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Asthma is a complex disease of the lungs that is marked by recurrent inflammation, increased mucus production, and narrowing of the airways. Close to 25 million people in the United States have asthma. While it can affect people of all ages, it is more common in children. Some of the symptoms are cough (especially in the night or early morning), shortness of breath or chest tightness, and wheezing.
Here in Arizona, many people may notice a spike in their asthma symptoms during monsoon season, during weather changes, and during high pollution advisory days. During our summers the hot temperatures can "trap" pollution making it harder for asthmatics to breath.
Over 60% of people with asthma will notice that their symptoms get worse when their allergies are also bad. Other common triggers to asthma include: pollution, smoke exposure, changes in the weather, colds or infections, and exercise.
Asthma can be diagnosed by the combination of taking a thorough history, a person's symptoms, pulmonary function testing (like spirometry), and by monitoring the lungs' response to the use of certain medications.
Asthma can be a serious condition, even life threatening, so it important that it is adequately treated under the care of a trained medical provider.
Asthma medications are divided into two categories: relievers and controllers. Relievers are used for asthma attacks and not for long-term treatment of the disease. Controllers are used to prevent asthma symptoms. For controllers to work properly, people with asthma have to use them consistently, even when feeling well.
Short-Acting Beta-Adrenergic Agonists
Short-acting beta-agonists (SABAs) such as albuterol can provide immediate symptom relief that lasts four to six hours. They do not decrease allergic inflammation but instead relax the muscles around the airway that tighten when an allergic person is exposed to an allergen or other asthma trigger. For people who rarely experience asthma attacks, SABAs may be used as the only medicine on an as-needed basis. People who are taking controller medicines often use SABAs for symptom relief.
Oral corticosteroids such as prednisone, methyl prednisolone, and dexamethasone are typically used to treat severe asthma attacks. People with very severe asthma may use corticosteroids as controller medications, taking them daily or every other day. When used long-term at high doses, oral corticosteroids can cause many side effects, including weight gain, high blood pressure, diabetes, brittle bones, thinning skin, muscle weakness, and cataracts. Doctors who treat people with severe asthma usually will use various combinations of medications to try to reduce the corticosteroid dose.
Inhaled corticosteroids are effective at improving quality of life and preventing severe asthma attacks in people with persistent asthma. These medications can sometimes cause yeast infections in the mouth. If given in very high doses for long periods, they may cause some of the side effects typical of oral corticosteroids, such as brittle bones and an increased risk of cataracts. People with moderate to severe asthma may take inhaled corticosteroids along with other drugs called long-acting beta-adrenergic agonists.
Leukotriene Receptor Antagonists and 5-Lipoxygenase Inhibitors
Leukotriene receptor antagonists (LTRAs) block the action of leukotrienes, chemical messengers involved in allergic reactions. They may be used alone to treat mild asthma or along with an inhaled corticosteroid to treat moderate asthma, as well as to treat allergic rhinitis. People who have both mild asthma and allergic rhinitis can take an LTRA to treat both conditions.
Long-Acting Beta-Adrenergic Agonists (LABAs)
This type of medication, like a short acting beta-agonists, helps to relax the muscles around the airway that tighten when a person is exposed to a trigger for their asthma. This medication helps to keep the airway open for longer than SABAs and are not approved for use for an asthma attack. LABAs are used to help control asthma when they are combined with other medications such as inhaled corticosteroids.
These medications are reserved for people with moderate to severe asthma which is not adequately controlled by inhaled steroids or inhaled steroid and LABA combinations. These medications are injectable and require coming in for an injection at 2-4 week intervals. They work by helping to inhibit or block some of the body's immune responses that contribute to inflammation in the lungs. This type of medication can significantly improve asthma symptoms and reduce the number of asthma flares and the use of high dose steroids.
When asthma is triggered by your allergies, allergy shots can help to control the symptoms of asthma by making you less allergic. Allergy shots contain tiny amounts of the things that you are allergic to, such as pollen, mold, or animal dander. The shots stimulate your immune system so you become less sensitive and your allergy and asthma symptoms improve. Allergy shots must be given in office of a medical provider and are followed by a mandatory 30 minute wait period. These shots are continued for 3-5 years for most people.
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