Breathless: Causes and Treatments for Asthma

Asthma is a distressing condition and can have potentially fatal consequences if the disease is not properly controlled and monitored.

Asthma is a respiratory condition where the lining of the airways becomes inflamed and swollen producing mucus while the muscles around them tighten — causing symptoms of coughing, wheezing and breathlessness.

People suffering from asthma already have sensitive airways. But often, a trigger will cause symptoms to recur. These triggers can be allergies to pollen or animal hair, exercise, sudden temperature changes, some foods and medications, cigarette smoke, dust and stress.

Although some medicines trigger an asthma attack in certain individuals, not everyone will be affected. The worst culprits are usually over-the-counter medications that are bought without a doctor’s prescription. Aspirin affects 3% of asthmatics with one tablet alone causing a severe attack within two minutes to two hours. It can also be found as an ingredient in the manufacture of many other medications, so it is necessary to read the medicine packet very carefully before embarking on a course of treatment.

Other medications that can cause difficulties:
Ibuprofen and Indomethacin/Naproxin for rheumatic pain
Voltarol/Dicofenae sodium a prescription drug given for arthritis, gout, orthopaedic, dental and minor surgery
Paracetemol (although this usually has a mild effect and only in certain individuals)
Beta Blockers in the form of tablets
ACE inhibitors (captopril, enalapril, lisinopril)

A patient should always remind their doctor and pharmacist of their asthma before beginning any new treatments.

Food allergies can also cause a flare up in asthmatics with an accompanying tingling in the mouth, vomiting, diarrhea, skin rash, shortness of breath, wheezing and sometimes swelling of the face. These symptoms can appear within just a few minutes of eating the offending food or even up to two hours later. Some foods responsible are peanuts, sesame, dairy products such as milk and cheese, fish, eggs, shellfish as well as food coloring, dyes and preservatives. Histamine is another allergen as is Royal Jelly, propolis and bee venom. Although not allergic in origin, cold drinks can also trigger an asthma attack.

A doctor will refer anyone with a suspected food allergy to a specialist allergy clinic. A dietary history will be taken of what has been eaten, along with accompanying symptoms and other allergic reactions within the patient’s family. There are several tests that can be given to determine the cause of an attack. The skin prick test is where samples of suspected allergens are tested on the skin of the forearm and any reactions noted. This test is painless and the results are known within a short period of time. A blood test is another relatively simple test for these allergies.

There is also a test we call the Food Challenge. Samples of food are disguised and fed to the patient to see if there is a worsening in their condition, but this should only be undertaken under specialized guidance. An Exclusion Diet is where the foods suspected of causing the attacks are avoided for several weeks. A diary of symptoms is kept before, during and after the test along with peak flow readings. The suspected foods are then gradually reintroduced into the diet and any reactions are noted. Complementary tests for food allergies consist of electrodermal testing, hair analysis and applied kinesiology.

Exercise is a very common trigger for asthma attacks causing symptoms of chest tightness, wheezing, coughing and breathing difficulties. In particular, cycling and running have been found to be two of the worst culprits of exercise-induced asthma. Also, exercising in the cold air can worsen the condition by inflaming the airways. Prevention can consist of exercising indoors in a gym or perhaps swimming as there is usually a humid atmosphere near a pool. Asthmatics should always warm up ten minutes prior to exercising as well as warm down afterwards. If it is necessary to exercise in cold temperatures, the mouth and nose should be covered with a scarf.

Basic asthma care consists of taking drugs to relieve the inflammation of the airways. There are two groups of asthma medications. Bronchodilators stop attacks once they’ve begun by relaxing the muscles in the airways and allowing easier breathing. These are non-steroidal, anti-inflammatory and give short-term relief. However, they should not be over-used; when abused, bronchodilators can actually worsen the condition. Anti-inflammatories prevent an asthma attack from even starting by keeping the airways open, decreasing mucus and reducing swelling. Often, these are called “preventers” and are in the form of an inhaled corticosteroid that should not be confused with the anabolic steroids so often misused in the sports world. It is very necessary for an individual to take these on a regular basis in order for them to work, even when feeling well. Corticosteroids come in the form of sprays, pills, liquids and injections. They give few side effects, although there could be some symptoms if taken in the pill or liquid form over a long period of time. Side effects can consist of a sore throat, thrush, nervousness, a rapid heartbeat, insomnia, loss of appetite and nausea.

There are several inhalation devices that can be used to deliver asthma medication directly into the system. A metered dose inhaler is a small device that uses a chemical propellant to push the medication from the inhaler into the mouth. Nebulizers give a fine mist through a mask fitted over the mouth and nose by using oxygen or air under pressure. These are particularly useful in giving medicine to babies and children too young to use an inhaler as well as to give medication to elderly and acutely ill patients. Rotary or dry powder inhalers deliver the medication without using any chemical propellants such as the damaging CFCs (chlorofluorocarbons) that have wreaked such havoc on the ozone layer. Inhalers need to be used correctly and the prescribing doctor should teach their patient how to use their inhaler or nebulizer properly.

The progress of a person’s asthma is often recorded by a peak flow meter. This is a hand-held device that measures how fast a person can expel air from their lungs. Patients are often asked to keep diaries or charts to measure their progress so that the physician knows when and if their medication level needs to be altered.

Several complementary medicines have been found to help improve asthma symptoms, although these should never replace the use of conventional medications. Acupuncture has been shown to have short-term benefits in those people with allergy-triggered asthma. Herbal remedies such as coleys forskholii, ginkgo biloba, tylophora asthmatica, ephedra and saiboku-to have been useful in relieving symptoms but should only be given by a qualified herbalist or naturopath.

Yoga, hypnosis and relaxation techniques can help in the cases of stress-induced asthma by allowing the individual to learn techniques to cope with their anxiety. The Buteyko technique (named after the Russian professor who created it) is a system of breathing exercises and behavioural changes that alters the balance of oxygen and carbon dioxide in exhaled air. Many people undertaking this treatment have noted an improvement in their condition but more research is needed on the subject before any firm conclusions as to its efficacy can be noted.

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