Asthma
Definition
Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.
Symptoms
- Cough with or without sputum (phlegm) production
- Pulling in of the skin between the ribs when breathing (intercostal retractions)
- Shortness of breath that gets worse with exercise or activity
- Wheezing
- Comes in episodes
- May be worse at night or in early morning
- May go away on its own
- Gets better when using drugs that open the airways (bronchodilators)
- Gets worse when breathing in cold air
- Gets worse with exercise
- Gets worse with heartburn (reflux)
- Usually begins suddenly
Emergency symptoms:
- Bluish color to the lips and face
- Decreased level of alertness such as severe drowsiness or confusion, during an asthma attack
- Extreme difficulty breathing
- Rapid pulse
- Severe anxiety due to shortness of breath
- Sweating
Additional symptoms that may be associated with this disease:
- Abnormal breathing pattern --breathing out takes more than twice as long as breathing in
- Breathing temporarily stops
- Chest pain
- Nasal flaring
- Tightness in the chest
Treatments
There are two basic kinds of medication for the treatment of asthma:
* Long-acting medications to prevent attacks
The goal of treatment is to avoid the substances that trigger your symptoms and to control airway inflammation. You and your doctor should work together as a team to develop and carry out a plan for eliminating asthma triggers and monitoring symptoms.
There are two basic kinds of medication for the treatment of asthma:
* Long-acting medications to prevent attacks
* Quick-relief medications for use during attacks
Long-term control medications are used on a regular basis to prevent attacks, not to treat them. Such medicines include:
* Inhaled corticosteroids (such as Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation
* Leukotriene inhibitors (such as Singulair and Accolate)
* Long-acting bronchodilators (such as Serevent) help open airways
* Omilizumab (Xolair), which blocks a pathway that the immune system uses to trigger asthma symptoms
* Cromolyn sodium (Intal) or nedocromil sodium (Tilade)
* Aminophylline or theophylline (not used as frequently as in the past)
* Sometimes a single medication that combines steroids and bronchodilators are used (Advair, Symbicort)
Quick relief, or rescue, medications are used to relieve symptoms during an attack. These include:
* Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, Xopenex, and others
People with mild asthma (infrequent attacks) may use quick relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms. A severe asthma attack requires a check up by a doctor and, possibly, a hospital stay, oxygen, and medications through a vein (IV).
A peak flow meter is a simple device to measure how quickly you can move air out of your lungs. It can help you see if an attack is coming, sometimes even before any symptoms appear. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of a specific person's best results are a sign of a moderate asthma attack, while values below 50% are a sign of a severe attack.
Drugs
The chief methylxanthine drug is theophylline. It may exert some anti-inflammatory effect and is especially helpful in controlling nighttime symptoms of asthma. When, for some reason, a patient cannot use an inhaler to maintain long-term control, sustained-release theophylline is a good alternative. The blood levels of the drug must be measured periodically, as too high a dose can cause an abnormal heart rhythm or convulsions.
Beta-receptor agonists (drugs that trigger cell response) are bronchodilators. They are the drugs of choice for relieving sudden attacks of asthma and for preventing attacks from being triggered by exercise. Some agonists, such as albuterol, act mainly in lung cells and have little effect on the heart and other organs. These drugs generally start acting within minutes, but their effects last only four to six hours. They may be taken by mouth, inhaled, or injected. In 2004, a new lower concentration of albuterol was approved by the FDA for children ages two to 12.
Steroids are drugs that resemble natural body hormones. They block inflammation and are effective in relieving symptoms of asthma. When steroids are taken by inhalation for a long period, asthma attacks become less frequent as the airways become less sensitive to allergens. Steroids are the strongest medicine for asthma, and can control even severe cases over the long term and maintain good lung function. However, steroids can cause numerous side effects, including bleeding from the stomach, loss of calcium from bones, cataracts in the eye, and a diabetes-like state. Patients using steroids for lengthy periods may also have problems with wound healing, may gain weight, and may suffer mental problems. In children, growth may be slowed. Besides being inhaled, steroids may be taken by mouth or injected, to rapidly control severe asthma.
Leukotriene modifiers are among a newer type of drug that can be used in place of steroids, for older children or adults who have a mild degree of persistent asthma. They work by counteracting leukotrienes, which are substances released by white blood cells in the lung that cause the air passages to constrict and promote mucus secretion. Other drugs include cromolyn and nedocromil, which are anti-inflammatory drugs that often are used as initial treatments to prevent long-term asthmatic attacks in children. Montelukast sodium (Singulair) is a drug taken daily that is used to help prevent asthma attacks rather than to treat an acute attack. In 2004, the FDA approved an oral granule formula of Singulair for young children.
If a patient's asthma is caused by an allergen that cannot be avoided and it has been difficult to control symptoms by drugs, immunotherapy may be worth trying. In a typical course of immunotherapy, increasing amounts of the allergen are injected over a period of three to five years, so that the body can build up an effective immune response. There is a risk that this treatment may itself cause the airways to become narrowed and bring on an asthmatic attack. Not all experts are enthusiastic about immunotherapy, although some studies have shown that it reduces asthmatic symptoms caused by exposure to dust mites, ragweed pollen, and cats.
