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    Asthma is a chronic condition that limits your ability to breathe. It affects the tubes that transport air to your lungs, collectively known as the “airways”. Asthma affects 20 million Americans and is the most common cause of chronic illness in children. Off the grid, increased stress and exposure to new substances will only makes things worse. The family medic must know how to recognize and treat symptoms with limited supplies.

    When people with asthma are exposed to a substance to which they are allergic (an “allergen”), airways become swollen, constricted, and filled with mucus. As a result, air can’t pass through to reach the part of the lungs that absorbs oxygen (the “alveoli”).

    During an episode of asthma, you will develop shortness of breath, tightness in your chest, and start to wheeze and cough. This is referred to as an “asthma attack”. In rare situations, the airways can become so constricted that a person could suffocate from lack of air.

    Here are common allergens that trigger an asthmatic attack:

    • Pet or wild animal dander
    • Dust or the excrement of dust mites
    • Mold and mildew
    • Smoke
    • Pollen
    • Severe stress
    • Pollutants in the air
    • Some medicines
    • Exercise

    Yes, you can trigger an asthmatic attack with exercise. This doesn’t mean you shouldn’t stay in shape. Exercise strengthens lungs, which helps improve asthma control.

    There are many other myths associated with asthma; the below are just some:

    Asthma is contagious. (False)

    You will grow out of it. (False; it might become dormant for a time but you are always at risk for it re-emerging.)

    It’s all in your mind. (False; although may trigger it, it’s very real.)

    If you move to a new area, your asthma will go away. (False; it may go away for a while, but eventually you will become sensitized to something else and it will likely return.)

    Asthma should only be treated when an episode occurs. (False; asthma is best treated with constant medication to reduce frequency and severity of attacks. Encourage your asthmatic group members to stockpile meds.)

    You will become addicted to your asthma meds. (False; inhalers and oral asthma drugs aren’t addictive. It’s safe to use them on a regular basis.)

    Here’s are two “true” myths: Asthma is, indeed, hereditary. If both parents have asthma, you have a 70% chance of developing it compared to only 6% if neither parent has it. Also, asthma does have the potential to be fatal, especially if you are over 65 years old.

    (Note: In the 1980s, I treated a pregnant patient who had the worse type of asthma attack, called “status asthmaticus.” Once she improved somewhat, she insisted on going home against my advice  to care for her other children. She returned that night in an irreversible state of oxygen loss. Both mother and baby perished.)

    PHYSICAL SIGNS AND SYMPTOMS OF ASTHMA

    Asthmatic symptoms may be different from attack to attack and from individual to individual. Some of the symptoms are also seen in heart conditions and other respiratory illnesses, so it’s important to make the right diagnosis. Symptoms may include:

    • Cough
    • Shortness of Breath
    • Wheezing (usually of sudden onset)
    • Chest tightness (sometimes confused with coronary artery spasms/heart attack)
    • Rapid pulse rate and respiration rate
    • Anxiety

    Besides these main symptoms, there are others that are signals of a life-threatening episode. If you notice that your patient has become “cyanotic”, they are in trouble. Someone with cyanosis will have a blue/gray color to their lips, fingertips, and face.

    Cyanosis

    You might also notice that it takes longer for an asthmatic to exhale than to inhale. As an asthma attack worsens, wheezing may take on a higher pitch. As the attack worsens, the patient suffers a lack of oxygen that makes them confused and drowsy; they may possibly lose consciousness.

    Asthma vs Heart Attack

    As an asthma attack may resemble a heart attack, the medic should know how to tell the difference. For Asthma is usually improved by using fast-acting inhalers, a strategy that doesn’t offer relief from a heart attack or other cardiac events. Cardiac patients often have swelling of the lower legs, also called “edema.” This is rarely seen with asthma. Asthmatic also don’t have arm and jaw pain that is often seen with heart attacks. Those with a history of cardiac chest pain improve with the angina drug nitroglycerin.

    Although both may be associated with shortness of breath, few will confuse the symptoms of COVID-19 with asthma, but suffice it to say that COVID-19 is associated with fever and loss of taste or smell.

    DIAGNOSING ASTHMA

    On physical exam, use your stethoscope to listen to the lungs on both sides. Make sure that you listen closely to the bottom, middle, and top lung areas as described in the section on physical exams.

    In a mild asthmatic attack, you will hear relatively loud, musical noises when the patient breathes. As the asthma worsens, less air is passing through the airways and the pitch of the wheezes will be higher and perhaps not as loud. If no air is passing through, you will hear nothing, not even when you ask the patient to inhale forcibly. This person may become cyanotic.

    typical peak flow meter

    Sometimes a person might become so anxious (a “panic attack”) that they become short of breath and may think they are having an asthma attack. To resolve this question, you can measure how open the airways are with a simple diagnostic instrument known as a peak flow meter. A peak flow meter measures the ability of your lungs to expel air, a major problem for an asthmatic. It can help you identify if a patient’s cough is part of an asthma attack or whether they are, instead, having a panic attack or other issue.

    To determine what is normal for a member of your group, you should first document a peak flow measurement when they are feeling well. Have your patient purse their lips over the mouthpiece of the peak flow meter and forcefully exhale into it. Now you know their baseline measurement. If they develop shortness of breath, have them blow into it again and compare readings.

    In moderate asthma, peak flow will be reduced 20-40%. Greater than 50% is a sign of a severe episode. In a non-asthma related cough or upper respiratory infection, peak flow measurements will be close to normal. The same goes for a panic attack; even though you may feel short of breath, your peak flow measurement is still about normal.

    TREATMENT OF ASTHMA

    Asthma bronchodilator in inhaler

    The cornerstones of asthma treatment are the avoidance of “trigger” allergens, as mentioned previously, and the maintenance of open airways. Medications come in one of two forms: drugs that give quick relief from an attack and drugs that control the frequency of asthmatic episodes over time. In panic attacks, however, these medicines are ineffective; treatment for anxiety is discussed elsewhere in this book.

    Quick relief asthma drugs include “bronchodilators” that open airways, such as Albuterol (Ventolin, Proventil), levalbuterol (Xopenex HFA), among others. These drugs should open airways in a very short period of time and give significant relief. These drugs are sometimes useful for people going into a situation where they know they will exposed to a trigger, such as before strenuous exercise. Don’t be surprised if you notice a rapid heart rate on these medications; it’s a common side effect.

    If you find yourself using quick-relief asthmatic medications more than twice a week, you are a candidate for daily control therapy. These drugs work, when taken daily, to decrease the number of episodes and are usually some form of inhaled steroid. There are long-acting bronchodilators as well, such as ipratropium bromide (Atrovent HFA). Another family of drugs known as Leukotriene modifiers prevents airway swelling before an asthma attack even begins. These are usually in pill form and may make sense for storage purposes. The most popular is Montelukast (Singulair).

    Often, medications will be used in combination, and you might find multiple medications in the same inhaler. The U.S. pharmaceutical Advair, for example, contains both a steroid and an airway dilator. Remember that inhalers lose potency over time. Expired inhalers, unlike many drugs in pill or capsule form, have less effect than fresh ones. Physicians are usually sympathetic to requests for extra prescriptions from their asthmatic patients.

    NATURAL TREATMENT OF ASTHMA

    Ginger

    In mild to moderate cases of asthma, you might consider the use of natural remedies. Some involve breathing exercises:

    Pursed-lip breathing: This slows your breathing and helps your lungs work better. Breathe in slowly through your nose for two seconds. Then position you lips as if you were whistling, and breathe out slowly through your mouth for four seconds.

    Abdominal breathing: Similar to pursed-lip breathing but focuses on using the diaphragm more effectively. With your hands on your belly, breathe as if you were filling it with air like a balloon. Press down lightly on the belly as you slowly exhale.

    There are also a number of substances that have been reported to be helpful:

    Ginger: A study published in the American Journal of Respiratory Cell and Molecular Biology indicates that ginger is instrumental in inhibiting chemicals that constrict airways. Animal tests find that extracts of ginger help ease asthmatic symptoms in rodents. Use as a tea or extract twice a day.

    Ginger and Garlic Tea: Add three or four minced garlic cloves in some ginger tea while it’s hot. Cool it down and drink twice a day. Some report a benefits from just the garlic.

    Other herbal teas are thought to help: Ephedra, Coltsfoot, Codonopsis, Butterbur, Nettle, Chamomile, and Rosemary all have been used in the past to relieve asthmatic attacks.

    Caffeine: Black unsweetened coffee and other caffeine-containing drinks may help open airways.  Don’t drink more than 12 ounces at a time, as coffee can dehydrate you. Interestingly, coffee is somewhat similar in chemical structure to the asthma drug Theophylline.

    Eucalyptus: Essential oil of eucalyptus, used in a steam or direct inhalation, may be helpful to open airways. Rub a few drops of oil between your hands and breathe in deeply. Alternatively, a few drops in some steaming water will be good respiratory therapy.

    Honey: Honey was used in the 19th century to treat asthmatic attacks. Breathe deeply from a jar of honey and look for improvement in a few minutes. To decrease the frequency of attacks, stir one teaspoon of honey in a twelve-ounce glass of water and drink it three times daily.

    Turmeric: Take one teaspoon of turmeric powder in 6-8 ounces of warm water three times a day.

    Mustard Oil Rub: Mix mustard oil with camphor and rub it on your chest and back. There are claims that it gives instant relief in some cases.

    Gingko Biloba leaf extract: Thought to decrease hypersensitivity in the lungs; not for people who are taking aspirin or ibuprofen daily, or anticoagulants like warfarin (Coumadin).

    Lobelia: Native Americans actually smoked(!) this herb as a treatment for asthma. Instead of smoking, try mixing tincture of lobelia with tincture of cayenne in a 3:1 ratio. Put 1 milliliter (about 20 drops) of this mixture in water at the start of an attack and repeat every thirty minutes or so

    Further research is necessary to determine the effectiveness that some of the above remedies have on severe asthma, so take standard medications if your peak flow reading is 60% or less than normal.

    Don’t underestimate the effect of diet on the course of asthma. Asthmatics should:

    • Replace animal proteins with plant proteins.
    • Increase intake of Omega-3 fatty acids and vitamin D.
    • Eliminate milk and other dairy products.
    • Eat organically whenever possible.
    • Eliminate trans-fats; use extra-virgin olive oil as your main cooking oil.
    • Always stay well-hydrated; more fluids will make your lung secretions less viscous.

    Finally, various relaxation methods, such as taught in Yoga classes, are thought to help promote well-being and control the panic response seen in asthmatic attacks. Acupuncture is thought by some to have some promise as well.

    I’m sure you have your own home remedy that might work to help asthmatics. If so, let us know!

    Joe Alton MD

    Dr. Alton

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