Asthma is an inflammatory disorder (hyperreactivity of the airways) resulting in excessive mucus productions and airway spasm in susceptible people. Mucus production causes chest congestion and phlegm. Airway spasm causes coughing, chest tightness and wheezing.
The most common triggers for asthma include: Respiratory viral infections, allergies and smoking.
Managing asthma involves avoiding the triggers, treating mucus production (controller) and treating airway spasm (rescue).
Early recognition of asthma symptoms and initiating therapy are key to preventing asthma exacerbation.
Types of Asthma
Intermittent Asthma
Symptoms occur less than two times per week and are usually resolved within two weeks. If not recognized early, then rescue medication is required for short periods of time when asthma flares up. At times, controller medications may be needed for a short period of time (weeks). Lung functions are normal when not experiencing an asthma flare.
Persistent Asthma
Chronic condition involving underlying hyperactivity in the lungs with triggers making it worse. Controller medication is needed all of the time (months or even years). Usually, there are other family members who have the same condition. Rescue medication is required for short periods of time when asthma flares up. Lung functions are normal or abnormal depending on the severity of the asthma. The goals of therapy are to maintain lung functions as close to normal values.
Q: What are Well-controlled Asthma symptoms?
A: Patients are able to exercise and sleep with no coughing, chest congestion and/or wheezing. There should be no limitation of activity.
Q: What are Uncontrolled Asthma symptoms?
A: Patients experience a deep cough, chest congestion and/or wheezing on exertion or at night. Rescue inhaler is being used more than two times per week.
Goals or Therapy
- Asthma is not curable but controllable by avoiding triggers and taking medications.
- Reduce asthma symptoms so they occur less than 2 times per week or not at all.
- No nocturnal awakening caused by asthma.
- Full participation in desired physical activity and sports without asthma.
- Prevent asthma flare-ups/attacks, ER visits and hospitalizations.
- Avoid absences from school or work due to asthma symptoms.
- Maintain normal or near normal lung functions.
- Provide optimal treatment with minimal or no side effects.
- Avoid the need or use of oral steroids.
Asthma Triggers and Control Measures
- Colds and infections: Avoid people with colds or the flu while washing your hands on a frequent basis. Get a flu vaccine every year. If eligible, get pneumonia vaccine. Be sure to rest adequately, eat a balanced diet and exercise regularly.
- Dust mites: If allergic, then encase mattresses, pillows and box spring in dust mite-proof encasements. Wash all linens weekly in a hot water wash (130°F or above). Decrease humidity in the home to less than 50%. Removal of carpet and reduction of clutters such as soft toys can lead to a decrease in dust mite levels. If it is not possible to remove carpet, then regularly use a vacuum with a HEPA filter.
- Animal Dander: If allergic, then the removal of a pet from the home is the best method for reducing allergen exposure. It may take several months after removing a pet from the home to eliminate the allergen in the environment. If it is not possible to remove a pet from the home, then it is best to keep pets away from bedrooms and bathe them regularly. Also, aggressive measures in reducing reservoirs (such as carpet), using air filtration and vacuuming with a HEPA filter will help reduce allergen levels.
- Molds: If allergic, then keep bedrooms, bathrooms and the basement as dry as possible. Run a dehumidifier and keep humidity between 35% to 50%. Keep windows closed and run air conditioning when outdoor mold counts are high. Vent the bathrooms and kitchen. Clean washable surfaces with a 50% bleach solution.
- Cockroach: Take measures to keep cockroaches away by using sprays or roach traps.
- Pollen: If allergic, then keep windows closed and run air conditioning when outdoor pollen counts are high.
- Tobacco Smoke: Do not smoke and avoid all forms of secondhand smoke exposure.
- Smoke from woodstoves/leaves/gasoline: Avoid using wood burning stoves, fireplaces and kerosene heaters.
- Weather Extremes: Cover your mouth and nose with a scarf on windy or cold days. Avoid being outdoors on hot and humid days as well as on ozone action days.
- Strong Odors and Aerosol Sprays: Avoid strong perfumes/fragrances and aerosol sprays. Avoid exposure to paint fumes.
- Exertional Activity: Exercise is healthy but limit it to a tolerable level. Work toward better control of asthma in order to improve exercise tolerance.
- GERD (Gastroesophageal Reflux): Uncontrolled GERD can exacerbate asthma.
- Medications: Beta-Blockers and Aspirin can exacerbate asthma for some people. If that is the case, contact your physician before you stop taking these medications.
