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Introduction to Asthma and Self-Care
What Is Asthma?
Asthma is a chronic inflammatory disease of the airways that affects more than fifteen million people in the United States, live million of which are children. Incidence of asthma is increasing, and although widespread air Pollution is thought to be a factor, the cause of this increase is not really known Fortunately compared with other chronic diseases, asthma has a number of characteristics in its favor. Dr. Harold S. Nelson, senior staff physician at the world-renowned National Jewish Medical and Research Center in Denver, speaks from considerable experience when he says, "Asthma is reversible and can be controlled.
Another favorable aspect of the disease is that a person with asthma can be healthy and normal when not experiencing symptoms. -With good medical treatment and conscientious self-care most asthmatics can lead normal lives," assures Dr Nelson. In the absence of active symptoms even a physical examination may not reveal arty signs of asthma; lungs and airways may appear completely normal. Sophisticated tests sometimes reveal physiological changes in the lungs of asthmatics, but the effect on the body of such changes is not known, and they are not invariably present.
There is no cure for asthma as yet, but considerable progress has been made in recent years in diagnosis and treatment, and ongoing research promises the possibility of even better management in the near future. An important advance in treatment was made when the focus of research changed from decreasing the severity of the symptoms to preventing them from occurring In the past a person with asthma wastreated and given medication only when wheezing and shortness of breath occurred, today medications are prescribed on a maintenance schedule that aims at keeping the patient free of these symptoms. Since an important part of prevention is not only drugs but also diet and exercise, this new approach benefits the whole body, and asthmatics who faithfully follow this enlightened regimen may easily end up healthier than many of their nonasthmatic counterparts.
What Causes Asthma?
We still do not know the underlying causes of asthma, but we are beginning to understand what sets of symptoms and the physiological processes that take place when the symptoms occur.
We call the substance or activity that sets off asthma symptoms a "trigger," and we know that although some things are more liable to cause trouble than others, triggers can be almost anything. Years ago it was thought that all asthma was due to allergens, but that turned out to be only put of the story We now know there are two basic types of asthma: extrinsiccaused by allergy triggers, such as pollen and petsand intrinsiccaused by nonallergic triggers, such as an inflammation, a sinus infection, a cold, strew, or exercise. What constitutes a trigger vanes from person to person, even within a family.
According to Dr. Michael A. Kalimer of the National Institute of Allergic and Infectious Diseases, about 90 percent of children's asthma is extrinsic, whereas only 50 percent of adults fall into this category It is possible, however, to have both kinds of asthma simultaneously. (See Chapter 12, "Recognizing and Dealing with Asthma Triggers.")
Because stress tends to exacerbate asthma, it used to be thought that perhaps asthma was a psychosomatic disease. It is now understood that strew is a trigger that can cause asthma symptoms or make them worse, but that it will not give someone asthma or cause symptoms in anyone who does not already have the disease. A nonasthmatic will never get an asthma attack, no matter how upset or stressed he or she becomes.
What Happens When You Get an Attack?
The characteristic symptoms of asthmashortness of breath, a tot feeling in the chest, wheezing, and difficulty breathingare due partly to constriction of the muscles wrapped around the bronchial tubes (bronchospasm). In addition, the lining of the bronchial tubes (mucosa) swells and becomes inflamed, and an increase of thick, sticky mucus is produced. These three changes in the bronchial tubes narrow them so that there is less space for air to get through. The effort to force air through this narrowed space may cause the wheezing sound associated with asthma. If, however, the attack is severe enough so that no air gets through, there is no wheezing.
Coughing may occur in an effort to bring up the sticky mucus that is clogging the airways, if it is nonproductive, it may increase the constriction.
When air cannot easily get in or out, more air than usual (some air is always unexpelled) inevitably becomes trapped in the lungs, leaving less room for fresh, oxygenated air to get in. There is normally less resistance when breathing in than when breathing out, and during an asthmatic attack, although you may feel you are trying to breathe air in, breathing air out is what has really become critical.
Long before you reach this point; you will probably have used your inhaler, reversed the bronchospasm by relaxing the bronchial muscles, and restored normal breathing. If, however, there is much inflammation and you are not taking medication to reduce it, you may have a subsequent attack (the pulmonary late-phase response or We-phase reaction) because of the inflammation With proper management this need not happen.
The Pulmonary Late-Phase Response
An asthma episode usually happens immediately or very shortly (fifteen to thirty minutes) after exposure to a trigger Once the symptoms are brought under control and normal breathing has been attained most asthmatics would expect that to be the end of it What can sometimes happen, though, IS that while the bronchospasm may have been reversed, the airways are left with a hidden, inflammatory condition that lasts much longer. In this' case, several hours or even days later, a second episode may occur (the late-phase response) that is actually a continuation of the original one, although it may not be recognized as such.