Lower Airway Conditions

Allergic Asthma

Asthma is a respiratory condition in which the airways of the lungs (breathing passages) narrow and swell, often in response to an allergen. This disease affects people of all ages, but usually starts in childhood.

Air in the lungs travel through small airways called bronchial tubes. When the airways are clear, air moves in and out of the lungs easily. An asthma attack constricts the airways and interferes with the normal breathing process.

The common signs and symptoms of asthma include:

      • Frequent cough
      • Wheezing sound heard during breathing
      • Shortness of breath and coughing
      • Feeling of tightness in the chest
      • Pain in the chest

As people experience asthma attacks they learn to recognize specific triggers that contribute to these attacks and try to stay away from them. There are individual triggers for each person. Children exposed to certain triggers become highly sensitive which causes the lungs and airways to swell up and produce mucus. Some of the triggers include the common cold, weather changes, physical activity, and air pollutants such as smoke, dust mites, animal dander, and pollen.

Asthma can be difficult to diagnose. Your doctor will ask about the frequency of your symptoms and order some tests to rule out other conditions. A lung function test (spirometry) is done to measure the amount of air exhaled. Allergy skin testing may be helpful to identify allergens in people with asthma. In younger children the diagnosis is done based on the information provided about symptoms because lung function tests will be inaccurate before 6 years of age.

Treatment

You must know as much as you can about asthma, its triggers, and how to recognize and avoid them. Avoiding the triggers and with the right medication, an asthmatic can have a perfectly normal life.

Treatment of asthma includes prevention of symptoms and treatment of progressive asthma attacks. Your allergist may also prescribe two main types of medications, long- term control medications and quick- relief medications. Long-term medications that can be taken every day help reduce airway inflammation and prevent the asthma symptoms. Quick-relief medications provide rapid relief from symptoms during an asthma attack.

Inhaled short- and long-term control medications are used by inhaling measured amounts of the medication through inhalation devices. The most common is the metered dose inhaler that uses a chemical propellant to carry the correct dose of medication out of the inhaler. Dry powder inhalers (DPIs) do not use propellants but need a stronger and faster inhalation. A nebulizer is a type of inhaler that delivers medications in a fine mist through mouthpieces or masks. By visiting an allergist you can take control of your asthma and improve your quality of life.

Asthma in Pregnancy

Asthma is a chronic respiratory disease that affects the air passages that transport air to and from your lungs, making it difficult to breathe. During pregnancy, your asthma may sometimes worsen, adversely affecting you and your baby. Worsening of asthma symptoms usually occurs during the second and third trimester of pregnancy, peaking around 6 to 9 months. Hence, when you get pregnant, it is important to inform your doctor about your history of the condition so that you obtain appropriate treatment to control it.

It is necessary to treat asthma during pregnancy as avoiding treatment can result in high blood pressure and low oxygen supply to your baby, which can adversely affect growth, as well as cause premature birth and low birth weight. Your doctor will recommend that you continue your usual medications or will alter treatment depending on severity of your symptoms. Asthma medications are safe to take during pregnancy and breastfeeding.

During pregnancy, it is necessary to take the general precautions to prevent asthma attacks. You will be advised on how to alter your medications should you develop a respiratory infection which increases your likelihood of developing an attack. Your doctor will monitor your lung function and perform regular ultrasounds to examine your baby. Anti-allergic medications may help control symptoms but must be taken after consulting your doctor. It is important to monitor your baby’s movements and inform your doctor if you notice any reduced activity especially during an asthma attack. Avoid allergic triggers and exposure to smoking. A flu shot is safe at any time during pregnancy and is recommended for extra protection.

Follow your asthma treatment plan in order to ensure a safe and healthy pregnancy. If your asthma is managed well, you will have little or no risk of complications for you and your baby.

Exercise Induced Asthma

Asthma is a chronic respiratory disease that affects the air passages that transport air to and from your lungs, making it difficult to breathe. Asthma that is triggered by strenuous or prolonged physical exertion or exercise is termed exercise-induced asthma. It produces symptoms such as coughing, wheezing, chest tightness, shortness of breath and fatigue during or a few minutes after exercise. Exercise-induced asthma can also sometimes occur in those who are not suffering from chronic asthma.

During normal breathing, air is moistened and warmed as it passes through the nose. Exercise causes you to breathe through your mouth, resulting in cold and dry air entering into your lungs. This can trigger inflammation and constriction of the air passages and production of mucus in some people.

When you present with symptoms of exercise-induced asthma, your doctor will review your symptoms and medical history. A thorough physical examination is performed ruling out other possible causes of your symptoms. You may be instructed to exercise on a treadmill or other stationary equipment to reproduce your symptoms. Your doctor may administer a bronchodilator medication to open up your air passages and instruct you to repeat the exercises. Your response to exercise as well as medication is assessed by spirometry, a lung function test that determines how effectively you breathe.

Your doctor will prescribe short-term medication to be administered before engaging in exercise as well as long-term medication to be taken on a daily basis. Exercise-induced asthma should not be a reason to avoid exercise. You will be advised to avoid those sports that require extended periods of exertion such as distance running, and instead engage in activities that involve brief, intermittent periods of exertion such as tennis. Your symptoms may be minimized by warming up prior to exercise and breathing through your nose during exercise. You should avoid vigorous exercises when you have a respiratory infection.

Non-allergic Asthma

Asthma, a chronic respiratory disease, causes wheezing and breathing difficulty from allergic reactions to external triggers such as dust, mold, fur and dust mites. Non-allergic asthma is a condition that is not brought on as an allergic reaction, but is triggered by factors such as exercise, stress, anxiety, cold or dry air and hyperventilation. It usually occurs after mid life as a result of frequent respiratory tract infections and is chronic in nature.

Non-allergic asthma attacks usually occur at the time of year when cold infections are common. Symptoms include wheezing, difficulty breathing, purulent nasal discharge and reddish discoloration of the mucous membranes. No residual symptoms are seen on resolution of the attack however there may be over-distention of the lungs and emphysema (damage to the air sacs in the lungs).

When you present with the above symptoms, your doctor will review your medical history, perform a thorough physical examination and order tests such as lung X-rays and blood work, to diagnose non-allergic asthma and identify its cause.

If an influencing factor or secondary cause of non-allergic asthma is identified, your doctor will recommend that you make appropriate changes in your environment. You are advised to treat any infection as early as possible and maintain a healthy diet. Antibiotics as well as steroids may be prescribed to treat infection and control inflammation. Vitamin supplements may also be prescribed. Breathing exercises may be recommended to restore the size of the lungs. Psychological counseling may be necessary for some.

Pediatric Asthma

Asthma is a disease caused by long-term inflammation of the bronchioles (breathing passages) of the lungs. In children having asthma, the airways and lungs get inflamed easily as a result of exposure to triggers such as pollen. Childhood asthma may even flare up because of a cold or respiratory infection. The common signs and symptoms of childhood asthma include:

  • Frequent cough
  • Wheezing sound heard during breathing
  • Shortness of breath and coughing
  • Feeling of tightness in the chest
  • Pain in the chest

The first sign noticed in children with asthma is recurrent wheezing from a respiratory infection. The symptoms of asthma differ in children; some may worsen or get better over time. Children, who are exposed to certain triggers, become highly sensitive which causes the lungs and airways to swell up and produce mucus. Some of the triggers include common cold, weather changes, physical activity, and air pollutants such as smoke, dust mites, animal dander, and pollen.

Asthma is difficult to diagnose, your pediatric doctor will ask about the frequency of symptoms and may order some tests to rule out other conditions and identify the cause of your child’s symptoms. In children who are 6 years and above, lung function test (spirometry) is done to measure the amount of air exhaled by your child. Allergy skin testing may also be done. In younger children, diagnosis is done based on the information provided about symptoms because lung function tests will be inaccurate before the 6 years.

Treatment

Treatment of asthma includes prevention of symptoms and treatment of progressive asthma attacks. Long-term control medications such as inhaled corticosteroids, leukotriene modifiers, and theophylline are preventive medications that can be taken every day to reduce inflammation of the child’s airways. Quick-relief medications such as short acting beta agonists, oral and intravenous corticosteroids provide rapid relief from symptoms during an asthma attack.

Inhaled medication devices

Inhaled short- and long-term control medications are used by inhaling measured amounts of the medication. For infants, a face mask attached to a metered dose inhaler is used which helps the child to inhale correct amount of medicine. In older children a small hand-held device or a pressurized metered dose inhaler is used which releases fine powder of medicine that is easier for the child to inhale.

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