Date: Fri 29-Jan-1999

Publication: Hea

Author: JAN

Quick Words:

asthma-Lee-treatment

Full Text:

Aggressive Treatment Can Help Asthma Sufferers Breathe Easier

(with photo)

BY JAN HOWARD

Asthma is a chronic, inflammatory lung disease that causes breathing problems

called attacks or episodes.

Its cause is unknown, though there are a lot of theories, according to Dr

Richard Lee, of Allergy & Asthma Associates of Danbury. Among them are air

quality, infection, more sterile environments so the immune system is not

being challenged, and indoor air pollution.

There has been an increase in allergies and asthma since the 1960s, despite

significant improvements in treatment, Dr Lee said.

Asthma is not contagious. It can be controlled or managed, but not cured, Dr

Lee said. It can be successfully treated. "If it is not well controlled as a

child, it can lead to mild emphysema down the road," he said. "You can prevent

long-term results if it is treated aggressively early."

Dr Lee said contrary to what was believed years ago, when doctors slowly built

up medications, asthma should be aggressively treated at first to bring it

under control as soon as possible. Then the decision should be made as to what

the best treatment is for the long term.

He said he believes people are more aware of asthma and its symptoms than in

the past, but it is not being treated as aggressively as it could be.

Without proper treatment, asthma can be extremely dangerous, even fatal.

"Data has shown a slight increase in deaths from asthma," Dr Lee said. "With

more potent medicines, you'd think it would decrease."

The number of deaths attributed to asthma has increased by 111.2 percent since

1979, from 2,598 in 1979 to 5,487 in 1994, according to the American Lung

Association.

In severe, untreated asthma, airways become so scarred that no matter what

drugs are used, there is no reversibility.

Asthma is the sixth-ranking chronic condition in America. More than 14.6

million people have asthma. Nearly one third -- 4.8 million -- are children

under 18 years of age. Almost 1.6 million are 65 or older.

Asthma is the leading serious chronic illness among children, most of whom

have mild to moderate problems. In Connecticut, asthma affects about 56,000

children under the age of 18.

Anybody can get asthma at any age. But it does tend to be hereditary, Dr Lee

said.

According to the American Lung Association, a new study suggests that many

children and grandchildren of asthmatics have undiagnosed asthma themselves.

The study supports the presence of the hereditary component in asthma.

Another recent study found that among children under 5, those whose mother had

asthma had five times the likelihood of developing it themselves. Those whose

father had asthma had less than two times the risk of developing it. After age

5, this trend evened out. Children older than 5 with either a mother or father

with asthma had a similar risk of developing asthma.

Asthma is a result of an inflammation of the airways. Cells in the air tubes

make more mucus than normal. This mucus is very thick and sticky and tends to

clog up the tubes. The air tubes tend to swell and the muscles tighten. These

changes cause the air tubes to narrow, making it hard to breathe.

Symptoms

Any one of the following symptoms may indicate you have asthma. You can have

one or more of these symptoms or even different ones before experiencing an

asthma episode. These include coughing when you don't have a cold, light

wheezing, shortness of breath, restlessness while trying to sleep, and a

feeling of tightness in your chest.

These symptoms are clues that let you know you are having an asthma attack.

During the diagnosis, a doctor will take your personal and family medical

history, do a physical exam and some lab tests, which may include a chest

X-ray, blood and allergy tests, and lung-function tests. The doctor may also

refer you to an allergy specialist for testing to detect allergens.

Asthma Triggers

There is allergic and non-allergic asthma. If you have allergic asthma, your

lungs will go into an asthma episode or attack when you come in contact with

things you are allergic to.

Non-allergic asthma can be triggered by numerous other things, such as house

dust, fumes, exercise, changes in seasons or weather, and tobacco smoke.

Some common asthma triggers are reactions to pollens, feathers, molds,

animals, some foods and house dust; vigorous exercise; nighttime asthma;

infections, such as a cold or flu; cold air; household products such as

paints, cleaners and sprays; emotional stress and excitement; occupational

dusts and vapors such as those from plastics, grains, metals and wood; drugs

such as aspirin or heart medicines; and air pollution, such as from cigarette

smoke, ozone, sulfur dioxide and auto exhaust.

Once you know your triggers, you can do something to prevent asthma attacks by

taking medicine before exposure.

There are other asthma triggers you can get rid of or avoid, such as cold air,

dust, feathers or molds.

Cigarette smoking is another trigger that must be avoided. If you smoke, you

need to quit. If you breathe the smoke from someone else's cigarette, you may

get an asthma attack. Children are especially at risk from second-hand smoke.

Asthma Attacks

Asthma attacks may start suddenly or they may take a long time, even days, to

develop. They can be severe, moderate or mild.

In a severe attack, you may become breathless and have trouble talking. Neck

muscles may become tight as you breathe. Your lips and fingernails might have

a grayish or bluish color. The skin around the ribs of your chest might be

sucked in.

In case of a severe attack, take your asthma medicine as prescribed and get

emergency medical help right away. Go quickly to your doctor's office or an

emergency room. The sooner you see a doctor, the faster you get the help you

need.

Moderate and mild attacks are more common. You may start to feel tight in your

chest. You might start coughing or spit up mucus. You may feel restless or

have trouble sleeping and make a wheezing or whistling sound when you breathe.

Take your medicine as prescribed. Usually the air tubes in your lungs open up

in minutes. Or it can take several hours.

Dr Lee said any asthma sufferer can have a potentially dangerous attack. He

said those with mild asthma need to use their inhalers and aggressively treat

any symptoms when they feel a cold coming on.

Treatment

It is important to take asthma seriously and to take the medicines as

prescribed.

Treatments have been significantly improved, Dr Lee said. Asthma is more

manageable with better delivery of medications.

Asthma therapy includes efforts to reduce inflammation in the airways and to

relieve or prevent airway narrowing. Asthma accounts for an estimated three

million lost work days annually for people over 18 years old. In those under

18 years old, asthma accounts for ten million lost school days annually and is

the leading cause of school absenteeism attributed to chronic conditions.

Bronchodilators help stop asthma attacks after they have started and can help

prevent expected attacks, as from exercise. These medicines act to open the

airways by relaxing bronchial muscle, making it easier to breathe. They

include beta-adrenergic agonists, methylxanthines and anticholinergics.

Anti-inflammatories help control the airway inflammation and prevent asthma

attacks from starting. These work to keep the air tubes open all the time, to

lessen the chance of an asthma attack in the first place. These agents include

corticosteroids and cromolyn sodium.

Most medicines can be given in liquid, nebulizer, metered dose inhaler or pill

form. Metered dose inhalers usually have the least amount of side effects.

The latest inhalers, turbuhalers or disk shaped, release medication in a

powder form that is more effective, Dr Lee said.

Non-steroidal drugs can be used, according to Dr Lee, but they are new and

there are no long-term results as yet. "They're not as potent," he said. "They

are helpful for patients with less serious asthma."

Dr Lee said there are new treatments being worked on or in clinical trials. In

development of new drugs, the risk/benefit ratio must be taken into

consideration. If the drug is more potent but has less absorption, there will

be fewer side effects.

There are other ongoing clinical studies, such as into deep breathing and

other exercise programs that might help asthma patients, he said. Relaxation

techniques can help emotional factors.

While asthma may be a dangerous illness, with regular medical care people with

asthma can live normal, productive lives.