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What Does Severe Asthma Mean

How Can You Tell If You Have Asthma

Chest Retractions in a Severe Asthma Attack

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.

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What Are The Differences Between Mild

Patients who have mild-to-moderate asthma can generally control their disease with commonly prescribed medications. But patients with more severe illness, who are on high doses of medications including oral corticosteroids, still may find themselves visiting hospital emergency rooms because of an asthma attack and unable to control their disease. They may find that they have to typically adjust their daily lives, be it missing work, missing school, or not participating in physical activities. The asthma attacks experienced by patients with Severe Asthma may even result in death.

Patients with Severe Asthma are more reliant on their asthma medications. A cross-Canada survey conducted by Asthma Canada looking at the impact of Severe Asthma found that the majority of respondents said they use their controller medication once a day, and about seven out of every 10 said they use it at least twice a day. A significant portion of respondents with Severe Asthma said they use their reliever medication once a day, and 28.8% said they use it at least twice daily.

One of the other differences between mild-to-moderate asthma and Severe Asthma is that patients with severe disease are more likely to have co-morbidities or co-existing medical conditions. These include obesity, obstructive sleep apnea, and gastroesophageal reflux disease .

A Personalized Treatment Plan May Include:

Macrolide antibiotics are used to help the body fight infection. These medicines control the number of white blood cells found in your airways. One study showed positive results using macrolide antibiotics in people with high counts of neutrophils in blood or sputum samples. Doctors dont suggest these medications be used long term though because side effects, such as antibiotic resistance, can be very serious.

Oral corticosteroids are medicines that help to control inflammation. While experts recommend these medicines only for short-term use, doctors may prescribe them long-term for people with more frequent asthma flare-ups. Severe asthma patients use these medications in combination with quick-relief medicine, high-dose inhaled corticosteroids and long-acting bronchodilators. Side effects from using oral corticosteroids can pose a risk to the function of other bodily organs, but the benefits may at times outweigh the risk. The hope is that by using these powerful drugs for a short period of time, patients can gain better control and will eventually not need them at all. This treatment option is approved for adults and children, although long-term use in children is not recommended due to the higher risk side effects. If symptoms are still not controlled with long-term use of an oral corticosteroid, another treatment option should be considered.

Type of severe asthma

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How Long Asthma Lasts For

Asthma is a long-term condition for many people, particularly if it first develops when you’re an adult.

In children, it sometimes goes away or improves during the teenage years, but can come back later in life.

The symptoms can usually be controlled with treatment. Most people will have normal, active lives, although some people with more severe asthma may have ongoing problems.

Ruling Out Diseases Associated With Asthma

Asthma: Is It a Reversible Disease?

Aspirin-exacerbated respiratory disease , also known as ASA intolerance, is an intolerance of cyclooxygenase 1 inhibitors. It is associated with hypersensitivity to ASA, nasal polyps, chronic sinusitis, and asthma . The exact prevalence of AERD is uncertain and is reported as between 4 and 21% of asthma patients . Diagnosis can be confirmed only using ASA provocation as there is no valid skin or laboratory test for AERD .

Allergic bronchopulmonary aspergillosis should be suspected in the following cases:

  • Very high total IgE levels
  • Specific IgG and IgE antibodies to Aspergillus fumigatus
  • Fleeting pulmonary opacities

ChurgStrauss syndrome should be suspected in the following cases:

  • Blood eosinophils > 10%

Wherever possible, suspected cases of CSS should be further clarified by biopsy .

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Reducing The Burden Of Asthma

Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life.

There are two main types of inhaler:

  • bronchodilators , that open the air passages and relieve symptoms and
  • steroids , that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death.

People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.

It can be difficult to coordinate breathing using an inhaler, especially for children and during emergency situations. Using a spacer device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. A spacer is a plastic container with a mouthpiece or mask at one end and a hole for the inhaler in the other. A homemade spacer, made from a 500ml plastic bottle, can be as effective as a commercially manufactured inhaler.

Access to inhalers is a problem in many countries. In 2021, bronchodilators were available in public primary health care facilities in half of low- and low-middle income countries, and steroid inhalers available in one third.

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.

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What Causes An Asthma Attack

An asthma attack can happen when you are exposed to asthma triggers. Your asthma triggers can be very different from someone elses asthma triggers. Know your triggers and learn how to avoid them. Watch out for an attack when you cant avoid your triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, smoke from burning wood or grass, and infections like flu.

What Is An Asthma Attack

Signs a child is having a severe asthma attack

When you breathe normally, muscles around your airways are relaxed, letting air move easily and quietly. During an asthma attack, three things can happen:

  • Bronchospasm: The muscles around the airways constrict . When they tighten, it makes your airways narrow. Air cannot flow freely through constricted airways.
  • Inflammation: The lining of your airways becomes swollen. Swollen airways dont let as much air in or out of your lungs.
  • Mucus production: During the attack, your body creates more mucus. This thick mucus clogs airways.

When your airways get tighter, you make a sound called wheezing when you breathe, a noise your airways make when you breathe out. You might also hear an asthma attack called an exacerbation or a flare-up. Its the term for when your asthma isnt controlled.

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How Do I Know If Its Smokers Cough

Smoking is also a major cause of persistent cough, which usually affects long-term smokers.

The toxins in the cigarette damage the airways resulting in a smokers cough. Prolonged coughing can cause hoarseness and chest pain which further leads to lung cancer.

A smokers cough is more like a forceful cough during which a person pushes out air to clear the irritants blocking the airways.

Common symptoms of smokers cough include:

  • Last longer than 2-3 weeks.
  • Wheezing or crackling sound.

Why Is Severe Asthma Different From Mild

If you receive a severe asthma diagnosis, this means your asthma requires high doses of medication such as inhaled corticosteroids and others to control symptoms and prevent flare ups .

Even with proper medication and addressing all modifying factors that can influence your severe asthma it is still poorly controlled.

Flare-ups can be severe and life threatening. Quality of life is significantly impacted, and daily symptoms can be debilitating.

Being diagnosed with mild-moderate asthma on the other hand will not require such high doses of medications to control symptoms. Asthma does not present daily symptoms or prevent you from accomplishing everyday tasks and being physically active. Flare-ups and the risk of death are greatly reduced.

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How Is Severe Asthma Treated And Managed

Like patients with mild-to-moderate asthma, patients with Severe Asthma should try to minimize their exposure to triggers, both allergic and non-allergic, that exacerbate their asthma.

Similar to mild-to-moderate asthma, patients with Severe Asthma take inhaled medicationsto control the underlying inflammation in their airways, and medications that relax the muscles around the airways and treat symptoms like wheezing, coughing, or shortness of breath.

Unlike patients with mild-to-moderate asthma, patients with severe disease may be required to take oral corticosteroids in addition to their inhaled corticosteroids to provide additional control of the inflammation in their airways.

There has been a search for alternative treatments to oral corticosteroids because their long-term use is associated with side effects, including weight gain which can make asthma worse. Other side effects associated with long-term use of oral corticosteroids include the development of cataracts, osteoporosis, and elevated blood sugar that can trigger diabetes. In a study including 808 people with Severe Asthma, it was found that 93% of them had one or more conditions linked to their oral corticosteroid use including Type II diabetes, osteoporosis, dyspeptic disorders, and cataracts.

It is a goal of asthma care to empower patients with asthma to manage their disease. Accordingly, personalized Asthma Action Plans are instrumental for optimal self-management of this chronic condition.

Court Cases: Ada And Face Masks

Summer usually means fun in the sun, but for those with asthma it can ...

Resurrection School v. Hertel

In a ruling handed down on August 23, 2021, the Sixth Circuit Court of Appeals, upheld a district court ruling that refused to block a mask mandate put in place by the Michigan Department of Health and Human Services. Resurrection Catholic Elementary School sued Elizabeth Hertel, the Director of the Michigan Department of Health and Human Services, claiming the face mask mandate was a violation of their rights to free exercise of religion, equal protection, and due process, because face masks hide faces made in Gods image and likeness. Although the mask mandate in Michigan was lifted before this decision, the Sixth Circuits decision is important in the event a new mask mandate is imposed. The court relied on a rational basis test, saying the state has a legitimate interest to keep the public safe and that the mandate applied to all elementary schools and did not single out religious education institutions.

Pletcher v. Giant Eagle Inc.

Bunn v. Nike, Inc.

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Follow The Recommendations Below To Reduce Your Chance Of An Asthma Attack While Cleaning Follow Recommendations For Cleaning Your Home And In Your Facility

  • If you have asthma:
  • Ask an adult without asthma to clean and disinfect surfaces and objects for you.
  • Stay in another room when cleaners or disinfectants are being used and right after their use.
  • Use cleaning agents and disinfectant only when necessary. In routine situations, high-touch surfaces and objects might be cleaned effectively with soap and water.
  • Make a list of the urgent care or health facilities near you that provides nebulizer/asthma treatments and keep it close to your phone.
  • If you have an asthma attack, move away from the trigger, such as the cleaning agent or disinfectant or the area that was disinfected. Follow your Asthma Action Plan. Call 911 for medical emergencies.
  • The person cleaning and disinfecting should:
  • Choose disinfectants that are less likely to cause an asthma attack, using the U.S. Environmental Protection Agency s list of approved products, such as:
  • Products with hydrogen peroxide or ethanol . Ensure that products with hydrogen peroxide do not contain other chemicals that can trigger asthma attacks such as peroxyacetic acid or peracetic acid.
  • Limit use of chemicals that can trigger asthma attacks, such as bleach or quaternary ammonium compounds , and do not use them in enclosed spaces.
  • Follow additional precautions for cleaning and disinfecting places where people with asthma might be, to reduce exposure to asthma triggers.
  • Use products safely and correctly:
  • Make sure there is enough air flow .
  • Use only the amount recommended on the label.
  • Additional Medication For Severe Asthma

    In addition to a reliever and preventer inhaler, severe asthmatics may be prescribed other treatments. You may need to try several options before your healthcare provider finds the right choice for your needs.

    In addition to inhalers, treatment options include:

    • Long-acting bronchodilators these can be added to a preventer inhaler and help keep the airways open for at least 12 hours.
    • Leukotriene receptor antagonists a non-steroid tablet that helps to calm inflamed airways, block the effects of leukotrienes and help with allergies.
    • Long-acting muscarinic receptor antagonists a form of long-acting bronchodilator that can work for 12-24 hours.
    • Long-acting beta-agonists another form of long-acting bronchodilator that is used to relax the muscles in the airways.
    • Slow-release theophylline a non-steroid tablet that helps to relax the smooth muscles in the airways, enabling air to more easily flow through.
    • Short-acting beta 2-agonists a form of quick relief medication that can be used when asthma symptoms occur.
    • Daily steroids these are prescribed in tablet or liquid form and are a type of anti-inflammatory medicine. They work by helping to reduce the sensitivity in the airways.
    • Monoclonal antibodies a newer form of medication for severe uncontrolled asthma. They work by blocking the activity of immune system chemicals that trigger airway inflammation.

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    Why Are Asthma Cases Rising

    The total number of asthma cases is on the risethe American Thoracic Society estimates the number of Americans with asthma will grow 10% by 2039. That means asthma is also a serious public health issue, and one study projects that uncontrolled asthma could cost the U.S. health system around $300 billion in that timeframe5.

    Scientists dont know for sure why asthma rates are increasing, but its thought that increased urbanization, lifestyle changes, and even growing rates of obesity could play a role.

    Requirements For Treatment Optimization

    Diagnosing Asthma: Mild, Moderate and Severe

    The treatment of patients with severe asthma requires experience, is time-consuming, and often necessitates off-label drug use. As a result, severe asthma is sometimes inadequately diagnosed and treated . In our view, this situation makes the following desirable:

    • Inclusion of as many patients as possible in severe asthma registries such as
    • Better coverage of the diagnosis and treatment of severe asthma in physicians training
    • Assessment of patients with severe asthma in specialized asthma centers, in order to give them the opportunity to participate in clinical trials.

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    What Do We Currently Know About Severe Asthma

    Researchers believe the immune response that occurs in severe asthmatics is different than what occurs in traditional asthmatics. For instance, immune cells secrete different inflammatory proteins than the same cells in traditional asthmatics. This makes their airways hypersensitive in such a way that does not respond sufficiently and effectively to corticosteroids.

    Since patients with severe asthma experience most of the deaths associated with asthma and have more hospitalizations, its important . Identifying the phenotypes in certain individuals prone to develop severe asthma can allow physicians to tailor treatment to these individuals. The net result should be reduced symptoms, less progression of disease and lower health costs.

    Its important to note that there is some disagreement among the organizations that currently set the . When it is diagnosed, patients need to be educated so that they understand when it is not safe to remain at home because high grade treatment like intravenous magnesium sulfate, assistance in ventilation or possible short-term intubation may be necessary.

    In conclusion, a proper diagnosisan should lead your doctor to the best treatment options to help you obtain ideal control of your disease, reducing hospitalizations and complications. Ongoing research should equal better breathing in the near future for all asthmatics.

    Can You Answer These 6 Questions About Severe Uncontrolled Asthma

    Most people know someonemaybe a friend or family memberwho lives with asthma, a chronic disease marked by inflammation of the airway that makes it hard to breathe. At the heart of it all, asthma is not the same for everyone. It can have different triggers, attack in different forms, and may sometimes require specialized treatment.

    May is Asthma and Allergy Awareness Month, a peak season for the millions of Americans living with asthma and allergies. Here are the six most important questions you need to know about severe, uncontrolled asthma.

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