What you need to know about asthma.
People with asthma suffer from a disease that makes it hard for them to breathe at times. For some people, it is a minor problem, but for others it can be life threatening. Bronchial asthma is characterized by a reversible obstruction--a temporary blockage--of the bronchial airways, the tubes through which you breathe. The obstruction is caused by inflammation and mucus in the airways, contraction of the muscles that surround the airways, and airway swelling.
If You Have Asthma, You're Not Alone
Along with its sister allergic diseases, bronchial asthma is among the most common chronic diseases suffered by Americans. Approximately 15 to 16 million Americans suffer from bronchial asthma; between 30 and 35 million have other allergic diseases. In other words, these are very common diseases.
Asthma is often thought to be a benign disease, but about 4,000 Americans die from asthma each year. The group at greatest risk is older asthmatics, above the age of 50; 10 per 100,000 older Americans die each year from asthma. Among the middle-age groups, 1.5 per 100,000 people die from asthma each year; but below the age of 9, 2 children per 100,000 die per year from asthma.
Asthma is the number one cause of school absenteeism, and the number one cause of pediatric admissions to the hospital. Overall, for adults as well as
for children, it is the number six cause of admissions to all hospitals. There are 10 million office visits per year to physicians' offices for asthma. If you take into account office visits for asthma and allergies, the number becomes 30 million. One out of every nine office visits to physicians in the United States is due to asthma or allergic diseases.
Over-the-counter expenses for drugs to treat asthma exceed $2.3 billion dollars. Including prescription drugs, the expense is greater than $3 billion. Including the expense of office visits and hospitalizations, it's a staggering $4 to $5 billion.
What's Going on?
Asthma is not a problem with breathing in but a problem with breathing out. During normal inhalation, air moves smoothly from the mouth, through the trachea, bronchi, and bronchioles into the alveoli. If you're an asthmatic, you can do the same: you lower the diaphragm, you swing the ribs out, and that makes the lungs bigger. If there is an airway obstruction, the airway opens up and air can slide around the obstruction. However, breathing out is passive. Ordinarily, to breathe out all you do is stop breathing in, and you automatically breathe out. But if you're asthmatic, you can't do that. The minute you relax your ribs and let your diaphragm slide up, the obstructed airways block the airflow and air can't get out. You have a lot of dead air trapped in your lungs, and you end up breathing at the top of your lungs.
The four components that cause asthmatics to have trouble in breathing are secretion of excess mucus, swelling in the airway, inflammation in the airway (white blood cells invade the walls of the airways), and muscle spasm.
If you don't have asthma and want to get a sense of how an asthmatic feels, try this: breathe in. Now, don't let the air out. Hold that deep breath and breathe in and out using only the top of your lungs. You're going to find yourself getting tired. It's uncomfortable to breathe up here, and that's what an asthmatic does. You can relax now, but that exercise gives you an idea of what it would be like to have that trapped air.
Why You Wheeze. Ordinarily, the open airway through which you breathe is empty. The airway itself is lined with ciliated cells, cells topped with little hairs that move mucus. Beneath, there is a very thin basement membrane, an area known as the lamina propria, that is fairly devoid of cells. Next there is a thin muscle layer. Around that are submucous glands that secrete about 10 milliliters of mucus a day, about the amount in a tablespoon.
When an asthmatic's airway is full, it contains not only excessive, very sticky mucus but also a lot of other debris, including two kinds of white blood cells--eosinophils and neutrophils. Also, some of the cells that should be lining the airway lift off and resettle in clumps in the airway. Because the cells lift off, the airway itself becomes denuded; it does not have the normal cells that cover and protect it. The airway becomes hyperirritable; like scraped skin, it's sore. When an asthmatic coughs, or breathes in cigarette smoke or irritating fumes, he or she will begin to wheeze--a whistling sound--because the airways are hyperirritable and have constricted.
The basement membrane becomes very thick because of the deposition of additional materials. The area beneath the basement membrane, which has very few cells in the normal condition, grows full of inflammatory cells such as eosinophils and neutrophils. The blood vessels become dilated and full of white blood cells. The muscle layer thickens and muscle contraction occurs. The mucous glands become enlarged and actively secrete mucus that fills up the airway.
What Causes Asthma?
The causes of asthma include allergy, infections, industrial chemical exposures, complications from drugs and chemicals, exercise, vasculitis (inflammatory diseases of the blood vessels), and what are called idiopathic causes.
Allergy is the number one cause of asthma. About 90 percent of the people under 10 who have asthma have allergies. If you are younger than 30, there is a 70 percent chance that you are allergic. About half the people over 30 who have asthma have allergies.
How An Allergic Reaction Works.
Every tissue in the body has "mast" cells, a name derived from the German "mastung," which means well-fed. Mast cells are most heavily concentrated in the mucous membranes (the skin that lines the nose and the airways), where there are about 10,000 mast cells per cubic millimeter. On the surface of mast cells are many lgE antibodies. Antibodies are proteins made by the body, and ordinarily they protect against invaders like bacteria and viruses. In allergy, a special kind of antibody known as lgE is made by plasma cells and is directed against ordinarily harmless materials like pollen, dust, or food. When mast cells that are sensitized by having lgE antibodies on their surface encounter that antigen or foreign substance, they then trigger the release of histamine and other chemicals from inside the mast cells, and this causes the allergic reaction.
You don't exhibit an allergic reaction until you have been exposed to the antigen for a period of time. So, for instance, if you think you are safe because you bought a cat last month and you're not sneezing yet, just wait; you still may have an allergic reaction.
Ragweed is a common plant that can illustrate how this works. Ragweed produces about a billion pollen grains per year, per plant. Ragweed pollen is very light and carried far and wide by wind. When inhaled by an allergic person, the pollen will encounter mast cells that respond to the pollen by making lgE antibodies. The lgE then coats the surface of the mast cells.
After 2 or 3 years (or seasons) of breathing in an allergen like ragweed pollen, the next time that allergic person breathes in that pollen, instead of simply causing lgE to be produced, the mast cells, now sensitized with IgE, release histamine and other chemicals. These substances released from the mast cells interact with the airways and produce the changes that cause asthma. The same allergy mechanism applies to ragweed, grass, dust, mold, animal allergens, and a variety of other allergens that are inhaled. This can also occur in an asthmatic who is allergic to certain foods. In addition, there are mechanisms in the body that trigger the release of these same chemicals from the mast cells not in response to inhaled allergens or to foods, but to exercise. Asthma that is related to exercise is called exercise-induced asthma, and it does not necessarily involve lgE antibodies at all.
Not everybody is allergic and if you're not, your antibody-producing cells won't make lgE antibodies in response to pollen or other allergens. Allergies are hereditary; if you are a parent with allergies, the likelihood is that one in three or one in four of your children will have allergies. If both parents are allergic, all offspring are likely to be allergic, too.
When is allergy likely to be a contributing factor to asthma?
* when a blood relative-mother, father, sister, brother, aunt, uncle, or child has allergies;
* when the asthma begins at a young age;
* when the asthma symptoms occur or worsen seasonally, such as in fall and spring;
* if other allergic symptoms also occur, such as rhinitis (runny nose), hay fever, or eczema;
* if tests show that the blood and sputum contain an increased number of eosinophils.
Infections can also cause asthma. Bronchiolitis is a viral respiratory infection that occurs in children younger than two. It is usually caused by one of two viruses--respiratory syncytial virus or parainfluenza virus. A child may get a fairly bad cold and then develop respiratory distress. The child may cough and wheeze and even have croup. About 50 percent of these children, if they have an allergic parent, will go on to develop asthma. Generally, this asthma is fairly mild and is substantially improved before age ten. Nonetheless, it's a very common cause of childhood asthma.
Sporadic asthma can occur when people have an upper respiratory tract infection. Many adults only develop asthma as a consequence of a cold, often a cold that leads to bronchitis.
Industrial and occupational exposure can lead to asthma. Inhaled substances can act as allergens or as irritants that do not result in lgE production. The most common cause of occupation-related asthma is the inhalation of substances like toluene diisocyanates, trimellitic anhydrides, and enzymes. Anyone who inhales chemical fumes can develop bronchial irritation or can become allergic to the chemical. It is estimated that as many as 15 percent of asthmatics develop asthma in response to industrial exposure.
A very common cause of asthma is nonsteroidal anti-inflammatory drugs such as aspirin. Aspirin is a very potent drug. The way it takes away pain is to stop the formation of agents known as prostaglandins. There is a whole class of drugs, chemically distinct from aspirin, that acts the same way. About 5 to 10 percent of asthmatics will have asthma triggered by aspirin or other aspirin-like compounds--that includes phenylbutazone, indomethacin, ibuprofen, and other nonsteroidal anti-inflammatory drugs.
Patients with aspirin allergy tend to have chronic sinus infections, and often will have nasal polyposis--growths inside the nose. Aspirin-initiated asthma can be a very severe form of asthma. It can be prevented by avoiding aspirin and, in part, by aggressive treatment of the sinuses.
It was once thought that yellow dyes, the F, D, and C No. 5, known as tartrazine yellow, triggered asthma, and, for a while, physicians discouraged patients with aspirin sensitivity from eating foods containing yellow dye. It turned out not to be a real problem. It was also thought at one time that benzoate preservatives could trigger asthma. There is no convincing evidence that this is true.
One group of chemical additives that has in fact been found to trigger asthma attacks in susceptible people is sulfites.
In ancient times, the Romans began adding sulfites to wines as preservatives, and sulfites have been added to wine ever since. People who have asthma or allergies triggered by wine may be sulfite sensitive.
Most people have heard about asthma attacks occurring after someone eats at a salad bar or restaurant. Sulfiting agents (sulfuric acid derivatives) are added to many perishable foods to keep them from turning color. Generally, any fresh food that would turn brown upon standing could have sulfites added to it to prevent that browning. About 5 percent of asthmatics who ingest high concentrations of sulfites will develop a severe asthma attack.
The Food and Drug Administration requires labeling of sulfite-containing foods and prohibits salad-bar restaurants from adding sulfites to their fresh foods. However, other processed foods that are available at salad bars. for example. still may contain sulfites.
Sulfur Dioxide Foods with the Highest Equivalents Concentration as Consumed of Sulfites in Product (ppm) Pizza Dough 11-20 Instant Tea 5-6 Wine Vinegar 75 Fresh Shrimp 4-36 Grapes 15 Dried Fruits Apples, Raisins) 275 Grape Juice 85 Lemon Juice 800 Canned Vegetables 5-30 Instant Potatoes 35-90 Corn Syrup 30 Fruit Topping 60 Molasses 125 Beer 10 Wine 150
Beta blockers (beta adrenergic antagonists) have, since their first day of introduction, been recognized to cause asthma. Beta adrenergic antagonists are used for many purposes, including the treatment of migraine headache, glaucoma, rapid heart rate, high blood pressure, tremors, and many other conditions.
If you have asthma and have been advised to take a beta adrenergic blocking agent, tell your doctor that you have asthma and ask if an alternative drug can be prescribed. There is no question that these drugs will make mild asthma more severe and dramatically complicate the treatment of asthma.
Exercise is a potent stimulator of asthma. When you exercise, you hyperventilate by taking rapid, shallow breaths. Just as evaporating water cools the skin, hyperventilation cools the airways. A reflex reaction to this cooling of the airways causes asthma.
Exercise is as important for people with asthma as it is for everyone else. Fortunately, there are effective medications that prevent most exercise-induced asthma. Swimming doesn't cause much of a problem in people with asthma, biking causes somewhat more; and running is the worst type of exercise for asthma sufferers. Swimming is best because you are inhaling very moist air, thereby slowing down the cooling of the airway. If you want to exercise without taking medication, you can wear a surgical mask, enabling you to re-breathe humidified air and avoid asthma symptoms. A proper warm-up period also reduces exercise-induced asthma.
A rare cause of asthma is a type of vasculitis (inflammation of the blood vessels) known as the Churg-Strauss syndrome. In this disease, which occurs equally among males and females, allergic asthma suddenly and for no apparent reason gets much more severe. It is often diagnosed by an abnormal x-ray, which will show a white patch, indicating infiltration of inflammatory cells into the lungs.
Often physicians can't determine what is triggering someone's asthma, and they call it idiopathic, which is the medical term for "I'm not sure of the cause." This undefined type of asthma occurs most often in older individuals who have some bronchitis, a lot of excess mucus secretion, and perhaps sinus infection. For lack of a better definition, this is called idiopathic asthma, and it accounts for about 25 percent of the individuals above the age of 30.
Triggers of Asthma
Conditions that trigger asthma symptoms include sinusitis, gastroesophageal reflux, pregnancy, intense emotions, and hyperthyroidism.
Some asthmatics only have asthma symptoms in relationship to a cold and sinus infection. You'll recognize sinusitis because you will feel mucus dripping down the back of your throat. Often you will have headaches in the sites where the sinuses are, and you may run a fever. Sinusitis commonly causes asthma to worsen. The asthma and the sinusitis should be treated at the same time.
Gastroesophageal reflux means the backup of acid from the stomach up into the esophagus, or swallowing tube. In this case, asthma generally occurs at night, because when you are lying in bed, acid can leak out of your stomach and into your esophagus, thereby irritating the lining of the esophagus, setting up a reflex reaction in the chest, and triggering nighttime asthma.
Asthma complicates pregnancy about 1 percent of the time; about 1 woman in 100 develops asthma because of her pregnancy. But many asthmatics get pregnant. About half of people with asthma are women. And when those women become pregnant, one-third of them get better, one-third of them get worse, and one-third of them don't change.
In the one-third who get worse, the asthmatic symptoms that occur during the first pregnancy are generally the same in the second, third, and fourth pregnancies.
Fortunately, the asthma medications now in use do not have any bad effects on the unborn baby. Asthmatic patients go on to have normal pregnancies, normal deliveries, and normal children.
Intense emotions can trigger asthma. That doesn't mean that asthma is all in your head; it means that psychological stress can cause an asthmatic attack the same way that sinus inflammation and gastroesophageal reflux can.
Hyperthyroidism, which means overactivity of the thyroid gland, often causes an increase in asthmatic symptoms. It is one of the possibilities doctors consider when an asthmatic who has been stable suddenly gets much worse.
When a person with asthma symptoms comes into the doctor's office, the doctor usually gives the patient pulmonary function tests, which, for example, measure tidal volume. That is the amount of air you breathe in and out with a regular breath; it's usually about 500 milliliters. The doctor will then ask the patient to take a maximum inhalation and a maximum exhalation. By measuring the maximum expiratory level and the maximum inspiratory respiratory level, the doctor will calculate total lung capacity.
In a healthy person, about 75 to 85 percent of the air comes out within 1 second of a maximum exhalation (blowing out as hard as possible). By 3 seconds, the lungs have been essentially emptied. Asthmatics can't breathe in as much, because they have all that air trapped in the back of their lungs. Even at 6 and 7 seconds, they are still blowing out air.
At that point, the normal person would have already been ready to breathe in again. But a person with asthma can't move air out.
There are two major ways to treat asthma: by avoiding substances or events that trigger asthma, and by using various medications.
Pets. If an asthma sufferer is allergic, the best treatment is avoidance of the irritating substance. You should avoid cats, for example, if you are allergic to them. The source of allergen from both cats and dogs is saliva. Cats preen themselves, and it's the dried saliva left on their skin that becomes aerosolized and acts as such a potent allergen. Dogs hardly ever clean themselves, so generally a dog turns out to be a much less important source of allergen than is a cat.
People who are allergic to cats should not live with cats. People who are allergic to dogs should not have dogs. But many animal-lovers are very attached to their pets. If you must have a dog or cat indoors, at least don't let your pet in the bedroom. Give yourself 8 hours away from inhaling the allergen, if you can. Even birds should be avoided indoors, since feathers are a potent allergen. Feather pillows are another major source of allergy.
Pollen. If you have to be outdoors, recognize that airborne pollen levels are highest in the early morning on bright, sunny, windy days. Use air conditioning in your car during pollen season whenever possible.
Dust. A major source of allergens in dust is the dust mite. This microscopic bug lives mostly during the summer. During the winter, house dust contains parts of dead dust mites and their feces, which are actually the major source of dust allergens.
Dust mites live in wall-to-wall carpeting, in the springs and mattresses of beds, and any place dust collects. You can cover the springs and mattresses with allergy-proof encasements. You can keep table tops free from knickknacks. Shades are preferable to venetian blinds or curtains. Hardwood floors, or linoleum floors, and washable throw rugs are preferable to wall-to-wall carpeting. Closets are particularly laden with dust, so, if possible, use a clothes closet outside of the bedroom.
Air-filtering Devices. Air conditioning is extremely effective at clearing air particles, so during the pollen or dust seasons, if you have a proper air filter in your furnace and air conditioning throughout the house, you will be less likely to suffer from allergy-induced asthma.
Electrostatic air precipitators, on the other hand, are now safe and effective, although expensive. Older models produced ozone, which, even in very low concentrations cause asthmatic symptoms to get worse, since ozone is an irritant to mucosal membranes--the skin that lines the nose and the bronchi. But room air filters (the most effective ones are known as HEPA filters, high-efficiency particulate activating filters) are less expensive and are very efficient in removing air particles and don't produce ozone. Before buying a filter, rent one for your bedroom and see if it makes a difference.
If you have a choice, hot-water heat or radiator heat is better than forced hot-air heat. Forced hot-air heat distributes dust and mold throughout the house every time it circulates the air; radiators don't do that.
Sodium Cromolyn. Fortunately, there is a preventive drug for allergies. It is known as sodium cromolyn. It is used in an inhaled form for asthma, in an eyedrop form for allergic eye diseases, and in a nasal spray for allergic rhinitis. What this drug does is stop the mast cell from secreting the chemicals that cause allergies.
Unfortunately, sodium cromolyn does not work for everybody, but for those persons in whom it works, it works well. For anyone with allergic asthma, this drug is worth a try. It is also excellent for preventing exercise-induced asthma.
Bronchodilators. More commonly used than sodium cromolyn are bronchodilators. Bronchodilators relax the smooth muscles that line the airways, thereby opening those airways, if the muscle is contracted. There are three classes of bronchodilators: anticholinergics, methylxanthines, and beta adrenergic agonists.
Anticholinergic Drugs, known as atropine or atropine-like drugs, stop the action of acetylcholine, which triggers the muscles to contract. They relax the muscle by blocking its contraction. These are medium-potency drugs, certainly less potent than beta adrenergic agonists. Their duration of action is shorter. They are very important for the treatment of patients who produce excess mucus, and will be very important in the treatment of patients who have chronic obstructive pulmonary disease, but they are less important for treating asthma. However, clinical practice, particularly in some children and adults, has shown them to be very effective.
Methylxanthines have been around for quite a long time but have only become popular in the last 15 to 20 years. That's because we now have ways of monitoring methylxanthine blood levels, and we now have pills that can be taken once or twice a day. Therefore, methylxanthines are the major drug used in the United States for the treatment of asthma. The most commonly known methylxanthine is theophylline. People who can't tolerate theophylline can usually take another compound called oxytriphylline. By the way, caffeine, found in coffee and tea, is a derivative of methylxanthines. Caffeine is a very mild bronchodilator, so it wouldn't be effective to treat asthma with coffee or tea.
Theophylline acts by stopping some of the enzymatic actions in smooth muscle cells and thereby relaxing them. This is a very potent, very popular form of therapy, and there are no long-term complications from its use.
The last class of bronchodilators is beta adrenergic agonists. These are drugs related to the chemical adrenaline. When you are frightened, your heart starts beating, your airways dilate, and the pupils of your eyes dilate, due to adrenaline. Because adrenaline causes the airways to dilate, scientists were able to modify it into a very specific agent that works only in the lungs, causing them to open, without affecting the rest of the body. One of the most impressive things that's happened in the past 15 years in the treatment of asthma has been the creation of inhaled bronchodilators. We can now deposit bronchodilators, like these beta adrenergic drugs, directly into the airways and have the site of action only on the airways. They work very quickly, within minutes, and their effects last up to 6 to 8 hours. So these are the mainstays of therapy. Bronchodilators like methylxanthines and beta adrenergic agonists are the two drugs most prominently used in the treatment of asthma.
Corticosteroids. These are clearly the most effective drugs for the treatment of asthma. However, it is important to know how to use them, when to use them, who should use them, how long to use them, and when to stop them. They work by reducing swelling, reducing mucus secretions, stopping inflammation, reducing mast cell number and secretion, and even stopping the production of the lgE antibody.
On the other hand, corticosteroids are powerful drugs with serious side effects: they cause osteoporosis, a thinning of the bones; they cause weight gain; they lead to peptic ulcers; they can cause diabetes and increased infections; in children, they can stop growth.
Should we use them? Knowing how to use them properly minimizes the negative effects. Also over the past 5 to 10 years, inhaled steroids have been introduced; these have been pharmacologically engineered to work only in the lungs and have no systemic action. They work on asthma but don't create side effects. That's been the major breakthrough in the treatment of asthma in the past 10 years. While we once hesitated to use corticosteroids because of their side effects, we now use inhaled corticosteroids on many, if not most, asthmatics because of their safety and effectiveness.
Immunotherapy. Also known as allergy shots, immunotherapy is appropriate in people whose asthma has clear-cut allergic causes that are not adequately controlled with medication and avoidance of triggers. When immunotherapy works, it reduces not only the need for other treatments but also the disease itself.
Peak Flow Meters
In addition to avoidance of triggers and careful use of medications, the use of a peak flow meter can contribute to effective asthma management, particularly in children. This simple device helps patients monitor their own breathing. It measures the peak expiratory flow rate, which means the ability to breathe out quickly. A normal peak flow rate is first determined when an asthmatic child is feeling well, by blowing into the meter as hard and fast as possible several times. This measurement indicates how open the large airways are. The highest reading is recorded.
Peak flow monitoring is usually done several times a day or when the child feels ill. If the rate drops significantly, it may indicate that additional medication is needed to prevent asthma symptoms. Taking medication before severe symptoms are noticeable may prevent a full-blown asthma attack.
Some Myths About Asthma
Though very common, asthma is not very well understood by most people. Misconceptions about its causes and treatment abound.
Here are a few of these misconceptions:
1. "There's no sense treating my child, He's going to outgrow his asthma." This is both true and false. About 50 percent of the asthmatic children whose asthma develops between the ages of 2 and 10 will not have asthma in their teenage years; they'll have a spontaneous reduction in their asthma. But often the asthma recurs when those people reach their thirties. So it goes away, but it doesn't go away permanently. Lung function tests of former childhood asthmatics show that they still have abnormal airways disease.
Should you wait to treat them? No. Asthma is a serious disease. It impairs the capacity of your child to exercise, it impairs your child's self-image, and it shouldn't be ignored. There are effective ways to treat asthma, and there is no reason to let a child suffer, waiting to get better. Have your child seen by a specialist in asthma and allergies, and have him or her treated adequately.
2. "Asthma is all in your head." Or, "parents can cause asthma." Asthma is not "all in your head," and parents can't cause it. Psychological stress is one of the things that triggers asthma, but that doesn't mean that asthmatics are crazy or that parents are responsible. Emotional stress can make asthma worse, but you shouldn't feel guilty that your child has asthma. Your child has asthma because of other conditions over which you had no control. Psychological stress can trigger asthma symptoms, but it does not cause the disease.
3. "Asthmatics shouldn't exercise." Asthmatics should go out and exercise just like their friends. Eight percent of the athletes who represented the United States in the 1988 Olympics had exercise-induced asthma. They were able to perform in the Olympics because of proper medications to prevent asthmatic attacks caused by exercise.
4. "Allergic mothers shouldn't breastfeed." In fact, by breastfeeding, you reduce the opportunities for your child to become allergic to foreign proteins. Although breast milk is a distillate of proteins that you've eaten, your breast-fed child has a reduced exposure to non-human proteins. When a baby is born, its gastrointestinal tract is immature and it absorbs proteins that are much larger than proteins absorbed by adults. Adults break those down to very simple amino acids. By absorbing proteins that are macromolecules, the infant's body recognizes these as foreign antigens and makes antibodies to them. That's one reason children have such a high incidence of food allergy. Mothers who are themselves allergic, and therefore are more likely to have an allergic child, should breastfeed for at least 6 months to a year, if at all possible.
5. "Recurring asthmatic attacks lead to emphysema." Patients can have asthma all their lives and when they die, their lungs don't have any more damage to them than a non-asthmatic. There are two exceptions to this. There is a rare disease known as alpha-1-antitrypsin deficiency, which is a congenital enzyme deficiency that can present as asthma and leads to a very early and very destructive form of emphysema. The second is an unusual condition called allergic bronchopulmonary aspergillosis, which is an infection in the airways that leads to destruction of the airways. Other than those two very unusual causes of asthma, asthma does not lead to emphysema. Asthma is a fully reversible disease in its uncomplicated state. if you have asthma, don't worry about emphysema, but don't ignore the asthma; you still need to be treated.
6. "Smoking does not affect asthma." Asthmatics should not smoke. Inhaling someone else's smoke is also harmful to an asthmatic because smoke further irritates the airways. Parents should be very concerned. Recent studies suggest that children of smoking parents are at greatly increased risk of developing asthma.
7. "Certain foods can cause asthma." Clearly, foods can cause allergies, But they are rarely a cause of asthma. Except in the case of sulfites, foods should not be restricted for asthmatics.
8. "Over-the-counter drugs are all an asthmatic needs." If over-the-counter drugs were as potent as prescription drugs, they would not be sold without a prescription. Over-the-counter drugs are used much more than prescription drugs for asthmatics because they are easier to get to and they don't necessarily involve the expense of an office visit, but you sacrifice potency and specificity in the treatment. The drugs that are available over-the-counter are mild, non-specific agents that are mild bronchodilators, far less potent and far less effective than the drugs you can get by prescription. If you or your child has asthma, you should see a specialist, an allergist, or a pulmonologist who understands asthma and its treatment. As stated earlier, the two major advances in asthma treatment in the past 20 years, inhaled steroids and beta adrenergic agonists, are both prescription-only drugs.
At many research institutions around the country, including the National Institute of Allergy and Infectious Diseases, scientists are working to better understand the mechanisms involved in asthma, to develop new and improved treatments for asthma, and to find better means of preventing asthma symptoms. We have come a long way in our search to improve the quality of life for people with asthma and certainly hope that we will make even more progress in the decade ahead.
For Further information
American Academy of Allergy & Immunology
611 East Wells Street
Milwaukee, WI 53202
American College of Allergy & immunology
800 E. NW Highway, Suite 1080
Palatine, IL 60067
American Lung Association
New York, NY 10019
Asthma & Allergy Foundation of America
1717 Massachusetts Avenue, NW, Suite 305
Washington, DC 20036
Mothers of Asthmatics
10875 Main Street, Suite 210
Fairfax, VA 22030
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|Publication:||Pamphlet by: National Institute of Allergy and Infectious Diseases|
|Date:||Mar 1, 1990|
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