Primary Disease Name: Asthma
What is Asthma?
Asthma is one of the most common serious chronic diseases in the
United States. If you suffer from asthma, the more you know, the
more control you'll feel you have.
The medical definition of asthma is simple, but the condition itself
is quite complex.
Asthma is a chronic disease of the airways of your lungs. These
airways are also known as bronchial tubes. In the case of asthma,
chronic means that it never goes away.
Asthma is one disease that has two main components occurring deep
within the airways of your lungs:
. Inflammation. The airways of the lungs are always inflamed
if you have asthma, and become more swollen and irritated when an
attack begins. Your healthcare professional may refer to this swelling
and irritation as "inflammation." Inflammation can reduce
the amount of air that you can take in or breathe out of your lungs.
In some cases, the mucus glands in the airways produce excessive,
thick mucus, further obstructing the airways.
. Constriction. The muscles around the airways in the lungs
squeeze together or tighten. This tightening is often called "bronchoconstriction,"
and it can make it hard for you to breathe the air in or out of
your lungs.
Inflammation and constriction together cause narrowing of the airways,
which can result in wheezing, chest tightness, or shortness of breath.
In people with asthma, the airways are inflamed even when you're
not having symptoms.
Asthma has no set pattern. Its symptoms:
. Can be mild, moderate or severe
. Can vary from person to person
. Can flare up from time to time and then not appear for long
periods
. Can vary from one episode to the next
Asthma can be very serious. In the United States alone, it leads
to about 5,000 deaths, 2 million emergency department visits, and
500,000 hospitalizations each year. Furthermore, there is increasing
evidence that, if left untreated or improperly treated, asthma may
cause a long-term decline in lung function and lung scarring over
time. These factors can make it more difficult to breathe and cause
your symptoms to become more persistent and severe.
The cause of asthma is not known, and currently there is no cure.
However, there are many things you can do to control it.
Breathing: Normal Airway Versus Asthma Airway
In someone with normal lung function, air is inhaled through the
nose and mouth. It passes through the trachea (also called the windpipe)
before moving into the bronchi (large airways), which are branching
tubes leading away from the trachea. The bronchi branch into smaller
and smaller tubes, ending in many small sacs called alveoli. It's
in the alveoli that oxygen, which the body needs, is passed to the
blood, while carbon dioxide, which the body doesn't, is removed
from it.
People with asthma often have trouble breathing when they're in
the presence of what are called "triggers." When someone
with asthma has an asthma attack, it means that the flow of air
is obstructed as it passes in and out of the lungs. This happens
because of one or both of the following:
. The lining of the airways becomes inflamed (irritated, reddened
and swollen), and may produce more mucous.
. The muscles that surround the airways become sensitive and
start to twitch and tighten, causing the airways to narrow.
Both of these factors cause the airways to narrow, making it difficult
for air to pass in and out of them.
The airways of someone with asthma are inflamed, to some degree,
the more inflammed the more sensitive the airway becomes. This leads
to an increase in breathing difficulty.
- Asthma Can Affect Anyone
- Asthma is a chronic condition, meaning it can last a lifetime.
- Anyone can get asthma, although it's usually first diagnosed in
young people. - Currently, about three million Canadians have asthma.
Living with Asthma
Most people with asthma live full, active lives. The trick is learning
to keep asthma under control. If you have asthma, you can control
it:
. By avoiding your asthma triggers
. By taking your medication
. Through education from your healthcare team
. By following an asthma action plan
Types Of Asthma
Asthma is often put into categories or groups based on the "triggers"
that cause the asthma symptoms or attacks. Within each of these
categories, asthma can be further classified as intermittent or
persistent. The different types of asthma are:
Allergic Asthma
Allergic asthma is triggered by an allergic reaction to allergens
such as pollen or pet dander. People with this type of asthma typically
have a personal and/or family history of allergies, such as allergic
rhinitis and hay fever, and/or eczema (skin problem resulting in
itching, a red rash, and sometimes small blisters).
Seasonal Asthma
Seasonal asthma, a form of allergic asthma, can be triggered by
trees, grasses, or flowers releasing pollen into the air. For example,
some people find that their asthma is worse in the spring when there
is an increase in flowering plants. Others find their asthma is
worse in the late summer or early fall when ragweed and mold from
leaves on trees are more likely to cause problems.
Nonallergic Asthma
For some people with asthma, asthma attacks have nothing to do with
allergies. Although these people get the same symptoms and have
similar changes in their airways as people with allergic asthma,
their asthma is not triggered by allergens. However, like any person
with asthma, asthma attacks may be triggered or made worse by one
or more nonallergic asthma triggers including substances (irritants)
in the air you breathe, such as tobacco smoke, wood smoke, room
deodorizers, pine odors, fresh paint, household cleaning products,
cooking odors, workplace chemicals, perfumes, and outdoor air pollution.
Respiratory infections, such as the common cold, the flu or a sinus
infection may also cause symptoms. Finally, exercise, cold air,
sudden changes in air temperature, and even gastroesophageal reflux
(heartburn) may be triggers for people with either allergic or non-allergic
asthma.
Exercise-induced Asthma
Exercise-induced asthma (EIA) simply refers to asthma symptoms that
are triggered only by exercise or physical activity. These symptoms
are usually noticed during or shortly after exercise. Exercising
outdoors in the winter seems to be particularly bad for patients
with this type of asthma. However, exercise can also trigger symptoms
in people with other types of asthma.
Nocturnal Asthma
Nocturnal asthma can occur in a patient with any type of asthma.
It refers to asthma symptoms that seem worse in the middle of the
night, typically between 2 AM and 4 AM.
Things that can cause asthma symptoms to get worse at night may
include sinus infections or postnasal drip caused by allergens like
dust mites or pet dander. Your body clock may also play some role:
levels of substances your body makes like adrenaline and steroids,
both of which protect against asthma, are lowest between midnight
and 4 AM, making it easier for people with asthma to get symptoms
during these times.
Discuss your asthma with your healthcare provider to determine
what type of asthma you may have.
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How to Tell if You Have Asthma
Do you have asthma? You might, if you're experiencing any of the
following symptoms:
. Chronic (regular) cough.
. Shortness of breath
. Wheezing
. A feeling of tightness in the chest
If you suspect you might have asthma, your doctor will evaluate
your medical history and your family's and also perform lung-function
tests. Additionally, he or she may prescribe medications that can
conclusively determine whether or not you have asthma.
Being Diagnosed - Knowing for Sure if You've Got Asthma
Symptoms of asthma come and go; you may experience some of them
and yet not know for certain whether you've got asthma or not. For
example, you might experience trouble breathing around cats and
not know whether you have a simple allergy or chronic asthma.
Depending on your circumstances, your doctor will evaluate some
or all of the following:
. Your medical history
. Your family history
. What your symptoms are, how frequently they occur and whether
they improve with medication
. Whether you have allergies
. What your individual triggers are (that is, what things
or situations tend to lead to your experiencing asthma symptoms)
. Your lung function, using tests like peak flow monitoring
and spirometry to determine how quickly you can expel air top of page
Associated Conditions
Asthma & Allergies
Many people with asthma also have allergies, and your doctor may
refer you to an allergist if you are experiencing asthma symptoms.
However, just as not everyone who has allergies develops asthma,
not everyone who has asthma has allergies. Researchers are still
trying to determine the exact relationship between the two.
Rhinitis & Sinusitis
Rhinitis and sinusitis are very similar conditions. Both have the
following symptoms:
. Stuffy nose
. Itchy nose
. Runny nose
. Congestion
In each case, the linings of the sinuses become inflamed. The difference
is that rhinitis is usually caused by an allergy (as in the case
of hay fever), whereas sinusitis is usually caused by a viral, bacterial
or fungal infection.
If you have asthma and also develop rhinitis or sinusitis, your
doctor may recommend nasal sprays or other treatments in addition
to your regular asthma medication. By managing your sinusitis or
rhinitis, your asthma may be better controlled.
Gastroesophageal Reflux
You may have heard of a condition called acid reflux. This is a
short form for gastroesophageal reflux disease, sometimes also referred
to as GERD.
In most people, GERD is simply ordinary heartburn. But acid reflux
can also cause asthma symptoms, particularly coughing, when stomach
acid spills up into the airways of the lungs.
If you don't respond to conventional asthma treatments, or if your
asthma symptoms appear to be associated with heartburn, ask your
doctor to have you checked for acid reflux.
Talk to Your Doctor
As you have learned, asthma affects different people in different
ways, and its symptoms can vary over time. That's why it's so important
to work closely with your doctor or an asthma educator to determine
the medications and managment strategies that are right for you. top of page
Who gets Asthma?
Asthma is not contagious. While its causes are still unknown, researchers
have determined that asthma can be caused by both hereditary (inherited)
and environmental factors.
Just because you have a parent with asthma (or an allergy) doesn't
mean you'll have it too. But you might inherit the tendency to develop
asthma. In other words, if one or both of your parents has asthma
or allergies, it's more likely you will too. Exactly why, researchers
aren't sure.
Whether or not you have a family tendency to develop asthma, you
might have developed asthma by being exposed to one or more of your
personal "triggers." Occasionally, people who hold certain
types of jobs will come in contact with triggers in the workplace
that cause asthma episodes. Doctors call this kind of asthma "occupational
asthma."
While doctors can't always determine why someone gets asthma, they
can recommend the best way to treat it. You can make sure your asthma
is well-controlled:
. By avoiding your asthma triggers
. By taking your medication
. Through education from your healthcare team
. By following an asthma action plan
Common Asthma Triggers
About Inflammatory Triggers
Dust Mites
Dust mites are tiny, spider-like creatures that eat the skin particles
humans shed. These little creatures live wherever there is a lot
of human contact and shedding of skin particles. For example, you
can find dust mites in:
. Bedding
. Carpet
. Stuffed toys
. Sofas
. Curtains
While dust mites are generally harmless, their body parts and droppings
contain a substance that can cause inflammation of the airways in
those who are allergic.
Animals
Unfortunately, pets can make asthma worse if you're allergic
to them. Animals that can act as asthma triggers include:
. Cats
. Dogs
. Gerbils and hamsters
. Rabbits
. Mice, rats and guinea pigs
. Birds
. Horses
Often, people think that fur or feathers are what trigger symptoms
in people with asthma. But in fact, if you have asthma, you could
be sensitive to an animal's:
. Dander (particles of skin)
. Saliva
. Oil secretions
. Urine or feces
If you have an animal in your home and your family doctor or allergist
determines that it is a trigger for your symptoms, it is highly
recommended that you remove the animal from your home. Removal of
a pet from the home is the single most effective environmental avoidance
strategy for optimal asthma control.
If you can't remove an animal from your home, you will be increasing
your risk for more severe asthma.
If you are unable to remove the pet from the home, try these things
to minimize exposure:
. If the animal is a cat or a dog, have someone else wash
it twice a week.
. Remove carpeting in the home (especially in the bedroom).
. Clean the house (and especially your bedroom) frequently
using a vacuum equipped with a high-efficiency particular air (HEPA)
filter or a central vacuum system with an outdoor exhaust.
. Encase your mattress and pillows in special allergen-proof
covers.
. Don't allow the animal in your bedroom. Keep it off upholstered
furniture, and away from carpets and other soft surfaces where allergens
can accumulate.
. Use a HEPA air cleaner in the bedroom. top of page
Cockroaches
Cockroaches are one of most hated household pests, and for good
reason. Not only are they a terrible nuisance, their feces have
been shown to trigger symptoms in individuals with asthma.
If your home has cockroaches, make sure that food and water are
never left where they can get at them. To ensure they leave and
never come back, call a professional exterminator.
Moulds
Moulds are asthma triggers for many people. A type of fungus, their
spores float in the air where they're easily inhaled and can lead
to coughing, sneezing, wheezing and chest tightness.
You'll find moulds wherever it's damp. This includes piles of vegetation,
stagnant water, garbage containers, damp basements and more.
If you're sensitive to mould spores, try the following:
. Have piles of grass removed from your lawn immediately after
it's mowed.
. If leaves accumulate on your lawn, have them raked frequently
and removed immediately afterwards.
. Have outdoor garbage cans or composters cleaned regularly.
. Have outdoor containers that hold stagnant water removed.
. Ensure that eavestroughs on your house face away from the
house.
. Have your basement dried out.
Pollens
Pollens are a very common trigger for asthma symptoms. Generated
by trees, grasses and weeds, airborne pollens are easily inhaled,
especially during warm-weather months.
If you're allergic to pollen, there are a number of things you can
do to stay healthy:
. Use a HEPA-filtered air cleaner.
. On days when the pollen count is high, use an air conditioner
in your home and car, and also try to keep your windows closed as
much as possible.
. If you usually exercise outdoors, consider exercising inside
on days when the pollen count is high.
. Check the pollen count to see whether you should reduce
the amount of time you spend outdoors.
. Shower and change your clothing if you've been outdoors
on a high-pollen-count day.
. If there are plants in your yard that trigger symptoms,
have someone remove them.
. Use a good furnace filter.
. Don't place trees or plants near windows, or near the air-intake
of your furnace or air conditioner.
. Don't hang your laundry out to dry - use a clothes
dryer instead.
. Don't touch plants that you think might be triggers -
and if you do, wash your hands immediately afterwards. top of page
Cold Air
Cold air, or sudden changes in the weather, can also trigger asthma
symptoms. If you're affected by the cold, the following tips can
help:
. Try breathing through your nose. This helps warm the air
before it reaches your lungs.
. If you have to breathe through your mouth, wear a scarf
or a special cold-weather mask to help humidify and warm the air
you breathe, making it easier on your lungs.
. If you usually exercise outdoors, try exercising inside
on cold days.
Air Pollutants
While air pollution as a cause of asthma has not been verified,
there is good evidence that pollution causes the symptoms of many
people with asthma to get worse on days when the air-quality index
is high.
If you find your symptoms become worse on these days, try to:
. Reduce the amount of time you spend outside when air-pollution
is high.
. Exercise indoors if you usually exercise outdoors.
. Turn on the air conditioner in your home and car and keep
your windows closed.
Viral Infections
Viruses can both cause asthma episodes and make people with asthma
more sensitive to other asthma triggers.
Viral triggers include:
. The rhinovirus (common cold)
. Respiratory syncytial virus (RSV)
. Certain flu viruses
Your healthcare team can tell you about ways to avoid viral infections,
and what to do when you you get sick.
People with asthma are encouraged to get the flu shot in the Fall. top of page
What to expect if you have Asthma
Learning to Live with Asthma
If you've just been diagnosed with asthma, you may feel a little
discouraged. But you should know that with proper management and
medication, most people with asthma live perfectly normal, active
lives.
The first step towards taking control of your health - and your
life - is talking to your doctor. He or she will work with you to
determine the best strategies and the proper medications for controlling
your asthma so that its symptoms are minimized.
Your doctor will give you lots of useful advice, and possibly refer
you to a specialist or an asthma educator.
In addition, your doctor may:
. Suggest you use a peak flow meter to monitor your lung function.
This allows you to note any changes that might mean your asthma
is not being controlled properly.
. Prescribe medication that will help you keep asthma symptoms
to a minimum. Your doctor will prescribe the smallest amount of
medication to control your symptoms.
. Suggest you keep a diary of the results of your peak flow
monitor tests and your symptoms so that you and your doctor can
use it to create a personalized action plan.
Peak Flow Monitoring at Home
To monitor how well your asthma is controlled, your doctor may suggest
you use a peak flow meter.
This simple device measures what's called your "peak expiratory
flow," or PEF. Using it, you can:
. Determine whether your peak flows vary over time, or are
affected by the presence of certain triggers
. Monitor how well your medication is working
. Recognize whether you require immediate medical attention
. Develop an asthma action plan, a tool that helps you keep
your asthma under control
Using a Peak Flow Meter
Using a peak flow meter is simple. Read the instructions that come
with your particular model, and follow these steps:
1. Attach the mouthpiece to the peak flow monitor.
2. Set the marker (indicator) to the level of zero on the scale.
3. Stand up or, if you can't stand, sit up straight.
4. Breathe in as deeply as you can.
5. Close your lips around the mouthpiece.
6. Blow out as hard and as fast as you can. (i.e., A "fast
blast" of air)
7. Note the number next to the marker.
8. Repeat steps 2 through 7 two more times.
9. In a notebook or diary, record the highest of the three numbers.
This number is your PEF for that morning or evening.
Making Sense of Your Results
Your doctor or asthma educator will help you determine which of
your PEF measurements should be used as a "baseline" -
that is, your personal best peak flow. Use your peak flow result
with your written action plan to determine the action needed to
be taken to manage your asthma.
Once you know your personal best peak flow, you will be able to
know if your asthma is well-controlled. If the result of a PEF test
is 80 per cent or more of your personal best number, your asthma
is likely well controlled.
If it is less than 80 per cent of your personal best you are not
well controlled. Discuss your results with your doctor.
Remember that a peak flow meter can be a useful tool, but monitoring
your symptoms is the most important way to assess overall how well
your asthma is being managed.
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What to do if your Asthma Worsens?
When you have asthma, you know that your symptoms can vary from
time to time and situation to situation. It can be difficult to
know when changes in your symptoms are normal, and when they might
mean trouble.
That's why you should work with your doctor to create an asthma
action plan. Together, you can modify it as needed so that you always
know when a change in your symptoms means something serious.
The Three Asthma Zones
The Green Zone
When you're in the green zone, your symptoms are minimal. You're
still able to participate in normal activities, including attending
school or work regularly, exercising and sleeping.You are using
your reliever medication less than four times a week.
Being in the green zone means your asthma is well-controlled. Continue
to take your controller medications as directed by your doctor or
discuss decreasing the dose if you are in the green zone regularly.
The Yellow Zone
Most asthma episodes aren't sudden, and can be treated with an increase
or change in controller medication your doctor prescribes.
If you find that any of the following occur, you are in the yellow
zone:
. You have difficulty performing your regular activities or
exercise.
. Your asthma symptoms begin to disturb your sleep.
. You get a cold or other chest infection.
. You need to take your reliever medication more often than
normal.(> 3/week)
. You have to miss work or school due to asthma symptoms.
If you suspect you're in the yellow zone, ask your doctor about
modifying your controller medications.
The Red Zone
If you're experiencing severe asthma symptoms, you may be in the
red zone.
If so, you need to get medical attention immediately. Make sure
you recognize red zone signs:
. Excessive coughing
. Excessive wheezing
. Extreme tightness in the chest
. Extremely laboured breathing
. Sweating
. Gasping voice
. Pale or blue lips or fingernails
. Anxiety or fear
. Decreased activity level
. Symptoms that don't respond to your regular reliever medication
Important Phone Numbers
If any of the above symptoms are present, call your local emergency
service immediately. Have the following written down and kept close
at hand in case of an emergency:
. Your doctor's name
. Your doctor's phone number
. The phone number of your local emergency service
. The phone number of your local ambulance service
At the Emergency Department
If you have to go to the emergency department of a hospital, doctors
and healthcare professionals will treat you by:
. Giving you oral and/or inhaled corticosteroids
. Giving you bronchodilator and oxygen therapy
. Evaluating you with spirometry, peak flow monitoring and
oximetry assessments
Remember, it's better to be safe than sorry. To delay getting medical
help when you're in the red zone can mean unnecessary suffering,
even death. Always follow your action plan and your doctor's advice
about how best to manage your asthma.
When it comes to understanding all of the new asthma treatments
available, it's natural to feel a little confused.
The important thing to remember is that asthma is a "variable"
disease. In other words, the symptoms vary from person to person,
and even the same person's condition may fluctuate throughout the
year.
If you have asthma, your doctor will:
. Explain how you can keep your asthma under control by avoiding
your personal triggers
. Prescribe medication that will help minimize your symptoms
. Work with you so you have a written action plan
. Recommend that you visit on a regular basis so that your
symptoms can be monitored and your treatments adjusted if necessary
In order to minimize possible side effects, your doctor will prescribe
the lowest dose of medication needed to control your symptoms. It
may take some experimenting to find out what that dose is. You and
your doctor might have to try a few different doses or a few different
medications before you find what works best for you. Over time,
your medication needs may change.
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Asthma Treatment
The exact cause of rheumatoid arthritis is unknown. Many doctors
believe that a virus or a bacterium may prompt rheumatoid arthritis
to develop in those people who have a genetic predisposition to
it. Seven out of ten people who have rheumatoid arthritis have an
inherited chemical marker on their cells leading doctors to believe
that there is a correlation.
Some experts think rheumatoid arthritis is an autoimmune disease,
meaning that the body tissue is the victim of an immune response
against itself. The body creates antibodies that actually attack
the joints causing the swelling and redness. Excess fluid will flow
into the joint space making joint motion painful.
Severe stress may also play a role. In some cases, rheumatoid arthritis
will first appear after a person has experienced a life-changing
event like a divorce, loss of a job, death of a loved one or a severe
injury. top of page
Symptoms of Rheumatoid Asthma
In many cases, rheumatoid arthritis develops gradually and can
come and go over the years. About half of all people with this disease
will have a remission within two years. However, the symptoms can
return, as there is no permanent cure for rheumatoid arthritis.
If you developed rheumatoid arthritis after 60 years of age, you
have a greater chance of having a milder case than someone who developed
the disease when younger.
The joint lining, called the synovium, becomes inflamed in cases
of rheumatoid arthritis, leading to pain, stiffness, warmth, redness
and swelling. These inflamed cells release an enzyme that may even
digest cartilage and bone. It is important to start a course of
treatment so that you can continue to live your life the way you
want.
Other symptoms of rheumatoid arthritis include:
. Fatigue and/or weakness
. Stiffness following periods of immobility which gradually
improves with movement
. Rheumatoid nodules (lumps of inflamed cells) under the skin
usually found on the bony part of the forearm, ankle and fingers
. Minor fevers, anemia, weight loss
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Treatment of Rheumatoid Asthma
If your doctor suspects that you have rheumatoid arthritis, he
or she will order a series of diagnostic tests after performing
a physical examination. One test he or she may order looks for an
antibody called rheumatoid factor. Approximately 85 percent of people
with rheumatoid arthritis have this antibody.
Once a diagnosis is made, you can start a series of treatments designed
to help you continue to live your life. Advances in treatment have
been made so that few people with rheumatoid arthritis end up bed
ridden.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and
ibuprofen are used to reduce pain and swelling in the short term.
Disease modifying drugs (DMARDs) may also be used if you don't
respond to NSAID treatment. These slow acting drugs are designed
to help slow the progression of rheumatoid arthritis. Over the long
term, biologic response modifiers may be used. These drugs are either
injected or given intravenously. Corticosteroid medications, like
Prednisone, may also be used to help you during flareups.
Exercise is one of the best things you can do for your arthritis.
It will increase your strength and give you endurance. Stretching
will help your joints retain or gain flexibility. Exercise not only
helps your body but also will improve your state of mind. Remember
that there are many ways to exercise. Speak to your doctor before
starting an exercise program.
In some cases, surgery may be necessary. Surgery, such as joint
replacement, is considered when you and your doctor have concluded
that previous treatments for pain and mobility have been unsuccessful
and your quality of life is suffering. In addition to joint replacement
surgery, other types of surgery include the reconstruction or fusion
of a joint and the removal of diseased tissue from the joint (synovectomy). top of page
Treating Asthma
Two Kinds of Medication
Most people with asthma take two kinds of medication. That's because
each asthma medication treats only one aspect of the condition:
. Controllers, also called "preventers," reduce
inflammation in the airways. Controllers should be taken every day,
whether or not you're experiencing symptoms.
. Relievers are very good at helping to alleviate symptoms
immediately. If you are coughing, use a reliever medication to reduce
symptoms. However, reliever medications do nothing for the underlying
problem of inflammation. Relievers are only a short-term solution
to breathing problems and indicate that there is underlying inflammation
present that requires a different controller medication.
Relievers
Relievers are used to quickly alleviate asthma symptoms. They do
this by relaxing the bands of muscle that surround the airways.
However, they do not reduce inflammation in the airways - to treat
inflammation, you will need to take a controller medication.
Relievers have a number of different names. You may hear them called:
. Short-acting bronchodilators (bron-ko-di-la-tors)
. Beta2-agonists
. Rescuers or rescue medication
Examples of reliever medications include:
. Fenoterol (sold as Berotec®)
. Formoterol (sold as Foradil® or Oxeze®)
. Ipratropium (sold as Atrovent®)
. Isoproterenol (sold as Isuprel®)
. Orciprenaline (sold as Alupent®)
. Salbutamol (sold as Ventolin®, or Ratio-Salbutamol)
. Terbutaline (sold as Bricanyl®)
Relievers are safe but, as with any medication, you should never
take more than you need. Possible side effects of relievers include:
. Increased heart rate
. Restlessness
. Tremor (i.e., shaky hands)
Only take your reliever medication when you're experiencing asthma
symptoms or if prescribed, before you exercise. Since you can never
be sure when symptoms will happen, keep your reliever medication
with you at all times. That way you won't be caught off-guard.
If you find you're using your reliever medication more than three
times a week (not counting before exercising), it means your asthma
is not well-controlled. Talk to your doctor to see about a controller
medication adjustment.
Controllers
While relievers help you treat the symptoms of asthma, controller
medications help to treat the underlying inflammation of the airways
in a person with asthma. By controlling the inflammation, asthma
symptoms can be decreased and flare-ups prevented from occurring.
When you start taking controller medications, you may not notice
a difference right away. It may take a few weeks before the inflammation
in your airways is reduced. Even if you don't feel better right
away, don't stop taking your controller medication unless your doctor
tells you to.
Remember, controllers don't immediately relieve wheezing, coughing
or chest tightness, and should not be used to treat a severe asthma
attack. Make sure you understand the difference between your reliever
medication, which provides quick relief during an asthma episode,
and your controller medication, which controls your underlying inflammation
so that you're less likely to experience these symptoms in the first
place. top of page
Advair Asthma Medication
More Advair Information and Advair Side Effects
Advair Diskus (Fluticasone/Salmeterol) Information :
Advair is a corticosteroid and bronchodilator combination used to
treat and prevent or decrease the symptoms of asthma (e.g., wheezing,
trouble breathing), and also chronic lung disease (e.g., emphysema,
bronchitis, - COPD). Advair works by opening the airways in the
lungs (decreases bronchiolar swelling and causes muscle relaxation).
Advair may also be used to treat other breathing conditions as determined
by your doctor. Advair WILL NOT STOP an asthma attack once one has
started; use other quick-relief medicines/inhalers for sudden shortness
of breath or asthma attacks.
Advair Diskus (Fluticasone/Salmeterol) Side Effects :
Advair Diskus Side Effects:Advair Diskus SIDE EFFECTS that may occur
while taking this medicine include headache, tremor, irregular heartbeat,
muscle cramping, dry mouth, hoarseness, or irritated throat. If
they continue or are bothersome, check with your doctor. CHECK WITH
YOUR DOCTOR AS SOON AS POSSIBLE if you experience white curd-like
patches in mouth, rash, or sudden increase in wheezing after using
this medicine. CONTACT YOUR DOCTOR IMMEDIATELY if you experience
the following side effects or symptoms of toxicity: swelling of
hands, face, lips, eyes, throat, or tongue; difficulty swallowing
or breathing; or numbness or tingling of arms and legs. top of page
Spiriva Asthma Medication
Spiriva Caps and Device (Tiotropium) Information :
SPIRIVA (Tiotropium) Inhalation Powder contains tiotropium bromide
monohydrate. Tiotropium bromide monohydrate is used as a long-acting
bronchodilator for the maintenance treatment of chronic obstructive
pulmonary disease (COPD). SPIRIVA (Tiotropium) , a once-daily treatment,
has proven more effective in clinical trials than Boehringer's Atrovent,
an inhaled drug given three times a day that has been the standard
of care for COPD for over a decade. Both medicines help open the
airways by blocking action of the brain messenger chemical acetylcholine.
Capsules comes with Handinhaler. Each capsule contains 22.5 microgram
tiotropium bromide monohydrate equivalent to 18 microgram tiotropium.
The delivered dose (the dose that leaves the mouthpiece of the HandiHaler
device) is 10 microgram. Spiriva consists of a dry powder for inhalation.
The active ingreidiant in Spiriva is tiotropium bromide 18mcg intended
for oral inhalation using the Handihaler Device. The dry powder
or capsule is not intended for oral consumption. The dry powder
is delivered from the Handihaler device at a rate of 20L/min. The
capsules are light green hard capsules, containing a white or yellowish
white powder, with product code and company logo printed on the
capsule. The typical shelf life of Spiriva is 18 months. However,
the typical shelf life of an opened capsule is 9 days. Clean the
HandiHaler once a month. Open the dust cap and mouthpiece. Then
open the base by lifting the piercing button. Rinse the complete
inhaler with warm water to remove any powder. Dry the HandiHaler
thoroughly by tipping excess of water out on a paper towel and air-dry
afterwards, leaving the dust cap, mouthpiece and base open. It takes
24 hours to air dry, so clean it right after you used it and it
will be ready for your next dose. If needed, the outside of the
mouthpiece may be cleaned with a moist but not wet tissue. top of page
Spiriva Caps and Device (Tiotropium) Side Effects :
One side effect that often occurs after using SPIRIVA (Tiotropium) is a dry mouth (more than 1/10). This is generally a mild side effect of SPIRIVA (Tiotropium), which wears off when the treatment is continued. Another common side effect is constipation (1/100 - 1/10). A dry mouth and constipation are more common in elderly patients. Sometimes (1/1000 - 1/100) it was observed, that patients were hyper-sensitive, in particular a sudden water retention in the skin and mucous membrane (i.e. throat or tongue). At times there were also reports of allergic reactions (angio-oedeem), such as: breathing problems and/or itching and rashes. If you have any of these side effects, tell your doctor. Local irritation in the higher respiratory tract can also occur. In some cases (1/1000 - 1/100) serious side effects were observed, such as: Retention of urine in the bladder, especially in older men with a higher risk of this side effect (i.e. enlarged prostate gland); this is a serious side effect; for which you need medical treatment. In isolated cases a fluctuating heartbeat was reported, usually in patients who were sensitive to this. Other possible side effects which could occur, based on the characteristics of SPIRIVA (Tiotropium) are: dry throat, infection of the pharynx and sinuses, infection of the mucous membrane (moniliasis), rapid heartbeat, blurred vision, increased eyeball pressure (glaucoom) and difficulties in urinating. If you notice any side effects not mentioned in this leaflet, please inform your doctor or pharmacist.
SPIRIVA (Tiotropium) is a promising new medication for those with severe asthma and COPD. SPIRIVA (Tiotropium) is similar in action to Atrovent® (ipratropium bromide) and classified as an anticholinergic medication with extended action up to 36 hours. Like Atrovent®, SPIRIVA (Tiotropium) works from an opposite direction to provide bronchodilation than do Rescue Medications such as albuterol. SPIRIVA (Tiotropium) acts on the parasympathetic nervous system as opposed to the sympathetic. Anticholinergics inhibit muscarinic or "M" receptors. Tiotropium specifically targets M3 and to a lesser extent M1 receptors. These two receptors are important in bronchoconstriction and mucus production especially the M3 receptor. Tiotropium bromide is a long-acting, specific, muscarinic receptor antagonist, in clinical medicine often called an anticholinergic. By binding to the muscarinic receptors in the bronchial smooth musculature, tiotropium bromide inhibits the cholinergic (bronchoconstrictive) effects of acetylcholine, released from parasympathetic nerve endings. It has similar affinity to the subtypes of muscarinic receptors, M1 to M5. In the airways, tiotropium bromide competitively and reversibly antagonises the M3 receptors, resulting in relaxation. The effect was dose dependent and lasted longer than 24h. The long duration is probably due to the very slow dissociation from the M3 receptor, exhibiting a significantly longer dissociation half-life than ipratropium. As an N-quaternary anticholinergic, tiotropium bromide is topically (broncho-) selective when administered by inhalation, demonstrating an acceptable therapeutic range before systemic anticholinergic effects may occur. The bronchodilation is primarily a local effect (on the airways), not a systemic one. Dissociation from M2-receptors is faster than from M3, which in functional in vitro studies, elicited (kinetically controlled) receptor subtype selectivity of M3 over M2. The high potency and slow receptor dissociation found its clinical correlate in significant and long-acting bronchodilation in patients with COPD. Many COPD patients, as well as severe asthmatics, have a reduced effectiveness with beta2 agonists such as albuterol. Being able to stimulate some bronchodilatation through blocking the actions of the M1 and M3 receptors allows for better symptom control. Medications such as Combivent® already take advantage for this by combining albuterol and ipratropium. A drawback to ipratropium is its shorter length of action, though longer than albuterol. Ipratropium also inhibits the M2 receptor which may increase acetylcholine release and stimulate bronchoconstriction. A possible benefit from using SPIRIVA (Tiotropium) is an apparent reduction in side effects over ipratropium. This is probably due to it's reduced action on the M2 receptor. Some of the common side effects of ipratropium are nervousness, dizziness, headache, nausea, upset stomach, dry mouth, throat irritation, and cough. Another important advantage of SPIRIVA (Tiotropium) over ipratropium is length of action. One study saw a three day length of action. General consensus for length of action is around 36 hours, making SPIRIVA (Tiotropium) an excellent candidate for a daily long acting medication. Daily medications are seen as an effective way of increasing compliance among patie
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