What You Need To Know About Asthma
Asthma is a chronic lung disease - it cannot be cured, it can only be controlled. Asthma is characterized by:
- Constriction (The breathing passages tighten and narrow)
- Swelling ( Inflammation inside the lungs)
- More and thicker mucus within the airways
These cause the symptoms of asthma, which are:
- Shortness of breath
- Wheezing
- Tightness of the chest
- Cough
The goal of asthma therapy is to keep asthma under control without limiting activity and with the least amount of medications possible. This is done through monitoring asthma at home and having a plan on how to adjust medication as symptoms change. This plan should be developed with a physician based on peakflow results.
A peakflow is a handheld device that can be used at home to measure the ability to breathe. When using this device, medications can be adjusted according to your breathing ability. Managing asthma at home is essential to maintain control of asthma and to become an active participant in your own healthcare.
It is not clear what causes asthma, but we do know there is a hereditary component. There are also a variety of triggers that can stimulate an asthma attack including:
- Allergies
- Strong Odors
- Infections
- Exercise
- Cold Air
- Smoke
Asthma triggers only produce asthma symptoms in an asthmatic. Asthma is a physical problem that is characterized by tightening and swelling of the airways. Asthma is never caused by psychological problems, but may be worsened by stress.
The best way to find out if you have asthma is through pulmonary function testing (PFT). This is a test, done at a doctor's office, which measures how well your breathing passages can move air in and out. The test is done by blowing forcefully into a mouthpiece that is connected to a computer. The computer measures the air moving through the mouthpiece and will show whether your breathing is normal for your age and height.
Further testing may also be necessary. Usually after completing the first PFT a reversibility test is performed. This test is done by inhaling a medication known as a bronchodilator (reliever), and twenty minutes later another pulmonary function test is performed to see if breathing improves. If breathing improves at least 12%, this confirms a diagnosis of asthma. Some patients may have asthma and not improve. For this reason and others, doctors may recommend another test called a Methacholine Challenge.
A Methacholine Challenge Test is done by having a suspected asthmatic patient inhale increasing doses of Methacholine. Methacholine is a liquid medication that in an asthmatic only, will cause mild asthma symptoms and a decrease in the patient's pulmonary function test measurements. If breathing worsens by at least 20%, this confirms a diagnosis of asthma. If breathing does not worsen, then the patient is considered not to have asthma. This is a very useful and safe test to positively identify asthma in most cases.
No, a chest x-ray does not always show signs of asthma. It will help identify other lung problems that might be causing your breathing problems.
A pulmonary function test shows the severity of asthma.
- Studies have shown that asthmatics often under-report their symptoms because they have become so used to difficult breathing. Therefore asthmatics may not be receiving the proper amount of medication to fully control their asthma.
- The severity or even presence of asthma is difficult to establish because it is not always active at the time of the physician's exam.
It is critical for the health care provider to monitor pulmonary function tests to make sure the correct amount of medication is being taken so that permanent lung damage does not occur. All asthmatics should have pulmonary function testing done yearly, routinely and more often if asthma is unstable.
The NIH (National Institute of Health) has classified the severity of asthma in their recently published document "Guidelines for the Diagnosis and Management of Asthma" NIH Publication No. 97-4051, April 1997. There are four categories of asthma; mild intermittent, mild persistent, moderate persistent, and sever persistent. These categories are based on your pulmonary function test and your symptoms. The medicine you need depends on the category of your asthma.
Swelling and inflammation of the lungs, over time, if not controlled with medications will cause scarring in the lungs and make breathing more difficult and medications less effective. This has been shown to happen in even less than a year if asthma is not treated properly.
Controlling asthma is a threefold process:
- Finding the right physician and associated health care providers that can be partners in the management of your disease.
- Becoming aggressive in monitoring and caring for your own asthma.
- Taking the proper medications
The medications you need will be based on your category of asthma. You will need your doctor's help to discover what triggers your asthma. Remember, asthma consists of 3 major components:
- Constriction (The breathing passages tighten and narrow)
- Swelling (Inflammation inside the lungs)
- More and thicker sputum
Bronchodilators (reliever, albuterol, beta-agonist) - helps to relieve the constriction (tightening of the breathing passages).
Inhaled Steroids (controller, preventer, corticosteroids) - helps relieve the swelling and inflammation in the lungs. Over time inhaled steroids will help decrease all the symptoms of asthma.
Allergy Medications
This is where your doctor will need to help. The amount and type of medication will depend on your category of asthma. The category can change and adjusting medications will be necessary. The important thing is to keep your asthma under control.
Every asthmatic will need a bronchodilator (reliever) to use when they feel tight. Those patients who are in the mild intermittent category or only have asthma when they exercise will probably just need a bronchodilator. The other categories of asthmatics will need a bronchodilator, and a combination of inhaled steroids and other allergy and asthma medications
Some other asthma controller medications that are currently available include: Theophylline, Allergy cell stabilizers, Serevent modulators, and Leukotriene modulators.
The asthma pill or leukotriene modulator blocks the formation of a chemical called a leukotriene. This chemical is released in the asthmatic lung producing some of the symptoms of asthma. There are three types of leukotriene modulators - Zyflo, Accolate, and Singulair.
There are several signs that your asthma may be out of control. If you are using your reliever inhaler more than 2-3 times a week, if you awaken at night with asthma symptoms, or if you have to adjust your activity around your symptoms you should check with your doctor. These are cues that you might need to adjust your medications or see an asthma specialist.
A specialist should be seen if:
- The diagnosis of asthma or allergy is not certain.
- An asthmatic requires hospitalization or treatment in the emergency room once a year or more.
- Asthma is moderate to severe
- An asthmatic's activities have been limited by symptoms including missing school, work, or exercise.
- Persistent asthma symptoms occur frequently.
- An asthmatic requires more than one canister of a reliever inhaler a month.
- Use of greater than or equal to the highest recommended doses of an inhaled steroid.
- An asthmatic uses a steroid pill (prednisone) daily or more than 3 times a year.
- An asthmatic is having difficulty managing medications.
- An asthmatic is experiencing bothersome side effects from asthma medications.
- An asthmatic becomes pregnant.
These are guidelines, discuss a referral with your physician.
NHLBI 2002 Asthma Guidelines (PDF)
