Breathe easy – Understanding and managing asthma

Asthma attacks – and a struggle to breathe easily – can scare the most fearless of us. In fact, just the anticipation of an attack can cause us to limit our activities, and in some cases, send us to the emergency room. Nearly 26 million kids and adults suffer from asthma, and according to the CDC, around 60 percent of them limit their physical activity because of the condition. Plus, asthma accounts for nearly 2 million ER visits each year.

Board-certified allergy and immunology specialist Rand Malone, MD, of Overland Park Regional Medical Center part of HCA Midwest Health shares some facts on asthma, and five ways to better manage it to avoid trips to the emergency room, reduce the fear factor and enjoy a better quality of life.

“There are certainly ways to help children and adults with asthma better manage their condition and feel better overall,” stresses Dr. Malone. “It starts with understanding the condition and triggers, being on the right medication and possibly making some lifestyle changes.”

Step 1. Understand asthma basics

Asthma is a disease that swells and constricts the airways, making it difficult to move air in and out of your lungs, often resulting in coughing and wheezing with attacks, but minimal symptoms in between.

Those who suffer from asthma, Dr. Malone says, share a genetic trait that causes them to make less of a virus-fighting molecule called g-IFN. People with sufficient g-IFN are able to fight off a virus such as a cold relatively quickly. Those with asthma, however, struggle to fight off the virus, which can then make its way to the lining of the lungs.

Without sufficient g-IFN, the asthma sufferer’s body goes into overdrive, sending a host of white blood cells into the airways to fight off the infection or virus. The fighting white blood cells multiply in the walls of the airways causing inflammation, mucus production and swelling. The cells do a good job fighting the virus, but even after it goes away – and breathing feels back to normal – some inflammation and airway blockage lingers. As more and more inflammation is left over after each subsequent cold, the person with asthma gets increasingly accustomed to ongoing airway inflammation and blockage. They have sudden flares of asthma that can seem to come on suddenly, but which have actually been building. This is the wheezing and gasping we typically relate to an asthma attack. Because kids are prone to many more colds than adults, asthma tends to progress much more quickly in them.

Step 2. Know the signs – Asthma symptoms

“People are sometimes surprised to find out they have asthma because they’re not wheezing or experiencing shortness of breath or a tight chest,” says Dr. Malone. “In early asthma, what we often refer to as ‘smoldering asthma,’ the swelling and inflammation in the bronchial tubes is relatively mild with each cold, so it is typical to have minimal or no wheezing or shortness of breath; however, we often find with each subsequent cold that it is common to then have a cough that lasts weeks and is worse in the middle of the night.”

Common signs of underlying smoldering asthma making one susceptible to an attack include:

• A chronic cough
• Coughing spells that are worse at night, during exercise or when laughing
• Wheezing, raspy breathing
• Shortness of breath
• Chest pain or tightness
• Trouble sleeping and fatigue
• Frequent bronchitis, either as an adult, or history of it as a child
• Loss of exercise tolerance over time

In kids, watch for:

• Chronic coughing, especially in the middle of the night
• Wheezy breathing or a whistling sound when breathing
• Trouble breathing or rapid breathing with laughing and playing
• Loss of interest in playing outdoors where running might be involved
• Frequent chest colds that linger for weeks with coughing

Step 3. Be aware of asthma triggers

People with asthma are more sensitive to factors or “triggers” that may not impact others. Triggers can be “allergic” such as house dust, mold spores, animal dander or seasonal pollen, and “non-allergic” like pollution, smoke, exhaust fumes or strong odors, colds or other respiratory infections, exercise or extreme weather changes. Understanding what triggers asthma attacks can help you avoid and minimize them.

Step 4. An asthma diagnosis and plan

Undertreated asthma can cause permanent scarring and lung damage and makes attacks much more frequent, so Dr. Malone recommends promptly seeing your doctor or an asthma specialist when any of the signs of smoldering asthma mentioned above are present.

The doctor will get a health history, paying special attention to the frequency of breathing issues and what brings them on, perform a physical exam and possibly order lung function or other tests such as allergy testing or a chest or sinus X-ray.

“We make a diagnosis of asthma based on a history of each head cold leading to a cough that is worse at night and lasts longer than the cold symptoms,” explains Dr. Malone. “That’s why it’s important to talk with the doctor about past colds. Asthma can be further confirmed with pulmonary function tests to measure airflow from the lungs, and a newer test that measures the presence of a gas released from an inflammatory white blood cell in the airway.”

When underlying asthma is suspected, he adds, it is usually best to be on a daily maintenance or controller inhaler to heal the smoldering airway inflammation so asthma’s long-term effects can be prevented, severe attacks minimized, and normal activities maintained.

Step 5. Take charge of your condition

“Taking control of your asthma starts first and foremost by following the asthma plan your doctor prescribes,” says Dr. Malone. “Because the status of asthma changes overtime, that plan may need to be revised, so it’s important to communicate any changes to your doctor.”

Other tips:

• Track your symptoms to help your doctor refine your plan.
• Routinely check the Air Quality Index for air pollution to avoid days that may not be safe outside for those with breathing issues.
• Check your indoor air quality for mold or other triggers.
• Shower, wash your hair and change clothes if working or playing outside to avoid bringing pollutants or allergens inside.
• Regular exercise can build lung capacity making flares less severe.
• Try physical or relaxation exercises to better manage stress or fear of an attack.
• Work to maintain an optimum weight.

Know when you need the ER

Asthma attacks that don’t get better with rescue inhalers can turn into serious emergencies. Make sure your asthma plan reflects the symptoms to be aware of when emergency treatment is needed:

• Wheezing or shortness of breath that doesn’t get better when you use your rescue inhaler
• Shortness of breath that leaves you unable to walk or talk normally
• Rapid breathing and/or heart rate
• Feels like you’re straining your chest muscles to breathe

If you or your child is having an asthma emergency, HCA Midwest Health is ready to help with 11 emergency rooms across the metro area, all of which are equipped handle adult and pediatric emergencies.