Recognizing Asthma Triggers and Understanding Treatment Options

Asthma, the chronic inflammatory disorder of the pulmonary tissues, which causes breathing difficulties by narrowing and constricting the airways, affects 17 million Americans, with 5 million under the age of 18. Every year, asthma symptoms are responsible for millions of lost work days and an average loss of 10 million school days for children. Numerous children lose minutes of classroom instruction because of visits to the school's nurse to use inhalers and nebulizers. There are an average of 15 asthma-related deaths daily, and the occurrence of asthma continues to rise as a result of factors such as air pollution and indoor air pollution, resulting from better, more energy efficient construction. For an asthmatic, identifying personal triggers and avoiding them, are often the most important steps in the treatment and prevention of asthma attacks.

Asthmatics, as well as their families, should at least have a basic understanding of what asthma is as well as the importance of treatment and prevention.

Anyone can suffer from asthma, it crosses all socio-economic barriers, but the treatments are not always used properly. One possible factor for this may be the education that patients receive when a diagnosis is made. A recent study released by Johns Hopkins researchers found that African Americans have more severe asthma symptoms and it is thought this is due in part to the asthma care they receive. Women, according to the same study, were shown to be less likely than men to follow their daily asthma management plans and use their medications. Young children, usually those under the age of 5, typically do not receive a controller medicine, a corticosteroid that helps prevent asthma attacks. Often these same children have needed to rely frequently on bronchodilators.

A survey recently completed by the American Academy of Allergy, Asthma, and Immunology (AAAI), showed that many triggers can be found in classrooms, and the AAAI supports the position that responsible children should be permitted to carry their fast-acting inhalers with them in school. Asthmatics, as well as their families, should at least have a basic understanding of what asthma is as well as the importance of treatment and prevention. Developing an asthma management plan is one way to make this happen. Asthmatics should have one for daily treatment and one for emergency treatment.

Developed with the assistance of a physician, children should have a copy of both their daily and emergency treatments on file with the school's office.

By following an asthma management plan for daily treatment and avoiding triggers when possible, asthmatics now are able to participate in a wide range of normal activities. Since an asthmatic's lungs are almost constantly inflamed, it makes the daily treatment with an inhaled corticosteroid necessary to keep the airways open. Leukotriene slowly produces mucus that blocks the airways, and leukotriene blockers have been used for treatment in the past. In the past, asthmatics have had to sit out of normal physical activities, but with the treatments of today combined with regular exercise, asthmatics can be involved in activities of their choice. The benefits of regular exercise are the same as for those without asthma, but exercise also helps to counter the weakening effects of the corticosteroids on the muscle tissue. Triggers are different for each asthma sufferer. About 80 percent of asthmatics have a reaction to airborne substances such as pollen, mold, dust and dander. Irritants, such as strong odors like perfumes and other chemicals, cigarette smoke, and aerosol sprays also can affect asthma sufferers. Exercise on a cold or windy day can be a trigger. By keeping a record of the circumstances surrounding asthma attacks, the asthmatic is better able to identify triggers, predict an upcoming attack, and in so doing, allow the asthmatic to live a productive and active life.

The two physiological causes of asthma symptoms are inflammation inside the airways and broncho-constriction, the tightening of the muscles surrounding the airways. Corticosteroids are probably the most common daily preventative treatment for asthmatic symptoms. With treatment under one's daily management plan, the goal should be to reduce the number and severity of asthma attacks, while using the lowest, most effective dose of medicine. Though once believed to stunt growth in children, the cortico-steroids, a highly-topical treatment that reduces inflammation in the airways, have proven to be a major advance in asthma therapy. Oral steroids perform the same basic function as inhaled corticosteroids, but they are digested and have more side effects with long-term use, whereas the inhaled corticosteroids go directly into the lungs with little being absorbed into the bloodstream. Bronchodilators relax the smooth muscles in the bronchioles, the muscles that have spasms causing the constriction of the bronchial tubes during an asthma attack. Bronchodilators are used for the quick relief of asthma symptoms during an attack.

When used together, these two classes of medicines reduce the symptoms of asthma attacks and improve the peak expiratory flow. Acute asthma attacks come suddenly and require immediate attention. A single attack can last minutes or days and it can become life-threatening thereby requiring hospitalization. Often, during an asthma attack, the expiration of the breathing process is the hardest part for the asthmatic. The expiratory air, or residual volume, becomes trapped in the lungs and causes the intake of fresh air, or vital capacity, to be limited. Peak expiratory flow is measured by a peak-flow meter, and is sometimes used to predict an asthma attack. Another goal for the asthmatic is to achieve peak capacity or normal airflow which can be achieved by daily treatment and use of a peak flow meter. The peak flow meter is portable, allowing for its use anywhere and should be used two to three times daily. By improving the exhalation flow, stale air exits the lungs allowing for better oxygenation of the body, which promotes better health in general.

The use of antihistamines are used to help alleviate allergy symptoms by blocking the effects of histamine, a chemical compound released during allergic reactions. Histamine causes constriction of the bronchi, which occurs during an asthma attack. The FDA is currently considering labeling nonsedating antihistamines as over the counter, a move, which has some people bothered. In a letter to the FDA Advisory Committee, Nancy Sander, the president of the Allergy and Asthma Network Mothers Asthmatics, opposes the OTC status being considered for nonsedating antihistamines. Asthma is a life-threatening disease that should be diagnosed and treated by a physician, and Ms. Sander believes that nonsedating antihistamines may be safe for asthmatics but only under a physician's care. In the past, antihistamines have not been recommended for asthmatics, though they do relieve some of the symptoms of an asthma attack.

Other possible treatments are currently being explored. Immunotherapy, the practice of injecting an antigen into a patient to build their immunity to it, is a non-drug approach to asthma. Another possibility being explored is the use of mageniusm sulfate to treat asthma.

Another goal for the asthmatic is to achieve peak capacity or normal airflow which can be achieved by daily treatment and use of a peak flow meter.
Magnesium sulfate is currently used to treat preeclampsia and eclampsia, and it is used as an anti-inflammatory. The studies on the use of magnesium sulfate are conflicting at this time. With the new disks and turbohalers, patients do not have to coordinate breathing, since the devices are breath-activated. The discuss delivers both the corticosteroid and the bronchodilator. Inhalers are the preferred method to medicate because they deliver the medicine to the lungs directly allowing for immediate treatment. Though corticosteroids are the most widely used anti-inflammatory for asthma, they do have side effects. The National Jewish Center for Immunology and Respiratory Medicine has a program working toward finding replacement therapies. Current technologies being developed are designed to help asthma patients treat their asthma more easily and in so doing, allow asthmatics to follow their prescribed treatment plans more fully.

Asthma is currently on the rise in America and education for the asthmatic is crucial. If an asthmatic is informed then they are more likely to use their prescribed treatments and understand the importance of compliance. Following their management plans, avoiding triggers as mush as possible, and developing technologies will greatly improve the quality of life for asthmatics.

Helpful Information

Allergy & Asthma Network Mothers of Asthmatics

2751 Prosperity Ave., Ste. 150

Fairfax, VA 22031


American Lung Association

1740 Broadway

New York, NY 10019


National Jewish Medical & Research Center

1400 Jackson St.

Denver, CO 80206

(800) 552-LUNG

This article originally appeared in the November 2001 issue of HME Business.

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