Living (It Up) With Asthma

So how do you live it up with asthma? Isn't asthma that debilitating disease that keeps you locked up inside all the time and prevents you from having fun? Wrong!! Some of the most successful people from all walks of life have asthma, including Olympic Gold Medal winners and professional athletes. (Did you know Dennis Rodman has asthma? You may not want to be like Dennis, but he sure has his asthma licked.)There are a number of steps that YOU can take to get your asthma under control. That's right! I said "YOU"! YOU are responsible for controlling your asthma. Only YOU know what goals YOU want to achieve, so it's up to YOU to obtain the tools necessary to achieve them. You've already taken the first step by reading this. In the end, you should be more knowledgeable about your asthma than even your own doctor. After all, they're YOUR lungs! So let's take a look at what's necessary for you to be able to live (it up) with asthma! There are 4 components to asthma management:

1. Assessment and monitoring of lung function.
2. Avoidance and control of asthma triggers.
3. Pharmacotherapy (that's the medications).
4. Written asthma management plans.

• What is asthma?
• What happens during an asthma attack?
• What can trigger an asthma attack?
• What are my personal triggers?
• How do I control or avoid asthma triggers?
• What are my early warning signs?
• What do I do when my asthma starts to flare up?
• When do I call my doctor?
• What medications are available to treat asthma?
• What do each of my medications do?
• What are the potential side effects of my medications?
• How can I monitor my asthma at home?
• What is a peak flow meter and how can it help me?
• How do you use an inhaler properly?
• When should I stay home from work or school?

Your asthma specialist can help you with answering these. Only when you can start answering these questions can you start to live (it up) with asthma.

Assessment and Monitoring of Lung Function
Everyone being considered for a diagnosis of asthma should have pulmonary function testing. This is done using a machine called a spirometer into which you blow air. The spirometer measures the volume of air your lungs can hold, how much air you can blow out in one second, and how fast you can blow out the air. It should be measured at least once a year if you have persistent asthma.Many people with asthma benefit from a peak flow meter. A peak flow meter measures how fast you can blow air out of your lungs. It gives you a quick, accurate objective measurement of how your lungs are functioning at a given point in time. It's useful for a number of things, including measuring your response to medication, and measuring the severity of an asthma attack. It's very useful when communicating with your doctor.Another way of monitoring your asthma is to keep a symptom diary. Keeping track of the number of days you have symptoms, how often you wake up at night from asthma (an important measure of severity), and how often you need to take rescue medication to relieve asthma symptoms.It is important to bring these records with you to each doctor visit.

Avoidance and Control of Asthma Triggers
Avoiding or controlling exposure to asthma triggers is probably the best treatment of all. If it can't get to your lungs, it can't trigger your asthma! Obviously, some things are easier to avoid than others. Cigarette smoke and certain allergens such as animal dander may be relatively easy to avoid. Other triggers, such as upper respiratory infections and weather changes may be impossible to avoid. And still others, such as exercise, you may not want to avoid. It's important to know all of your triggers and take the necessary steps to control them. With proper avoidance/control, you can minimize the amount of medication you will need.Four out of five children and about half of adults with asthma have allergies. It is very important that anyone with persistent asthma get tested for allergies. There's no benefit in avoiding something you're not allergic to, and an allergist can educate you in how to control your exposure to the things you are. Also, a series of vaccinations (allergy shots) can be very helpful in selected patients with allergic asthma.Another important trigger is infections. Although infections are hard to avoid, every person with asthma should get a flu shot each fall. Uncontrolled asthma is often due to infected sinuses, and sometimes asthma won't clear up until antibiotic therapy is instituted.Exposure to cigarette smoke is an important asthma trigger, particularly for young children. There should never be any smoking in the home or car of someone with asthma, even when that person is not around.Certain medications, particularly aspirin and other NSAID's (ibuprofen, Advil, Motrin) after trigger asthma symptoms. Some heart and blood pressure medications, such as beta-blockers and ACE-inhibitors, are often not tolerated by asthmatic individuals.Finally, exercise is a trigger for most asthmatics. Increasing your exercise tolerance helps asthma, so it's not something you want to avoid. Most people can prevent symptoms by taking an inhaler such as albuterol (Proventil, Ventolin) or cromolyn (Intal) 10-30 minutes before exercise. This may be repeated in a couple of hours if the activity is prolonged and symptoms develop. If you have pollen or mold allergies, wearing a mask or moving indoors should help. Improving your physical conditioning will help also. Many great athletes have overcome asthma to be the best in their respective fields. You can too!

Pharmacotherapy
There are generally two classes of medications for asthma - preventive medicines, or controllers, and rescue medications, or relievers. It's important to know which medicines fall into which category and how each is intended for use.The most effective controller medicines are anti-inflammatory, ones that suppress inflammation in the airways. The best of these are the corticosteroids. Oral steroids (prednisone, Medrol) may be used in the most severe cases, but we prefer to use the inhaled steroids (Aerobid, Azmacort, Flovent, Pulmicort, Vanceril) for most patients because they are safer. A new class of anti-inflammatory drug has just been developed. These drugs are leukotriene-modifiers (Accolate, Singulair, Zyflo) and are not related to steroids. They are taken in pill form, and can be used alone or in combination with the inhaled steroids. Other anti-inflammatory drugs that can be helpful are cromolyn (Intal) and nedocromil (Tilade). These inhaled medications, aren't as strong as steroids, but often work in mildly asthmatic patients.Other controller medications are used primarily in conjunction with the above meds. Most notable are the long-acting bronchodilators (Serevent, Volmax, Proventil Repetabs). Theophylline also falls into this category.Controller medications are to be used every day even when symptoms are not present.The best reliever medicines are the short-acting bronchodilators, particularly the short-acting beta-agonists (albuterol, Proventil, Ventolin, Maxair). These are intended to provide immediate relief of symptoms, and are usually not to be taken unless symptoms are present. Sometimes prednisone will be given to provide relief of symptoms when these medicines are not effective.

A Brief Word on Inhaler Technique
When using inhalers, it is EXTREMELY IMPORTANT to use the proper technique. For some inhalers, only 10-15% of the medicine gets into the lungs, even when they are used correctly. Imagine how little gets there if you don't use the proper technique! Make sure a knowledgeable person reviews this with you. Many people benefit from spacers or holding chambers. These devices eliminate some of the coordination problems inherent in using an inhaler, particularly in children and the elderly. They also can improve the amount of medicine that gets into the lungs by as much as 50%, and they help reduce the side effects of some steroid inhalers

Written Management Plan
The final component of proper asthma management is having a written plan. You should really have two plans- one for long-term management and one for management of acute exacerbations. The long-term plan basically includes your medications, avoidance measures and monitoring instructions. The acute plan, or action plan, gives you step-by-step instructions in how to manage an exacerbation. It tells you when to take your rescue medication (how much and how often), when to increase your anti-inflammatory medicine, when to start oral steroids, when to call your doctor, and when to go to the hospital.An action plan often incorporates your peak flow readings or symptom diary into the steps. A traffic light system may be used in which Green means "Go" (80-100% of your best peak flow), Yellow means "Caution" (50 - 80% of best peak flow), and Red means "Stop" or "Danger" (less than 50% of best peak flow). Each zone has specific steps for you to take.It is important that your management plan be updated at each visit.

Now that YOU have the tools to manage YOUR asthma, let's see you LIVE IT UP!