Asthma and Allergies

A sthma and A llergies Pamela Amelung, MD Mini-Med School Fall 2006 University of Maryland School of Medicine

What is asthma?
Asthma facts and statistics
Who is most at risk to get asthma?
Symptoms and triggers, including
allergies
Management of asthma
How to avoid triggers and attacks
T opics C overed

Chronic inflammatory disorder of the medium and small airways.
These airways are hypersensitive to certain “triggers” in the environment.
Intermittent and recurrent episodes of...
Wheezing
Shortness of breath
Chest tightness
Cough - night, early morning
Usually reversible
Asthma cannot be cured but its symptoms can be controlled with proper environmental changes and medication.
W hat is A sthma ?

About 17 million Americans have asthma
Most common chronic childhood disease, affecting about 5 million children (6% of children under 18)
14 people die each day from asthma
Nearly 2 million emergency room visits each year
T he facts about A sthma

H ow many people have A sthma ?
The number of Americans diagnosed with asthma has risen.
Self-reported prevalence increased 75%
Close to 21 million Americans have been diagnosed with asthma in their lifetime.
*MMWR December 04, 1998 / 47(47);1022-1025 13.7 17 Millions of individuals diagnosed

T he cost of A sthma !
Asthma costs billions of dollars each year and the cost is rising.
The estimated annual cost of asthma in 2000 was $14.5 billion.
* www.cdc.gov 1990 2000 $6.2 billion $ 14.5 billion

3 million lost work days
10 million lost school days each year from asthma

Deaths from asthma have increased more than 50% in the past 20 years, and have increased more than 75% in children under 19
*CDC MMWR April 24, 1998 / 47(SS-1);1-28

R ace and asthma M ortality

A sthma M ortality : Female vs. Male

R isk factors for A sthma
Allergy / Atopy
Family history of asthma/allergy
Perinatal exposure to tobacco smoke
Viral respiratory infections
Low birth weight
Male gender - pre-adolescence
Low-income, urban residents
Obesity

C lassification of A sthma
Intermittent -
Asthmatics who have symptoms that occur with a cold from time to time.
They often grow out of the disease.
Persistent -
Asthmatics having symptoms at least twice a week during the day and twice a month during the night
These asthmatics are further classified as mild, moderate, or severe.

Coughing
Wheezing
Chest tightness
Shortness of breath
S ymptoms of A sthma

A sthma T riggers
For people with asthma, exposure to certain substances they are sensitive to can lead to an asthma attack or exacerbation.
These substances are known as triggers.
Not all people with asthma have the same triggers that will cause an asthma attack.

I ndoor air T riggers
Environmental tobacco smoke (ETS)
Cockroaches
Dust mites
Animal dander
Mold, mildew
Strong scented products (perfumes, scented cleaners)

All of the common asthma triggers are found indoors
Americans spend about 90% time indoors
Reducing exposure to indoor allergens and irritants can reduce asthma symptoms
Prevention is an important asthma management tool
W hy i ndoor air is I mportant

Contains more than 4,000 substances (over 40 are carcinogenic)
Is particularly harmful to young children
Can trigger asthma attacks and cause young children to develop asthma
S econdhand S moke

Found in most homes
Live in soft bedding
Feed on skin flakes
Mites and mite droppings can be asthma triggers
Most common asthma trigger in adults and kids
D ust M ites

Skin flakes, urine and saliva of warm blooded animals can be asthma triggers.
Triggers can remain in the home for several months after a pet is removed, even with cleaning.
P ets

Can be found almost anywhere.
Key to mold control is moisture control.
Clean up the mold and get rid of excess water or moisture, this also helps reduce other triggers, such as dust mites and cockroaches.
M olds

Droppings or body parts can be asthma triggers.
Cockroaches likely contribute significantly to asthma problems in inner city area.
Asthmatic children allergic to cockroaches are three times more likely to be hospitalized if exposed in the home.
C ockroaches and other P ests

O utdoor air T riggers
Ozone
Particulate matter
Sulfur dioxide
Nitrogen dioxide - vehicle exhaust
Outdoor pollens and mold

A dditional T riggers
Viral upper respiratory infections
Exercise
Aggravating conditions - gastric reflux, sinusitis, rhinitis
Diet, medication
Cold air
Changes in weather
Menstrual cycle, pregnancy

W hat causes an A sthma A ttack ?
An allergic reaction to triggers or exposures
Airways swell and fill with mucus and secretions
The muscles around the airways contract and spasm
Airways can collapse, causing classic symptoms, even death

I ndications of a severe A ttack
Breathless at rest
Hunched forward
Talking in words rather than sentences
Agitated
Peak flow rate is less than 50% of normal

M anagement of A sthma
Asthma is one condition that, when treated with timely and effective regular outpatient care, prevents hospitalization and ED visits.

Consult with a physician to develop an asthma management plan, which includes:
Medication
Education: identification of asthma triggers & ways to reduce/avoid exposure to your asthma triggers
Peak flow monitoring
Emergency plan
M anaging A sthma

G oals of asthma M anagement
Control chronic asthma symptoms and asthma attacks during the day and night
no sleep disruption due to asthma
no missed school or work because of asthma
no or minimal need for emergency care or hospitalizations
Avoid attacks or exacerbations
Maintaining normal activity levels, including exercise and other daily activities
Having normal or near-normal lung function
Avoid side-effects of medications
Prevent asthma mortality

Choose not to smoke in your home or car and do not allow others to do so either.
A voiding secondhand S moke

Wash sheets and blankets once a week in hot water
Choose washable stuffed toys-- keep stuffed toys off beds
Cover mattresses and pillows
Vacuum often (when asthmatic is not present)
Maintain low indoor humidity, ideally between 30-50%
A voiding dust M ites

Consider keeping pets outdoors or even finding a new home for your pets, if necessary.
Keep pets out of the bedroom at all times.
Keep pets away from fabric-covered furniture, carpets, and stuffed toys.
A voiding pet T riggers

Wash mold off hard surfaces and dry completely, absorbent materials (ceiling tiles and carpet) may need to be replaced.
Use exhaust fans or open windows in kitchens and bathrooms when showering, cooking, or using the dishwasher.
Maintain low indoor humidity (between 30-50% relative humidity).
Fix leaky plumbing or other sources of water.
Keep drip pans in your air conditioner, refrigerator, and dehumidifier clean and dry
Clean bathrooms frequently.
A voiding mold T riggers

P est A voidance
Free your home of places for pests to hide and sources of food and water
Regular, careful cleaning - kitchen
Daily trash removal
Store food in airtight containers
Extermination - baits, gels (not sprays)

P revent outdoor T riggers
Ozone - advisories, stay indoors
Pollens and Molds (if allergic)
Close windows, doors
Use air conditioners, clean filters regularly
Dry clothes indoors
Avoid raking leaves, gardening
Outside - less breezy, after gentle rain

P eak expiratory flow (PEF) M eters Allows the patient to assess the status of his or her asthma

P eak flow C hart
People with moderate or severe asthma should take readings —
Every morning and evening
After an exacerbation
Before inhaling certain medications
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI

M anagement of A sthma
Quick-relief medications used to treat asthma attacks and acute symptoms
“ Relievers”
Long-term control medications reduce the airway inflammation that causes these symptoms
“ Controllers”

A sthma M edications
Quick-relief medications
Short-acting bronchodilators
Relax smooth muscle around the airways
Long-term Medications
Steroids
Inhaled, tablets
Anti-inflammatory
Long acting bronchodilators
Relax smooth muscle
Leukotriene inhibitors
Anti-inflammatory

A sthma action P lan National Heart, Lung, and Blood Institute

A sthma is I ncreasing
Why the increase?
Increased recognition, diagnosis-shifting
Environmental allergens - indoor, outdoor
Energy-efficient buildings, carpet
Exposure to mother’s tobacco smoke
Psychosocial and socioeconomic factors
More time indoors
Overcrowding
Access to care

“ H ygiene H ypothesis” Are we too clean ?
Immune Response
Th1
Responds to harmless bacteria, dirt, animal droppings after birth
Not activated in sterile birth environment
Subdues the more hyperactive Th2
Th2
Not as effective as Th1
Fight allergens, cause allergies
T0 T2 T1

“ H ygiene H ypothesis” Are we too clean ?
Less allergies and asthma:
1990 East vs. West Germany
Farm vs. city children
Daycare before 6 months of age vs. later
Older siblings vs. none
Failure to develop balanced immune system
Detergents/chlorine, antibiotics, vaccines, antibacterial soaps

H ealthy people 2010 Objectives
Reduce asthma deaths
Reduce hospitalizations for asthma
Reduce hospital ED visits for asthma
Reduce activity limitations - reduce # of school/work days missed
Increase proportion who receive formal patient education
Increase proportion who receive appropriate asthma care
Establish in  25 states a surveillance system for tracking asthma
http://www.health.gov/healthypeople

C onclusions
Asthma affects 5-10% of the population and the prevalence is rising in developed countries.
Allergies often play a key role in asthma and act as triggers for asthma symptoms.
Asthma can not be cured but can usually be well controlled in most people.
Controlling asthma involves patient education, lung function monitoring, avoidance of triggers, and in many, medications.

Asthma and Allergies

by MedicineAndHealth on Feb 03, 2009

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