US Pharm. 2012;37(7):17-18.
Reactive Airway Disease
Asthma is a disease of the lungs caused by inflammation
and narrowing of the airways, which results in symptoms of shortness of
breath, coughing, wheezing, and a burning or tight sensation in the
throat or chest. Asthma is sometimes referred to as “reactive airway
disease” because it responds to certain triggers (e.g., allergies, upper
respiratory tract infections, drugs, exercise), causing the muscles
around the airways to tighten and making it even more difficult to
breathe. Excess mucus production and cough are also common problems.
Asthma can be diagnosed using the history of symptoms
along with a physical examination and breathing test (spirometry).
Spirometry testing can compare how well the lungs work before and after
inhaling medicine that dilates (widens) the airways.
Although asthma is a chronic condition without a cure, it
can be controlled through proper diagnosis, avoiding triggers,
immunotherapy (allergy shots), and treatment with inhaled or oral
medication. If asthma is well controlled, it has little impact on
lifestyle. Uncontrolled or poorly treated asthma can seriously affect a
person’s well-being or even be fatal.
The proper maintenance medication will control asthma
symptoms over a long period of time. In addition, every patient with
asthma should have a personal action plan for treating symptom
flare-ups, including instructions on the use of a personal peak flow
meter as well as how and when to use inhaled and oral medications to
treat an acute asthma attack. When asthma symptoms are managed with
maintenance medications and acute flare-ups are treated early by
following an asthma action plan, the risk of serious complications is
Chronic But Manageable Respiratory Condition
Asthma is a common condition in the United States, with
more than 20 million sufferers. Symptoms are often noticed in early
childhood, although asthma can develop at any age. Those most likely to
develop asthma have a history of allergies or a family member with
asthma or allergies, known as atopic asthma. Occupational asthma
is caused by workplace hazards such as inhaled chemicals or dust. There
are also people who develop asthma symptoms during vigorous exercise, a
condition known as exercise-induced asthma. A person can have more than one cause or trigger for asthma symptoms.
Diagnosis and Spirometry Testing
Regardless of the cause, people with asthma share a common
problem—they have difficulty breathing as a result of reactive airways,
which tighten during an asthma attack due to inflammation and swelling
of the airway lining, and muscle reactivity, which narrows the airways
even further. Individual symptoms and triggers may vary, and as a
result, diagnosis can be difficult without further testing.
Asthma is diagnosed using a history of symptoms and their triggers, a physical examination, and spirometry testing. Spirometry
is a breathing test in which the patient blows as hard and as long as
possible into a tube connected to a computer. The test is repeated two
or three times to increase the accuracy of the readings. Spirometry
reveals the amount of air that can be forced out of the lungs and how
fast the air is pushed out. This test can be used for diagnosis and
monitoring asthma, as well as checking during office visits to see how
well asthma medications are working to improve breathing.
Asthma patients are often advised to use a pocket-sized version of the spirometer, called a peak flow meter,
to determine their personal best lung function at home. Three readings
on the peak flow meter, twice a day for several weeks, can be charted by
the patient and used to determine baseline breathing capacity. This
information is useful to monitor asthma during a flare-up. A peak flow
meter is an important part of an asthma action plan; it can alert
patients to begin early treatment of an asthma attack before symptoms
Maintenance and Rescue Medications
Medications used to treat asthma fall into two categories:
maintenance medications or quick-relief medicines. Maintenance
medications are taken every day to control asthma symptoms and avoid
flare-ups. These are long-acting medications that treat the inflammation
(corticosteroids), narrowing of airways (bronchodilators), or both.
They are available in inhaled or oral forms. They are not intended to
work during an acute asthma attack. Leukotriene inhibitors, another
category of oral medications, are also used to stop airway inflammation.
Quick-relief medications, sometimes called rescue medications,
are short-acting inhaled bronchodilators. These medications are
intended to work quickly when asthma symptoms worsen. They do not take
the place of maintenance medications. They should be carried at all
times by a patient with asthma, especially when away from home. They are
also used just prior to physical activity in people who have
Asthma is a life-long illness, but if managed properly, it
does not have to interfere with a normal life style. Staying healthy
with asthma means avoiding triggers known to worsen symptoms.
Maintenance medications should be taken as directed, an asthma action
plan should be followed when asthma symptoms worsen. Regular office
visits should be scheduled for accurate monitoring of asthma using
spirometry testing and adjustment of medications, if needed.
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