Asthma Management – Symptom relief and prevention

Asthma Management

Summary

Asthma is a chronic inflammation of the body’s bronchial (airway) tissues. People with asthma experience shortness of breath, chest tightness, coughing and wheezing.  More than 20 million Americans suffer from asthma, according to the American Academy of Allergy, Asthma and Immunology.

People with asthma experience intensified symptoms during an asthma attack, which occurs when exposure to allergens or other stimuli further inflame the airways, leading to an inability to expel trapped air from the lungs.

There is no cure for asthma. People with asthma have a chronic and variable, but controllable, condition. Patients can combine education, lung function measurement, avoidance techniques, lifestyle changes and appropriate medications to reduce the likelihood of experiencing symptoms. Such a comprehensive approach is known as asthma management.

The key goals in an asthma management plan include achieving the following:

  • Minimal or nonexistent chronic symptoms
  • Minimal or nonexistent flare-ups
  • No restrictions on physical activity
  • No missed work or school days due to asthma
  • No emergency room visits or hospital room stays
  • Minimal need to use short-acting inhaled beta-agonists
  • Minimal or nonexistent side effects due to medications

Once an individual has been diagnosed with asthma, a physician will develop a specific asthma action plan to help the patient monitor the condition.

About asthma management

An asthma management plan is a blueprint for monitoring, treating and preventing asthma symptoms. Asthma patients can work with their physician to develop a treatment regimen that encompasses education, lung function measurement, lifestyle modifications, avoidance techniques and certain medications that prevent and treat symptoms. An asthma management plan should be adapted as necessary to the patient’s symptoms, needs and circumstances.

Asthma is a chronic inflammation of the lower airways that leaves people susceptible to reactions when they encounter certain allergens or irritants. During an asthma attack, people may experience symptoms such as shortness of breath, chest tightness, coughing and wheezing.

There is no cure for asthma. Asthmatics have a chronic condition that will not disappear. However, asthmatics can take control of their condition and lead an active life that includes participating in normal activities. The goal of asthma therapy for adults and children over 5 is to maintain normal or near normal lung function. The following outcomes indicate that patients are successfully managing their asthma:

  • Minimal or nonexistent chronic symptoms
  • Minimal or nonexistent flare-ups
  • No restrictions on physical activity
  • No missed work or school days due to asthma
  • No emergency room visits or hospital stays
  • Minimal need to use short-acting inhaled beta-agonists
  • Minimal or nonexistent side effects due to medications

To achieve such outcomes, patients can take several steps to monitor and reduce the symptoms of asthma. These include:

  • Avoidance techniques. Limiting exposure to allergens and irritants that trigger symptoms.

  • Lifestyle modifications. Noting asthma signs and symptoms, regular exercise and weight management are important lifestyle modifications that can reduce the risk of attacks.

  • Medications. Certain medications can help prevent asthma symptoms, or control them once they appear. There are two forms of medications: long-term control and rescue medications. These medications are designed to be used in the appropriate situation by the patient. For example, rescue medications should not be used for long-term control needs. 

  • Lung function measurement. Patients can use a small, hand-held device known as a peak flow meter to monitor changes in the status of their airways. Measurements taken with peak flow meters can warn patients of an impending asthma attack and alert them that they should take certain medication or contact their physician. Physicians can also use these measurements to determine the effectiveness of a treatment plan and whether or not any changes are necessary.
     
  • Education. People often improve their control over asthma by learning more about it. Patients should research the topic and openly discuss their questions and concerns with their physicians. People can also benefit from joining a support group. These groups allow patients to share helpful tips and coping skills.  

Once an individual has been diagnosed with asthma, a physician will develop an asthma action plan with the patient to help monitor the condition. This is a plan to manage asthma symptoms and reduce the occurrence of asthma attacks. A typical plan will contain the following elements:

  • A list of specific symptoms that often precede an individual’s asthma attacks

  • Steps to take during an attack

  • How to recognize a serious attack, and what to do about it

  • How to recognize an emergency

  • Changes in environment and behavior that can reduce the chances of an asthma flare-up

Since traveling often involves environmental changes that may affect asthma, patients should consult with their physician for asthma management techniques while traveling. For instance, physicians may be able to provide patients with tips for avoiding allergens (e.g., dust mites, mold) commonly found in cars, buses, trains, cruise ships, airplanes and hotel rooms.

It may also be beneficial for a patient to provide certain people (e.g., family, coworkers) with copies of their asthma management plan. This provides family and friends with the knowledge of how to respond when the patient cannot help him or herself. Asthmatics should also wear a medic alert bracelet in case of an emergency.

Symptom avoidance

People with asthma cannot be cured of the condition. However, patients can reduce the likelihood of suffering symptoms by making several lifestyle modifications. Avoidance is the most important of these. This technique involves limiting exposure to allergens or stimuli likely to trigger symptoms or full-blown asthma attacks.

Many asthmatics find that allergy symptoms can trigger their asthma. For these patients, managing allergy symptoms is an important technique for reducing asthma attacks.

Allergens and irritants known to trigger asthma include:

  • Pollen
  • Mold
  • Dust mites
  • Air pollution
  • Pet dander
  • Cockroach debris
  • Tobacco smoke
  • Certain foods
  • Feathers in pillows
  • Hair spray
  • Spray-on deodorants
  • Wood burning smoke
  • Strong odors (from perfume, household chemicals, air fresheners or paints)

Other triggers include:

  • Cold air

  • Exercise

  • Temperature changes

  • Menstrual cycles (when hormonal changes may trigger asthma)

  • Pregnancy

  • Viral respiratory infections (including colds, bronchitis and flu)

  • Sinus infections

  • Gastroesophageal reflux disease (GERD)

  • Nonsteroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen)

  • Beta-blockers (drugs used to treat heart disease, high blood pressure and migraines)

  • Sulfites (a preservative in salad bars, dehydrated soups, dried fruit, alcohol and other foods)

People with asthma can also make lifestyle modifications that will leave them less vulnerable to reacting to allergens and other stimuli. For example:

  • Lead a healthy lifestyle. This includes adequate monitoring of asthma symptoms, proper rest, good nutrition and regular exercise.

  • Combat obesity. There appears to be a correlation between obesity and increased incidence of asthma.

  • Reduce stress. Anxiety and stress can cause fatigue, which in turn can trigger asthma symptoms.

In addition, asthmatics need to learn to assess and monitor asthma severity with symptom reports and measurement of lung function with a peak flow meter. The more informed the patient is about asthma triggers and management techniques, the less asthma symptoms will interfere with daily activities.

Symptom relief and prevention

For some people, avoidance techniques and lifestyle modifications will not be enough to control symptoms. In such situations, medications may be needed. Asthma medications can be divided into one of two categories:

  • Quick-relief medications. Also called “rescue” medications, these are designed to instantly relieve the symptoms of an asthma attack. They are usually not meant to be taken long-term.

  • Long-term-control medications. These are designed to be used regularly to minimize inflammation and prevent asthma flare-ups before they occur. Topical corticosteroids are most often used. Long-acting beta2 agonists are added when a patient’s symptoms are uncontrolled with corticosteroids alone.

Asthma medications are delivered in various forms, including:

  • Pills. Solid form of medication that is swallowed or chewed. The medication dissolves and is absorbed into the bloodstream through the lining of the stomach and intestines.

  • Inhalers. Aerosol devices that allow medications to be delivered directly to the interior of the lungs through inhalation.
  • Nebulizers. Devices that convert liquid medication into a fine mist that can then be inhaled into the lungs.

Asthma medications must be taken as prescribed to be effective. Many asthmatics overuse quick-relief medications and underuse long-term control medications. Proper asthma management requires the patient to use medications appropriately. Patients who find themselves increasingly using their quick-relief medications should contact their physician. They may require changes in their asthma management plan.

Current asthma treatment focuses primarily on preventing or reducing the inflammation process, and relaxing the smooth muscle that tightens during bronchospasm. Healthcare professionals use asthma medications with two goals in mind:

  1. To keep the airway clear so the patient can breathe normally.

  2. To prevent airway remodeling, a thickening of the bronchial walls that can result from chronic inflammation and lead to permanent damage.

Bronchodilators are the primary class of medications used to treat asthma. These widen a person’s airways by relaxing the bronchial smooth muscle. Short-acting bronchodilators (such as beta2 agonists) provide immediate rescue relief of asthma symptoms and should be used only when necessary. Long-acting bronchodilators (which include long-acting beta2 agonists) relieve symptoms for longer periods of time and are used once in the morning, and once at night.

It is important to not overuse these medications. Such abuse can make an asthmatic condition worse and possibly even increase the risk of death from asthma.

Other asthma medications stop an asthma attack before it starts by preventing the bronchial inflammation that constricts airways and hampers breathing. These drugs include:

  • Corticosteroids. Medications similar to the body’s hormones that prevent/reduce the inflammation associated with asthma. They are usually given by inhalation. 

  • Leukotriene modifiers. Medications that inhibit the role of leukotrienes, which are a type of chemical involved in an asthma attack. They may be taken daily or several times a day to prevent an asthma attack from occurring.

  • Mast cell stabilizers. Medications that prevent mast cells from triggering reactions that can lead to an asthma attack or allergic reaction. This class of drug is rarely prescribed.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about asthma management:

  1. What steps should I take before, during and after an asthma attack?

  2. When should I go to the hospital for an asthma attack?

  3. How can I tell if my asthma management plan is working?

  4. Under what circumstances may you make changes to my asthma management plan?

  5. Will my child’s asthma management plan change as they get older?

  6. What types of allergens and irritants should I avoid as part of my asthma management plan? How can I avoid them?

  7. How often should I use my asthma medications? How much should I take?

  8. My asthma management plan requires me to lose weight. Can you recommend a diet and exercise plan?

  9. My asthma management plan requires me to reduce stress. Can you recommend stress management techniques?

  10. What changes will I have to make to my asthma management plan when I travel?
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