Living the Life with Asthma
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Author: Megan Wong
December 7, 2010

Abstract:
This report will summarize the basic information of asthma and what many people do not know what others who have this disease are living through.

Introduction:
Over 20 million Americans suffer from the disease, Asthma and I am one of them.
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I was interested in studying and researching asthma because I have been a carrier of this disease since I was 7 years old and yet to have grown out of it. I have grown up playing sports at a competitive level all my life and asthma has affected me in many occasions, mainly playing soccer. Not only do I have asthma, but I also have allergies. I am allergic to corn, peanuts, horses, cats, dogs, grass, and weeds.
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According to the article that I found on Google Health....
Overview
Asthma is inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.
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Causes
Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swell. This reduces the amount of air that can pass by, and can lead to wheezing sounds. Most people with asthma have wheezing attacks separated by symptom-free periods. Some patients have long-term shortness of breath with episodes of increased shortness of breath. In others, a cough may be the main symptom. Asthma attacks can last minutes to days and can become dangerous if the airflow becomes severely restricted. In sensitive individuals, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).
Common asthma triggers include:
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  • Animals (pet hair or dander)
  • Dust
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Exercise
  • Mold
  • Pollen
  • Respiratory infections, such as the common cold
  • Strong emotions (stress)
  • Tobacco smoke
Many people with asthma have an individual or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.
Symptoms
  • Cough with or without sputum (phlegm) production
  • Pulling in of the skin between the ribs when breathing (intercostal retractions)
  • Shortness of breath that gets worse with exercise or activity
  • Wheezing
    • Comes in episodes
    • May be worse at night or in early morning
    • May go away on its own
    • Gets better when using drugs that open the airways (bronchodilators)
    • Gets worse when breathing in cold air
    • Gets worse with exercise
    • Gets worse with heartburn (reflux)
    • Usually begins suddenly
Emergency symptoms:
  • Bluish color to the lips and face
  • Decreased level of alertness such as severe drowsiness or confusion, during an asthma attack
  • Extreme difficulty breathing
  • Rapid pulse
  • Severe anxiety due to shortness of breath
  • Sweating
Additional symptoms that may be associated with this disease:
  • Abnormal breathing pattern --breathing out takes more than twice as long as breathing in
  • Breathing temporarily stops
  • Chest pain
  • Nasal flaring
  • Tightness in the chest
Test & Diagnosis
Allergy testing may be helpful in identifying allergens in people with persistent asthma. Common allergens include pet dander, dust mites, cockroach allergens, molds, and pollens. Common respiratory irritants include tobacco smoke, pollution, and fumes from burning wood or gas.
The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard. However, lung sounds are usually normal between asthma episodes.
Tests may include:
  • Arterial blood gas
  • Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin)
  • Chest x-ray
  • Lung function tests
  • Peak flow measurements
Treatments
The goal of treatment is to avoid the substances that trigger your symptoms and to control airway inflammation. There are two basic kinds of medication for the treatment of asthma:
  • Long-acting medications to prevent attacks
  • Quick-relief medications for use during attacks

Long-term control medications are used on a regular basis to prevent attacks, not to treat them. Such medicines include:
  • Inhaled corticosteroids (such as Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation
  • Leukotriene inhibitors (such as Singulair and Accolate)
  • Long-acting bronchodilators (such as Serevent) help open airways
  • Omilizumab (Xolair), which blocks a pathway that the immune system uses to trigger asthma symptoms
  • Cromolyn sodium (Intal) or nedocromil sodium (Tilade)
  • Aminophylline or theophylline (not used as frequently as in the past)
  • Sometimes a single medication that combines steroids and bronchodilators are used (Advair, Symbicort)

Quick relief, or rescue, medications are used to relieve symptoms during an attack. These include:
  • Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, Xopenex, and others
  • Corticosteroids, such as methylprednisolone, may be given directly into a vein (intravenously), during a severe attack, along with other inhaled medications
People with mild asthma (infrequent attacks) may use quick relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms. A severe asthma attack requires a check up by a doctor and, possibly, a hospital stay, oxygen, and medications through a vein (IV).
A peak flow meter is a simple device to measure how quickly you can move air out of your lungs. It can help you see if an attack is coming, sometimes even before any symptoms appear. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of a specific person's best results are a sign of a moderate asthma attack, while values below 50% are a sign of a severe attack.
Prognosis
There is no cure for asthma, although symptoms sometimes improve over time. With proper self management and medical treatment, most people with asthma can lead normal lives.
Complications
The complications of asthma can be severe. Some include:
  • Death
  • Decreased ability to exercise and take part in other activities
  • Lack of sleep due to nighttime symptoms
  • Permanent changes in the function of the lungs
  • Persistent cough
  • Trouble breathing that requires breathing assistance (ventilator)
When to contact a doctor
Call for an appointment with your health care provider if asthma symptoms develop.
Call your health care provider or go to the emergency room if:
  • An asthma attack requires more medication than recommended
  • Symptoms get worse or do not improve with treatment
  • You have shortness of breath while talking
  • Your peak flow measurement is 50-80% of your personal best

Go to the emergency room if:
  • Drowsiness or confusion develops
  • There is severe shortness of breath at rest
  • The peak flow measurement is less than 50% of your personal best
  • You have severe chest pain
Preventions
1. Asthma symptoms can be substantially reduced by avoiding known triggers and substances that irritate the airways.
2. Bedding can be covered with "allergy proof" casings to reduce exposure to dust mites. Removing carpets from bedrooms and vacuuming regularly is also helpful. Detergents and cleaning materials in the home should be unscented.
3. Keeping humidity levels low and fixing leaks can reduce growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people.
4. If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the patient's bedroom. Filtering material can be placed over the heating outlets to trap animal dander.
5. Eliminating tobacco smoke from the home is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma symptoms.
6. Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes, as much as possible.

Inhalers
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It is normal clinical practice to administer combination inhalers twice (sometimes once) daily at a dose that is related to the severity of asthma and to use a short-acting β2-agonist (SABA), such as salbutamol, as required to relieve any breakthrough symptoms. Frequent use of the SABA indicates either poor compliance with inhaled corticosteroids or the need for a higher maintenance dose of the combination inhaler. A recent large global study involving 3,000 patients attempted to achieve better, and if possible total, control of asthma, by progressively increasing the dose of the controller inhaler. Control was more easily and rapidly achieved with the salmeterol/fluticasone combination inhaler than fluticasone alone and at a lower total dose of inhaled corticosteroid. However, some patients required rather high doses of the combination inhaler to achieve satisfactory control of their asthma and a proportion of patients had continuing symptoms despite maximum therapy (Barnes, 2007).

Cellular events in the bronchi in mild asthma and after bronchial provocation.


Scientists have undertaken detailed cellular and ultrastructural examination of bronchial biopsies and bronchial lavage fluid from allergic asthmatic patients in order to determine the nature and degree of the inflammatory processes in mild allergic asthma. Eight atopic asthmatic patients (mean PC20 histamine, 0.90 mg/ml) and four nonasthmatic control subjects underwent fiberoptic bronchoscopy. All asthmatic subjects were clinically stable for 2 wk prior to bronchoscopy and required either no treatment or inhaled albuterol alone. A single 50-ml bronchial wash was undertaken, followed by endobronchial biopsy of subcarinae. These procedures were repeated in the asthmatic subjects 18 h after bronchial provocation with allergen or methacholine. Subsequently, all subjects underwent bronchial reactivity testing with inhaled histamine. The clinical and physiologic data were not revealed to the pathologist interpreting the specimens. The asthmatic subjects shed a significantly greater number of epithelial cells into the lavage fluid than did the nonasthmatic subjects (7.23 versus 1.48 x 10(4)/ml, p = 0.048). There was a statistically significant inverse correlation between the lavage epithelial cell count and bronchial reactivity (rho = -0.64, p = 0.03). In the asthmatic subjects, but not in the control subjects, there was extensive deposition of collagen beneath the epithelial basement membrane, mast cell degranulation, and mucosal infiltration by eosinophils, which exhibited morphologic evidence of activation. Eosinophils, monocytes, and platelets were found in contact with the vascular endothelium, with emigration of eosinophils and monocytes in the asthmatic subjects. These changes were found irrespective of bronchial challenge with allergen. We conclude that allergic asthma is accompanied by extensive inflammatory changes in the airways, even in mild clinical and subclinical disease. (Beasley, R., et. al. 1989)
Many asthmatics may have bacterial infections in their lungs and a new study indicates that many patients with asthma may have bacterial infections in their lungs, and that treatment with antibiotics can improve their ability to breathe. Researchers at National Jewish Medical and Research Center report in the June issue of the journal Chest that 31 of 55 chronic, stable asthmatics showed evidence of infection with mycoplasma or chlamydia bacteria.After six weeks of treatment with the antibiotic clarithromycin, these patients demonstrated clinically significant improvements in their lung function (Allstetter, 2002).

In atopic asthma, activated T helper lymphocytes are present in bronchial-biopsy specimens and bronchoalveolar-lavage (BAL) fluid, and their production of cytokines may be important in the pathogenesis of this disorder. Different patterns of cytokine release are characteristic of certain subgroups of T helper cells, termed TH1and TH2, the former mediating delayed-type hypersensitivity and the latter mediating IgE synthesis and eosinophilia. The pattern of cytokine production in atopic asthma is unknown. (Robinson, 1992).





References

Allstetter, William. Many Asthmatics May Have Bacterial Infections In Lungs. Daily University Science News. June 2002. http://www.unisci.com/stories/20022/0611022.htm

Barnes, P.J., Scientific rationale for using a single inhaler for asthma control. 2007. European Respiratory Journal. Vol. 29, No. 3. p.587-595. http://erj.ersjournals.com/content/29/3/587.short
Beasley R, et.al. Cellular events in the bronchi in mild asthma and after bronchial provocation. [[file:///C:/Users/Wong/Documents/megan/micro references.docx|Am Rev Respir Dis.]] 139(3):806-17. 1989 Mar. http://www.ncbi.nlm.nih.gov/pubmed/2923380
National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publication 08-4051. www.google.com/health

Robinson , Douglas S., M.R.C.P.,et.al. Predominant TH2-like Bronchoalveolar T-Lymphocyte Population in Atopic Asthma. N Engl J Med 1992; 326:298-304January 30, 1992. http://www.nejm.org/doi/full/10.1056/NEJM199201303260504