Take Charge of Your Health
An article by Dr. Kirtland Culmer

Asthma: The Breath Stealer
How wonderful and exhilarating it is to step into the fresh air and take several deep breaths. Most of us take this activity for granted, but, for the asthmatic, this is indeed a luxury.

The word asthma is from the Greek word meaning panting. The air passages of an asthmatic become constricted when stimulated by allergens or certain other “triggers”. This is followed by an inflammatory response in which the immune system of the body sends white blood cells and other immune factors to the airways causing swelling, filling with fluid and the production of thick sticky mucus. This results in wheezing, breathlessness, inability to breathe out properly, and a phlegm-producing cough. The cause of asthma is not clearly defined, but it is probably the result of heredity factors, which involves several genes, in addition to environmental triggers.

Some of these triggers are allergens, pollution and cigarette smoking, food allergies, chemicals, exercise, infections and hormones. Allergens may be animal dander, pollen molds, and fungi. In the home, there may be things like dust mites and cockroaches. Fumes like diesel and gas, cigarette smoke and any industrial smoke or gases can trigger off an attack. Food substances such as MSG found in some canned soups, cheese, certain vegetables and preservatives can also cause attacks. Exposure to chemical fumes like chlorine or ammonia can also do the trick. More than one third of all persons with asthma have a history of having an asthmatic member of their immediate family. Exercise will trigger coughing, wheezing and shortness of breath in a large number of asthmatics. Some viral and bacterial infections trigger the attacks, and in some women, attacks are coincident with the menstrual period. Other triggers include cold air, thunderstorms, extreme emotion, and certain medications such as aspirin and beta-blockers.

Some people seem to be more prone to asthma than others. For instance, those with gastro esophageal reflux disease that causes heartburn are associated with a high incidence of asthma. Five to ten percent of the world’s population has asthma. Deaths from asthma occur mostly in the elderly. The good news is that the number of deaths from asthma has been declining since 1989. Others that are at high risk for asthma and asthmatic deaths are the very poor. They are less likely to stick to a medical regimen. Highly trained athletes like long distance runners and swimmers are also susceptible to asthma. It is becoming more and more apparent that overweight people are very susceptible to asthma.

This is an alarming disease. The symptoms are very frightening, and make the illness appear worse than it is. Nothing creates more panic than being unable to breathe properly. It is therefore important that the asthmatic person should know what to expect from his or her doctor, and follow instructions very carefully. The doctor must be certain that the diagnosis is accurate, establish a doctor-patient relationship to address the patient’s concerns and set a definite plan of action to manage the patient as well as to teach him or her self-management. The emphasis must be to reduce inflammation, symptoms and recurrences of attacks. The doctor should prescribe anti-inflammatory medications like inhaled steroids, cromolyn, or nedocromil. The plan should include reducing exposure to the triggers of asthma mentioned above. Both the doctor and the patient should monitor and manage the asthma over time. The patient should be seen at regular intervals to make sure that goals are attained, treatment adjusted if necessary, and the action plan is continuously reviewed. Attacks should be treated promptly.

Unfortunately asthma is out of control for many patients. Poorly controlled asthma symptoms cause hospitalizations, emergency room and urgent care visits, many sick days, and activity limitations that reduce the quality of the asthma sufferer’s life. It is vitally important that doctors follow the guidelines for proper asthma care, and that the care given meets with the satisfaction of the patient.

I consider that the best way to equip the patient to TAKE CHARGE is to encourage him or her to recognize the need for greater patient education about asthma.