Understanding asthma

This common disease can claim lives, so control it as early as possible. By Dr. Sonia J. Silos

A good friend of mine in his mid-30s has had asthma since childhood. He tells me that his attacks since then have been few and far between, but that they come at the most inopportune moments. He says, "It has reminded me of its presence at the worst times: when I am elated, when I exert myself physically or at the tail end of the flu."

Yes, living with asthma is difficult but it doesn't have to be that way. The first step is learning about the disease and how it affects you. This will help you better understand how to treat, manage and, ultimately, control asthma. 

What is asthma?
Asthma is an inflammatory disease of the lungs and its airways. It affects adults and children alike, but asthma in children is different, explains Dr. Agnes Sebastian-Sanchez, pediatric pulmonologist at the Victor R. Potenciano Medical Center and the Healthway Medical Clinics (both in the Philippines). "Children have smaller airways so the symptoms are exaggerated, particularly in younger kids."

Asthma is a chronic condition characterized by acute attacks. These attacks are caused by hyperreactive airways, which produce increased mucus, then subsequently tighten and narrow, causing airway obstruction. All these bring about the common asthma symptoms of coughing, wheezing, and shortness of breath.

But what exactly causes the airways to hyperreact? There are numerous asthma triggers and each individual has his own particular trigger. Once you identify what sets off your asthma attack, you can begin to avoid or limit your exposure to them.

Dr. Rommel Tipones, adult pulmonologist at the National Kidney and Transplant Institute in the Philippines and the Healthway Medical Clinics, shares these handy tools for controlling asthma triggers.

• Quit smoking. Ban smoking inside your home.
• Keep furry pets out of your home.
• Keep doors and windows closed to control the entry of outdoor allergens. Air-conditioning, although expensive, will help.
• Remove stuffed animals, carpeting, curtains, or anything that collects dust, from the bedroom. Cover your mattresses and pillows with airtight covers.
• Get a flu shot each year. These are safe for adults and children over 3.

Drugs defined
Asthma medications can either be inhaled or swallowed (systemic medication). Tipones says inhaled medications are preferred because they deliver the drug direct to the airways, decreasing any side effects that affect the whole body (systemic effects). Medications are classified into relievers, which help stop attacks once they start, and controllers, which help prevent attacks from starting.

Relievers consist of bronchodilators, which keep the airways open, allowing you to breathe during an attack. Inhaled bronchodilators in the proper dose and frequency are very effective. It is the one medication that every asthmatic should have handy wherever he goes. Inhaled bronchodilators are the medication of choice for exercise-induced asthma and are the only medication that those with mild asthma will ever need.

Systemic bronchodilators, although equally effective, have more associated side effects and so are not frequently used. Side effects include a rapid heartbeat, nausea and vomiting, indigestion, dizziness, irritability and difficulty sleeping. When these occur, tell your doctor immediately.

Controllers are anti-inflammatory medications that reduce the swelling of airways and their mucus production. There are different types, including the ever-popular corticosteroids. These are recommended for daily use and are safe and highly effective for long-term therapy. But remember that they have to be used regularly and consistently for maximum effect.

Inhaled corticosteroids are the most frequently used controller medication, but they require spacer devices to avoid side effects such as throat infections. Systemic steroids are only given for severe, uncontrolled asthma. They are extremely effective but can cause serious side effects with prolonged use. Among the many side effects are weight gain, nausea and vomiting, face puffiness and foot swelling, hyperacidity, growth retardation in kids, early cataracts, delayed wound healing and infections.

As such, avoiding their long-term use whenever possible, especially in children, is prudent.

The doctor's role
Your treatment program will usually be individualized because each person's asthma is different. What works for your friend may not work for you. It is the doctor's role to choose the right medication at the right dose for your particular asthma.

After you have been prescribed asthma medicine, see your doctor even when you feel well. Regular checkups can help your doctor ascertain if the medicine is working well for you. "Generally, improvement should be seen within a month of starting treatment," Tipones points out. It is vital for your doctor to know if:

• You are taking more than the usual recommended dose.
• You have symptoms at night and have trouble sleeping.
• Your daytime symptoms are increasing.

These things signal that your treatment program is not working, and a change of medication or additional medicine might be needed.

Asthma and you
Finally, successful asthma management relies heavily on you as the patient. Everyone with asthma has a responsibility to learn everything about the condition.

Know your symptoms and what to do about them. During an attack, knowing the signals that precede it is vital, especially in young children, who usually can't report what they feel. Your job as a parent is to spot those early signs to ward off a severe attack. Be alert for cough especially at night, noisy, irregular breathing, wheezing, flaring nostrils and pursed-lip breathing.

Learn about your medication and how it works. Inhaled bronchodilators relieve symptoms quickly. They take effect within five to 10 minutes, when symptoms should start abating. The earlier treatment is given, the less medicine you'll need to control the attack. It is best to give treatment within five minutes of an attack.

Discover what your triggers are and work hard to avoid or control them.

Complete control of all your triggers is impossible, but you can decrease the frequency and severity of attacks. For instance, those with exercise-induced asthma need not curb their sports activities; they may be advised to take medication instead before engaging in strenuous activity.

Swimming has long been touted as the best exercise for asthmatics. Sebastian-Sanchez says, "Children can benefit from swimming because it teaches proper breathing techniques and there are less environmental triggers associated with it."

Take your med exactly as prescribed, even when you feel well. With controller medicine, the effects are not evident immediately. It takes a few weeks for them to work. For this reason, some people discontinue medication because they deem it unnecessary or see no attack forthcoming.

To control your asthma continuously and permanently, you must adhere to the treatment exactly as the doctor recommends. "Asthma management requires a partnership between the patient, his family and their doctor," Sebastian-Sanchez stresses. Asthma can last a lifetime and can even be life threatening, but if you manage it properly, it is almost always controllable.

From health Today online; see the source article here.
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