Moderate And Severe Persistent Asthma

What is moderate or severe persistent asthma?

Asthma is long-term inflammation and narrowing of the airways in your lungs. This causes less airflow to your lungs and makes it hard to breathe. When you have moderate or severe persistent asthma, you have symptoms every day. You may also have symptoms at night. Your asthma attacks can last a few hours to a few days. Severe asthma may make it difficult for you to do daily activities and other things you enjoy.

What triggers an asthma attack?

An asthma attack is when your symptoms are worse than usual. During an asthma attack, the muscles around your airways tighten. This causes the airways to swell and make more mucus. Stress, activity, alcohol, or illegal drugs can trigger an asthma attack. The following may also trigger an asthma attack:

• Allergens:
  
  
  • Certain foods
    
    
  • Cockroach droppings, dust, or dust mites
    
    
  • Dander (tiny dead skin flakes) from animals such as cats and dogs
    
    
  • Mold or plant pollen
  
  
• Irritants:
  
  
  • Air pollution, chemical fumes, or cigarette smoke
    
    
  • Strong-smelling body care products
    
    
  • Very cold or hot weather, with high or low humidity
  
  
• Medical problems and medicines:
  
  
  • A cold or the flu
    
    
  • Infection in your airways, lungs, or sinuses
    
    
  • Medicines such as NSAIDs, aspirin, or heart medicine

What increases my risk of asthma?

• Family history: You have parents or other family members who have asthma.
  
  
• Medical conditions: Lung infections, sinusitis, and gastric reflux can damage your airways and cause them to react easily to triggers.
  
  
• Pregnancy and monthly periods: Women who are pregnant or having their monthly period are at higher risk for an asthma attack.
  
  
• Closed, crowded spaces: Poor air flow in closed spaces may lead to buildup of dirt, dust, chemicals, and smoke. If you breathe in these irritants, it may trigger an asthma attack.

What are the signs and symptoms of an asthma attack?

• Coughing: This is usually worse at night or early in the morning.
  
  
• Wheezing: This is a whistling or squeaky sound when you breathe.
  
  
• Struggling with activities: Asthma can slow you down when you exercise or play sports. You may have trouble with activities at work or school. You may need to slow down, or stop to catch your breath often.
  
  
• Allergies: Your nose may red, runny, and clogged, and your eyes may be itchy and teary. You may also have dry, red, itchy, or flaking skin.
  
  
• Trouble breathing: Your chest may feel tight and you may take hard, fast breaths. You may feel like you cannot get enough air in or out of your lungs. You may raise your shoulders to force air in and out of your lungs.
  
  
• Trouble sleeping: Coughing and breathing problems may make it hard for you to fall asleep. Your symptoms may wake you from your sleep at night, or early in the morning. This can make you feel very tired the next day.

How is asthma diagnosed?

Your caregiver will ask about your medical history and examine you. Tell him what triggers your symptoms and how often you have attacks. You may need any of the following tests:

• Peak flow testing: A peak flow meter is a small, tube-shaped device that measures how much and how fast you exhale.
  
  
• Pulmonary function test: This helps caregivers learn how well your lungs work. During the test, you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time.
  
  
• Bronchoprovocation testing: This measures how much air you can breathe out as fast as you can. This test is done first to see how well your lungs work normally. Then, your caregiver will give you a chemical to trigger a mild asthma attack. After 10 minutes, your caregiver will repeat the test. If the amount of air you breathe out decreases, it is likely that you have asthma.
  
  
• Allergy testing: These tests help caregivers find out if you have allergies and if those allergies trigger your asthma. Your caregiver will put drops of different liquids on your arm or back. These may include liquids from foods and some chemicals. He will prick the skin under these drops with a needle. He will wipe off the drops and watch closely for any redness or swelling on your skin. He will monitor you closely during this test.
  
  
• Blood tests: You may need blood tests to determine if your asthma attack is triggered by an infection.
  
  
• Chest x-ray: This is a picture of your lungs to look for signs of infection, such as swelling and fluid.

How is asthma treated?

Your caregiver will work with you to make an asthma action plan. Your action plan will include a list of your medicine, how much you should take, and how often to take it. This will help you manage your asthma, and may help prevent asthma attacks. Carry your asthma action plan with you at all times. You may need the following medicine:

• Inhaled short-acting bronchodilators: These are given to help open your airways quickly. They start to work right away and are used to relieve sudden, severe symptoms, such as trouble breathing. They are called relievers or rescue inhalers.
  
  
• Steroids: These help decrease swelling and open your airways to help you breathe easier. They may be given as pills or in an inhaler. After an asthma attack, you may need steroid pills for several days. Inhaled steroids are used for long-term control.
  
  
• Combination inhalers: These include a long-acting bronchodilator and a steroid. They help open the airways over time, and are used to decrease and prevent breathing problems. They are only used when your asthma is not controlled with other medicines. They are not helpful during an asthma attack.
  
  
• Immunomodulators: These may help control your asthma symptoms over time. They are given in the hospital or doctor's office.

What types of inhalers may be used to treat asthma?

Inhalers are devices used to give your medicines as a mist or powder for you to breathe in. Your caregiver will help you choose an inhaler that is easy for you to use and carry. Ask your caregiver for more information about the inhaler that would be best for you.

• Metered dose inhaler: This is a small, tube-shaped device. You hold the open end inside your mouth. The medicine comes out as a mist when you press a switch. Breathe in deeply to get the right amount of medicine. You can use a spacer with this inhaler. A spacer is a large tube that holds the mist before you breathe it in.
  
  
• Nebulizer: A long tube goes from the machine to a small round container that holds asthma medicine. The liquid turns into a mist once the machine is turned on. You breathe in this mist through a mouthpiece.
  
  
• Dry powder inhaler: This is a small tube or disc-shaped device that contains powder asthma medicine. You hold the open end inside your mouth. The powder is released when you press a switch. With this type of inhaler, you must breathe in hard to suck in the powder.

What are the risks of asthma?

Without treatment, your asthma attacks can last longer and happen more often. Your symptoms can get worse. Asthma can cause your airways to thicken and fill with mucus, letting less air through them. Your lung tissue can get damaged and scarred. This may increase your risk for other lung conditions such as emphysema or COPD. Your body may not get enough oxygen. This can cause damage to your organs and be life-threatening.

How can I help prevent an asthma attack?

• Avoid triggers.
  
  
• Follow your asthma action plan.
  
  
• Try to avoid people who are sick.
  
  
• Use air conditioning to control the temperature and humidity in your house.
  
  
• Keep pets out of your home. If you have cockroaches or other pests in your home, get rid of them quickly.
  
  
• Remove old carpets, fabric-covered furniture, drapes, and furry toys in your house. Use hypoallergenic covers for your mattresses and pillows.

Where can I find support and more information?

• American College of Allergy, Asthma, and Immunology
  85 West Algonquin Road, Suite 550
  Arlington Heights , IL 60005
  Phone: 1- 847 - 4271200
  Phone: 1- 800 - 8427777
  Web Address: www.acaai.org
  

• National Asthma Education and Prevention Program
  National Heart, Lung and Blood Institute
  National Asthma Education and Prevention Program
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/about/naepp/
  

When should I contact my caregiver?

Contact your caregiver if:

• You cough or wheeze more than usual.
  
  
• Your medicines do not relieve your symptoms as well as they used to.
  
  
• Your symptoms keep you awake at night.
  
  
• You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

• You have wheezing or shortness of breath that does not get better with treatment.
  
  
• You feel that very little air is reaching your lungs and you cannot breathe.
  
  
• You feel dizzy or faint.
  
  
• You have severe chest pain.
  
  
• Your lips or fingernails turn gray or blue.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.