ASTHMA

MANAGING ASTHMA

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Asthma is one of the most serious, if not life-threatening, symptoms of chronic airway-digestive inflammatory disease (CAID). There are millions of people who are affected by asthma, ranging from the very young to the very old, crossing ethnic barriers and socioeconomic groups. In the United States, asthma is the number one killer of children.

The symptoms

Understanding the Respiratory System

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Asthma affects the functioning of the lungs and the entire respiratory system. As discussed in category 1, the nose is the portal to our body’s airway, allowing us to breathe clean, filtered, and humidified air. Once air is processed by the sinuses, it moves toward the lungs through the trachea (3, page 32). The trachea

What Happens During an Asthma Attack?

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During an asthma attack, the muscles surrounding the bronchi tighten, significantly reducing the size of the bronchi (8). This is referred to as acute (sudden) airway obstruction. Meanwhile, the mucous membrane that lines the bronchi and alveoli begins to swell and produce more mucus, further obstructing the bronchi. This inflammation can occur as a response to various stimuli; changes in the structure and function

CAID and Asthma

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Many of the same triggers for CAID can also prompt an asthma attack. Sinus disease is now recognized as a leading factor in respiratory illnesses and is known to actually worsen asthma. The sinuses are the filters that clean the air we breathe: It, therefore, makes sense that breathing dirty air will irritate the lungs. Postnasal drip alone is a common cause of asthmatic flare-up leading to wheezing.

Defining Asthma Symptoms and Conditions

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Based on the intensity of the symptoms, asthma is classified as one of the following:

■ Mild intermittent asthma. People with this condition experience symptoms less than twice a week, with no more than two nocturnal awakenings per month, meaning that they are awakened from sleep because of difficulty breathing. Typically, those in this category develop symptoms when being exposed to a triggering factor

WHEN IT'S NOT ASTHMA

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Wheezing and shortness of breath can occur even if you do not have asthma. For example, a bronchial infection, known as bronchitis, might make you feel as if you were suffering from asthma. During bronchitis, the bronchial tubes are chronically constricted and partially or totally blocked by the large amount of mucus produced by the inflamed lining. These

Decoding My Problem

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Asthma symptoms should not be taken lightly. Review your results j from the asthma portion of the CAID Quiz (p. 72). Locate your score so that you can define your next course of action. Follow the guidelines ] as listed here:

■ Any asthma score greater than 5 should be treated by a physician. 1

■ If you also suffer from other CAID symptoms, you need to see an j ear,

A Visit with a Physician

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A careful history, a comprehensive physical examination, and pulmonary | function tests, should help a physician narrow down your complaints. 1 Make sure to relay all prior episodes of asthma or lung problems, aller - : gies, family history of asthma or allergies, and triggering factors that you < have decoded.

The pulmonary

Medical Treatment Options

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Asthma can be completely controlled through the proper and consistent use of medication. The type of proper medical treatment depends on what kind of asthma you have, and the severity of your symptoms. Treatment is divided into two protocols: long-term control or maintenance for each of the various types of asthma and quick relief during acute exacerbations.

LONG-TERM AND MAINTENANCE

Delivering Asthma Medications

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Because asthma attacks can occur with a quick onset, the best way to deliver medication is often by inhaling it. Inhaled medications relax the muscles around the bronchial tubes so that air can flow freely. Inhaled medications can be delivered in three distinct ways. The first is via a small compressor called a nebulizer. Liquid medication is poured into a

chamber that is connected with tubing to both

Dry Powder Inhalers

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Inhaled medication can also be dispensed in a dry powder form. For some, the inhalation technique is easier than the MDI: You do not have to synchronize your breathing with the pressure of the inhaler. For powders, the medication is released by your inhalation effort, known as breath activated. A commonly used dry powder inhaler is Advair. This combines two medications: a long-acting

LONG-TERM MEDICATIONS Inhaled Corticosteroids

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ICSs play an important role in the management of chronic asthma. Studies have shown that if used regularly, the ICSs reduce the frequency of the symptoms, reduce the need for rescue inhalers, reduce the risk
of serious complications, lower the rate of hospital admissions,

Leukotriene Receptor Antagonists

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A new class of medication used in the treatment of bronchial asthma is leukotriene receptor antagonists. This medication blocks the release of the chemical compounds that are normally released by the inflammatory mucous membranes in the lung during the acute phases of asthma.

Inhaled Cromones (Mast Cell Stabilizers)

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Mast cell stabilizers act by reducing the inflammation of the bronchial tubes and seem to be effective in mild asthma. They are also found to be more effective in children than in adults. These medicines include Cromolyn and Nedocromil. To gain the most benefit, do not miss doses. Side effects are minimal, but include the following:

QUICK-RELIEF, OR EMERGENCY MEDICATIONS

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Quick-relief medications relax the muscles around the bronchial tubes so that air can flow freely through them. As noted earlier, these medications are called bronchodilators or beta-agonists because they connect rapidly to beta-receptors, causing them to work. These agents work well but act only for a short period

ORAL CORTICOSTEROIDS

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Steroids in an oral or intravenous form are used to treat a range of asthma attacks. Their role is to reduce the inflammation of the bronchial tube’s lining, thus reducing the accumulation of mucus and clogging of the airways. The side effects of oral steroids are serious, as discussed in earlier categorys. However, a single treatment regimen of steroids is relatively safe. An intravenous dose of steroids

OXYGEN

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During an acute attack, it is necessary to administer oxygen continuously until the flare-up is completely over. As described earlier, during an asthma flare-up, your oxygen levels can drop considerably. Oxygen should be administered only under a doctor’s direct supervision.

ASTHMA MEDICATIONS DURING PREGNANCY

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Women with asthma used to be discouraged from becoming pregnant, but advances in medication have made pregnancy extremely possible. Yet like all other aspects of pregnancy, it can change the natural course of asthma. Asthma symptoms can worsen, improve, or remain unchanged. The general principles of asthma therapy can be followed during pregnancy, with these guidelines:

Children and Asthma

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Children usually experience complete remission from asthma more frequently than adults do. Between 30 and 70 percent of children who develop asthma either improve or are totally asymptomatic after the onset of puberty. Asthma appears to be more severe in girls than in boys. Furthermore, a small subgroup of children with asthma is linked to maternal smoking. It is interesting that recent studies have shown that those

Lifestyle Changes

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Asthma related to allergies and CAID can be controlled, and often prevented, through avoidance and education. If you can recognize your triggers, as well as your trigger symptoms, you will be able to control your asthma through early use of your medication.

The first step is to create

Surgical Treatments

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There are no surgical treatments that can control asthma symptoms, but for patients who suffer from both sinus disease that requires surgery and asthma, I have found that these patients report that their asthma flares less often after they have had sinus surgery. In the past,

This initial hit of inflammation would probably lead you to believe that you had come down with a simple cold.