Asthma is a chronic lung disease that occurs when the main air passages in your lungs, known as the bronchial tubes, become inflamed or swollen. This inflammation causes the muscles around the bronchial tubes to contract or spasm, narrowing the airways and making it hard to breath. The inflammation can also lead to increased mucus production in your airway, which further blocks the air passages. Asthma cannot be cured, but we can control the asthma by controlling the inflammation in your airways.

WHAT ARE THE SYMPTOMS OF ASTHMA?
Symptoms of asthma may include wheezing (an audible, high-pitched or whistling sounds made when you breath), cough, chest tightness or shortness of breath (breathlessness). Fatigue is often seen in patients having an asthma exacerbation (attack). Most patients have symptoms occasionally, but some will have symptoms every day. The symptoms may vary from one exacerbation to the next; one exacerbation may be so mild that it's hard to be certain if you're even having an attack, while the next exacerbation may be so severe it can result in hospitalization, or even be life-threatening. Recognizing and treating the earliest symptoms of an asthma exacerbation will usually help prevent the attack from becoming severe.


WHAT CAUSES ASTHMA?
Most patients with asthma have an inherited, genetic predisposition to the condition. There are usually other family members with asthma or allergic conditions, but not always. What you inherit is a tendency for the airways to become inflamed, and this inflammation causes your airways to be overly sensitive to various factors that can trigger an asthma exacerbation.


TRIGGERS OF ASTHMA EXACERBATIONS:

1. Infections, especially colds, influenza and sinus infections.

2. Allergens, such as animal dander, pollen, dust mites, molds and sometimes foods.

3. Irritants, such as air pollution, cigarette smoke, strong odors, and even cold air. Any chemical exposure, especially at a work site, can cause asthma exacerbations.

4. Physical exertion, including exercise.

5. Certain medications, especially anti-inflammatory drugs like aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve) and many prescription anti-inflammatories. Beta-blocker drugs used for treatment of hypertension, heart disease and headaches can also trigger exacerbations.

6. Sulfites-preservatives used in wine and some foods, especially dried fruit.

7. Gastroesophageal reflux disease (GERD). Many patients whose asthma is worsened by GERD do not have the usual symptoms of heartburn or indigestion.

8. Stress and anxiety can also cause asthma exacerbations.

PREVENTING ASTHMA EXACERBATIONS:
All patients with asthma need to have asthma medications readily available at all times in case they have an exacerbation. Many asthmatics also need to take medications every day to control the airway inflammation that can lead to asthma exacerbations. The best way to prevent asthma attacks, though, is to identify and control your asthma triggers. It also helps to lead a healthy lifestyle. This means eating a proper diet, getting enough sleep, and exercising regularly. Regular aerobic exercise will help to strengthen your heart and lungs and help stabilize your asthma. If you're overweight, weight loss can result in significant improvement in your asthma symptoms.


AVOIDING ALLERGEN TRIGGERS:
All patients with asthma should avoid exposure to the many irritants that can trigger asthma exacerbations. However, just about anything you can see, smell or sense in the air can cause your airways to become more inflamed, leading to bronchial muscle constriction and an asthma attack. Therefore, you should avoid exposure to irritants such as smoke, chemicals, strong odors, airborne particulate matter (such as house dust from vacuuming), as well as cold air and air pollution as best you can (on spare the air days, you should try to stay inside and not exercise outdoors). If you know you will be exposed to these things, wear a face mask, use good ventilation and minimize your exposure time. Washing your hands frequently may help decrease your risk of catching a cold or flu. If you have allergic asthma, then avoiding those things you are allergic to is critically important. Skin testing will help identify any allergies you may have.


CONTROLLING YOUR ASTHMA
Asthma control means several things. It means keeping you from having any severe asthma attacks that lead to emergency room visits or hospital stays. It means reducing any long-term lung damage you may suffer as a result of your asthma. It means minimizing the impact of asthma on your life. Achieving adequate control of your asthma usually requires that you:

1. Identify and avoid your asthma triggers as best as you can.

2. Monitor your breathing by paying attention to symptoms and measuring your breathing capacity with a peak flow meter.

3. Use medications correctly. Failing to use your medications as prescribed will probably lead to more trouble with your asthma. It will also make it harder for your doctor to know if the medications are working well enough for you, or if they medications need to be changed. Having a written asthma action plan will help you know what to do when you first notice asthma symptoms. This is important because early action can help prevent a more severe attack from developing.

WHAT ARE THE GOALS OF ASTHMA TREATMENT?
If your asthma is well controlled, you should expect:

1. to have minimal, if any, symptoms of asthma

2. to have no need for visits to the emergency room or urgent care

3. to not miss work or school because of asthma

4. to have no side effects from your asthma medications

5. to be able to do anything you want to do

If this is not the case, and asthma is having a significant impact on your life, let me know. Working together, we can usually control your asthma, rather than letting the asthma control you.

WHAT MEDICATIONS ARE USED FOR ASTHMA?
There are two kinds of medicines for asthma: rescue medications to treat acute attacks and controller medications to prevent the symptoms in the first place. All asthmatics need to have the rescue medications available at all times. Patients having chronic symptoms (more than once or twice a week) or with frequent severe attacks need a controller medication that they should use every day to help prevent attacks.

Rescue medications are used to treat the symptoms of an acute attack

1. Short acting bronchodilators (Albuterol, Maxair or Xopenex) relax the tightened muscles around the airways to help open them up and relieve the acute symptoms of an asthma attack such as coughing, wheezing, shortness of breath and difficulty in breathing. If you need these medications more than once or twice a week your asthma is NOT well controlled and you may need to start anti-inflammatory medications.
Side effects: rapid heart beat, tremors, insomnia, anxiety

2. Anticholinergics (Atrovent) are inhaled bronchodilators that are sometimes used along with albuterol to treat acute attacks.
Side effects: dry mouth

Controller medications are taken every day to control your asthma and prevent or lessen asthma attacks, and are generally used for patients having symptoms more than once or twice a week. Do not stop these medications without consulting your physician:

1. Inhaled Corticosteroids (Flovent, Pulmicort, Beclovent, Vanceril, Azmacort, Aerobid, Q-var) are the best medications we have to control asthma. These medications should be taken every day and work by reducing the swelling and inflammation in your airways, thus making the airways less likely to react to your asthma triggers. Oral steroids are used to treat severe asthma attacks.

Side effects: hoarseness and thrush (a yeast infection in the mouth). You can reduce your risk of developing thrush by using a spacer when taking an inhaled steroid and rinsing your mouth with water after use. Using the inhaler just before you brush your teeth is a good way to both remind yourself to use the inhaler and to rinse after use. The use of very high doses of inhaled steroids for long periods of time may be associated with slowing of growth in children and osteoporosis (thinning of the bones) in children or adults. Such high doses, though, are only required for patients with severe asthma. Taking oral steroids for a long period of time or in high doses can cause many more side effects than inhaled steroids, and are associated with an increased risk of growth suppression and osteoporosis. One of the goals of asthma treatment is to minimize your need for use of oral steroids.

2. Leukotriene modifiers (Accolate, Singulair) also control asthma by reducing inflammation but are not steroids. They typically do not work as well as the inhaled steroids, and are generally only used if the inhaled steroids are not working well enough to control your asthma.
Side effects: headache, stomach upset, both rare.

3. Long acting bronchodilators (Serevent, Foradil) do not reduce inflammation but help to control asthma by relaxing airways for long periods of time (8-12 hrs). Unlike the short acting bronchodilators, these drugs are used routinely to control asthma and should NOT be used to treat acute asthma symptoms or an asthma attack. Use of higher than recommended doses of these drugs may cause abnormal heart rhythms, which can be dangerous.
Side effects: rapid heart rate, tremor, insomnia, anxiety.