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Your Asthma Book
WHAT IS ASTHMA?
Asthma is a long-term disease that causes the air passages in the lungs to become inflamed and narrow or blocked. It can range from annoying to life-threatening. When you’re having an asthma episode or attack, you get a tight feeling in your chest. Often it feels like you’re breathing through a straw pinched in the middle. You may have occasional symptoms or they may be there most of the time.
SYMPTOMS OF ASTHMA
Chest tightness, Difficulty breathing, Shortness of breath, Coughing, Wheezing (as air whistles through narrowed passages)
The symptoms of asthma may be different for each person. You may have a dry cough at night or wheeze when you have a cold. You may have chest tightness when you exercise. You may have episodes of wheezing and difficulty breathing. When asthma begins to act up, you may have a scratchy throat, itchy eyes, or a runny nose.
You may have symptoms every day or only occasionally. Learn to recognize your own symptoms and what to do. If you act quickly, your attack is likely to be less severe. Work with your health care provider to make an individualized plan to control your asthma.
WHAT CAUSES ASTHMA?
The main problem in asthma is inflammation (redness and swelling) of the walls of the small breathing tubes. The cells and substances that cause inflammation build up in the wall of the airway. The small blood vessels inside the bronchial tubes become leaky. The lining of the airway becomes swollen and produces extra mucus or phlegm.
The small breathing tubes are also surrounded by muscle. When exposed to an asthma trigger, this muscle tightens and narrows the airway. This process is called bronchospasm.
The inflammation and the bronchospasm combine to make it hard to get air in and out of the lungs.
WHO GETS ASTHMA?
Anyone can have asthma. Some people that are more likely to have asthma are:
• Children with parents who have asthma, allergies or eczema.
• People with allergies or eczema.
• Children who were born prematurely.
• Children whose parents smoke.*
* To protect yourself and your child, don’t smoke. Keep your home smoke-free. For a list of cessation programs, ask your health care provider or call 1-877-3BREATH.
The Truth About Asthma
• Asthma is not contagious. (People don’t “catch” asthma.)
• Asthma is not an emotional illness. (While strong emotions can trigger asthma that is already present, and relaxation can help calm an asthma flare-up; stress does not cause asthma.)
WHAT TRIGGERS ASTHMA?
When you have asthma, exposure to certain things that generally do not bother people without asthma can affect your sensitive airways. These things are called asthma triggers. They can be irritants, infections, exercise, or allergens. Irritants, infections, and exercise are triggers for most people with asthma. Many people with asthma are also sensitized to allergens such as pollens, animal dander, cockroaches, dust and molds. You should discuss with your doctor whether you are allergic to anything and, if you are, what you are allergic to. Once you have identified your particular asthma triggers, you can often control your asthma by avoiding them.
Indoor Irritant Triggers
Common irritant triggers in the home: Smoke (from cigarettes, fireplace or incense), Perfumes, Aerosol sprays (including hair spray), Strong chemical fumes
What you can do about irritant triggers in the house:
DO NOT smoke or let yourself breathe smoke.
• Keep your entire home smoke-free.
• If you or a guest must smoke, go outside.
• Do not allow smoke in your bedroom, bathroom, garage or car.
• Avoid areas where people are smoking.
• Do not use fireplaces, wood burning stoves or incense.
AVOID household chemicals with strong odors such as hair spray, perfumes, deodorizers, glues, paints, etc. Don’t use household cleaning products with strong odors.
Indoor Allergen Triggers
You may be allergic to things in your home such as animal dander the shedding skin of your pets), dust mites (microscopic insects that live in bedding and carpet), molds (mold grows in damp areas, such as the kitchen, the bathroom, and in the soil of house plants and on Christmas trees) and cockroaches. If you are allergic to any of these things, there are important avoidance measures you should take. If you are not allergic to these things, you do NOT need to take these precautions. Your doctor can test you to see what you are allergic to.
How to control indoor allergen triggers:
DO NOT have pets in your home if you are allergic to them.
• Keep pets outdoors.
• At least keep the pet out of your bedroom and bathe the pet weekly. A weekly bath may keep down the amount of dander.
DO control dust and house dust mites if you’re allergic to them.
If you are allergic to dust mites, reduce your exposure. Since you spend at least 8 hours per day in the bedroom, this room deserves the most attention.
• Enclose mattresses, box springs, and pillows in zippered plastic covers. You may be able to get these from allergy supply houses, the local pharmacy, department stores or ask your doctor.
• Wash bedding in hot water at least every 1 to 2 weeks (including the blankets).
• Avoid stuffed animals and other dust collectors in the bedroom.
• Clean shelves (with or without books) regularly.
Additionally consider changing heating and air conditioning filters monthly, install HEPA filters in your living areas and avoid carpeting in your bedroom.
Limit carpets elsewhere in the house. Linoleum, tile or hardwood floors are best. If you cannot remove the carpet, vacuum the carpet weekly using special allergy bags. Steam cleaning is helpful (steam kills dust mites).
DO exterminate cockroaches if you are allergic to them.
Tips for keeping your home cockroach-free:
1. Don’t let them in (seal cracks in walls, repair screens, check bags
and boxes before bringing them into the house).
2. They need food and water sources. Clean up soon after eating.
Clean up spills and repair water leaks.
DO control mold if you are allergic to it.
If you are allergic to indoor molds, reduce your exposure.
• Do not use humidifiers or vaporizers. In areas with high humidity (particularly in bathrooms and bedrooms), a dehumidifier may be useful.
• Houseplants are sources of dampness and mold. Keep plants out of your bedroom. Limit plants elsewhere in the house.
• Bleach can kill mold (1 part bleach + 9 parts water).
Outdoor Irritant Triggers
Irritant Triggers: Change of weather; cold, dry air and smog
What you can do about irritant triggers in the outside environment:
• If cold air triggers your asthma, wear a scarf over your mouth and nose.
• Stay indoors on “Bad Air Days” (Spare the Air Days) especially in the afternoon.
Go to www.aqmd.gov/telemweb/forecast.aspx for more information.
Outdoor Allergen Triggers
You may be allergic to things which are in the outdoor air during certain times of the year such as tree pollen, grass pollen, weed pollen and outdoor molds (fall). In general it is difficult to avoid these triggers. When you are having problems consider closing windows and taking a shower after being outdoors.
Common outdoor allergen triggers: Grass, trees; weed, pollen and mold spores
Ear infections, sinus infections, lung infections and the common cold can cause asthma flare-ups. If you cannot control a flare-up easily, see your doctor. You may have an infection that needs to be treated. “Flu” can be particularly dangerous for asthma patients Yearly flu shots are recommended for all asthmatics.
Although exercise is an asthma trigger for many persons with asthma, exercise is important for our health. Having asthma should not keep you from playing sports or participating in other physical activities Medications are available that can control asthma triggered by exercise.
DO NOT TAKE ASPIRIN (or other drugs in the same class as aspirin such as Motrin) if you are not sure if you tolerate it or not. Tylenol products are not known to trigger asthma.
Beta Blockers are sometimes used to treat high blood pressure, heart failure, heart attack, migraines and glaucoma. They can make asthma worse and interfere with the effectiveness of your reliever inhaler. If you think you may be on a beta blocker, ask your doctor.
Foods occasionally trigger asthma. Usually there is a skin reaction, such as eczema (scaly itchy skin) or hives, as well as asthma. If you think a food is a trigger discuss it with your doctor.
PREGNANCY AND ASTHMA
If you have asthma and are pregnant, adequately controlling your condition is one way to assure the well being of both you and your unborn baby. We recommend that you tell your obstetrician that you have asthma and ask what, if anything, you should or you should not do. You should also keep the doctor who looks after your asthma informed about your pregnancy and all the medications you take. You and your doctors’ goals during the pregnancy should include:
• Maintaining control of asthma
• Continuing normal activities including regular exercise
• Preventing acute asthma attacks
• Avoiding serious side effects of medications to mother and baby
• Delivering a healthy baby
Asthma symptoms may reduce the amount of oxygen available to the baby. Remember that you are breathing for two. Therefore, it is important that you follow your asthma action plan very carefully. It is very important that you visit your doctor more often to ensure that your asthma is being well controlled.
Better control of your asthma and reduction of any possible side effects of medications can be achieved by using your inhalers properly. You may set up a system to help you remind yourself to take your medications every day as prescribed, even when your asthma feels fine. Avoidance of asthma triggers becomes even more important during pregnancy.
None of the medications for the general management of asthma have been shown to have any risk for the baby. Pulmicort (an inhaled corticosteroid) now has the FDA approval for use in pregnancy.
Although some asthma medications may enter breast milk, the amounts are extremely small and do not have an adverse effect on the baby.
There are two types of asthma medications: Controllers (also called "prevention" or "maintenance") and Relievers (also called "rescue")
To be most effective, preventive medication must be used every day. If you do not feel better immediately, you may be tempted to stop using them. DON’T! Some of these medications take up to 6 weeks to work best.
CAUTION: Controller medications do not provide rapid relief of asthma symptoms.
They are the most effective preventive treatment for long term control of asthma. They reduce swelling, inflammation, and mucus in the airways. Examples: Aerobid, Azmacort, Beclovent, Flovent, Pulmicort, Qvar, Vanceril
The inhaled corticosteroids are safe when used in recommended doses. Side effects are uncommon, but can include: cough, hoarse voice, yeast infection in the mouth (with white spots on the inside cheeks).
There is also concern about risks in long-term use, particularly with higher doses in young children. These risks are considered minor compared to the risk of poorly controlled asthma. You can decrease risks and side effects by using a spacer device and rinsing your mouth and spitting after taking the medication.
Spacers/holding chambers cannot be used with all metered dose inhalers. The potential but small risk of delayed growth is well balanced by the inhaled corticosteriods effectiveness. Low to medium doses of inhaled corticosteroids my have the potential of delaying growth for the first year but this effect on growth is not substantiated in subsequent years. Studies following children for more than 10 years suggest that final height is attained. There are no significant effects on the incidence of cataracts, glaucoma or osteoporosis.
Inhaled Long Acting Bronchodilators
(Keeps airways open for about 10 – 12 hours)
These drugs are frequently used to assist the inhaled corticosteroids to control asthma. Examples: Foradil, Serevent
Combination medication devices are available. Ask your doctor or pharmacists what they replace. Examples: Advair, (Flovent & Serevent)
Other Types of Asthma Medications
Inhaled cromolyn sodium and nedocromil - stabilizes the airways, blocks response to triggers. Examples: Intal and Tilade
Theophylline - keeps airways open.
Leukotriene modifiers - block response to some triggers. Examples:Accolate, Singulair, Zyflo
Relievers (Quick Rescue/Relief Medications)
Short Acting Bronchodilators
These medications relax the muscle bands around the breathing tubes. Then the air passages open and breathing becomes easier within minutes. They can also be used to prevent exercise induced asthma. Examples: Albuterol, Breathaire, Maxair, Proventil, Ventolin, Xopenex
Caution: Rescue/reliever (bronchodialator) medications do not reduce inflammation or swelling of the breathing tubes.
If you need to use symptom-relieving medications often (more than twice a week), the underlying inflammation is not controlled. Ask your doctor about how to get the inflammation under control. Other than mild, occasional asthma, it is important to treat the underlying inflammation in addition to relieving the asthma symptoms.
Possible side effects: rapid heart rate, tremors, nervousness and headache
These side effects are usually very minor and decrease over time as your body gets used to the medication.
Primatene Mist (inhaled epinephrine) is not recommended since it has more side effects and is less effective than other symptom relieving medications.
These medications reduce the inflammation that causes an asthma flare-up. Examples: Orapred, Pediapred, Prednisone, Prelone
*These corticosteroids are not the same as the anabolic steroids misused by athletes.
Use: Oral corticosteroids may be used for several days to reverse a moderate to severe asthma flare-up. This is referred to as a “short burst” of corticosteroids.
CAUTION: It can take several hours to several days for an oral corticosteroid to reverse an asthma flare-up. Use your rescue/reliever treatment medication to help the asthma symptoms until the underlying inflammation is reversed.
Possible side effects:
Mood changes, increased appetite (Most of these side effects go away after the medication is stopped.)
Oral corticosteroids taken for more than 10 days can have more severe side effects and risks. Do not take an oral corticosteroid for longer than 10 days unless directed by your doctor. Because of these risks, oral corticosteroids
should NEVER be first line treatment!
How To Take Asthma Medications
Inhaled medications go directly to the lungs. They give you the most benefit with the least side effects. There are several ways to take inhaled medications.
Metered dose inhalers (MDI) deliver the medication as a spray. Metered dose inhalers are sometimes called “inhalers,” “puffers” or “spray.”
Possible side effects: Spacer devices (or holding chambers) can be used with most metered dose inhalers. With a spacer, more medication goes directly into the lungs and less gets in the mouth and throat. Less coordination is needed. Examples: Aerochamber, EZ Vent, InspirEase
Dry powder inhalers allow you to inhale the medication as a dry powder. To use them you need to suck air in rapidly. Nebulizers deliver the medication as a fine mist. It takes about 15 minutes to give a nebulizer treatment.
How to use a metered dose inhaler with spacer/holding chamber
Inhalers need to be used correctly to work. Ask your doctor, nurse, respiratory therapist, or pharmacist to check the way you use inhalers.
Follow these steps:
1. Sit or stand upright.
2. Take cap off. Shake the inhaler well and insert into the spacer/holding
chamber device. Hold upright.
3. Breathe out normally.
4. Place the mouthpiece of the spacer/holding chamber into your mouth.
5. Press down on the canister (releasing 1 puff of medication only).
6. Breathe in slowly and deeply. Fill your lungs with as much air as possible.
Your spacer/holding chamber should not make a noise.
7. Hold your breath and count to 10.
8. Breathe out slowly.
9. Wait 1 minute before taking the next puff.
10. When you are done, be sure to replace the protective cap on the
mouthpiece of the inhaler.
11. Rinse your mouth and spit after using an inhaled corticosteroid.
12. Wash spacer/holding chamber and MDI boot weekly with a mild soap
and water (e.g, Joy), rinse well and allow to dry.
You should be prescribed and use a spacer/holding chamber with a mask or a metered dose inhaler without a spacer. Please be sure your health care provider has instructed you on proper use. Review use with your doctor.
How many puffs are left?
A metered does, an inhalation device which uses a propellant under pressure to push the medicine out, may discharge propellant even when there is no medication left. To find out when your inhaler will be out of medication, divide the number of puffs used each day by the number of puffs in the canister. This will give you the number of days the medication will last. Mark this day on your calendar. When this day comes, replace your inhaler.
Inhaler = # of puffs
Aerobid = 100
Albuterol = 200
Azmacort = 240
Maxair = 200
Tilade = 112
Qvar = 100
Beclovent = 200
Flovent = 120
Intal = 200
Another method is to make a check mark each time you take a puff. When the number of check marks equals the number of puffs in your inhaler, your inhaler is empty. It is a good practice to reorder when there are 6-8 doses remaining to avoid running out completely.
THE PEAK FLOW METER (A WARNING TOOL)
The peak flow meter measures how closed or opened your breathing tubes are. The higher the peak flow, the more open your breathing tubes. A lower than usual peak flow means your breathing tubes are closing down. However, if you don’t coordinate or try hard, your peak flow will also be lower.
The peak flow meter works in a very simple way. If the breathing tubes are open, you can blow out hard. If the breathing tubes are closing down, you cannot blow out with as much force. The peak flow meter measures the force used to blow out.
WARNING: Different peak flow meters may give different results, so always use the same meter. It is best to bring your own peak flow meter when you need to go to the doctor or hospital.
The peak flow meter is an early warning tool. Your peak flow may go down before there is any coughing, wheezing or chest tightness.
Who can use a peak flow meter?
Anyone over age 5 can use a peak flow meter. Ask your doctor how to get a peak flow meter for yourself. Ask your doctor, nurse, respiratory therapist, or pharmacist to check how well you use the peak flow meter.
When should you measure a peak flow?
Ideally, the peak flow should be checked once a day to get the earliest clue to an asthma flare-up. Be sure to check the peak flow more often if you get a cold or have a runny nose, coughing or wheezing.
How to use the peak flow meter:
1. Stand up straight and place the mouthpiece of the flow meter in your mouth. Be sure that the indicator is at the bottom of the scale.
2. Breathe in as much air as your lungs will hold.
3. Then huff out ( a quick forceful exhalation) as hard and fast as you can.
4. Repeat these steps 3 times, using the highest of the 3 readings as the peak flow rate.
5. Take peak flow readings once a day for 2 weeks “when you are well”
to find your personal best peak flow rate.
My personal best peak flow rate is_______________________.
(The best peak flow usually occurs between 2 and 4 p.m.)
The amount of medication needed to keep asthma in control depends on how severe it is. Discuss with your doctor the specific medication plan for you.
Types of Asthma:
Mild, Intermittent - Your asthma is intermittent if you can go for long periods of time without symptoms. You do not need controller medications.
Persistent - Your asthma is persistent if you have asthma symptoms more than twice a week for daytime symptoms and more than twice a month for nighttime symptoms. If you use more than 2 canisters of reliever/rescue inhalers per year (unless using to prevent exercise induced asthma). You need controller medication. Anyone with asthma can get severe flare-ups. Please consult you doctor.
GOALS OF THERAPY
The amount of medication needed to keep asthma in control depends on how severe it is. Discuss with your doctor the specific medication plan for you. After following your plan for several weeks your asthma should meet these goals:
1. Minimal or no regular symptoms (cough, wheeze, chest tightness, shortness of breath) day or night.
2. Minimal or no exacerbations.
3. No limitations on activities; no school or work missed.
4. Maintain near normal peak flow rates.
5. Minimal use of your reliever inhaler.
6. Minimal or no side effects from medications.
*If these goals are not met, see your doctor to find out why.
Possible reasons for not meeting asthma management goals:
You have an asthma trigger in the house; You have an infection; You are not using your inhaler correctly; You need more controller medication
ASTHMA SELF-CARE PLAN
How Do I Control My Asthma?
Green, Yellow, and Red Zone Management Plans
Your asthma does not stay the same all the time. Sometimes it will be better and sometimes it will be worse. Working with your doctor, you can have a plan for when you are well (Green Zone), are having a mild flare-up (Yellow Zone), or are starting to have a severe flare-up (Red Zone).
Ask your doctor for a written asthma self-care plan.
Green Zone (Asthma that is well-controlled):
You should be in the Green Zone all the time. Take the daily controller medication suggested by your doctor. In the green zone, you are able to do normal, usual activities. You are sleeping all night and not waking due to asthma more than two times per month. Your asthma bothers you no more than two times a week.
My Green Zone peak flow is more than ___________.
My Green Zone plan is: ________________________________________
Yellow Zone (Caution: a flare-up is starting):
Increased coughing, wheezing and shortness of breath are symptoms in the Yellow Zone. Waking due to asthma more than twice a month is also a symptom.
Start the Yellow Zone plan that you and your doctor have agreed on that is written on your asthma self-care plan. You may start using symptom relieving medication (bronchodialator) as well as taking more controller
medication (inhaled anti-inflammatory).
If you are stuck in the Yellow Zone for more than 2-3 days, call your doctor. If you are in the Yellow Zone more than twice a week on a regular basis, your asthma is not controlled. Contact your doctor.
My Yellow Zone peak flow is from __________ to __________.
My Yellow Zone plan is: ________________________________________
Red Zone (Danger: a flare-up is in progress):
You may have continuous coughing, wheezing, chest tightness or fast breathing. Response to medications or treatment may be poor or short-lived. You may be waking frequently due to asthma. A severe flare-up has begun.
Start the Red Zone plan suggested by your doctor that is written on your asthma self-care plan. Call your doctor for a severe flare-up. For severe
distress, call 911.
My Red Zone peak flow is less than ___________.
My Red Zone plan is: ___________________________________________
FREQUENTLY ASKED QUESTIONS
Q. Can I die of asthma?
A. Yes, but deaths due to asthma are very uncommon. The most common concerns are poor quality-of-life, and the risk of lung damage from poorly controlled asthma. Follow your asthma action plan carefully to minimize all these risks.
Q. Is asthma psychosomatic, (an emotional problem)?
A. No, but stress can aggravate asthma and make it harder to treat.
Q. Why did the doctor prescribe a steroid?
A. The steroids used to prevent asthma are corticosteroids, which are not the same as the steroids used to enhance athletic performance. They are medications that have been proven safe, effective and powerful enough to control inflammation (swelling) in the airways of an asthmatic.
Q. Why is my asthma not well controlled?
1. You are not taking your medications correctly, “maintenance” medicine.
2. You have severe triggers:
• Gastroesophageal acid reflux (GERD)
• Underling respiratory infection
• Severe allergen exposure
• Environmental factors (i.e. cigarette smoke)
3. Consider other diagnosis; consult with your doctor.
National & Regional Organizations
Asthma and Allergy Foundation of America
(800) 727-8462 www.aafa.org
Allergy and Asthma Network/Mothers of Asthmatics, Inc.
(800) 878-4403 www.aanma.org
American Academy of Allergy, Asthma & Immunology
(800) 822-2762 www.aaaai.org
BREATHE California of Los Angeles County
(323) 935-8050 www.breathela.org
National Heart, Lung & Blood Institute
Long Beach Alliance for Children with Asthma
(562) 427-4249 www.lbaca.org
South Coast Air Quality Management District (SCAQMD)
Asthma & Outdoor Air Quality Consortium
(909) 396-2582 www.aqmd.gov
Asthma and Allergy Foundation of America - So. CA Chapter
(800) 624-0044 www.aafa-ca.org
Environmental Protection Agency/Asthma & Indoor Env.
(202) 343-9370 www.epa.gov/asthma
Los Angeles County
Citrus Valley Medical Center – Covina, CA
(626) 915-6283 - Nancy Anderson
Community Medical Center
Agoura Hills - (818) 707-9603, ext. 1250 - Nora Hayes
Simi Valley - (818) 707-9603, ext. 1250
West Hills - (818) 707-9603, ext. 1250
Kaiser Permanente Medical Center Asthma Centers*
*automated appointments for Kaiser Permanente members
Downey - (562) 657-2236
South Bay - (310) 517-3236
Los Angeles - (323) 783-4472
Panorama City - (818) 375-4474
Molina Health Care – Breathe With Ease
(800) 526-8196, ext. 126137
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