Asthma: How Can We Breathe Easy?

When I was in college, I volunteered at a homeless shelter.  Back then people were allowed to smoke indoors, and after a night shift I would leave with my hair stiff with cigarette smoke.  Then I caught a cold, and a cough that did not go away.  I hacked all day and woke up through the night coughing.  After a month of misery, I went to the infirmary.  The Physician Assistant there said I had a cold and gave me some cough drops. 

Weeks later, still hacking, I went back.  The PA did the same things, to no effect.  Weeks after that I went back yet again, insisting on seeing the doctor.  The doctor listened carefully to my story, said I had mild asthma from the combination of the cold and the cigarette smoke, and gave me an inhaler.  Within days my cough was gone.

Many people find asthma confusing and complex.  It is sometimes hard to diagnose, like my episode above.  It can be triggered by many things and the medicines can be confusing- what do I give my kids when they are sick?  How do we use an inhaler?  What medicines should they take when they are well?  How do I avoid asthma attacks?

Asthma, simply put, is wheezing that can be reversed by medicines.  In asthma, the airways in your lungs are extra sensitive to irritants.  The airways close up to keep out those irritants: cold viruses, pollen, cigarette smoke, extra cold air.  When the airways narrow and close, the wheezing you hear and feel is your breath whistling through those skinnier passages. 

To reverse airway narrowing, we use two classes of medicines.  The first are called bronchodilators, that open up (“dilate”) your airways (“bronchioles”).  These medicines are breathed in through inhalers and nebulizers.  the second medicines are steroids, like prednisone, which take away the swelling in inflamed airways.  Prednisone is a different steroid from the steroids athletes abuse.  For the four-to-seven day courses we use for asthma, prednisone does not cause weight gain, hair growth, or rage attacks.  For people with really bad asthma, there are medicines to take daily to make the airways less sensitive and help prevent attacks.  These are called “controller” medicines.

More important than treating asthma is avoiding asthma and its attacks.  Asthma is increasing in the population in the past 25 years, and many of the things that cause asthma are all around us.  Pollutants like smoke, soot, and diesel exhaust eat at our lung tissue as we breathe.  We live more and more indoors these days, and therefore have more exposure to indoor lung irritants like dust and mold.  The more time we spend indoors too, the more time we are exposed to our fellow humans and the cough and congestion viruses they give us. 

All those irritants assaulting the lining of our air passages add up.  Some people have lungs that can take the abuse.  Those with more sensitive lungs, like kids, get asthma.  As we talked about above, when the air passages have had enough, they close up to keep out the bad stuff.  Unfortunately, when they close up, they also keep out the air we need to live.  What little air we can move in and out whistles through those narrowed air passages and we wheeze, and we have to pull and tug to get the air in and out.

So how do we and our kids avoid all those irritants?  First, let’s not be so hard on the Environmental Protection Agency (the EPA).  The EPA is not there to shut down factories, it is there to help those factories do less damage to our lungs from air pollution.  Second, we need to avoid cigarette smoke.  Smokers should never smoke indoors, at home with children, or at work or at bars with adults.  Heck, smokers should see a doctor for help to quit!  Finally, we and our kids need to spend more time outdoors, away from indoor dust and mold and sick people.  Exercise is good for the lungs (and the rest of the body too) so outdoor activities are a double win.

So if you or your kids have a cough that won’t go away, or wheeze, see your doctor.  You should talk about how to avoid asthma irritants, medicines to take for attacks, and if need be, medicines to prevent attacks.  You and your kids should be allowed to breathe easy.     

 

Asthma- smoke, allergens, inhalers, steroids- help!

When I was in college, I volunteered at the local homeless shelter.  Back then you were allowed to smoke indoors, and the morning after a night shift I would leave with my hair stiff with the smell of cigarettes (I had a lot more hair back then).  The next time I caught a cold, I was left with a cough that did not go away.  I hacked all day and woke up through the night coughing.  After a month of misery, I went to the college infirmary.  The PA there said I had a cold, and sent me on my way with a paper packet of cheap and gritty cough drops. 

Weeks later, still hacking,  I went back.  The PA said and did the same things, again to no effect.  Weeks after that I went back yet again, this time insisting on seeing the doctor.  The doctor listened carefully to my story, said I had mild asthma from the combination of the cold and the cigarette smoke, and gave me an inhaler.  Within days, my cough was gone.

Many people find asthma confusing and complex.  It is sometimes hard to diagnose, like my episode above.  It can be triggered by so many things and all the medicines can be confusing- what do I take when I am sick, and what medicines do I take when I am well?  Hopefully the next few paragraphs will give you a better understanding.

Asthma, simply put, is wheezing that can be reversed by medicines.  In asthma, airways in your lungs are extra-sensitive to irritants, and close up to keep out those irritants- cold viruses,  pollen and other allergens, and cigarette smoke.  When the airways narrow and close, the wheezing you hear and feel is your breath whistling through those skinnier passages. 

To reverse that airway narrowing, we use two classes of medicines.  The first are called bronchodilators, that open up (“dilate”) your airways (“bronchioles”).  These medicines are breathed in through inhalers and nebulizers.  The second medicines are steroids, which take away the swelling in inflamed airways.  Prednisone, taken as pills or syrup, is the most commonly used steroid.  Prednisone is very different from the steroid athletes abuse.  For the short five-to-seven day courses we use for asthma, it does not cause weight gain, hair growth, or rage attacks. 

The most important treatment for asthma is to avoid the things that irritate.  If dogs make your kid wheeze, don’t get a dog!  Teach your asthmatic kids good hand-washing so they don’t get so many cold viruses at school.  If you smoke and your kid has asthma, quit!  At the very least, smoke outside the house and car where your kids breath.  

Finally, for bad cases of asthma, there are medicines to take when you are well, all the time.  There are pills and inhaled steroids (again, perfectly safe)  that keep your airways from being so sensitive.  If exercise makes your kid wheeze, there are inhalers to take before exercise to help that.  All asthmatic kids should get a flu shot in the fall, since the influenza virus is particularly hard on airways.

If all this is still confusing, ask your doctor for a written asthma plan to help you keep it straight.  Your child with asthma should be able to go to school, to run and play, without having asthma attacks.  If he can’t, see your doctor to improve the asthma plan.  And for heaven’s sake, if you smoke, see your doctor about ways to quit!