Severe Difficult To Control Asthma Steroid
Children that do not seem to respond to standard treatment are referred to as severe or difficult to control asthma, and these children experience substantial morbidity from asthma symptoms. To classify a child into this phenotype, the first step is to exclude an incorrect diagnosis, poor adherence to treatment, or incorrect technique with an inhaler and spacer . Supervised asthma therapy programs can be extremely useful in managing asthma symptoms and reducing healthcare utilization for children with poor medication adherence and inhaler and spacer technique . It is important to differentiate between severe therapy-resistant asthma and difficult-to-treat asthma due to comorbidities Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities, such as allergic rhinitis and chronic exposure to asthma triggers, are directly targeted. Home visiting programs and assessment of the school environment are important features of the evaluation for children with concern for chronic exposure to asthma triggers . Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard asthma therapy should be referred to an asthma specialist to consider more potent biologic therapies such as anti-IgE, anti-IL-5, or anti-IL-13 therapies and further evaluation .
Pulmonary Structure And Function
Additional data suggest that advanced age, irrespective of any concomitant pulmonary disease, is associated with increased bronchial hyperresponsiveness., In a study of 148 subjects, ranging from age 5 to 76 years, age had an independent association with bronchial hyperresponsiveness as measured by a methacholine challenge. In another study, bronchial hyperresponsiveness to histamine challenge was associated with increased eosinophil count and allergic sensitization; however, older age maintained an independent association with bronchial hyperresponsiveness, which was more prominent in subjects with respiratory symptoms. In addition to age, it is recognized that smoking and the baseline forced expiratory volume in 1 second have strong effects on bronchial hyperresponsiveness., Furthermore, aging is associated with a progressive decline in lung function. Coupled with these findings, breathing is exaggerated through increased air trapping and a reduction in chest wall compliance with increased age. Actually, it is reported that bronchodilators, such as long-acting beta2 agonist , have an add-on effect to inhaled corticosteroid .
What To Think About
One of the best tools for managing asthma is a daily controller medicine that has a corticosteroid . But some people worry about taking steroid medicines because of myths they’ve heard about them. If you’re making a decision about a steroid inhaler, it helps to know the facts.
At the start of asthma treatment, the number and dosage of medicines are chosen to get the asthma under control. Your doctor may start you at a higher dose within your asthma classification so that the inflammation is controlled right away. After the asthma has been controlled for several months, the dose of the last medicine added is reduced to the lowest possible dose that prevents symptoms. This is known as step-down care. Step-down care is believed to be a better way to control inflammation in the airways than starting at lower doses of medicine and increasing the dose if it is not enough.footnote 10
Because quick-relief medicine quickly reduces symptoms, people sometimes overuse these medicines instead of using the slower-acting long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as reducing how well these medicines will work for you in the future.footnote 11
You may have to take more than one medicine each day to manage your asthma. Help yourself remember when to take each medicine, such as taping a note to your refrigerator to remind yourself.
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How Is Asthma Different In Older Adults
Most people with asthma experience their first symptoms at a young age. But asthma can develop for anyone at any age. It is not uncommon for adults in their 70s or 80s to develop asthma symptoms for the first time. When asthma does occur at a later age, the symptoms are much like those experienced by anyone else. The most common causes of an asthma flare up are a respiratory infection or virus, exercise, allergens, and air pollution . Allergens and irritants are substances found in our everyday environment. People who have asthma may experience wheezing, cough, shortness of breath, and chest tightness.
Asthma creates a much greater risk for older adults because they are more likely to develop respiratory failure as a result of the asthma, even during mild episodes of symptoms.
Did you know . . . Older patients with mild asthma symptoms can have the same level of breathing difficulty as younger asthma patients experiencing a severe asthma episode?
Unlike asthma in younger persons, asthma in older adults rarely goes into remission. Instead, asthma is more likely to remain a potentially serious, and many times, a disabling disease.
Altered Perception Of Airway Obstruction
Some data have suggested that for people over 65 years, those with adult-onset asthma of a longer duration may have more severe airway obstruction than those with a more recent asthma diagnosis, yet they report fewer asthma symptoms. This might adversely influence the implementation of an asthma action plan, which relies on the accurate interpretation of asthma symptoms. Older individuals might attribute respiratory symptoms to bronchitis, respiratory tract infection, obesity, poor fitness, or even to the aging process and be more accepting of a progressive decline in mobility and activity.
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What Happens After Being Diagnosed With Asthma
After being diagnosed with asthma, the doctor must now prepare an asthma action plan for managing the disease. Managing asthma can be very simple or very challenging; this will depend on how severe the asthma is.
To doctors, prevention and long-term control are crucial to stop asthma attacks even before they start. Treatment usually involves detecting triggers that may initiate an asthma attack and, of course, avoiding them. Also, patients should keep track of their medications to keep their symptoms under control.;
There are various types of treatments for asthma. Still, the right action plan for managing asthma will depend on several factors. For example, age, symptoms, triggers, and responsiveness to treatment. The different types of asthma medicines are the following.
What Is The Best Way To Live With Asthma
The key to good living with asthma is developing a strong partnership between patients, caregivers, and physicians. Practical steps include the following:
;; Make an asthma care management plan with your physician. An asthma management plan helps you understand what to do when specific situations arise. Each time you visit the physician, talk about your plan, and make any necessary changes.
;; Educate yourself. Stay informed about the latest developments in asthma and allergy care and treatment. Ask your physician about new medications or research findings that may relate to your care.
;; Get regular medical care. If you have asthma, you should see your physician at least once a year, even if your symptoms are under control. When you become sick, or if you have significant changes in your health, you should also talk with your physician about how your asthma could be affected.
;; Take your medicine. Your asthma medications will make you feel better and sometimes people think thats the time to stop. Its not! Use your medications as prescribed.
With good management, asthma symptoms can be controlled. Most people who develop adult onset asthma are able to lead normal lives. Expect success!
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How Is The Condition Diagnosed
To diagnose asthma, your physician will question you about your symptoms, perform a physical exam, and conduct lung function tests. You also may be tested for allergies.
Your internist or family physician may refer you to an allergist or pulmonologist for specialized testing or treatment.
After middle age, most adults experience a decrease in their lung capacity. These changes in lung function may lead some physicians to overlook asthma as a possible diagnosis.
Untreated asthma can contribute to even greater permanent loss of lung function. If you have any asthma symptoms, dont ignore them, and dont try to treat them yourself. Get a definitive diagnosis from your health care provider.
Wheezing And Asthma Phenotypes In Childhood
Childhood wheezing phenotypes have been explored given that nearly 50% of children experience wheezing before age 1, yet only 20% of those children progress to have continued wheezing later in childhood . While there are several longitudinal birth cohorts that have described wheezing phenotypes, we will describe the classifications according to the earliest of these studies: the Tucson Children’s Respiratory Study and the most recent systematic comparison of the clinical and epidemiologic classifications .
This Describes Children who do not Experience any Wheezing.
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What Kind Of Physician Treats Adult Onset Asthma
Many older patients are treated for asthma by their internist or family physician; however, if your asthma symptoms are not under control within three to six months, or if you have severe persistent asthma, or if you are having asthma episodes that need emergency treatment, it may be time to see an asthma specialist. Allergists/Immunologists or pulmonologists are specialists who treat asthma. Those who have completed training in those specialties are usually called board-certified or board-eligible.
A Condition With No Cure
- During an asthma attack, the muscles around the airways tighten, so the tubes narrow and the lining becomes inflamed. Symptoms include coughing, wheezing, shortness of breath and tightness in the chest.
- There is no cure for asthma, but it can be controlled. In the UK, 5.4million individuals receive treatment for the condition.
- 1.1million children have asthma. In two-thirds of cases it disappears by adulthood but can reappear later in life. About a third of cases are diagnosed after the age of 16, according to Asthma UK.
- The number of new cases each year is now three to four times higher in adults and six times higher in children than 25 years ago.
- The UK has one of the highest asthma prevalence rates in the world, along with New Zealand, Australia and Ireland.
- The exact causes of asthma are not known, but a family history and lifestyle factors such as diet are likely risk factors.
- Asthma results in 74,000 emergency hospital admissions each year. About 1,500 people die from asthma annually, over a third of whom are sufferers under the age of 65.
www. asthma. org.uk
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What Are The Causes
Several causes may induce an asthma episode; this includes factors that can play a significant role in a hyperactive response of the airways. Nonetheless, it will also depend from patient to patient. Among the factors that can contribute to developing asthma are the following:
- Environmental allergens such as house dust mites, animal allergens, and fungi
- Viral respiratory tract infections
- Aspirin or NSAIDs hypersensitivity
- Perinatal factors include prematurity, increased mother age, maternal smoking.
This list is a little bit extensive but covers the majority of the possible causes for developing asthma. However, three very specific situations may flare up an asthma crisis. These situations are the following.
Getting The Diagnosis Correct
One man in his 60s ended up going to Wechslers Cohen Family Asthma Institute at NJH after seeing two physicians who had incorrectly diagnosed him with COPD.
The man had been coughing and wheezing, and became short of breath, Wechsler said. The doctors gave him a rescue inhaler, but they did not treat him for ongoing airway inflammation.
When the man failed to improve, he went to NJH, underwent a series of sophisticated tests, and was correctly diagnosed with asthma.
To define if a patient has asthma, we do a pulmonary test, spirometry, to determine if there is any airflow obstruction consistent with asthma, and then assess the degree of reversibility, Wechsler said. If we see asthmatic symptoms plus airflow reversibility, we can assess the degree of hyper responsiveness. Imaging by CAT scans helps us look for other components. The patient may have sinus disease, reflux, post-nasal drip, or aspiration.
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When To Call A Doctor
911 or other emergency services right away if:
- You are having severe trouble breathing. Signs of this include:
- Breathing very fast. Shortness of breath can interfere with the ability to speak smoothly.
- Appearing anxious and being unable to eat because it’s too hard to breathe.
- Using the neck, chest, and belly muscles to breathe so that the skin between, above, and under the ribs sinks inward with each breath. Your nostrils may open wide when you breathe in.
- Taking longer than usual to breathe out and sometimes having a high-pitched, musical sound when breathing in.
- Sitting up, leaning forward, or sitting with your nose tilted up as if sniffing the air.
- Having skin color that stays pale, gray, bluish, or mottled, including the tongue, lips, earlobes, and nail beds.
or seek immediate medical care if:
- Your symptoms do not get better after you have followed your asthma action plan.
- You have new or worse trouble breathing.
- Your coughing and wheezing get worse.
- You cough up dark brown or bloody mucus .
- You have a new or higher fever.
- You need to use quick-relief medicine on more than 2 days a week within a month .
- You cough more deeply or more often, especially if you notice more mucus or a change in the color of your mucus.
- You have asthma and your peak flow has been getting worse for 2 to 3 days.
If you have not been diagnosed with asthma but have mild asthma symptoms, call your doctor and make an appointment to be checked.
What Do The Two Types Have In Common
Exact causes of asthma can be difficult to pinpoint. Allergies and triggers in the environment can cause asthma symptoms and an asthma flare-up, and genetics can also play a role. But the exact reasons why people develop asthma remain unclear.
Childhood asthma and adult-onset asthma share many of the same triggers. For all people with asthma, exposure to one of the following triggers may cause an asthma attack, though different people have different triggers:
- smoke
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Asthma Triggers Include But Are Not Limited To: 1
- Exercise and vigorous physical activity
- First- and second-hand tobacco smoke
- Dust mites
- Sprays
- Pollen
- Infections
- Changes in weather
- Certain foods or food additives such as sulfites found in beer, wine, shrimp, dried fruit, processed potatoes, and processed meats
- Certain over-the-counter and prescribed medications, including aspirin, cold medicines, ibuprofen, and eye drops
Asthma Medication Is Important
Asthma can be well-controlled with the appropriate medication in almost all people. To maintain and improve your asthma control both in the short and long term, it is important to continue to take your asthma medications;and discuss any symptoms and concerns with your doctor, nurse or pharmacist.
The main types of medication are:
- preventers that slowly make the airways less sensitive to triggers by reducing swelling and mucus inside the airways. This medication is taken daily. There are also combination preventer medications containing two different medications.
- relievers that act quickly to relieve symptoms by relaxing the tight muscles around the airways. This medication is used during an asthma attack
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Treatment Of Asthma In Adults
The medications and treatments for adult asthma are:
- Anti-inflammatories inhaled corticosteroids are taken daily to prevent asthma symptoms by reducing airway sensitivity and inflammation. Steroid tablets can be taken for acute flare-ups and more severe asthma.
- Bronchodilators inhaled short-acting and long-acting bronchodilators are taken occasionally to relieve symptoms. They work within a few minutes and shouldnt be needed more than three times a week.
- Leukotriene receptor antagonists daily tablets to improve prevention if needed.
- Theophylline taken daily to prevent symptoms if they are still not well controlled.
- Monoclonal antibody therapy also called biological medicines or biologics, these injections block some of the bodys immune response to triggers.
- Bronchial thermoplasty is a surgical procedure done on the airway itself to reduce its thickness.
Asthma Can Cause Short
Asthma complications that develop over the short run, include:
Problems Engaging in Normal Daily Activities According to;David Rosenstreich, MD, chief of the division of allergy and immunology at the Albert Einstein College of Medicine in New York City, symptoms of asthma like coughing, wheezing, and shortness of breath may prevent you from attending work or school, impacting your productivity.
Asthma symptoms may also interfere with sleep or prevent you from exercising or engaging in other leisure or social activities. Disengagement from all of these activities can affect your overall health and increase your risk for conditions like heart disease and diabetes.
People who have;poorly controlled asthma, either because of failure to adhere to treatment or because asthma is difficult to control with treatment,;are more likely to experience work and overall activity impairments than people who have asthma under control.
Severe Asthma Attacks Up to 10 percent of people who have asthma may have whats termed severe asthma. For these people, asthma symptoms occur daily and are often difficult to control, says Patricia Takach, MD, an associate professor of clinical medicine in the Section of Allergy and Immunology at the University of Pennsylvanias Perelman School of Medicine in Philadelphia.
Some severe asthma attacks may require a trip to the emergency room or require hospitalization. Seek immediate medical attention if your symptoms are not responding to your usual treatment.
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