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.
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.
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.
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.
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 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.
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).
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.
Continued on page 8: How can I prevent asthma?