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Outpatient treatment of asthma.

CHARACTERISTICS OF ASTHMA

Asthma is a lung disease that has three characteristics: airway obstruction, airway inflammation and airway hyperresponsiveness. Asthma requires continuous medical care.

According to the Guidelines for the Diagnosis and Management of Asthma report released from the National Asthma Education Program, asthma treatment has four components:

1. the use of objective measures of lung function (spirometry, peak flow expiratory flow rate) to assess the severity of asthma and to monitor the course of treatment

2. medication therapy desired to reverse and prevent the airway inflammation component of asthma as well as to treat airway narrowing

3. environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups including consideration of immunotherapy

4. patient education that includes a partnership among the parent, his or her family, and the physician.

According to the Guidelines there are five goals to effective management of asthma:

1. Maintain (near) "normal" pulmonary function rates.

2. Maintain normal activity levels, including exercise.

3. Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the night, in the early morning, or after exertion.)

4. Prevent recurrent asthma flare-ups.

5. Avoid adverse effects from asthma medications.

Proper medications and dosage is important to the management of asthma. These medications include anti-inflammatory agents and bronchodilators.

ANTI-INFLAMMATORY AGENTS

Anti-inflammatory agents stop the development of inflammation in the lungs. They also help to prevent inflammation in the lungs.

Corticosteroids

Corticosteroids are the most effective anti-inflammatory medications for the treatment of airway obstruction in the lungs. Corticosteroids can be administered orally or in an inhaled form.

Sometimes the oral form is used for a short period of time when the patient's asthma is out of control. Possible side effects include weight gain, high blood pressure, cataracts, weakening of bones, muscle weakness and swelling.

Inhaled corticosteroids are safe and effective for the treatment of asthma. Because this medication works on the inflammatory aspect of asthma, it is being used as the primary medication for moderate and severe asthma. Possible side effects include oral candidiasis and occasional coughing caused by the aerosol device.

Cromolyn Sodium

Cromolyn sodium is a preventive medication that is inhaled directly into the lungs and prevents immediate as well as later symptoms, sometimes called the late phase. It works to stop the effects from environmental irritants or allergens (including after exercise, and after exposure to cold air and sulfur dioxide). Cromolyn sodium comes in a powder form to be used with a spinhaler, a liquid form for a nebulizer machine and in an inhaled form. There are few side effects.

Other anti-inflammatory medications are being tested in clinical trials in the U.S., but are not yet approved for asthma treatment. They include nedocromil sodium, antihistamines and ketotifen.

BRONCHODILATORS

The bronchodilator's main job is to open up the airway by relaxing the bronchial smooth muscle. The two types of bronchodilators are beta-adrenergic

agonists ([beta.sub.2] agonists) and methylxanthines (theophylline).

[Beta.sub.2] Agonists

[Beta.sub.2] agonists work to relax the airway smooth muscle and to aid in the control of persistent airway narrowing (overuse of a [beta.sub.2] agonist is not recommended). They are adrenalin-like medications that can be taken orally through tablets or liquids, by inhalation or through injection. Injections are used primarily in emergency situations. Inhaled [beta.sub.2] agonists are the medication of choice for the treatment of acute flare-ups of asthma and for the prevention of exercise-induced asthma. Inhaled [beta.sub.2] agonists are available in meter-dosed inhalers, dry-powder capsules and compressor-driven nebulizers.

Methylxanthines

Theophylline is the major methylxanthine used in asthma therapy. It serves as a mild-to-moderate bronchodilator. The sustained release formula is useful in controlling nighttime asthma. It sometimes is used with inhaled [beta.sub.2] agonists to provide additional bronchodilation. It also may help to reduce muscle fatigue and has some anti-inflammatory benefits. Possible side effects include abdominal pain, nausea, vomiting, nervousness and insomnia.

IMMUNOTHERAPY

Immunotherapy involves the injection of small amounts of allergens into the patient. This helps to create a tolerance or resistance to allergies that trigger asthma flare-ups. Concentrations of the allergens are increased over time to reduce or eliminate the patient's allergy symptoms.

ENVIRONMENTAL MEASURES

Between 75 and 85 percent of patients with asthma also have allergies. This fact reinforces the concept that controlling allergies will benefit the allergic asthmatic. To prevent allergic reactions, environmental control measures to reduce exposure to indoor and outdoor allergens and irritants are essential.

Avoid Outdoor Allergens

Reduce your exposure to outdoor allergens by staying indoors when the pollen count or humidity is high and on windy days when dust and pollen are whipped about. Minimize early morning activity when pollen is most often emitted. Keep your windows closed, especially at night and use air conditioning which cleans, cools and dries the air.

Eliminate Indoor Allergens

House Dust Components

House dust itself is not an allergen, but what is in the house dust can cause allergic reactions. House dust can be comprised of animal allergens (if allergic, remove all warm-blooded animals from the home), house dust mites (these are found in mattresses, pillows, carpets, upholstered furniture, bed covers, clothes and soft toys), and cockroach allergens (roach control benefits asthma patients).

Indoor Molds

Indoor molds can be found in bathrooms, basements, kitchens and other areas where high humidity is present. Allow adequate ventilation and conduct frequent cleaning in these areas. Dehumidifiers should be set for less than 50 percent, but above 25 percent.

Air Controlling Devices

There are several indoor devices that help to control indoor allergens. These include air conditioning, indoor air cleaning units, humidifiers and vacuum cleaners.

Indoor air-cleaning devices may be useful, but even more important is controlling the source of allergens. The high-efficiency particulate air or HEPA filter is the most effective filter and can be used within central heating and cooling systems or free-standing units.

Vacuum cleaners can spread allergens when used. Allergic patients should wear a dust mask when vacuuming. Some homes with central vacuums have a collecting bag outdoors. Several vacuum brands can be fitted with a HEPA filter.

Humidifiers are great sources for mold growth when not cleaned properly. Setting the humidity level too high can encourage mold growth. Set unit level to between 25 and 50 percent humidity.

Other Indoor Irritants

There are other irritants that can cause flare-ups in the patient with asthma. These include tobacco smoke, smoke from wood burning stoves, strong odors, and sprays and air pollutants including ozone and sulfur dioxide.
COPYRIGHT 1992 American Academy of Allergy and Immunology
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Publication:Pamphlet by: American Academy of Allergy and Immunology
Article Type:Pamphlet
Date:Nov 1, 1992
Words:1077
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