Disease, Illness and Condition Library
Asthma
reversible - in response to certain stimuli. If you are an asthma sufferer the thought of a high pollen count, combined with your neighbor burning leaves, your cat shedding and accidentally ingesting that milk which triggered your last asthma attack is scarier than any Hollywood horror production. This combination would probably send you to the ER to see your favorite medical professional. Any one of these 4 irritants could cause a serious or not so serious asthma attack. There are literally hundreds of irritants that can cause an asthma attack. You Are Not Alone Not so long ago, asthma was perceived a mild inconvenience that the little boy with the coke bottle glasses was constantly struggling with, but things are changing. Asthma is rapidly becoming an epidemic in North America with an estimated 25 millions people affected by this lung condition. Children under ten years of age make up the largest group followed by adult women. Recent statistics in the United States show that one out of every ten children has asthma and in England one out of seven has the disease. It is also the leading chronic illness among children.
asthma, even at an advanced age. Asthma in children can interfere with normal growth and development. Looking Into Asthma? The main feature in all asthma cases is easily irritated lungs which can range from a minor nuisance to a life threatening event. When the lungs become irritated the tubes through which oxygen passes (bronchi and bronchioles) become swollen or inflamed. Adding insult to injury, the glands within the air passages swing into action producing excess mucus, which makes the blockage even worse. At this point the person having the asthma attack gasps for air, feeling as though he or she is attempting to suck air through one of those crimped restaurant straws that we all have grown to love. Besides struggling to breathe, other common signs of asthma are a tight feeling in the chest and chronic coughing but it is worth pointing out that not all of these symptoms occur in every case. Current research studies are suggesting that food allergies can trigger asthma attacks. Eliminating allergenic foods has been shown to produce notable improvement in three fourths of asthmatic children and in one third of asthmatic adults. In children the most common asthma catalysts are eggs, peanuts and shellfish. Foods associated with delayed onset asthma include milk, wheat, citrus, certain food additives and food colorings. Two Types of Asthma: Extrinsic and Intrinsic. Extrinsic Asthma accounts for over half of the cases in children and young adults. This type of asthma is usually caused by airborne allergens such as smoke, pollen, dust, animal dander and vehicle exhaust. Intrinsic Asthma is thought be caused by exercise and cold air. Studies suggest that allergies may be a trigger as well. Intrinsic can also be secondary to chronic or recurrent infections of the tonsils, bronchi, sinuses, and adenoids. Hypersensitivity to the bacteria propagating the chronic or recurrent infection is thought to be the cause. As with so many different types of disease genetics seem to play a role in asthma as well. Asthma patients usually have a family member with a personal history or allergy and asthma. If both parents have asthma, at least one in three of their children are likely to develop asthma symptoms at some time. Asthma in mothers is a stronger indicator of early onset asthma in a child than paternal asthma.
Airway obstruction is often cause by abnormal sensitivity of cholinergic and peptidergic receptors, which cause the muscles of the airways to contract when they should not. Certain cells in the airways, particularly the mast cells, are though to be responsible for initiating the airway narrowing. Mast cells throughout the bronchi release substances such as histamine and leukotrienes, which cause smooth muscle to contract, mucus secretion to increase, and certain white blood cells to migrate to the area. Eosinophis, a type of white blood cell found in the airways of people with asthma, release additional substances, contributing to airway narrowing. In an asthma attack, the smooth muscles of the bronchi narrow (called bronchoconstriction), and the tissues lining the airways well from inflammation and secrete mucus into the airways. The top layer of the lining of the airways can become damaged and shed cells. These actions further narrow the diameter of the airways; the narrowing requires the person to exert more effort to move air in and out of the lungs. In asthma, airway obstruction is reversible through suitable treatment or on its own. In which case muscular contractions of the airways stop, the airway obstruction ends, and the airflow into an out of the lungs return to normal. When a person has asthma, the airways narrow in response to stimuli that usually do not affect the airways in normal lungs. The narrowing can be triggered by many inhaled allergens, such as particles from dust mites, pollens, body secretions from cockroaches, particles from feathers, and pet dander. These allergens combine with immunoglobulin E (a type of antibody) on the surface of mast cells to trigger the release of asthma causing chemicals from these cells. (This type of asthma is referred to as allergic asthma.) Although food allergies induce asthma only rarely, certain foods (such as shell fish and peanuts) can bring on severe attacks in people who are sensitive to these foods. Cigarette smoke, cold air, and viral infections can also provoke asthma attacks. Additionally, a person who has asthma can develop bronchoconstriction when exercising. Stress and anxiety can trigger mast cells to release histamine and leukotrienes and stimulate the vagus nerve (which connects to the airway smooth muscle), which then contracts and narrows the bronchi. Symptoms and Complications Asthma attacks vary in frequency and severity. Some people who have asthma are symptom free most of the time, with only an occasional, brief, mild episode or shortness of breath. Other people cough and wheeze most of the time and have severe attacks after viral infections, exercise, or exposure to allergens or irritants, including cigarette smoke. Crying or spirited laughing may bring on symptoms in some people. Some people with asthma produce a clear and at times sticky (mucoid) phlegm (sputum). Asthma attacks occur most often in the early morning hours, when the effects of protective medications start to lose their effect and the body is least able to prevent bronchoconstriction. An asthma attack may begin suddenly with wheezing, coughing, and shortness of breath. Wheezing is particularly noticeable when the person breaths out. At other times, an asthma attack may come on slowly with gradually worsening symptoms. In either case, people with asthma, usually first notice shortness of breath, chest tightness, and coughing. The duration of an asthma attack can vary greatly, from being over in minutes to lasting for hours or even days. Itching on the neck may be an early symptom, especially in children. A dry cough at night or while exercising may be the only symptom. During the actual asthma attack, shortness of breath may become severe, creating a feeling of severe anxiety. The person instinctively sits upright and leans forward, usuing the neck and chest muscles to help in breathing, but still struggles for air. Sweating is a common reaction to the effort and anxiety. The pulse usually quickens, and the person may feel a pounding in the chest. In a very severe asthma attack, a person is able to say only a few words without stopping to take a breath. However, wheezing may diminish, because hardly any air is moving in and out of the lungs. Confusion, lethargy, and a blue skin color (cyanodis) are signs that the person’s oxygen supply is severely limited, and emergency treatment is needed. Usually, a person recovers completely with appropriate treatment, even from a severe asthma attack. Rarely, some people develop attacks so quickly that they lose consciousness before they can give themselves effective therapy. Such people should wear a medical alert bracelet and perhaps carry a cellular phone to call 911. Rarely, the small air sacs of the lung (alveoli) may rupture, allowing air to build up in the space between the membrane layers covering the lungs and inner chest wall (the pleural space). This complication (pneumothorax) greatly worsens the shortness of breath; often a chest tube needs to be inserted into the affected pleura space to drain the air and re-expand the collapsed lung. Prevention and Treatment There is no shortage of drugs that can be used to prevent and treat asthma attacks. Most of the drugs used to prevent asthma are also used to treat asthma attacks but in higher doses or in different forms. Some people need to use more than one drug to prevent and treat their symptoms. Therapy is based on two classes of anti-asthmatic drugs. The first are anti- inflammatory drugs, which suppress the inflammation that triggers the airways to narrow. The second are bronchodilators, which help to relax and widen (dilate) the airways. Within each of these two classes, several drugs are available. Anti-inflammatory drugs include corticosteroids (which are inhaled, taken by mouth, or given intravenously), leukotriene modifiers, and cromolyn. Bronchodilators include betaadrenegicagonists and theophylline. Becoming more knowledgeable about how to prevent and treat asthma attacks is beneficial for all people who have asthma and as well as family members. Proper use of inhalers is essential for effective treatment. People should know what can stimulate an attack, what helps to prevent an attack, how to use drugs properly, and when to seek medical care. Many people use a hand held peak flow meter to evaluate their breathing and determine when they need intervention, before their symptoms get extreme. A person who experiences frequent severe asthma attacks should know how to reach help fast. In is not unusual to find asthma suffers who have detailed written treatment plans devised by their doctor. Such a plan allows them to take control of their own treatment and has been shown to decrease the number of times people need to seek care for asthma in the emergency department. Preventing Attacks Asthma is a chronic condition that cannot be prevented or cured; however, individual attacks can often be prevented. Asthma attacks may commonly be prevented if the factors that trigger them are identified and treated or avoided. People who have asthma should avoid cigarette smoke. Often, attacks triggered by exercise can be blocked by taken medication before exercising. When dust and allergens are the problem, air filters, air conditioners, and other types of barriers (such as mattress covers, which reduce the amount of particles from dust mites that are in the air) can help a great deal. For people whose asthma is stimulated by allergies, desensitization through the use of allergy shots may prevent attacks. Some people who have asthma may have sensitivity to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs); if this is the case, these drugs must be avoided. Drugs that block the beneficial effects of beta-adrenergic agonists (called beta-blockers) usually worsen asthma. Most asthma suffers take medications, such as inhaled or oral corticosteroids, leukotriene modifiers, long acting beta-adrenergic agonists, theophylline, antihistmines, or cromolyn to prevent attacks. Prevention efforts are individualized according to the frequency of attacks and the stimuli that trigger the attacks. A new treatment for asthma is being studied and developed based on the use of a special antibody (given intravenously or injected just under the skin) that binds immunoglobulin E, blocking its attachment to mast cells. By preventing immunoglobulin E from attaching to mast cells, these cells can no linger release the substances that cause allergic asthma. Treating Attacks An asthma attack can be a downright scary experience, both to the person experiencing it and to others around. Even asthma symptoms are relatively mild; the symptoms provoke anxiety and alarm. A severe asthma attack is a life threatening emergency that requires immediate, skilled, professional care. If not treated adequately and quickly, a severe asthma attack can cause death. People who have asthma are generally able to treat most attacks without assistance from a health care professional. In normal cases an inhaler is used to deliver a dose of short acting beta-adrenergic agonist. At this point they should move to fresh air (away from cigarette smoke or other irritants), and sit down and rest. Some people may inhale a corticosteroid in addition to a beta-adrenergic agonist. An attack usually subsides in 5 to 10 minutes or gets worse. If it is the later it is likely to require additional treatment supervised by a doctor. Because people with severe asthma commonly have low blood oxygen levels, a doctor may check the level of oxygen either by using a sensing monitor on a finger or ear or by taking a sample of blood from an artery. Supplemental oxygen may be given during attacks. However, in severe attacks, a doctor also needs to monitor carbon dioxide levels, and this test requires a sample of blood from an artery. A doctor may also check pulmonary function, usually with a spirometer or peak flow meter. Usually, a chest x-ray is needed only in severe asthma attacks. People experiencing very severe asthma attacks may need to have an artificial airway passed through their mouth and throat (intubation) and be placed on a mechanical ventilator. As a general rule, people who have severe asthma are admitted to the hospital if their lung function does not improve after receiving a beta-adrenergic agonist and corticosteroids or if they have a seriously low blood oxygen level or a high blood carbon dioxide level. Intravenous fluids may be needed if the person is dehydrated. Antibiotics also may be needed if a doctor suspects a lung infection; however, most such infections are due to viruses for which (with a few exceptions) no treatment exists. Drugs for Preventing or Treating Attacks Drugs allow most people with asthma to lead relatively normal lives. Most of the drugs used to treat an asthma attack can be used (often in lower doses) to prevent attacks. Short-acting Beta-adrenergic Agonists: Short acting beta-adrenergic agonists are usually the best drugs for relieving asthma attacks. They can prevent certain attacks, such as exercise induced asthma. These drugs are also referred to as bronchodilators because they stimulate airways. Bronchodilators that act on all beta-adrenergic receptors to widen (dilate) the airways. Bronchodialtors that act on all bet-adrenergic receptors throughout the body, such as epinephrine, cause side effects such as increased heart rate, restlessness, headache, and muscle tremors. Bronchodilators (such as albuterol) that act mainly on beta 2 adrenergic receptors, which are found primarily in the lungs, have little effect on other organs and thus cause fewer side effects. Most beta receptor agonists, especially the inhaled ones, act within minutes, but he effects last only 2 to 6 hours. A new bread of long lasting bronchodilators are available, but because they do not begin to act as quickly, they are used for prevention rather than for attacks of asthma. When the long acting beta-adrenergic agonists are used together with inhaled corticosteroids, better results are obtained. A combination of salmeterol (a long acting beta-adrenergic agonist) with a corticosteroid in an inhaler is also available. Commonly, beta-adrenergic agonists are inhaled using metered dose inhalers (handheld cartridges containing gas under pressure). The pressure turns the drug into a fine spray containing a measured dose of drug. Inhalation deposits the drug directly in the airways, so that it acts quickly, but the drug may not reach the airways that are severely obstructed. For people who have a difficult time using a metered dose inhaler, spacers or holding chambers can be used. With any type of inhaler, proper technique is vital; if the device is not used properly, the drug will not reach the airways. A dry powder drug formulation is also available. The powder formulation is easier for some people to use, in part because it requires less coordination with breathing. Beta-adrenergic agonists can also be delivered directly to the lungs using a nebulizer. A nebulizer creates a mist of drug, and its use does not have to be coordinated with breathing. Nebulizers are more portable than they were in the past; some units can even be plugged into a cigarette lighter socket in a car. Beta-adrenergic agonists can also be taken in liquid or tablet form or injected. However, the oral drugs tend to work slower than the inhaled or injected ones and are more likely to cause side effects. Side effects include abnormal heart rhythms, which could suggest excessive use. Other bronchodilators may be combined with bet-adrenergic agonists for acute attacks, including intravenous infusions of aminophylline (a type of theophylline) and nebulized ipratropium. A combination of ipratropium with albuterol in a metered dose inhaler is also available. Prompt medical attention should be sought when a person who has asthma feels the need to use more of a beta-adrenergic agonist than is recommended. Overusing these drugs can be very dangerous. The need for continuous use indicates severe bronchoconstriction, which can lead to respiratory failure and death. Theophylline: Theophylline is another drug that produces bronchodilation. It is usually taken by mouth but can be given intravenously in the hospital. Oral theophylline comes in many forms, from short acting tablets and syrups to long acting sustained release capsules and tablets. Theiphylline is used for both prevention and treatment of asthma. The amount of theophylline in the blood can be measured in a laboratory and must be closely monitored by a doctor. Too little drug in the blood may provide little benefit, and too much drug may cause life threatening abnormal heart rhythms or seizures. When first taking theophylline, a person who has asthma may feel slightly jittery and may develop headaches. These side effects usually disappear as the body adjusts o the drug. Larger doses may cause a rapid heartbeat, nausea, or palpitations. A person may also experience insomnia, agitation, vomiting, and seizures. Antcholinergic Drugs: Anticholinergic drugs, such as ipratropium, block acetylcholine from causing smooth muscle contraction and from producing excess mucus in the bronchi. These drugs are usually inhaled but can be given intravenously in the hospital. These drugs further widen (dilate) the airways in people who have already been given beta adrenergic agonists. However, doctors use anticholinergic drugs mainly in the emergency department in combination with a beta-adrenergic agonists. When used alone, anticholingergics are only marginally effective. Leukotriene Modifiers: Leukotriene modifier, such as montelukast, azfirlukast, and zileuton, are the newest drugs available to help control asthma. These are anti-inflammatory drugs, preventing the action or synthesis of leukotrienes, chemicals made by the body that cause bronchoconstriction. These drugs, which are taken by mouth, are used more to prevent asthma attacks than to treat them, although because leukotrienes are increased in acute asthma, these drugs potentially can be used during an attack as well. Cromolyn and Nedocromil: These drugs, which are inhaled, are though to inhibit the release of inflammatory chemical from mast cells and make the airways less likely to narrow. Thus, they are also anti-inflammatory drugs. They are useful for preventing but not treating an attack. These drugs may be helpful for children who have asthma and for people who develop asthma from exercise. Cromolyn and nedocromil are very safe and must be taken on a regular basis even when a person is free of symptoms. Corticosteroids: These drugs block the body the body’s inflammatory response and are exceptionally effective at reducing asthma symptoms. They are the most potent form of anti-inflammatory drugs and have been an important part of asthma treatment for decades. They are given in the inhaled form to prevent attacks and improve lung function. They are given by mouth in higher doses for people experiencing severe attacks. Corticosteroids given by mouth are generally continued for at least several days after a severe attack. Corticosteroids can be taken in several different forms. Often, inhaled versions are best because they deliver the drug directly to the airways and minimize the amount sent through the body. They come in several strengths and are generally used twice a day. The person should rinse the mouth after use to decrease the likelihood that an infection of the mouth (thrush) develops. Oral or injected corticosteroids may be used in high doses to relieve a sever asthma attack and are generally continued for 1 to 2 weeks. Oral corticosteroids are prescribed on a long term basis only when no other treatments can control the symptoms. If taken for long periods, corticosteroids gradually reduce the likelihood of an asthma attack by making the airways less sensitive to a number of provocative stimuli. Long term use of corticosteroids, especially larger doses taken by mouth, can produce side effects. Prevention Management of asthma attacks starts with prevention. Taking preventative measures gives the patients a feeling of some control over their disease and reduces their feelings of helplessness. Most asthma suffers are open to suggestions on ways to control environmental and emotional events that could trigger an asthma attack. A Few Simple Steps for Avoid Asthma Attacks * Rugs or Bugs – Roll up the rugs. Rugs collect dust and dust mites, so if you must have rugs make sure they are clean. * Teach Your Cat to Shower – That might be a little too much to ask but pet dander is a major trigger for asthma. A better suggestion is to shower with your cat. This is not an easy task with adult felines but if you are able to start your cat at a young age they will learn to tolerate it well. * Leather and Vinyl – Buy leather and vinyl rather than upholstered furniture * Stay Away from Smoke – Unless you are communicating with your friends by smoke signal, and if you are wear a mask, people with asthma should be nowhere near tobacco or any other type of smoke. * Wear a Mask – There are times when a simple surgical mask can be helpful in filtering out dust, pollen and other allergens. Example: When doing yard work * Wash with Hot Water – Hot water kills dust mites * Replace Air Filters – Replace your air filter once a month. Your filter should have a dust and allergen rating of 8 or higher. * Preemptive Strike - If you know you are going to encounter an allergy attack trigger use your bronchodilator inhaler beforehand. Helpful Herbal Remedies for Asthma
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