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Asthma and allergies power point schools
- 1. Asthma and Allergies Causes and prevention Asthma and Allergies Total Health Clinic Cnr Sauvignon Pde, Brygon Creek Drive Upper Coomera Amanda Franzi Health Coach
- 2. Topics Covered • RespiratoryHealth an Important Health care issue • Allergic Diseases are now epidemic • Causes of allergy • Allergy as an immune response • The gut connection • How to avoid triggers and attacks • Asthma what is it and how to avoid it. • Natural treatments for the prevention of allergies and asthma
- 3. Respiratory Health isan Important healthcare issue Chronic respiratory diseases are very prevalent in Australia – an estimated 5.8 million Australian had at least one long term respiratory condition 2001. Respiratory diseases are major causes of illness and mortality in Australia. They place great stresses on the health care system and are a significant financial burden for the individual and the community disrupting the daily life and productivity of many individuals (Australian institute of health and welfare, Chronic respiratory diseases in Australia. Their prevalence, consequences and prevention. August 2008
- 4. Allergic Diseases arenow Epidemic • Over the last 50 years the prevalence of diseases such as hay fever, atopic dermatitis, and allergic asthma has increased significantly in the developed world. • Allergic diseases are now epidemic in the most westernized societies, affecting approximately 20%-30% of their populations, and ranking first among the causes of chronic disease in children. • 1 in 6 now suffer allergies. • Grammatikos Ap. The genetic and environmental basis of atopic disease. Ann Med. 2008,4(07)482-95
- 5. Causes of Allergy Environmental Factors Allergen sensitivities Genetic Factors Having few siblings Presence of specific HLA alleles Excessive hygiene Genetic Polymorphisms Receipt of antibiotics in the first two years of life Vaccination and prevention of disease Atopy Triggers Defects in Target Organs Viral infections Bronchial epithelium Skin Exposure to allergens Gut Tobacco smoke Indoor and outdoor pollutants Th2 mediated allergic inflammation.
- 6. Signs and symptomsof allergies Symptoms of food allergy include •wheezing •stomach upsets and •skin rashes •Bloating •Gastrointestinal pain and gas •Mood and behavioural disturbances Symptoms of food intolerance are similar to food allergy, but can be associated with conditions including •asthma, •chronic fatigue syndrome and •irritable bowel syndrome (IBS). •ADD/ADHD
- 7. The Hygiene Hypothesis •The prevalence of atopic diseases has increased abruptly in recent years in most Westernized societies • The best paradigm available to day to explain this steep rise, the ‘Hygiene hypotheses’ , supports that it is the excess cleanliness of out environments that has led to the decline in the number of infectious stimuli that are necessary for the proper development of out immune system. Grammatikos Ap. The genetic and environmental basis of atopic disease. Ann Med. 2008,4(07)482-95
- 8. Weak Immune System Causes Allergies
- 9. Allergy as animmunological disorder • It is defined as a disease that follows an immune system response towards an otherwise innocuous antigen (AG) and is usually equated by the type of hypersensitivity reaction. • Key Points • The presence of particular gene variations modifies an individuals likelihood to develop allergic diseases. • Exposure to infections during the maturation of a child's immune response may be crucial to reduce reactivity to innocuous environmental particles • More than any specific infection, it is the overall microbial burden early in life that seems to protect against development of allergies.
- 10. Immune Imbalances contribute toAllergy • Children are born THelper 2 dominant • Viral Bacterial and Parasitic infections protective against allergy, although helmiths induce Th2 response, and virus and bacteria skew towards Th1 response, the high overall infection burden seems to be an instrumental factor in the development of the anti-inflammatory regulatory network. Instead of the Th1-Th2 dichotomy, a pro-versus anti- inflammatory T-Cell regulatory axis may be central to the outcome. • Meaning that in order to have immune balance we must be exposed to bacteria and pathogens in order to activate immune TH1 response. Otherwise over activation of Th2 is present resulting in allergy response.
- 11. What Causes aWeak Immune System? Technology VS Environment
- 12. Obesity Over Cleanliness Environmen t Pollution
- 13.
- 14. Digestive Enzymes • Whatare enzymes? These are protein like substances, formed in animal and plant cells, that act as catalysts to initiate or speed up specific chemical reactions and breakdown of proteins within the cells. We have trillions of enzymes, and as they complete their function they die. Enzymes are in every cell of our body, performing vital functions every mili-second. • Where do they come from? All living cells contain enzymes - they are the "spark of life" in the cells. We are born with a "bank of enzymes". Although, to some degree, we can replenish enzymes by manufacturing metabolic enzymes in the liver and digestive enzymes in the pancreas (primarily for protein digestion), the number of enzymes each cell can produce is limited. Most of the enzymes needed for digestion should come from food. • What do enzymes do and why are they so important? These tiny substances are vital to all cellular activity in our bodies. Your heart, lungs, liver, eyes, skin, glands, immune system - every organ, tissue and cell in your body are dependent upon enzymes for every process and function. Enzymes help prevent degenerative disease, keep us youthful, increase our energy. Digestive enzymes break down food and insure complete digestion and assimilation of nutrients. When our enzyme bank is depleted, we die, so we want to be sure they are not wasted.
- 15. Where do weget them from? • Protease, helps digest proteins. Un-digested proteins wind up in circulatory system and other parts of your body. Food Sources: Broccoli, Figs, Guava, Ginger root, Green plants, Kiwi, Mushrooms, Papaya, Pineapple, Romaine lettuce, Spinach, Soy bean, Wheat, Kidney beans • Amylase, helps digest carbohydrates. Incomplete digestion can cause blood sugar imbalances, allergies, and asthma Food sources: Banana, Beets (roots, leaves and stems), Cabbage, Reishi mushrooms, Sweet potato Egg, Maple sap, Milk, Honey, Sugar-cane, Barley, Corn, Oats, Rice, Wheat, Kidney beans • Lipase, helps digest fat. Incomplete digestion can lead to clogged arteries causing blood pressure and heart problems. Food Sources: Avocado, Coconuts, Corn, Flaxseeds, Raw red meats, Romaine Lettuce, Spinach, Wheat germ ,Rice, Soybeans, Rape seeds • Cellulase, Helps break down cellulose (soluble fiber). Helps bind heavy metal and toxins to be expelled out of body Food Sources. Avocado, Peas, Reishi mushrooms, Oat sprouts,
- 16. continued • Maltase, Helpsconvert complex sugar found in malt and grain products into glucose Food Sources: Banana, Beet leaves, Green plants, Brewers' yeast, Mushroom, Sugar-cane, Rice, • Lactase, Helps digest lactose found in dairy products Food Sources. Almonds, Apples, Peaches, Persimmons, Tomatoes, Milk. • Sucrase, Helps digest sucrose including table sugar Food Sources. Cucumbers, Potato, Romaine Lettuce, Spinach, Sugar-cane • Alpha Galatosidase, Hydrolyzes sugars in beans that ferment and cause gas. This enzyme is in the Bean-o ,Helps prevent gas. Food Sources: Cucumbers, Sprouted legumes (soy beans, cowpeas) • Phytase, Helps digest Phytic acid (Phytate) found in Grains and Seeds releasing phosphorus, calcium and other nutrients
- 17. Digestive Enzymes andtheir influence on allergies • Different research ex-periments that were performed by Dr. Willstatter as far back as 1929 proved that white blood cells contain eight different types of amylase, protease, and lipase. He states that "white blood cells provide transportation for enzymes throughout the body". Antigens, bacteria, yeast, and other toxins enter the body through the digestive tract. They leech onto food substances we ingest and then multiply prolifi-cally within the body of the immune system if it is not strong and healthy enough to destroy them. • Al-lergens (substances causing an allergy) can also en-ter the body simply through the air that we breathe. Most antigens, bacteria, viruses, and yeasts are proteins. Often the toxins causing allergies and in-fections are secreted by bacteria that also contain protein substances. • At this point it should be understood that the body needs a tremendous supply of protease (protein di-gestive enzymes) to counteract the constant bom-bardment of these proteins to digest and eliminate them. This digestion of protein is done by enzymes, not only in the digestive tract, but in the bloodstream itself. Undigested proteins are often found in the bloodstream. If digestion is not properly accom-plished, undigested substances can be absorbed through the digestive tract. • Antigens that cause allergies attach themselves to these proteins in the blood (antigen complex), deposit in the walls of tiny capillaries and secrete sub-stances that cause inflammations which result in swellings, sneezing, hayfever, hives, asthma, etc. In order for the body to rid itself of the allergen, it must be separated from the protein molecule. This is ac-complished by enzymes that digest the protein and release the allergen so the body can eliminate it via the lymphatic system
- 18. Digestive Enzymes • Howcan enzymes be wasted? When we eat foods that don't contain digestive enzymes, our body must use its limited supply of metabolic enzymes to digest our food, for digestion is the body's main priority • Digestive enzymes are supposed to come from food. Our bodies cannot make up for the amount of enzymes needed to digest the average meal. • Why don't most of our foods contain enzymes? Cooked, processed and chemical laden foods do not contain enzymes. Even people who eat healthfully include cooked foods in their diet, for some foods must be cooked. Also, "live" foods (raw fruits, vegetables, etc.) that are not organically grown don't contain enough enzymes. • Not only do many of our foods not contain the necessary digestive enzymes, they --especially all "junk foods" -- use up an excessive amount of your metabolic enzymes as your body attempts to digest these "foodless foods".
- 19. Digestive Enzymes whatif we don’t have enough? • What happens when we don't have enough enzymes for digestion? We experience digestive problems of all kinds, usually with gas, pain, allergies and discomfort. Essential nutrients are not assimilated and lack of nutrients leads to disease. In addition, incomplete digestion causes toxicity from undigested food particles and toxicity also leads to disease. Perhaps the most serious result of lack of enzymes and incomplete digestion is a weakened immune system. • Many people, who would benefit from taking digestive enzymes, are taking over-the-counter medicine for digestive disturbances and what is commonly called "heartburn". These are harmful, and in fact, until recently, some of the more powerful ones could only be obtained by prescription. These medicines block the production of hydrochloric acid, which is essential for the digestion of minerals and protein. (In addition, hydrochloric acid is our first line of defence against harmful bacteria…but that's a different presentation.)
- 20. Allergic Infants haveless beneficial bacteria • Infants who develop allergy were less often colonised with enterococci, bifidobacteria and bacteriodes in their stool cultures. • Allergic infants had higher counts of Staphylococcus Aureus and clostridia counts. Kim Ds, Drake-Lee AB. Infection, allergy and the hygiene hypothesis: historical perspective. J Laryngol Otol. 2003 Dec; 117(12):946-50
- 21. Bacteria, parasites and microbes • What are they? • Bacteria &Yeast • Microbes & Parasites • Intestinal Permeability (‘Leaky gut’) • Inflammation • Constipation & Diarrhoea • Food Sensitivities and Allergens
- 22. Symptoms of amicrobial infection • Headaches, “heavy head,” “heavy-feeling headaches.” • Alternated periods of mental “fuzziness” and greater mental clarity. • Feeling “muggy-headed” or “blah” or sick in the morning. • Transient malaise, flu-like symptoms. • Transiently increased fatigue, waxing and waning fatigue, feeling more tired and sluggish, weakness. • Dizziness. • Irritability. • Sensation of “brain firing: bing, bong, bing, bong,” “brain moving very fast.” • Depression, feeling overwhelmed, strong emotions. • Greater need for “healing naps.” • Swollen or painful lymph nodes. • Runny nose, low grade “sniffles,” sneezing, coughing.
- 23. Bacteria • What dothey do? • Support immune system, Adsorption of food and nutrients, Reduce inflammation, inhibit growth of harmful bacteria and pathogens) • Can they effect brain function? • Why treating with Antibiotics does not work? • Signs and symptoms of bacterial infection… Abnormal stools, fevers that come and go, persistent nasal congestion or cough, and behaviours that are abnormal
- 24. Yeast infections (Candida) •What is yeast? • What are the symptoms? Itching, rashes, eczema, abdominal bloating, increase in flatulence, constipation or diarrhoea, smelly stool; silly/giddy behavior, aggressive, stimming, chewing - on anything, low energy, cravings for bread, pasta and sweets • Why do we get it? • How do we treat it?
- 25. Yeast • Candida albicans,which lives almost everywhere in the body, is an example of such a yeast. These yeasts live naturally in the intestinal tract and vaginal areas of animals and humans. They can take over our whole body if the immune system is weakened. It is important to realize that yeasts are also protein bodies and can be digested by enzymes if the body has a proper supply. • Candida can change form in the human intes-tines. It can remain in a yeast-fungal form and enter the circulation or develop a root structure that pen-etrates the intestines, creating a large enough open-ing for other bacteria, antigens, and undigested pro-tein to enter. These other substances that enter are a major cause of allergies, anxiety, fatigue, digestive disturbances, vaginitis, cystitis, menstrual problems, and migraine headaches. This is the reason for the similar approach in treating both candida and aller-gies.
- 26. Parasites • What isa parasite? • Where do we get them from? • Signs and Symptoms of a parasitic infection… Allergies, Headaches, Anxiety, Depression, Comprehension difficulty, Brain Fog, Gas and bloating, Constipation, Diarrhoea, Foul smelling stools, Chronic fatigue, low energy or hyperactivity, Flu symptoms, fever and aches, Poor Immune function, Sleep disturbances, Grinding teeth at night, Vision problems, Anaemia, Eczema, Rashes and itchy back passage, Allergies, Weight gain or loss
- 27.
- 28. Leaky gut causeschronic inflammation
- 29. Hypochlorhydria (Low Hydrochloric acid) •Hypochlorhydria is the lack of adequate stomach acid (hydrochloric acid) production • Insufficient stomach acid also causes absorption of partially digested food molecules, leading to food sensitivities. • Low stomach acid increases the overgrowth of pathogens in the lower intestine. • Malabsorbtion of minerals vitamins and amino acids and increases the chances of food sensitivities.
- 30. Hydrochloric Acid whatimpact does it have? • Hydrochloric acid helps break down proteins and also plays an important role in signalling to the pancreas to release digestive enzymes and bicarbonate. • HCl helps sterilize stomach contents so that bad bacteria cannot hitch a ride into the small intestine for invasive and destructive colonization. • Plenty of folks over 40 or 50 have insufficient HCl for digestion; heartburn is often linked to low HCl levels and over- the-counter medicines only address the symptom and not the root cause and can lead to poor digestion, dysbiosis, leaky gut and allergies.
- 31. Symptoms/signs of stomachacid deficiency? Stomach aching/pain/discomfort or Multiple food sensitivities bloating after meals Trouble digesting red meat Feel unwell/fatigued right after meals Constipation Food or water 'sits in stomach' Low iron levels High fat foods cause nausea/stomach upset Frequent nausea Undigested food in stool Nausea/reflux after supplements Reflux &/or heartburn (e.g. fish oil) Poor appetite or feel overly full easily Burping after meals
- 32. What is Asthma? 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.
- 33. What causes anAsthma Attack ? • 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
- 34. The facts aboutAsthma • 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 • Asthma is not curable but is preventable
- 35. Histamine and Leukotrienes arekey mediators of asthma • Histamine is an important protein involved in many allergic reactions. Allergies are caused by an immune response to a normally innocuous substance (i.e. pollen, dust) that comes in contact with lymphocytes which stimulates TH2 immune response to release histamine. Histamine acts very quickly and stimulates bronchoconstriction and excess mucus production. • Histamine, along with other chemicals, causes the contraction of smooth muscle (Schmidt et al 1999). Consequently, the muscles surrounding the airways constrict causing shortness of breath and possibly complete trachial-closure, an obviously life-threatening condition. • If the effects of histamine during an allergic reaction are inhibited, the life of an allergic person can be eased (in the case of inflammation) or even saved by preventing or shortening asthma attacks. • One of the best ways to reduce histamine over production is Vit C
- 36. Indoor air Triggers • Environmental tobacco smoke (ETS) • Cockroaches • Dust mites • Animal dander • Mold, mildew • Strong scented products (perfumes, scented cleaners)
- 37. Why indoor airis Important • All of the common asthma triggers are found indoors • We spend about 90% time indoors • Reducing exposure to indoor allergens and irritants can reduce asthma symptoms • Prevention is an important asthma management tool
- 38. Secondhand Smoke • 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
- 39. Dust Mites • 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
- 40. Pets •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.
- 41. Molds • Can befound 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.
- 42. Cockroaches and otherPests • 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.
- 43. Outdoor air Triggers •Ozone • Particulate matter • Sulfur dioxide • Nitrogen dioxide - vehicle exhaust • Outdoor pollens and mold
- 44. Additional Triggers • Viralupper respiratory infections • Exercise • Dietary sensitivities • Aggravating conditions - gastric reflux, sinusitis, rhinitis • Diet, medication • Cold air • Changes in weather • Menstrual cycle, pregnancy
- 45. Management of Asthma Asthma is one condition that, when treated with timely and effective regular outpatient care, prevents hospitalization and ED visits.
- 46. Managing Asthma Consult witha physician or alternative health practitioner 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
- 47. Goals of asthmaManagement • 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
- 48. Avoiding secondhand Smoke Choosenot to smoke in your home or car and do not allow others to do so either.
- 49. Avoiding dust Mites •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%
- 50. Avoiding pet Triggers • 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.
- 51. Avoiding mold Triggers • 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 with non caustic products
- 52. Pest Avoidance 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)
- 53. Peak expiratory flow(PEF) Meters Allows the patient to assess the status of his or her asthma
- 54. Peak flow Chart 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
- 55. Nutritional deficiencies commonin asthma • Magnesium deficiency is a common electrolyte disorder in patients with acute asthma. There are some data suggestion lower levels of Mg2+ in asthmatic patients compared to non- asthmatics. • Fish oils reduce airway inflammation and the severity of exercise induced bronchoconstriction with a concomitant decrease in bronchodilator use. • Vit D is an immune modulator, immune induced asthma has been shown to decrease with the use of Vit D in children suffering from Low Vit D.
- 56. Conclusions • Asthma affects5-10% 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. • The gut and its function plays a key role in allergies that may affect asthma • Deficiencies in specific enzymes may also play a key role in the development of allergies and asthma related effects. • 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 and dietary correction.
- 57. Thank you -Any Questions? Amanda Franzi
Editor's Notes
- #3 Note This presentation does not discuss medical interventions for asthma (see page 10 of the notes for more detailed explanation). You can modify and expand the information presented to include the medical aspects of managing asthma.
- #14 According to Hippocrates – ‘all disease begins in the gut’. And certainly this is true with the disorders we are talking about today. (ADD, autism, anxiety etc). Digestion and gut health affect the overall health of the individual as well as affecting the brain. Our gut is one of the most important organs in the body; responsible for the breakdown and absorption of nutrients, immune function and elimination of wastes. If digestive system is working properly then the symptoms that are often experienced by patients can be markedly reduced if not eliminated. So it makes sense to support digestion and GI health in all mood disorders
- #24 Beneficial bacteria in the gastrointestinal system are responsible for the digestion and absorption of nutrients from food, they reduce inflammation, they inhibit the growth of harmful bacteria and pathogens. They also support the immune system and keep us disease free. Negative bacterial overgrowths are responsible for many gut disturbances. Such as constipation, diarrhoea, stomach pains, gas, and bloating In addition to causing damaging local effects to the gut tissue, abnormal bacteria have been shown to affect the brain. Probably because of GI inflammation and abnormal immune function, children with autism have abnormal levels of harmful bowel organisms. Frequent antibiotic use in the first years of life can contribute to the chronic imbalance referred to as intestinal dysbiosis. This is when the balance of bad or negative bacteria out weights that of the good bacteria. It has been documented in the literature that children with autism and behavioural disorders often have elevated levels of potentially harmful and toxin producing bacteria in the GI tract. The most common of these is from the Colstridium family. Others are often found in the bowel including Streptococcus. So what do we see in our kids with behavioural disorders? Abnormal stools are a huge tip off that there is abnormal bacteria growing. Fevers that come and go where the immune system is trying to fight the bacteria, also Persistent nasal congestion or cough, and behaviours that are abnormal
- #25 Candida is a type of yeast. We all have it; it occurs naturally, though normally in small amounts. The problem with Candida is, when the immune system is compromised in any way, Candida can get out of control and grow. When there is a problem with yeast overgrowth in the body, toxic by products enter the blood stream and make their way to the brain where they can cause symptoms such as inattention, ‘spaciness’, concentration problems and emotional ups and downs. These by products are substances such as alcohol, carbon dioxide gas and other toxins. No wonder we see so many people who are fatigued, they feel ‘out of it’ and have lots of gas! We commonly see yeast infections in children who are ‘run down’ and have recurring infections. Often they crave sugars and carbohydrate laden foods and this will be the only thing they want to eat! Bread, cereal, pasta and more bread, for example. They also may have been treated with antibiotics early in life on more than one occasion. Yeast infections are best treated with anti-fungals, as well as diet modifications, and immune enhancing supplements.
- #27 Parasites are opportunistic organisms, that have adverse effects on the human body. Infestation can occur in typically clean environments from even the most cautious of parents. Basically everyone is susceptible to infection from parasites, bacteria and fungus. How parasites affect brain function Parasites often excrete toxins to increase their chance of survival. These toxins will often change blood PH allowing the parasite to multiply and maintain its perfect host environment. Toxic excretions effect many bodily functions in the human body, especially immunological and neurological function. The toxins excreted can cross the blood brain barrier and create inflammation in the brain. They can also slow down and inhibit immune function, affect concentration, comprehension and creating brain fog.
- #33 For introduction, ask how many people have asthma. Then ask how many people have a family member with asthma. To picture what mild, uncontrolled asthma feels like, think of what it would feel like to breathe through a straw. Asthma is a chronic inflammatory disorder of the medium and small airways. Chronic means long-term or having recurring episodes. Inflammatory disorder of the airways means that a person’s capacity to breathe is limited. These airways are hypersensitive to certain “triggers” in the environment. Asthma is a manageable disease. Asthma episodes, also called asthma attacks, are usually reversible either spontaneously or with medical treatment. Asthma cannot be cured but its symptoms can be controlled with proper environmental changes and medication. It is crucial environmental changes and proper use of medication are used in conjunction with each other.
- #34 Airways are the passages that carry air to the lungs. As the airways progress through the lungs, they become smaller and smaller, like branches of a tree. When asthma is under control, as in the person on the left, the airways are clear, and air flows easily in and out. When asthma is not under control, as in the person on the right, the sides of the airways in the lungs become narrow, and less air can pass in and out of the lungs. Asthma causes breathing difficulties because of three reasons. First, the muscles around each air passage constricts or tightens, making the airways smaller. Second, the lining of the lungs are irritated and get inflamed and swollen, much like your skin would when you get a sunburn or a rash. Finally, the airways produce more mucus than normal, and anyone who has had a stuffy nose knows that mucus can also inhibit air passage. Asthma can develop quickly, and it can range from being a mild discomfort to a life-threatening attack if breathing stops completely. Asthma episodes are often separated by symptom-free periods. Asthma attacks are allergic reactions to triggers or exposures and each person with asthma has different conditions that can trigger an asthma attack. During an attack, The airways swell and fill with mucus and The muscles around the airways contract. As the airways swell and muscles contract, Airways can collapse from excess swelling and spasm, causing shortness of breath and even death. How many people here have asthma? I like to ask that question because usually about 10% of people in a room have asthma. Can someone describe how an asthma attack feels? The way I like to describe it is to picture what it is like to breath through a paper towel holder. Its basically like breathing normally. Now try breathing through a coffee stirrer, because that is how small the airways shrink. Try and catch your breath. It is almost impossible – not only is it hard to get air in, but it’s even harder to get air out. Some people describe it as having an elephant on your chest. You are literally starving for air. Airway narrows, caused by --- A tightening of the muscles surrounding the airways. A swelling of the inner lining. An increase in mucus production.
- #35 Asthma is a significant health problem in this country, and it is on the rise. Ask your audience: How many people know someone who has asthma? (probably most people will raise their hands!) Children are particularly affected by asthma, and yes, asthma can and does cause death.
- #38 Let’s consider the fact that many allergens and irritants are found indoors. Add to that the fact that Americans spend up to 90% of their time indoors. Therefore, it is not surprising that exposure to indoor asthma triggers is a significant contributor to the asthma problem. Conversely, controlled studies show reducing exposure to indoor allergens can reduce asthma symptoms. Therefore, avoiding indoor asthma triggers is important to helping avoid asthma attacks. Also, when asthma episodes do happen, they could be less severe. However, many people are still focusing only on treating asthma once an episode has already started. Let’s see if we can learn about how to keep these asthma attacks from starting in the first place.
- #39 Secondhand smoke is also known as Environmental Tobacco Smoke. Secondhand smoke includes both exhaled mainstream smoke from smokers and sidestream smoke from the end of a cigarette, cigar, or pipe. It contains more than 4,000 substances, including over 40 that are linked to cancer. Many of the compounds in tobacco smoke are released at higher rates in sidestream smoke than in mainstream smoke. Young children and babies are especially vulnerable to secondhand smoke, and up to 1 million asthmatic children have their condition made worse by exposure to secondhand smoke. Secondhand smoke can also cause young children to develop asthma. In addition, children exposed to secondhand smoke are more likely to suffer from pneumonia, bronchitis, and other lung diseases, and be more likely to have ear infections.
- #40 Dust mites are tiny, spider-like animals which are too small to be seen. Dust mites feed on skin flakes and like to live in warm, humid places. Therefore, ideal places for mites to live are mattresses, pillows, carpets, fabric-covered furniture, bedcovers, clothes, and stuffed toys, where there is high humidity and an ample food source. Both the dust mites themselves, and their feces or droppings, are allergens and can trigger asthma. On average, a double-sized bed can easily contain 2,000,000 dust mites, with each mite producing 10-20 waste particles (feces) per day. As with secondhand smoke, dust mite exposure can also cause young children to develop asthma.
- #41 Every one probably knows someone who is allergic to animals. Contrary to popular belief, people are not allergic to the fur on pets, but to the animals’ skin flakes, saliva, and urine. Here, pets refers only to warm-blooded animals such as dogs and cats. For most asthmatics, owning fish and turtles or other reptiles should not be a problem for their asthma. Most people don’t realize that pet allergens can actually stay in a room long after a pet has been removed.
- #42 Mold can also trigger asthma attacks. Molds can be found almost anywhere; they can grow on virtually any substance when moisture is present. Molds produce tiny spores that reproduce, just as plants produce seeds. Mold spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot, they may begin growing and digesting whatever they are growing on in order to survive. Molds can grow on wood, paper, carpet, and food. When excessive moisture or water accumulates indoors, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed. There is no practical way to eliminate all mold and mold spores in the indoor environment. Keeping that in mind, it is possible to control indoor mold growth, and that is by controlling moisture. Remember that when tackling a mold problem, you need to both clean up the mold and correct any problems of excess moisture. Reducing moisture also has the benefit of helping to reduce other asthma triggers, such as dust mites and cockroaches.
- #43 Cockroaches, or, more accurately, their body parts and droppings, can trigger asthma symptoms. Because of higher cockroach populations in inner cities, cockroaches are probably a more significant factor for asthmatics in inner city areas. The key to controlling cockroaches is to keep them from entering your home, and keep your home free of sources of food and water. Pests in the home are the most unwelcome and most difficult conditions in the home for asthmatics. Infestations of cockroaches, mice and rats all can cause allergic reactions Even after pests are gone, their skin, hair and feces can remain and cause allergies A study of 180 homes in Boston, half of which were Section 8 housing, showed that 75% of the houses had pest infestation problems. The most common problem is with mice. Mice pose a particular problem in New England and are especially hard to get rid of. The efforts in ridding pests from houses that have the best impacts on health happen by trying to get rid of the infestation as quickly in order to limit the overall burden of allergens. Children with asthma bear the greatest burden when it comes to pest problems. Asthmatic children allergic to cockroaches were more than 3 times as likely to be hospitalized if exposed to roaches in their home. I have heard some people scoff at cockroach allergy because they were exposed to cockroaches as a child and were fine. The way l like to explain it is that cockroach allergy is just that, an allergy. I do not have ragweed allergy but I do not deny that such an allergy exists. For people who suffer from it, cockroach allergy is very real and when they are exposed to it, cause very real worsening of their disease. 30% of children from inner city Boston are allergic to cockroaches.
- #45 Aspirin classic medication Systemic conditions in the home, such as Temperature shifts and extremes, either hot or cold, can cause asthma attacks. Excessive heat and humidity encourages dust, molds, and infestations into homes, a wet and warm environment attracts them and helps them breed. Dry heat can make airways more vulnerable to infections and allergic reactions by drying out the natural fluids in the lungs that fight infections and keep allergens from attaching to the lungs. Excessive heat, such as steam heat and radiator heat in houses, encourages dust, molds, and infestations into homes. Cold swings can cause airways to swell. Just as many of us without asthma can feel cold air enter our lungs, some people with asthma can be allergic to the chemicals that are released through cold air exposure.
- #46 How do we manage both the day to day symptoms and the attacks?
- #47 Fortunately, asthma is a manageable disease. There are two parts to managing asthma: preventing asthma attacks and treating asthma episodes when they do occur. Your doctor or health care provider is an important person in helping you develop an effective asthma management plan. Have a written asthma management plan, and make sure that the plan includes both medical and environmental management. By following your plan, an asthmatic can lead a full and active life and significantly reduce, or even prevent, asthma attacks. In this presentation, we will not cover asthma medications, emergency plans, or peak flow monitoring. Your doctor or health care provider can and should assist you in these areas. This presentation will discuss the most common indoor asthma triggers in detail, but will not cover how to identify which triggers are problems for you. Again, your doctor or health care provider can provide you assistance.
- #48 Prevent irreversible airway obstruction
- #49 Given the adverse health effects of secondhand smoke, it is important to avoid smoking in your home or car. Until you can quit smoking, you should smoke outside. Never smoke in the presence of asthmatics or children, who are particularly susceptible to the effects of secondhand smoke. Do not allow babysitters or others who work in your home to smoke in the house or near your children.
- #50 When avoiding dust mite triggers, try to both kill dust mites and clean to remove mites and their droppings. Wash bedding once a week in hot water, which has been shown to reduce mites. Stuffed toys are often overlooked as a reservoir for mites. Choose washable stuffed toys and wash them regularly. Keep them off beds to reduce the exposure received during long hours of sleep. Zippered mattresses and pillow covers which do not allow the mites to pass through appear to be effective in reducing the amount of exposure. Vacuum floors and/or remove dust often, which may help reduce exposure to dust mite allergens. Avoid vacuuming when the person with asthma is in the room. As you know, mites like to live in high humidity. Keeping humidity levels low, between 30-50% relative humidity, can be effective in lowering mite populations. Humidity levels can be measured by hygrometers which are available at local hardware stores.
- #51 Because pets and people move around in a home, it can be difficult to contain pet allergens in any home where there is a pet. If an asthmatic is allergic to animals, it is best not to have a pet at all. Consider keeping the pet outdoors or finding a new home for the pet. As we saw in the previous slide, pet allergens can remain long after a pet has been removed. Therefore, if you remove a pet, be sure to clean very thoroughly to remove the pet allergens. Clean the floors, walls, and especially the carpets and upholstered furniture. Some asthmatics may find that isolating the pet is sufficiently effective in helping to keep their asthma under control. If so, be sure to keep the animal out of sleeping areas at all times, and keep the animal away from upholstered furniture, carpets, and stuffed toys.
- #52 There are a number of common places in the home where moisture and mold can be a problem, such as kitchens, bathrooms, and basements. Fix any plumbing leaks immediately. If water damage occurs, you should dry water-damaged areas completely within 24 to 48 hours. In some cases, soaked materials such as carpeting may need to be replaced. Check the various drip pans in your home and keep them clean and dry. Use the exhaust fans in your bathrooms and kitchens when showering or cooking. Make sure that your clothes dryer vents to the outside. Keep the relative humidity in your home between 30 and 50% to maximize comfort and minimize asthma triggers. Using an air conditioner or dehumidifier can help to lower humidity when it is high. Avoid installing carpet directly on concrete floors in the lowest level of your home. Optional Exercise Before you show this slide, ask your audience to brainstorm a list of common locations for mold to grow in the home (such as shower curtains and window moldings). Record their responses on a flipchart.
- #54 These are peak expiratory flow meters. PEF meters come in different styles, but they all measure the amount of air a person can blow out in liters per minute. You set the indicator to zero, take a deep breath, put your lips around the mouthpiece and exhale as hard and fast as you can. Then you read the number on the scale. The proper use of PEF meters can help predict asthma episodes and monitor response to therapy. The goal is to monitor the airflow consistently to recognize any changes from normal. People with asthma need to know how and when to use the PEF meter and how to record the results.
- #55 This is an example of a peak flow chart. The chart can help display a person’s personal control zone, caution zone, and danger zone. People with moderate persistent or severe persistent asthma should take peak flow readings and record them every morning and evening and before inhaling certain medications. A person also should take a peak flow reading when he or she has symptoms to determine the severity of the episode and monitor the response to therapy.