Living with asthma

Keys to proper management for healthy lungs

Tyreese felt the tightening of his chest after a few minutes on the basketball court. He was about to have an asthma attack. He had forgotten to use his inhaler that morning. Where was his inhaler? When he checked his gym bag, it wasn’t there.

He was scared. It was getting harder to breathe. His coach called 911. By the time the paramedics arrived, Tyreese was struggling to breathe and felt like he was about to pass out.

The neb treatment he got in the ambulance and the additional nebs and IV medication in the emergency room helped. Still, he required admission to the hospital for two days before he was well enough to go home.

Tyreese was lucky. He survived. Some children are not so fortunate.

What is asthma?

Asthma is a disease that affects your airways. Your airways are tube-like structures that carry air in and out of your lungs. If you have asthma, the inside walls of your airways are prone to becoming irritated and inflamed. They may overreact to things that you are allergic to, such as changes in the weather, exposure to toxins in the air, or infections. When this happens, they get narrower, filled with mucous, and your lungs get less air.

Symptoms of asthma include:

•    wheezing

•    cough, usually early in the morning or at night

•    chest tightness

•    difficulty breathing

Not everybody who has asthma has these symptoms, and having these symptoms doesn’t mean that you have asthma. Well-controlled asthma may be asymptomatic (showing no symptoms).

How often symptoms of asthma occur depends on how severe, or intense, the asthma is, and what your exposures are. Some people have daily symptoms, while others have symptoms only a few days of the year.

An asthma attack happens when your asthma symptoms become worse than usual. Severe asthma attacks require emergency care and are sometimes fatal.

How common is asthma?

Asthma is the most common chronic disease affecting children in the U.S. It disproportionately affects minority communities. African American children are twice as likely to be hospitalized and nine times more likely to die from asthma as are White children. Certain factors increase your risk of developing asthma, including the environment you live or work in, your family history, and your ethnic background or race.

How is asthma diagnosed?

Your doctor makes the diagnosis of asthma based on medical history, a physical exam, and lung function tests. You may also have allergy tests. He or she will make sure that there is no other medical condition causing the asthma symptoms. You may need to see a doctor who specializes in asthma, called a pulmonologist.

Testing for asthma

One kind of pulmonary function test is spirometry. The test involves breathing in and out through a tube connected to a computer. It measures how much and how quickly the air moves when you breathe in and out with the maximum effort.

Another test is the peak expiratory flow (PEF) test to measure how quickly you can blow air out using maximum effort. If you have a history of allergies, skin or blood tests can be done to find out which allergens in the environment affect you.

How is asthma treated?

Asthma is treated with two main types of medicine: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms. Quick-relief medications include inhaled short-acting beta2-agonists like albuterol, to quickly relax tight muscles around your airways. Control medicines include inhaled corticosteroids to reduce the body’s inflammatory response.

These should be taken each day. If your symptoms worsen, your doctor may have you take corticosteroids by mouth for short periods. Other types of medicine include “biologics,” which are antibodies used in people who have severe asthma.

Leukotriene modifiers may be used to reduce the effects of leukotrienes that are released in the body as part of the response to allergens, and mast cell stabilizers can help prevent airway inflammation caused by exposure to allergens or other triggers. Inhaled long-acting beta2-agonists (LABAs) keep the airways open. LABAs often come combined with inhaled corticosteroids to reduce narrowing and inflammation.

Emergency care

In case you have a severe asthma attack, you will need emergency care. Treatment includes medicines like those listed above, given with a nebulizer or by IV. Patients often also need oxygen and, in some cases, may need to be placed on a breathing machine.

Preventing asthma attacks

While there is no cure for asthma, the good news is that with proper management and treatment you can live a normal, healthy life. If you have asthma, it is especially important to take your medicine as prescribed by your doctor and to follow the asthma action plan that is provided to help you adjust your medications based on your symptoms.

Dr. Andrew Kiragu is medical director of the Pediatric Intensive Care Unit at Hennepin Healthcare and an associate of the Children’s Respiratory and Critical Care Specialists Group. The group provides ICU coverage at Children’s Hospital and Gillette Children’s Hospital. He is an assistant professor of pediatrics at the University of Minnesota. He is past president of the MN Association of Black Physicians and the MN Chapter of the American Academy of Pediatrics.