoring your peak flow can help you determine how well your medications are working and may help you identify the triggers of your asthma. It can even signal an impending asthma attack: reduction in your peak flow can often be measured before you notice any asthma symptoms and can be a sign to implement your asthma action plan which likely includes taking fast-acting medications for asthma attacks.
Medications for asthma can be placed into two general classes: long-term control medication and quick-relief medication. Most people use a combination of both to control their asthma.
Long-term control medications
These medications are taken on a daily basis to improve lung function and reduce the frequency of asthma attacks.
Corticosteroids are some of the most powerful and effective medications for asthma. However, inhaled corticosteroids do not appear to alter the progression or underlying severity of the disease in children. Corticosteroids are hormones normally released in the body by glands called the adrenal gland to help you manage stress. Synthetic versions of these hormones can be taken daily to help control asthma symptoms. They have powerful anti-inflammatory effects, meaning they can reduce or prevent inflammation and stop mucus from building up in the lungs. Inhaling corticosteroids delivers a small, targeted dose directly to the sites where they are needed: the lung airways. Inhalation also reduces the amount of these hormones that gets into the bloodstream and lowers the incidence of side effects. Examples of some inhaled corticosteroids include budesonide (Pulmicort), fluticasone (Flovent), and triamcinolone (Azmacort).
The side effects of inhaled corticosteroids can include voice hoarseness and infections of the mouth and throat caused by the anti-inflammatory effects, which reduce the ability of the immune system to fight infections.
Long-acting beta-2 agonists (LABAs)
The LABAs are bronchodilators, meaning they help keep the smallest branches of the lung airways (the bronchioles) open. The body normally produces chemicals called beta-2 agonists that signal the smooth muscles surrounding the bronchioles to relax and open wide. These natural signals are released in times of stress and allow you to bring more air into your lungs when necessary. In asthmatics, an asthma attack causes the smooth muscle surrounding the bronchioles to contract and narrow their diameter, overwhelming the natural signal to keep them open. LABAs are synthetic versions of beta-2 agonists and taking them regularly can help tip the scales away from bronchoconstriction and toward open airways. These drugs are taken daily using an inhaler. LABAs should not be used alone to treat asthma; they are used in combination with inhaled corticosteroids for long-term control and prevention of symptoms in moderate or severe persistent asthma. In 2005, the Food and Drug Administration (FDA) released an advisory stating that the LABAs may increase the risk of severe asthma attacks and possibly death from such an attack. Examples of LABAs include Serevent (salmeterol) and Foradil (formoterol).
Combination drugs that include both an LABA and an inhaled corticosteroid are becoming more popular. Examples include Advair (combination fluticasone/salmeterol) and Symbicort (combination budesonide/formoterol)
These drugs work by either blocking the production of or preventing the action of natural body molecules called leukotrienes. These molecules are released during an asthma attack and cause the cells that line the lung airways to become inflamed. Leukotriene modifiers block this effect. These drugs are taken orally once or twice daily and are usually not as effective as corticosteroids at preventing asthma attacks. Side effects of these medications include gastrointestinal problems and sleep disorders. Examples of leukotriene modifiers include montelukast (Singulair) and zafirlukast (Accolate).
Cromolyn sodium and nedocromil
Cromolyn sodium and nedocromil are medications that stabilize cells called "mast" cells which release inflammatory substances. They can be used in addition to other medications to control asthma and they can also be used as preventative treatment before exercise or exposure to known allergens.
Theophylline is a type of drug called a methylxanthine that is similar in structure and function to caffeine. One of its effects is bronchodilation, which opens airways and improves breathing, but its other effects include rapid heartbeat, confusion, nausea, vomiting, and nervousness. It is taken daily in pill form. Theophylline is rarely prescribed anymore due to its side effects. If you are prescribed this medication a blood test to monitor serum theophylline concentration must be performed regularly.
Many asthmatics have allergic asthma; their symptoms are caused by allergic reactions in the lung airways. Treating their allergies can help improve their asthma symptoms. Examples of allergy treatments include allergy-desensitization shots (immunotherapy) in which you are given small doses of allergens that trigger your asthma symptoms and over time you become less sensitive to them. In addition, medication containing anti-IgE monoclonal antibodies such as omalizumab (Xolair) may reduce the number of asthma attacks you experience by blocking the action of IgE antibodies, which cause allergies. Allergy treatments can only be administered in a physician's office or hospital with facilities and trained personnel available to treat any life-threatening reactions that occur. These severe reactions are rare but they do happen.
While the long-term control medications aim to prevent asthma attacks, they are not effective in rapidly relieving symptoms of an asthma attack when one does occur. Several quick-acting medications can be taken at the onset of an asthma episode to shorten the attack and lessen its symptoms. These medicines work by dilating the bronchioles and improving air flow to the lungs.
Short-acting beta- 2 agonists (SABAs)
Like the long acting version (LABAs), these drugs work by activating the system that normally signals the smooth muscles surrounding the bronchioles to relax and open wide. During an asthma attack, the smooth muscle surrounding the bronchioles contract and narrow their diameter, overwhelming the natural signal to keep them open. When inhaled, the short-acting beta- 2 agonists reverse this effect within minutes and allow breathing to return to normal, but they do not prevent further attacks from occurring. SABAs are the preferred treatment for the relief of acute symptoms and prevention of exercise-induced asthma/ bronchospasm. Side effects may include tremor, palpitations, and headache. Examples include Salbutamol (albuterol) and Xopenex (levalbuterol).
Daily or chronic use of SABAs is not recommended. Increasing use of SABA treatment often means that the patient's asthma is not under good control. If you find yourself using SABAs more than your doctor recommends, you should make an appointment so he or she can reevaluate your long-term anti-inflammatory therapy.
These drugs work by blocking body signals that cause the bronchioles to constrict and release mucus. The body has a system to naturally constrict bronchioles in order to direct fresh air to other bronchioles that need it. During as asthma attack, this system is no longer adaptive and so anticholinergic drugs block this effect from occurring. When inhaled, these drugs will open bronchioles and restore breathing, but they will not prevent future attacks. Side effects can include headache, dizziness, dry mouth, cough, nausea, upset stomach, and blurred vision. Examples of anticholinergics include ipratropium (Atrovent) and tiotrpium (Spiriva).
Oral and intravenous corticosteroids
These corticosteroids work in the same manner as the inhaled version mentioned above: by preventing inflammation. However, taken orally or by I.V., corticosteroids may help treat acute asthma attacks. They tend to take a little longer to work than a fast-acting inhaler, up to a few hours or days to be fully effective. Also, because oral or I.V. administration delivers these steroids to the entire body, the risk of side effects is greater than with inhaled corticosteroids. Long-term use can cause cataracts, osteoporosis, muscle weakness, decreased resistance to infection, high blood pressure, and thinning of the skin. Examples of these medications include prednisone, methylprednisolone, and hydrocortisone.
Depending on the severity of your asthma symptoms, you may need to take only one type of drug or a combination of several. Many doctors will prescribe both a long-acting medication for control of asthma symptoms and a quick-acting medication for rapid relief during an asthma attack. If at a follow-up appointment your asthma seems well controlled, your doctor may prescribe fewer medicines or lower doses.
Preventing asthma from developing:
A person can develop asthma at any age and there is no way of knowing for sure who will get it. There are risk factors for asthma that you cannot control and some that you can. If you are a prospective parent or if you have children already, there are some additional things you can do to reduce the risk of your children developing asthma.
As an adult, you can reduce your risk of developing asthma by limiting the risk factors that you have control over. This is especially important if you have any of the non-controllable risk factors such as a family history of asthma or allergies, having allergies yourself, African American or Puerto Rican ancestry, or low birth weight. The known risk factors that you may be able to control include: obesity; gastroesophageal reflux disease (GERD); exposure to tobacco smoke, environmental irritants, mold, dust, feather beds, or perfume; and occupational triggers, such as chemicals used in manufacturing. Losing weight if you are obese is a good way to reduce risk. If you have GERD, losing weight may actually alleviate your GERD symptoms as well. Avoiding all possible irritants is difficult, but limiting your exposure, especially long-term exposure, as much as possible can help reduce your risk for developing asthma.
If you have children or plan on starting a family, you can reduce the risk of your children developing asthma by limiting their asthma risk factors. This is especially important if you or another close relative has asthma or allergies because this means your children are already at increased risk. Risk factors that you may or not be able to control include low birth weight, frequent respiratory infections in childhood, growing up in a low-income environment, and living in a large urban area. The risk factors that you can control include: exposure to tobacco smoke before birth or as an infant and exposure to environmental irritants, mold, dust, feather beds, or perfume.
Preventing asthma attacks:
If you already have asthma, there is no cure, but there are steps you can take to prevent asthma attacks.
Avoid asthma triggers:
The best way to prevent asthma attacks is to identify your asthma triggers and do your very best to avoid them. If you have allergic asthma, you can get tested for allergies and find out what substances provoke the biggest reactions for you, and then try to avoid them. Whether you have allergic asthma or not, certain allergens and irritants tend to worsen asthma symptoms in most asthma patients and you can do your best to avoid them. These include:
-- Tobacco smoke
-- Dust mites
-- Mold spores
-- Pet dander
-- Irritating fumes
-- Cold air
For some people with asthma, avoiding allergens and irritants may be sufficient to keep most of their symptoms at bay. For most asthma sufferers, other steps are needed. Seeing your doctor regularly is the best way to determine an asthma action plan that is right for you. This means going back for regular checkups to make sure the plan you are using is still optimal. Doctors are very knowledgeable but they cannot always predict how each individual patient will react to medications or how their symptoms will change over time. The doctor may need to make adjustments to your plan several times before the two of you discover an optimal management plan for your disease. Even then, things can change so it is important to keep the lines of communication with your doctor open.
Your asthma action plan will include key elements like a medication regimen for both long-acting and quick-relief medications and on methods you can use to avoid exposure to triggers. It will also include methods to help you anticipate asthma attacks and, over time, you may be able to feel subtle changes in your breathing that warn of an impending asthma attack. The sooner you administer quick-relief medications such as your fast-acting inhaler, the sooner you will start relief and the less severe the attack will be. When the peak flow meter indicates an attack is beginning, take your medications as soon as possible and, if it's possible, remove yourself from the environment that caused the attack.
If your asthma symptoms occur only during exercise (exercise-induced asthma / bronchospasm), you should have an asthma action plan for managing your symptoms. This plan may primarily consist of medications that you use before beginning to exercise (e.g. SABAs or LABAs) or it may include long term control therapy if your symptoms are frequent or severe. A warm-up period prior to exercising may also help to reduce your symptoms and a mask or scarf over the mouth may lessen cold-induced exercise-related asthma attacks.
If you have asthma, some events may carry a higher risk of complications for you than for those who do not have asthma. Two examples are pregnancy and surgery, which are discussed below.
Pregnancy and asthma
Pregnancy causes major changes in hormone levels and it can cause changes to your asthma symptoms. However, pregnancy does not affect all women with allergies in the same way. About one third of women with asthma experience improvement of their symptoms while they are pregnant, about one third have their symptoms get worse, and the other third stay about the same. If your asthma is mild to begin with and it is well- controlled during pregnancy, there is a good chance you will not have any attacks while you are pregnant. Talk to your doctor about your pregnancy to discuss any changes that will be necessary to your medications or other aspects of your treatment. In general, inhaled drugs may be used during pregnancy, whereas you may have to stop taking pills or other treatments that could cross the placenta.
The danger in pregnancy is that if your symptoms are not well controlled, the amount of oxygen you can breathe in is reduced. Pregnant women have about 50% more blood than normal and all that blood needs to be oxygenated. Less oxygen and more blood means reduced oxygen supply to the developing baby and may result in serious problems. Talk with your doctor and take all necessary steps to control your asthma while you are pregnant to limit the chance that your asthma will affect your unborn child.
Surgery and asthma
If you have moderate or severe asthma, you are at higher risk of developing problems during and after having surgery than people who do not have asthma. If you have asthma and are planning to have surgery, talk with your doctor about preparations you can take to avoid asthma problems during and after the surgery. Make sure your symptoms are well controlled leading up to the surgery and tell your doctor if they are not. You may need to take some additional medication such as corticosteroids for a short time to improve lung function before surgery and prevent complications.