Asthma : Monitoring Symptoms, Using Medicine

by Food and Drug Administration (FDA)

(Page 3 of 4)

Thomas says he felt lucky to survive his bad asthma attack in New York, but the experience was so traumatic that he took a month off work and went back home to his parents' house to recover. "I had panic attacks and a lot of anxiety about having another attack," he says. His anxiety level eased as he got a better handle on monitoring and preventing symptoms and using medicine.

Thomas has gone for 10 years without a major asthma attack, and he attributes that to several factors. He uses a daily long-term inhaled corticosteroid called Azmacort (triamcinolone acetonide) to relieve the inflammation that can cause an asthma attack, and he uses a Ventolin (albuterol) inhaler as needed for short-term quick relief of acute symptoms. He says that in the weeks before his bad asthma attack, he was using a quick-relief inhaler several times a day, even sometimes several times in the same hour. He now recognizes such use as a sign of trouble.

Thomas avoids known triggers and monitors his breathing with a peak flow meter. "As a kid, I just dealt with the asthma attacks as they happened," he says. "Now, I pay attention to what's going on before it gets bad."

According to the NAEPP Expert Panel Report, peak flow meters may be most helpful for people with moderate or severe asthma. A meter reading will tell you your peak flow zones, which are based on the colors of a traffic light. The green zone signals that your asthma is in good control, the yellow zone signals caution and is a sign to use quick-relief medicine to relieve symptoms, and the red zone signals a medical alert that means you should contact a doctor. Written plans can be useful for telling you what kind of medicine to take and how much to take when you're in each zone.

Inhaled asthma medications are delivered through many different devices, including metered dose inhalers, dry powder inhalers, and nebulizers. It's important to get instructions on how to use each medicine you take, and to have your doctor or nurse check your technique. To improve effective use of medication for kids or adults, plastic devices called spacers are often used with inhalers. Spacers create a space between the inhaler and the person's mouth to help more medicine get into the lungs. A nebulizer, which delivers medicine in a fine mist, also is useful for young children.

The issue of using asthma medications in school remains a challenging area for children and parents. To date, 18 states have laws or policies allowing children to carry inhalers in schools, according to AANMA. Many schools require an inhaler to be kept in the nurse's office because it's a drug. "But if a child is in gym class and the nurse is three buildings away, that could be a problem," says Sheerin, the asthma specialist in Atlanta. Experts say the two best things we can do for children with asthma are to teach them how to manage their asthma as they grow up, and to share a written plan from your doctor with the school.

Fusco-Walker, who now works with AANMA as an educator, points to the American Lung Association's asthma camp program as a good support system for parents of children with asthma. "It's a great place for children to learn how to manage their asthma, and parents can enjoy peace of mind while their children experience summer camp," she says. Kids participate in regular camp activities like swimming and biking, and there are trained medical personnel who teach the kids proper use of medication and other aspects of asthma management.

Sheerin says all kids should be able to sleep, play and learn. "If parents are up at night, if kids can't play, or if they are missing a lot of school because of asthma, then the asthma management plan is not right."

NIH Updates Asthma Guidelines

When it comes to managing asthma, adherence has two parts. "The first is that doctors use the guidelines on asthma management, and the second is that people with asthma follow their plans," says William Busse, M.D., professor of medicine in allergy and immunology at the University of Wisconsin Medical School. Busse is also chairman of the National Asthma Education and Prevention Program Expert Panel, which updated the Guidelines for the Diagnosis and Management of Asthma in June 2002.

Targeted to doctors, these guidelines were first published in 1991 and then revised in 1997. An update in June 2002 reflects scientific advances over the last five years. Here are highlights from the most recent update:

Inhaled corticosteroids, which treat chronic inflammation of the airways, are safe, effective, and preferred first-line therapy for children and adults with persistent asthma.

Inhaled corticosteroids are safe at recommended dosages. There has been concern about slowed growth in children due to use of inhaled corticosteroids. Research shows that this potential risk is temporary and possibly reversible. Nonetheless, doctors should monitor children's growth while giving inhaled corticosteroids, because slowing of growth is a good marker for side effects in other organs in the body. The expert panel also found that other concerns associated with use of corticosteroids, such as reduced bone mineral density, suppressed adrenal function, and increased risk of cataracts, are not considered significant risks for children. The risk-benefit assessment favors the use of inhaled corticosteroids for the treatment of persistent asthma.

When inhaled corticosteroids are not achieving optimal effectiveness, doctors should add a long-acting beta-2 agonist. These types of drugs, also known as bronchodilators, relax the muscles surrounding the airways.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.