By Adem Lewis / in /


Asthma is a condition in which the respiratory
system, particularly the lungs, becomes over reactive to the outside world. There’s really
no cure for asthma since asthma is an exaggeration of what the lungs are supposed to do. Everyone,
when they breathe in air that’s too cold or two smoggy or infected; everybody’s lungs
have a tendency to overreact to the outside world. It’s just that some people’s lungs
react too much. Your doctor can talk to you about other causes for asthma and treatment
options for asthma, but what I really want to talk about is what can trigger asthma.
Since there’s really no cause for asthma, what is critical is that the multiple triggers
for asthma are minimized. The number one trigger for asthma is colds
or infections. The number one trigger that will put people in the hospital or make them
go to the emergency room or make them end up on cortisone for asthma is getting a bad
cold. So, there are several issues with colds. Number one is don’t get sick. Hand washing
is important. Any child that’s in school; it’s very important that they wash their hands
before they eat and everyone needs to wash their hands a lot so they don’t get sick.
Once a cold starts however, asthma can take off aggressively. So, it’s very important
that medicines are started at the first sign of a cold if people have a history of asthma.
Even before the asthma symptoms start, we want to start asthma medicines as soon as
possible. Sometimes that will be a medicine like abuterol that will give immediate relief,
but other medicines we use are inhaled cortisone sprays such as Advair or Qvar or Flovent or
Pulmicort; these are medicines that won’t work immediately but if they’re started before
the asthma starts, can work very effectively at limiting or slowing down how long an asthma
attack can occur. Anybody with asthma needs flu shots in the fall at any age. And adults
who have asthma will frequently be recommended getting a pneumovax or a pneumonia shot. Second trigger for asthma is exercise. When
one exercises, the nose which usually filters the air, doesn’t have time to filter the air
and that unfiltered air gets down to the lungs and triggers the lungs to tighten up. On the
other hand, the most important thing that people can do who have asthma is to be able
to exercise. If, at any point, someone who has asthma cannot exercise on an ongoing basis,
it is critical that they talk to their doctor about being able to exercise appropriately.
Now, we’re not talking about when you have an acute asthma flare, you don’t want to exercise.
But if you find well, jeez, I can’t exercise because my asthma bothers me, you need a tune
up and you need to do something preventative. If you do indeed have exercise induced asthma,
using this medicine called albuterol is a very safe intervention and medicine to use
prior to exercising. Even if you exercise and have symptoms, if you’ve pre-dosed, it
would be okay to take the albuterol during or after exercise. If that does not help,
then you need to consult your doctor. Frequently, warming up before exercise, doing a slow lap
of swimming or running or jogging, can really make a difference in minimizing exercise induced
symptoms. Third trigger for asthma is stress. There’s
a direct connection between the brain and the lungs. And it’s very important that people
who have asthma have minimal amount of stress in their life, and guess what, the best way
to minimize stress is to be able to exercise appropriately. Very commonly, stress will
mask as asthma. And in order to determine whether people are having trouble breathing
because of stress or having an anxiety attack versus asthma, is there’s a meter called the
peak flow meter, and that can help distinguish between what is truly asthma and what is a
panic attack. In addition, it’s very important that if you’re taking care of an asthmatic
or an asthmatic child that you don’t make them more anxious. You need to know what to
do if, in the course of an asthma attack, the medicines that you’ve been recommended
don’t work. And what we recommend for that is a backup asthma plan. Everybody who has
asthma needs this backup plan in which you know what to do if the inhaler or the nebulizer
does not work. And most of the time in that bad situation we will recommend taking albuterol,
either by inhaler or nebulizer, up to every 15 to 20 minutes, three times. If that does
not work then you either need to go to an emergency room or urgent care or call your
doctor right away. It’s very important that we try and keep people out of the emergency
room or urgent care if possible because the stress or anxiety of being in the emergency
room for several hours can actually aggravate the attack. On the other hand, obviously,
if you can’t breathe, you have to go to the emergency room if this backup plan does not
work. Fourth trigger for asthma is what we call
irritations in the air. Anything you see or smell in the air that nose and lungs don’t
want — chemicals, cleaning fluids, smoke — need to be avoided, particularly if there’s
any active asthma happening. So, it’ just takes common sense that if you’re cleaning
the shower or you go to a place where there’s a fireplace smoke, that those areas are avoided
as much as possible. The fifth trigger for asthma is what we call
allergies. An allergy is when your body’s immune overreacts to biologic things in the
air such as pollen or dust or mold or animals. Most people ignore these things, but when
you have an allergy, your immune system, which lines your nose and lungs, will overreact
to these allergens and as a result, asthma can be flared. I’m not going to talk specifically
about what you can do with allergies, but you can certainly talk to your doctor about
that. One thing I will mention however is that most allergens will accumulate in bedding.
And anybody who has any sort of asthma needs to make sure that the pillows aren’t too old,
comforters are being washed regularly and that faces aren’t going into old couch pillows.
It’s also recommended for most people who have asthma to get special allergy covers
at least for the pillows. If needed, and you have ongoing asthma, you may want to come
see me as an allergist because we can do allergy testing to find out exactly what you’re allergic
to. The final trigger for asthma is what we call
acid reflux. Stomach acid belongs in the stomach and if it comes up and hits your esophagus,
you’ll get what we call heartburn which really isn’t heartburn, it’s esophagus burn. But
sometimes there is no heartburn, the stomach acid actually goes into your throat and you
inhale it into your lungs and that can aggravate asthma. If you have asthma that worsens after
eating or especially when you lie down at night, acid reflux may be playing a role in
all this. So, it’s very important that you may bring this up to your doctor because there
are very safe medicines for this acid reflux as well. One final note is that the medicines
we use for asthma are very, very safe. Many of these medicines have cortisone in them,
but they come in spray form. These cortisone sprays work like a shield of protection to
protect your lungs from reacting to pollens or dust or smoke or stomach acid or even infections.
And these medicines don’t do anything immediately, but they are the long-term treatment of choice
for asthma should environmental measures and infection control measures and other preventative
interventions fail.


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