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| Volume 1, Issue 5 | FEBRUARY 2002 |
| Inside This Issue | |||||
| 1 | Asthma | ||||
| 2 | Updates and Announcements | ||||
| 3 | Drug Fact Sheets | ||||
Medical Information Fact Sheet
Asthma is a chronic condition that occurs when the main air passages of the lungs, the bronchial tubes become inflamed. The muscles of the bronchial walls tighten and extra mucus is produced, causing the airways to narrow. This can lead to everything from minor wheezing to severe difficulty breathing. In some cases breathing becomes so labored that an asthma attack becomes life threatening.
Asthma is a treatable disease. Most flare-ups and deaths can be prevented. New drugs have been developed. Greater emphasis is now put on managing your own condition. You and your doctor can work together to gain control over symptoms, reduce the risk of severe attacks and help maintain a normal life.
Diagnosis:
Diagnosing asthma can be difficult. Symptoms can range from mild to severe and be similar to other lung conditions. Diagnosis may come as a result of medical history, physical exam and lung function tests. Lung function tests determine how much air moves in and out when you breathe. If your lung function test improve after you have been given a bronchodilator medication it is likely you have asthma. Your doctor may order a methacholine bronchial challenge. If you have asthma inhaling the methacholine will cause mild constriction of your airways, which can be measure by a lung function test.
Signs & Symptoms may include:
- Increased shortness of breath or wheezing
- Disturbed sleep caused by shortness of breath, coughing or wheezing
- Chest tightness or pain
- Increased use of bronchodilators
- A fall in peak flow rates as measured by a peak flow meter, a simple and inexpensive device that allows you to monitor your own lung function
In Children:
- An audible whistling or wheezing when the child exhales
- Coughing especially if the cough is frequent and occurs in spasms
- Waking at night with coughing or wheezing
- Shortness of breath, which may or may not occur when child exercises
- A tight feeling in the child's chest
Causes:
Asthma is more likely if you inherited the predisposition to the condition and are sensitive to allergens or irritants in the environment. Asthma can develop at any age. If you're younger than 30 it is most likely triggered by allergies.
In most cases asthma is caused from a combination of allergic and nonallergic responses. Triggers may include:
- Allergens, such as molds, cockroaches and pollen
- Air pollutants and irritants ¨ Smoking and secondhand smoke
- Respiratory infections including the common cold
- Physical exertion including exercise
- Cold air
- Certain medications including beta blockers such as propanolol, aspirin and other nonsteroidal anti-inflammatory drugs
- Sulfites and preservatives added to some foods
- Emotional stress
- Gastroesophageal reflux disease
- Sinusitis
Risk Factors:
- Living in large urban areas, especially inner city, which may increase exposure to environmental pollutants
- Exposure to secondhand smoke
- Exposure to occupational triggers, such as chemicals used in farming, hairdressing, paint, steel, plastics and electronics manufacturing
- Having one or both parents with asthma
- Respiratory infections in childhood
- Low birth weight
- Obesity
- Gastroesophageal reflux disease
Treatment:
There are three types of medical treatments available for asthma:
- Medications that acutely relieve symptoms or prevent flare-ups
- Medications that suppress airway inflammation over days, weeks or months
- Immunotherapy or allergy desensitization shots.
· Symptom relief:
Bronchodilators are medications that open up constricted airways and provide temporary relief of asthma symptoms. They include:
Beta-2 agonists. There are two types: short acting and long acting. Short acting medications begin working in minutes and last 2-4 hours. Long acting lasts up to 12 hours.
- The short-acting medications are typically prescribed for relief of asthma symptoms or flare-ups. The most common drugs, such as albuterol (Proventil, Ventolin) and pirubuterol (Maxair), act quickly to relieve symptoms and can be used as preventative measure before you exercise or breathe cold air. Prescribed "as needed" they may relieve Symptoms for up to 6 hours.
- Salmeterol (Serevent) and formoterol (Foradil) are long acting bronchodilators that relieve airway constriction for up to 12 hours. They are generally used to prevent symptoms especially at night. They are not recommended as a "rescue" medication for immediate relief during an asthma attack. They are usually used with an anti-inflammatory medication such as inhaled cortisone.
- Theophylline (Slo-Bid, Theo-Dur). This bronchodilator is taken in pill form every day. It is especially helpful in relieving nighttime symptoms of asthma. It does have many side effects and can promote gastroesophageal reflux disease. If taking this medication you should have regular blood tests to check if dosage is correct.
- Ipratropium (Atrovent) is a bronchodilator that is typically not recommended for the immediate relief of asthma symptoms.
· Long-term Treatment:
Anti-inflammatory are the mainstay medications for asthma. These drugs are continually taken to prevent attacks. Anti-inflammatory drugs reduce inflammation in the airways and prevent blood vessels from leaking fluid into airway tissues. The most widely used of the drugs include:
Corticosteroids are the most effective drugs for asthma. They help to decrease the frequency of attacks and lower the dosage of other medications needed to calm symptoms. Long term use of these types of steroids (oral and intravenous) can cause serious side effects. Inhaled corticosteroids deliver medications directly to your airways and therefore have fewer side effects and are very effective at controlling most types of asthma. If using a dose metered inhaler be sure to use a spacer and gargle with water after use and spit out the water. This will reduce side effects such as mouth and throat irritation and oral yeast infections. Inhaled corticosteroids may affect some children's growth; children should have their growth rate regularly monitored.
Leukotriene modifiers are a new class of medications used to treat asthma. These drugs work by reducing the production, or blocking the action, of leukotrienes - substances released by cell in your lungs during an asthma attack. Leukotrienes cause the lining of your airways to become inflamed, which leads to wheezing, Shortness of breath and mucus production. Using in conjunction with other medications can prevent more attacks. They are generally not as effective as inhaled corticosteroids.
Although they are not effective for everyone, daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) may help prevent attacks of mild to moderate asthma. In some cases they may help to prevent asthma triggered by exercise if taken an hour before rigorous activity.
· Immunotherapy:
If you have allergic asthma that can't be easily controlled by avoiding triggers and medications, allergy desensitization shots (immunotherapy) may help. Skin tests will be done to determine the allergens that cause the most problems, followed by a series of injections containing small doses of those allergens. Injections are generally given once a week for a few months, then once a month for a period of 3-5 years. Over time you should lose your sensitivity to the allergen. Immunotherapy carries the risk of an allergic reaction to the shot.
Prevention:
The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants. Even if you reduce indoor and outdoor allergens and irritants, managing asthma can be challenging. It often takes ongoing communication and teamwork with your doctor.
In addition to knowing and avoiding triggers, adopt the following behaviors:
- Develop an action plan. With the health care team write a detailed plan for taking maintenance medications and managing an acute attack. Asthma is an ongoing condition that requires regular monitoring and treatment.
- Monitor your Breathing. Like many people you may recognize your own signs of an impending attack. But because your lung function may decrease before you notice symptoms, regularly measure peak airflow with a home peak flow monitor.
- Treat attacks early. If one acts quickly, they are less likely to have a severe attack. Less medication will then be needed to control the symptoms. When the peak flow measurements show an impending attack, take medication as instructed and stop any activity that may have triggered the attack right away. If symptoms don't improve please seek medical attention.
Self-Care:
Although many people with asthma rely on medications to relieve symptoms and control inflammations, there are several things that can be done to maintain overall health and lessen the possibility of attacks:
Exercise. Regular exercise can strengthen the heart and lungs so they don't have to work as hard. It can help to achieve weight loss and decrease chances of other serious conditions. Keep in mind that cold weather exercises are more likely to cause wheezing. If exercising in the cold wear a mask to warm the air breathed in. Don’t exercise if temperature is below zero.
Use an air conditioner. Reduce exposure to airborne pollen from trees, grasses and weeds. Air conditioning also reduces humidity and can reduce exposure to dust mites.
Decontaminate your décor. To minimize dust that may aggravate nighttime symptoms, encase pillows, mattresses and box springs in dust proof covers. Replace bedding with synthetic materials. Wash sheets, pillowcases and mattress pads in hot water weekly. Replace synthetic pillows every 2-3 years.
Maintain optimal humidity. Keep humidity low (between 40%-50%).
Keep indoor air clean. Have furnace and air conditioner checked yearly. Change the filters according to the manufacturer's instructions. Possibly install small-particle filters.
Reduce pet dander. Avoids pets with fur or feathers. Have pets bathed regularly.
Clean regularly. Clean home at least once a week. Since cleaning may stir up dust, wear a mask or have someone else clean.
Limit use of contacts. Try substituting eyeglasses for contact lenses when pollen count is high. Pollen grains can be trapped under the lenses.
Mayo Clinic. (2001). Asthma. [Online]. Available: http://www.mayoclinic.com/findinformation/diseasesandconditions/invoke.cfm?id=DS00021&
HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!
This month I will be doing training on Reading and Comprehension of Drug Screens Results.
I will be moving to a new office at court so that I may be more available to the court staff that I serve.
In March we will be making the final arrangements to have a public health nurse at the juvenile court in Indio.
Editor: Kristen Thompson, PHN,Contributors: Hermia Parks, SPHN, MA, and Judy Earp, MHA, Director of Public Health Nursing.
