Gary R. Epler, M.D.
You can manage your asthma better than anyone else. Millions of people have asthma. New medications and treatments have been developed that can have a huge positive impact in people’s lives. And, if you can learn about them and how to use them, you too can effectively manage your asthma.
How to manage your asthma?
Asthma is inflammation of the airways and bronchospasm. The inflammation occurs in the bronchial airways, which are the slender tubes that branch out from your trachea, or windpipe. Bronchospasm is the periodic contraction of the smooth, circular muscles around the bronchial airways. This can quickly narrow your airways. The airway inflammation plugs up the bronchial airways with congestion, and the bronchospasm further decreases the amount of air you can draw into the lungs. These two features account for the typical symptoms of asthma, such as wheezing, coughing, and chest tightness. Asthma is a chronic condition with intermittent symptoms.
What type of asthma do you have?
Part of managing asthma involves knowing what type of asthma you have. Childhood asthma usually develops between ages five and seven, and about 80% have allergies. Adult-onset asthma may develop at any age. Up to one-third of people with asthma have their first attack after age 30. In addition to allergy asthma, other types of asthma have specific triggers. For some people, exercise is the only thing that triggers asthma. Aspirin can cause an asthma attack in some people. Occupational asthma is a special situation where individuals may develop asthma from exposures at work and others may develop asthma from exposures while doing their hobbies such as making pottery or sculpting at home. This means that a person becomes allergic to the substance or chemical, and takes several weeks or months to develop the sensitivity. Occupational asthma develops from specific substances, and once it’s established, a small exposure to the specific substance will trigger an asthma attack. For example, a baker may develop asthma sensitivity to rye flour but not to wheat flour. Some chemicals such as isocyanates and the epoxies can cause sensitizing asthma.
Asthma is classified as mild intermittent, mild persistent, moderate persistent or severe persistent, the last classification is rare, less than 5% of people with asthma.
What do you need to know about diagnosing asthma?
You may think that diagnosing disease is the doctor’s job. This is true, yet it is helpful for you to learn about the diagnostic process because you may be able to think of causes and triggers. You will be asked when and where the symptoms occur, about family history of asthma, about medications you may be taking, and about work or environmental exposures. Your lungs will be examined for wheezes. Routine blood tests will measure eosinophils, which are blood cells increased from allergies, and sometimes special blood tests for allergies. Pulmonary function tests are helpful for diagnosing and monitoring asthma. These are non-invasive tests that include how much air you exhale in one second called the forced expired volume in one second (FEV 1) and peak flow which is maximum speed of air you can exhale. You may have a chest x-ray or chest computer (CT) scan if an infection is suspected or other cause of the asthma attack is suspected.
What to know about asthma treatment options?
The good news is that asthma is treatable. If that doesn’t sound right to you, you might be remembering a time, as short a time ago as the 1980s, when people considered asthma a disease that would limit people. Now, with treatment, 95 percent of people with asthma, all but those with the most severe cases, can do pretty much anything. Think of asthma as a vulnerability to inflammation and bronchospasm. To manage your asthma successfully, you need to manage the airway inflammation and the bronchospasm. Treatment depends on the classification of asthma. An occasional bronchodilator inhaler is used for mild intermittent asthma. Treatment for people with persistent asthma means treating the underlying inflammatory condition means that involves not only a bronchodilator, but also an inhaled corticosteroid. You use the bronchodilator to rescue you from an asthma attack. It works quickly to relax the smooth muscles around the bronchi when they go into bronchospasm. You use the corticosteroid inhaler to reduce the underlying airway inflammation and the chronic vulnerability to bronchospasm. Inhaled corticosteroids maintain your underlying bronchial health, and regular use will help you manage your asthma. Inhaled corticosteroids for asthma are anti-inflammatory and considered safe. They do not circulate widely through the blood, but are deposited on the bronchial airways and stay there decreasing the amount of inflammation. Sometimes, corticosteroid as prednisone tablets or even intravenous are used for severe asthma or a disabling asthma attack. In these situations, it is helpful to know the adverse effects of prednisone, especially if the prednisone is used for more than ten days.
Monitor your asthma.
Monitoring your asthma is helpful so that changes can be detected and treatment can be adjusted to prevent an attack. For asthma, wheezing is the most common symptom to monitor. It usually signals constriction of the airways. The narrowing creates the wheezing sound, meaning that it’s time to use the bronchodilator inhaler. Sometimes, a cough is the first symptom. It’s helpful to monitor your triggers and whether you’ve developed a respiratory infection. If green phlegm develops, it’s probably time for an antibiotic. A peak flow meter can be used to monitor asthma. You blow into a tube and the measurement is recorded. You may see a decrease before you develop symptoms so that you can use your bronchodilator inhaler early, preventing an audible asthma attack. In addition, you can write down your activities during the peak flow monitoring and might discover triggers of your asthma attacks. When you monitor a disease you need to ask three questions. Are the symptoms better? Are they the same? Are they worse? If they’re better, take no action. If wheezing or chest tightness is the same, take another puff of the bronchodilator inhaler. If they’re worse, and not improving with the inhaler, especially if the symptoms worsen quickly, you might need to call 911 or visit the emergency room.
How do you create a healing environment?
How can people with asthma say they are “healed” when they have an illness that requires treatment every day? Because, healing is within the mind. Creating a healing environment combines the physical attributes of the body and the powerful influence of the mind. The three traditional physical components consists of eight hours of sleep, one hour of exercise daily, and eating the right foods in the right amount including lean protein and slow-burn carbohydrates. For severe persistent asthma, a pulmonary rehabilitation program can be useful. There are several ways to use your mind, first, use a positive approach to the illness. You can manage your asthma. You are in charge of your asthma. Second, use visualization. Visualize strong healthy airway cells replacing inflamed cells. You can use this mental imaging daily or whenever you think about it. Third, have compassion for your lungs. Portions of your lungs are perfect; the asthma is the issue and can be relegated to the background. Fourth, use controlled breathing. If you are having an asthma attack, try diaphragmatic breathing – put your hand on your stomach, breathe out as much as you can, and push in your stomach, lowering your hand. Keep breathing out as long as you can until there is no more air, then take in a new breath and repeat this for three to five breaths every few minutes. If you’re not having an attack, use controlled breathing for a calming effect and stress release. For example, concentrate on breathing in the same amount as breathing out – 50% in and 50% out – for several minutes. Breathing opposite to your usual breathing method for a few breaths can have a calming effect. Put your hand on your stomach and breathe in. Instead of having your hand lower, make your hand move upward. Try this when you find yourself stressed or nervous. You will be calmer after a few of these opposite breaths. Yoga breathing exercises can also be helpful. Fifth, learn to use your alpha brainwaves while awake and make alpha brainwave time every day. This can be through traditional meditation or eyes-open meditation. No need to dwell on feelings of hopelessness and despair. Replace these thoughts with strength, resolve, and persistence, which lead to increased energy for healthy management of your asthma.
Learn about your asthma, know the types of asthma and the diagnostic process, understand the treatment options, monitor your asthma, and create an environment for healing. You are in charge. You can manage your asthma better than anyone else. Your chances of success are unlimited.
Gary R. Epler, M.D. at www.eplerhealth.com
Best-selling author of “Asthma: You’re the Boss”