Asthma

Asthma may develop at any age, although the majority of people are diagnosed in
childhood. There is often a strong family history of asthma or allergies. Asthma can be
very mild in some people, and vary to the extreme of severe and life-threatening (and
even death) in some people.

Definition - a reversible inflammatory disorder of the airways, often triggered by
allergen exposure, exercise, and cold air

Diagnosis - is based on 2 key elements
1. History or presence of respiratory symptoms consistent with asthma - wheeze, cough
(typically worse at night), and/or shortness of breath (that are better with a bronchodilator
like albuterol)
2. The demonstration of variable airflow obstruction (by formal pulmonary function
testing or in office or at home peak expiratory flow measurement=peak flow).

Other conditions which may simulate asthma - post nasal drip syndrome (can cause
upper airway wheeze-like sounds), gastroesophageal reflux disease (GERD), post-viral
cough, habitual/psychological cough, vocal cord dysfunction, panic disorder, cough from
ACE inhibitor blood pressure medicines, COPD (emphysema), and congestive heart
failure

Treatment & Management

1. Monitoring of patients with asthma - symptom assessment and office/home
monitoring with peak flow meters
2. Patient Education - learn how to monitor their symptoms and pulmonary function,
and use their medicines
3. Controlling triggers - this can help decrease need for medications, and patients need
to be aware and decrease trigger exposure - like allergens at home, workplace, daycare,
or school, indoor allergens (dust mites, animal dander, molds, cockroaches) and
respiratory irritants (tobacco smoke, wood smoke, cleaning products, perfumes, air
pollutants) - consider formal allergy testing
--be aware of conditions that can worsen asthma - like sleep apnea, GERD, obesity,
rhinitis/sinusitis, vocal cord dysfunction, and depression/chronic stress, and medicines
that can worsen asthma (like blood pressure beta blockers and aspirin in some people)
4. Medicine Treatment - the goal is to minimize symptoms, reduce the chance of bad
outcomes (hospitalizations or loss of lung function), and minimize adverse effects from
medicines
-inhaled medicines can be taken in metered dose inhalers (some can be used with a spacer
for younger children) and in aerosolized nebulizer breathing treatments

Treatment depends upon the asthma severity- from intermittent asthma (symptoms
less than 2 days/week, and usually just needing a rescue inhaler=short acting
bronchodilator as needed), mild persistent asthma (symptoms greater than 2 days/week-
usually treated with a low dose inhaled cortisone or Singulair), moderate persistent
asthma (symptoms daily-usually treated with a medium dose inhaled cortisone and long
acting bronchodilator or Singulair), and severe persistent asthma (symptoms throughout
the day - usually treated with a high dose inhaled cortisone with long acting
bronchodilator and Singulair, and often additional medicines)

Rescue Inhalers - short acting bronchodilators
- all asthma patients need to have one available when/if needed for
cough/wheeze/shortness of breath flares, and can be used a maximum of 4x/day for not
longer than 1 week, and if needed 4x/day for more than 1 day you must see your
physician
- only brand name metered dose inhalers are now available in the U.S. because of
regulations that they need to be ozone friendly - Proventil HFA, Ventolin HFA, ProAir
HFA, and Xopenex HFA, the least expensive available is a small size Ventolin HFA
which you can get only at Walmart and Target pharmacies, and if needed due to cost, you

- generic albuterol solution is available for nebulizers (and brand name Xopenex is also
available for nebulizers)

Daily Controller Medicines

Inhaled Glucocorticoid (cortisone)-the most potent anti-inflammatory agents available
for asthma treatment, and rinsing the mouth is required after using to avoid developing
thrush/yeast infections
-Flovent
-Pulmicort
-Qvar
-Asmanex
-Azmacort and AeroBid
Inhaled Glucocorticoids with Long Acting Bronchodilators
-Advair (available in a powder round inhaler, or HFA inhaler)
-Symbicort
Long Acting Bronchodilators-must be used only along with a cortisone inhaler
-Serevent
-Foradil
Leukotriene Receptor Antagonists-these decrease infammation and
bronchoconstriction
-Singulair
-Accolate
Chromones-decrease the early stages of asthmatic response/infammation
-Cromolyn (availabe in inhaler and nebulizer)
Theophylline-has both bronchodilatory and antiinflammatory properties, but can have
irritating and serious side effects, and requires blood tests to keep the blood level
adequate (want 5-15mcg/ml)
Oral Glucocorticoids(cortisone) - a short 7-10 day course can be required for asthma
flares, or rarely for long term asthma control

Source: http://www.excellforlife.com/wp-content/uploads/Resources/Asthma.pdf