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ALL ABOUT ASTHMA
Written by: Melissa
Rose, student, University of Florida
Asthma is one of the most prevalent
diseases of our time. Any person at
any age can develop asthma, whether
it is allergic asthma or exercise-induced
asthma, although it usually reveals
itself in children. Fortunately though,
there are a variety of medications and
treatments available for people with
asthma. Also, with proper assistance,
people with asthma can enjoy the same
benefits from exercise as people without
asthma (1, 3,
8).
Asthma is a disease of the lungs that
affects the bronchial
airways. The term “asthma”
comes from the Greek meaning “to
breathe hard” and is defined by
medical terminology as reversible obstructive
airway disease (ROAD)
(1).
In a healthy lung, air moves without
restraint. But in the lungs of people
with asthma it is harder to inhale and
exhale, and the person may experience
an asthma attack. This happens when
a person’s bronchial tubes, which
are made of smooth muscle and a mucous
membrane, release mucous and become
inflamed. This inflammation causes the
muscles of the lungs to contract and
generate spasms, which in turn causes
a person to wheeze (1).
There are numerous types of asthma.
Allergic
asthma in responsible for 90% of
all asthma cases. There is a wide gamut
of causes of allergic asthma. Most often,
the sources are specific allergens,
such as pet dander, pollen, and dust
mites. Some other causes include pollutants,
smoke, and chemicals. Most childhood
asthma is considered an allergic type
of asthma and strikes more regularly
in young boys than girls. As indicated
by research, maternal smoking can contribute
to asthma along with a wide array of
other respiratory problems before the
child is even born
(1).
Intrinsic
asthma is diagnosed when allergies
are not involved. It is predominately
diagnosed in people over age forty rather
than in children. Perfumes, cleaning
agents, gastroesophageal reflux (GERD),
smoke, and cold air are causes of intrinsic
asthma (1).
Exercise-induced asthma occurs in at
least eleven percent of people who do
not have asthma. It can affect anyone
at any age and may be accredited to
the loss of heat and moisture in the
lungs that occurs with arduous exercise.
Although frequent coughing may be the
only symptom of exercise-induced asthma,
in cold and dry conditions, the symptoms
can be much more severe (1).
Nocturnal
asthma affects people when they
are sleeping and can occur anytime when
a person is asleep, regardless of the
time of day. Symptoms of nocturnal asthma
tend to be the worse from midnight until
4 a.m. and can be prompted by allergens
in the bedding or bedroom, a colder
bedroom temperature, and gastroesophageal
reflux (GERD). It is estimated that
75% of people with asthma are affected
by nocturnal asthma (1).
Occupational
asthma occurs directly as a result
of breathing wood dust, chemical fumes,
and any other irritants over long periods
of time. It is estimated that 15% of
people with asthma have occupational
asthma (1).
Unfortunately, overuse
of asthmatic medications, especially
steroids, can lead to status
asthmaticus, which is a severe asthma
attack that does not respond to medication
and may require mechanical ventilation
to undo (1).
Although the exact cause of asthma
is unknown, researchers think that a
combination of factors interact to produce
asthma, most often early in life. These
factors include parents who have asthma,
an inherited tendency to develop allergies
(called atopy),
certain respiratory infections during
childhood, and contact with some airborne
allergens or exposure to various viral
infections in infancy or in early childhood
when the immune system is developing
(2).
Another possible cause of asthma is
explained by the “hygiene
hypothesis.” Researchers believe
that our Western culture places a lot
of emphasis on hygiene and sanitation.
This has resulted in a change in peoples’
living conditions and has also caused
a decrease in infections that could
normally occur in early childhood. Many
young children today do not encounter
the same types of environmental exposures
and infections as children did in the
past. This may have affected the way
that these children’s immune systems
developed in early childhood, thus possibly
escalating their risk for atopy and
asthma (2).
Asthma can be diagnosed with a variety
of medical tests. Allergy testing may
be helpful in diagnosing asthma. Some
common allergens to test for include
pet dander, dust mites, and molds. Also,
identifying respiratory irritants such
as tobacco smoke and pollution may be
helpful in recognizing asthma (6).
A stethoscope may also be used to diagnose
asthma, although lung sounds are usually
normal in between asthma episodes. Other
tests include an arterial
blood gas (ABG), lung
function tests, peak
flow measurements, and chest x-rays
(6).
A breathing test, called a spirometry,
can also be done to diagnose asthma.
This involves having the patient inhale
and exhale into a tube that feeds into
the machine. The spirometer measures
the patient’s respiration rates.
If the results of the test suggest that
the patient may have asthma, then a
physician will give the patient a drug
to inhale. Albuterol
is usually the drug of choice because
it is short acting and its results can
be seen within five to twenty minutes.
After the administration of albuterol,
the patient will repeat the spirometry
test. If the results are better, then
the patient will be diagnosed with asthma
(7).
There are numerous treatments for people
with asthma, including long-acting medications
to prevent attacks, quick-relief medications
for use during attacks, treatments for
allergy-induced asthma, and natural
remedies.
Long-acting medications are used to
prevent attacks rather than treat them.
Such medications include inhaled corticosteroids
(such as Azmacort, Vanceril, AeroBid,
and Flovent). These medications are
used to reduce airway inflammation and
are the most commonly used long-term
asthma medication. Long-acting
beta -2 agonists (LABAs) such as
bronchodilators (like Serevent) help
open airways, reduce inflammation, and
are often used to treat persistent asthma
in combination with inhaled corticosteroids.
Leukotriene
inhibitors (such as Singulair and
Accolate) are another. They open airways,
reducing inflammation and are mainly
for people who have allergic asthma
because they also decrease mucous production
(3, 6).
Quick relief, or rescue, medications
are used when a person is suffering
from an asthma attack. There are short-acting
beta-2 antagonists, such as albuterol,
which is inhaled and act to relax airway
muscles. Albuterol acts within minutes,
and effects can last from four to six
hours. Ipratropium is another quick
relief medication. It is a bronchodilator
(or inhaler) that relaxes the airways
and makes it easier to breathe. Oral
and intravenous corticosteroids, such
as prednisone
and methylprednisolone,
are used to treat acute asthma attacks
or very severe asthma
(3, 6).
Medications for allergy-induced asthma
decrease a person’s sensitivity
to a particular allergen or prevent
their immune system from reacting to
allergens. Allergy-desensitization shots
(immunotherapy) are normally given once
a week for a few months, then once a
month for a period of three to five
years. Over time, they work to gradually
reduce a person’s immune system
response to specific allergens. Another
medication is Anti-IgE
monoclonal antibodies, such as omalizumab
(Xolair). This drug reduces a person’s
immune system's reaction to allergens.
Xolair is injected into the person’s
arm or leg every two to four weeks (3).
“Home remedies” that may
be helpful for some people with asthma.
Belly breathing is one such type. The
person should lie on their back and
place a book on their abdomen. They
inhale and exhale enough so that the
book moves up and down a couple of inches.
This can be practiced several times
a day. Vitamin B12 also helps to ease
asthma symptoms, as does taking two
doses of steamed ginger tea with garlic
cloves twice a day. Smelling honey can
also reduce asthma symptoms, as will
drinking a hot cup of water, tea, or
coffee. Unfortunately though, these
natural remedies might not be enough
if a person is having an acute asthma
attack (7).
Physical activity is important for
good health, and should be controlled
for people with asthma rather than avoided.
Research has shown that as tolerance
for physical exertion is built up over
time, the likelihood that a person with
asthma will encounter an asthma attack
is reduced (4,
8).
There are several steps a person with
asthma can take in order to ensure that
they will be able to exercise easier.
The individual should set boundaries;
they should avoid exercise when they
are feeling sick. They should use treatment;
the individual should use their inhaler
just prior to beginning any type of
exercise. The individual should warm-up;
they should get their body ready for
exercise by stretching and doing a few
warm-up activities. The individual should
weather-proof themselves; they should
wear a scarf over their mouth to help
warm the air before they breathe it
in. They should also make sure that
pollen counts are not high if they are
exercising outdoors. Lastly, the individual
should listen to their body; they should
rest when they need to (5,
9).
Some exercises and sports are more
favorable for people with exercise-induced
asthma because the physical activity
occurs in spurts. These include walking,
jogging, short track and field events,
gymnastics, and swimming. Exercises
that involve long periods of running
(especially in cold, dry air) such as
soccer, cross country, or hockey, may
aggravate a person’s asthma causing
them to have an asthma attack
(9).
There are several actions to take,
and adapted physical activities, to
prevent students as well as other individuals
with asthma from having an attack, including
varying the type, length, and frequency
of an activity. If the physical education
class is warming up by jogging on a
recently mowed field or refinished gym
floor, consider having the student with
asthma warm up in a different location.
Also, if running is scheduled for the
class, have the student with asthma
either walk the whole way or alternate
between walking and running. If a student
is having trouble breathing when their
physical education class is playing
a game, have them keep score, time,
or equipment handler until they are
able to fully participate again. Remember
that dressing out for physical education
and participating at any level is always
better than not dressing out and being
left behind. It is also helpful to change
the student’s physical education
class to midday or indoor if possible
when their asthma is worsened by cold
air or pollen (8,
10).
There are several types of asthma,
all of which a person can become diagnosed
with at any time in their life. Fortunately,
with all of these different types of
asthma, there are specific causes and
treatments for them. Specific allergens
may be the cause of allergic asthma
in some people, and luckily, these people
can turn to the medication Singlulair
for treatment. People with asthma should
not turn away from physical activity.
They can alternate running with walking
rather than just running, which will
decrease their probability of having
an asthma attack. With proper assistance,
people with asthma can enjoy the same
satisfaction from sports, physical activity,
and in addition, life, as people without
asthma (1, 8,
10).
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