The best way to manage your asthma is to avoid triggers that aggravate or cause your symptoms.
Avoidance is the most effective way to manage allergic asthma.
If you are allergic to airborne pollens and molds, use air conditioning in your home, your car, and at work. Keeping doors and windows closed also is an effective way to keep out airborne pollens and molds. Dry your laundry inside during pollination times. Clean up areas of obvious mold growth. Consider a dehumidifier for damp basements. If you have seasonal allergic asthma, it may help to leave the geographic area during the allergy season. For example, if you are allergic to ragweed, consider going to places such as the Rocky Mountains or northern Minnesota during the ragweed season.
If you are pet allergic, removing them from your home and cleaning the house thoroughly may give complete relief of symptoms. If you decide to keep your furry pets, wash them weekly. After washing your cat once a week for several weeks, you may reduce the amount of its allergen that floats in the air (airborne allergen). A special filter such as a HEPA can reduce the dander level in the air. Keep your pets outside as much as possible. Do not let them on your bed or even in your bedroom. Also, keep them out of other rooms in which you spend a lot of time. If you are allergic to animals, do not buy furniture or rugs that are made with animal hair.
For dust mite allergy, encase the mattresses and pillows in allergy control barriers, wash the blankets and sheets weekly, and keep the humidity down. Have the bedroom out of the basement and have smooth floors where possible. If you are allergic to cockroaches, use a roach control method to rid your home of these pests.
If you have chronic asthma, avoid irritants such as dust, smoke, and cold air. Obviously, you cannot completely avoid all irritants, but you can take precautions.
Do not smoke. Try to avoid smoke-filled surroundings. Being in an enclosed space with a smoker can trigger asthmatic symptoms. Make sure your hobbies are not contributing to asthma symptoms. Paint fumes, wood dusts, paint removers and similar irritants can make asthma symptoms worse. Remodeling a room in a house can increase symptoms of asthma due to the presence of these irritants and others, such as dust. If you have a forced-air furnace and are allergic to dust, use a filter for dust control and change it frequently. Avoid doing work that creates dust or working in a dusty environment. Wear a dust mask when it is impossible to avoid being exposed to dust. In cold temperatures, use a cold-air mask that covers your mouth and nose. Avoid smoke of all types: tobacco smoke, smoke from burning leaves, burning rubbish and wood stoves. Smoke of any kind irritates the eyes, nose, and bronchial tubes.
Moving To A Different Climate
Most people with asthma will not be helped by moving to a different climate.
Adopt A Healthy Lifestyle
When possible, reduce tension and fatigue. Although the effects of fatigue and tension on asthma vary from person to person, both can increase the effects of other factors on asthma. Eat nutritious meals, drink adequate water, and get adequate sleep. Balance work and relaxation.
Exercise may aggravate asthma symptoms, but symptoms can be controlled by proper preparation and pre-medication. In fact, a number of Olympic athletes with asthma compete regularly and have won gold medals!
Benefits of regular exercise include:
- Reduced chance of further exercise-induced asthma
- Increased sense of well-being
- Improved exercise tolerance and endurance
- Improved quality of life
If medications are needed to help you manage your asthma, your Dakota Allergy & Asthma allergist will help you decide what is best for you. There are many different medications available, and the type prescribed will depend on the severity of your asthma.
Some asthma medications can provide quick relief during an asthma attack by relaxing airway muscles to allow more normal breathing. This is the primary form of reliever called bronchodilator.
Other asthma medications are taken regularly to prevent or reduce inflammation and excessive mucus production and are called controllers. They are generally anti-inflammatory medications and need to be taken regularly even if you do not have symptoms.
Children or adults unable to use an inhaler are often treated with a nebulizer. This is a device that vaporizes liquid medication into a fine mist that can be inhaled through a mouthpiece or mask. Less commonly, other forms of medication are used, such as capsules of dry powder for inhalation.
Note: Never discontinue or cut back on your medications without first discussing it with us. To best manage your asthma, you will want to follow the plan we have devised for you.
New Preventative Controller Treatments
The asthma controller XOLAIR®, also known as anti-IgE therapy, has been a success with many severe allergic asthmatics. It is given every 2 to 4 weeks as a shot to decrease the allergy antibodies, thus reducing the subsequent allergy and asthma reactions when one is exposed to the allergy. This reduces symptoms, hospitalizations and medication.
Patients with persistent asthma should use a controller medication every day, and the most effective controllers are inhaled corticosteroids. These agents should be taken regularly to control airway inflammation and can be adjusted based upon asthma severity. While any of the controllers can be chosen for mild persistent asthma, inhaled corticosteroids are the treatment of choice for moderate and severe persistent asthma. Inhaled corticosteroids can be used with a second controller such as an inhaled long acting bronchodilator. Some patients with severe asthma may require three controller agents.
Other controllers can be prescribed in mild persistent asthma as single agents, or as adjunctive agents in moderate and severe persistent asthma. These non-steroid controllers include:
- Cromolyn (Intal®)
- Salmeterol (Serevent®)
- Theophylline, leukotriene receptor antagonists-zafirlukast (Accolate®) and montelukast (Singulair®),
- Leukotriene formation inhibitor: Zileuton (Zyflo®)
- Omalizumab (Xolair®)
- Allergen-specific immunotherapy (Allergy Shots, drops)
Note: Some patients with severe asthma require the continuous (daily or alternate day) use of oral corticosteroids. The dose of corticosteroids must be individualized balancing the need for asthma control with the risk of corticosteroid-induced adverse effects.
Corticosteroids reduce inflammation and swelling of the bronchial tube lining, and they can be life saving. Corticosteroid medications can be given by inhalation, pill, intramuscular injection or through a vein (IV).
Six types of synthetic corticosteroids are inhaled as sprays:
- Budesonide (Pulmicort®)
- Fluticasone (Flovent®)
- Mometasone (Asmanex®)
- Beclomethasone (Vanceril®, Qvar® or Beclovent®)
- Triamcinolone (Azmacort®)
- Flunisolide (AeroBid®)
These sprays provide the benefits of corticosteroids with less serious side effects.
Occasional side effects include:
- Mouth and throat irritation
- Thrush (a yeast infection in the mouth or throat)
You can decrease the chance of getting thrush by using a spacer and/or by gargling and rinsing your mouth with water after using these aerosols. Generally, aerosol corticosteroids are considered safer than corticosteroid pills or injections, however, if you are using high doses of inhalant we may discuss the risks and benefits with you.
Corticosteroid sprays are not bronchodilators and will not give immediate relief in an acute asthma attack. Their effect on the bronchial tubes comes about more slowly and helps to prevent future asthma attacks. It is important to take these sprays on a regular basis. Medications available to be taken by mouth include:
- Dexamethasone (Decadron®)
- Triamcinalone (Aristocort®)
- Methylprednisolone (Medro®l)
While corticosteroids taken in pill or injection form are effective in reversing severe asthma, they may cause significant side effects. Side effects from long-term systemic use may include:
- Round face, thin skin, easy bruising, weight gain, increased appetite
- Increased facial and body hair growth
- Suppression (shrinking) of the adrenal and pituitary glands
- Cataracts, increased risk of infection, high blood pressure, diabetes
- Weakening of the bones (osteoporosis), slowing of growth in children
- Sleep disturbances and emotional problems
- A form of arthritis of the hips (avascular necrosis)
Discuss the use of these medications with your physician. Inhaled corticosteroids generally do not cause these side effects at usual doses
Cromolyn and Nedocromil
Cromolyn (Intal®) [and now off the market nedocromil (Tilade®)] are other anti-inflammatory drugs that help prevent narrowing of the bronchial tubes in people with allergic asthma and exercise-induced asthma. They can be inhaled through the mouth and work best if used before exposure to allergens or exercise. These drugs are not bronchodilators and will not help an asthma attack once it is in progress. Cromolyn and nedocromil seldom have side effects.
Leukotriene Modifying Agents
These medicines are taken by mouth and can decrease the number of asthma symptoms if used regularly. They decrease the effects of special messengers called leukotrienes. Singulair® and Accolate® are most often used and help with exercise-induced asthma as well as normal asthma and are both generic. Zileuton (Xyflo) is another type.
Long Acting Bronchodilators
There are two families of these medications. Theophylline is given by mouth and helps open the bronchial tubes for many hours. The beta-agonists such as Serevent and Foradil are inhaled and last 12 hours. (Included in the medications Advair, Dulera, and Symbicort). Short-acting relievers are used with these drugs as needed.
Allergy immunotherapy is also called desensitization, hyposensitization or allergy shots. It is a form of treatment that can make you less sensitive to allergens. It is helpful for allergic asthma and allergic rhinitis, especially for allergies to trees, grasses, weeds, cats, and dust mites. It can also help with mold or dog allergies. It is generally not helpful for nonallergic asthma, rhinitis or nasal polyps.
Allergy immunotherapy involves regular injections of the allergen(s) to which you are allergic. The injections start with a small dose once or twice weekly and gradually increase to the maximum dose determined by your allergist. Then the injections are extended gradually to monthly doses and continue year-round.
Approximately 70 to 80 percent of people who have allergic asthma or allergic rhinitis benefit from allergy shots. The inconvenience and expense of going to the doctor for immunotherapy must be balanced against the severity of the symptoms, the cost of the other drugs, and the side effects of these other medications.
While it is uncommon, you can have an allergic reaction to the allergy immunotherapy injections. Life-threatening reactions and deaths have occurred, but are extremely rare. You will be asked to wait in your physician's office for 30 minutes following an injection so that if a reaction occurs, it can be properly treated.
After five years, if these injections provide relief from allergy symptoms, consideration can be given to stopping the injections. Most patients continue to enjoy relief for years after stopping the injections. If no benefit is seen after a year, a reevaluation of this therapy is suggested.
Allergy drops are starting to be used to help control asthma. Only some allergy triggers can be helped by them, so be sure to discuss shots vs. drops with your asthma triggers.
Many other therapies for asthma are under extensive study. Ask us about new treatment options for to treat your asthma.
Bronchodilators open up the bronchial tubes and relax muscle spasms in the walls of the tubes. The main types of short acting bronchodilators are beta agonists and anticholinergic medications.
Beta agonist bronchodilators, also know as adrenergic agents, stimulate the nervous system. Recent studies suggest that, with mild asthma, these drugs should be used only as needed, although sometimes regular use is necessary.
Some Types Over The Years Included:
- Albuterol (Ventolin®, ProAir®, Proventil®)
- Metaproterenol (Alupent®, Metaprel®)
- Terbutaline sulfate (Brethaire®)
- Isoetharine (Bronkometer®)
- Bitolterol (Tornalate®)
- Pirbuterol (Maxair®)
- Epinephrine (Primatene®)
Inhaled beta-agonist bronchodilators should not be needed more than four times a day, two puffs each time. Additional use suggests that your asthma is not adequately controlled. This can be unhealthy. If you need to use these inhalers more often, follow your action plan or call Dakota Allergy & Asthma. Another type of medication may be needed to control your asthma symptoms.
Some side effects you may experience while using beta-agonist medications are:
- Restlessness or tremor (shaking)
- Palpitations (prominent or rapid heart beat)
- Throat irritation
Call us if you experience increased or prolonged side effects.
Anticholinergic medications open the airways by blocking cholinergic nerve impulses. Ipratropium bromide aerosol alone (Atrovent®) or with albuterol (Combivent®) is often used for maintenance treatment of bronchospasm in chronic obstructive pulmonary disease. This medication lasts three to six hours and is helpful for some people with asthma. The most common side effect is a dry mouth. It can aggravate glaucoma if sprayed in the eyes.
A short burst of an oral corticosteroid such as prednisone is often used to help relieve worsening of asthma in conjunction with the short acting bronchodilators (albuterol). Typically, this will be for five days. Your action plan may tell you to start this in certain circumstances. As there are many possible side effects, it is limited to only short bursts when truly needed.
Emergency treatment may not be limited to the above medications. Home emergency kits may include adrenaline in injection form, such as Epi-Pen Auto-Injector.