UNM COC:  Your Healthcare Primer for Long Term Care

 
Asthma

Sharon Witemeyer MD (Pediatrician)

Definition

Asthma is a lung disease that can be treated. It is a condition in which the airways are narrowed because of sensitivity to certain stimuli that causes inflammation. The airway narrowing is reversible.

Introduction

Over 14 million Americans have asthma. It is the seventh-ranking chronic condition in America. Asthma can be very different from one person to another and from one attack (episode) to another. For some, asthma causes only mild symptoms once in a while. For others, everyday can be a struggle to breathe. Some asthma attacks last only a few minutes while others go on for days. Asthma can be a life-threatening disease if not properly managed.

The most common symptoms of asthma are:

1. Recurrent wheezing (a whistling or hissing sound as you breathe out)

2. Recurrent shortness of breath

3. Recurrent feeling of tightness in the chest

4. A cough that lasts for more than a week.

Not all people with asthma wheeze. For some, coughing – especially at night or after exercise may be the main symptom.

During an asthma attack, shortness of breath may become severe. This may cause a feeling of anxiety. The person wants to sit upright and leans forward and uses the neck and chest muscles to help in breathing. There is a struggle for air. Sweating is a common reaction to the effort and anxiety. In a very severe attack the person will only be able to say a few words before stopping for breath. Confusion, drowsiness (lethargy) and blue skin color (cyanosis) is signs that a person’s oxygen supply is very limited, and emergency treatment is needed.

Diagnosis

A doctor suspects asthma when a patient reports the characteristic symptoms noted above. The diagnosis can be confirmed by special pulmonary function tests such as spirometry. Many of our clients are unable to cooperate well enough for these test to be performed accurately. Peak expiratory flow (the fastest rate at which air can be exhaled) can be measured using a small handheld peak flow meter (see illustration.) (Many of our clients can be taught to use the peak flow meter. This test can be used to monitor the severity of asthma at home.

Prevention and Treatment

The best asthma attack is the one that never happens! Asthma symptoms and attacks usually get started by "triggers." Common "triggers" include animal dander, pollen, tobacco smoke, air pollution, the common cold and similar respiratory infections, or even cold air. Avoiding known "triggers" can prevent many asthma attacks. Often attacks which are "triggered" by exercise can be avoided by taking medication beforehand.

Keeping track of asthma symptoms is the starting place. The best way to do this is to follow the written Asthma Management Plan developed by the physician. You need to follow the plan even when the client does not have any asthma symptoms. This allows you to spot symptoms that are getting worse before they get bad. This allows you to treat the symptoms early, when they are easiest to control.

Drug treatments allow most people with asthma to lead normal lives. Your client’s Asthma Management Plan will detail which medications are indicated for prevention, maintenance, rescue and emergency therapy.

Bronchodilators (including beta-adrenergic receptor agonists and theophylline) act to reverse the narrowing in airways. They can be taken by mouth, injection or they can be inhaled. They are highly effective. (See "How to Use a Metered Dose Inhaler")

Corticosteroids block the body’s inflammatory response and are exceptionally effective at reducing asthma symptoms. However, long-term use of oral steroids may cause many serious side effects including bone loss, stomach bleeding, poor wound healing, cataracts, high blood sugar, hunger, weight gain and mental problems. For long-term use, inhaled corticosteriods are usually prescribed.

Cromolyn and nedocromil are thought to inhibit the release of chemicals within the lung tissues and make the airways less likely to constrict. They are helpful for preventing an attack but not for treating an attack of asthma.

Leukotriene modifiers are the newest drugs available to help control asthma. They prevent the action or synthesis of leukotrienes, which are chemicals made by the body that cause asthma symptoms.

Emergency Situations – What can go wrong?

Asthma attacks may start suddenly and become severe suddenly. Take every asthma attack seriously.

1. Keep track of your client’s lung function at home

2. Use and follow the written Asthma Management Plan

3. Use and follow instructions for what medications to take for an acute asthma attack.

4. Know the signs of a severe asthma attack

1. Breathlessness

2. Cyanosis (lips and nailbeds may have a bluish or grayish color)

3. Use of chest or neck muscles to breathe

In the case of a severe asthma attack:

1. Give the client his asthma medicine and get emergency medical help right away.

2. You can get into trouble if you wait too long to get help. This is how people die from asthma.

3. Go quickly to the doctor’s office or to the emergency room. The sooner you see the doctor, the faster your client gets the help he needs.

Conclusion

Asthma is a lung disease that can be treated. When a disease is as unpredictable as asthma it can be hard to understand. But with proper education millions of people with asthma lead full and active lives.

Sharon Witemeyer MD (Pediatrician)