Asthma

Ask a Nurse
by Geraldine Bednash Ph.D., RN, FAAN, American Association of Colleges of Nursing (AACN)

(Page 3 of 5)

Asthma is a disease in which the air passages in the lungs periodically become narrowed, obstructed, or even blocked. The airways usually narrow in reaction to certain stimuli, typically something inhaled. These stimuli are commonly called triggers. When a person with asthma comes into contact with a trigger, the muscles that encircle the bronchial air passages squeeze the passages, reducing airflow. These contractions are known as bronchospasms. In addition, the linings of the bronchial tubes become inflamed and swollen, which narrows the air passages; the linings also produce a large amount of thick, gummy mucus, which can further narrow and clog the air passages.

Asthma triggered by allergies is known as extrinsic asthma. It is also called allergic, or atopic asthma. In this form of the disease, an asthma attack is clearly linked to the body's response to something inhaled or, occasionally, ingested. The most common allergens are tree and grass pollen, mold, animal dander (pieces of sloughed-off skin, much like dandruff), and dust mites. Asthma that develops in people over the age of 30 is usually intrinsic, or nonallergic, asthma. This form of asthma may be triggered by respiratory infections, exercise, stress, inhalation of chemical irritants (such as cleaning fluids or paints), and air pollution.

Symptoms: Asthma attacks are characterized by wheezing, coughing, chest tightness, and shortness of breath.

Diagnosis: Generally, diagnosis involves a medical history, physical examination, and an evaluation of your pulmonary function (how well your lungs operate). Your practitioner is looking for two critical signposts: 1) that airway obstruction or narrowing is episodic, and 2) that airway obstruction improves with medication or self-care. Once these are established, diagnostic tests or procedures may be ordered to determine what is causing the airway obstruction or to rule out other conditions.

Treatment: Medications prescribed for the treatment of asthma reverse symptoms during an acute attack and prevent the onset of attacks. Asthma drugs are generally placed in two categories — quick relief medications used to treat acute attacks (bronchodilators), and long-term-control medications (anti-inflammatory drugs and leukotriene modifiers). Anti-inflammatory medications, including steroids, prevent inflammation of the airways or, if inflammation is already present, stop it from getting worse. Leukotriene modifiers, a relatively new class of drugs, attack substances that contract the airways, increase mucus secretion, and activate inflammation.

"Understand your treatment plan," says Janyce Cagan Agruss of Chicago. "If you use inhalers (steroids and bronchodilators), use the bronchodilator first, then wait three to five minutes and use the steroid inhaler. After using the steroid inhaler, always rinse your mouth with water because the steroid can cause infections in the mouth."

Self-care: Self-care is the cornerstone to managing asthma. "Asthma is a disease that takes a lot of responsibility and self-care," says Lygia Holcomb of Orlando, Florida.

• "Know what your breathing capacity is and carefully monitor it so you don't get into trouble," says Holcomb. You can do this by taking your peak flow measurement. You take a deep breath while holding a peak flow meter in front of your mouth, exhale hard, fast, and quick, then read the marker on the meter's scale. This measures airway obstruction and can give you advance notice of progressive airway narrowing so that you can take preventive medications. "This is the best way of making an objective determination of how well you're breathing and how well your lungs are functioning," says Barbara Sarter, Ph.D., RN, FNP-C, of the University of Southern California-Los Angeles.

• Learn to recognize your triggers, says Janyce Cagan Agruss of Chicago. That way you can eliminate your exposure to them or prepare for your exposure, says Lygia Holcomb. If your asthma is triggered by allergies, follow the avoidance tips in the "Allergies" section. If irritants are your problem, do what you can to avoid them.

• Don't smoke, and restrict smoking inside your house, suggests Paula Siciliano of Salt Lake City.

• Don't use chemicals inside; if you must, wear a dust mask or, better yet, have someone else use them for you.

• If certain foods or food additives trigger a reaction, avoid those foods.

• If stress is your problem, take steps to reduce its causes and try a relaxation technique (see "Stress").

• If exercise is a trigger, discuss with your practitioner how to avoid setting off an asthma attack while exercising.

• Exercise. This is an important part of asthma management. It improves muscle tone and builds lung strength and endurance. Aerobic exercise makes the body's muscles more efficient at taking oxygen from the blood, which means the lungs don't have to work as hard to bring in extra air. Exercise can reduce the severity of exercise-induced asthma and make the lungs less sensitive to other triggers. People who experience exercise-induced asthma, however, may need to take preventive medications before they become active. Check with your practitioner, though, before you start any new exercise regimen.

• Drink plenty of water to keep your body hydrated and to thin mucous secretions.

• Get adequate amounts of vitamins and minerals, particularly antioxidants such as vitamins C and E, beta carotene, and selenium. Several studies indicate that these nutrients seem to protect sensitive lungs.

• Try pursed-lip breathing, suggests Paula Siciliano of Salt Lake City.

Over-the-counter treatment: Because allergies often trigger asthma attacks, the antihistamines and decongestants listed in the "Allergies" section earlier in this chapter may be helpful in treating asthma. People with mild asthma may also find relief from OTC bronchodilators, which interfere with nerve signals passed to the muscles and stimulate the production of an enzyme that helps relax muscles in the air passages. These drugs are generally administered by way of inhalers. They include epinephrine and ephedrine. (A word of caution here, though: Because asthma can be life-threatening if not treated properly — or promptly, in the case of severe attacks — be sure to consult a health care professional before embarking on any self-care, including OTC products and herbal remedies.)

Brand names of epinephrine include:

Adrenalin Chloride
Asthma Nefrin
Bronitin Mist
Bronkaid Mist
Primatene Mist

Brand names of ephedrine include:

Bronkaid
Bronkolixer
Primatene

Copyright © 2001 by American Association of Colleges of Nursing and People's Medical Society

About the Author

Geraldine Bednash Ph.D., RN, FAAN, Has been the executive director of the AACN since 1989. She serves as the vice president of nursing of Health Professions Education Council of the Association of Academic Health Centers and is a member of the editorial boards of several nursing publications.

The American Association of Colleges of Nursing (AACN) represents 550 schools of nursing at public and private universities and senior colleges nationwide.