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Asthma 101

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Created: Wednesday, 21 August 2013 16:24

Written by Dr. Bell

Fall is rapidly approaching and now is the time to reevaluate our child's asthma management. With school come colds, exposure to allergens, and sports. These, combined with cold weather, are unfortunate triggers of asthma attacks. The management of asthma, however, is relatively simple, but there still remains a lot of confusion regarding the details. Here are a few pointers and reminders about asthma.

1. Asthma is an inflammatory disease of the lungs.

I hear often from parents, "He only gets asthma when he is sick." This is wrong. This is comparable to saying "I only have diabetes when my sugars get high." Children with asthma have a continual inflammation of the small airways and alveoli of the lungs. Allergens and irritants cause increases in the inflammation. The "asthma attack" occurs when the child is aware of overwhelming inflammation combined with the muscle constriction of the small and larger airways. Think of it this way, you can survive with just one lung. 50%. You would not even notice a decrease in oxygen. You can feel normal with 70% of your lungs compromised! Recurring asthma attacks are dangerous and should not be the late sign to do something.

2. Steroids are bad for the body, but good for just the lungs.

When you take oral steroids, it goes everywhere, not just the lungs. Steroids have damaging effects on the eyes, causing glaucoma and cataracts, and the heart, causing high blood pressure and heart disease, also the kidneys, the adrenal glands, the pancreas, etc. Reoccurring use of oral steroids for asthma should be considered a failure in asthma management. The use of steroids for asthma should be discussed in the office during an exam with your child. Inhaled steroids, however, go directly to the lungs to decrease inflammation and prevent asthma attacks. Inhaled steroids are the best daily control for asthmatics to maintain healthy lungs.

3. Inhaled steroids are safe

This is true. It is comparable to putting topical cortisone on poison ivy affected skin. There may be some minimal absorption to the the blood stream and the rest of the body, but it is minimal. A 5 day course of oral steroids has more systemic effect on the body than up to 3 years of maximum inhaled steroids. The decision to not use inhaled steroids for health reasons should be weighed with the knowledge that just one asthma attack needing steroids has lost the systemic effect argument.

4. Do not be confused between your inhaled steroid and albuterol inhaler.

Albuterol is not a preventative medication. It is like tylenol for your lungs. It relaxes the muscles tightening around your lungs for a few hours and you feel better. It does nothing for the inflammation. Albuterol can be given as a nebulized solution, or used in a puffer like ProAir and Proventil (a terrible name, because it doesn't prevent anything).

There are many different types of inhaled steroids that we use in the office now: Flovent, Qvar, Asthmanex, Azmacort, Pulmicort. There are also combination inhalers that have steroids and a long acting albuterol medicine, like Advair and Symbicort.

You use your steroid inhaler daily, and you use your albuterol when you need it. If you need it often, you probably need to be taking more inhaled steroid. This is when you see the doctor!

5. Use a Spacer!

A spacer, or Aerochamber, is the best way to get your child to inhale the "spray" deep into the lungs. It is very difficult to time a pump-spray-inhale for an adult, even more for a child. An aerochamber allows you to pump/spray into a tube, and give the child, at their speed, time to breath out first and take a deep breath thru the aerochamber into the lungs. This can be demonstrated in our office or online:

Demonstration of How to Use an Aerochamber with Inhaler - YouTube

6. How do you know when you need more inhaled steroid?

There many ways of assessing asthma. (None, however, are that great.) The simple answer is "If you are using your albuterol/rescue inhaler more than once a week, you need more inhaled steroid."

There are more scientific ways of assessing asthma. ACT(Asthma Control Test™ (ACT) is: a 5 question test that asks specifically in the past 4 weeks how often you need to use your albuterol inhaler, how often you had shortness of breath, how often you wake up due to asthma

how often asthma kept you from doing what you wanted to do, and how you rate your asthma. At the office we do have many ways of determining what is right for your child. Call the office and talk to one of our nurses or medical assistance for help.

We also have spirometry, or Pulmonary Functioning Testing (PFTs) to objectively rate your lungs ability to blow out air. If we still have trouble determining asthma we can send children for further testing or refer to a pulmonary specialist.

7. Allergies and Asthma:

Allergies are often the cause of asthma inflammation. This is why children can have no asthma issues all year until spring and fall come around.

We often used medications like Loratidine (Claritin), Cetirizine (Zyrtec), and Fexofenadine (allegra) during allergy seasons for asthma and allergies. Singulair (also known as montelukast) is an antiinflammatory pill that helps with both asthma and allergies.

8. What you can do at home:

Asthma is often triggered by allergens and irritants in the home. Children spend a third of their life in their bedroom. This is a good starting point to control asthma flare ups:

• keep pets out of the bedroom.
• put dust covers over mattresses.
• take rugs out of the bedroom.
• decrease the number of shelves in the room to prevent sources of dust.
• keep smokers outside of the house. (another room in the house does not count!)
• keep windows closed to prevent early early morning pollen from drifting in.
• get a HEPA air filter for their room.

In summary: (the Cliff Note version)

• Asthma is a hidden disease that a child may not notice until there is severe lung inflammation.
• Oral steroids can be helpful, but should be used wisely.
• Inhaled steroids are the best and safest way to control asthma inflammation.
• Know your steroid in haler and use it EVERY DAY.
• If you are unsure if your inhaled steroid is enough try the ACT test or call our office.
• Allergies also cause asthma and there are medications that can help.
• There is also many things you can do in your house to decrease asthma inflammation.
• AND always feel free to call our office for help! (We pride ourselves on low asthma hospitalizations, ER visits, and oral steroid use.)