Wheeze, wheeze, cough, cough… Another asthma attack! by Roselys

Asthma…does the word make you think of people who cough and wheeze all the time? Don’t people with asthma have to avoid sports and strenuous activities? And, when it comes right down to it, isn’t it “all in their heads?” Well, before I had my first asthma attack I was one of those people who had stereotypes about asthma.

My first attack happened in my second year of University. At the beginning, I didn’t know what was going on. I knew I was allergic to some things but never to the extent that I would have difficulty breathing. Until the day I was studying after class and started coughing, I didn’t make anything of it. After a while, I couldn’t breathe and I felt as if someone was sitting on my chest, squeezing my lungs, and preventing me from breathing. When my roommate asked me what was wrong, I couldn’t answer her. Thank God we lived a block away from the hospital. She decided to take me to the Emergency room. By the time I got there, I felt so much pressure on my chest, my heart was speeding and I couldn’t stop coughing and wheezing. They took one look at me and ushered me to an examination room for oxygen therapy and was given some rescue medicine to get my breathing normal again.

When I went to my Primary Care Provider, he told me that I couldn’t have asthma and I was too old to have developed it. He told me that it was most likely a respiratory infection and gave me antibiotics to treat it. A few days later, I went back to the ER with the same coughing that would never stop until I feel like someone is squeezing my lungs. My PCP couldn’t ignore the symptoms any longer and diagnosed asthma. I had to accept his diagnosis but questions were going through my mind: What is Asthma? What causes it? How can you prevent it? Is it curable?

While doing research on the subject, I learned that when asthma symptoms appear and are diagnosed in adults older than 20, it is typically known as adult-onset asthma. Adult-onset asthma is more common in women than in men and is possibly related to allergies or allergic asthma. About half of adults who have asthma also have allergies.

Researchers have described Asthma as a disease of the lungs in which the airways become blocked or narrowed causing breathing difficulty. Asthma is commonly divided into two types: allergic (extrinsic) asthma and non-allergic (intrinsic) asthma.

Allergic (extrinsic) asthma (asthma symptoms triggered by an allergic reaction) is the most common form of asthma. Many of the symptoms of allergic and non-allergic asthma are the same (coughing, wheezing, shortness of breath or rapid breathing, and chest tightness). However, allergic asthma is triggered by inhaling allergens such as dust mites, pet dander, pollens, mold, etc. Through a complex reaction, these allergens cause the passages in the airways of the lungs to become inflamed and swollen. This results in coughing, wheezing and other asthma symptoms.

Non-Allergic (intrinsic) asthma (asthma symptoms triggered by factors not related to allergies) is triggered by factors such as anxiety, stress, exercise, cold air, dry air, hyperventilation, smoke viruses or other irritants. In non-allergic asthma, the immune system is not involved in the reaction, as with allergic reaction.

An estimated 20 million people in the United States have asthma and, despite the availability of treatments, it remains poorly controlled among many. This health problem is the reason for nearly 500,000 hospital stays each year. People with asthma can be of any race, age or sex. Its treatment costs billions of dollars each year. It has been documented that asthma has a genetic origin and is a disease you are born with, and passed down from generation to generation. Like baldness, height and eye color, the capacity to have asthma is an inherited characteristic. Yet, although you may be born with the genetic capability to have asthma, asthma symptoms do not automatically appear. It isn’t known for certain why some people get asthma and others do not. However, doctors doing research have found that certain traits make it more likely that a person will develop asthma.

Heredit: to some extent, asthma seems to run in families. People whose brothers, sisters or parents have asthma are more likely to develop the illness themselves.
Atopy: a person is said to have atopy (or to be atopic) when he or she is prone to have allergies. For reasons that are not fully known, some people seem to inherit a tendency to develop allergies. This is not to say that a parent can pass on a specific type of allergy to a child. In other words, it doesn’t mean that if your mother is allergic to bananas, you will be too. But you may develop allergies to something else, like pollen or mold.
In addition, several factors must be present for asthma symptoms to develop:

Specific genes must be acquired from parents.
Exposure to allergens or triggers to which you have a genetically programmed response.
Environmental factors such as quality of air, exposure to irritants, behavioral factors such as smoking, etc.
People with asthma have inflamed airways which are super-sensitive to things which do not bother other people. These things are called “triggers.” Although asthma triggers vary from person to person based on if you have allergic asthma or non-allergic asthma, some of the most common include:

Substances that cause allergies (allergens) such as dust mites, pollens, molds, pet dander, and even cockroach droppings.
Irritants in the air, including smoke from cigarettes, wood fires, or charcoal grills.
Respiratory infections such as colds, flu, sore throats, and sinus infections. These are the number one asthma trigger in children.
Exercise and other activities that make you breathe harder. Exercise—especially in cold air—is a frequent asthma trigger. A form of asthma called exercise-induced asthma is triggered by physical activity.
Weather such as dry wind, cold air, or sudden changes in weather can sometimes bring on an asthma episode.
Expressing strong emotions like anger, fear or excitement. When a person with asthma laughs, yells, or cries hard, natural airway changes may cause wheezing or other asthma symptoms.
Some medications like aspirin can also be related to episodes in adults who are sensitive to aspirin.
People with asthma react in various ways to these triggers. Each case of asthma is unique. If you have asthma, it is important to keep track of the factors or triggers that you know provoke asthma episodes.

Since my diagnosis, I have used a different type of treatments from anti-inflammatory, bronchodilator asthma inhalers to oral medications. Early and aggressive asthma treatment is key to relieving symptoms and preventing asthma attacks. Asthma medication can work quickly to stop coughing and wheezing.

While in Haiti, I had asthma episodes almost every day and I had to start a new treatment with prednisone.

Prednisone is an oral steroid medication. Oral steroids may also be prescribed when your asthma symptoms worsen but you do not require hospitalization. They are not the same as anabolic steroids, which some athletes take illegally to build muscles.

Oral prednisone is a systemic steroid. That means that after taking prednisone by mouth (orally), it goes directly into the bloodstream which means it traveled to the whole body, unlike inhaled steroids (anti-inflammatory asthma inhalers) that go straight to the lungs. Prednisone and other systemic steroids may be used to treat asthma attacks and help people gain better asthma control. Steroids are used with other asthma medications to either control sudden and severe asthma attacks or to treat long-term, hard-to-control asthma. Steroids have many potential side effects, especially when given orally and for a long period of time.

Side effects with short-term use include: weight gain, fluid retention, high blood pressure and elevated blood sugar
Side effects with long-term use include: growth suppression, diabetes, cataracts of the eyes, bone-thinning osteoporosis and muscle weakness
Because each case of asthma is different, treatment needs to be tailored for each person. One general rule that does apply, though, is you should remove all the things in your environment that you know are factors that make your asthma worse.

Asthma medications may be either inhaled or in pill form and are divided into two types—quick-relief and long-term control:

Long-Term Controller Medications

Long-term control medications help you keep control of your asthma. The NHLBI Guidelines state that you probably need a long-term control medicine if you have symptoms more than twice a week. You will need to take this medicine every day.

The anti-inflammatory group of controller medicines is the most important group of the long-term controller which prevents or reverses inflammation in the airways. This makes the airways less sensitive and keeps them from reacting as easily to triggers. In other words, they actually prevent asthma episodes.
Cromolyn and Nedocromil Sodium including Nasalcrom, Intal, Opticrom prevent airways from swelling when they come in contact with an asthma trigger. These nonsteroids can also be used to prevent asthma caused by exercise.
Inhaled Corticosteroids including Advair, Aerobid, Asmanex, Azmacort, Flovent, Pulmicort, Symbicort, Qvar prevent and reduce airway swelling and decrease the amount of mucus in the lungs. You may also need to add an oral corticosteroid or a short-acting beta-agonist (bronchodilator) for relief.
Oral Corticosteroids (pills, tablets, liquids) are used as short-term treatment for severe asthma episodes or as long-term therapy for some people with severe asthma. Again, these are not the same as anabolic steroids.
Leukotriene modifiers (tablets) are a new type of long-term control medication. They prevent airway inflammation and swelling, decrease the amount of mucus in the lungs, and open the airways.
The long-acting bronchodilator group is another type of the long-term controller medicines which help open the airways over a long period of time. They are taken in addition to anti-inflammatory medicines.

Long-acting beta agonists (inhaled) can be taken with or without an anti-inflammatory medicine to help control daily symptoms, including nighttime asthma. This type of medicine can also prevent asthma triggered by exercise. Long-acting, inhaled beta agonists are not a substitute for anti-inflammatory medicine.
Combined therapy medicine (inhaled) contains both a controller and reliever medicine. This combination of a long-acting bronchodilator and corticosteroid is used for long-term control.
Anti-IgE therapy (injected) is a new treatment for people with moderate or severe allergic asthma. For people with allergic asthma, anti-IgE therapy works by helping to reduce the production and diffusion of Immunoglobulin E (IgE), a primary trigger of allergic inflammation in the lungs.
Quick Reliever Medications

Quick-relief medicines (inhaled and pills) are used to ease the wheezing, coughing, and tightness of the chest that occurs during asthma episodes.

Short-acting bronchodilators (inhaled) are one type of quick-relief medicines. They open airways by relaxing muscles that tighten in and around the airways during asthma episodes.
Short-acting beta agonists (inhaled) including albuterol (Proventil HFA, Ventolin HFA, AccuNeb), Alupent, Maxair, Xopenex relieve asthma symptoms quickly and some prevent asthma caused by exercise.
Oral beta agonists (syrup, tablets and long-acting tablets) syrup may be used for children, while long-acting tablets may be used for nighttime asthma. Oral preparations generally cause more side effects than the inhaled form.
Theophylline (oral, slow-acting) can be used for persistently symptomatic asthma, and especially to prevent nighttime asthma. Theophylline must remain at a constant level in the bloodstream to be effective. Too high a level can be dangerous.
For people with asthma, having an “asthma management plan�? is the best strategy to prevent symptoms. An asthma management plan is something developed by you and your doctor to help you control your asthma, instead of your asthma controlling you. An effective plan should allow you to:

Be active without having asthma symptoms.
Participate fully in exercise and sports.
Sleep all night, without asthma symptoms.
Attend school or work regularly.
Have the clearest lungs possible.
Have few or no side-effects from asthma medications.
Have no emergency visits or stays in the hospital.
Four Parts of Asthma Management Plan:

1. Identify and minimize contact with asthma triggers. Avoiding triggers is the best way to reduce the need for medication and to prevent asthma episodes.

2. Take medications as prescribed. Asthma medicines are usually inhaled through a machine called a nebulizer, through a small device called a metered dose inhaler (also called an inhaler, puffer, or MDI) or through a dry powder inhaler (DPI).

3. Monitor asthma and recognize early signs that it may be worsening. Asthma episodes almost never occur without warning. The key to controlling asthma is taking the medicine at the earliest possible sign of worsening.

There is a simple, pocket-sized device called a peak flow meter that can detect narrowing in airways hours, or even days before you feel symptoms. You simply blow into it, to monitor the airways the same way one might use a blood pressure cuff to measure high blood pressure or a thermometer to take the temperature.

4. Know what to do when the asthma is worsening. If you understand your asthma management plan and follow it, you will know exactly what to do in case of an asthma episode or an emergency.

There are many natural asthma remedies touted to relieve asthma symptoms. However, because there have been few or no research studies on most types of alternative medicine for asthma, the effectiveness and safety of many are unknown.

Here are some examples of natural asthma remedies:

Yoga. Oftentimes, breathing exercises used in yoga have been found to help some people with asthma control breathing and relieve stress, a common asthma trigger.
Asthma Diet. Restricting dairy products and sugar has reportedly helped some children with childhood asthma.
Acupuncture. This Chinese medicine technique uses needles on pressure points to relieve symptoms.
Biofeedback. Learning to increase the amount of air inhaled has reduced fear and anxiety during an asthma attack for some people with asthma.

Written by Opa staff – Roselys