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.