Managing Asthma

Mary P. Andersen, M.S.
MU School of Medicine
(573)882-2991

Asthma is a tricky disease. Identifying and managing asthma requires good cooperation between a patient and physician. People may not realize they have asthma until a life-threatening attack occurs. Asthmatics often fail to manage their disease correctly, resulting in hospitalization, chronic illness, or even death. Asthmatics can live a normal life when their disease is well controlled. Although asthma is more common in the inner city, many of the factors which make it difficult to control also occur in rural areas.

Asthma is usually caused by an allergic reaction of the lungs, although cold air and exercise also may cause attacks. In asthma, the lungs react to an allergen or irritant much the same way as the skin responds to a bee sting or poison ivy; becoming swollen and red. When this happens in the lungs, the airways become narrower, making it hard to breathe, and often causing a whistling sound, called wheezing. The lungs also produce mucus to help move the irritant out. In asthma, an overabundance of mucus coats the airways, making it even harder to breathe. In a severe attack, airways can be completely blocked. Asthma makes a person more prone to lung infections. In fact, frequent chest colds are a clue that a person may have asthma. Asthma sufferers may feel constantly tired because they do not get enough oxygen when they breathe.

The first step in controlling asthma is to try to identify and get rid of the cause(s). A physician's help is often needed in this process. Once the problem is identified, avoiding it can be difficult, especially if the solution is to get rid of a beloved pet, remove carpeting or upholstered furniture, or give up smoking. The most common allergen associated with asthma is the dust mite, found in house dust. Similarly, on farms, storage mites have been identified as a major cause of asthma. Animal dander, cockroaches, bacteria, mold, pollen and cigarette smoke may also cause asthma. Obviously, keeping a clean, dust-free environment is an important way to manage asthma. In the home, if dust mites are the problem, bedding needs to be washed often in hot water, and pillows may have to be kept in special casings. For the dust-sensitive, feather pillows won't do! Nighttime or early morning episodes of shortness of breath are a clue that the bedroom is a source of trouble. High levels of ozone, usually a problem in cities during smog alerts, are linked to asthma attacks. In a rural area, surprisingly, it is still possible to be exposed to high ozone levels if working near a copier, laser printer, or other high voltage equipment.

The second step in controlling asthma is to correctly take the prescribed medicine. This is usually inhaled, requiring a carefully practiced method. A physician should observe the patient on more than one occasion to make sure it is being done correctly. Newly designed inhalers are easier and more efficient to use. One of the biggest problems with asthma is that the lungs are not very sensitive to a drop in lung function. For example, when a person is getting a chest cold, lung function may drop to half of normal before the person feels tightness in the chest. Because of this, it is difficult to notice when a problem is developing, and then adjust the medication accordingly. A simple device to solve this problem is called a peak flow meter. The patient blows into the device, and records the result. Measured once a day, at the same time each day, peak flow becomes a familiar indicator to the asthmatic of how he is doing. A peak flow meter can be purchased in most drug stores, and is small enough to carry in a purse. Some even fit in a pocket. Asthmatics usually are prescribed two types of medication. The first is a bronchodilator, which quickly opens the airways. It is the most common type of asthma medication. In addition, inhaled steroids are used to decrease the long-term inflammation of the lungs. Because it takes up to 60 days for inhaled steroids to work, patients often quit the steroid in the mistaken belief that it does not help them. Patients need to understand the very slow but important action of this type of medicine, and use peak flow, as well as regular office visits, to monitor their progress. Another common concern patients have about steroids is that they may have the same side effects that other steroids have. However, the only common side effect of inhaled steroids is that they sometimes cause yeast to grow in the throat. This is prevented by rinsing the throat after use.

Another serious problem for asthma sufferers is the lack of access to health care. As it is, asthmatics often wait too long to seek help. Many times, early treatment of an asthma attack can prevent the need for emergency hospitalization. One solution is the increasing use of 800 numbers by physicians and pharmaceutical companies. Most respiratory specialists can tell right away if a patient needs to see a doctor. The University of Missouri Division of Pulmonary Medicine can be reached at 800-207-LUNG.

In summary, asthma sufferers must actively manage their disease. To do this, they must understand how the disease works so that they can try to remove or avoid the irritants, take the medication correctly, watch their lung function, and know when to get help if the medicine is not controlling the symptoms. A good health care provider must teach the patient all of these things, and listen carefully to address the patient's concerns.