Prevention of Asthma

You can reduce asthma symptoms by avoiding known triggers and substances that irritate the airways.

• Cover bedding with "allergy-proof" casings to reduce exposure to dust mites. Pillows and the warm bedroom air that surrounds them are perfect breeding grounds for those undesirable invisible companions making themselves at home in your bed. It has been estimated that a large proportion of the weight of your pillow may be made up of bugs, dead skin, dust mites and their feces.
• Remove carpets from bedrooms and vacuum regularly.
• Use only unscented detergents and cleaning materials in the home.
• Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold.
• Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people.
• If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Asthma is strongly associated with allergies, and exposure to allergens can worsen asthma symptoms.
• liminate tobacco smoke from the home. This is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma symptoms. Children are especially susceptible to developing asthma or experience a worsening in symptoms if they are exposed to secondhand smoke. Children breathing secondhand smoke are more likely to suffer from bronchitis and pneumonia, ear infections, coughing and wheezing, and more frequent.

Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes as much as possible.

Integrative Therapies (Good Scientific Evidence)

Boswellia: 

Boswellia has been proposed as a potential therapy for asthma. Future studies are needed to assess the long-term efficacy and safety of boswellia and to compare the efficacy of boswellia to standard therapies. Boswellia should not be used for the relief of acute asthma exacerbations. Boswellia is generally believed to be safe when used as directed, although safety and toxicity have not been well studied in humans. 

Avoid if allergic to boswellia. Avoid if have history of stomach ulcers or stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble medications, agents metabolized by the liver's cytochrome P450 enzymes, or sedatives. Use cautiously with impaired liver function or liver damage or lung disorders. Use cautiously in children. Avoid if pregnant due to potential abortifacient effects or if breastfeeding.

Buteyko Breathing Technique : 

The Buteyko breathing technique (BBT) consists of breathing techniques, relaxation exercises, and asthma education. The technique aims to reduce hyperventilation. Studies have shown reduced use of rescue inhalers among patients receiving BBT. Improvements in other measures of asthma severity have not been shown. Additional study is warranted.

BBT is generally considered safe. Avoid with asthma that changes suddenly ("brittle asthma"). BBT may interact with asthma medications and should be used with caution when decreasing asthma medication. Asthma should be treated by a qualified healthcare professional and patients should always carry a rescue inhaler. Avoid if pregnant or breastfeeding.

Choline :

Choline is possibly effective when taken orally for asthma. Choline supplements seem to decrease the severity of symptoms, number of symptomatic days and the need to use bronchodilators in asthma patients. There is some evidence that higher doses of 3 grams daily might be more effective than lower doses of 1.5 grams daily. Choline is generally regarded as safe and appears to be well-tolerated. Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.

Coleus : 

There is a lack of sufficient data to recommend for or against the use of coleus in the treatment of bronchial asthma. Preliminary data appears to be promising. However, larger, randomized, controlled trials are needed to confirm the safety and efficacy of coleus in bronchial asthma. Coleus is generally regarded as safe, as very few reports have documented adverse effects. However, only a few short-term trials have assessed its safety in a small sample size of patients. Avoid if allergic to Coleus forskohlii and related species or with bleeding disorders. Avoid if pregnant or breastfeeding.

Ephedra :

Ephedra contains the chemicals ephedrine and pseudoephedrine, which are bronchodilators (expand the airways to assist in easier breathing). It has been used and studied to treat asthma and chronic obstructive pulmonary disease, such as asthmatic bronchoconstriction, in both children and adults. Other treatments such as beta-agonist inhalers (for example, albuterol) are more commonly recommended due to safety concerns with ephedra or ephedrine. However, the U.S. Food and Drug Administration (FDA) has collected thousands of reports of serious toxicity linked to ephedra (including over 100 deaths). Ephedra products are banned from dietary supplements because of serious health risks, including heart attack, heart damage, breathing difficulties and fluid retention in the lungs. Avoid ephedra if pregnant or breastfeeding.

Psychotherapy :  

Family psychotherapy may slightly improve wheezing and thoracic gas volume for asthma in children, according to several studies.

Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire of the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.

Pycnogenol : 

Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine (Pinus pinaster spp. atlantica), which is grown in coastal south-west France. Pycnogenol may offer clinical benefit to both children and adults with asthma. Additional study is needed before a conclusion can be made. Avoid if allergic/hypersensitive to pycnogenol, its components, or members of the Pinaceae family. Use cautiously with diabetes, hypoglycemia, or bleeding disorders. Use cautiously if taking hypolipidemics, medications that may increase the risk of bleeding, hypertensive medications, or immune stimulating or inhibiting drugs. Avoid if pregnant or breastfeeding.

Yoga : 

Multiple human studies report benefits of yoga (such as breathing exercises), when added to other treatments for mild-to-moderate asthma (such as standard drug therapy, diet, or massage). Better research is needed before a firm conclusion can be drawn.

Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

Types Of Inhalers

Dry-Powder Inhaler: 

  

Dry-powder inhalers are the most common inhalers used today. This type of inhaler does not need a propellant. Instead, the individual inhales the medicine so it can reach the lung. Children, people with severe asthma and people suffering from acute attacks may be unable to produce enough airflow to use these inhalers successfully.

Metered-Dose Inhaler: 

The most efficient way to get asthma medication into the airways is with a metered-dose inhaler (MDI). When used properly, about 12-14% of the medication is inhaled deep into the lungs with each puff of the MDI. They are especially important for delivering quick relief medication - short-acting beta agonists - that relieve an acute asthma attack. 

MDIs are also used to deliver some long-term control medications, including anti-inflammatories and long-acting bronchodilators, which are taken routinely to manage asthma symptoms. An MDI is especially recommended for use with inhaled steroids because it reduces the amount of drug dispersed into the mouth, which reduces the risk of side effects.

Metered-dose inhalers are designed to release a pre-measured amount of medication into the lungs. There are several different types, but in general, they all have a chamber that holds the medication and a propellant that turns the medication into a fine mist. A button is pushed to force the medication out through the mouthpiece.

Medication that is inhaled acts more quickly than medication taken by mouth. It also causes few adverse effects because the medication goes directly to the lungs and not to other parts of the body.

If an MDI is not used correctly, symptoms may persist or worsen. Individuals who have trouble using the device correctly may use a spacer to help them get the medication they need. Spacers are attached to the mouthpiece, and they hold the discharged, pre-measured medication in a chamber until the patient breathes in. Spacers are recommended for young children and older adults who have trouble coordinating breathing and activating the MDI.

Nebulizer:

A nebulizer is an electrical device that sends medicine directly into the mouth by a tube (or mask in children). This method does not require hand-breath coordination. The patient puts the prescribed amount of medication into the tube, and then places the tube in the mouth (or places the mask over the child's nose and mouth). Then the patient breathes normally until all of the medication is gone.

Treatment of Asthma

Long-term :

• Combined therapy medicine: Combined therapy involves both a controller (long-acting bronchodilator) and reliever (corticosteroid) medicine. This therapy is used to manage asthma symptoms for long-term. 
• Cromolyn sodium and nedocromil sodium: Cromolyn sodium (like Intal® and nedocromil sodium (like Tilade®) are used to help prevent the airways from swelling when they are exposed to asthma triggers. These inhaled non-steroids may also help prevent exercise-induced asthma attacks. 
• Immunotherapy: During immunotherapy (also known as allergy shots), the patient receives periodic injections, as determined by the allergist/immunologist, over the course of three to five years. The solutions in the injections contain the substances the individual is allergic to. The treatment helps the immune system tolerate the allergens and lessens the need for medications. 
• Peak flow meter: A peak flow meter is a portable device that measures airflow, or peak expiratory flow (PEF). When asthmatics blow into the device quickly and forcefully, the peak flow reading indicates how open the airways are. Patients should compare their daily peak flow recordings with their "personal best" recording. The device helps patients determine the severity of the asthma. It is enables patients to check their responses to treatment and monitor their treatment progress. 
• Inhaled corticosteroids: Inhaled corticosteroids (Aerobid®, Azmacort®, Beclovent®, Flovent®, Pulmicort® or Vanceril®) are used to prevent and reduce airway swelling, as well as decrease the amount of mucus in the lungs. These medications are generally considered safe when taken as directed. 
• Leukotriene modifiers: Leukotriene modifiers (like Accolate® or Singulair®) are a new type of long-term control medication. They help prevent airway inflammation and swelling, as well as decrease the amount of mucus in the lungs. 
• Long-acting beta agonists: Long-acting beta agonists, such as Serevent® (which is inhaled) may be taken with or without anti-inflammatories to help control persistent symptoms. Long-acting, inhaled beta agonists should not be used as a substitute for anti-inflammatories. This type of medicine may also prevent exercise-induced asthma. However, these medications cannot relieve symptoms quickly, and they should not be used to treat an acute attack. A short-acting, inhaled beta agonist should be used to treat acute symptoms. 
• Oral corticosteroids: Oral corticosteroids like (Aristocort®, Celestone®, Decadron®, Medrol®, Prednisone® or Sterapred®) are available in pill/tablet format for adults. Liquid corticosteroids (like Pediapred® or Prelone®) are available for children. These medications can be used short-term for severe asthma episodes or as long-term therapy for individuals who have severe asthma. 
• Trigger avoidance: Since asthma can be triggered by allergens, symptoms can be caused or aggravated by the environment. An allergist or immunologist can help patients recognize the allergens and irritants that trigger asthma attacks. Exposure to common irritants, including pollen, animal dander, mold spores and dust mites, may trigger asthma.

 

Eliminate potential food allergens, including dairy (milk, cheese and sour cream), eggs, nuts, shellfish, wheat (gluten), corn, preservatives and food additives (like dyes and fillers). Food allergies can be a contributing factor in immune imbalance triggering symptoms of asthma.

Short-term :

• Oral beta agonists: Oral beta agonists (like Alupent®, Brethine®, Bricanyl®, Proventil®, Repetabs®, Ventolin® or Volmax®) may be used to decrease acute symptoms that arise quickly. Oral beta agonists are available in pill, syrup and inhaled form. 
• Short-acting bronchodilators: Short-acting bronchodilators are also used for quick relief of asthma symptoms. They open airways by relaxing the muscles that tighten around airways during an asthma attack. 
• Short-acting beta agonists: Short-acting beta agonists (like Albuterol®, Brethaire®, Bronkosol®, Isoetharine®, Maxair®, Medihaler-Iso®, Metaprel®, Proventil®, Tornalate® or Ventolin®) may help relieve asthma symptoms quickly. These medications may also help prevent exercise-induced asthma. If these medications are taken daily, or if they are taken more than three times in a single day, the asthma may be worsening, or the inhaler may not be used correctly. 
• Theophylline: Theophylline (like Aerolate®, Elixophyllin®, Quibron-T®, Resbid®, Slo-bid®, T-Phyl®, Theolair®, Theo-24®, Theo-Dur®, Theo-X®, Uni-Dur® or Uniphyl®) may be used to treat persistent asthma symptoms and to prevent nighttime asthma. In order to be effective, theophylline must remain at a constant level in the bloodstream. If the level is too high, it can be potentially dangerous. A qualified healthcare provider will perform regular blood tests to ensure safety. Sustained release theophylline is not the preferred primary long-term control treatment, but it has been shown to be effective when taken with anti-inflammatories to control nighttime asthma attacks.

 

Pregnancy :

• General: Many asthma medications are considered safe for pregnant patients because the risk of adverse effects appears to be less than the risk of uncontrolled asthma. Medications that have been used in pregnant women include inhaled bronchodilators, cromolyn sodium and beclomethasone, all of which have a local effect. Theophylline has also been used during pregnancy if the asthma is not adequately controlled by the other medications. Oral steroid medications, such as prednisone, should only be used when necessary for severe asthma during pregnancy. Consult a qualified healthcare professional before beginning any treatment.

Classifications and Diagnosis of Asthma

Asthma is classified as either allergic or non-allergic. Both conditions cause airway obstruction and inflammation that is partly reversible by medication. They also produce the same symptoms. The main difference, however, is their cause.

Allergic (extrinsic) asthma: 

An allergic reaction triggers what is known as allergic asthma. Inhaled allergens like dust mites, mold spores, pollen and pet dander may trigger allergic asthma. It is the most common form of asthma, affecting more than 50% of asthma sufferers.

Non-allergic (intrinsic) asthma: 

Non-allergic asthma is not related to allergies and does not involve the immune system. Instead, factors like anxiety, stress, exercise, cold air, dry air, smoke, hyperventilation, viruses and other irritants trigger the disease.

Severity of Asthma

• Mild intermittent: Symptoms occur twice a week or less. Exacerbations are short and the intensity varies. Nighttime symptoms occur twice a month or less.
• Mild persistent: Symptoms occur more than twice a week but less than once a day. Exacerbations may affect daily activities. Nighttime symptoms occur more than twice a month.
• Moderate persistent: Symptoms occur daily. Exacerbations occur twice a week or more. Nighttime symptoms occur more than once a week. 
• Severe persistent: Symptoms are constant and limit the individual's physical activities. Frequent exacerbations disrupt daily activities, and nighttime symptoms occur more than twice a week.  

Predisposition to Asthma

• Infants or young children who wheeze and suffer from viral upper respiratory infections. 
• Individuals with strong allergies. 
• Individuals with a family history of asthma and/or allergy. 
• Perinatal exposure to tobacco smoke and allergens.

Diagnosis

If your doctor feels like you might have asthma, he may have you do some breathing tests. Spirometry is a noninvasive way to evaluate the air capacity of the lungs. Physicians are able to measure the volume of air exhaled before and after a bronchodilator (inhaler) is used.

During this procedure, the spirometer measures the airflow when the patient exhales, comparing lung capacity to the average capacity for the individual's age and racial group. Then the patient inhales medicine from a short-acting bronchodilator. The doctor once again measures the patient's lung capacity. If there is an increase in capacity it is likely that the asthma symptoms can be controlled.

In addition, the physician should have the patient perform some form of physical activity to increase the breathing rate and check for changes in lung capacity (both with and without a bronchodilator).

Types Of Asthma

Childhood asthma :

Asthma rates in children younger than five years old have increased more than 160% from 1980 to 1994. One study found a strong correlation between obesity and asthma, but no similar relationship between obesity and allergies. Researchers believe that asthma was the result of the increased physical exertion of the lungs in obese individuals.

Many children with asthma have what is known as allergic asthma. In such cases, exposure to allergens like dust mites, pollen, mold and animal dander may irritate the airways, causing even more constriction, as well as causing the production of excess mucus and inflammation of the airway passages.

Adult onset asthma :

Asthma symptoms may appear at any time in life. Individuals who develop asthma as adults have what is known as adult onset asthma. It is possible to develop asthma at the age of 50 or later.

Unlike children who usually experience intermittent symptoms, individuals with adult onset asthma are more likely to experience persistent symptoms.

The cause of adult onset asthma is unknown. However, some evidence suggests that allergy and asthma may be genetically inherited.

In addition, obesity appears to significantly increase the risk of developing asthma as an adult.

Pregnancy and asthma :

Asthma is one of the most common, potentially serious medical problems that occur during pregnancy. According to some studies, asthma may complicate up to seven percent of all pregnancies.

Researchers estimate that about one-third of pregnant women with asthma will experience increased symptoms during the pregnancy; another third will experience the same symptoms, while the last third will experience a lessening of symptoms.

Pregnant women with asthma have an increased risk of delivering prematurely or giving birth to an infant with low birth weight. In addition, pregnant women with asthma are more likely to experience hypertension (high blood pressure) or a related condition called pre-eclampsia (swelling, high blood pressure and kidney malfunction).

If asthma is not controlled, the mother has lower levels of oxygen in her blood. This may result in decreased oxygen in the fetal blood, which may also cause growth deficiencies or death in the fetus.

However, proper treatment and management of asthma symptoms helps reduce the risk of complications, according to research.

Aspirin-induced asthma :

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil® or Motrin®), may cause asthma symptoms, nasal congestion, watery eyes and, occassionally, facial flushing and swelling in about 10% of asthmatics. Since sensitization and IgE production are not involved in aspirin-sensitive asthma, it is not considered an allergic reaction.

In the body, these drugs inhibit the cyclooxygenase-1 (COX-1) enzyme, which produces inflammation and fever. Their ability to inhibit the enzyme allows NSAIDs to reduce pain, inflammation and fever.

Inhibiting the enzyme also allows NSAIDs to clear the way for different enzymes that have adverse effects in some people. One of these enzymes triggers the release of chemicals that can cause the airways to swell and increase mucus production, leading to an asthma attack. The process is an unwanted side effect NSAIDs, not an immune-system reaction to NSAIDs.

Asthmatics and especially asthmatics who also have nasal polyps, are vulnerable to asthma as a side effect of aspirin and aspirin-like drugs.