Family Health Magazine - FAMILY MEDICINE
Understanding this common chronic disease
Asthma is the most common chronic disease of childhood. Unfortunately, over 500 asthma-related deaths occur each year in Canada. The good news is that they are all preventable.
More and more people are being diagnosed with asthma, for many reasons. Indoor and outdoor air pollution may contribute. Health care professionals are also increasingly aware that a persistent wheeze or cough may actually be asthma. Ten to 15 percent of children are estimated to have asthma. About half of these ‘grow out’ of asthma by the time they reach the age of 15. Now the bad news – smoking plus asthma is a recipe for emphysema and chronic bronchitis. These conditions are known as chronic obstructive pulmonary (lung) disease (C.O.P.D.). Untreated asthma or under treated asthma may also lead to C.O.P.D.
The 30-second Asthma Test
If you answer yes to one or more of the following questions, bring this test to your doctor.
- Do you cough, wheeze or have a tight chest because of your asthma? (4 or more days a week)
- Do coughing, wheezing or chest tightness wake you up at night?
- Do you stop exercising because of your asthma?
- Do you ever miss work or school because of your asthma? (in the past three months)
- Do you use your inhaler four or more times a week? (except one dose per day for exercise)
From the Asthma Control Team: Asthma Landmark Surveys, The Lung Association and Asthma Society of Canada
What is asthma?
In asthma, the airways are inflamed. Think of it as having patches of eczema in the airways. The muscles that wrap around the airways tighten while the airways narrow.
Asthma can combine several symptoms that are sometimes or always present. These include:
- shortness of breath
- chest tightness
- wheezing (only some people with asthma wheeze)
- problems in the airways triggered by cold, tobacco smoke, allergens like dust and pollen, viral respiratory infections (such as colds) or exercise.
Diagnosis - talking with your doctor
Before treatment can begin, your family doctor must be sure you have asthma. It is also important to understand the severity of your asthma. The doctor will assess you, considering the following questions.
- Is there a family history of asthma, eczema (a skin condition caused by allergies), nasal polyps (bumps on the lining of the nose), or hay fever?
- What symptoms do you have and what time of day do asthma attacks occur? Are attacks worse at night? How often do you have attacks and how long do they last? Women have their most serious asthma during their period or lowest hormone phase.
- What physical signs do you have? Signs can include a cough, mucus in the airways, shortness of breath, allergic rhinitis (hay fever), raccoon eyes (dark circles), allergic creases or nasal polyps.
- What is your age? Asthma can start at any age but is more common in the young. Recurrent bronchitis and pneumonia should raise suspicions of the possibility of asthma.
- Is exercise a trigger? Is it the only time asthma occurs?
Asthma may be diagnosed based on this history and a complete physical examination. As well, a spirometry test can show how limited airflow is in your lungs. More sophisticated tests can be used if the diagnosis is in doubt.
Your asthma can be classified using guidelines from the Canadian Asthma Consensus Report (see sidebar.) The level of severity is based on the treatment needed to control the asthma.
Remember, even people with very mild asthma can develop severe symptoms given the right stimulus or trigger. Your asthma is well-controlled if:
- there are no absences from work or school
- rescue medication (blue inhalers) are used less than four times per week, not including exercise
- you can continue with normal physical activities
- nighttime symptoms are rare
- daytime symptoms occur only once or twice a week
- lung function is 90 per cent of best.
To treat asthma, exposure to triggers should be limited and inflammation reduced. In Canada, asthma treatment is based on a continuum. This flexible approach takes into consideration individual needs, the seriousness of the asthma and how well it is controlled.
Treatment should be simple and specific to each person’s needs. You must know what to do if asthma symptoms become worse, or if they worsen to the point where emergency help is required. Regular follow-up visits should be made and treatment adjusted if needed.
Education of the patient, family and caregivers is the most
Control of the Environment
important part of treatment. This includes information about the disease, medications, prevention measures and control of the environment, and what to do in an emergency.
Keeping pets out of the bedroom and controlling dust and house dust mites are just a few of many changes to the environment that can help. Avoiding tobacco smoke is very important. Medications are not a substitute for avoiding contact with allergens and irritants. When these common allergen triggers have been considered and dealt with, allergy testing can be very helpful if problems continue.
Always aim to use the smallest amount of medication necessary to achieve control.
- Inhaled corticosteriods (ICS) are the cornerstone of therapy. Flovent™, Pulmicort™ and Qvar™ are some commonly used brands.
- LTRAs – Leukotriene Receptor Antagonists (Singulair™) are effective, especially for children and those who are sensitive to ASA, exercise and cold. LTRAs are also for those who cannot or will not use inhaled corticosteriods.
- Non-steroids (Tilade™ and Intal™) are only for very mild asthma.
- Theophylline is mostly used for severe asthma.
- Atrovent™ is used in emergency rooms.
- Long acting B2-agonists such as Serevent™ or Oxeze™ should never be used without a controller medication.
- Combinations (including Serevent™ and Symbicort™) are combined bronchodilators with a controller. They are used for moderate and severe asthma, as well as for C.O.P.D.
- Relievers – short-acting B2-agonists (Ventolin™, Airomir™ and Bricanyl™) are also common. Everyone with asthma should have these fast-acting bronchodilators available. The new inhalers have no CFCs and are safer and more friendly for the environment.
- Prednisone, usually taken orally, is used for very severe asthma attacks or for those who cannot get asthma under control. It is powerful and has significant side effects, but can be lifesaving.
We still have much to learn about the genetics and cause of asthma. If you have asthma, your goal is to gain the best possible control by avoiding triggers and controlling the environment, while using the least amount of medication necessary.
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physican promptly. Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6 [FM_FHd04]