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Asthma
Asthma may develop at any age, although the majority of people are diagnosed in childhood. There is often a strong family history of asthma or allergies. Asthma can be very mild in some people, and vary to the extreme of severe and life-threatening (and even death) in some people. Definition - a reversible inflammatory disorder of the airways, often triggered by allergen exposure, exercise, and cold air Diagnosis - is based on 2 key elements 1. History or presence of respiratory symptoms consistent with asthma - wheeze, cough (typically worse at night), and/or shortness of breath (that are better with a bronchodilator like albuterol) 2. The demonstration of variable airflow obstruction (by formal pulmonary function testing or in office or at home peak expiratory flow measurement=peak flow). Other conditions which may simulate asthma - post nasal drip syndrome (can cause upper airway wheeze-like sounds), gastroesophageal reflux disease (GERD), post-viral cough, habitual/psychological cough, vocal cord dysfunction, panic disorder, cough from ACE inhibitor blood pressure medicines, COPD (emphysema), and congestive heart failure Treatment & Management
1. Monitoring of patients with asthma - symptom assessment and office/home monitoring with peak flow meters 2. Patient Education - learn how to monitor their symptoms and pulmonary function, and use their medicines 3. Controlling triggers - this can help decrease need for medications, and patients need to be aware and decrease trigger exposure - like allergens at home, workplace, daycare, or school, indoor allergens (dust mites, animal dander, molds, cockroaches) and respiratory irritants (tobacco smoke, wood smoke, cleaning products, perfumes, air pollutants) - consider formal allergy testing --be aware of conditions that can worsen asthma - like sleep apnea, GERD, obesity, rhinitis/sinusitis, vocal cord dysfunction, and depression/chronic stress, and medicines that can worsen asthma (like blood pressure beta blockers and aspirin in some people) 4. Medicine Treatment - the goal is to minimize symptoms, reduce the chance of bad outcomes (hospitalizations or loss of lung function), and minimize adverse effects from medicines
-inhaled medicines can be taken in metered dose inhalers (some can be used with a spacer for younger children) and in aerosolized nebulizer breathing treatments Treatment depends upon the asthma severity- from intermittent asthma (symptoms less than 2 days/week, and usually just needing a rescue inhaler=short acting bronchodilator as needed), mild persistent asthma (symptoms greater than 2 days/week- usually treated with a low dose inhaled cortisone or Singulair), moderate persistent asthma (symptoms daily-usually treated with a medium dose inhaled cortisone and long acting bronchodilator or Singulair), and severe persistent asthma (symptoms throughout the day - usually treated with a high dose inhaled cortisone with long acting bronchodilator and Singulair, and often additional medicines) Rescue Inhalers - short acting bronchodilators - all asthma patients need to have one available when/if needed for cough/wheeze/shortness of breath flares, and can be used a maximum of 4x/day for not longer than 1 week, and if needed 4x/day for more than 1 day you must see your physician - only brand name metered dose inhalers are now available in the U.S. because of regulations that they need to be ozone friendly - Proventil HFA, Ventolin HFA, ProAir HFA, and Xopenex HFA, the least expensive available is a small size Ventolin HFA which you can get only at Walmart and Target pharmacies, and if needed due to cost, you
- generic albuterol solution is available for nebulizers (and brand name Xopenex is also available for nebulizers) Daily Controller Medicines Inhaled Glucocorticoid (cortisone)-the most potent anti-inflammatory agents available for asthma treatment, and rinsing the mouth is required after using to avoid developing thrush/yeast infections -Flovent -Pulmicort -Qvar -Asmanex -Azmacort and AeroBid Inhaled Glucocorticoids with Long Acting Bronchodilators -Advair (available in a powder round inhaler, or HFA inhaler) -Symbicort Long Acting Bronchodilators-must be used only along with a cortisone inhaler -Serevent -Foradil Leukotriene Receptor Antagonists-these decrease infammation and bronchoconstriction -Singulair -Accolate Chromones-decrease the early stages of asthmatic response/infammation -Cromolyn (availabe in inhaler and nebulizer) Theophylline-has both bronchodilatory and antiinflammatory properties, but can have irritating and serious side effects, and requires blood tests to keep the blood level adequate (want 5-15mcg/ml) Oral Glucocorticoids(cortisone) - a short 7-10 day course can be required for asthma flares, or rarely for long term asthma control
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