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Asthma

Frequently Asked Questions: Asthma

Friday, March 16, 2012 - 17:05

Contributing Author: Guy Slowik FRCS

Here are some frequently asked questions related to asthma in adults.

Q: What breathing exercises can help me during an asthma attack?

A: Pursed-lip breathing involves closing the lips tightly and blowing air out past them the way you would when blowing out a candle. This action helps keep the airways open during exhalation by keeping the pressure in them a little higher. Pursed-lip breathing acts like a "splint" to keep the airways open a little longer and allow stale air to be blown out of the lungs. Remember that fresh air can't be drawn into the lungs if stale air is still there. Practicing relaxed breathing and the pursed-lip technique will give you the confidence to handle almost any emergency situation. Of course, the best time to practice such exercises is when you are not having an attack. That way, you can strengthen the respiratory muscles without the panic of being short of breath. Strong respiratory muscles will help you if another attack should come.

Q: What are the biggest "mistakes" that people with asthma make?

A: During the panic and agitation of an asthma attack it is easy to make mistakes:

  • Taking tranquilizers or sedatives. Drugs such as Valium should never be taken to control the anxiety associated with shortness of breath during an attack. These drugs depress breathing.
  • Taking the wrong medicine during an attack. Remember, it is only the short-acting beta2-bronchodilators that produce immediate relaxation of your airways. Know which of your asthma medicines are your reliever medications, carry them with you, and know the dose your doctor wants you to take during an attack. On their own, the preventer inhalers and oral drugs will not help an attack. Always follow your personalized asthma action plan. Seek emergency treatment when you are instructed to do so by your personalized plan.
  • Overmedication. Taking more than the prescribed dose of a reliever medication will not help relieve the attack. The side effects will only be made worse. Follow the emergency plan worked out with your doctor. If he or she has instructed you to take additional beta2-bronchodilators during an attack, follow those instructions but do not exceed the dosage.
  • Undermedication. Some people with asthma make the mistake of waiting too long to follow their action plan. Know and be sure of the correct dose of your asthma medicines and take them faithfully. Don't try to take the least possible dose and don't try to "tough it out" if an asthma attack starts. Follow your action plan and seek emergency help when it is wise to do so.
  • Failure to avoid triggers. With more effective drug control of asthma symptoms, some people with asthma may take fewer precautions when it comes to avoiding their known triggers. Don't fall into this habit. Identify and remove or avoid situations and conditions that you know may cause your asthma to flare up. Elimination of known triggers is an important step in the long-term management of asthma.

Q: I know that my breathing passages are constricted during an asthma attack. Can I use any bronchodilator drug as a reliever to relax the airways?

A: Although relaxation of airways is needed in a severe asthma episode, some bronchodilators work too slowly to be of any immediate benefit. Short-acting beta2-bronchodilators such as albuterol, terbutaline, pirbuterol, and bitolterol work quickly to relax airway muscle that is in spasm and are, therefore, called "rescue" medications. Other bronchodilators such as long-acting beta2-bronchodilators, anticholinergic bronchodilators (ipratropium), and theophylline may be useful in the treatment of an asthma episode, but should not be used in place of short-acting beta2-bronchodilators for treatment of acute symptoms.

Q: I love to cross-country ski but I'm worried about a flare-up in my asthma. Should I stop exercising?

A: First of all, check with your doctor to make sure this type of exercise is suitable for your asthma condition. You may have two triggers involved here: cold weather and physical exertion. Drying of the linings of the airways due to cold air, exercise, or both, may trigger an episode. For many people, pretreatment with a beta2-bronchodilator 10 to 15 minutes before activity allows them to exercise without experiencing asthma symptoms. Ask your doctor if pretreatment medicine would help you stay active. Some of the preventer medicines used to control persistent asthma symptoms are also useful in controlling exercise-induced and cold air-induced asthma. The benefits of exercise in persons with asthma cannot be overemphasized.

Q: Why is my chest so tight during an asthma attack when I try to breathe out?

A: Because the airways are swollen and narrowed they close earlier in expiration. This "traps" air in the lungs that would normally be exhaled. Therefore, breathing occurs at a higher lung volume than normal, causing a feeling of "tightness" of the chest due to over-distended lungs.

Q: What is the link between triggers, inflammation, and asthma?

A: Triggers are irritating factors that make asthma worse, and they are usually different for different people. Because the airways of people with asthma are chronically inflamed, the airways are sensitive or reactive to triggers. Know what your triggers are and how best to avoid them.

Q: I'm allergic to ragweed, which makes my eyes and nose runny and itchy for most of the summer. My doctor calls it "seasonal rhinitis." Will it give me asthma?

A: Not necessarily. Not all people with asthma have allergies, and not all people with allergies develop asthma. It depends. There are complex factors at work here, such as your genetic make-up, the reactivity of your airways, and the success you have in controlling your "hay fever" condition. Pollens and other things can trigger asthma in susceptible people, and there's nothing you can do about your genetic background. Therefore, the best approach is to work with your doctor to control your seasonal allergy.

Q: What's the difference between corticosteroids and anabolic steroids? I don't want to "pump up," I just want to control my asthma.

A: Although the term "steroids" is used widely, there are many types of steroids with many different effects. In fact, our bodies actually produce steroids for beneficial effects of various kinds. The types of steroids that body-builders may abuse are called anabolic steroids. The types of steroids used to control asthma symptoms are called corticosteroids, and they do not have the same effects as the anabolic steroids. Corticosteroids are taken because they help control inflammation in the body. They have virtually no muscle-building or performance-enhancing effects like those produced by the anabolic steroids.

Q: My wife really wants a pet. She doesn't seem allergic to pets and skin tests show she's not allergic to dogs or cats. How about it?

A: As you've stated, your wife is not allergic to dogs or cats. Having a pet in the house is only a problem if the person is allergic to that animal. However, the problem here is that she may become allergic over time with regular exposure to the animal. If that occurs, the airways remain slightly irritated. This may set her up for asthma attacks triggered by other factors.

Q: I forgot to refill the prescription for the inhaler that gets rid of my wheezing on bad days. Can I just use my other inhaler - the one with the steroid I normally use every day for asthma control?

A: No. You really need to get your prescription filled as soon as possible. The medications in the two inhalers are quite different and are not interchangeable. The inhaled steroid is the "preventer" drug. It normally does a great job of preventing the symptoms of asthma by controlling the inflammation that triggers it. The "rescue" inhaler contains the drug you may need to counter the tightness and wheeze that can occur if the "preventer" drug isn't able to block your symptoms.

Q: Should we consider moving to a different climate?

A: Moving to a different climate will probably not help in cases of allergic asthma. Asthma is quite common in all parts of the country. Generally, families that move to a new area find that asthma symptoms continue to occur, usually because of different triggers in the new environment. Nonallergic asthma may improve with a move to a different climate having less pollution or warmer temperatures if triggers such as industrial pollution or cold air temperatures were responsible for the asthma episodes. Check with your doctor.

Q: Can "allergy shots" help if I have allergic asthma?

A: Once your personal "troublemakers" have been identified, your doctor may try some different approaches to control inflammation and your response to these triggers, including:

  • Avoidance. This is the simplest approach, but not always easy to carry out. If strong chemical odors are suspected as a trigger, avoid such irritating substances. But if your personal trigger is the pollen released from a particular tree or weed, not much can be done to avoid it.
  • Injections. These injections, commonly called "allergy shots," may make you less sensitive to the trigger substance. In this treatment, very small amounts of the trigger substance are injected in doses that are slowly increased over time to increase your tolerance. (The treatment works best for allergies to pollen, dust mites, and cat dander.)
  • Drugs to prevent asthma episodes. Certain preventer drugs are used to control inflammation and asthma symptoms even though allergies are still present.

Q: What are the most important things I can do to help improve my asthma?

A: Three actions are most important: check the environment, keep lines of communication open with your doctor, and understand your treatment plan. Removing a trigger from the environment can often do wonders. For example, if you are allergic to cat dander, you can survive the presence of a cat by inhaling corticosteroids to control asthma, but you would probably be far better off if the cat went to another home. Generally speaking, the more triggers you can remove, and the less medicine you have to take as a result, the better off you will be in the long run. Good communication between you and your doctor is essential in identifying and minimizing triggers and developing your personal asthma action plan.

Asthma