Asthma Treatment Goals

The good news is that you can avoid these problems. As with asthma during any time of life, proper treatment can help you, and your baby, stay healthy. With your asthma under control, you usually can expect:

- Fewer asthma symptoms, such as hard breathing, even at night

- No limits on moderate exercise or other activity appropriate during pregnancy

- Normal or near-normal tests of lung function

- Few or no asthma attacks

- No trips to the emergency room or hospital for asthma

- Easy use of medication with few side effects for you or your baby

- Delivery of a healthy baby

The key to achieving these goals is to create a personal asthma management plan for your pregnancy. Your obstetrician or nurse-midwife can help you understand how asthma can change during pregnancy. Your primary care provider can also help. Feel free to ask questions, gather information, and voice concerns. If you have severe asthma or allergic asthma, you also should see an asthma specialist during your pregnancy.

When you're pregnant, you need to consider carefully the three features of asthma management: triggers, medication, and monitoring.

Talking with your doctor

When you're at the doctor's office, do more than just listen. Ask questions. Be honest about any concerns you might have. Honesty with your doctor is essential. You're not the only person who thinks asthma is complicated or confusing. Researchers have spent years trying to unravel the mysteries of this condition, and they're still hard at work on these efforts. Knowledge about asthma changes rapidly, so it's not surprising that you may have questions.

Your doctor has treated other people who have asthma and won't be surprised to hear your questions. Maybe you've heard that asthma medications are dangerous. They aren't, and your doctor can tell you why. Perhaps someone told you that asthma is all in your head. It's not. Now's the time to ask questions and share any concerns you might have about your health.

Diagnosis Older Adults with Asthma

In older adults, asthma can be difficult to diagnose because its symptoms are similar to common conditions, such as chronic obstructive pulmonary disease (COPD). This general term describes a number of lung conditions (particularly chronic bronchitis and emphysema) in which your lungs gradually become less efficient at inhaling and exhaling air. In other words, your lungs don't function as well as they once did. Heart disease also may cause asthma-like symptoms.

Elderly adults with asthma may cough often, feel a sensation of tightness in the chest, feel out of breath, and wake up at night frequently. To diagnose asthma, a health care provider will do a physical examination, take a medical history, and perform one or several specific lung function tests. If a doctor is still uncertain, older adults might be asked to try an asthma medication. If symptoms respond, then asthma is probably the cause.

As for everyone with asthma, an asthma treatment plan involves avoiding asthma triggers, taking the right medication, and monitoring breathing.

Cough-Variant Asthma

Cough-variant asthma is common, especially in children. If you have cough-variant asthma, your main symptom is coughing, frequently at night. During the day, you feel fine and have no other symptoms. In fact, you may even find it hard to believe that your cough is asthma because you don't wheeze or have other typical asthma symptoms.

If you find you're not sleeping at night because you keep waking up coughing, you may have cough-variant asthma. Or, if you find that you are coughing during the day but do not have a cold or other illness, you may have cough-variant asthma. Your doctor may ask you to monitor your asthma using a peak-flow meter for two weeks. The goal of this monitoring period is to see how your breathing ability changes over time. A peak- flow meter can tell you whether your airways are narrowed.

Once your diagnosis is established, you and your health care provider will develop a personal asthma management plan for you, "Managing Your Asthma Day to Day." This plan includes asthma medications and a medicine plan, "Asthma Medications."

Situations of Living With Asthma - Under the Weather

It's morning and you don't quite feel well. Should you go to work or school or stay home? In general, you can probably go to the office or school if you have a stuffy nose but are not wheezing or if have a little wheezing that goes away after taking your asthma medicine. It's probably a wise decision to stay home from work if you have:

- a sore throat; swollen, painful neck glands; or other physical signs of infection

- a temperature greater than 100 degrees Fahrenheit (F) [oral] or 101 degrees F (rectal)

- wheezing or coughing that still bothers you after 1 hour after taking your asthma medicines

- weakness or fatigue that makes it difficult to perform your daily activities

- difficulty breathing or breathing very fast

- peak-flow reading below 65 to 70 percent of your personal best and no response to treatment

If you are unsure whether you should stay home, call your doctor. Be prepared to describe your symptoms and when they appeared.

Medicine Plan of Special Types of Asthma

The goal of a medicine plan for this kind of asthma is to help you maintain normal activity levels without asthma symptoms. Your health care provider will tell you how to prepare your airways for exercise or other strenuous activity. As with other forms of asthma, the key is to treat your airways before symptoms begin, or at least worsen.

For most people with exercise-induced asthma, inhaling a short-acting beta9 agonist within an hour before exercise prevents asthma symptoms. You can usually count on the medication working for about two to three hours. Other medications your doctor may prescribe are cromolyn and nedocromil. Again, these medications are taken before exercise.

You also may get less, and less severe, exercise-induced asthma if you use anti-inflammatory medications on a regular basis. You and your doctor will decide if this option is better for you.

What to Remember About Inhaling Asthma Medicine

You Have A Choice. When deciding how to inhale quick reliever or long-term controller medications, you have several options. MDIs are the most popular way to inhale asthma medicine. But you also can try a dry powder inhaler or, if you have severe asthma, a nebulizer. Consider using a spacer, which makes inhaling medication easier. Keep in mind that inhalers are improving. Ask your doctor about different types.

Technique Matters. Your inhaler only works if you use it correctly. Learning how takes time, patience, and practice. Ask your health care provider how to use an inhaler. While still at the doctors' office, practice. Also, get written instructions about using inhalers. Last, bring your inhaler to your check-up visits. Each time, show your doctor how you're using it. All this may sound like a lot of effort just to take your medication. But it's worth it. Good inhaler technique will help you get the full effect of your medication.

What should you do before going to the doctor

During the time leading up to your appointment, start a list of things you want to discuss. Take notes. Write down questions and symptoms as soon as they occur to you. Plan to update your doctor about anything that has happened since your last visit. For example, you should let your health care provider know about a recent emergency room visit; a recent cold or other illness; any changes in your weight, sleep, energy level, or appetite; side effects from medication you may be taking; and any major stresses or changes in your life.

If you start an asthma diary, you might keep your "topics to discuss" list with that diary. This list will help jog your memory when you're at the doctor's office. On the day of your doctor's appointment, bring this list. Also bring your asthma diary and medications, including those prescribed by other health care providers and nonprescription drugs that you take regularly.

How to use a nebulizer correctly

1. Wait one hour after eating before using your nebulizer. Alternatively, you can use the nebulizer before eating. Wash your hands before you get started.

2. Measure the amount of saline (salt water) solution and medicine to go into the nebulizer cup. Most people like to buy pre-mixed medication that you can just pour into the cup.

3. Attach the mouthpiece to the T-shaped part and then attach this to the nebulizer cup. (If you're using a mask instead of mouthpiece, fasten it to the cup.)

4. Put the mouthpiece in your mouth, and tightly close your lips around it. (Or place the mask on your face.)

5. Turn on the air compressor machine.

6. Slowly take deep breaths in through your mouth.

7. Hold each breath for a second or two before breathing out.

8. Repeat this procedure for about 10 minutes or until all the medicine is gone from the cup.

What To Remember About Quick Relievers

Don't Overuse Them. If you need to use a quick-reliever medicine often, it may be a sign that the swelling in your airways is getting worse. It also may mean your medication isn't working properly. If you need a short-acting beta agonist at least 3 times a week, see your doctor. You may need to take a controller medication every day, while using a quick reliever just during asthma attacks. (One exception to the no-more-than-3-times-a-week rule is exercise-induced asthma. If you are an athlete with asthma, ask your doctor how often to take asthma medication.)

Technique Matters. No matter what your asthma symptoms, your doctor probably will suggest that you keep an inhaler nearby in case you need a quick reliever medication during an asthma attack. To get the full benefit of these drugs, you must use the right inhaler technique.

Exercise-Induced Asthma

What do track star Jackie Joyner Kersee and diver Greg Louganis have in common? Both have won Olympic medals. Both also have asthma. They and other athletes, including "weekend warriors", know that it's possible to exercise even if you have asthma. Most people with asthma get symptoms during vigorous activity.

For some, exercise is the only trigger. Either way, you don't have to stop being active, but you do need to take special care. If your asthma only occurs during a game of tennis, pick-up basketball, a run through the park, or other sports activity, you have exercise-induced asthma. Having this form of asthma doesn't mean you have to avoid these sports. Often, using an inhaled bronchodilator before, during, or after your workout (or sometimes all three) can control this kind of asthma.

Which Drugs Are Unsafe For Pregnant Women?

There are a few drugs you should avoid taking while pregnant, if possible. Ask your doctor about specific medications if you have a condition that requires medicine. In general, avoid taking:

- Decongestants: These over-the-counter medicines are used to treat colds.

- Live virus vaccines: Ask your doctor before getting any vaccine while pregnant. Killed-virus vaccines, in which the virus is deactivated entirely, are okay.

- Immunotherapy: These allergy shots are okay if you already are taking them. If you aren't, wait until after your pregnancy to begin.

- Iodides

- Over-the-counter inhalers: Don't use over-the-counter medications, like epinephrine, phenylephrine, or brompheniramine. Instead, ask your health care provider which medicine is right for you.

Trigger of Special Types of Asthma

Exercise-induced asthma, sometimes called exercise-induced bronchospasm-, is believed to be caused by a loss of heat, water, or both from your lungs because you are breathing more heavily than normal. Typically, the air you inhale is cooler and drier than air in your lungs, which is warm and moist. The exchange of air leaves your airways dry and cold. There is disagreement, however, whether cold or dry air is the true culprit.

During exercise-induced asthma, your airways constrict minutes after you become active. You may cough, wheeze, feel tightness or pain in your chest, or get other asthma symptoms. Exercise-induced asthma usually happens during or minutes after vigorous activity, peaking about 5 to 10 minutes after you stop. Symptoms go away 20 to 30 minutes later.

Occupational Asthma

Sometimes, your workplace can cause asthma. About 2 percent of all cases of asthma are related to the job. What are the clues? Symptoms usually appear within a few months to about four years after your first exposure. Your coworkers might have similar symptoms, such as wheezing, chest tightness, and difficulty breathing. You should suspect occupational asthma if you notice that asthma symptoms go away when you're away from work for several days, such as for a vacation or at the end of a weekend.

You might miss this cause-and-effect relationship if your symptoms appear only after you've been at work for several hours. Asthma symptoms may occur within your first hour at work, or as much as eight hours later, or even at night.

Strong Odors and Sprays

While some odors may smell pleasant, you may find that strong odors and sprays, even ones that smell nice, are the cause of your asthma symptoms. These days, you can find more and more products that are available in fragrance-free versions.

- Leave your home while it is being painted. Return to your house once the paint has dried.

- Avoid perfume and perfumed products, including talcum powder and hairspray. Opt for fragrance-free products.

- Do not use room deodorizers.

- Use fragrance-free household cleaning products.

- Use a fan or open windows in the kitchen to reduce cooking odors.

- Avoid exposure to air pollution by remaining inside on days when pollution is high.

Medication and Breast-Feeding- A Special Note

Many women with asthma prefer to breast-feed their babies. You can do this safely. It's true that nearly all medications enter breast milk, but the amount of medicine usually is low. It's rare that a baby is affected. The American Academy of Pediatrics has reported that a range of asthma drugs are safe for mothers of nursing infants, including terbutaline, a quick reliever, and prednisone, a long-term controller. One drug, theophylline, may cause vomiting or shakiness in sensitive newborns. As with drugs during pregnancy, it's a good idea to ask your doctor which asthma medications have a history of safe use during breast-feeding.

Cleaning Your Nebulizer Daily

It's very important to clean your nebulizer every day. If bacteria build up in your nebulizer, you can inhale it and get an infection. Keeping your nebulizer clean will also make it last longer. Ask your health care provider exactly how to clean the equipment. In general, you should clean your nebulizer every time you use it by doing the following:

1. Rinse the mask or mouthpiece and T-shaped part in warm water, sterile or distilled water is best, for about 30 seconds. (Do not wash the tubing.)

2. Put the pieces on a towel to air dry.

3. Put the mask or mouthpiece and T-shaped part, cup, and tubing back together. Connect the tubing to the compressed air machine, turn on the machine, and let it run for 10 to 20 seconds.
This dries out the inside of the nebulizer.

4. Take the tubing off the compressed air machine. Store the nebulizer in a sealed plastic bag.

5. Cover the compressed air machine.

A note about over-the-counter asthma medicine

Most asthma medications are only available with your doctor's prescription. A few inhaled quick-reliever medications, however, are sold over-the-counter at drugstores. These general medications are advertised to treat asthma, chronic bronchitis, emphysema, and other lung disease. Don't use them. As you've learned, everyone's asthma is different. Together, you and your doctor can decide which, and how much, medication is right for you. Simply puffing on an over-the-counter inhaler whenever you feel short of breath will not improve your asthma. And it may even make your symptoms worse.

Food Allergens

Most allergens that induce asthma symptoms are ones that you breathe in. Food is a less common cause. But if you experience asthma symptoms after eating processed potatoes, shrimp, or dried fruit or when drinking beer or wine, you may be sensitive to the sulfites present in these foods, although sulfite allergy is a rare asthma trigger. Sulfites are used to preserve foods and beverages. If your asthma seems to be triggered by sulfites, avoid food and beverage products that contain these preservatives, and read ingredient labels before eating processed foods.

Asthma Imitators

A long list of other conditions can imitate asthma. The most important of these is chronic obstructive lung disease (COLD), sometimes called chronic obstructive pulmonary disease (COPD). COLD is most often the result of smoking. It sometimes causes changes in the lung that might lead an inexperienced observer to think of asthma, but it does not respond to most of the measures used to treat asthma. Most people who are seen in public using a nasal tube and an oxygen tank are in the end stage of COPD, the result of smoking.

Heart failure can also imitate asthma, bit usually occurs in people 60 or older and in patients who have other signs and symptoms of cardiac failure. In heart failure, the heart is unable to push out of the lungs as much blood as the body requires in its circulation. Backed-up blood then fills the lung, displacing air and causing wheezing. One of the complications of COLD is lung fibrosis (scarring), which thickens lung tissue, making passage of blood more difficult. Also in the older age group, blood clots in the lung (pulmonary embolism) may be confused with asthma, but a chest X ray will show tie difference. Finally, certain anatomic changes along the path air takes from nose to lungs may mimic asthma, particularly tumors. These, too, can be sorted out by various medical procedures, such as electrocardiograms and X-ray modalities.

Cystic fibrosis is a metabolic disease that is passed in the genes to some members of certain families. It is often confused with asthma, but is a completely different disease. Some of the treatments for asthma are helpful to patients with cystic fibrosis, but none are curative.

The Nervous Connection

Besides inflammation, another path leads to tightening of the bronchial muscles. A network of nerves (autonomic nervous system) exists throughout our bodies to regulate bodily functions on a moment-to-moment basis. This autonomic network is independent of our thought processes in that we have no control over it at all.

The autonomic nervous system serves all parts of the body. Controlling the heart and blood vessels, it adjusts blood pressure and pulse rate. In the digestive tract it controls movement of food and production of enzymes needed for digestion. It coordinates muscle movements and controls our balance. There is no bodily function that does not involve the autonomic nervous system.

In the lungs, the autonomic network has two types of connections. There are nerves that cause the bronchial muscles to contract (parasympathetic nerves) and others that cause them to relax (sympathetic nerves). These networks also regulate secretions of mucus in the respiratory tract. The nerve fibers that contract the bronchi also increase secretions of the bronchial mucous membranes. The fibers that relax the bronchial muscles tend to decrease secretions. Activity of the parasympathetic nerves is one immediate cause of tightening of the bronchial muscle-tubes.

Autonomic nerves, both sympathetic and parasympathetic, connect the sinuses and the lungs. As a result, blockage of outflow from the nose or sinuses may cause tightening of the bronchial muscles, one mechanism by which infection of the sinuses can cause bronchospasm and bronchial asthma. There are, however, many other pathways that lead to bronchospasm.

Alternative Asthma Treatments-Yoga

Yoga also comes from the science of the East, this time from India in the early Christian era. The name means "union' referring to the union of mental, physical, and spiritual energies to improve health and well-being. Yoga uses specific physical and mental exercises to influence the workings of the autonomic nervous system. Since the relationship between asthma and the autonomic nervous system is generally accepted, we might expect yoga to improve breathing in asthma. Indeed, it has been shown to do just that.

A special concept (pranayama) in yoga that involves control over the breathing process is of special interest to the patient with asthma. Pranayama training aims to alter the breathing pattern so that breathing out (expiration) takes twice as long as breathing in (inhaling) with each breath. As part of this system, there are alternate nostrils breathing exercises designed to clear the nasal passage. However it may work, yogic control of breathing patterns has been shown to improve pulmonary function test results and exercise tolerance.

Medical literature includes studies of yoga that are mostly in otherwise healthy people. For example, there is yogic relaxation exercises used alone and with pranayama to improve breathing of healthy people. Many of these published reports describe benefits from yoga in breathing. A difficulty arises with yoga because breath control training (like the exercises in this book) can't be learned during an acute episode of asthma. It is best learned during asthma-free periods.

What Lungs Are and How Lungs Work

The name "asthma" goes back to an ancient Greek word meaning "difficult breathing." Originally, asthma was used to describe difficult breathing from any cause, but in the 20th century it has come to mean difficult breathing because of a problem that begins in the bronchial tubes of the lungs. To understand what goes wrong with the lungs in asthma, we must fist look at the mechanics of breathing via the structure (anatomy) and workings (physiology) of the chest. When we know how the lungs are put together and how they work, we can consider the process of breathing and understand what the lungs do to fulfill their job of providing a dependable supply of oxygen to the body. Understanding about the workings of the lung is required to make useful much of the information contained in this website.

There is no easy way to control asthma, no pill that alone can give complete and permanent relief. There is much that can be done to help the patient, but management must be more than taking a pill or a shot. What can be done requires that the asthmatic patient be thoroughly knowledgeable about the disease, especially in understanding the structure and functioning of the body, particularly the lungs. To understand asthma, you have to know the purpose of lungs, how they work, how air gets into the lungs, what is the pathway of air out of the lungs, and how that pathway affects the disease process.

Asthma in the Workplace

Some exposures in the workplace are likely to cause asthma, a problem in all of the developed countries. In the United States and Japan, estimates suggest that as many as 15% of people in the workplace suffer from occupational asthma. There are also a group of people with true bronchial asthma whose disease worsens after industrial exposure. There are about 250 chemicals (mentioned elsewhere in this book) identified as causing occupational asthma on a list that includes almost any substance that can be inhaled. For example, chemicals called isocyanates, used in fabrication of plastics, are known to cause asthma. Isocyanate-induced asthma develops in 10% of workers exposed to it. With isocyanates, as with other exposures in the workplace, avoidance of the industrial exposure is the best and often the only cure. For most patients with occupationally induced asthma, management consists of retraining for another occupation that will avoid the exposure to harmful airborne substances.

The diagnosis of occupational asthma has social and economic implications as well as those related to health. Legal implications are certainly significant. In Canada, each settled claim against the governmental agency that manages this disease results in costs of $35,000. In the United States, there are also tort law approaches to liability claims.

Blood Tests

Testing the patient's blood offers additional information that is somewhat useful in studying asthma. Blood tests are not nearly as useful as lung function testing in diagnosing and following the course of asthma. Routine counting of the blood cells is not helpful except to call attention to a serious infection that might otherwise be overlooked.

In some patients with asthma caused by allergies, one type of cell (the eosinophile) may be unusually abundant. A high number of eosinophiles in the blood might make a doctor think of allergies as a cause of asthma, but is otherwise not helpful. There is little information otherwise to be gained by a "complete blood count". Nor are the usual "blood chemistry" tests helpful except perhaps to suggest some unsuspected condition coexisting with asthma.

There is other information to be gained from the blood. The amounts and percentages of oxygen and carbon dioxide in the blood are important criteria for thinking about the severity of an episode of asthma. These results are of great significance to the doctor. For example, one test compares the percentage of oxygen carried by the blood with the percentage it could carry at best. This measurement is called oxygen saturation. Doctors show concern about the condition of a child whose oxygen saturation is less than 91%.

The Doctor as a Person

Doctors are people too, before they become doctors and thereafter. Years of training have made them excel at what they do, but have also hardened them about the facts of illness to the point where they may seem callous in their approach to diseases and their effects. Doctors bring to their relationships their own experiences, their own likes and dislikes, their own biases. As a result of their extensive schooling, doctors have more information than the usual patient, especially about healthcare. They are protective of their position in the healthcare scene: Doctors are leaders and they never forget it. They work under stress, tend sometimes to be curt and uncaring when they are just busy and in situations that, unusual to patients, are quite commonplace in the life of a doctor.

Support groups for asthmatics and their families can be found in many communities and on various electronic services where they often appear as "chat" groups. Lots of personal feelings and information about doctors can be found in this arena that is useful in selecting a doctor to treat asthma. Remember that the information you gather from word-of-mouth sources does not have the same status as information from recognized governmental and professional channels; still, it never hurts to ask around the neighborhood.

How to Relate to Your Doctor

You've spent time selecting a doctor and presumably have found one to whom you can relate comfortably. How should you deal with her or him? Remember who your doctor is, a dedicated professional with lots of training, someone who is almost as interested in maintaining your health as you are. The doctor is also a person, with feelings of her or his own that come to bear on every relationship. Treat your doctor as an authority, but also as a friend. Having read this book, you are far more knowledgeable about asthma than the average patient. Let this come forth in your dealings with your doctor. Present clearly and informatively the information you have about your health and about the disease in general. Use medical terminology as a way to present your information clearly, but do not hold yourself forth as an expert on a level with your doctor. Try "I did well using just my bronchodilator spray last time" not "All I need is my spray."

Say "My child seems to prefer liquid medicine," not "We tried your capsules last time but he wouldn't take them."

In short, treat your doctor as you would like to be treated yourself. You'll get better medical care and feel better about your doctor if you obey the Golden Rule when you deal with her or him.

Finding a Doctor by Credentials

Finding a doctor for the asthmatic patient is not difficult. Your local library will have a Directory of Medical Specialists, which lists doctors certified by professional boards with subspecialties in allergy/asthma. The directories list doctors by geographic location of the office, so you need only look at the doctors listed for your city and state. Directories of the various specialists' colleges and academies are another source of information. These listings as well as those of the Directory of Medical Specialists describe the training of each doctor, the name of the medical school attended, hospitals where additional training was obtained, number of years of additional training, and in which states medical licensure is held. In fact, by assuming the doctor to have graduated from medical school at age 27, it is possible to approximate the doctor's age.

Every doctor must be licensed to practice in the state where he or she works; it is advisable to be sure such a license is valid, particularly when the doctor is a recent arrival in your community. But remember, the license ensures only that the requisite basic medical education and training for licensure has been successfully completed. It tells nothing about specialty status.

How to Work with Your Doctor

You can't do it all by yourself. You need help from your doctor for everything at first. He must make the diagnosis, authorize tests, prescribe medicines and equipment, and teach you how and when to use them. lie is your best source of information about new treatments as they come available.

To enlist the cooperation of your doctor, tell him you want to learn about managing asthma, your asthma. He should be happy to help you learn. The more you learn, the less often you will have to trouble him with questions that are worrisome to you but routine and repetitious to him. He will be spared the day-to-day details of your illness. Like so many things in medicine, asthma management has become routine for doctors who deal with it all of the time.

Your doctor will appreciate your efforts to help. The more you learn, the easier it will be for the doctor to help you. What can you learn? Learn what the treatments are, learn how best to use them, learn when and how to stop using each medicine, and learn what treatment is most effective for you and when to begin. In short, learn all about your disease and its management. Everything you need to know is in this book. Learn how to use the information.

Which Spray to Use

There are two schools of thought about management of low-grade, ongoing asthma. One school says that cortisonelike sprays should be the mainstay of management; the other recommends bronchodilator sprays. The final decision should depend on how you, as the patient, respond to each method. At the suggestion of your doctor, try either one. If not completely relieved, if asthma continues despite treatment, try the other route.

Prednisolone Dosage for Average-Sized Adult
Day Dose

First day 60 mg
Day 2 50 mg
Day 3 40 mg
Day 4 30 mg
Day 5 20 mg
Day 6 10 mg
Day 7 5 mg
Day 8 None
Day 9 5mg
Day 10 None

In either case, do not begin treatment with steroids without consulting your doctor. An exception to this is when the asthma recurs late at night, as it so often does. If you have a steroid medicine at home, it is permissible to take a starting dose and call the doctor in the morning. You may want to ask your doctor to prescribe extra steroid tablets to be used in time of emergency. This will make life easier for both you and your doctor.

Herbal Medicine and Diets

Over the centuries, herbal medicine has contributed much to the advancement of medical treatment. Specifically in asthma care, ephedrine and the family of drugs it spawned have been important contributors to the management of asthma. Similarly, the earliest of the cromolyn drugs were derived from the root of an Egyptian plant. Searching among herbal medicines for effective drugs is ongoing at all times, and new drugs can be expected from herbal sources. With each herb proposed, care must be taken to consider safety as well as effectiveness. But to date there are no organized trials of herbal medicines in the fashion that would meet the approval of the Food and Drug Administration.

The same is true for special diets. Foods and food additives may cause asthma in a small number of people. Troublesome foods and additives can be identified by keeping a diary of dietary intake. Careful consideration of the relationship of foods eaten to onset of asthma can be very helpful. But aside from allergies as a cause of asthma and avoidance as a treatment, there is no special diet that protects against or treats asthma.

Treating Asthma with Medicines-Guaifenesin and Iodides

One medicine is often used to thin lung secretions. It is guaifenesin (glyceryl guaiacolate), and is available simply as the sole active ingredient of a syrup (Robitussin) and as a tablet (Humi-bid L.A.). It also appears in many so-called cough mixtures, medicines that may contain several other ingredients. Those other ingredients are often either not helpful in asthma or potentially harmful. For example, most cough/cold medicines contain cough suppressants, members of the morphine family of medicines. Morphine-related drugs tend to increase spasm of the bronchial muscles, which is certainly not what is needed in the treatment of asthma.

Guaifenesin is the best of available medicines to make secretions more coughable in the asthmatic, but it works just slightly better than water. The additional combined medicines in cold/cough remedies may even be harmful. So your best bet for thinning lung secretions is simply to drink lots of water.

Medicines containing iodine are sometimes used by mouth to thin bronchial mucus. Their effectiveness has never been clearly demonstrated, and iodides also have important side effects that limit their usefulness.

Simulated Bronchospasm

Lung tumors, cystic fibrosis, a ring of blood vessels around the trachea (tracheal ring), softening of the voice box and windpipe (laryngotracheal malacia), and birth defects (congenital deformities) of heart and lungs can simulate bronchospasm by causing wheezing. An uncommon condition in which digestive juices from the stomach back up into the esophagus may cause wheezing in infants and children. Called "gastro esophageal reflux," this is another sympathetic nervous system reflex that can sometimes cause asthma.

A word here about croup, a viral disease that occurs for the most part in infants and children under 4 years of age. Croup is usually associated with a viral infection of the respiratory tract that can cause swelling of the vocal cords. Swelling diminishes the space through which air passes between the cords, sometimes to the point where no air can pass into and out of the lungs. Accordingly, croup is one of the few true medical emergencies in childhood. It begins quite suddenly, sometimes with a repetitive, harsh, brassy, "tickle" cough and goes on rapidly to wheezing and severe difficulty in breathing.

Asthma in Labor and Delivery

Labor is a very physical process. It requires that the woman coordinate her physical efforts toward helping the baby through the birth canal. The physical effort demanded can be significant, and with that effort comes the demand for adequate lung function. So one of the recommendations of a National Institutes of Health committee that looked at asthma in pregnancy was that the mother's lung function be carefully considered.

Most women will have no problem in pregnancy, but a few women with asthma uncontrollable as labor approaches may develop problems for themselves and the baby. Women at risk in this regard must be identified beforehand by monitoring of lung function throughout pregnancy. Lung function tests may be needed toward the end of pregnancy, even peak flow determinations in the early stages of delivery (Of course, the baby's progress through the labor is also carefully monitored.)

Positional Drainage of the Lungs

A patient who is poorly hydrated and has thick, sticky mucus secretions will often need assistance clearing that mucus out of his airways. By positioning his body so that his chest is some-what higher than his windpipe and mouth, he can encourage the mucus to run "downhill" inside the bronchi to a place from which it can be "coughed up" and expectorated.

There is difficulty in maintaining a head-down position during an acute episode of asthma because that position pushes the abdominal contents up against the diaphragm and raises it. A raised diaphragm is comfortable for expelling trapped air, but it makes inhaling a little more difficult. So positional drainage is best used between acute episodes of asthma. With proper use of bronchodilating medicines, with attention to hydration, positional drainage should rarely be necessary.

Wheezing with Inhaling

Croup occurs more frequently in allergic children than in others and may occur in children who are prone to have asthma. An episode of croup is easily differentiated from an asthma attack. In croup, the wheezing is heard when the child breathes in. The wheezing in asthma, as we know, comes with breathing out.

Since croup can occur in the asthmatic child, make sure to notice whether the wheezing comes with breathing in or with breathing out. This is very important because croup is more serous from the start and gets more severe more quickly than asthma. Treatment for croup and for asthma is somewhat the same, involving the use of humidified air, the adrenaline family of drugs, and steroids.

When these and other wheezing Conditions peculiar to childhood have been ruled out, asthma is the problem. Asthma usually is identified by wheezing, but in some children, the troublesome sign is a cough instead of wheezing. The cough is often a dry, hacking cough, usually worse at night. Such a cough is considered to be the equivalent of asthma and sometimes precedes wheezing by several hours. In this case, there is enough spasm of the bronchi to cause coughing but not enough to cause wheezing. Sometimes the wheezing is absent because the young child's respiratory muscles are too weak or too tired to provide the effort that is needed for wheezing. A mucus drip at the back of the throat (postnasal drip) can also cause a hacking cough.

Asthma in Children

Asthma is a leading cause of chronic illness in childhood, and is responsible for a significant portion of school days lost because of chronic illness. It is also estimated that between 5 and 10% of children will at some time in their lives have signs and symptoms compatible with asthma. Before puberty, about twice as many boys are affected as girls; after puberty the numbers are equal.1 As in adults, the incidence of asthma and the death rate from childhood asthma are on the rise.2 There is no simple explanation for the increase in illness and death caused by childhood asthma, but delay in seeking treatment and increase in air pollution are two possible causes.

Despite the fact that both adult and childhood asthma are on the rise, there are some basic differences between asthma in adults and that in children. Allergy plays a more important role in childhood asthma than in adults. Most asthmatic children will have one or more other signs and symptoms of allergic disease and most children who will develop asthma have their first attack before age 2. Childhood asthma seems to be more prevalent in homes where the parents smoke, as are other respiratory diseases including the common cold, the result of air pollutants in cigarette smoke.

Asthma from Exercise- The Scourge of Olympians

Some people develop asthma simply from exercising, regardless of age. Within a few minutes after starting to run or beginning any other strenuous exercise, about 10 percent of all asthmatics develop full-blown asthma. Exercise-induced asthma is believed to be caused by the irritation and drying effect of large amounts of air, rapidly inhaled, especially cold, dry air.

Running is the usual cause of exercise-induced asthma. This is true not only for casual runners, but also for highly trained athletes. In a survey of the 1984 summer Olympians, 11% reported history or symptoms of exercised-induced bronchospasm (EIB),another term for asthma. Bicycling is a less common cause of EIB since the bent-at-the-hip position of the biker makes it easier to exhale. Swimmers are taught to control their breathing, to inhale quick and exhale completely in a controlled, rhythmic fashion. This appropriate breathing pattern makes swimming a rare cause of exercise-induced asthma. According to a 1996 study from the Sport Science Center at the University of Delaware, 30% of indoor figure-skating athletes develop EIB while exercising in the cold, damp, and sometimes moldy rink environment. None of this seems to handicap these athletes, especially since medicines that relieve bronchospasm are on the short list of medicines approved by Olympic authorities for use by competitors.

Asthma - Antibody Tests

Allergy antibodies are members of the group of IgE antibodies. In this group can be found antibodies against the protein of trees and grasses, against animal hair and other inhaled substances, and against foods. Blood tests for IgE antibodies against plants and animals are very reliable, very helpful in diagnosing allergies. Testing for food antibodies is less satisfactory than testing for antibodies to the inhaled substances.

The technology used for determining these allergy antibodies is called RAST testing. Using RAST, it is possible to look for antibodies that react to allergy-causing substances. RAST can also be used to follow the progress of an allergic disease. As the condition lessens, the antibodies diminish, too. Tests for many allergy-causing substances (allergens) can be done on a single, small specimen of blood. This makes blood testing quicker and easier than skin testing, the traditional method of finding IgE antibodies. Skin testing is still the usual method of finding antibodies, however, because it detects smaller amounts of antibodies than RAST testing and is less expensive.

Testing of any type is best done on an individualized basis, the tests selected to correspond to information obtained from the medical history. There is no need to test for grass pollen in a patient whose symptoms are exclusively in the winter, no purpose to testing for foods such as lobster that the patient never eats. In any case, although the history is most significant in evaluation of an allergic patient, many tests are available to establish the diagnosis and observe progress with treatment.

Alternative Asthma Treatments-Psychological Management

There is no doubt that the mental and emotional state of a person can influence health. In the 1940s through the 1970s, there was widespread interest in the mind-body relationship. Elaborate programs were designed to produce better adjustment of the patient to his or her social environment. The outcome sought was better understanding of the relationship of mind to body and how this was influenced by the social milieu. Some progress was made in management of some diseases in this manner.

In this period, it was fashionable to consider asthma as a psychosomatic illness and to offer psychological counseling or psychotherapy as a treatment. Some practitioners went so far as to liken wheezing to the cry of an infant for its mother. But with large-scale improvement in methods of managing physical health, interest in psychosomatics waned. These days, although it is understood that emotional state has an influence on asthma, there is much less acceptance of psychological problems as a cause for asthma. Although counseling is now considered important, it is only part of any management program.

Alternative Asthma Treatments-Homeopathy

The principles underlying homeopathy reach back to Hippocrates, the Greek physician of antiquity who is hailed as the father of medical practice. Hippocrates believed that certain substances caused disease and that taking the same substances, when diluted sharply down, would cure the disease. This theory was popular in the United States in the 1700s but fell out of favor when it failed to produce the results expected of it. Homeopathy is still recognized in Britain by the National Health Service as the only alternative form of healthcare.

There is little evidence that homeopathy works, but doses of all substances used are so low that they can't cause any trouble. For example, according to Dr. Oliver Wendell Holmes, writing in 1842, "Doctor Hahnemann, father of homeopathy, describes dilutions of a billionth, trillionth, quadrillionth ... and much higher" for treatment of actual patients.

Alternative Asthma Treatments-"Hands-On" Management

What about treating asthma by lying on of the hands? Chiropractic theory suggests that most diseases result from misalignment of the spinal column. The theory proposes that realignment by manual adjustment of the position of the vertebrae in the spinal column can offer relief. In practice, chiropractors use X rays of the spine to demonstrate misalignment of the bones. Then, using their hands to manipulate vertebrae of the spine, claim to correct the alignment and provide relief. There is no evidence that this is true. There is also no proof of effectiveness of various "ray" treatments, low-grade radiation that does not pass through the skin. It is likely that any improvement in asthma following chiropractic treatment is the result of relief of psychosocial stress or of improvement in breathing technique such as suggested elsewhere in this book.

Alternative Asthma Treatments-Acupuncture

As an example, there is acupuncture, a treatment developed in China about 5000 years ago and still widely used there but rarely in the United States. Asthma is one of the diseases described as treatable with acupuncture, a technique that involves inserting thin needles through the skin at certain sites. Acupuncture needles placed in exact positions definitely improve acute exercise-induced asthma in some patients. Improvement often occurs within one-half hour, but is not permanent and not all patients treated get better, but patients who improve once can be expected to improve again after additional treatment. The amount of improvement is also fairly constant, although bronchospasm improves only by about 50%. Acupuncture is helpful only in exercise-inducted asthma; it does not seem to benefit patients with asthma related to allergies or inflammation.

Most of the information about treatment by acupuncture comes from China, where that treatment is readily available and inexpensive. Publications such as the Journal of Traditional Chinese Medicine and the American Journal of Chinese Medicine publish well-conceived and implemented studies of the usefulness of acupuncture in treatment of asthma. Results are equivocal, some demonstrating usefulness of acupuncture, others not.

Although studies are readily available, in the United States experienced practitioners are hard to find and treatment is not nearly as convenient as and much more expensive than traditional therapies. This situation could change dramatically as and if acupuncture proves itself in the asthma-care marketplace.

Reflexology, sometimes called zone therapy, is a second cousin to acupuncture. It involves massaging specific points on the foot, or sometimes the hand, to treat asthma. From 1987 through June 1996, there were several articles in medical journals descriptive of reflexology but none of these concerned reflexology and asthma.

Asthma - Alpha, Antitrypsin Disease

Airflow obstruction arises also with alpha antitrypsin disease. In this disease, a protective antibody globulin (alpha antitrypsin) is missing or in short supply in the blood of the patient.

The antibody is needed to protect against enzymes produced by bacteria that normally inhabit the lungs. Without the protective antibody, lung tissue is digested by bacterial enzymes, resulting in destruction (fibrosis) of the lungs. In the process, coughing and wheezing are troublesome, depending on the severity of illness. The disease is transmitted genetically, and appears in a spectrum of severity from mild to very severe. Although the exact details of the disease process are unknown, causative genes have been identified. This is one of a number of genetics-based diseases that may ultimately be prevented or treated by genetic engineering. It is also possible to produce the missing protective antibody on a commercial scale, so specific treatment may be available some time in the future.

Also well known is the relationship between smoking and this genetic disease. Smoking and other harmful environmental exposures increase the severity of this disease. Until then, antitrypsin disease will persist as an unusual disease that causes wheezing.

Asthma - Airborne Causes of Bronchospasm

Irritation produced in the lung by inhalation of chemicals like formaldehyde is still another known cause of asthma. These exposures usually occur at work, so the problem is called "occupational" asthma. About 250 agents can cause occupational asthma. Among the substances that may provoke occupational asthma are toxic gases including dry-cleaning fluids, metals such as solder, dusts (particularly grain dusts and seed dusts), organic chemicals, plasticizers, plant sprays, and toxic gases. For the most part, no allergic mechanism is associated with this type of asthma, but inflammation is a factor. Reaction to these exposures can cause severe asthma, which, when it occurs in the workplace, can lead to lawsuits.

Occupational asthma does not always happen on the job. I can vividly recall a whole family, including three small children, who developed coughing and wheezing only at home. Rather than use the municipal service, the family had their own well; testing the well water did not disclose a cause for the family's asthma. Next, the family was tested for possible allergies but nothing came up. On a visit to the home it became apparent that the problem had begun shortly after insulation had been blown into the walls. The culprit turned out to be formaldehyde, a plasticizer that continued to evaporate into the air for months as the insulation set The family was forced to move to a new home to solve the problem. This led to a lawsuit against the installer of the insulation, a suit in which the family prevailed.

Asthma: Use of Medicines in Pregnancy

Control of maternal asthma may require use of medicines. Happily, none of the medicines generally used to treat asthma are known to cause trouble for the developing baby in the womb. Adrenalinelike and theophylline medicines are okay. Drugs of the cortisone family have never been shown to cause problems to the developing baby.

The sickest asthmatics, those who need oral steroids continually to prevent asthma, are more likely to have their babies a little earlier than the expected date. The babies are early, but of normal birth weight and appearance. Doctors do not know whether this higher incidence of "preterm delivery" is the result of the asthma or of the medicines used to prevent it. No matter which, the problem is not severe enough to require any special management.

If you are considering having a child, your asthma need not discourage you. If your asthma is kept in check, there should be no problem for you or your baby Even if the asthma requires use of medicines, ifs still okay to get pregnant, since it has been shown in many studies that the commonly used asthma drugs are safe for the mother and safe for the fetus.