What is Asthma?
In response to a trigger the air tubes of the lungs become narrower or completely blocked due to inflammation, thus restricting normal breathing. In severe cases, this narrowing can lead to death. The condition affects the bronchi or bronchioles (airways); it does not affect the lungs' air sacs. Narrowing results when the lining of the airways becomes inflamed and the muscles surrounding the airways contract. Despite its worrying implications, however, with proper treatment, the condition is both controllable and reversible.
Cause for Concern
Fact: asthma is on the increase. Today, in the United States and Australia, an estimated five percent of adults and ten percent of children suffer from the condition. In the UK, the number of new cases of adult onset and childhood asthma amount to a total of nearly three million people (around five percent of the British population).
Increased air pollution and other factors associated with 21st Century lifestyles have resulted in an alarming escalation in the number of newly diagnosed cases of bronchial asthma.
New Departures in Asthma Research
According to Dr. Robert Youngson, an authority on respiratory disorders, research into the mechanisms that can cause the condition has revealed that, in the allergic type, blood cells called eosinophils can release highly irritating substances that cause inflammation of the air tube linings. In the non-allergic type, however, helper T-cells are also present, along with eosinophils. Until this discovery, helper T-cells had not been associated with the causes of asthma.
The term "asthma" comes from the Greek meaning "to breathe hard". Medical terminology defines the condition as a Reversible Obstructive Airways Disease (ROAD).
Types of Asthma
Asthma can strike anyone at any time and under any circumstances. Until recently, the condition was divided into two clearly defined types: "extrinsic" (allergic) and "intrinsic" (non-allergic). Nowadays, however, a more group-type of approach is preferred
The Origins And Causes Of Asthma
Common Causes of Asthma: Allergic and Non-Allergic
Although clear patterns do exist, the specific causes of asthma are far from straightforward. Research has established that the causes cannot simply be divided into allergic and non-allergic. Allergic asthma is triggered by allergens: substances capable of stimulating the body's immune system into bringing about an allergic reaction.
Many other factors also come into play. These can be as diverse as emotional upsets, environmental stress and even exercise. Exercise induced asthma can be particularly severe, particularly if exertion occurs in cold, dry conditions.
The causes of asthma are wide ranging. Some causes, however, are more common than others. At the top of the list are specific allergens. People suffering from specific allergy induced asthma are usually very aware of the offending allergen and try to avoid it.
Pollutants, dust, smoke, irritants, chemicals, viral infections, bacteria, stress, emotion and exercise are other frequently diagnosed causes.
- Allergies cause approximately ninety percent of the cases of asthma in children under the age of sixteen.
- The causes in approximately seventy percent of sufferers under age 30 are allergy related.
- Approximately eleven percent of the non-asthmatic population
- experiences exercise induced asthma. Many of these people have allergies or a family history of allergies.
- In the elderly, the condition can be missed easily, commonly blamed on aheart condition or another lung disease like bronchitis or emphysema.
Asthma in Children and Passive Smoking
Research has concluded that maternal smoking can seriously impair infant lung function, even before the child is born. Experts agree that inhaled cigarette smoke increases the tendency of the respiratory tract to react to other asthma triggers. Babies and younger children are particularly vulnerable.
A Genetic Link?
Research has uncovered several areas of the genome that may be associated with the inheritence and development of asthma. Recent data published in the journal Science characterises a novel receptor, GPRA (which stands for G protein–coupled receptor for asthma susceptibility), which is thought to play a role in the inflammation observed in some forms of allergy and asthma. The discovery is important not only for providing insight into potential causes of the disease, but also for leading to the development of new treatment strategies.
So, is asthma hereditary? Not in itself, but the tendency or predisposition to develop the condition can be. It is believed that genetic susceptibility, combined with environmental factors, is what leads to asthma.
Expert opinions regarding the degree to which the condition is hereditary vary widely. One fact that all experts agree upon, though, is that the likelihood of becoming asthmatic increases significantly if one or both parents already suffer from the asthma.
Asthma in Children: The Hereditary Link
Dr. Glennon Paul, in All About Asthma and How To Live With It, concludes that if neither parent suffers from asthma, the chance of their offspring becoming asthmatic is as low as 10 percent. The likelihood increases to 25 percent when one parent is asthmatic and to 50 percent when both parents are asthmatic.
How Would I Know If I'm Having An Asthma Attack?
Child and Adult Asthma Symptoms
Also described as asthma 'flares' or 'episodes', asthma attacks refer to any period when an asthmatic suffers a noticeable shortness of breath that requires some form of treatment or medical intervention to restore normal breathing.
Onset: The onlooker will notice a distinct shortness of breath and wheezing, particularly while exhaling.
The next stage: Wheezing increases markedly and becomes apparent during both inhaling and exhaling.
Advanced stage: Sometimes symptoms do not progress beyond the wheezing stage. In other cases, the attack continues to the stage where the sufferer stops breathing because the airways become totally blocked.
Warning! This development is dangerous. Immediate medical intervention is required.
Typical Symptoms of Asthma Attacks:
- shortness of breath
- constriction of the chest muscles
- sputum production
- excess rapid breathing/gasping
- rapid heart rate
Identifying Adult Asthma Symptoms
Under-diagnosis and misdiagnosis of asthma in today's UK adult population remains at an alarmingly high level. This applies particularly to elderly sufferers, where adult asthma symptoms are often mistaken as the symptoms of other diseases associated with cardiac (heart), pulmonary (lung), and bronchial conditions.
Adult asthma symptoms include:
- chronic coughing during the night
- chest pains
- chest tightness
- insomnia due to shortness of breath
- intolerance to the smell of chemicals.
How Does Asthma Differ from Similar Conditions?
First, asthma attacks tend to be intermittent. Asthma can often lie dormant for lengthy periods of time, but for established sufferers, the risk for a flare-up is always present.
Another distinguishing characteristic of asthma, when compared with other respiratory conditions, is the degree to which the airflow in the lungs is obstructed. For all ages of asthma sufferers, airflow to the lungs can vary considerably at different times, from mild to severe. Also, levels of wheezing and shortness of breath can change suddenly—often in minutes.
Other Conditions that Obstruct the Airways
- chronic obstructive pulmonary disease (COPD)
- cystic fibrosis
- severe sinusitis
- chronic bronchitis.
What is Anaphylactic Shock?
Anaphylactic shock is similar to a massive allergic response that affects the whole body. When a large number of the body's mast cells releases histamine and other substances into the blood stream, the respiratory tract can be severely compromised. Blood flow to major organs is also compromised. Anaphylactic shock is a medical emergency and requires prompt treatment.
- rapid heartbeat and shortness of breath, at onset
- swelling of the throat
- vomiting and nausea
- chest tightness
- severe wheezing
- drop in blood pressure.
What is the Treatment for Anaphylactic Shock?
Treatment usually consists of intravenous epinephrine (adrenalin). In certain cases, antihistamines and steroids are also administered. Aminophylline (a respiratory stimulant and bronchodilator) is used occasionally in situations where the patient fails to respond to epinephrine. Anyone at risk of anaphylactic shock should carry a pre-loaded adrenaline syringe (often referred to by the brand names Ana-Guard® or Epipen®).
Anyone suffering from anaphylactic shock is seriously ill and needs IMMEDIATE medical treatment. The condition is life threatening and may lead to cardiac arrest.
Symptoms of Asthma and Recognising Triggers
Asthmatic bronchitis is on the rise. The reason for this increase is unknown. Some experts believe worsening atmospheric pollution and increasing allergens are the cause. Others believe that our homes have become too clean, and that our children are not exposed to enough allergens while growing up.
Childhood and infant asthma affects an estimated ten percent of children in the Western hemisphere. These statistics are indeed a cause for concern for both parents and the medical profession.
Although medication and treatment are becoming increasingly targeted and specific to help manage these alarming trends, there is much that asthmatics and parents of affected children can do to control the numerous asthma triggers that exist in our everyday environment.
What is a trigger?
A trigger is any substance or condition that provokes a reaction in the respiratory tract, thus 'triggering' an asthma attack. Anyone who already suffers from asthma or exhibits allergic symptoms of asthma is particularly sensitive to such triggers.
The Key to Asthma Management
Asthma triggers are everywhere in our environment: indoors, outdoors and in the very air we breathe. Identifying asthma triggers, however, is not always simple. It usually involves a process of elimination. A good place to start is a consultation with your doctor. Ask for guidance. Your doctor may recommend a skin test for allergies.
To assist your doctor, keep a personal medical diary to record the details of instances when your symptoms become particularly aggravated. It could be something as simple as entering a smoky or dusty environment or exercising outdoors in the cold air.
But first things first: learn to recognise the general symptoms of asthma caused by exposure to such triggers.
Typical symptoms include:
- tightness of the chest (often
- wheezing (loudness varies from almost inaudible to very loud)
- sweating, increased pulse rate and anxiety (more pronounced in severe cases)
- bluish tint to face and lips
- (cyanosis) in acute attacks
- cough (due to the accumulation of phlegm – sputum – in the lungs).
Recognising Infant Asthma
Identifying symptoms and triggers in cases of infant asthma is not as straightforward as one might expect. Sometimes the symptoms are masked so a parent might be unaware that the child has asthma. Parents can easily misdiagnose the symptoms of asthma as merely "a bit of a wheeze".
The sobering reality is that the majority of infants who die from asthma do so because their parents have failed to identify the seriousness of their condition.
Learn to distinguish between the symptoms of a common cold and those of serious asthmatic bronchitis in your infant. Persistent hacking or a congested cough, with or without wheezing, can sometimes indicate the onset of asthmatic bronchitis in infants. Better to be safe than sorry: if in doubt, consult your child's paediatrician.
In addition to wheezing and coughing, signs of laboured breathing include:
- rapid rate of breathing. More than40 breaths per minute in a sleepinginfant is a warning sign.
- nasal 'flaring' (nostrils widen)
- difficulty with breast or bottle
Asthma Triggers: Cat Dander, Dust Mites, Air Conditioning
In modern Western society, avoiding contact with the numerous pollutants and substances that can trigger an asthma attack is virtually impossible. In the home, the workplace, even in the air we breathe, we're surrounded by an endless list of potential asthma triggers.
A vast range of stimuli can trigger asthma attacks. Chief culprits include dust mites, air conditioning (which cycles offending substances into the air we breathe) and something as simple as cat dander.
Individual asthmatics, however, tends to have their own 'red-alert' triggers. The following is a list of common asthma triggers:
- air conditioning
- animal saliva and urine
- atmospheric ozone
- bird, dog and cat dander
- chemicals (e.g., hexachlorophene, formalin, ethylene diamine)
- cold air
- colds and upper respiratory tract infections
- drugs (especially aspirin, cimetidine, antibiotics, beta blockers)
- dust mites
- emotional upset
- exertion (especially if strenuous and in cold air)
- food additives or preservatives (e.g., tartrazine, sulphur dioxide)
- fungal spores
- fumes (e.g., paint)
- gum acacia
- hair particle proteins
- high humidity
- house dustmite droppings
- kapok and feather stuffing (e.g., in pillows and cushions)
- metals (e.g., cobalt, platinum, nickel)
- penicillin spores from mouldy cheese
- ragwort pollen
- reflux of acid into the lower gullet
- sawdust (especially oak, boxwood and cedar wood dust)
- smoke pollution
- strong odours
- temperature/humidity changes
- tree and grass pollens
- vegetable dusts (e.g., coffee and castor bean).
Dander. What is it?
Pet dander is simply dead skin flakes. The skin itself, or the fur on your pet is not the cause of your allergy. Rather a certain protein found in cat saliva and present on the dander is often the offending allergen.
Cat dander can remain in the environment for up to six months. Dander is somewhat sticky in nature. Although it can easily be removed from smooth surfaces, textured or porous surfaces such as sofas, carpets, cushions, or wood panellingare more difficult to clean.
The Environment and Asthma Triggers
The increase in atmospheric pollution, especially in cities, is largely to blame for the rise in the incidence of asthma. Increases in industrial effluents and heavy concentrations of nitrogen oxides from motor vehicle exhausts help contribute to a declining air quality.
Studies have concluded that the ozone produced when sunlight reacts with these oxides are damaging to the ciliated lining of the airways.
Central air conditioning and heating systems tend to blow accumulated dust, cat dander, pollen, dust mites, and other common allergens into the air. If the environment is moist, mould spores will also be part of the mix. Filters should be changed regularly and air ducts cleaned at least annually. Request that the company providing the cleaning service attends to all components of your system.
The Practical Approach to Asthma Control
So, we've identified potential triggers. We understand the risks associated with exposure to those triggers. Apart from eliminating the obvious, such as not smoking, what exactly can we do about them when our daily activities involve regular contact and avoidance just isn't practical? The answer is: a great deal!
Tips for Preventing and Controlling Asthma Triggers
In most cases, a minor adjustment to our everyday routine is all that's required to control asthma triggers and prevent an attack.
All asthmatics should always carry their asthma inhalers with them, even when they think they are entering a 'low' risk environment. This is the best practical measure you can take. Asthma inhalers are designed to help prevent the onset of an asthma attack – fast. These devices are light and easy to carry but, most important, they are highly effective at delivering medicine to the airways quickly.
- Occupational asthma is frequently misdiagnosed as chronic bronchitis. If you suspect that substances in the workplace precipitate your asthma, consult your doctor immediately. Request an allergy test.
- Are you exposed to platinum salt dust, baker's flour, isocyanates (used in manufacture of polyurethane foams, paints and electronic insulation), or trimellitic anhydride (TMA) and ophthalmic acid anhydride (hardening agents used to set epoxy resins)? All are known potent allergens.
- If your occupation requires that you wear rubber gloves, substitute non-latex gloves. Allergies to latex (and latex dust) are fairly common.
- If left untreated, occupational asthma will only worsen with time and you may even risk permanent lung damage.
Asthma in the Home
- Replace feather and down-filled pillows, quilts and cushions with those filled with man-made fibres.
- Cover mattresses and box springs with zippered, dust-proof covers.
- Keep your home as dust-free as possible. No half measures—house dust mites are major asthma triggers!
- Remove carpets from the bedroom.
- Replace upholstered bedroom furniture with leather or vinyl.
- Keep windows tightly shut during pollen season.
- Consider the possibility that your pet cat, dog, bird or any other furry or feathered friend is the root cause.
Asthma and Pregnancy
- Look into your family medical history. The tendency to allergic asthma can be inherited. If you or a family member is asthmatic, there's a higher risk that your baby could be affected.
- Pregnancy doesn't pose a problem in the majority of asthma cases.
- However, you're advised to take a little more care with your normal
- management routine. Most likely, you will be advised to continue taking your prescribed medication. Studies suggest that most prescribed
- asthma medications are generally safe for the foetus. Your physician should be consulted for specific recommendations.
- Although management of the condition usually doesn't change
- dramatically during pregnancy, take care in the first few weeks to avoid any unnecessary medication. Avoid combination remedies that contain drugs other than standard asthma medications.
- A few drugs should be avoided as far as possible. These include
- adrenaline, aspirin, Nurofen®, Naprosyn®, Voltarol®, Brufen®, and beta blockers.
- Don't be complacent if your child has a wheezing cough or is breathless. Consult your doctor and explore the possibility that your child may be suffering from childhood asthma.
- Don't smoke or take your child into a smoky environment. Cigarette
- smoke is a well-known trigger.
- Ask your doctor to test whether your child has become sensitised to dust mite protein. Those who have will produce IgE antibodies. Reduce the likelihood that your child's toys are infested with D. pteronyssius mites (known to trigger asthma attacks). Tip: To kill these mites put the soft toy in the freezer for a few hours.
- Make sure that your child knows how to use an inhaler properly. (Does your child possess the latest version of asthma inhalers?)
- Use a peak flow monitor to measure your child's breathing capacity.
- Limit exposure to strenuous outdoor play, particularly in the spring and autumn when pollen levels are high.
- Stress and emotions are major triggers of childhood asthma. Never
- underestimate even a young baby's ability to react to a stressful
Exercise Induced Asthma
- Avoid intense exertion in cold, dry conditions.
- If you're prone to wheezing while exercising, don't just assume you're unfit. You may be suffering from exercise induced asthma.
- Asthmatics should try to avoid participation in winter sports, e.g. skiing, vigorous skating, and ice hockey.
- Outdoor sports involving sustained exertion, such as rowing or
- long-distance running, are less suitable sports than those involving short bursts of exertion.
- Consider activities that are more leisurely paced.
Improving the Air You Breathe: Air Purifiers and Filters
Asthmatics often use an HEPA home air filter.Indoor air can often prove a greater threat to asthmatics than the air they breathe outdoors.
Pollutants generated in a 'sealed' indoor environment commonly build up to dangerous levels. Studies by the United States' Environmental Protection Agency report that levels of indoor pollutants tend to be two to five times (and in certain cases 100 times) higher than levels of outdoor pollutants. Furthermore, air conditioning and heating systems are notorious for producing abrupt changes in temperature that can very easily trigger an asthma attack.
The EPA report also concluded that "poor indoor air quality" was the fourth largest threat after "volatile organic compounds, lead dust and asbestos".
According to the National Asthma Campaign some 1500 to 2000 people are diagnosed each year in the UK with asthma. An estimated twenty percent have had no previous allergies or were sensitive to any particular trigger. Those who are routinely exposed to asthma triggers, or who spend a good deal of time in a poorly air-condition or air-filtered environment are at highest risk.
Improving Indoor Air Quality (IAQ)
Approximately 24 million working days are lost each year in the UK due to 'sick building syndrome'. Although total elimination of indoor air pollution is not always possible (or feasible), a great deal can be done to improve indoor air quality. For example, HEPA filters and the use of air purifiers, air filters and specially designed vacuum cleaners can produce dramatic results. For the asthma sufferer, such devices can make a world of difference.
|Device/Mechanism||Description||How it improves IAQ|
|HEPA (High-Efficiency Particulate Air) filters||HEPA filters have a minimum particle removal efficiency of 99.97% for all particles of 0.3 micron diameter and higher. This size covers most pollens, mould spores, animal hair and dander, dust mites, bacteria, smoke particles and dust.||Generally accepted as an essential piece of equipment for the control and management of indoor pollutants, HEPA filters are used extensively in medical and industrial environments. They are now commonly used in residential air cleaners.|
|Air purifiers||Air purifiers are classified according to the technology they use to remove different-sized particles from the air. They can be either mechanically or electronically operated; certain versions use a chemical process (e.g., ozonization).|
|(i) large room unit air purifiers||Equipped with powerful air filters or 'collecting' plates, some large units use electrostatic precipitation.||Highly effective at removing pollutants (especially smoke and dirt) from large rooms. Generally considered more effective in a single room unit than as fixed central air filters.|
|(ii) tabletop air purifiers||Equipped with small panels of dry, loosely packed, low-density fibre filters and a high velocity fan.||Although relatively inexpensive and generally a good value, caution is required when selecting tabletop air purifiers. Make sure that the specifications match your requirements. (Can the device cope with very small particles noted for their ability to penetrate the lungs, thus triggering an asthma attack?)|
(Efficiency is usually measured according to the size of particle that the device can remove).
|Air filters fall into two broad categories: central filtration systems (sometimes called 'induct' systems) and portable units with fan attachments. Induct system filters are installed in heating, ventilation and air conditioning systems (know as HVAC). Air filters can be mechanically or electronically driven, or a hybrid of both.||Asthma sufferers are often advised to choose a HEPA type filter that is capable of trapping both very large and very small sized particles.|
|Specially designed vacuum cleaners, (e.g., HEPA vacuum cleaners)||Equipped with high spec pre-filter and filter systems, these sealed and allergen-free units are capable of removing and trapping asthma-inducing pollutants that normal vacuum cleaners don't.||These high-performance vacuum cleaners are recommended for their capacity to remove potentially dangerous allergens, such as bacteria and mould filled dust.|
Portable air filters or central filtration systems?
Portable air filters are ideal for removing air pollution from a single room.
Central filtration systems are better suited to a whole building environment.
Recognising Allergic Asthma And Its Triggers
The Link Between Allergies and Asthma
Asthma is a condition that often arises from allergies. More specifically, the respiratory problems that arise during an asthma attack usually occur because of a reaction to certain allergens such as dust or specific foods.
Of course, anyone can have allergic reactions without actually being asthmatic. Conversely, not all asthma attacks are triggered by allergies. Stress, for instance, is a prime example of a non-allergy asthma trigger.
According to The National Asthma Campaign, moving house can be a dangerous time for asthmatics, "The act of moving house is said to be one of the most stressful times in our lives and as stress can be a trigger for asthma, it is no wonder that some people's asthma becomes worse at this time". But asthma sufferers who are planning a move can rest assured. Effective medication and stress management techniques are available for coping with stress-induced asthma attacks.
Allergic Reactions to Food and the Severely Asthmatic
Most asthma sufferers are only too aware of the dangers lurking in allergens such as dust mites and animal hair. What is not common knowledge, however, is that food allergens are equally capable of triggering a severe asthma attack, or even causing anaphylaxis.
What complicates diagnosis is the fact that food allergy symptoms do not always develop immediately. Sometimes they become apparent hours after the exposure.
According to Dr Gideon Lack, lead researcher from St. Mary's Hospital London, in a recent study, food allergies can trigger severe asthma attacks in children. "This study stresses the importance of detailed allergy investigations in asthmatic children. This should allow paediatricians to identify a group of children at risk for severe reactions and the potential cause for severe asthma in certain children".
Anaphylactic shock, or anaphylaxis, is a severe allergic reaction that affects the entire body. Anaphylaxis results in a sudden drop in blood pressure, possibly a skin rash, stomach upset, and most importantly for asthmatics, severe breathing difficulties. If not treated immediately, anaphylaxis can be fatal. Emergency treatment includes injections of adrenaline (epinephrine). Anyone with severe allergies should always carry an anaphylaxis kit containing epinephrine.
Immunotherapy and Allergy Symptoms
Immunotherapy is occasionally used to reduce allergy symptoms in asthmatics. Only an allergist-immunologist or other specialist GP should prescribe the treatment. Also, immunotherapy should be administered only in facilities specifically equipped to treat anaphylaxis.
Immunotherapy involves a series of injections, each containing minute quantities of substances, such as dust mites, pollen, mould spores, animal hair and dander or any other substance to which the patient has tested positive in an allergy skin test. Food allergens are not included in immunotherapy as the effectiveness of their inclusion has not been proven.
Early forms of immunotherapy were initially discontinued in the UK due to the considerable side effects. However, newer, safer immunotherapy preparations have recently become available and are now more popular.
Allergy injections are administered once or twice a week, during the build up phase. Once the condition is stabilised (after approximately 3 to 4 months), the frequency is reduced to a maintenance level of an injection every 2 to 3 weeks. Immunotherapy may continue for several years.
Although still the subject of continuing research, immunotherapy has been shown to 'switch off' the abnormal allergic reactions triggered by allergens.
Most asthmatics respond well to immunotherapy. However, a small percentage of them fail to respond. In these cases, treatment is discontinued. Occurrences of fatal anaphylactic episodes as a result of immunotherapy treatment are rare.
Asthma and Airborne Allergens in the Home
Of all the inhaled allergens that affect indoor air quality, dust is the most common. More specifically, the culprits are dust mites and their waste products. Dust mites, pet hair, dander, and pollen are common allergens. Pollens cause seasonal rhinitis, commonly known as 'hay fever'.
Pet Problems: Cat Allergy and Other Offenders
Cat hair and dander, as well as animal saliva, urine and excrement are recognised as common causes of allergic reaction. However, the animal fur/hair itself is not the problem; it is merely the carrier of common allergens such as dust mites, pollen and mould.
Although cat allergy is very common among asthmatics, dogs, too, have been known to cause allergic symptoms. Bird feathers and droppings are also common sources of allergens. In addition to cats, dogs and birds, other small animals such as rabbits, mice, rats, guinea pigs, hamsters, and gerbils may be problematic. Furthermore, their bedding can dramatically affect indoor air quality.
Even outdoor pets, farmyard animals, animal feed, and bedding can cause problems. Horses, cows, goats, and poultry can all harbour potent allergens.
A study published in the March 30, 2002 issue of the British Medical Journal concluded that common allergens such as dust mites and pet hair and dander might act together with respiratory viruses to make asthma worse. The study also suggested that the probability of asthma sufferers being hospitalised increases considerably if they are exposed to allergens.
Practical Solutions for Pet Allergies
Removing pets is not always a practical option. Current statistics report that over fifty percent of UK homes have a pet in residence. This poses something of a dilemma for asthmatics. So, what can be done about pet allergies if exposure to pets is unavoidable?
For those with chronic asthma symptoms, the regular use of inhalation steroids is recommended. Steroid inhalers are used even when feeling well, as they work in a preventative capacity and aim to reduce the swelling and inflammation in the airways. Other types of inhalers (beta 2 agonists) relieve symptoms directly, and are available to control ongoing attacks.
Also, if your asthma is allergy-induced, you'd be wise to consult an allergist-immunologist for advice on medications that are appropriate for the treatment of specific animal allergies, such as cat allergy. Typical treatments may include nasal sprays, decongestants, or antihistamines.
Cat Allergy: New Hope for Asthmatic Cat-lovers!
Until recently, accepted wisdom on the subject was simply to get rid of the cat. Dr. Thomas Platts-Mills, head of allergy and asthma at the University of Virginia, in the US, holds an opinion that gladdens the hearts of cat lovers.
According to Dr. Platts-Mills, not enough evidence supports the standard recommendation to families with allergies or asthma that they "get rid of the cat". New studies have revealed that, in cases of childhood asthma, if a child tests positive for allergies to dust mites and pollen, but negative for cat hair and the parents still get rid of the cat, the child may later become allergic to cats.
Controlling Your Home's Indoor Air Quality
- Apart from 'damage limitation' measures, other practical steps one can take to control the level of allergens in the home environment include the following.
- Restrict pets to certain common rooms - keep them out of the bedroom.
- Locate litter trays far away from sources of air supply to the rest of the home.
- Bathe your cat or dog in clean/clear water regularly - use running water
- to rinse your pet rather than a tub or sink filled with water. (Cats are
- not as averse to bathing as is commonly believed, particularly if you
- start bathing them at a young age).
- Use a specially designed vacuum cleaner. It can be particularly effective at removing allergens such as dust mites.
- Eliminate as far as is feasible, the common allergens, moulds and fungi.
- Improve indoor air quality. Install a central air cleaner and have it
- switched on for at least four hours a day.
- Keep bedrooms free of feather and down pillows and quilts.
- Reduce indoor humidity to less than fifty percent.
- If you are allergic and must visit a home with pets, make sure that you take your medication immediately before the visit.
- Design a 'safer' garden. Keep allergens such as grass, tree, and weed pollen to a minimum. Birch tree pollen can be a particular problem.
- Tomato plants, interestingly, are also known to cause allergic reactions.
Coping With Asthma And Food Allergies
Food Allergy Reactions and the Asthmatic
For some asthmatics, common food allergies, such as a peanut allergy, can trigger a sudden asthma attack. Immediate reactions to certain food products are potentially life threatening and can occasionally result in the onset of anaphylactic shock.
In other asthma sufferers, the symptoms of a food allergy are delayed and develop over a period of time. Although the symptoms are less immediately obvious, a delayed reaction also has serious implications for the asthmatic.
Delayed reactions, for instance, can lead to the development of chronic bronchial asthma. Also, those asthmatics who exhibit delayed symptoms of a food allergy tend to develop a more severe and inflammatory type of chronic asthma.
In all cases of food allergy, whether immediate or delayed, the occurrence of one severe reaction to a food allergen (e.g., a wheat allergy) puts the asthmatic at greater risk of developing other allergic reactions.
Identifying Food Allergies
Foods that produce a positive allergy skin test result should be removed from the diet immediately. A problem can arise when certain foods fail to produce positive skin test reactions but are still capable of aggravating an allergic reaction.
An extensive process of food elimination trials is often the only option to diagnose the offending substance properly.
A dietician can help design a diet that will eliminate your particular food allergens and meet your nutritional requirements while satisfying your taste buds.
Typical Symptoms of a Food Allergy
Food allergens can be inhaled and act directly on the lung tissue, or can be absorbed from the digestive tract into the general circulation. Their presence in the bloodstream can trigger a range of symptoms including constriction of the muscles surrounding the airways. This can trigger an asthma attack. Peanut allergy, in particular, is known for its severe and nearly immediate effect.
Symptoms of a food allergy can range from very mild to a potentially life-threatening anaphylactic reaction.
Common Food Allergies
The severity of many food allergies tends to be related to the amount of the offending food consumed. However, with certain food allergens, the reaction can be immediate and severe if even a small amount of the food is eaten.
Peanut allergy: A common ingredient in many food products, peanuts can cause severe allergic reactions. (Restaurants now commonly print a warning on their menus when peanuts are used in a dish).
Fish/Shellfish allergy: Those allergic to crustaceans like lobster and shrimp can have severe reactions. Keep in mind that even sharing a glass or a kiss with someone else who has eaten shellfish can trigger a reaction!
Milk allergy: Many asthmatics are intolerant (as opposed to allergic) to milk proteins; suggested alternative sources of calcium for those with milk allergy or intolerance include soy products, spinach and other leafy greens.
Wheat allergy: Wheat gluten and other grains such as corn and rye are common allergens.
Other common food allergens: Various berries and peppers have been known to produce symptoms of a food allergy.
To learn more, visit the Food Allergy web site.
What's for Breakfast?
Whole-wheat toast with butter and coffee with cream? A bowl of cereal with milk? Not if you have a wheat allergy or milk intolerance! Rice and maize are generally well tolerated by those with a wheat allergy. And remember: many other options are available to fulfill your daily calcium requirements.
A cross-reaction to foods and other allergens can be very dangerous for asthmatics and, in severe cases, can result in the onset of anaphylactic shock.
Studies have determined that some people who are allergic to latex rubber are also particularly sensitive to certain foods, including avocados, apples, bananas, chestnuts, kiwis, peaches, cherries, plums, pineapples, melons, pears, hazelnuts, almonds, celery, carrots, and papaya.
If you are asthmatic and begin to experience a tingling or itching sensation in your mouth or on your lips after eating certain foods, seek medical assistance, immediately.
Asthma And The Adverse Drug Reaction
Hidden Risks: Drugs and Allergy Medications
Avoiding drugs that could precipitate an asthma attack (or, in the case of severe adverse drug reaction, anaphylactic shock) is not always easy. This is because some of the most likely asthma triggers are the drugs themselves! One class of drugs, the beta blocker, is liable to cause severe attacks in any asthma sufferer.
What You Must Tell Your Doctor if You Are Asthmatic
The importance of informing your GP of a previous adverse drug reaction to any of the following drugs before being prescribed any allergy medications or drugs for allergy-induced asthma cannot be stressed enough. This list is by no means comprehensive and represents only a sample:
Prescription Drugs: salbutamol, diclofenac, ephedrine, epinephrine, pseudoephedrine, terbutaline, ibuprofen, voltarol.
Allergy Medications: including any other drugs that contain the above, e.g. cold medications, diet pills.
Beta Blockers: such as propranalol, metoprolol and atenolol.
Antidepressants/MAO Inhibitors: such as amitriptiline, imipramine and fluoxetine.
Non-Prescription Drugs: aspirin, cold and flu remedies as well as smoking cessation drugs.
Also tell your doctor if you have received drug treatment in the past for any of the following conditions:
- heart disease
- high blood pressure
- overactive thyroid gland
The Dangers of Beta Blockers
The ß2 antagonist (beta blocker) drugs can be very dangerous for asthmatics. This is because they interfere with the body's normal autonomic system action that widens the airways.
Remember: some of the most effective drugs used to treat all forms of asthma, including allergy-induced asthma, are the beta-receptor agonists. Clearly, the asthma sufferer must avoid, at all cost, any drugs that have the opposite effect.
Although some beta blockers are less dangerous than others, asthmatics should always bear in mind that all beta blockers have some action in blocking the ß2 receptors.
What is reassuring to know, however, is that diagnosed asthmatics are rarely prescribed beta blockers, unless in the form of eye drops.
Although, not well documented, research suggests that taking beta blockers produces an increased risk for anaphylactic shock caused by an adverse drug reaction among those with food allergies.
Identifying Beta Blockers
A beta blocker's generic name can generally be recognised by its ending:
Examples include acebutalol, atenolol, betaxolol, bisoprolol, carvedilol, celiprolol, esmolol, labetalol, metoprolol, nadolol, nebivolol, oxprenolol, pindolol, sotalol, propranolol, timolol.
Aspirin and Aspirin Type Drugs
Sensitivity to aspirin may trigger an adverse drug reaction in the asthmatic. This sensitivity can set off an asthma attack or occasionally lead to the onset of anaphylactic shock.
Because this type of reaction doesn't appear to involve the immune system, aspirin sensitivity is often referred to as a 'pseudo-allergy'. From the asthmatic's point of view, however, this description is entirely academic since the effect is the same!
Asthmatics should avoid all forms of aspirin and medications containing aspirin, including: Anadin, Aspro, Alka-Selzer, Beecham's Powders, and Disprin.
Also, if you have suffered from an adverse drug reaction to aspirin in the past you may also react to compounds in the non-steroidal anti-inflammatory drugs (NSAIDs) group, including: azapropazone, diclofenac, felbinac, ibuprofen, ketoprofen and piroxicam.
Alternative Ways to Relieve Asthma Symptoms
If you are asthmatic and have a cold, sore throat, influenza, bronchitis, or any other non-asthma related respiratory type condition, seek medical advice immediately.
Discuss with your GP whether secondary respiratory infection prevention is necessary. Under these circumstances, most medical practitioners agree that asthmatics should be given antibiotic medication.
And Finally . . . Prevention is Better than Cure!
If you are asthmatic and have previously suffered an adverse drug reaction to allergy medications, take preventative measures to avoid the need for these drugs in the first place! Here are a few simple, practical measures you can take, in your everyday life:
- If you are a smoker, the most useful thing you can do for yourself is to stop. Right NOW.
- Avoid passive smoking: steer clear of pubs, clubs or environments in which your ability to enjoy clean air is compromised.
- Insist on clean air in your home.
- The workplace is a danger zone for allergy-induced asthma attacks. Take positive steps to remove yourself from dangerous allergens that you know may trigger an attack.
- Have your vehicle checked for exhaust emissions.
- Try to avoid driving in dense traffic.
Asthma Treatments: Medications and Their Effects
Asthma Treatments: Medications and Their Effects
This site reviews the various types of treatment available today, including the different asthma medication drug groups, how the medications work and any significant reactions or side effects of the drugs. It also looks at the day-to-day prevention of attacks and treatment of the condition with a particular emphasis on the use of inhalers and bronchodilators.
Medication Delivery Methods
Methods for administering asthma products and asthma medication can be divided into three broad categories:
- oral: pills and liquids
- inhalation: via mouth or nose
- injection: into muscle or vein.
Available Asthma Treatments
Forms of asthma medication and treatment vary according to the nature and severity of the attack. Certain treatments, however, are typical:
- Mild asthma attacks:
- Short-acting inhaled
- bronchodilators relieve
- Moderate to severe asthma attacks: A combination of bronchodilators and
- anti-inflammatory drugs reduce constriction and inflammation of the airways.
- Acute asthma attacks: A combination of
- bronchodilators, such as theophylline, and
- intravenous (epinephrine) are used. The use of
- inhaled steroids (as
- opposed to oral steroids) is preferred.
- Specific allergy-induced asthma attacks:
- Anti-allergic medication usually administered by injection desensitizes the asthmatic to the allergen.
How Asthma Treatments Work
Each of the asthma medications or treatments has a specific mode of action.
- Bronchodilators relax the muscles surrounding the airways.
- Anti-inflammatory agents (steroids or corticosteroids) reduce the
- swelling and irritation in the
- Preventative asthma products such as cromoglicate sodium control and prevent the onset of an asthma attack.
- Adrenaline (epinephrine) is used in emergency situations to rapidly relax the muscles surrounding the airways.
Preventing Asthma Attacks
Asthmatics can rest assured that a treatment suitable to their condition is available. In fact, asthmatics have a wide range of products at their disposal that can effectively control their symptoms, often within seconds.
Advances in the area of asthma treatment are certainly encouraging. Most asthmatics, however, would much prefer to avoid a lifetime of dependence upon medication in the first place! Prevention of asthma triggers should be the first line of defence.
Knowledge of how to prevent or avoid asthma triggers is vital. If you have asthma, you should know:
- the degree of severity of your
- attacks, and whether they're
- stabilizing or deteriorating
- whether your prescribed medication is the most appropriate for your needs
- whether any changes in your
- condition might benefit from a
- different type of asthma treatment.
Using Inhalers And Nebulisers To Treat Asthma Attacks
Salbutamol: Instant Relief for Asthmatics
The salbutamol inhaler (often referred to as a metered dose inhaler or simply MDI) has revolutionized asthma treatment. The other good news is that in the vast majority of cases, an inhaler is all that's required of both child and adult asthmatics to control their condition.
Salbutamol is an inhaled bronchodilator that relaxes the muscles in the respiratory tract and dilates the airways to improve breathing. The salbutamol might be mixed with cromolyn to prevent the onset of another attack. Prescribed usage might be one or two sprays every four to six hours, for example, depending on the severity of the condition and the attacks. Some patients with very mild asthma only need to inhale medication now and then, just when they feel they need it.
How to use your inhaler for maximum effect:
- Shake the canister thoroughly to ensure even dispersal of the drug in the propellant.
- Hold the canister upright. This is important! If you don't do this properly, the internal metering chamber won't fill the next dose correctly.
- Hold the inhaler 1-2 inches away from your open mouth.
- Activate the inhaler.
- Breathe in steadily and slowly.
- Continue to inhale fully after the spray of asthma medicine has been delivered.
- Hold your breath for a count of 5 to 10 seconds.
- If you need two sprays, do not deliver both during the same inhalation.
Salbutamol Inhaler vs. Oral Medications
The function of corticosteroids is to reduce inflammation in the bronchi. Corticosteroids are identical to (or simulate the actions of) natural steroid hormones. These synthetic steroids are generally far more powerful than the natural hormones hydrocortisone and corticosterone.
Examples of corticosteroids include beclomethasone, flunisolide and mometasone.
Compared with taking asthma medicine by mouth, the salbutamol inhaler wins hands down!
The reason? When swallowing tablets or syrup, the drugs must pass through the stomach into the small intestine. This can take up to an hour. The drugs must then be absorbed into the blood vessels and carried (in diluted form) to the lungs. The salbutamol inhaler short-circuits this drawn out process. It goes directly to its target: the lungs.
Nebulisers: How They Differ from Inhalers
Cromolyn, an anti-inflammatory asthma medicine, is used routinely to prevent the onset of an asthma attack. Its function is to prevent the airways from swelling up when they come into contact with an asthma trigger. The drug, however, becomes ineffective once the attack is under way. Cromolyn is used in both MDIs and in liquid form in nebulisers. The drug is often used for the specific treatment of exercise-induced asthma.
A nebuliser is a device that converts liquid asthma medicine into a cloud of tiny aerosol particles. The device is driven by a compressed air machine. It comprises a cup, a mouthpiece (usually attached to a mask) and thin plastic tubing that connects the mouthpiece to the compressed air machine.
Nebulisers have one big advantage over ordinary inhalers: they can deliver the drugs to the airways and control an asthma attack, even when movement of breath in and out of the lungs is severely reduced.
Used extensively in hospitals, nebulisers are particularly effective for the treatment of three categories of patients:
- infants and children under the age of five years
- adults and children who, for whatever reason, are unable to use a normal salbutamol inhaler
- any age group suffering from a severe asthma attack.
Inhaled, Oral and Injected Asthma Drugs
Drugs to treat asthma can be categorized into a few general drug groups. Members within each group are considered more or less interchangeable.
Bronchodilators (asthma drugs that relax the muscles around the airways) are generally the most frequently used drugs in the treatment of asthma. Bronchodilators can be inhaled, taken by mouth, or injected into the muscles or veins.
The following is a summary of common medications used in asthma treatment.
Drug group: Beta2 (ß2) adrenoreceptor agonists (adrenoreceptor refers to a site where adrenaline works)
Common drugs: Common ß2 agonists include salbutamol (Ventolin®, Volmax®), terbutaline (Bricanyl®), bambuterol (Bambec®) and salmeterol (Serevent®)
How they work: Adrenoreceptor agonists have the same effect as natural adrenaline: they help keep the airways open by relaxing the muscles in the walls of the airways. ß2 receptor agonists are normally inhaled and are used at irregular intervals and as a first line treatment.
Possible side effects: Although ß2 agonists can be highly effective immediately (and for up to six hours) if taken in high dosage, they sometimes produce a "rebound" effect that can trigger an additional attack. Also, ß2 agonists have no effect on inflammation.
Drug group: Corticosteroids (steroid drugs)
Common drugs: Common corticosteroids include Beclomethasone
(AeroBec®) and Fluticasone (Seretide®)
How they work: Corticosteroids can be taken by mouth, inhaled, or injected.
These drugs are highly effective in suppressing inflammation, and
reducing mucus secretion.
Possible side effects: Dosage must be monitored carefully by a physician.
Some patients may experience suppression of the body's
production of natural steroids, growth suppression, the likelihood
of new infections, high blood pressure, exacerbation of stomach
or duodenal ulcers, osteoporosis, diabetes, glaucoma, cataracts
and increased growth of body hair.
Drug group: Anticholinergic drugs
Common drugs: Common anticholinergic drugs include ipatroprium bromide
(found in Combivent®) and oxitropium bromide (Oxivent®).
How they work: Inhaled anticholinergic asthma drugs relax the airway
muscles much like atropine (belladonna), but without the
unpleasant side effects to the nervous system. If a ß2 is followed
by ipratropium, the two drugs tend to enhance each other's
Possible side effects: Not always effective in preventing the narrowing of
airways in exercise and cold air-induced asthma.
Drug group: Xanthine derivatives
Common drugs: Common xanthine derivative bronchodilators include
theophylline (Slo-phyllin®, Nuelin®).
How they work: Theophylline has a similar (although lesser) effect to
caffeine. Theophylline has a strong effect in widening the
airways. Its main action is to relax the muscles in the bronchi and
improve efficiency of the diaphragm.
Possible side effects: Excessive doses of theophylline have been known to
cause convulsions and in rare cases, brain damage. This drug
group is not recommended for people who are prone to panic
disorders. Other possible side effects include heart irregularity,
personality changes, hyperactivity, nausea and vomiting.
Drug group: Sodium cromoglicate drugs
Common drugs: Sodium cromoglicate is more commonly referred to as simply
cromoglicate (Intal®, Aerocrom®).
How they work: Taken by inhalation in aerosol solution or as a powder driven
by a turbo inhaler, cromoglicate works by preventing the release
of histamines into the airways. Cromolglicates are particularly
effective in the treatment of allergy-induced asthma.
Possible side effects: Although sodium cromoglicates don't actually widen
narrowed airways, they nevertheless help indirectly by preventing
them from becoming narrower.
What is Cardiac Asthma?
Cardiac asthma, although technically not a form of asthma, is a term used to describe asthma-type symptoms caused by heart failure. Like asthma, it can develop at any age and can exhibit many similar symptoms. Patients may wheeze due to a build-up of fluid in the lungs. In cases of cardiac asthma, the patient also exhibits additional symptoms that indicate heart failure such as heart and liver enlargement and fluid retention.
Treatment for cardiac asthma differs from normal asthma treatment in that diuretics are often administered to reduce the build-up of fluids.
Sometimes called multiple allergen immunotherapy or allergen desensitisation therapy, immunotherapy is generally accepted by the medical profession as an effective and safe treatment for asthma in both children and adults. Despite this, immunotherapy is only used in the UK as a last resort. Studies to date, including those documented by the National Asthma Campaign, indicate that immunotherapy can be particularly effective in treating allergic asthmatics. A word of caution, however: in rare cases fatalities have resulted from allergen immunotherapy.
Asthma & Brain Damage
Probably the greatest concern about recurrent asthma attacks is whether they can cause mental impairment or, at worst, brain damage.
The risk is a function of the damage that can result if the brain is deprived of oxygen, even for a few minutes. If the airways are blocked completely, as is sometimes the case during a severe asthma attack, breathing becomes highly restricted and in extreme cases, impossible.
Fortunately, this is a very rare occurrence. In the overwhelming majority of cases, the constriction that occurs during an asthma attack is completely reversible with medical treatment. Rarely does it cause any permanent damage.