Asthma is a Greek word meaning panting. It is a chronic
(condition that has a long duration) lung disease, characterized by
recurrent episodes of breathlessness, wheezing, coughing, and chest
tightness, termed exacerbations. The severity of exacerbations can
range from mild to life threatening. Exacerbations can be triggered by
exposures and conditions such as: respiratory infections, house dust
mites, cockroaches, animal dander, mold, pollen, cold air, exercise,
stress, tobacco smoke and indoor and outdoor air pollutants. Both the
frequency and severity of asthma symptoms can be reduced by using
medications and reducing exposure to environmental triggers.
It causes bronchoconstriction (narrowing of the airways) due to
inflammation (swelling) and tightening of the muscles around the
airways. The inflammation also causes an increase in mucus production,
which causes coughing that may continue for extended periods.
Asthma currently affects more than 15 million Americans,
approximately half of whom have mild, but persistent asthma (symptoms
more than twice a week). It is currently estimated to cost the U.S.
economy $11.3 billion in health costs and lost productivity. The
additional cost of treating all patients with mild persistent asthma
with daily medication is estimated at $2 billion.
For the past 15 years, an epidemic of asthma has been underway in
the United States. The steady rise in the prevalence of asthma
constitutes an epidemic, which by all indications is continuing. Even
if rates were to stabilize, asthma would continue to be a profound
public health problem. It is a potentially fatal, chronic disease
responsible for over 1.8 million emergency room visits per year, over
460 thousand hospitalizations per year and over five thousand deaths
per year. Although the burden asthma affects Americans of all ages,
races and ethnic groups, recent data indicate that children, low-income
and minority populations have been most severely affected.
It is only within the past 20 years that scientists have learned
that asthma is due to an inflammatory process in the bronchial air
passages of the lungs that causes chronic irritation and narrowing of
the airways, resulting in loss of lung function. In 1991, the NHLBI's
"Guidelines for the Diagnosis and Management of Asthma" emphasized for
the first time the role of inflammation in asthma and called for the
use of anti-inflammatory agents to reduce inflammation over the long
term, in addition to medications to provide symptom relief.
In 1997, the updated Guidelines recommended that patients with mild
persistent asthma take daily medication, such as inhaled
corticosteroids or anti-leukotrienes, to prevent or reverse airway
inflammation. Since anti-leukotrienes were a relatively new class of
medication, the guidelines also called for additional research on them.
Asthma is difficult to diagnose because it has varying degrees of
severity and its symptoms are similar to other lung conditions. Working
closely with your physician to set up a comprehensive management plan
can help reduce the risk of severe attacks and increase your quality of
life. By identifying and eliminating triggers, routinely monitoring
your breathing and properly using medications, you can help control
symptoms and maintain your usual lifestyle. Patients must learn to
identify these triggers and practice avoidance techniques. Patients
should be aware of any circumstances or substances that worsen their
asthma.
In most people younger than age 30, asthma is triggered by
allergies. About 40 to 50 percent of adults with asthma are allergic to
airborne particles. Skin testing is the best way to determine to what
substances you may be allergic. Allergens include house dust mites,
cockroaches, tobacco smoke, pollen, molds and dander from animals,
especially cats.
In some people, aspirin and other (Voltaren, Ibuprofen/Advil,
Motrin/Nuprin/Aleve, Ketoprofen / Orudis, Indomethacin, Indocin,
Keterolac/Toradal) nonsteroidal anti-inflammatory drugs (NSAIDs) can
worsen symptoms, causing sudden, severe attacks. Sulfites are
preservatives added to some perishable foods which can cause hives and
shortness of breath in a few people with asthma. The Food and Drug
Administration (FDA) now prohibits sulfites in fresh fruits and
vegetables, except potatoes, and requires warning labels on foods
containing the preservatives.
Nutritional supplements that may be helpful include Vitamin B6, of
which a deficiency is common in asthmatics, Magnesium, Selenium,
Vitamin C and Vitamin E.
- Action Against Asthma A Strategic Plan for the Department of Health and Human Services May 2000
