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Asthma is a chronic lung condition. It is characterized by difficulty in breathing.
People with asthma have extra sensitive or hyperresponsive airways. The airways react by narrowing or obstructing when they become irritated. This makes it difficult for the air to move in and out. This narrowing or obstruction can cause one or a combination of the following symptoms:
This narrowing or obstruction is caused by:
Two factors provoke asthma:
Common triggers of bronchoconstriction include everyday stimuli such as:
Smoke acts as a very strong trigger. Second-hand smoke has been shown to aggravate asthma symptoms, especially in children. The effects of one cigarette linger in the home for 7 days, and therefore it is very important to provide a SMOKE-FREE HOME for all children. In fact, some health care workers feel that smoking in a home where there is a child with asthma is a form of child abuse.
Children should not be exposed to a polluted environment over which they have no control.
Causes or Inducers
The most common inducers are:
Inhalant allergens are the most important inducer or cause of inflammation and airway hyperresponsiveness. Probably 75-80% of young asthmatics are allergic.
The most common inhaled allergens include:
Exposure to an allergen (e.g. cat secretions) may cause immediate symptoms such as wheeze or cough. This occurs because airways are hyperresponsive and react by tightening. These symptoms can easily be relieved by a bronchodilator (such as VentolinÂ®). However, about 4 and 7-8 hours after exposure to the secretion, a late response occurs which is caused by the inflammation. This inflammation develops over time. Because of the late response, it is often difficult for the patient and physician to identify what is actually causing the asthma.
Respiratory Viral Infections
In children, respiratory viral infections may cause a deterioration in his or her asthma. A respiratory viral infection is probably one of the most common causes of asthma. In some cases, the influenza vaccine is indicated. This may help to prevent respiratory complications that can occur from developing influenza. This vaccine is contraindicated for those individuals who have an allergy to eggs.
Making a correct diagnosis is extremely important: if asthma is correctly diagnosed it can be treated appropriately.
The diagnosis of asthma involves all of the following:
Because of the variability of symptoms (meaning symptoms can become worse and improve over time) a diagnosis cannot always be made immediately.
Patient education is an important area where asthma treatment can be improved. Asthma is common and controllable. Asthma is a disease that is variable, meaning that symptoms may get worse and may improve over time. Because of this variability, it is often necessary to review and change the treatment. In order to enhance the patient-physician relationship, the patient must be familiar with the following:
The patient with this type of knowledge can communicate to the physician in order to work out an appropriate treatment plan. The goals of treatment should be understood and agreed upon by both the physician and the patient.
Long Term Asthma Management
Environmental control should always be initiated along with taking the appropriate medications. If exposure to inducers is avoided, less medication is required.
It is not always easy to identify what inducer is making asthma worse. It often means reviewing the history of symptoms carefully i.e. keeping track of the symptoms.
Controlling the inside and outside environment at home and in school, should be considered for those people who have identified allergies. For example:
The successful approach to asthma management depends on using anti-inflammatory medications with bronchodilators as needed for immediate and occasional relief of symptoms.
The successful approach to asthma management, both in and out of hospital settings, is dependent upon the use of anti-inflammatory treatments with bronchodilators being prescribed for immediate and occasional relief of symptoms.
It has been shown that regular, frequent use of bronchodilator therapy may actually worsen asthma. Again this stresses the need for adding anti-inflammatory medications if bronchodilator therapy is required often to control symptoms.
Anti-Inflammatory Medications (Preventers)
Types of Anti-Inflammatory Drugs
There are steroidal and non-steroidal anti-inflammatory drugs. The most common ones include:
Corticosteroid drugs are the most effective preventer.
They work by reducing and preventing airway inflammation, swelling and mucus.
They must be used regularly and DO NOT have immediate effects. This means they have NO VALUE when an effect is needed in minutes.
A stepwise approach to the treatment of asthma involves the introduction or change in anti-inflammatory medication.
Increased asthma symptoms indicate the need to increase the anti-inflammatory in order to achieve control. As control is achieved and the patient remains symptom-free over a period of time (as specified by the physician), a decrease of medications can be initiated by the patient.
Side Effects of Corticosteroid Inhalers
Corticosteroid tablets or PrednisoneÂ®:
Other preventers are IntalÂ® and TiladeÂ®. They are non-steroidal and again, are used to reduce the inflammation.
Leukotriene Receptor Antagonists
Leukotriene receptor antagonists are a new class of oral asthma medications.
They act against one of the inflammatory components of asthma and provide protection against bronchoconstriction when taken before exercise or exposure to allergens or cold. They decrease both the early and late asthmatic response.
Because they are still so new, the actual role of leukotriene receptor antagonists in the management of asthma is not clear, i.e. it is not fully understood who exactly will benefit most when taking these medications.
Examples of leukotriene receptor antagonists available in Canada are:
Don’t let asthma manage you; you manage your asthma.
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