Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Understanding and Controlling Asthma



Bronchial asthma is the number one cause of missed school and work in the United States. In some cases, it emotionally cripples both children and adults because of the poor control they feel over their lives. Today there are medications available which should allow all children and adults with asthma to lead full and normal lives, to avoid missed school and work, and to choose to participate in practically any activity or sport.

The definition of asthma is recurrent, reversible, obstructive airway disease or in simple terms a patient who wheezes or coughs repeatedly and responds to bronchodilator medication. In children, not every child who coughs repeatedly or wheezes has asthma but the great majority of kids do. Much new research points to the fact that asthma is a chronic inflammatory disease. Because of this recognition the therapy for asthma has changed dramatically in the past ten years. Whereas theophylline medicines were the first line treatment for asthma ten years ago, they are now third to fourth line therapy behind beta adrenergic (such as Ventolin, Proventil and Alupent) and anti-inflammatory medicines such as Cromolin and corticosteroids.

Even for a mild to moderate asthmatic patient it is preferable to treat them with inhalation therapy with anti-inflammatory medicines such as cromolin and inhaled corticosteroids and intermittent use of beta-adrenergics to control their cough and wheezing flare-ups. By keeping them on continuous inhalations on a daily basis of either Intal or corticosteroids sprays such as Beclovent, Vanceril, Azmacort and Aerobid it is possible to decrease the day to day and week to week coughing and wheezing and minimize the need to take beta-adrenergics. If the combination of these medicines does not control their asthma, then theophylline can be added as a fourth line medicine and even bursts of oral prednisone if need be. An exception to this is if a patient has very mild asthma with only once or twice a year coughing and wheezing, he can control it with simple theophylline therapy of which the main advantage is that it is cheap. In the past patients were treated mainly with medicines by mouth in America and only the most severe patients were placed on inhalation therapy. Now because of the realization of the safety and importance of using anti-inflammatory medicines and beta adrenergics we are using more inhalation treatments than ever. It is very important that they be used properly and if a machine such as a nebulizer is not used then a spacer device should be used with the hand held meter dose inhalers. An example of a spacer device would be an aerochamber. This increases the effectiveness of getting the medicine down into the lower airways dramatically. Numerous studies have shown this over the past few years. Using an inexpensive spacer device is especially important for school age children. Other new medicines which are on the horizon for treatment of asthma include atropine which is an effective bronchodilator now being recommended for adults with asthma and chronic bronchitis. It comes in an inhaler called Atrovent and will probably be available for children in the not too distant future. Magnesium, interestingly has a bronchodilator effect and by simply giving a patient oral or intravenous magnesium you can treat many cases of bronco-constriction. This is still experimental and not recommended as official therapy yet. There are some new medicines, including an antihistamine which has a bronchodilating effect and is possibly soon to be on the market and a medicine called nedocromil which is an anti-inflammatory medicine similar to cromolin but even more effective.

Even with all of the better therapies available for asthma today the basics of environmental control are still very important and excess dust, mite, molds and animal hair and cigarette smoke should be avoided as much as possible. Cold air is a common irritant for asthmatics and, for that reason, running sports such as cross country running, football and basketball are frequently bothersome. However, swimming is frequently well tolerated by asthmatic patients. With determination, practically any asthmatic can participate in the sport of their choice with proper and optimal therapy.

This has been proven by many Olympic athletes including Nancy Hogshead who was a gold medalist in swimming and Jim Ryan who was the first high-schooler to break the four minute mile in track. Both of these individuals are big promoters of proper asthma therapy and were speakers at the recent American College of Allergy meeting.

Finally, asthma like any other chronic disease, must be best understood to be controlled and a positive attitude is extremely helpful in handling any chronic disease, especially asthma. A close and open working relationship with your doctor is vital. There are so many opportunities to take advantage of for better understanding and control of asthma, including educational materials from your doctor and local speeches and support groups. A few include the Asthma and Allergy Foundation, Lafayette Chapter, which meets monthly at Voorhies Hall at University Medical Center. There is a speaker each month and refreshments and sharing support stories, tips and even medicines and medical equipment. Camp Azzie, a non-profit children's asthma camp, sponsored by the Opelousas General Hospital over the past five years, will be taking place again this summer. Anyone can contact the respiratory department at Opelousas General Hospital for information on the specifics of camp each summer.