Asthma

What Is Asthma?

Asthma is a condition that affects the air passages of the lungs. It is a two-step problem:

  • When a person has asthma, the air passages are inflamed, which means that the airways are red and swollen.
  • Inflammation of the air passages makes them over extra-sensitive to a number of different things that can “trigger,” or bring on, asthma symptoms.

During breathing, air is normally brought in through the nose where it is warmed, filtered, and humidified. It then passes through the throat and into the windpipe, called the trachea (TRAY-kee-a). The trachea divides into two large tubes called the right bronchus (BRONG-kus) and left bronchus. These then split up into much smaller tubes, which in turn branch into thousands of very small airways called bronchioles (BRONG-kee-olz). It is the large and small bronchi that are generally affected in asthma.

Respiratory System

When a person is exposed to one of these irritants, or triggers, the oversensitive air passages react by becoming narrower, swollen, and even more inflamed. This obstructs airflow to and from the lungs and makes it very difficult for the person to breathe.

Nice To Know

Is All Asthma The Same?

Asthma is a chronic condition. This means that while it often looks like it goes away for awhile, the inflammation of the air passages remains present all the time. However, in some instances, this inflammation may go unnoticed for long periods of time. As long as the air passages are inflamed, asthma can flare up at any time. This is one of the reasons that an awareness of the triggers that cause the flare-ups is so important in preventing asthma episodes.

  • Allergic asthma – Allergic asthma is most common in children and adolescents. Usually, but not always, the allergies that cause the asthma appear before the age of 35. An asthma attack or episode occurs when a person comes into contact with something to which he or she has developed an allergy.
  • Nonallergic asthma – This type of asthma is most common in middle-aged adults. Asthma attacks may occur in response to triggers such as exercise, cold air, or respiratory infections. The allergic mechanism is not responsible for the asthmatic reaction.

What Is An Asthma Episode (Asthma Attack)?

Asthma symptoms can vary from very mild to very severe. Some adults with asthma have only seasonal bouts of symptoms. Some have symptoms only after exercise or after exposure to something to which they are allergic, such as a dog or cat. Others have a chronic form of the disease and experience asthma symptoms almost daily.

In an “asthma episode,” also known as an “asthma attack,” the symptoms develop because the oversensitive airways of the lung react by becoming more inflamed and narrows, thus obstructing the normal flow of air through the air passages. The reduced size of the air passages occurs because:

  • The muscles around the airways tighten
  • The linings of the airways become swollen
  • The normal secretion of the airways (called mucus) becomes “trapped,” thus clogging the airways

As the airways become narrower and more obstructed, it takes extra effort to breathe and force air through them. The air may make a whistling or wheezing sound as it goes past the narrowed parts of the air passages. A person having an asthma attack may also cough a lot and spit up a lot of very sticky mucus.

So one or more of the following symptoms may occur once the airways have narrowed in response to a trigger:

  • Coughing. Coughing is often a sign of asthma, but is easily overlooked. As a general rule, healthy people don’t cough unless they have something in their throats or have a cold.
  • Wheezing. Wheezing is a whistling noise heard during breathing, as if something is “caught” in one of the breathing passages.
  • Tightness of the chest. Many adults with asthma describe a tightness of the chest, an uncomfortable feeling caused by over-inflation of the lungs due to difficulty in pushing air out through the narrowed airways.
  • Shortness of breath. Shortness of breath is the feeling that a breath is barely finished before another is needed. It has been described as “air hunger” by some people.
  • Mucus production. Many people with asthma produce excessive, thick mucus that obstructs the airways, which can lead to coughing.

For many people, asthma symptoms are worse at night and in the early morning or after exercise. Furthermore, an asthma episode often gives early warning signs, thus giving the person time to act.

Nice To Know

Q. What makes my breathing passages so sensitive to triggers?

A. The underlying cause of the sensitivity in the airways is inflammation. Inflamed airways are highly reactive to triggers. In other words, they are easily irritated and respond by contracting, swelling, and filling with thick mucus. Some of the breathing passages don’t have much supporting cartilage in their walls the way the windpipe does. As a result, they are not very “stiff” and are easily squeezed closed. Think of them as tiny tubes with thin muscle fibers wrapped around them like “rubber bands.” If the “rubber bands” (airway muscle) tighten, the thin-walled passages are more easily choked off, making you short of breath.

Are Asthma Episodes Dangerous?

Most of the time asthma episodes are mild, and the airways will open up in a few minutes to a few hours in response to medication. But some attacks can be severe, lasting for a long time and not responding to the regular medication. And they can be very dangerous. A very severe, prolonged attack can threaten a person’s life. Such an episode requires immediate emergency attention in a hospital.

Learning to recognize signals and take action to prevent asthma symptoms from becoming worse is an important step in the long-term control of asthma. So is managing an episode if it does occur.

Learning all about asthma will ultimately help a person have fewer and milder episodes and reduce the risk of a more serious attack. This includes understanding about:

  • The way your lungs work
  • The things that cause asthma episodes
  • The ways you can avoid those things
  • The medicines that help prevent and control symptoms

What Does “Good Asthma Control” Mean?

The long-term goal in asthma management is “good asthma control.” In fact, because of a better understanding of the disease and the development of newer drugs, drug treatments are so effective that many adults with asthma can go for long periods of time without symptoms.

Good asthma control includes the following goals:

  • There is no wheezing, coughing, or shortness of breath.
  • Nighttime sleep is not interrupted by asthma symptoms.
  • Exercise and daily activities can be carried out normally.
  • Reliever medication is used less than three times per week.

For asthma treatment to be successful you need to learn all you can about asthma and its treatment, work closely with your doctor, and cooperate fully with other members of your health care team.

Facts About Asthma

  • The process of moving air into and out of the lungs is something most people take for granted. But for as many as 15 million Americans living with asthma, this simple activity requires significant effort.
  • Asthma cannot be cured, but with proper treatment it can be effectively controlled. Good asthma control allows most adults to live full, active, trouble-free lives.
  • Without satisfactory control of asthma, long-term damage can occur in the respiratory system. Poorly controlled asthma can lead to reduced physical activities, missed work, and extra visits to the emergency department.
  • For most adults with asthma, a reduced quality of life doesn’t have to happen. Arming yourself with information is an important step in maintaining a healthy life.

 


What Causes Asthma?

We don’t know what causes asthma. But we do know that:

  • Asthma and allergies are likely to run in families and may be inherited.
  • Children who have allergies at a young age may be at greater risk for developing asthma as adults.
  • Some adults with asthma also had asthma as teenagers and as children. In some individuals, the condition may become less severe over time, but in others, the reappearance of symptoms in adulthood occurs. A respiratory infection sometimes sets it off, but often there is no apparent reason for the reoccurrence or increase in symptoms.

    For more information about asthma in children, go to Asthma In Children.

Certain conditions seem to make asthma worse. And for some it seems to be worse on certain days and at different times of the year. Asthma symptoms occur when sensitive lungs overreact to certain factors called triggers . These irritating factors are part of the environment in which we live and are different for different people.

  • Allergies are a common asthma trigger.
  • Other asthma triggers range from dust to air pollution, from exercise to weather changes.

Nice To Know

Because everyone with asthma responds to different triggers, an important step in gaining control of asthma is to identify the factors that trigger asthma episodes in your lungs. Once you have discovered your own personal triggers, you will be able to work better with your doctor to prevent and control asthma attacks.

 


Asthma Caused By Allergies

In some people, an asthma episode is brought on by an allergy to something in the environment. Allergies occur when the body reacts to common harmless substances that normally don’t trigger a response in another person. These substances are called allergens.

In the person with allergic asthma, a flare-up of the airways can occur when the allergen is introduced to the body. At first, reactions may be very minor, barely noticeable. But repeated exposure gradually increases sensitivity.

In an allergic reaction, certain body cells release various chemicals. In an asthma attack brought on by an allergen, these chemicals irritate the already inflamed air passages and cause the reactions that make the airways narrow and breathing difficult.

Common things that can trigger allergic asthma include tiny particles in the air derived from:

  • House dust mites
  • Cockroaches
  • Mold (spores)
  • Plants (pollen)
  • Animals dander

House Dust Mites

House dust mites are extremely small organisms that live in dust and feed on skin cells that have been shed by people. Products of dust mites are a common cause of allergies. They look like very tiny insects but are actually distant cousins of spiders. House dust mites thrive in warm, damp climates and are commonly found in mattresses, pillows, bedding, carpets, and upholstered furniture.

How-To Information

Ways to reduce exposure to dust mites:

Dust mites cannot be entirely avoided. But you should aim to lessen your exposure to them, particularly in the bedroom:

  • Put plastic zippered covers on mattresses and pillows.
  • In the bedroom, move out anything that collects dust (including the carpet if possible) and avoid upholstered furniture and clutter.
  • Wash all bedding each week in hot water (at least 130┬║ F).
  • Linoleum, tile, and hardwood floors are best for minimizing both dust and dust mites.
  • If possible, try to have someone who does not have allergic asthma do the vacuuming when you are not in the bedroom.
  • Vacuuming will not get rid of mites, and in fact spreads them up into the air for several minutes before they settle again. Try to use a vacuum cleaner with a HEPA air filter (which stands for “high efficiency particle arresting”) or a double-layer collecting bag.
  • Keep the humidity in the room low, around 35% if possible (never over 50%), because high humidity encourages dust mite growth.
  • Curtains should be laundered often; it is better to avoid heavy curtains and use window coverings such as easy-to-clean blinds.

Cockroaches

The dried-up body parts of dead cockroaches are a very potent stimulator of asthma in those allergic to them. Regular cockroach control is essential to good control of asthma for people allergic and exposed to them. This can be a particular problem in big cities.

Mold

Mold is the greenish, gray, or black material that grows in damp places. Molds or fungi release microscopic particles called spores for their reproduction. These spores can float through open windows into the house, especially on cool nights in the spring and fall. Asthma attacks may also be triggered by the type of mold that grows in the house.

How-To Information

Ways to reduce exposure to molds include:

  • The use of air conditioners and dehumidifiers to reduce humidity. (They must be cleaned often to prevent mold growth.)
  • Regular ventilation of the kitchen, bathroom, basement, and other damp areas of the house. (Exhaust fans in the kitchen and bathrooms work well.)
  • Cleaning out mold from damp places in the house such as shower stalls, and clearing out moldy objects from closets. Use a spray cleaner with a fungicide in it.
  • Keeping bedroom windows closed to keep out mold spores and pollen.
  • Keeping drainage from rain water away from the house, in order to decrease humidity in the basement.

Pollen

Pollen are microscopic particles released by plants for their reproduction. Pollen is more a cause of hay fever than asthma. But there are some people with allergic asthma who clearly have problems with ragweed and other typical plant pollens that can cause a flare-up in their asthma.

Make note of whether your episodes of asthma are worse when the pollen count is high.

How-To Information

To prevent allergic reactions due to pollens:

  • Pay attention to the pollen count in your area. Whenever necessary, keep the windows shut.
  • Air conditioning can be very helpful in minimizing pollen entry into the house and in keeping the humidity down. But check with your doctor before purchasing expensive equipment.
  • On days of high mold and pollen counts, if you have been outside for a prolonged period, take a shower and wash your hair before bedtime (to get the pollen and mold out). Also, leave your outdoor clothes out of the bedroom.
  • Change pillowcases every two to three days.

Animal Hair And Dander

Many people are allergic to a substance in the saliva and on the skin of furry animals. This substance, called dander, is a powerful allergen. It gets on a dog’s or cat’s coat and is spread into the air and onto surfaces.

Dander can float through the air for hours. Cat allergen particles, for example, are only about one-tenth the size of dust mite allergen particles and can escape the filtration system on most vacuums. Cat dander can still be found in the dust of a house even months after a pet has left.

Hamsters, gerbils, mice, and rats can produce the same problem. In some individuals, fine particles on feathers may also set off an allergic reaction.

Nice To Know

Animal allergens are a potent stimulator of asthma. It is very likely that frequent asthma symptoms in someone living with a furry pet are caused by the pet.

How-To Information

To prevent allergic reactions due to exposure to animals:

  • The best way to deal with pet allergy is to find the pet another home.
  • If this is out of the question, the pet should be kept outdoors as much as possible and never allowed into the bedroom.
  • Frequent washing (twice weekly at least) of the pet may also reduce the presence of animal dander in the home. Dog washing does not present any major problems when animal shampoo and lukewarm water are used. Cats present a greater challenge but can be slowly accustomed to the ritual by associating a positive experience such as feeding with the bath. Shampoo is not needed nor is it necessary to immerse the cat in water. A gentle wiping with a damp cloth will help remove some of the cat dander.
  • Deciding what to do about a pet is not easy, but if its presence really worsens the asthma condition, making the hard decision is the right thing to do.

Need To Know

Do some foods cause asthma?

Foods are rarely implicated as a cause of regular asthma. Asthma in some people can be triggered by an allergy to certain foods, but the asthmatic symptoms are usually part of a serious reaction called anaphylaxis.

 


Other Asthma Triggers

A host of other things can bring on an asthma attack in susceptible people. These include:

  • Respiratory infections
  • Irritants
  • Industrial fumes and dusts at work
  • Air pollution
  • Exercise
  • Nighttime
  • Weather
  • Emotions
  • Hormonal changes
  • Health problems

Respiratory Infections

Asthma can be made worse by common colds, sinusitis, and influenza (the flu). Viral infections are known triggers of asthma attacks. Antibiotics don’t work against viral infections, but medication to open up the air passages can help.

How-To Information

To prevent asthma episodes triggered by respiratory infections:

  • Ask your doctor for flu and pneumonia shots for yourself and your family.
  • Stay healthy with daily exercise, nourishing foods, and enough sleep.
  • Avoid contact with people who have upper respiratory infections.
  • Wash your hands frequently.

If you notice one of the following changes, suspect a respiratory infection:

  • Fever or chills, sore throat, muscle aches, runny nose, cough

If you have a respiratory infection and experience signs that indicate you are losing control of your asthma, call your doctor as soon as possible. These signs include:

  • Shortness of breath or wheezing
  • Cough that is getting worse
  • Production of a large amount of mucus, or mucus that is thicker than usual or is changed in color
  • Awakening at night with asthma
  • Increased need for your rescue inhaler

Follow your doctor’s instructions and your asthma should quickly be brought under control again:

  • Take whatever medicine your doctor prescribes, exactly as directed.
  • Don’t stop taking the medicine unless your doctor tells you to, even if you feel better.
  • Follow directions for clearing your lungs of mucus.
  • Keep your doctor informed of any change in your condition.

Irritants

Common products in the home can trigger an asthma episode. For example, inhaled fumes from a variety of common household products can irritate the sensitive airways of people with asthma and trigger episodes. These products include:

  • Cleaning solvents
  • Paints, thinners, stains, varnish, and shellac
  • Liquid chlorine bleach
  • Sprays such as furniture polish and oven cleaners
  • Personal products with strong smells such as hair sprays, perfumes, spray deodorants, and cosmetics

How-To Information

To prevent asthma episodes triggered by irritants:

  • Keep strong-smelling chemicals out of the house, or try to stay out of areas where household cleaners and other substances with strong odors are being used.
  • Rooms where hobbies are performed that produce strong smells should be aired thoroughly and often.

Industrial Fumes And Dusts At Work

Reactions to industrial irritants may occur suddenly or take years to develop. Substances known to trigger asthma episodes in susceptible people do so through either an immune response or through irritation of air passages.

Industrial substances causing an immune response include:

  • Wood products (western red cedar)
  • Dusts (flour, cereal)
  • Metals (platinum, chromium, soldering fumes)
  • Mold (decaying hay)

Industrial substances causing an asthma response because of irritation include:

  • Dusts (cotton)
  • Gases (sulfur dioxide, chlorine gas)

How-To Information

Because of the nature of many industrial jobs that bring workers into contact with these known asthma triggers, avoidance is usually not possible. The best protection is the use of approved personal protection and safety equipment associated with your job:

  • Protective eyewear (glasses, goggles, hoods)
  • Masks and respirators with approved filtration devices
  • Proper ventilation and filtration of air in the work area

Air Pollution

There are certainly some “bad days” when it comes to air quality in some of the larger cities. Fine particles, gases, vapors, and smoke are added to the air near industrial areas. These substances can serve as powerful irritants of the sensitive and inflamed airways of some people with asthma. Inhaled pollutants that can act as asthma triggers include:

  • Oxides of nitrogen
  • Ozone
  • Fine particles
  • Sulfur dioxide

Cigarette smoke is a common indoor pollutant that can aggravate inflamed air passages.

How-To Information

To prevent asthma episodes triggered by substances in the air:

  • Avoid breathing secondhand smoke from cigarettes, pipes, and cigars.
  • Make sure no one smokes in your house or car.
  • Always look for non-smoking sections in public areas.
  • Insist on your right to clean air. No one has a right to create a health hazard for you.
  • If possible, avoid places with dirty, congested air such as smoke-filled rooms, parking garages, dusty work areas, and traffic jams.
  • Avoid smoke from barbecues and outdoor fires.
  • Check the ventilation in your home. Modern, airtight homes often trap indoor pollution.
  • Make sure that all fuel-burning appliances such as wood stoves and gas fireplaces are properly adjusted and vented.
  • During days of heavy air pollution, check the news for air quality and pollution alerts.
  • On really bad days, stay indoors and use the air conditioning if you have it.
  • Avoid strenuous outdoor activities on days of poor air quality if air pollution is identified as one of your asthma triggers.

Exercise

Exercise can bring on an asthma episode in some people. Symptoms of asthma may begin after several minutes of exercise or after the exercise is over. They may last for a few minutes to an hour and usually get better by just stopping the exercise, but can continue even with resting.

These symptoms may limit play and interfere with performance. The severity of the asthma episode will depend on how intense and for how long the person has exercised. The symptoms are not caused by the physical effort itself, but by the loss of heat and moisture from the air passages that occurs when dry, cold air is inhaled rapidly.

Nice To Know

Q: Can I still play the same sports I used to?

A: Most adults with asthma under good control can play sports if a good treatment plan has been worked out. Swimming is particularly encouraged by many physicians, but stick with the sports you most enjoy. Exercise and sport is most definitely encouraged for people with asthma.

Remember that one of the goals of asthma control is to allow normal activities to be enjoyed. Exercise is important for both general health and for the health of the lungs. Therefore, if the exercise you enjoy seems to be acting as an asthma trigger for you, ask your doctor about taking medicine before exercise so that the episode can be prevented.

How-To Information

To prevent asthma episodes triggered by exercise:

  • Work out a plan with your doctor. This may mean taking medication 10 to 15 minutes before exercising to prevent symptoms while exercising or playing sports.
  • Appropriate warm-up is important in reducing symptoms and can be very important for competitive athletes.
  • Drink lots of fluids and adjust your activities accordingly on hot, humid days.
  • If asthma symptoms occur during sports, take a short rest and then continue if possible. Medication may need to be taken when symptoms occur.

Nice To Know

As many as 10% of all Olympic athletes are asthmatic.

Nighttime

Asthma symptoms that occur at night are part of nighttime asthma, or nocturnal asthma, a very common condition for many people with asthma. Sleep is not the actual trigger, but while we sleep the airways tend to narrow and mucus tends to build up in the airways, often triggering a bout of coughing. There are many causes of nocturnal asthma, including:

  • At night there are changes in body chemicals, which allow airwayinflammation to increase.
  • The drop in body temperature at night causes airway cooling and narrowing.
  • Allergens encountered in the daytime may produce a delayed response three to eight hours later, just in time for nighttime sleep.
  • Increased drainage from the sinuses while lying down may trigger a reaction in sensitive airways.
  • Lying horizontally may allow some of the stomach contents to rise up into the esophagus. This is called reflux and may trigger an asthma episode in sensitive individuals.

    For more information about gastro esophageal reflux disease, go to Heartburn (GERD).

How-To Information

To help prevent nighttime asthma symptoms:

  • Check with your doctor if you have symptoms of nighttime asthma. Nocturnal asthma often responds to asthma medicines taken before bedtime.
  • If reflux of stomach contents is the cause of your nighttime asthma symptoms, they may be minimized by antacids taken before bedtime, raising the head of the bed, or avoiding meals and alcohol just before bedtime.

Weather

The onset of asthma may be seasonal. Weather affects different people in different ways. For example:

  • Heat, humidity, air pollution, and pollen counts in the summer can trigger an asthma episode in some people.
  • In others, the wet conditions of the spring and fall may encourage the growth of certain molds that can trigger an attack.
  • For others, the buildup of smoke, animal dander, and mites in a sealed house in the winter can aggravate asthma. Or, the cold temperature outside may serve as a trigger during physical activity.

How-To Information

To prevent asthma episodes triggered by weather:

  • When the air quality is poor, try to limit outdoor activity.
  • Try to eliminate sources of dampness in the home that may encourage mold growth.
  • Replace furnace and air conditioner filters.
  • Clean humidifiers and dehumidifiers to limit mold growth.
  • Breathe through the nose when outside in cold weather. Cover the nose and mouth with a scarf on extremely cold days.
  • Moving to a different climate with different weather won’t cure asthma. Different triggers are found in different places, but asthma is quite common in all parts of the country. Remember that it is the sensitivity of the airways that is responsible for asthma episodes. The environmental trigger is simply the irritant that starts the process.

Emotions

Emotions do not cause asthma, but sometimes laughing, crying, and yelling stimulates nerves that cause the tiny muscles in the walls of airways to tighten in sensitive lungs.

People with asthma can become angry or frustrated with their condition and may refuse to take the medicines that will help them. Thus, in an indirect way, emotions such as anger may contribute to asthma symptoms.

How-To Information

To help minimize asthma symptoms due to emotions:

  • Ask your doctor about taking extra medication if you are under severe stress. Do not change your dose on your own.
  • When you start to feel excited, try to concentrate and relax your breathing.
  • Always follow your doctor’s instructions so that you can gain control of your asthma. With control of the situation, frustration and fear will be reduced.

Hormonal Changes

In some women, asthma symptoms increase at a particular time of their menstrual cycle, usually just before their periods. Asthma symptoms may become better or worse during pregnancy, because they may be influenced by hormonal changes.

How-To Information

Ask your doctor if adjusting your asthma medication during times of hormonal change would help you better control your asthma.

Health Problems

Asthma symptoms can be triggered by a variety of health-related factors such as:

  • Respiratory infections such as the common cold and flu
  • Sinusitis (inflammation of the linings of the sinus cavities). Excess mucus production from the nose and sinuses (“postnasal drip”) may drain into the throat and airways. This drainage combined with the release of body chemicals from inflamed sinus linings may act as trigger to irritate the linings of the airways, especially at night.

    For more information about sinusitis, go to Sinusitis.

  • Allergies (pollen, mold, dander)
  • Gastro esophageal reflux disease (GERD) is a disorder in which the acid contents of the stomach enter the lower part of esophagus. In sensitive individuals, this may cause the asthma to worsen. Heartburn and nighttime asthma symptoms may indicate GERD disease. Inform your doctor of your nighttime difficulty with breathing and your heartburn symptoms. The doctor will prescribe medication that will reduce the symptoms of GERD and provide you with greater asthma control.

    For more information about gastro esophageal reflux disease, go to Heartburn (GERD).


Your Asthma Trigger Checklist

Triggers are things that can make asthma worse in susceptible people by irritating inflamed airways. Here is a list of common triggers:

Allergies

Yes

No

Pollens (trees, grasses, ragweed)

   

Molds

   

Animals and animal products (dander, wool, feathers, down pillows)

   

Insect parts and dust mites

   

Note: Dust is a problem only if it has an allergen content to which the person is allergic. Sources of dust in the home include:

Cloth upholstery, carpets, draperies

   

Brooms and dusters

   

Dirty air filters on furnaces

   

Leaky vacuum cleaners

   

Respiratory Infections

Common cold virus

   

Flu virus

   

Sinusitis

   

Irritants

Household vapors and sprays:

Vapors (Cleaning solvents, paint, paint thinner, shellac, varnish)

   

Aerosol sprays (Furniture polish, oven cleaners, starch, room deodorizers)

   

Personal products (Spray deodorant, hair spray, perfumes, colognes)

   

Industrial dusts, vapors, and fumes:

Wood products (western red cedar)

   

Flour, cereals, grains, cotton

   

Metals (Platinum, chromium)

   

Mold (Hay)

   

Air Pollution

Air pollution and traffic jams

   

Parking garages

   

Smoke-filled rooms

   

Wood fires, barbecues

   

Exercise

Medication may have to be used before exercise

   

Wheezing sometimes begins during exercise as airways dry out

   

Exercise indoors on the coldest days

   

Nighttime

Increase in airway inflammation

   

Stomach acid and heartburn

   

Postnasal drainage leading to coughing

   

Weather

Seasonal changes (May trigger allergies due to pollen and mold spores)

   

Humidity, wind, dryness

   

Cold air may induce asthma in some people

   

Weather fronts, especially in the fall

   

Emotions

Airway narrowing caused by laughing, crying, or yelling

   

Fear, frustration, and anger

   

Hormonal Changes

Symptoms caused by changes in hormonal balance during menstrual cycle or pregnancy

   

Health Problems

Infections and allergies

   

Sinusitis

   

Gastro esophageal reflux disease (GERD)

   

 


Medications Used To Treat Asthma

There are two completely different types of asthma medications, and they are used for completely different purposes:

  • Medications to prevent asthma symptoms from developing
  • Medications to relieve asthma symptoms once they’ve started

Need To Know

Medication to prevent asthma attacks will not relieve an asthma attack. They are intended to prevent attacks, not treat it. They do not provide immediate relief of symptoms.

Asthma medications come in many forms – liquids, tablets, injections, powders, and vapors – so that it can always be taken in the most appropriate way.

Asthma medicines are tailored to a persons individual needs. Some adults with asthma only need an occasional dose of medication, while others need asthma medication on a regular basis.


Medications To Prevent Asthma Attacks

Knowing how airway inflammation prompts asthma symptoms, researchers have developed powerful “preventer medicines” for asthma that halt inflammation in a number of ways, including:

  • Stopping the production of chemicals in the body that cause inflammation
  • Blocking the release of these harmful chemicals from the cells that make them
  • Competing with these harmful chemicals so as to prevent them narrowing of the airway

Anti-Inflammatory Medicines

These medications prevent asthma attacks by:

  • Reducing the swelling of the lining of the airway
  • Reducing the narrowing of airways due to tightening by the surrounding muscle
  • Reducing mucus formation in the airways

How-To Information

Anti-inflammatory medications are taken on a regular basis every day to prevent symptoms, even when you feel well.

  • They are slow-acting (They take hours or weeks before they become effective).
  • They do not provide immediate relief of symptoms
  • Regular use should decrease the need for your reliever medication.

Contact your doctor if you still have symptoms after two weeks

The main anti-inflammatory preventer drugs are inhaled corticosteroids. Examples of inhaled corticosteroids are:

  • AeroBid; Bronalide (flunisolide)
  • Advair (fluticasone + salmeterol)
  • Azmacort (triamcinolone) (has a built-in spacer device)
  • Beclovent; Vanceril (beclomethasone)
  • Flovent (fluticasone)
  • Pulmicort (budesonide)

(Names under which these drugs are sold – the trade names – are given first, followed by the generic name in parentheses.)

Corticosteroids are the most effective anti-inflammatory drugs for the prevention of asthma symptoms.

  • The corticosteroids used in asthma treatment are not the same as the anabolic steroids used by some athletes to build muscle mass and “bulk up.”
  • Using a spacer with inhaled steroids reduces the risk for mouth and throat irritation. Gargling and rinsing the mouth with water after using the inhaler also is recommended.

At the usual doses inhaled steroids are well absorbed in the lung and produce few side effects. At higher doses, side effects may include:

  • Hoarseness
  • Cough
  • Thrush (yeast infection in the mouth)

Other Preventer Medications

Sometimes the long-term control and prevention of asthma symptoms requires the use of other medicines in addition to, or in place of, inhaled corticosteroids. Your doctor will tell you exactly what to do if a dose adjustment in your inhaled steroid is required or if other asthma medicines are to be added.

Need To Know

Do not stop taking the inhaled steroid preventer medicine unless you are directed to do so.

Other preventer drugs that can help control asthma symptoms include:

  • Long-acting beta2-bronchodilators
  • Theophylline bronchodilators
  • Oral corticosteroids
  • Nonsteroidal antiallergics
  • Leukotriene modifiers

Long-Acting Beta2-Bronchodilators

These medications include Foradil (formoterol) and Serevent (salmeterol). These are inhaled medications that are used in addition to inhaled anti-inflammatory steroids. They should not be used alone.

  • The amount of other preventer medicines you take may be adjusted by your doctor after you start taking long-acting bronchodilators. Do not change dosages of any asthma medicines on your own.
  • Long-acting beta2-bronchodilators are much more potent than short-acting beta2-bronchodilators such as albuterol. Do not take more than your doctor ordered.
  • These very potent and long-acting drugs relieve airway constriction for a long period of time (about 12 hours) but are not indicated for the relief of symptoms during an acute asthma attack.
  • If your action plan instructs you to take a short-acting reliever drug such as albuterol during an asthma attack, continue using your long-acting medication as directed.

How-To Information

Always carry a short-acting beta2-bronchodilator for fast relief during an asthma episode.

Theophylline Bronchodilators

These include Theo-Dur, Theolair (theophylline). They are oral bronchodilator drugs (tablet or syrup) that work in a different way than the beta2-bronchodilators to relieve muscle spasm of the airways.

  • Long acting and useful for nighttime asthma symptoms.
  • Effectiveness in controlling asthma symptoms is related to the amount of drug in the bloodstream.
  • Regular blood tests to determine the blood level of theophylline are required.
  • The blood level of theophylline can be increased by many different drugs such as erythromycin (an antibiotic) and conditions such as cirrhosis of the liver. The blood level of theophylline can be decreased by other drugs such as benzodiazepine (a tranquilizer) and factors such as cigarette smoking.
  • At higher doses, side effects may include nausea and vomiting, headache and dizziness, nervousness and irritability, and insomnia.
  • When theophylline is used properly and monitored under a doctor’s care, it is a safe and useful drug in the management of asthma symptoms.

Oral Corticosteroids

These include:

  • Delta-Cortef (prednisolone)
  • Deltasone (prednisone)
  • Medrol; Solu-Medrol (methylprednisolone)

These steroids are related to cortisone produced in our bodies. They are sometimes required to control more severe episodes of asthma.

  • If used for more than a few weeks, the dose must be gradually reduced if the drugs need to be withdrawn
  • Long-term use of oral steroids can produce significant side effects such as high blood sugar, weight gain, fluid retention, high blood pressure, muscle weakness, and slow wound healing.
  • Your doctor may try to minimize these side effects by prescribing a very low dose of oral steroids, having you take the medicine every other day, or some combination of instructions.

Need To Know

Do not change the dose of oral steroids in any way unless instructed to do so.

Nonsteroidal Antiallergics

These include Intal (cromolyn) and Tilade (nedocromil). Cromolyn andnedocromil are not related to the corticosteroids.

  • These drugs work by blocking the release of inflammatory chemicals from certain cells in the body.
  • They are useful in protecting the airways from exposure to allergens or to the irritating effect of exercise or cold air.
  • They may reduce the need for inhaled corticosteroids and bronchodilators.
  • The nonsteroidal antiallergics must be taken continually for maximum protection.

Leukotriene Modifiers

These include:

  • Accolate (zafirlukast)
  • Singulair (montelukast)
  • Zyflo (zileuton)

Leukotriene modifiers (or antileukotrienes) are the first new class of prescription asthma medication to be introduced in 20 years. The drugs control leukotrienes, which are inflammatory chemicals released by cells in the lung during an attack.

Leukotrienes cause lung tissue to become inflamed, mucus to be secreted, and smooth muscle around the airways to contract. These changes lead to asthma symptoms such as wheezing and shortness of breath.

  • Zafirlukast and montelukast control asthma symptoms by blocking the action of leukotrienes on the airways. Zileuton blocks the actual production of leukotrienes.
  • When used in combination with inhaled corticosteroids, the leukotriene modifiers may be helpful in preventing more attacks.
  • All of the leukotriene modifier drugs are oral medications, making them easier to take than most other asthma medicines that are taken into the lungs by inhaler.
  • Side effects may include headache and nausea, and the drugs may interfere with the action of blood thinners.

Nice To Know

Q: Can I cure or treat my asthma with a special diet?

A: There is no cure for asthma. And there is no diet treatment that can serve as an alternative to taking asthma medications and following the asthma control plan worked out with your doctor. A wholesome, nourishing diet helps promote general health, which is essential in the overall control of asthma.

 


Medications To Relieve An Asthma Attack

Asthma medications that relieve the muscle spasms responsible for narrowing of the airways are called reliever medicines. The medications that best accomplish this are the bronchodilators. (“Bronchodilate” means to open up the airway, and that’s exactly what these medications do.)

Points to keep in mind concerning the bronchodilator drugs include:

  • They relax the airway spasms to provide immediate relief.
  • Bronchodilators are used before exercise or before exposure to triggers such as cold air.
  • They are to be kept with you at all times.
  • You should contact your doctor if you are not getting immediate relief from your symptoms.
  • Bronchodilators should not be used every day unless prescribed by your doctor.

A number of different inhaled drugs are available that relieve asthma symptoms. They include:

  • Short-acting beta2-bronchodilators
  • Anticholinergic bronchodilators

Need To Know

Bronchodilators are commonly used medications that immediately relax the muscle of airways that are in spasm during an asthma episode and generally provide prompt relief. Side effects can include:

  • Tremors
  • Fast or pounding heartbeat
  • Nervousness
  • Dizziness

When taken as directed by your doctor, these reliever medications do not cause long-term side effects.

Short-Acting Beta2-Bronchodilators

This group of inhaled short-acting reliever drugs includes:

  • Brethaire; Bricanyl (terbutaline)
  • Maxair (pirbuterol)
  • Tornalate (bitolterol)
  • Ventolin; Proventil (albuterol in the U.S.; salbutamol in the U.K. and Canada)

Need To Know

If you need to use these medications too frequently, or they don’t appear to be as effective as they used to be, this can be a signal that your asthma is not being controlled effectively and may be an early warning signal of an asthma episode. These drugs are not recommended for long-term daily treatment of asthma. Always carry a short-acting beta2-bronchodilator for fast relief during an asthma episode.

Anticholinergic Bronchodilators

One example of an anticholinergic bronchodilator is Atrovent (ipratropium).

  • It relaxes airway muscle by blocking the nerves that cause constriction of the airways.
  • It is sometimes used in combination with a short-acting beta2-bronchodilator.
  • It should be used with caution if you have glaucoma. Accidental spraying of the mist in the eyes can worsen the eye problem.
  • It is not fast-acting enough to be used as “front-line” reliever medicines during an asthma attack.
  • Common side effects include dry mouth, dry throat, dry nose, and headache.

Your Asthma Medication Checklist

Currently there are eight classes of drugs available to treat asthma:

Trade names

Generic names

Preventer drugs and drugs to control persistent asthma symptoms

 

1.Inhaled corticosteroids These medications block the production or release of inflammatory chemicals in the body. Few side effects are produced by the inhaled drugs because of their local action in the lung.

 

– AeroBid; Bronalide

flunisolide

– Advair

fluticasone + salmeterol

– Azmacort

triamcinolone

– Beclovent; Vanceril

beclomethasone

– Flovent

fluticasone

– Pulmicort

budesonide

2. Long-acting beta2-bronchodilators – These cause relaxation of the muscle fibers surrounding the airways, thus opening up the narrowed passageways. These drugs are slowly cleared from the body; therefore, their bronchodilating effects last for a long time (about 12 hours).

 

– Serevent

salmeterol

– Foradil

formoterol

3. Theophylline bronchodilators – These cause relaxation of constricted airways by blocking the action of chemicals that cause contraction of muscles surrounding the airways. Oral, slow-release theophylline drugs are commonly used in asthma maintenance therapy. (A fast-acting intravenous form of theophylline is also available for emergency room treatment of severe asthma episodes.)

 

– Theo-Dur; Theolaire

theophylline

4. Oral corticosteroids – These medications block the production or release of inflammatory chemicals in the body. Oral administration of corticosteroids for a prolonged time can produce several undesirable side effects.

 

– Delta-Cortef

prednisolone

– Deltasone

prednisone

– Medrol; Solu-Medrol

methylprednisone

5. Nonsteroidal antiallergics– These medications block the release or action of inflammatory chemicals in the body, thus reducing the symptoms of inflammation, including relief of airway constriction.

 

– Intal

cromolyn

– Tilade

nedocromil

6. Leukotriene modifiers These block the production or action of inflammatory chemicals called leukotrienes, thus reducing inflammation, relaxing the airways, and reducing mucus production.

 

Accolate

zafirlukast

Singulair

montelukast

Zyflo

zileuton

   

Rescue medication for use during an asthma attack.

 
   

7. Short-acting beta2-bronchodilators – These medications cause the muscle fibers surrounding the airways to relax, thus opening up the narrowed passageways. These drugs are rapidly cleared from the body, therefore, their effects last for a relatively short time (about 3 to 4 hours).

 

Brethaire; Bricanyl

terbutaline

Maxair

pirbuterol

Tornalate

bitolterol

Ventolin; Proventil

albuterol

8. Anticholinergic bronchodilators – These medications block the nerve responses that normally cause narrowing of airways. They are commonly used in combination with a beta2-bronchodilator such asalbuterol

 

Atrovent

ipratropium

 


Using Inhalers for Asthma

Many of the drugs given to prevent and treat asthma are inhaled. Inhaled medications do not have to be processed in any way by digestive organs in order to start working. Instead, they travel directly to the lungs, produce their effects quickly, and cause relatively few side effects.

Several different inhaler devices are available to suit the needs of different people with different kinds of asthma. All of them have their own advantages and disadvantages. Your doctor will decide which ones are best for you.

The basic kinds of inhaler delivery systems available for adults with asthma are:

  • Metered-dose inhaler
  • Metered-dose inhaler with spacer
  • Dry powder inhaler
  • Nebulizer

Metered-Dose Inhaler (MDI)

The medication is contained in a small, pressurized canister that releases a pre-measured or “metered” dose. Most canisters hold around 200 individual doses, but 50-dose and 100-dose inhalers exist for some drugs.

The pressurized metered-dose inhaler (pMDI) is sometimes called a “puffer” because the medicine contained in it is delivered to the lungs as small “puffs”.

A variety of asthma medications are available in MDI form, including preventer and reliever medications. They include:

  • Preventer medications and other drugs used to control persistent asthma symptoms
  • Reliever medications to treat symptoms of an asthma attack

The correct use of a “press and breathe” MDI takes practice and coordination between activating the MDI and breathing in at the right time to carry the drug into the lungs.

Most MDIs are pressurized by propellants called CFCs. CFCs are thought to contribute to depletion of the ozone layer and are being phased out in most countries. These substances are being replaced by non-CFC propellants that have a different taste and “feel” when they are sprayed into the mouth and throat. The newer MDIs also deliver a more gentle spray. These differences do not change the effectiveness of the asthma medication.

Correct inhaler technique is what delivers the medication to the lung, not the propellant used to power the device.

How-To Information

How do I use a metered-dose inhaler (MDI) without a spacer?

There are two basic ways of taking medication with an MDI without a spacer. Your doctor will tell you which of these methods you should use:

  • Remove the cap from the inhaler and shake the canister well.
  • Tilt your head back and slowly breathe all the way out.
  • Prepare to inhale with Method 1: Place the mouthpiece of the MDI 1 to 1 1/2 inches in front of your open mouth. This is a distance about as wide as two fingers.

OR:

  • Prepare to inhale with Method 2: Place the mouthpiece of the MDI past your teeth and gently place your lips around it to form a seal.
  • With either method, take a long, deep breath as you push down on the top of the MDI canister. Breathe in slowly through your mouth for about five seconds to deliver the medication mist to your lungs. (Don’t be surprised by the “puff” that occurs as you press down on the canister.)
  • Hold your breath for a count of 10. Remove the inhaler from your mouth and breathe out slowly. This is one inhalation or “puff.” Your doctor will tell you how many puffs to take.
  • If you are instructed to take a second puff, wait at least 30 seconds before repeating the procedure.
  • It is recommended to rinse your mouth with water, after using an MDI containing inhaled steroid medication.
  • To check on the contents of your MDI, remove the canister from the plastic inhaler, hold the canister close to your ear, and shake it to listen for medication movement. On a calendar you can keep a rough estimate of the total number of puffs you have taken for the month to know when you should refill your prescription. There are also MDI add-on devices that you can buy that keep track of the total number of doses delivered by the inhaler.

Metered-Dose Inhaler With Spacer

A spacer or holding chamber is a small container attached to the MDI as an extra device. Some MDIs (for example, Azmacort) have a built-in spacer.

  • The spacer acts as a reservoir that changes the characteristics of the medication. The puff of medication from the MDI goes into the spacer where it “slows down” and turns into a very fine mist instead of a high pressure puff. This fine cloud of medication stays in the spacer until the person breathes in through a one-way valve, drawing the dose of medicine into the lung.
  • The cloud of vapor is so fine that most people don’t feel or taste it as they breathe in. The fine drug particles are carried deep into the lung where they do the most good, instead of hitting the tongue or the back of the throat the way a blast from an MDI sometimes does.

How-To Information

How do I use a metered-dose inhaler with a spacer?

  • Remove the cap from the metered-dose inhaler (MDI) and shake well to mix up the medication.
  • Push the mouthpiece of the MDI into the rubber end piece of the spacer, making sure the gasket of the spacer seals around the MDI mouthpiece.
  • Breathe in deeply, then breathe out.
  • Place lips firmly around the mouthpiece of the spacer.
  • Press down on the canister of the inhaler, holding the spacer upright.
  • Take a slow deep breath and hold your breath for five to 10 seconds. If you cannot hold your breath, breathe in and out normally for 3 to 5 breaths.
  • Wait at least 30 seconds before administering another puff, if you are directed to take more than one puff by your doctor.
  • It is recommended to rinse your mouth with water, after using an MDI containing inhaled steroid medication.
  • Wash the spacer in warm water with a small amount of liquid detergent and rinse thoroughly. Let dry overnight. Most spacers are dishwasher safe when place upright on the top rack and washed on the setting normally used for dishes.
  • Once a week, clean your spacer as described, then boil in water for 10 minutes to disinfect and eliminate bacteria. Check the directions with your brand of spacer for any additional or special cleaning instructions.

Dry Powder Inhaler (DPI)

Dry powder inhalers depend on the force of the air drawn into the lungs to pick up measured doses of the drug in the form of very small granules that are delivered to the lungs.

Some DPIs require very little effort to breathe in and be activated. Others require a greater effort and may not be suitable for everyone. Your doctor will decide if a DPI is best for you and, if so, which model to choose.

No coordination between activation of the unit and breathing in is required with DPIs, because they are “breath-activated.” Your doctor will show you how to load and use your DPI.

Preventer medications and other drugs used to control persistent asthma symptoms that are available in DPI form include:

  • Inhaled corticosteroids (such as budesonide)
  • Long-acting beta2-bronchodilators (such as salmeterol and formoterol)

Reliever medications to treat symptoms of an asthma attack that are available in DPI form include:

  • Short-acting beta2-bronchodilators (such as albuterol)

Multiple-dose and single-dose DPIs are available. Multidose-units offer convenience. Single-dose DPIs may be well-suited for children or adults where control of each individual dose is required:

Multidose DPIs include:

  • Turbuhaler: 200-dose disposable unit with dose indicator; each dose is dispensed from a chamber when a knob on the base of the unit is rotated in one direction and then in the other.
  • Diskus: 60-dose disposable unit with dose indicator; each dose dispensed from a dosing disc when a lever on the unit is moved.
  • Diskhaler: 8-dose unit (Ventolin; Beclovent) and 4-dose unit (Serevent) with dose indicator; each dose dispensed from a dosing disk when the lid on the unit is raised, piercing a foil blister; replaceable medication disks

Single-dose DPIs include:

  • Rotahaler: Rotating the sleeve of the unit breaks a capsule, releasing the powdered drug inside the unit; drug inhaled through fine mesh screen; reusable.
  • Spinhaler: Sliding sleeve in and out punctures a drug capsule, releasing the powdered drug inside the unit; inhaling turns a small propeller that spins powdered drug out of the unit; reusable
  • Aerolizer: Pressing two levers pierces a capsule. The capsule rotating during inhalation releases the powder into the air stream.

How-To Information

Which inhaler do I use during an asthma attack?

Inhalers are color-coded for the different drugs they contain. Different companies use different colors for their inhalers, but the color of the inhaler containing the reliever drug will always be different than the color used on the inhalers containing other asthma medications. Make note of the:

  • Color of the inhalers (MDIs and DPIs) you use as preventer medicines; and the
  • Color of the inhalers (MDIs and DPIs) you use for relief of asthma symptoms.

This awareness can be vitally important during the stress and anxiety of an asthma attack. Know which color inhaler contains your “rescue” medicine. Most companies use a blue color code on inhalers containing a short-acting beta2-bronchodilator to be used in an asthma emergency to relieve airway constriction.

Small-Volume Nebulizer (SVN)

Nebulizers consist of a small air compressor unit that turns liquid asthma medication into a fine mist that is breathed in through a mouthpiece. Treatments usually last around 10 minutes.

No coordination is required to deliver the medication because it is simply taken in with the breath. Compared with other inhalers, however, nebulizers are wasteful of drug. The units are compact but lack the convenience of portable MDIs and DPIs.

A limited number of medications are available in a form suitable for nebulizers.

Preventer medications and other drugs used to control persistent asthma symptoms that are available in nebulizer form are:

  • Inhaled corticosteroids (such as budesonide)
  • Nonsteroidal antiallergics (such as cromolyn)

Reliever medications to treat symptoms of an asthma attack that are available in nebulizer form are:

  • Short-acting beta2-bronchodilators (many, such as albuterol)
  • Anticholinergic bronchodilators (such as ipratropium)

How-To Information

How do I use a small-volume nebulizer?

  • Measure the prescribed amount of medication into the nebulizer container.
  • Close the container and turn on the nebulizer.
  • With the mouthpiece in place, begin to breathe the medication mist in and out through your mouth normally.
  • The container on the nebulizer generally holds enough medication for a treatment that lasts for about 10 to 15 minutes.
  • It is recommended to rinse your mouth with water, after taking inhaled steroid medication.
  • Follow the manufacturer’s directions for cleaning and disinfecting the small-volume nebulizer.

 


Asthma: The Peak Flow Meter

The peak flow meter is an important device that can give you valuable information about your air passages. Peak flow measurements provide a very simple way of measuring how quickly air can be forced out of the lungs.

Why Should I Do Peak Flow Monitoring?

Measurements of forced expiration are important in the overall assessment of lung function and are commonly used in pulmonary function testing.

  • Peak flow monitoring gives a valuable early warning sign for asthma that may be getting worse. Sometimes peak flow values decrease for hours, or even a day or two, before an attack is noticed. This early warning sign can be seen in the daily record of peak flow values. Because peak flow values are actually measured, they are objective and more reliable than feelings of “tiredness” sometimes experienced by people with asthma.
  • Peak flow monitoring is very sensitive and can help you communicate with your doctor. Keeping a diary of these measurements gives your doctor a written record of the condition of your breathing passages. The record you keep provides valuable information about how you’re doing and how well your asthma medications are working.
  • Peak flow monitoring gives important information that allows your doctor to adjust your medication if needed. The record also tells the doctor when emergency care may be needed to control an asthma episode that is worsening.

How-To Information

How often should you take a peak flow reading?

It depends on the plan your doctor has worked out.

  • If the asthma is quite mild, the doctor may suggest using the meter only when you are wheezing, or feel an attack is coming on.
  • Peak flow readings are useful when starting on a new medicine, because the peak flow readings will show clearly how well the medication is working.
  • If the asthma is quite severe, your doctor may want you to use the meter daily, at the time of day when the asthma is usually worst.
  • Many people take peak flow readings once or twice a day, usually in the morning before taking their medication and in the evening before going to bed. Whatever schedule your doctor suggests, try to take your peak flow readings at the same time each day to produce an accurate record.

How-To Information

How do I use the peak flow meter?

  • Have an empty mouth…no gum or food.
  • Stand up, if possible.
  • Set the meter at “zero.”
  • Hold the meter correctly, so fingers don’t get in the way.
  • Take a really deep breath, with the chest puffed up as far as it can go.
  • Close lips around the mouthpiece, with the tongue out of the way.
  • Blow as hard and fast as possible, as if blowing out candles on a cake.
  • The arrow will move until it points to a number on the scale. This is the peak flow number.
  • Make a note of the peak flow value next to the indicator (or the zone color on the meter). Your doctor may have attached a “Zone Indicator” of some kind to the meter so that you can record the “color” of the peak flow that you achieved.
  • Reset the indicator back to “zero” at the bottom of the scale.
  • Repeat the entire process two more times and write down best of three numbers in the daily record chart provided by your doctor. Note the date and time.

Remember to take a deep breath and blow as hard as possible into the meter to get the highest possible number. Do not spit into the flow meter because this will result in an artificially low value for peak flow.

Your “personal best” peak flow rate is the highest rate you can reach regularly when you are symptom-free. To determine this value, take your peak flow rates for a week when you wake up and before your evening meal. At each of these times, record the best number of your three tries.

Need To Know

How do I know if I’m using the meter correctly?

  • Watch: Make sure your chest puffs out, not your cheeks.
  • Listen: There should be no whistling noises from the meter.
  • Record: Look at the numbers on the scale and keep a record.
  • Clean: Keep your peak flow meter clean. Wash the plastic body in warm water at least once a week. Let air dry

What Do The Numbers Mean?

Many doctors recommend a three-zone system based on your “personal best” flow rate. This value is the highest peak flow measurement you can achieve on a day when your asthma is under good control.

  • The green zone: This includes readings higher than 80% of your best peak flow rate.
  • The yellow zone: This indicates you are able to achieve only 50% to 80% of your personal best peak flow rate.
  • The red zone: Your are able to achieve only half, or less than half, of your personal best peak flow rate.

Your goal is to stay in the green zone as long as possible. If you enter the yellow zone, follow your plan so that you do not enter the red zone.

  • If your peak flow reading is in the safety or green zone: This peak flow reading indicates there is no problem and suggests that current treatment is working.
  • If your peak flow reading is in the caution or yellow zone: A reading in the caution zone means that the asthma is worse, even if you feel fine and look well. Now you need to act on the plan worked out with your doctor – give or increase a particular medication or prepare for an attack.

    Your asthma action plan should make clear when the doctor is to be contacted. In many cases, this is not necessary unless readings repeatedly enter the Caution Zone, or stay there even after the treatment prescribed in your plan has been given.

  • If your peak flow reading in the danger or red zone: This means you are able to achieve only half, or less than half, of your personal best peak flow rate. It often means that an asthma attack has begun.

    Your plan should make clear what you need to do. This will include specific medication to be taken immediately. You should get in touch with your doctor if the medicine doesn’t stop the attack, or go immediately to the emergency room.

Need To Know

Do not rely on the numbers alone when using a peak flow meter. You must also make note of your symptoms. Sometimes the peak flow numbers are within your normal range but asthma symptoms are still present. This could be a signal to your doctor that your medication dosage needs to be adjusted.

Nice To Know

Q. How accurate are peak flow meters?

A. When used correctly, peak flow meters are excellent tools that reflect the state of the lungs, but you need to treat the device with respect. Keep it clean, use it as directed, check it frequently for damage, and it will give accurate measurements. However, remember that symptoms are just as important as numbers. In some cases, you can get a good peak flow “score” even when you are having symptoms such as difficulty in sleeping at night. If that’s the case, make a note of the peak flow numbers and talk to your doctor.

 


The Asthma Action Plan

An asthma action plan is a written plan developed by your doctor to help in the management of asthma episodes. It is a customized plan that tells you what to do based on changes in your symptoms and peak flow numbers. It is also called a crisis intervention plan, asthma self-management instructions, or written guidelines for asthma.

Asthma action plans can be organized in any number of ways, but the important thing is that your individualized action plan gives you and your family information that can be invaluable in an asthma emergency. Action plans may include:

  • A list of the triggers responsible for your asthma and how to avoid them.
  • A list of peak flow meter readings and zones based on your personal best.
  • A list of routine symptoms such as coughing, wheezing, tightness in the chest, shortness of breath, and excess mucus production, and what you should do if these symptoms occur.
  • What you should do if nighttime asthma symptoms awaken you.
  • A list of more serious asthma symptoms such as decreased effectiveness of your reliever medicine and breathlessness, and what you should do if these symptoms occur.
  • The name and dose of the preventer medication that needs to be taken, even when there are no symptoms, and the name and dose of the reliever medication that needs to be taken when you are having an asthma attack.
  • Emergency telephone numbers and locations of emergency care.
  • Instructions about when to contact your doctor, whom to call if your doctor is unavailable, and a list of where to get emergency treatment.
  • Information about asthma organizations and support groups.

Keep your action plan handy and keep it current. Action plans should be reviewed with your doctor at least once a year. Changes in the plan may be needed because of changes in your peak flow numbers or the medications you are taking.

Need To Know:

If you work closely with your health team and learn to manage asthma, you can expect to have a trouble free and fully active life, and you will have achieved the goals of asthma treatment which include:

  • Prevention of chronic and troublesome symptoms such as coughing and breathlessness at night;
  • Maintenance of normal activity levels, including exercise and other physical activity;
  • Prevention of recurring asthma episodes and the need for emergency department visits.

 


Warning Signs Of An Asthma Attack

Asthma is an unwelcome intruder in a person’s life. It is a chronic lung disease and it can’t be cured. But there are several unique features of the disease that are not found with most other respiratory diseases.

  • Asthma is reversible. With good treatment, the damage to the lung can be reversed or minimized.
  • It can be controlled by avoiding asthma triggers and taking the right medicines.
  • Asthma attacks usually can be predicted. Asthma episodes normally do not occur suddenly, without warning (although it may seem that way at times). They develop over a period of time, providing a chance to start countermeasures to ward off an attack.

What Conditions May Bring On An Asthma Attack?

Changes in the external environment may signal an increase in the irritating effect of certain triggers for some people with asthma:

  • Decrease in the environmental air quality (increasing pollution index)
  • Increase in the pollen count
  • Windy, dusty conditions
  • High humidity and high temperature
  • Low humidity and low temperature

The best course of action on such days is to avoid them if at all possible by staying indoors where the environment can be better controlled.

Need To Know:

Predicting An Attack

Any number of triggers can irritate the linings of the airways in sensitive lungs. As the airways overreact, changes occur that signal a worsening of asthma control. Prediction of an asthma attack is based on recognizing changes that occur in:

  • The number of times you need to use reliever medication
  • The effectiveness of asthma medicines
  • Your sleep pattern
  • Physical activity
  • Breathing pattern
  • Peak flow meter readings

Q. Are there any early warning signs of an asthma attack that are reliable? Usually by the time I notice wheezing and coughing I’m already in bad shape.

A. Unfortunately, some “early warning signs” are not all that early for some people. Learning to recognize a cough when you don’t have a cold or something caught in your throat might help. The best thing you can do is use a peak flow meter regularly and record the readings. Changes in peak flow values are usually reliable and they may occur hours or days before you notice symptoms. However, always make note of your symptoms. Peak flow measurements on their own are not enough to predict asthma attacks in every case.

If Symptoms Get Worse

Early warning signs of an asthma episode may include symptoms such as:

  • Runny, stuffy nose
  • Sneezing
  • Chin or throat itchiness
  • Headache
  • Feeling or looking tired
  • Reliever drug being used more often than usual
  • Difficulty sleeping because of symptoms such as coughing
  • Physical activity brings shortness of breath

What to do: Follow your action plan and take your medications as per the plan.

Signs that your asthma is becoming severe:

  • Awakening at night, unable to sleep
  • Reliever drug is bringing little relief
  • Breathlessness is getting worse

What to do: Contact your doctor immediately.

Signs that you asthma has become dangerous:

  • Reliever drug brings no relief
  • Peak flow stays in the red zone after using rescue medication
  • Difficulty speaking
  • Walking is difficult
  • Feeling of fright
  • Faint-headed

What to do: Go to the closest hospital emergency department immediately.

How-To Information

If your symptoms do not improve even after you have followed your action plan, you should go to the emergency department.

What To Expect At The Emergency Department

  • Fast-acting beta2-bronchodilators that open the airways will probably first be given to you with a small-volume nebulizer. Nebulizers produce a fine mist of medication that can be inhaled through a facemask or mouthpiece and require no “coordination” between breathing in and the delivery of drug to the lungs.
  • You will also probably receive additional asthma medications, possibly through an intravenous (IV) line that delivers drug directly to the bloodstream.
  • Steroid medication may be necessary to quickly reduce the inflammation in the air passages.
  • Oxygen will probably be delivered through a facemask or through small tubes that fit under your nose.
  • In more serious cases of asthma, intubation may be required. In this procedure a breathing tube is placed into the throat so that oxygen can be delivered directly to the lungs.

What Should I Do During An Asthma Attack?

Ideally, your early warning signs such as a feeling of tightness in your chest, wheezing, coughing, and restlessness while trying to sleep will have given you the extra time you need to take the steps outlined in your personal action plan.

If the episode is just beginning:

  1. Follow the instructions in your action plan. Take the medicines your doctor has prescribed to keep the episode from getting worse.
  2. Pay close attention to the type of medication being taken. Because of the feeling of urgency and distress during an asthma attack, people sometimes mistakenly use their preventer medicine. This will not help the symptoms of an asthma attack. The reliever drug at the dose prescribed is what is needed. Make note of the color of the two different kinds of inhalers and make sure you use the one containing the reliever medicine.
  3. Relax your breathing.
  4. Use pursed-lip breathing.
  5. Cough to loosen mucus in the airways and cough again to bring it up. Spit out the mucus into tissues.
  6. Call your doctor if the attack is getting worse and you have taken the proper medicine and done everything else you can think of. This is not a time to feel embarrassed or ashamed. If you have followed the action plan and you are still having an asthma episode, it’s time to seek medical attention. Don’t wait too long to get a doctor’s help when needed.

Need To Know:

Your preventer medication will not be of help in a severe asthma attack. Be sure you are using the reliever medication, not the preventer medication.

How-To Information

Relaxing in order to breathe more easily is not easy in a situation where fear, anxiety, and anger are natural feelings. But it can be done with practice:

  • Start by sitting comfortably in a chair. Do not lie down.
  • Relax your shoulders and neck. Concentrate on not gasping for air as you drop your shoulders.
  • Breathe in slowly through your nose. Concentrate.
  • Purse your lips together tightly the way a trumpet player does, and blow out slowly through your mouth. Take as much time as possible to exhale in this way.
  • Relax. Keep using the pursed-lip breathing until the breathless feeling goes away. Rest between breaths if you feel dizzy.

 


Pregnancy And Asthma

If you are pregnant and have asthma, you should try to learn all you can about the drugs you are taking to control your asthma. Good asthma control is essential to provide the oxygen your body and the fetus needs. Your doctor will work out the asthma plan best suited to your needs while you are pregnant.

You must also communicate with everyone involved. Make sure your obstetrician knows that you have asthma and what you are doing about it. Also, you must keep the doctor who looks after your asthma informed about your pregnancy and the medications you may be taking. Your doctors will usually be well informed and experienced in treating asthma in pregnant women.

  • As a general rule, your doctor will try to determine the lowest amount of medication required to control your asthma. It is important to keep your asthma well controlled during pregnancy so that you and your baby will be in the best possible condition for the birth.
  • The drugs used for control and relief of asthma symptoms are not tested on pregnant women because of ethical reasons. (In fact, proof of safety during pregnancy is not established for most drugs.) However, limited studies of asthma medications in pregnant animals, and the routine use of such drugs in pregnant women with asthma, suggest the drugs are safe. There is little to suggest an increased risk to the fetus. Therefore, there is wide acceptance by experts that the usual asthma drugs should be used to control asthma symptoms in pregnant women. Maintaining adequate oxygen supply to the fetus is essential. Because some drugs have not been tested in pregnant women does not mean that they are harmful. It means that a medical decision must be made regarding their use during pregnancy, and that the dosage and effects be closely monitored by your doctors.
  • Always ask your doctor about the use of over-the-counter (OTC) medicines during pregnancy and never change the dosage of your asthma medicines without directions from your doctor. Follow your action plan.

Nice To Know:

Interestingly, the fetus protects itself against low oxygen levels by producing a special type of hemoglobin in its red blood cells. (Hemoglobin molecules carry oxygen in the bloodstream.) This special hemoglobin makes the baby’s red blood cells very efficient in receiving oxygen from the mother. In fact, even in women who have moderate to severe chronic asthma, the fetus usually receives enough oxygen for its needs.

 


Frequently Asked Questions: Asthma

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.


Putting It All Together: Asthma

Here is a summary of the important facts and information related to asthma in adults.

  • Asthma is a condition in which extra-sensitive lungs overreact to certain irritating conditions called “triggers.”
  • In asthma, the air passages of the lung are chronically inflamed, meaning they are red and swollen. When an asthma attack occurs, the muscle in the walls of the air passages may contract, causing the airways to narrow.
  • The signs of an asthma attack or episode include difficulty in breathing because of narrowed airways caused by tightened muscles around the airways, swelling of the inner linings of the airways, and mucus that is clogging the airways.
  • Symptoms of asthma may include coughing, wheezing, tightness in the chest, shortness of breath, and excess mucus production.
  • “Good asthma control” means that one does not experience wheezing, coughing, shortness of breath, and interruption of sleep, that exercise and daily activities are carried out normally, and that reliever medicines are used less than three times per week.
  • We don’t know why some adults get asthma, but many have a history of childhood allergies, asthma, or both.
  • Asthma is a chronic condition that cannot be cured but can be successfully treated.
  • Both allergic and non-allergic types of asthma exist.
  • Asthma symptoms usually develop over a period of time and may be triggered by changes in the external environment such as very hot or cold weather, and by changes in the pollution and pollen levels in the air.
  • Managing asthma episodes includes taking the correct medications, using breathing relaxation and pursed-lip breathing exercises, and coughing and mucus removal.
  • Medications to manage asthma come in various forms, such as tablets and inhaled forms.
  • Using a peak flow meter as the doctor recommends can help you determine if an asthma attack is coming, even if you feel fine at the time.

Glossary: Asthma

Here are definitions of medical terms related to asthma in adults.

Allergen: A foreign substance that triggers an allergic response in a susceptible person. Allergens are usually common items encountered in everyday life such as substances from insects, animals or plants (such as pollen).

Allergy: An unusual response to a small amount of a foreign substance that normally does not cause a reaction in another person.

Asthma: A chronic, reversible obstruction of the airways. Allergic asthma is caused by an allergic stimulus; most common in children and adults; caused by exposure to substances such as dust mites, plants, pollens, and molds. Nonallergic asthma is caused by exposure to substances or conditions such as cold air, exercise, or respiratory infections, rather than exposure to allergens.

Asthma attack; asthma episode: The development of asthma symptoms, usually at rest, which are not immediately relieved by “rescue” or “reliever” medications; symptoms include coughing, wheezing, and shortness of breath caused by narrowing of the airways.

Chest tightness: A symptom of asthma caused by overinflation of the lungs due to the difficulty in pushing air out through obstructed air passages.

Dry powder inhaler (DPI): A portable device used to deliver dry powdered medication to the lungs; single and multi-dose models are available; no propellant is required; all models are breath-actuated and require no hand-lung coordination.

Inflammation: A tissue reaction in which increased numbers of cells invade the tissues. These cells release chemicals that cause changes such an increase in mucus production, swollen linings of airways, and constriction of the airways due to muscle spasm.

Metered-dose inhaler (MDI): A portable device used to deliver a fine aerosol mist of medication to the lungs; powered by propellant; use of the inhaler must be coordinated with the intake of breath.

Mucus: The secretion normally released into the airways to coat and protect them; mucus normally traps inhaled smoke and dust particles to prevent them from reaching deeper into the lungs.

Peak flow meter: A small, portable monitoring device that measures the amount of effort to force air out of the lungs; obstructive diseases such as asthma often cause an increase in the effort to breath out, which shows as a decreased value on the peak flow meter.

“Preventer” medication: A group of asthma drugs that prevent the symptoms of asthma by controlling the production, release, or activity of inflammatory chemicals, or by providing long-acting relaxation of airways (such as for 12 hours). Examples are inhaled corticosteroid, oral corticosteroid, leukotriene modifier, long-acting beta2-bronchodilator, nonsteroidal antiallergic, theophylline bronchodilator.

“Reliever” medication: A group of asthma drugs that counter, or relieve, the symptoms of asthma by causing the relaxation of airways. Examples are short-acting beta2-bronchodilator, anticholinergic bronchodilator.

Small-volume nebulizer (SVN): A device that uses a small compressor, nebulizer, and face mask to deliver a fine aerosol mist of drug to the lung; no hand-lung coordination required; units are bulky and not portable.

Spacer device: A small tube-like device, usually made out of plastic, to which a pressurized metered-dose inhaler (MDI) is attached; depression of the MDI canister delivers a dose to the spacer which holds it long enough for the medication mist to turn into a very fine cloud of vapor that is inhaled when a breath is taken.

Trigger: An irritating substance or condition to which a person reacts when they are exposed.

Wheeze: A symptom of asthma caused by the whistling sound made when air is pushed past an obstruction or narrowed area of an airway.


Additional Sources Of Information: Asthma

Here are some reliable sources that can provide more information on asthma in adults.

Books

  • American Lung Association: The Asthma Handbook. American Lung Association, New York, 1992. 24 pages.
  • Bush RK and Georgitis JW. Handbook of Asthma and Rhinitis. Blackwell Science, Malden, MA, 1997. 270 pages. ISBN: 0-86542-433-0.
  • Gershwin ME and Klingelhofer EL. Asthma: Stop Suffering, Start Living. 2nd ed. Addison-Wesley Publishing Co., Reading, MA, 1992. 211 pages. ISBN: 0-201-60847-2.
  • Hannaway PJ. The Asthma Self-Help Book (revised and expanded). Lighthouse Press, Marblehead, MA, 1992. 271 pages. ISBN: 1-55958-166-2.
  • Harrington G. The Asthma Self-Care Book: How to Take Control of Your Asthma. Harper Collins Publishers, New York, 1991. 272 pages. ISBN: 0-06016584-7.
  • Hogshead N and Couzens GS. Asthma and Exercise. Holt, New York: Holt, 1990. 239 pages. ISBN: 0-8050-0878-0.
  • Newhouse MT and Barnes PJ. Conquering Asthma: An Illustrated Guide to Understanding and Care for Adults and Children. Decker Periodicals, Toronto, 1991. 124 pages. ISBN: 0-9695171- 1-4.
  • Shayevitz MB and Shayevitz BR. Living Well with Chronic Asthma, Bronchitis, and Emphysema. Consumer Reports Books, Yonkers, NY, 1991. 210 pages. ISBN: 0-89043-416-6.

Resource Organizations

  • American Academy of Allergy, Asthma and Immunology 
    Phone: 1-800-822-2762
    Phone: 414-272-6071
    http://www.aaaai.org
  • American College of Allergy, Asthma and Immunology 
    Phone: 708-427-1200
    http://www.acaai.org
  • Asthma and Allergy Foundation of America 
    Phone: 1-800-7ASTHMA
    Fax: 202-466-8940
    http://www.aafa.org
  • National Allergy and Asthma Network / Mothers of Asthmatics, Inc. 
    Phone: 1-800-878-4403
    Phone: 703-385-4403
    http://www.aanma.org
  • LUNG LINE┬«, National Jewish Medical and Research Center 
    Phone: 1-800-222-LUNG or in Denver, CO,
    Phone: 355-LUNG
    http://www.njc.org
  • Allergy Task Force Project 
    http://www.theallergyreport.org

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