Successfully Managing Your Asthma
More than 10 million Americans have asthma. This common but complex lung disease can appear at any age, from infancy through late adulthood. The symptoms can be mild and occur only occasionally, or disabling and occur daily. The most common symptoms are wheezing, tightness in the chest, and shortness of breath.
Asthma Death Rates Are Climbing
Asthma cannot be cured, but it can be controlled. Effective medications are available that can enable people with asthma to enjoy sports and exercise, sleep through the night without interruption, and avoid serious asthma attacks. However, despite steady improvements in the diagnosis and management of asthma, death rates from this disease have been climbing all around the world for the past several decades. Between 1980 and 1987, total asthma deaths in this country rose from 1.3 to 1.7 per 100,000-a 31 percent increase. The rise in death rates has occurred primarily among adolescents, who may not be motivated to follow their doctors’ instructions; inner-city residents, who may be exposed to high levels of pollution and may have limited access to good health care; and asthmatics who smoke or live with a smoker.
This troubling trend underscores the importance of taking asthma seriously. People with asthma should see their doctors regularly and take an active role in the day-to-day management of their disease. Your doctor will begin by performing a physical examination and asking you a number of questions to identify the factors that trigger your symptoms. Your doctor will then tailor a treatment program for you, based on your specific needs.
Peak Flow Monitoring
One of the best ways to keep asthma under control is to perform a “peak flow” test at home twice a day, usually in the morning and in the evening. The test is simple and takes only minutes. Results from the test can alert you to symptoms before they become obvious. That’s when symptoms are easiest to manage. Your doctor may ask you to keep a diary in which you record the results of your twice-daily peak flow measurements. This information can help your doctor to adjust and fine-tune your asthma treatment program, to keep you free of trouble.
Depending on your symptoms and their severity, your doctor may prescribe medications. Several different classes of drugs are used to treat asthma, including beta-agonists, topical steroids, cromolyn salts, theophyllines, and oral steroids.
For most asthma sufferers, beta-agonists are the first class of drugs used. These drugs are bronchodilators. They relax the airway muscles that tighten during an asthma attack. Beta-agonists can be administered in several ways. Metered-dose inhalation, using a handheld canister of aerosolized medication, is one of the most effective methods. Activating the canister releases a puff of drug-saturated aerosol directly to the airways.
Beta-agonists such as Proventil relieve asthma symptoms more effectively than any other asthma medication, but their effectiveness depends on the effectiveness of the delivery. Be sure that your health care provider demonstrates proper use of the metered-dose inhaler for you, and periodically observes your use of the device. Even a very young child can be taught to use a metered-dose inhaler if a parent depresses the canister while the child takes a breath. For both adults and children, spacing devices can greatly improve drug delivery with metered-dose inhalers. Your doctor can recommend a good spacing device.
The effectiveness of beta-agonist medications is also dependent on the drugs’ duration of action. For this reason, the newest, long-acting beta agonist (Serevent) is often used with older, short-acting beta-agonists. Serevent has become popular because it is effective for up to 12 hours; however, it is not recommended for immediate asthma symptoms. It is not a “rescue” medication. It is most effective when used regularly to prevent symptoms before they can occur. In using beta-agonists, patients should be aware of possible side effects, including irregular or rapid heartbeat, nervousness, muscle tremors, nausea, vomiting, dizziness, weakness, sweating, and chest pain. If any of these appear, you should discontinue the drug and call your doctor. If necessary, rush to an emergency department.
Patients also need to know that there have been reports of tragic complications associated with the use of aerosolized metered-dose inhalers. If the cap of an inhaler is left on by accident, it can be propelled into the mouth or even the airways. Newer aerosols have hinged tops to prevent this. Another danger of all inhalers is that foreign objects, especially dirt, can become lodged in the mouthpiece. These particles, too, can be propelled into the mouth or airways. Be sure to always take the cap off of your metered-dose inhaler before using it, and follow the cleaning instructions that come with the device.
Nonaerosol drug powder inhalation devices are an effective alternative to aerosolized metered-dose inhalers. The most common variety is the Rotahaler. Despite its effectiveness, the Rotahaler is not very popular. Many patients find it difficult or inconvenient to use.
Beta-agonists also can be delivered via a nebulizer. Proventil, for example, is available in solution by nebulization via a Pulmo-Aide. This is by far the most effective way of delivering beta-agonists. For people with moderate to severe asthma or for very young children, the use of the Pulmo-Aide device is strongly recommended for nebulization. For families who can’t afford such a device, the local lung association may be able to help provide one.
Inhaled steroids (e.g., Vanceril) constitute another important class of asthma medication. These drugs relieve inflammation of the airways and help to keep the lungs free of symptoms. Inhaled steroids avoid the potentially serious adverse effects of oral steroids, which include weight gain, water retention, and high blood pressure. Inhaled steroids are not absorbed into the body in significant amounts, and can form the basis of an extremely effective preventive program for patients with asthma. Recent studies suggest that inhaled steroids such as Vanceril are an important early, and perhaps first-line, treatment of asthma.
Theophyllines are drugs that are chemically very similar to caffeine. Because these drugs can cause such side effects as nausea, vomiting and nervousness, most patients use them only if beta-agonists and inhaled steroids are insufficient to control their symptoms. To ensure correct dosing for patients who use theophylline, doctors regularly draw blood to measure theophylline blood levels. Theophylline can interact negatively with some other drugs, so patients who take it should be sure to tell their physicians about all other drugs (including over-the-counter medications) they may be taking.
Cromolyn sodium, a synthetic chemical originally isolated from an Egyptian weed, is also used to control or ward off symptoms in people with chronic asthma, especially those with moderate to severe symptoms. In America, it is marketed as Intal and comes in two forms: in a metered-dose inhaler and as a solution for nebulization. Cromolyn is extremely effective for exercise-induced asthma. Among its advantages is the fact that, unlike other asthma medications, it causes few undesirable side effects and does not interact with other drugs. However, cromolyn is entirely a preventive measure and may need to be taken for several weeks before it begins to work. Patients must realize that reaching into their pockets and using cromolyn for here-and-now symptoms of asthma is useless. Second-Generation cromolyn called Tilade has been released recently, but it does not appear to offer great advantages over Intal.
Another class of drugs, the anticholinergics (e.g., Atrovent), deserves special mention. Atrovent can help prevent the airways from going into spasms. Using Atrovent together with a beta-agonist can produce an additive and beneficial effect on the airways. Asthma is a life-long and potentially life-threatening problem, but it can be effectively controlled with a carefully tailored treatment program that emphasizes prevention. You can work with your doctor to develop a treatment plan that will keep you active and free of symptoms.