Allergic Asthma

What is asthma?

Asthma is a common disorder which occurs in both children and adults. During an attack there is a temporary spasm of the breathing tubes, that is, they contract suddenly and involuntarily so that the patient finds it hard to breathe. In between attacks, which can be distressing, the breathing may be perfectly normal. Asthma does not cause any permanent damage to the heart or lungs.

 

Are there different types of asthma?

Yes, two main types are recognized. 'Allergic' asthma affects people who are abnormally sensitive to common substances, such as grass pollen, house dust, house mite, feathers or animal hair. These substances are known as 'allergens' and contact with them will start an asthma attack in people who are sensitive to them. This form of asthma usually begins in childhood. The other type, which starts in adult life, is not associated with any allergies, except perhaps to aspirin, and patients with this form of asthma often have nasal symptoms as well.

 

Is asthma hereditary or infectious?

A proportion of people with allergic asthma have relatives who also suffer from this condition or one associated with it, namely hay fever or eczema. However, by no means, all children of asthmatic parents develop the condition. Asthma is not infectious and cannot be 'caught' from other people.

 

Are other allergic conditions related to asthma?

Asthma is related to two other allergic disorders, viz. eczema and hay fever but it is quite common to have one without the other. When two of these conditions occur in the same person, one may get worse while the other becomes better, or both may cause trouble at the same time.

 

Do emotional or psychological factors play a part in asthma?

Asthmatic patients may suffer an attack during an emotional or psychological upset. However, although stress can aggravate or precipitate an attack, it is not thought to be the primary cause of the disorder.

 

What brings on attack of asthma?

Attacks are commonly brought on by contact with substances to which the patient is allergic. These substances are known as 'allergens' and when inhaled or swallowed lead to swelling and spasm of the bronchial tubes the offending substances include pollens, feathers, animal hair, and fur, and most common of all, ordinary house dust and house mites Allergy to foods is less common. Most people with allergic asthma are sensitive to many different substances, and It Is extremely difficult to avoid them all. Other factors which may bring on an attack are chest infections such as those which result from colds, emotional upsets and tension, vigorous physical exertion, laughter and a sudden change in temperature.

 

What is known about house dust allergy?

A microscopic mite which lives in house dust plays an important part in allergic asthma it can only live in special conditions, as it needs humidity, warmth, and food to thrive. Since this mite feeds off the minute scales of skin which people normally shed particularly in bed, it is mainly found on mattresses and bedclothes.

 

How long does an asthma attack last?

An acute attack may last for only a few minutes but it is not uncommon for the symptoms to persist for several hours or longer, especially if effective treatment is not given in good time.

 

Can asthma attacks be prevented?

Some forms of allergic asthma can be prevented once the cause is discovered. The risk of an attack can be reduced by avoiding contact with substances to which the patient is sensitive, both at work and at home Particular attention should be given to reducing contact with house dust although it is impossible to avoid it completely Desensitising infections, although often effective in preventing hay fever, do not work in most cases of asthma. However, there are modern drugs, including bronchodilators and steroids which help to prevent attacks, provided they are taken regularly.

 

How is asthma treated?

The usual form of treatment is with bronchodilator drugs which relax the spasm of the bronchial tubes. They are usually given as inhalers which deliver a small dose of the drug with each inhalation. For a severe attack, a doctor may need to give the drug by injection. For patients whose asthma is too severe to respond to bronchodilators, the best treatment is with steroids. This usually produces a dramatic improvement within 24 to 48 hours. In some cases, a short course is effective while in others a regular maintenance dose is needed to keep asthma under control.

 

How should inhalers be used?

Bronchodilator inhalers deliver a measured dose of the drug into the lungs, provided the patient uses them properly. Their action is rapid and relief is normally obtained within minutes. Although it is often said that exceeding the prescribed dose can be harmful, in practice most asthmatics use their inhalers too little and not too much. The beneficial effect of each dose lasts for four hours or longer.

Steroid Inhalers are also available. They have no immediate effect and must be used regularly every day to be effective in preventing asthma.

The advantage of inhaled drugs is that they act selectively on the lungs and are not absorbed into the rest of the body. Thus, the effective dose is much smaller and there are practically no side effects. This applies to both steroid and bronchodilator inhalers.

 

How can an asthmatic help himself?

Asthma can be variable in severity, and treatment should be adjusted to keep pace with it. It is most important to start treatment at the onset of symptoms, usually with a bronchodilator inhaler. If there is no improvement, consult a doctor because more radical treatment is needed.

 

Is smoking harmful?

Yes! No patient with any chest trouble, particularly those with asthma or bronchitis, should smoke. Tobacco smoke is a powerful irritant and will have a harmful, long-term effect on the bronchial tubes. Smoke from other people's cigarettes should also be avoided.

 

Is exercise harmful?

No, asthmatic patients, children as well as adults, should live as normal a life as possible and this includes regular exercise. In some children, and less commonly in adults, asthma is brought on by vigorous exercise, especially running, but this may be prevented if the patient takes an anti-asthmatic drug beforehand. Such children can even swim without developing symptoms, and this should be encouraged.

In general, people with asthma should exercise regularly, but they should try to avoid exertion which causes distress.

 

What can be done at home to help the asthmatic?

The patient's bedroom should be free of materials which harbor dust. Avoid carpets or rugs, use plastic material rather than fabric for the curtains for the bed choose foam rubber pillows and man-made fiber blankets and encase the mattresses in a plastic cover. Feather-filled pillows should not be used and all bedclothes must be laundered frequently.

Ideally, bedmaking, dusting, and cleaning should be done while the patient is out of the room. If the patient has to do these tasks, he or she should wear a disposable paper mask. A vacuum cleaner should be used rather than a broom or a brush.

 

Inhalers and Their Use in Asthma

The breathing difficulties that are known as asthma are caused by the narrowing of the air passages of the lungs. Hence it appears logical to treat asthma by inhaling medicines directly into the narrowed air passages.

There are two important advantages of inhaling asthma medications:-

• Firstly-a much smaller dose is required than when the same medicine is swallowed. Therefore, the possibility of unwanted side effects is greatly reduced.
• Secondly-the medicine will act faster if it is inhaled. This is especially beneficial for medications used to dilate (open up) the air passages to relieve chest tightness and wheezing.

Many devices are available for inhaling medicines for asthma relief and prophylaxis.

The nebuliser is usually driven by a small electrically powered air compressor unit or by oxygen from a cylinder.

The dose of medicine given using the nebuliser is very much larger than that given by other devices.

 

The Metered Dose Inhaler (MDI) or pressurized aerosol

MDI is the most popular device used in treating asthma. Here, the medicine is suspended in liquid and forced under pressure into a small canister, fitted into a plastic case. When the canister is pressed, a measured dose of the medicine is released through the mouthpiece.

To ensure maximum effectiveness of the inhaled medicines, it is important to

• Press the canister at the right moment
• Breathe in along with the release of the medicine
• Hold breath long enough after inhaling.

Small children may need some help to use the inhaler. So mothers should practice pressing the canister just after the child has started to breathe in.

People whose hands are not strong may find it easier to use both hands to press the canister.

Keep the protective cover on the mouthpiece while not in use so that dirt can't get into it.

There are, however, a sizeable number of people especially the very young and the very old or those with arthritis or other disability affecting their arms and hands who find the pressurized aerosol difficult to use.

For these reasons, other devices are available, which facilitate inhalation therapy in these patients.

 

Dry Powder Inhaler or Rotahaler

These employ a dry powder of the medicine enclosed in a capsule (called a rotacap). The rotacap is inserted into the inhaler (called a rotahaler) and is broken so that the powder is released and inhaled.

The rotacap is pushed in through a small opening in the base of the rotahaler. The rotahaler barrel is then twisted to split open the capsule. Sucking through the mouthpiece draws in a cloud of the powdered medicine which is breathed in.

 

Nebulizers

The nebulizer produces a fine mist of the solution of the medicine which is breathed in through a mouthpiece or through a mask.

The nebulizer is usually driven by a small electrically powered air compressor unit or by oxygen from a cylinder.

The dose of medicine given using the nebulizer is very much larger than that given by other devices.

 

Important

To get the full benefit of inhaled medicines, you must learn to use your inhaler properly.

If you find that you are not getting relief from your inhaled medicines, in spite of using it correctly, it is likely that your asthma is getting worse and needs different treatment. Please consult your doctor for advice immediately.

 

Directions for Use: Inhaler

• Remove the protective cover from the mouthpiece. Make sure the canister is fully and firmly inserted into the outer plastic body.  Shake the inhaler well.
• Hold the inhaler between your index finger and thumb in its upright position Breath out gently through the mouth and immediately place the mouthpiece in the mouth
• Close lips around the mouthpiece. Start to breathe in slowly through the mouth and simultaneously press the canister (A) to release one metered dose and continue (B) to breathe in.
• Remove the inhaler Hold breath for 5 to 10 seconds and then breathe out slowly
• If another dose is needed, wait for at least one minute and repeat the steps (1 to 4). After use, replace the protective cover on the mouthpiece.
• Cleanse the inhaler at least once a week to clean, remove the canister, rinse the mouthpiece and protective cover in warm water; dry and re-assemble.
• As with all aerosol medications, it is recommended to "test-spray" into the air before using for the first time and also in cases where the aerosol has not been used for a week or more

 

Note

Do not rush steps 2 and 3. It is most important that you begin to breathe in slowly through the mouth just before pressing the canister. Escaping 'mist' from the top of the inhaler or the sides of the mouth indicates failure of the technique. If this happens, the whole exercise must be repeated from step 2.

Small children may need some help to use the inhaler. So, mothers should practice pressing the canister just after the child has started to breathe in.

People whose hands are not strong may find it easier to use both hands to press the canister.

Keep the protective cover on the mouthpiece while not in use so that dirt can't get into it.

 

Directions for Use: Rotahaler

• Remove the Rotahaler from its box. Hold by the mouthpiece and twist the barrel in either direction until it stops.
• Take a rotacap from its container. Insert the rotacap; transparent end first, into the raised "square" hole and press firmly till the top end of the rotacap is level with the top of the hole.
• Hold the Rotahaler horizontally and twist the barrel briskly in the opposite direction until it stops. This separates the two halves of the Rotacap. The Rotahaler is now ready for use. Breathe out fully.
• Grip the mouthpiece between your teeth and lips and tilt your head slightly backward. Breathe in through your mouth as deeply as you can hold your breath and remove the rotahaler from the mouth. Hold your breath for as long as comfortable.

 

Note

The quantity of powder inhaled depends on the force of inspiration. In case powder remains in the rotacap shell after the first inhalation, repeat the operation until most of the powder is inhaled. After use, pull the two halves of the rotahaler apart and discard the empty rotacap shells. (There is no need to remove the shell that is still lodged in the "square" hole since it will be pushed out on insertion of a fresh Rotacap during subsequent use of Rotahaler). Reassemble the Rotahaler.

 

IF THE DOCTOR HAS INSTRUCTED YOU TO USE A SECOND ROTACAP THEN REPEAT THE PROCEDURE

At least every two weeks wash the two halves of the rotahaler in warm water, making sure that the empty Rotacap shell is removed from the raised "square" hole before-hand. Dry the rotahaler thoroughly before reassembling it. Always store the rotahaler in its box to keep it clean. It is recommended that fresh rotahaler is used every six months. Make a note of the date on which you received your current rotahaler. The rotacaps should only be inserted in the Rotahaler immediately prior to use Failure to observe this instruction may affect the operation of the Rotahaler.