The asthma is a chronic condition that happens when the conduits of air of the lungs, the bronchial tubes become inflamed. The muscles of the bronchial walls you apretan and an additional quantity of snot takes place causing that the conduits of air are narrowed. This is manifested from a sílbido in the chest until severe difficulty to breathe. In some cases the asthma attack can threaten the patient's life.

However, the asthma is a friendly condition, recently the scientists have had a better understanding about the asthma and their causes. Jointly with their doctor you can control the asthma and to reduce the severe attacks helping him to take a normal life.

Asthma is very common among children, teens and adults. It is a disease that causes the airways of the lungs to tighten.

An asthma attack is when your lungs aren’t getting enough air to breathe. Asthma attack symtoms are:

Trouble breathing
Wheezing
Coughing
Chest pain
Chest tightness

Two factors provoke asthma:

-Triggers result in tightening of the airways (bronchoconstriction).
-Causes (or inducers) result in inflammation of the airways.

In contrast to triggers, inducers cause both airway inflammation and airway hyperresponsiveness and hence are recognized as causes of asthma.
Inducers result in symptoms which may last longer, are delayed and less easily reversible than those caused by triggers.

The most common inducers are:

1. Allergens
2. Respiratory viral infections
 

- Allergens
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:

pollen (grasses, trees and weeds)
animal secretions (cats and horses tend to be to the most allergen causing)
molds
house dust mites
 
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 Ventolin®). 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:

A detailed history which would include:
family history of asthma, allergies, hay fever, eczema; children will have a greater chance of developing the above if there is a family history of allergies and asthma
child's medical history including:
when parents first noticed the child developed breathing problems; history of nasal stuffiness (rhinitis), itchy eyes (allergic conjunctivitis) and eczema, which are common accompaniments to asthma, and hives (urticaria).
history of recurrent and persistent cough following a cold, frequent colds, croup, seasonal changes (i.e. worse in the spring and fall), exercise limited by breathing problems, waking at night with symptoms.
school absences, emergency room visits (hospitalizations)
environmental history

Physical examination: i.e. listening to the lungs with a stethoscope; examination of nasal passages etc.

Chest x-ray may be done once to exclude the possibility of breathing problems being caused by something other than asthma.

Blood tests and sputum studies may be done.

Allergy prick skin testing: Skin tests can confirm the presence or absence of allergies; they must, however, be correlated to the history of symptoms.

Spirometry is a breathing test which measures the amount and rate at which air can pass through airways; if the airways are narrowed because of inflammation it will be more difficult for air to pass through the airways. This will result in changes in spirometry values. With children under the age of five years, generally this test is not indicated because there is a certain amount of effort and cooperation required. However, this is a very dependable method of making a diagnosis. Any difficult or troublesome asthma should be confirmed objectively by performing spirometry.

Challenge tests: Exercise challenge tests and methacholine inhalation tests are procedures used most frequently in clinical laboratories to evaluate airway responsiveness.

Differential diagnosis: Other possible causes of shortness of breath, wheeze, cough and chest tightness must be investigated in order to rule these out. i.e. such as heart disease, other lung conditions, gastroesophageal reflux.

A trial use of asthma medications: If asthma medications are taken and improvement in symptoms is seen this further supports the diagnosis of asthma.
Because of the variability of symptoms (meaning symptoms can become worse and improve over time) a diagnosis cannot always be made immediately.

Reduce Triggers in Your Home

-Mold

Mold grows on damp things such as shower curtains.

What you can do?

If you see mold, clean it up with soap and water.
Use exhaust fans or open a window in the bathroom when showering and the kitchen when cooking or washing dishes.
Fix leaky plumbing or other sources of water as soon as possible.
Dry damp or wet items within 1-2 days to avoid mold growth.

-Dust Mites

Dust mites are tiny bugs you can’t see. They live in sheets, blankets, pillows, mattresses, soft furniture, carpets, and stuffed toys, such as stuffed animals.

What you can do?

Wash bed sheets and blankets once a week. Dry completely.
Use dust-proof covers on pillows and mattresses.
Vacuum carpets, rugs and furniture often.
Wash stuffed toys. Dry completely.

-Secondhand Smoke

Asthma can be triggered by the smoke from the burning end of a cigarette, pipe, or cigar, or the smoke breathed out by a smoker. Choose not to smoke in your home or car, and don't allow others to do so either.

What you can do?

Don’t smoke in your home or car.
Don’t let anyone smoke near your child.
Pledge to make your home and car smoke-free

-Cockroaches

Cockroach body parts and droppings may trigger asthma attacks.

What you can do?

Keep counters, sinks, tables, and floors clean.
Clean dishes, crumbs, and spills.
Store food in air tight containers.
Cover trash cans.

-Cats and Dogs

A warm-blooded animal's urine and saliva may also trigger attacks.

What you can do?

Keep pets outside if possible.
If you have a pet inside, keep them out of the bedroom and off the furniture.
Vacuum carpets and furniture often.

-Nitrogen Dioxide

Nitrogen dioxide is an odorless gas that can irritate your eyes, nose, and throat and may cause shortness of breath. This gas can come from the use of appliances that burn fuels, such as gas, wood, and kerosene.

What you can do?

If possible, use fuel-burning appliances that are vented outside. Always follow the manufacturer's instructions on how to use these appliances.
Gas cooking stoves: Never use these to keep you warm or heat your house. If you have an exhaust fan, use it when you cook.
Unvented kerosene or gas space heaters: Use the proper fuel and keep the heater adjusted the right way. Open a window slightly or use an exhaust fan.
Wood stoves: Make sure the doors are tight fitting. Follow the maker's instructions for starting, burning, and putting out the fire.
Fireplaces: Always open the flue.

-Chemical Irritants

Chemical irritants found in some products in your house, such as scented or unscented products, including cleaners, paints, adhesives, pesticides, cosmetics, or air fresheners, may make your child's asthma worse.

What you can do?

Use these products less often and make sure your child is not around when you use the products. Also, consider trying different products.
Take great care to follow the instructions on the label. If you use these products, try to make sure that windows or doors are open and that you use an exhaust fan.

Medications: Anti-inflammatory

The successful approach to asthma management depends on using anti-inflammatory medications with bronchodilators as needed for immediate and occasional relief of symptioms.

1. Anti-Inflammatory - Preventers: Anti-inflammatories are used to treat the inflammation that is caused by exposure to inducers.

2. Bronchodilators - Relievers (Rescue): Bronchodilators are used to relieve the bronchoconstriction provoked by triggers.
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 the asthma. Again this stresses the need for adding anti-inflammatory medications if bronchodilator therapy is required often to control symptoms.

- Anti-Inflammatory Medications (Preventers)

prevent and reduce inflammation, swelling and mucus
prevent symtpoms such as cough, wheeze and breathlessness
need to be taken on a regular basis
are slow acting (hours or weeks)

Types of Anti-Inflammatory Drugs

There are steroidal and non-steroidal anti-inflammatory drugs. The most common ones include:

Steroids

beclomethasone (Beclovent®, Vanceril®, Becloforte®)
budesonide (Pulmicort®)
flunisolide (Bronalide®)
fluticasone (Flovent®)
Non-Steroidal

sodium cromoglycate (Intal®)
nedocromil (Tilade®)

Corticosteroid Inhalers

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 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

few side effects at low doses
high doses MAY cause growth suppression; studies have shown that children whose asthma is not controlled do not grow as quickly as other children.
side effects, in general, are usually restricted to the throat:
hoarseness and sore throat
thrush or yeast infection
This can be prevented by rinsing the mouth and gargling, and by using a holding chamber.

Corticosteroid Tablets

Corticosteroid tablets or Prednisone®:

are used when inflammation becomes severe
reduce inflammation, swelling & mucus, and help bronchodilators work better
start to work within a few hours, but may take several days to have a full effect
often are used for short periods of time to get the inflammation under control
there are many side effects if used long-term, such as water retention, bruising, puffy face, increased appetite, weight gain and stomach irritation

Other Preventers

Other preventers are Intal® and Tilade®. They are non-steroidal and again, are used to reduce the inflammation.

sodium cromoglycate (Intal®)
- for mild asthma
- can protect against the effects of cold air and exercise
- requires 4-6 weeks to be effective
- few side effects.

nedocromil (Tilade®)
- similar to Intal®
- requires 3-4 weeks to be effective
- has a bad taste
- fewer doses/cannister; therefore, you may need more than one cannister per month.

ketotifen (Zaditen®)
- used for mild asthma
- may be useful for asthmatics who also have hay fever
- helps to reverse inflammation of airways
- can be used orally: comes in tablets or syrup
- requires regular use of 8-12 weeks to be effective
- side effects include drowsiness and weight gain

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:

zafirlukast (Accolate®)
montelukast (Singulair®)

-Bronchodilator Medications (Relievers)

Bronchodilators, or relievers, in general relax the muscle around the bronchi, which allows breathing to become easier.

are rescue medications, therefore, are used only when needed, and rarely on a regular basis (unless the asthma is under poor control)
provide quick relief of symptoms
relax the muscles of the airways
useful with exercise induced bronchospasm
usually in blue devices

Types of Bronchodilator Drugs

The most common bronchodilators are:

B2-Agonists
Anticholinergic Inhaler
Theophylline
B2-Agonists
- salbutamol (Ventolin®, Apo-Salvent®, Novo Salmol®)
- fenoterol (Berotec®)
- terbutaline (Bricanyl®)
- pirbuterol (Maxair®)
B2-Agonists are rescue medications which:

relax the muscle around the airways which allows breathing to become easier within minutes.
are used only when needed and rarely on a regular basis, unless the asthma is under poor control.
make the airway muscle less likely to contract.
are usually in blue devices.
When to use B-Agonists

to relieve the symptoms of cough, chest tightness, wheezing and shortness of breath
a few minutes before exercising or before exposure to any trigger you know worsens your asthma
Side effects of B2-Agonists include:

trembling
nervousness
flushing
increased heart rate

B2-Agonists are safe when used properly; for example, when you are experiencing symptoms or before exposure to a trigger.

Regular, frequent use of B2-Agonist bronchodilators may actually worsen the asthma.

Frequent use means you need to step-up your treatment plan. For example, you need to add or increase your anti-inflammatory medication.

It is safe to frequently use (every 5 minutes) your B2-Agonist bronchodilator when you are on the way to the nearest emergency department.

Anticholinergic Inhaler
- Atrovent®
Atrovent opens the airways by blocking the signals from the nervous system which cause the airways to become narrow.

It takes one to two hours to reach its maximum effect; therefore, it should not be used as an immediate get out of trouble medication.

There are few side effects, a bad taste possibly being one.

Theophylline
- TheoDur®
- Uniphyll®
- Phyllocontin®
-TheoLair®
Theophylline is an oral bronchodilator that works directly on the airway muscle to relax it.

It is used in the evening if shortness of breath disturbs sleep, or regularly if asthma is severe. Theophylline levels can be affected by other medications - ensure your physician is aware of all the medications you are taking, including over-the-counter drugs.

Side effects include:

- diarrhea
- nausea
- heartburn
- loss of appetite
- headaches
- nervousness
- rapid heart beat
- upset stomach
The right dose is important and must be determined by your physician. Theophylline is not commonly used in the treatment of asthma.

salmeterol (Serevent®)
formoterol (Foradil®, Oxeze®)
Serevent®, Oxeze® and Foradil® are inhaled bronchodilators. However, because they take longer to achieve this bronchodilator effect, they should not be used as rescue medication. If an individual is on anti-inflammatory medication and still continues to need a bronchodilator on a regular basis, the physician may prescribe Serevent®, Oxeze® or Foradil®.

Anti-inflammatory medications should not be stopped while using Serevent®, Oxeze® or Foradil®.

Asthma medications come in many forms. However, most often they are taken by the inhaled route:

Metered Dose Inhaler (puffer)
Dry Powder Inhalers (Aerolizer®, Diskus®, HandiHaler®, Turbuhaler®)
Nebulizer
The technique of using these devices is very important. You should review this with your pharmacist.