Asthma Inhalers

Asthma is a common disease, affecting millions of people in the United States. It is characterized by difficulty breathing, wheezing, cough, sputum production, and tightness in the chest. Asthma is caused by an inflammation of the airways which impedes airflow. This is usually triggered by allergens found in the house and outside such as dust mites and pollen. Exercise and drug side effects can also trigger asthma attacks. Asthma can be treated by both reliever and preventer (steroid) inhalers. Reliever inhalers are used to alleviate the symptoms during an asthma attack, whereas steroid inhalers - also known as Preventers - are taken daily to reduce the chances of an asthma attack occurring.

Genetics can make you more likely to develop asthma. However, regular exposure to allergens i.e. dust, cigarette smoke and certain workplace materials i.e. chemicals can cause the first symptoms of asthma, to develop. If you have asthma the exposure to certain allergens or situations may cause you to have an asthma attack or to experience asthmatic symptoms. Asthma triggers include:

• Animal dander or hair
• Dust mites
• Cockroaches
• Fungi
• Dust
• Viral infections affecting the lungs or throat
• Tobacco smoke
• Wood smoke
• Chemical irritants inc. pain and cleaning products
• Exercise
• Rapid breathing
• Cold, damp climate
• Hay Fever
• Certain types of eyedrops
• Emotional distress
• Stress

If you have had any of the following conditions, you may be more likely to experience asthma:

• Acid Reflux or Gastroesophageal reflux disease (GERD)
• Obesity
• Chronic sinusitis or rhinitis (inflammation of the sinuses or nose)
• Being born prematurely with underdeveloped lungs
• Having a mother who smoked whilst pregnant

Signs and symptoms of asthma include the following:

• Wheezing
• Coughing
• Shortness of breath
• Chest tightness/pain
• Blue lips
• Fast pulse
• Deep and labored breathing
• Trouble eating
• Trouble speaking in complete sentences due to breathlessness
• Feeling unable to lie down
• Agitation
• Using abdominal muscles to assist breathing
• Disorientation - this may happen as oxygen levels decrease

If someone experiences these symptoms, they may be having an asthma attack or there may be some other obstruction to their airway. If they are asthmatic, you should help them to take their inhaler. If they are not asthmatic or if their symptoms do not resolve, you should seek emergency medical attention.

A diagnosis of asthma is made after establishing the following:

• The patient has symptoms that suggest the airflow is temporarily obstructed
• The airflow obstruction and asthmatic symptoms are partially reversible, the patient does not experience the symptoms all the time
• Other conditions are excluded.

A doctor will ask the patient to describe their symptoms to establish if they correlate with the symptoms that would be expected in asthma. Following this, a spirometry test should be done to measure the change in airflow obstruction. Spirometry involves breathing into a tube before and after being given some medication to relax the airways.

Other tests may also be done to confirm an asthma diagnosis:

• A pulse oximetry device that clips onto the end of your finger is used to measure the oxygen in your blood. This is done to rule out a diagnosis of low blood oxygen in patients with acute asthma.
• A chest x-ray may be done to confirm an asthma diagnosis and to check for any other issues affecting the lungs and airway.
• FeNO testing measures exhaled nitric oxide, which is an indicator of inflammation and allergies.

Evidence suggests that asthma is increased in children who experience the following events:

• Certain infections, such as Mycobacterium tuberculosis, measles, or hepatitis A
• Living in suburban areas
• More frequent use of antibiotics, especially right after birth, although this may be due to respiratory infections
• Premature birth
• Maternal smoking and smoking in the household
• Lack of early exposure to oily fish
• Genetics- a child is six times more likely to get asthma if a parent has asthma
• Obesity and higher cholesterol although this may be due to the lack of exercise or steroid use
• Being of black or Hispanic race
• Boys are more prone to asthma than girls
• Skin allergies

The National Asthma Education and Prevention Program recommend that asthma is monitored closely. This is because asthma can vary over time. When you first start treatment for asthma, your doctor should follow-up with you every 2-6 weeks to ensure that your treatment is effective. After this, your doctor should follow-up with you every 1-6 months to check that you are on the best medication for you. In your follow-up appointments, your doctor will check that you understand the symptoms of an asthma attack, that you know how to avoid flare-ups and that you use your inhaler properly. They may also talk to you about controlling environmental factors that may trigger your asthma and changes to your treatment plan.

Asthma medication

Asthma is managed through medications that relieve or prevent asthma attacks. Often the first treatment you are prescribed will be a Reliever inhaler such as Ventolin or Salamol. This contains a bronchodilator, which means that it will widen and relax your airway when you take it. This is designed to be taken when you begin to experience asthmatic symptoms, as and when you need it.

Asthma is managed using a stepwise therapy method. This means that the first goal is to stabilize your symptoms. Then different medications can be added or removed and your dosages can be adjusted to the severity of your symptoms or to minimize any side effects.

If your asthma is more severe, or if you have been unable to manage your asthma using just Reliever inhalers, you may also be prescribed a Preventer inhaler. Preventer inhalers contain steroids, which help to protect you from an asthma attack occurring in the first place. Preventer inhalers should be taken daily to prevent asthma attacks.

If your asthma symptoms are not controlled by using both a Reliever and a Preventer inhaler, you may be prescribed a combination inhaler such as Seretide or Symbicort. These inhalers combine ingredients from Reliever inhalers and Preventer inhalers. They are also taken every day and they help to manage your asthma symptoms and to prevent asthma attacks.

Allergen avoidance

As part of your asthma treatment, it may be recommended that you avoid allergens that might trigger your asthma. Skin testing or lab tests should be done to assess your sensitivity to different allergens. This will help you to identify potential triggers and how you can avoid them. Some of the methods to avoid allergen exposure are listed here:

• Keeping a clean home to keep dust and other allergens under control
• Using air filters to remove allergens from the air
• Dehumidifiers and extractor fans can help to reduce mold growth
• Carpets can be replaced with hardwood or solid surface floors to reduce dust and dust mites
• Ensuring that chemicals such as cleaning products are used in well-ventilated areas.