Asthma

General information about Asthma

Asthma has 3 main components, or parts. Asthma can also be intermittent
(no symptoms for weeks at a time) or persistent (almost never without
symptoms during any given week). The treatment of asthma needs to take
the stage into account. The symptoms may be the same at any stage:
shortness of breath, increased work of breathing, and cough, especially at
night. Small children may cough till they vomit, and the vomiting may be
most worrisome to the parent.
Many people think they have phlegm in their chests when they feel the need
to cough. Certainly phlegm, or by anything that bends the airway cilia (the
little hairs on the inside of the lung tubes) makes you want to cough, but
the hairs can be bent simply by the airways getting narrower than the cilia,
so that the cilia rub against one another. Then coughing actually can rip
small amounts of their airway lining off; you may see it in your sputum as
little black specks.
Stage 1 of asthma is bronchospastic. That means that the muscles around the
littlest airways (bronchioles) go into spasm, and contract. The bronchioles
get smaller, and airflow slows. It takes longer to exchange air in the air sacks
(alveoli) where your body takes up oxygen and gets rid of carbon dioxide.
You start to feel short of breath, and breathing is harder work. We treat stage
1 asthma with bronchodialators, like Proventil, Alupent and others.
Stage 2 asthma is inflammatory. Inflammation is like the painful redness you
get around a scrape or small burn: the tissues swell up and the little blood
vessels open. As a result, the walls of the airway tubes get thicker. In turn,
that makes the passageway, or lumen, smaller. Bronchodialators dont help
much because the airway narrowing is not caused by muscle spasm, but
rather by thickening of the airway walls themselves. Stage 2 asthma is
treated with anti-inflammatory medications like prednisone or other steroids,
and can be prevented by the anti-leukotrienes, like Singulair or by the
cromones, like Cromolyn.
Stage 3 is insipation, or plugging. When the airways get inflamed and
irritated they make extra mucus, much like your nose gets runny. That

mucus dries out because the cilia cant keep the airways clean they are
inflamed cramped or have been damaged by the wind-force of coughing.
This is the most dangerous stage of asthma because most of our medications
cant make it better. People who have been taking a lot of bronchodialators
will temporarily feel better, while further loosing airways. We try to prevent
this stage! Medications like Atrovent dry the mucosa and decrease the
amount of mucus, and the water in nebulizers helps to loosen up the dried
mucus plugs, but mostly, the lungs have to clean themselves once the
inflammation and the spasm have improved.
If asthma is intermittent, we need only treat the attacks. If it is persistent, a
patient needs to be on medications to prevent, or control attacks.
Bronchodialators like Albuterol do not prevent asthma attacks, they only
relax the muscles around the airways. Use a bronchodialators if you feel a
little tight, or if you are about to engage in an activity that usually puts you
into bronchospasm. If you find you are using your inhalers too much, you
are probably moving into a different stage and need other treatment.
Of course, DONT SMOKE is about the best prevention there is!
Although steroids are great at treating inflammation, they can cause
problems if taken for more than a week or two at a time. We try to prevent
inflammation with drugs that can safely be taken for a long time, primarily
the cromones and anti-leukotrienes. Atrovent keeps the airways
appropriately dry, preventing crusts. Most of all: DONT SMOKE! Smoking
paralyses the cilia, preventing the lungs from cleaning themselves, and
damages the alveoli. Eventually, the alveoli dissolve, rupture and coalesce,
causing emphysema. No medications regrow alveoli; emphysema (or
COPD) isnt curable.
Kids who have asthma will often get a little worse anytime they get sick
with anything, especially if they get a viral cold. Some doctors will give the
littlest ones antibiotics, but older children just need more intensive treatment
of their asthma while they have the cold. A short course of prednisone is
sometimes used.
Your Peak Flow Meter (PEF) is one of your best tools at home to measure
how well your lungs work. Learn what is your usual, your best and your I
need to go to the hospital! number.

How to use an inhaler properly -- you may carry this page with you or show the
school nurse.
Using an inhaler well is difficult, but is a skill worth learning. Used badly, an inhaler
delivers very little of the medication, but when used correctly, can be as effective as the
nebulizers in the hospital.
An inhaler has medication suspended in a carrier fluid, and propelled by a pressurized
fluid. The device is designed to deliver only a specific dose per activation. The carrier
fluid is made to evaporate quickly, so the particles of medicine get smaller and can get
deep into your lungs where they are most effective. The medications are not absorbed
from your tongue, teeth or tonsils, so the more that gets into your lungs, the more
effective the medication is. Of course, the spray travels in a straight line and doesnt
know how to turn corners unless it is pulled in, along with air that you are breathing in.
There are 6 steps to using an inhaler most effectively.
1. Take off the cap!
2. Shake well to mix the propellant, carrier fluid and medication
3. Lean forward, jaw up to make the passage from your lips to your lungs as straight as
possible. Open your mouth wide to get your tongue, teeth and tonsils out of the way.
4. Hold the inhaler about 2 inches away from your mouth. The extra fraction of a second
it takes the medicine to travel to your mouth will make the particles smaller so you
can more easily inhale them deep into your lungs and less likely to land in your
mouth.
5. Breathe out gently, then breathe in exactly as you squeeze the inhaler to activate it.
This is the step that requires the most practice and coordination for most people.
6. Hold your breath for about 20 seconds to let the medicine deposit in your lungs, so
you dont breathe it out.
After 1-2 minutes by the clock, you may take another dose if you need it.