How to Treat Asthma
Treating asthma is tough, so prevention is #1.
Rob Lamberts, MD
Listen
How to Treat Asthma
Today’s article is part 2 of my series on asthma. If you haven’t already done so, read my last article, which talked about the basics of asthma – it’s important background for this one.
What are Asthma Attacks?
As I said in my last article, asthma is a long-term disease that can occasionally get dangerous. In this article, I am going to discuss those dangers, what to do when things do get bad, and how to prevent them from getting bad in the first place.
Most of the time, the symptoms of asthma are cough, and maybe some wheezing. But there are times when things get bad. They have episodes of wheezing that is so bad it makes it hard to breathe at all. These episodes are known as asthma “attacks.” An asthma “attack” happens when the airway narrowing gets severe,. In this condition, a person can’t get enough air out of their lungs to get rid of carbon dioxide and also can’t get enough oxygen in. Initially, the person compensates for that by breathing faster, but eventually, two things can happen:
-
the tired muscles cause the breathing to slow, resulting in less oxygen and more carbon dioxide in the blood.
-
High levels of carbon dioxide in the blood make a person sleepy, slowing the breathing even more. Eventually, this vicious cycle will kill if it is not treated.
How is Asthma Treated?
So how is asthma treated? Since the problem is in the tubes that supply air to the lungs, most asthma medication is delivered directly to the lungs. There are two ways to do this: through an inhaler or through a nebulizer (which is a machine that turns the medication into a mist). The nebulizer is generally used when the person has significant enough symptoms that make taking a deep breath difficult.
There are two main types of inhaled medications: medications that reduce airway spasms, and medications that reduce inflammation. The medications that reduce spasm are called bronchodilators. Because these medications are related to adrenaline, they make the heart race and make the person feel shaky. Albuterol is the most common medication in this class.
Asthma and Steroids
But relaxing the muscles only does half of the job; the underlying problem is inflammation, which is caused by white blood cells in the airways releasing substances that cause swelling of the bronchi. The medications used to treat inflammation are inhaled steroids. No, I’m not referring to the kind of steroids that will make you big and burley; I’m talking about steroids, like cortisone, that are given to reduce inflammation. That’s just like the hydrocortisone that you put on a skin rash to reduce the redness and swelling, except that it’s given for the lungs and inhaled.
When a person is really sick with asthma, they are given oral or even intravenous steroids to quickly reduce asthma. These medicines are really strong, but also have significant side effects, so they should only be given when necessary. Obviously, a person dying from asthma doesn’t worry about side effects.
How to Prevent Asthma Attacks
The ultimate goal is to prevent asthma attacks altogether. The rule of thumb is that people who use a bronchodilator like albuterol more than twice a week or those who wake up with asthma symptoms more than twice a month should be on preventive therapy. That is important because people who have mild but persistent symptoms are just as likely to die from asthma as those with severe symptoms. That is really important, so I am going to restate it: If you need a bronchodilator more than twice a week or wake up more than twice a month with symptoms, your asthma could kill you! Get it treated! Don’t ignore it!
What Triggers Asthma?
Avoiding things that trigger asthma is the first step in prevention. If you have asthma you should avoid the following:
Cigarettes – If you smoke and have asthma, please stop. Smoking asthmatics are like the guy coming to my office who says, “Doc, it really hurts me when I hit my hand with this hammer. What should I do?” Stop hitting yourself with a hammer.
Second-Hand Smoke – Children of people who smoke are at increased risk of developing asthma and at increased risk of going to the hospital with it. Don’t hit your kid with a hammer either.
Allergies – For those who have asthma related to allergies, avoiding the allergen is the best strategy. If you are allergic to cats and have asthma, you probably should get rid of Fluffy. Dust mites and molds are common allergens and can be reduced by taking certain measures. Special air filters, like HEPA filters, can remove pollen from indoors and reduce asthma symptoms (although when you step outside, all bets are off). Allergy shots reduce allergy symptoms, but it isn’t clear if they help asthmatics.
Pollution – Cities with bad pollution problems have higher rates of asthma. If you live in such a place, pay attention to air quality reports.
Additionally, exercise can trigger asthma. But if a person has symptoms when they exercise, I don’t recommend avoiding exercise altogether. It’s really common for asthmatics to do this, but it shouldn’t happen. I don’t consider asthma under control unless a person has no limitations on activity. If asthma limits you, get treatment.
How to Prevent Asthma with Medication
Inhaled steroids are the mainstay of preventive medications. Since they are inhaled and act mainly on the lining of the bronchi, they have much fewer side effects than those taken by mouth or IV. Someone who is prone to asthma attacks can greatly reduce their chance of having one by using inhaled steroids on a daily basis.
There are also prescription allergy pills that reduce inflammation, and there are also are long acting brochodilators, both of which can reduce asthma severity and prevent attacks. Talk to your doctor to see which medication is best for you. Dang, that sounds like a TV commercial.
Quick and Dirty Tips for Asthma
I’d better go on to my Quick and Dirty Tips.
Tip 1: Look for the Signs
If you have a persistent cough, unexplained shortness of breath with exercise, or episodes of wheezing, see your doctor to find out if you have asthma. Remember, intermittent symptoms could make diagnosis tricky.
Tip 2: Take Asthma Seriously
Remember that asthma can be fatal. If you have asthma that gives symptoms more than twice a week or wakes you up more than twice a month, visit your doctor and ask about preventive medication. Pay close attention to symptoms, and look for signs of worsening. There are even home devices that measure how quickly you can exhale; talk to your doctor about this. The earlier you catch an asthma attack, the less likely it will be serious.
Tip 3: Have a Plan
Any asthmatic with more than mild symptoms should have a plan of action for worsening of symptoms. When do you increase your medications? When do you take oral steroids? When do you visit your doctor? When do you go to the hospital? All of these questions should be addressed in an asthma plan.
Tip 4: When in Doubt, Get Evaluated
It’s always better to react too early than too late. The tragedy of asthma-related deaths is that they are nearly always preventable. Don’t be afraid of what the doctor will think, be afraid of asthma.
That’s it. Believe it or not, there is more, but this is Quick and Dirty Tips, not 60 minutes.
If you have questions you want answered, send them to housecalldoctor@quickanddirtytips.comcreate new email. You can find me on Twitter as @housecalldoc and on Facebook under “House Call Doctor.”
Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
Boy with Asthma image courtesy of Shutterstock