Asthma

Excerpt From Clearing the Air One Nose at a Time: Caring For Your Personal Filter by Hana R. Solomon, M.D.

Asthma Facts
More than 30 million Americans have been diagnosed with asthma.

• Cost of asthma in the United States is over ten billion.
• Asthma is the third-leading cause of hospitalization for children younger than 15 years old.
• Accounts for 14 million missed days of school annually.
• Adults miss 11.8 million work days due to asthma.
• In 2002, there were 13.9 million outpatient asthma visits.
• In 2002, asthma was the cause of deaths in more than 4,000 people.

Asthma is a chronic inflammatory disease that affects your airways, the tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways are inflamed, making the airways swollen and sensitive. They tend to react strongly to things that you are allergic to or find irritating. When the airways react, they get narrower, they produce more mucus, and less air flows through to your lung tissue. This causes symptoms like wheezing, coughing, chest tightness and trouble breathing, which tend to be worse at night and in the early morning.

There are many triggers that can bring on asthma symptoms and lead to asthma attacks. Some of the more common asthma triggers include exercise, allergens, environmental irritants and viral infections.

Asthma Triggers

• Allergens
• Animal dander (from the skin, hair, saliva or feathers of animals)
• Dust mites
• Cockroaches
• Pollen from trees, grasses and weeds
• Mold
• Cigarette smoke
• Air pollution
• Cold air or changes in weather
• Strong odors, like those from painting or cooking
• Scented products
• Strong emotional expression (including crying or laughing hard)
• Stress
• Medications such as aspirin and beta-blockers
• Sulfites in food (dried fruit) or beverages (wine)
• Irritants or allergens that you may be exposed to at work, such as specific chemicals or dusts
• Infections

The increased costs of asthma are illustrated in a 2003 study published in The Journal of Allergy and Clinical Immunology. This study reported the average annual cost of care for an asthma patient as $4,912 - with 65% going to direct expenses like medications, hospital admissions and nonemergency doctor visits, and the remaining 35% going to indirect costs like lost time at work. (Total yearly costs were $2,646, $4,530, and $12,813 for people who self-reported mild, moderate and severe asthma, respectively.)

Families with children who have asthma report that this illness influences a range of decisions concerning home furnishings, carpets, lifestyle, household spending, holidays and pets.

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Stacey M Kerr, M.D., a board certified family physician, author and writer contributed this article for the Santa Rosa Press Democrat and was published September 2010.

Crisp cool air and the smell of wood smoke take me back to my childhood, when summer was over and the thrill of Halloween was just around the corner. But while the lovely scents of fall bring pleasure to many, to some children cool air and wood smoke are scary triggers that make it difficult to breathe. These children have asthma, and worldwide, their numbers are increasing each year.

At the very least, asthma causes mild but embarrassing respiratory distress. At worst, it can be fatal. Because a child's airways are narrower than an adult's, triggers that cause only mild symptoms in adults can cause severe symptoms in a child.

Occasional signs of asthma can be as mild as a persistent nighttime cough. A more severe exacerbation may cause shortness of breath, rapid breathing, coughing or tightness in the chest. Any child having difficulty breathing associated with anxiety, sweating, blue lips, or a decreased level of alertness needs emergency care as soon as possible.

The first step to controlling asthma is making the diagnosis. A physician will consider the symptoms you report, listen to your child's lungs, and may order some tests. Once asthma is diagnosed, you and the physician should create and use an asthma action plan to manage your child's lung disease.

Prevention is the first part of any asthma action plan, starting with avoidance of identified asthma triggers. It is essential to avoid any exposure to cigarette smoke, including the residue left on a smoker's clothes and hair. Pets may need to be kept outside, sheets washed in hot water to destroy dust mites, and humidity controlled to prevent mold. Any child over the age of two with asthma should learn to wash his nose, keeping his body's air filter clean of allergens and dust.

The second step in controlling asthma is to monitor symptoms. Asthma's earliest symptom is usually a cough. But by using a 'peak flow meter', inflamed airways can be detected even before the cough appears. A peak flow meter is a simple handheld device that measures the maximum amount of air a child is able to force out of his lungs when he blows as hard as he can. Even mildly inflamed airways restrict the outflow of air, so a lower than expected peak flow can diagnose an asthma exacerbation before symptoms occur. This is the perfect time to treat.

When the airways are inflamed, they become swollen and produce mucus. Chronic inflammation remodels the airways, causing permanent damage. Some asthma medications are used for rescue during exacerbations, and some for control of chronic inflammation. Most of these medicines are inhaled so they can affect the airways directly.

Since the target for inhaled medication is the small airway system deep in the lungs, it is important to effectively use the right delivery system. Even young children can learn to use a nebulizer to successfully get medicine into their lungs. Anyone using hand-held inhalers should use a spacer. This will help deliver medicine deep into the airways and prevent it from simply coating the mouth and the tongue.

Rescue medications for children are usually taken as soon as symptoms occur, and children with mild asthma may only occasionally need to use their rescue medicine. However, if an exacerbation is severe and does not respond quickly to the inhaler, your child may need oral or intravenous steroids.

Medicines to prevent exacerbations and to control chronic inflammation are the mainstay of asthma management. These are taken regularly every day, even when there are no symptoms. Inhaled steroids are usually the first choice of treatment to prevent airway swelling. If symptoms persist, other medications may need to be combined with steroids to gain adequate control.

Most of the time, asthma can be well controlled by preventing exacerbations and maintaining control of airway inflammation before it causes damage. But never underestimate the dangers of a severe asthma attack. Understanding the management of your child's asthma can lead to effective treatment and allow him to breathe in the lovely scents of fall without fear.

For more information on the Web go to www.mayoclinic.com and search for "Childhood Asthma".

Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and has been certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hand-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. Email comments to: This email address is being protected from spambots. You need JavaScript enabled to view it. .

Special Section: Let's Hear From The Expert
Asthma And The Nose

Asthma is a common childhood and adult ailment, one which all primary care physicians evaluate and treat. The issue is this: like the nasal area, the bronchial tubes, which connect the upper airway to the lungs, develop congestion with swelling and increased mucus production.

For years, asthma was thought of as a separate condition from allergies. Now we know better. In fact, a majority of asthma cases are directly related to upper airway allergies. Rarely does an asthmatic patient come in complaining of tight chest or coughing without a preceding history of nasal or sinus congestion. This actually is no surprise. If one breathes through the nose, the air is filtered and warm. If the nose is congested, mouth breathing is required but this bypasses both air filtering and air warming. Thus, unfiltered, cool air aggravates the bronchial tubes, resulting in constriction of the airway muscle, increased airway mucus production and airway 'reactivity' or sensitivity.

Yes, there are many medications which treat the symptoms of asthma, and they are effective. There are steroids (inhibit the natural immune response), medications that dilate the bronchial tube muscles (prevent them from constricting) and other chemicals, which affect the immune response to 'inflammatory mediators', just to name a few. In my practice, I approach my patients with asthma as any family physician would. The difference is this: I also evaluate the nose and sinuses. Without addressing these areas, the asthma is only partially treated. In fact, when upper airways are maintained clean and free of irritants, asthma remains quiet.

The last thing I wish to offer my patient is another medication, on top of antihistamines, decongestants, bronchodilators, nasal and inhaled steroids and perhaps antibiotics. Therefore, I suggest a good nasal wash to clean the upper airway. Over the years, I have witnessed a reduction of asthma episodes in addition to a reduced dependency on medications when nasal washing is incorporated into a daily habit. Simple and effective.

George Prica, M.D., Board Certified Family Physician
Columbia Family Medical Group, Columbia, Missouri

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A Family's Relief
I have suffered with asthma and allergies since birth and experience recurrent sinus infections. My mother showed me how to wash. Needless to say, the sinus infection cleared up quickly. I am now a devoted user. It definitely helps me deal with all the pollen. My children have started washing daily as well!

Linda B., Memphis, Tennessee

Free At Last
I have diseased sinuses from years of allergy attacks and recurrent sinus infections. I had gotten used to not being able to fully breathe through my nose, and gave up on using nasal sprays and various medications that only treated the symptoms. I started washing as soon as I received my kit. It took me about three tries to get the proper angle and flow. The tissues in one of my nostrils were completely swollen, so at first, it was difficult to push the solution through. However, once I had used the system a few times, I noticed a dramatic difference in the condition of my nasal tissues. I was able to actually breathe through my nose almost immediately. Now, I wash my nose every morning and evening, just like brushing my teeth. This has made such a difference for me that I plan to stop using adhesive strips on my nose when I go to sleep at night. I don't think I will need them anymore! The best part, in my opinion, is that this is a completely natural way to clean the sinuses and nasal membranes, which in turn keeps them healthy, eliminating the need for medications.

Heather Ryan, Hollywood, Florida