asthma

Asthma

» Asthma symptoms can range from persistent coughing to the full-blown manifestations of respiratory failure.

Asthma is the most common chronic disease of childhood. Acute asthma is one of the most common acute illnesses that primary care physicians are called upon to manage, either in their office or often at night in the emergency room.

Symptoms

• Wheezing
• Cough
• Shortness of Breath
• Sense of impending doom
• Anxiety

Symptoms can range from persistent coughing to the full-blown manifestations of respiratory failure. Asthma is the leading cause of missed school, account for 17% of pediatric emergency care, and are the leading cause of hospitalization among children, accounting for 11 to 17% of pediatric admissions in major US cities.

Asthma Facts

• Afflicts 15 to 21 million Americans and up to 9 million American children <>
• Over 5000 Americans died from Asthma in 1996.
• Asthma is the 7th most common illness in the U.S.A.
• Deaths from Asthma increased 150% from 1977 to 1991.
• Direct costs to treat Asthma exceeded $ 6 BILLION in 1996.
• There were 500,000 hospitalizations due to Asthma in 1996.
• The incidence of Asthma has increased 30% over the last decade.

Causes, incidence, and risk factors

Bronchial asthma is usually intrinsic (no cause can be demonstrated), but is occasionally caused by a specific allergy (such as allergy to mold, dander, dust). Although most individuals with asthma will have some positive allergy tests, the allergy is not necessarily the cause of the asthma symptoms.Symptoms can occur spontaneously or can be triggered by respiratory infections, exercise, cold air, tobacco smoke or other pollutants, stress or anxiety, food allergies or drug allergies. The first step in an acute asthma attack is inflammation of the lining of the lungs and the small airways leading into and through the lung. In response to the inflammation, the muscles of the bronchial tree become tight and the lining of the air passages become swollen, reducing airflow and producing the typical wheezing sound. Mucus production is increased in response to the inflammation.Most asthma sufferers have periodic attacks followed by periods of normal breathing. Asthma attacks can last minutes to days, and can become dangerous if not deadly if airflow becomes severely restricted. Asthma affects 1 in 20 of the overall population, but the incidence is 1 in 10 in children. Asthma can develop at any age, but some children seem to outgrow the illness. Risk factors include self or family history of eczema, allergies or family history of asthma.

Diagnosis

Asthma should be considered in the presence of the following clinical presentations:

• recurrent or chronic lower respiratory wheezing
• recurrent or chronic coughing
• repeated diagnoses of bronchitis (in children and nonsmokers)
• repeated diagnoses of pneumonia

The diagnosis is most efficiently confirmed by demonstrating the complete response of acute symptoms, when present, to an inhaled bronchodi lator and/or a 5 to 10 day course of high-dose oral corticosteroids.Example products: Proventil® (albuterol, USP), Ventolin® (albuterol, USP) and generic equivalents, Maxair® (pirbuterol acetate), and Brethaire® (terbutaline sulfate).

Treatment

» Patients with seasonal allergic disease may require maintenance medication only seasonally, and patients with chronic disease may require seasonal increases in their maintenance medication.

Therapeutic strategies fall into two categories:
Intervention - measures to stop acute symptoms.
Maintenance - measures to prevent symptoms.
All patients require availability of efficient and effective intervention measures. These should be available at home and the patient/families should be taught when and how to apply them. Patients with chronic disease additionally need maintenance medication to prevent their daily symptoms. Patients with seasonal allergic disease may require maintenance medication only seasonally, and patients with chronic disease may require seasonal increases in their maintenance medication. A variety of medications for treatment of asthma are available and include:

• anti-inflammatory medications
• inhaled corticosteroids (Azmacort, Flovent, Vanceril, AeroBid)
• oral or intravenous corticosteroids (such as prednisone, methylprednisolone, and hydrocortisone)
• cromolyn sodium (Intal) or nedocromil sodium (Tilade)
• zarfirlukast (Accolade) and montelukast (Singulair)
• bronchodilators
• Immediate acting agents - for acute attacks:
• inhaled or oral (Proventil, Alupent, Maxaire, Brethaire)
• Long-Acting agents (NOT FOR ACUTE ATTACKS - Maintenance only):
• inhaled salmeterol (Serevent)
• aminophylline or theophylline

People with mild asthma (infrequent attacks) may use inhalers on an as-needed basis. Persons with significant asthma (symptoms occur at least every week) are usually treated with anti-inflammatory medications, preferably inhaled corticosteroids, and then with bronchodilators such as inhaled Alupent or Vanceril. Acute severe asthma may require hospitalization, oxygen, and intravenous medications.

Home Monitoring of Lung Function

A peak flow meter, a simple device to measure lung volume, can be used at home to check on lung functions on a daily basis. This often helps determine when medication is needed or can be tapered in the case of an exacerbation of symptoms.

Expectations (prognosis)

Asthma is a disease that has no cure. With proper self management and medical treatment, most people with asthma can lead normal lives.

Calling your health care provider

Call for an appointment with your health care provider if you or your child experience mild asthma symptoms (to discuss treatment options). Call your health care provider or go to the emergency room if severe chest pain develops, an attack requires more intensive use of medication than usual or requires more medication than recommended in the prescription, or if shortness of breath occurs at rest.Call your health care provider if symptoms worsen or do not improve with treatment or if new symptoms develop.

Prevention

Decrease or control exposure to known allergens by staying away from cigarette smoke, removing animals from bedrooms or entire houses, and avoiding foods that cause symptoms.Asthma can dramatically impair quality of life and can be fatal. Most patients can be effectively managed with carefully designed therapies and full patient compliance to prescribed care. If you or a loved one suffers from asthma help is available through asthma specialists throughout the country. Visit our physician locator for network asthma specialists in your area.