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Asthma Treatment and Diagnosis
By Richard Robertson
If you ever met anyone with asthma, an attack usually encompass a shortness
of breath that soon passes without treatment. But it can also be a very life
threatning event that can end up putting the sufferer in an emergency room. An
average of 5,000 asthma deaths are reported in the United States each year. Most
of the deaths occurred in patients who misjudged the severity of their symptoms
or failed to reach a hospital or clinic in time to prevent death.
Diagnosing Asthma
Asthma diagnosis is based on repeated, careful measurements of how
efficiently the patient can force air out of the lungs and on a thorough medical
history and laboratory tests to find out what triggers the patient's acute
attacks.
People with asthma react to external irritants in a way that non-asthmatics
don't. Many, but not all, sufferers have allergies that cause their bodies to
produce an abnormal array of chemicals in response to environmental allergens.
In that sense, asthma is like pollen allergies, hives, and eczema. But in
asthma, the allergic reaction contributes to inflammation of the airways rather
than of skin, eyes, or nose and throat. An acute asthma attack may come on
rapidly after exposure to an irritant or develop slowly over several days or
weeks, which can complicate the job of identifying a patient's asthma
triggers.
Which drugs asthma patients need, when to use them, and how much to use
depend largely on the character of their illness, as shown by the degree of
breathing impairment and the frequency and severity of acute attacks. Many
docotors and researchers agree that the first line of defense is avoidance of
whatever brings on an acute asthma episode. In some asthmatics, attacks can be
brought on by strenuous exercise, exposure to cold outdoor air, industrial or
household chemicals and food additives such as sulfites. Influenza or even cold
viruses can also trigger asthma episodes. There are many cases where triggers
cannot be identified, even after a thorough investigation.
Asthma Treatment
Knowing what provokes an asthma attack is critically important in prevention,
but it's often difficult or impractical to avoid contact with triggering
irritants. Today, however, doctors can prescribe drugs to lessen the risk of
acute attacks after exposure to an offending irritant, as well as halt attacks
that can't be prevented.
The drugs used to treat asthma fall into two broad categories: controllers to
prevent acute attacks and relievers that check acute symptoms when they occur.
Some drugs do both.
In light of mounting evidence that asthma is fundamentally an inflammatory
disease, asthma authorities today regard inhaled corticosteroids--marketed under
numerous brand names as the most effective agents for controlling airway
inflammation and thus preventing acute asthma attacks. Corticosteroids in pill
or tablet form and in liquid form for children are prescribed long-term for some
patients with severe asthma, or short-term for patients with a serious asthma
episode.
Bronchodilators work to help open the breathing tubes (bronchi), but do not
treat the underlying inflammation. There are both short-acting and long-acting
bronchodilators. Long-acting inhaled bronchodilators, and long-acting oral
bronchodilators, are often used in conjunction with anti-inflammatory agents to
control symptoms. They don't provide immediate relief of symptoms, but their
preventive action persists for many hours, which makes them useful in
controlling attacks that might occur during hours of sleep.
Drugs to bring quick relief in acute asthma attacks are chiefly short-acting
inhaled bronchodilators that act rapidly but for a relatively brief time to
relax bronchial constriction. Although these drugs are effective in treating
asthma, there is some controversy about their safety, especially when they are
overused. Scientific debate makes it clear, however, that an increasing need for
inhaled bronchodilators, or a decreasing response to each dose, is a signal that
the patient's asthma is not being adequately controlled. Patients who have an
increasing need for short-acting inhaled bronchodilators should be reevaluated
promptly by their physicians.
Both prescription and over-the-counter short-acting bronchodilators are
available. Like the prescription drugs, the OTC drugs act only to provide
symptom and relief, and they are generally effective for a shorter period. They
may be useful, therefore, as temporary treatment for mild asthma attacks. Ready
availability in drugstores makes the OTC products potentially helpful as a
"stopgap" for patients who do not have their prescription medication at hand
when an asthma attack occurs. More importantly, patients who use OTC inhalers
should still seek advice from a health professional about the long-term
treatment of their asthma.
The key to effective, long-term treatment of asthma is finding the drugs and
dosage plan most effective in dealing with or preventing acute episodes. But
effective treatment depends as well on the patient and the care-giver knowing
what the various anti-asthma drugs do, when and in what amount each drug should
be used, when a change in symptoms or in the response to a particular drug
requires a call or visit to the physician, and when to get emergency help.
Physicians who specialize in treating asthmatics go over these points in detail
as part of an overall treatment plan designed and, as necessary, adjusted to
meet the needs of each individual patient.
A cure for asthma is judged by experts to be still a far-off possibility. But
the majority of asthma sufferers can lead essentially normal, symptom-free lives
by understanding and sticking to a well-planned strategy to keep clear of asthma
triggers and to use the right drugs in the right way.
asthma treatment resources
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