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Asthma: A fight for breath

Yet often well-controlled

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Asthma:  A fight  for breath

Asthma is known by its telltale wheezing or whistling sound, but it’s the coughing, chest tightness and shortness of breath that often cause concern. In asthma the airways are inflamed and clogged with mucus. The muscles surrounding the airways contract leaving little space for air to enter. Symptoms are often worse at night, resulting in a persistent dry cough, making it hard to get a good night’s sleep.

Author: Photo by: Katherine C. CohenFaye Holder-Niles, M.D., M.P.H. is the medical director of Primary Care Asthma Programs, Primary Care & Office
of Community Health at Boston Children’s Hospital.

There is no cure, but the news is not all that bleak. With medication asthma can often be well-controlled.

Roughly 25 million or 8 percent of people in this country are afflicted, according to the Centers for Disease Control and Prevention. Asthma is the leading chronic disease in children and the top reason for missed school days. In childhood the disease is more common in boys than girls, but in adulthood, the reverse is true. It is more prevalent in those of lower income and strikes the Northeast and Midwest more than other sections of the country.

For reasons unknown, the prevalence of asthma in black children is almost two times higher than it is in whites, and blacks are three times more likely to be hospitalized for asthma. Studies are underway to investigate the possibility that blacks may respond differently to asthma medications.

The impact of asthma on the economy is noteworthy. Yearly visits to emergency departments, physician offices and hospital outpatient departments can exceed 13 million. The total annual cost is estimated to be $56 billion.

Recognizing asthma symptoms in your child can be a bit tricky. The symptoms can closely mirror those of allergies or even the common cold. “For young kids in particular you rely on the symptoms and history,” explained Dr. Faye Holder-Niles, the medical director of Primary Care Asthma Programs at Boston Children’s Hospital. “A parent might say that the child is coughing a lot at night or when running and playing even when they are not sick.”

CONTROLLING YOUR ASTHMA

Take an active role in controlling your asthma:

1. Develop a partnership with your primary care provider

2. Learn what asthma is and how it affects your body

3. Create and follow your asthma action plan

4. Identify and avoid triggers

5. Know which medication is which and how to take it correctly

6. Be able to recognize a flare-up and know what to do

7. Exercise regularly and practice precautions to prevent a flare-up

8. Get regular check-ups

9. Don’t smoke or be around people who do

10. Learn to control your stress levels

11. Get a yearly flu shot

At age six and older the parameters of diagnosis change. In addition to the history and symptoms, asthma can be confirmed by a pulmonary function test called spirometry. This test measures how much and how fast you can move air into and out of the lungs.

The National Heart, Lung and Blood Institute has developed a series of guidelines to help diagnose the disease and measure its severity. Asthma ranges from intermittent to severe persistent, and varies by the frequency and seriousness of the symptoms. For instance, those with intermittent asthma may have no interference with normal activities. On the other end of the spectrum a person may experience symptoms throughout the day and have to rely on daily preventive medications.

The cause of asthma is unclear. It is probably a combination of environmental as well as genetic factors. Asthma tends to run in families; it is not uncommon for multiple family members to be affected. Additionally, in some cases it is part of a triad that it shares with allergies and eczema.

In asthma the airways maintain a level of inflammation, but exposure to certain substances or conditions called triggers can increase the inflammation, resulting in an attack. Dust mites, mold, rodents and cigarette smoke are examples. Although triggers vary from person to person, one or two invariably are on most lists. One particularly common trigger is change in weather, especially when the weather changes from hot to cool in the fall. September is one of the worse months for asthma attacks, according to Holder-Niles. In the spring there is exposure to seasonal allergies and frequent viruses in the winter.

COMMON ASTHMA TRIGGERS

Triggers are substances or conditions that make asthma worse. They differ from person to person. Examples of triggers are listed below.

  • Respiratory infections, like colds, flu or sinus infections
  • Smoke from cigarettes, cigars and fireplaces
  • Weather, including pollen and air pollution, cold weather
  • Animals with fur or feathers, such as dogs, cats and birds
  • Pests, such as rodents, cockroaches
  • Dust mites
  • Mold and moisture
  • Strong odors, such as hairsprays and cleaning products
  • Medicines, such as aspirin and NSAIDS, beta blockers for heart disease
  • Medical conditions, such as acid reflux
  • Exercise
  • Strong emotions, such as stress, anger, fear

The trick is figuring out just what those triggers are. The best way is to begin a series of queries to find out what has changed. Did you move into a new apartment? Do you have a pet? Does the attack occur when you go outside? Do they happen when you are running and playing or during gym at school? These are all examples of questions to narrow the source of the offending agent. Boston Children’s Hospital provides home visits to make the home “asthma friendly.”

Several medications for asthma are available. Some reduce inflammation, while others relax the airways. Still others target allergies. The two main categories of medications are preventive, which are taken every day for persistent asthma, and rescue medications for intermittent symptoms during a flare-up. “Even people on daily medication will require rescue medication,” explained Holder-Niles. “At any time a person can have increased asthma symptoms with coughing, wheezing or chest tightness. It is important to always have your rescue inhaler available for emergencies at home, school and after-care.”

Preventive medications are modified according to each person’s response. If symptoms persist, medications can be increased, but they can also be reduced if a person is well-controlled for a period of time.

In spite of the availability of these medicines, asthma attacks still persist. The CDC found in its national prevalence of asthma attacks report of 2015, that almost 47 percent of persons with asthma reported having one or more asthma attacks, and over 439,000 were admitted to a hospital.

Some people seem to “outgrow” their asthma. It’s not that it’s gone, but it appears to be tamped down. “Once you have asthma, you still have asthma,” said Holder-Niles. “Some adolescents and adults do very well and have few asthma symptoms, but there is still the possibility of an attack, so patients should always be vigilant.”

Asthma cannot be prevented, but Holder-Niles offers tips to keep it in check. Most important is to partner with your primary care provider to create your personal asthma action plan. The plan details your prescribed medicine and is color-coded to advise you of the status of your control. Green means you are doing okay. Yellow means caution — that your asthma is getting worse. Red means you are in trouble and require immediate treatment. This plan should be shared with your school nurse, daycare providers and community health worker who are also part of your child’s team and play an important role in helping to keep your child healthy.

Education and pro-active management are key. Learn what your triggers are and avoid them. Understand which medicine is which and how to take it correctly. You need to know the symptoms of asthma, she warned. “If a person is wheezing, and using the abdominal (stomach) muscles to breathe and is unable to speak, that is an emergency,” she explained. “The point is to call before that happens. Call when you are in the yellow phase.”

Holder-Niles is trying to put a different face to asthma. Parents should have the attitude that “my child can do anything.” We want to support and empower families to manage their child’s asthma, she explained. That is possible once you feel empowered to control the disease.

“You name it; you claim it and then you fight it,” she said.