1. Asthma: The Basics Jim Krieger, MD, MPH February 19, 2008

2. Today’s Goal: Be able to answer the following questions: What are asthma symptoms? What is asthma? What happens in the lungs to cause asthma symptoms? What are asthma triggers? What is an allergen? What features of asthma make it a chronic disease? What are the most important things to do to control asthma? What should be expected if asthma is well controlled? What are the commonly used asthma medicines? How do they work? What are their side-effects?

3. Asthma is... chronic inflammatory disease of the airways an obstructive disease disease that may cause permanent changes (remodeling) if not properly treated cannot be cured, but can be controlled

4. Who Has Asthma? 17 million Americans More common among children, but affects all ages More common and severe among African Americans More severe among people with low incomes

5. What are the symptoms of asthma?

6. Symptoms Intermittent cough Wheeze Shortness of breath Chest tightness Waking at night  Waking at night with asthma symptoms is a key sign of uncontrolled asthma

7. Early Symptoms Coughing Irritability Restlessness Not sleeping well Feeling tired, low energy level Decreased exercise tolerance Dizziness, headache Feeling sick Itchy, watery eyes Hoarse voice Dry mouth, feeling thirsty Loss of appetite, stomachache Runny/stuffy nose Sneezing Itchy throat or tight chest

8. Late Symptoms Difficulty walking or talking Continuous wheeze or cough Persistent shortness of breath, even after medicine Skin cold and sweaty Pale skin/blue-gray color around lips Nostrils flaring Increased coughing interfering with breathing Retractions of the muscles in the neck and between ribs Breathing fast Grunting Stomach muscles tense

9. What causes these symptoms?

11. How asthma affects the lungs Narrowing of the airways  Inflammation of the airways swelling mucus  Airway muscles tighten Abnormally sensitive airways (hyper-responsive to triggers) Reversibility

14. What is a trigger?

15. Asthma triggers A substance or condition which can cause airway inflammation and/or airway constriction and bring on asthma symptoms Several types of triggers  allergens  irritants  emotions  other environmental conditions

16. What is an allergen?

17. Allergens A substance in the environment that:  when inhaled,  causes an immune reaction in the lungs, which,  causes swelling and mucus production

18. Asthma Triggers Allergens Dust mites Pollens Freshly cut grass Cockroaches Pets (proteins from cats, dogs, birds, rodents, etc.) Mice and rats Molds and mildew Foods (not common)

19. Asthma Triggers Exercise Viruses and colds Irritants  Tobacco smoke  Chemicals  Air pollution  Wood smoke  Perfumes, deodorants, air fresheners and strong odors Weather  Cold air  Dry air  Sudden weather changes Strong emotions with laughing, crying, anger or fear Heartburn

20. Is asthma an emotional disease?

21. Asthma and emotions Asthma is not an emotional disease: emotions do not cause asthma. But for some people with asthma, strong emotions like crying or laughing can set off an asthma attack.

22. What is a CHRONIC disease?

23. Asthma is a chronic disease  Always present, though symptoms come and go. There is NO cure.  Asthma stays in people’s lungs all the time and people have it for many years.  It is hard to predict if a child will “outgrow” asthma. The potential for symptoms to return is always present.  Asthma requires attention even when a person feels well.

24. What are the key things for controlling asthma?

25. Effective Control of Asthma Reduce exposure to triggers Use asthma medications regularly and as prescribed Monitor asthma and identify signs that it is worsening promptly Have a plan for what to do if the asthma gets worse Get regular follow-up medical care

26. Key Features of an Asthma Action Plan Written plan should be keyed to symptoms and should include:  Daily management as well as management for worsening symptoms  Medication names and dosing  When to call clinic  When to call 911 Use of PEFR monitoring is optional Make sure school/caretakers have copies

27. Asthma Action Plan Examples

28. What can be expected with a good asthma control? Be as physically active as anyone Go to school or work every day Be free of asthma symptoms like cough, wheezing and shortness of breath Sleep all night without being woken up by asthma problems Avoid asthma attacks and the need to go to the emergency department or hospital Minimal medication side effects

29. Medicines to Treat Asthma Medicines are very effective Two major types  Relievers (rescue) provide quick relief of symptoms relax and open the airway muscles take as needed to relieve symptoms  Controllers (daily preventive) prevent symptoms from happening decrease inflammation (mucus and swelling) take every day to prevent symptoms, EVEN IF FEELING WELL, just like a vitamin

30. Medicines to Treat Asthma: many ways to take them Inhalers  metered dose and dry powder types  spacers (chambers) make it easier to use metered dose inhalers Nebulizers Pills Liquids

33. Medicines: Steroids Side Effects Inhaled: Yeast infection of mouth, hoarseness, cough, but NO long-term effect on growth. Oral: Short-term: upset stomach, fluid retention, mood changes, increased appetite, high blood pressure Long-term: delayed growth, acne, weak bones, high blood pressure, weight gain, cataracts

34. Medicines:Beta 2 Agonists ( Bronchodilators ) Side Effects Shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache

35. Medicines: Mast Cell Stabilizers Side Effects Bad taste, cough (rare)

36. Medicines: Others Side Effects Theophylline: Upset stomach, diarrhea, fast heart beat, hyperactivity, headache, dizziness, muscle cramps, shakiness, sleep problems Leukotriene Blockers: Generally well tolerated with occasional headaches

37. Medicines: Warning! Now you know a lot about them NEVER give advice about changing them!!! If you have questions about a medicine a client is using, ask the CAN.