Staging And Treatment Of Asthma
The goals of long-term management of asthma should include the following: 1) achievement and maintenance of control of symptoms 2) prevention of asthma exacerbations 3) maintenance of pulmonary function as close to normal levels as possible 4) maintenance of normal activity levels, including exercise 5) avoidance of adverse effects from asthma medications 6) prevention of the development of irreversible airflow limitation and 7) prevention of asthma mortality.
The recommended GINA treatment algorithm, together with the clinical features and staging of severity of asthma, are available on the GINA website . It is important to note that the forced expiratory volume in one second levels are before treatment, i.e. in the unmedicated state.
Until the advent of anti-inflammatory drugs, asthma was treated on an as-needed basis and treated as an acute disease rather than a chronic disease. With the recognition that asthma is a chronic inflammatory disease, there has been a gradual move towards treating it more aggressively and earlier in the hope that this may change the natural history of asthma and prevent some of the remodelling that sometimes occurs.
How Can You Tell If You Have Asthma
It can be hard to tell if someone has asthma, especially in children under age 5. Having a doctor check how well your lungs work and check for allergies can help you find out if you have asthma.
During a checkup, a doctor will ask if you cough a lot, especially at night. He or she will also ask whether your breathing problems are worse after physical activity or at certain times of year. The doctor will then ask about chest tightness, wheezing, and colds lasting more than 10 days. He or she will ask whether anyone in your family has or has had asthma, allergies, or other breathing problems. Finally, the doctor will ask questions about your home and whether you have missed school or work or have trouble doing certain things.
The doctor may also do a breathing test, called spirometry, to find out how well your lungs are working by testing how much air you can breathe out after taking a very deep breath before and after you use asthma medicine.
Goal: Improve Respiratory Health
Respiratory diseases affect millions of people in the United States. Healthy People 2030 focuses on increasing prevention, detection, and treatment of respiratory diseases.
More than 25 million people in the United States have asthma.1 Strategies to reduce environmental triggers and make sure people get the right medications can help prevent hospital visits for asthma. In addition, more than 16 million people in the United States have COPD , which is a major cause of death.2 Strategies to prevent the disease like reducing air pollution and helping people quit smoking are key to reducing deaths from COPD.
Interventions tailored to at-risk groups can also help prevent and treat other respiratory diseases for example, pneumonia in older adults and pneumoconiosis in coal miners. And increasing lung cancer screening rates can help reduce deaths from lung cancer through early detection and treatment.
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What Are The Stages Of Copd
Doctors generally use the Global Initiative for Chronic Obstructive Lung Disease Program to stage COPD. These staging guidelines have been proven to be consistent and accurate by doctors and scientists. Other methods can be used to stage COPD, but they may be influenced by other factors.
There are many treatment options and ways to manage COPD. The newest 2017 guidelines emphasize the use of combined bronchodilators as first-line therapy for COPD. Doctors recommend vaccinations for people with the condition to decrease the risk of lower respiratory tract infections. Alterations in health-related behaviors is emphasized. Spirometry measurements can help determine the extent of obstructive lung disease. As COPD progresses, oxygen therapy, especially if you have obstructive sleep apnea, may help improve your survival.
Like COPD, there are many treatment options and ways to manage asthma. Your primary care doctor and/or an allergist will discuss and suggest the best choice of treatment and management drugs for you. Medications used include corticosteroids, short acting beta agonists , and occasionally anticholinergic medications for severe exacerbations.
Emergency treatment of life-threatening asthma or COPD may involve intravenous corticosteroids, intubation, mechanical ventilation, and oxygen treatment until the crisis is resolved.
Can Asthma Get Worse At Different Times In My Life
There are certain stages in your life that might affect your asthma. For example, some women find that being pregnant can make asthma either better or worse and hormonal changes, at puberty, menopause or during the menstrual cycle might have an impact too.
There are lots of other life changes that might temporarily affect your asthma symptoms. Stress, for example, whether from a relationship breakdown or family illness, can make symptoms worse.
Having frequent asthma attacks can also make asthma worse over time. Asthma attacks can cause scarring in your airways which makes them narrower. This is sometimes called airway remodelling.
If your airways are scarred and narrow, youre more likely to have worse symptoms more often.
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The Importance Of Controlling Your Asthma
Regardless of the type or severity of asthma you have, your physician should focus on controlling it. You cannot control the type or severity of asthma you have BUT you can focus on achieving control of your disease.
Uncontrolled asthma is defined as:
- Poor symptom control OR
- More than two exacerbations/year OR
- At least one hospitalization or ICU stay per year OR
- Low lung function
Achieving asthma control is the central focus in the management of patients with asthma. Your goal should be to be able to live a productive and symptom-free life with asthma.
What Should I Do If I Have A Severe Asthma Attack
A severe asthma attack needs immediate medical care. The first step is your rescue inhaler. A rescue inhaler uses fast-acting medicines to open up your airways. Its different than your normal maintenance inhaler, which you use every day. You should only use the rescue inhaler in an emergency.
If your rescue inhaler doesnt help or you dont have it with you, go to the emergency department if you have:
- Anxiety or panic.
- Bluish fingernails, bluish lips or gray or whitish lips or gums .
- Chest pain or pressure.
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What Happens During An Asthma Attack
People with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs and airways:
Lungs and airways overreact to certain triggers and become inflamed and clogged.
Breathing becomes harder and may hurt.
There may be coughing.
There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because:
Muscles that surround the airways tighten, and the inner lining of the airways swells and pushes inward.
Membranes that line the airways secrete extra mucus.
The mucus can form plugs that further block the air passages.
The rush of air through the narrowed airways produces the wheezing sounds.
What Are The Symptoms Of Asthma
The symptoms of asthma include
- Chest tightness
- Shortness of breath
- Wheezing, which causes a whistling sound when you breathe out
These symptoms can range from mild to severe. You may have them every day or only once in a while.
When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.
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What Do I Do If I Have A Respiratory Illness
- Talk with your doctor about your symptoms. Ask if you can take over-the-counter medicines to reduce some of your symptoms.
- Follow your Asthma Action Plan. Be sure your Asthma Action Plan tells you what to do if you get sick. If it doesnt, call your doctor to ask if you should change how you take your prescribed asthma medicine while you are sick. If you get symptoms of flu or COVID-19, or any symptoms that concern you, contact your doctor right away.
- Keep your quick-relief asthma medicine with you at all times to treat asthma symptoms.
- Trouble walking or talking due to shortness of breath
- Cyanosis which is tissue color changes on mucus membranes and fingertips or nail beds the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
- Fast breathing with chest retractions
Measures For Reducing Adverse Effects Of Air Pollution In General
The detrimental effects to health from air pollution are largely determined by the concentration of air pollutants and the amount of exposure time. People can take many measures to reduce the amount of pollutant inhalation. Some measures are appropriate for all people. Some others are of particular importance for those with chronic respiratory diseases. People should keep a good living habit and regulate their daily activity according to the local air quality report. For people with chronic respiratory disease like COPD, reduction of exposure to indoor and outdoor air pollution can reduce the risk for acute exacerbation of COPD. For asthma patients, less exposure can reduce the onset of asthma. Regular treatments under the guidance of physicians are recommended. Patients should not change daily remedies without permission from their doctors. Because air pollution usually maintain at different level for days or months, taking extra measures is of help for people especially those with chronic respiratory diseases.
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Four Components Of Asthma Treatment
The use of objective measures of lung functionspirometry, peak flow expiratory flow rateto access the severity of asthma, and to monitor the course of treatment.
The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airways.
The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.
Patient education that includes a partnership among the patient, family members, and the doctor.
Is Asthma The Same For Everyone
Everyone with asthma has their own personal set of triggers and symptoms. Using a is the best way to keep a record of your individual treatment plan.
You can have a certain type of asthma too. For example, occupational asthma is caused by triggers in your workplace. Around 4% of people with asthma have a type of asthma called severe asthma, which needs specialist treatment because the usual medicines dont keep symptoms under control.
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Whats An Asthma Attack
When you breathe normally, muscles around your airways are relaxed, letting air move easily. During an asthma attack, three things can happen:
- Bronchospasm: The muscles around the airways constrict . When they tighten, it makes the airways narrow. Air cannot flow freely through constricted airways.
- Inflammation: The airway linings become swollen. Swollen airways dont let as much air in or out of the lungs.
- Mucus production: During the attack, your body creates more mucus. This thick mucus clogs airways.
What Are The Symptoms
Asthma can be different for everyone. Asthma symptoms can also vary over time, with few or no symptoms when asthma is well controlled. The common signs and symptoms of poorly controlled asthma include:
- Shortness of breath
- Trouble sleeping because of breathing difficulty
- Being unable to take part in physical activities without breathing difficulty
These symptoms can occur slowly over hours or days, or they can come on as sudden, recurring attacks after which the symptoms can persist for some time before disappearing. If left untreated, asthma can cause permanent structural changes in your airways called airway remodelling, which is why it is important to get your asthma under control and keep treating it over the long term.
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Staging And Treatment Of Chronic Obstructive Pulmonary Disease
The stages of COPD are defined primarily by lung function . This emphasises the important clinical message that the diagnosis of COPD requires the measurement of lung function. The stages of COPD suggested in the GOLD Guidelines are as follows. Stage 0: At risk, cough or sputum present but lung function normal. Stage 1: Mild COPD, FEV1/forced vital capacity < 70%, with an FEV1 â¥80% predicted, with or without chronic symptoms. Stage 2: Moderate COPD, FEV1/FVC < 70% and FEV1 % pred> 30% and < 80%. Stage 2 is split at an FEV1 of 50% pred since the existing data support the value of inhaled corticosteroids below an FEV1 of 50% pred but not above. Stage 3: Severe COPD, FEV1< 30% pred and FEV1/FVC < 70%.
In the GOLD guidelines, Stage 0 is a newly defined stage that was included to give a strong public health message that symptoms of chronic cough and sputum production should alert the clinician to the presence ofan ongoing pathophysiological process even when lung function is normal. This may progress to clinically significant COPD in a proportion of those exposed . The analogy that is perhaps most relevant is that mild hypertension in some but not all , with mild elevation of blood pressure will progress to clinically significant hypertension.
What Is An Asthma Trigger
A trigger is anything that irritates your airways. Asthma is caused by two types of triggers.
- Allergic trigger: cause allergic reactions. Allergic triggers include things like dust mites, pollens, moulds, pet dander,
- Non-allergic trigger: are usually irritants. Non-allergic triggers include things like smoke, cold air, certain air pollutants, intense emotions
Learn more about different types of asthma triggers and how to manage them.
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Causes And Triggers Of Asthma
Asthma is caused by swelling of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow.
It may happen randomly or after exposure to a trigger.
Common asthma triggers include:
- smoke, pollution and cold air
- infections like colds or flu
Identifying and avoiding your asthma triggers can help you keep your symptoms under control.
How Is Asthma Managed
People with asthma can learn to identify and avoid the things that trigger an episode. They can also educate themselves about medications and other asthma management strategies:
Asthma is a chronic disease. It has to be cared for all the timenot just when symptoms are present:
The four parts of continually managing asthma are:
Identify and minimize contact with asthma triggers.
Understand and take medications as prescribed.
Monitor asthma to recognize signs when it is getting worse.
Know what to do when asthma gets worse.
Working with a health care professional is the best way to take care of asthma.
The more information a person with asthma has, the better asthma can be controlled.
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Signs Symptoms And Complications
How often signs and symptoms of asthma occur may depend on how severe, or intense, the asthma is and whether you are exposed to allergens. Some people have symptoms every day, while others have symptoms only a few days of the year. For some people, asthma may cause discomfort but does not interfere with daily activities. If you have more severe asthma, however, your asthma may limit what you are able to do.
When asthma is well controlled, a person shows few symptoms. When symptoms worsen, a person can have what is called an asthma attack, or an exacerbation. Over time, uncontrolled asthma can damage the airways in the lungs.
Will I Always Have Asthma
Asthma is a lifelong condition most people who have asthma will always have asthma.
But if youve been diagnosed with asthma as a child, your asthma might improve or disappear completely as you get older, particularly if the asthma was mild.
Even if asthma goes away it can come back later in life, perhaps because youve come into contact with new triggers in your job, or youve moved to an area with more air pollution for example. Hormonal changes such as pregnancy and menopause can also bring it on again.
But the good news is that even though asthma doesnt go away there are lots of safe and effective treatments available to help you stay symptom-free.
If youve tried taking all the usual treatments in the right way, but youre still having symptoms, your GP can refer you to a specialist to see if you have severe asthma. This kind of asthma only affects around 4% of all people with asthma. An asthma specialist can help you find the right treatments for you, for example monoclonal antibodies.
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What Is An Asthma Attack
An asthma attack is the episode in which bands of muscle around the airways are triggered to tighten. This tightening is called bronchospasm. During the attack, the lining of the airways becomes swollen or inflamed, and the cells lining the airways make more and thicker mucus than normal.
All of these things — bronchospasm, inflammation, and mucus production — cause symptoms such as trouble breathing, wheezing, coughing, shortness of breath, and trouble with normal daily activities.
Other symptoms of an asthma attack include:
- Severe wheezing when breathing both in and out
- Coughing that won’t stop
- Feelings of anxiety or panic
- Pale, sweaty face
- Blue lips or fingernails
An asthma attack can get worse quickly, so it’s important to treat these symptoms right away.
Without immediate treatment, such as with your asthma inhaler or bronchodilator, it will become harder to breathe. If you use a peak flow meter at this time, the reading will probably be less than 50% of your usual or normal peak flow reading.. Many asthma action plans suggest interventions starting at 80% of normal.
As your lungs continue to tighten, you wonât be able to use the peak flow meter at all. Your lungs will tighten so there is not enough air movement to make wheezing. You need to go to a hospital right away. Unfortunately, some people think that the disappearance of wheezing is a sign of improvement and donât get emergency care.