Asthma, Part 1

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Asthma is a chronic condition that affects your ability to breathe. It affects the airways, which are the tubes that transport air to your lungs. When people with asthma are exposed to a substance that they are allergic to (an “allergen”), these airways become inflamed. As the airways become swollen, the diameter of the airway decreases and less air gets to the lungs.  As such, 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 oxygen.  This extreme condition is sometimes referred to as “Status Asthmaticus”. 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

There are many 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 returning)
  • ·         It’s all psychological (False)
  • ·         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)
Here’s a “true” myth: Asthma IS hereditary.  If both parents have asthma, you have a 70% chance of developing it compared to only 6% if neither parent has it.
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 sudden)
  • ·         Chest tightness (sometimes confused with coronary artery spasms)
  • ·         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 blue/gray color to their lips, fingertips, and face.  You might notice that it takes longer for them to exhale than to inhale. Their wheezing may take on a higher pitch. Once the patient has spent enough time without adequate oxygen, they will become confused, then drowsy, and then possibly lose consciousness.
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. In a mild asthmatic attack, you will hear relatively loud, musical noises when the patient breathes for you.  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 is in trouble.
To learn what wheezes sound like, search for this short YouTube video by a Dr. Solanki:
title:  Breath Sounds – Wheezes
Of course, there are a number of lab tests and X-rays that are useful to evaluate this condition, but they will likely be inaccessible in a major disaster or collapse.  This is why it is so important to learn basic physical examination skills now.
The cornerstones of asthma treatment are the avoidance of “trigger” allergens 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.
Quick relief drugs include inhalers that open airways (known as bronchodilators), such as Ventolin, Albuterol, and Proventil, among many 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 are 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 Atrovent.  Another family of drugs known as Leukotriene modifiers prevent airway swelling before an asthma attack even begins.  These are usually in pill form. Often, medications will be used in combination, and you might multiple medications in the same inhaler, such as Advair and Symbicort.
It’s important to figure out what allergens trigger your asthma attacks and work out a plan to avoid them as much as possible. Furthermore, make sure to stockpile as much of your asthma medication as possible in case of emergency.  Physicians are usually sympathetic to requests for extra prescriptions from their asthmatic patients.
Next time, we’ll talk about natural remedies to treat asthmatic conditions, as well as how to use a Peak Flow meter.
Dr. Bones

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Asthma, Part 2: Natural Remedies
Respiratory Infections, Part 2: Natural Remedies

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