Breathing is easier if you follow your asthma action plan
May 24, 2011
FORT HOOD, Texas"Asthma sufferers can breathe easier knowing that the medical professionals at Carl R. Darnall Army Medical Center are prepared to help them control their asthma.
“Control is the most important aspect when dealing with asthma. Uncontrolled asthma can lead to potentially fatal consequences,” said Wanda Gomez, certified asthma educator at CRDAMC’s Population Health Clinic. “Our number one priority is to determine if the patient’s asthma is controlled. The goal of asthma management is to attain and then maintain control with the least medication and the fewest side effects.”
Asthma is a lifelong disease, and can be diagnosed at any age. About 1 in 12 people (25 million) have asthma, and the numbers are increasing every year, according to the Center for Disease Control.
Asthma affects the large airways in the lungs. It is a chronic disease in which the airways are affected in three primary ways: the airways become swollen and inflamed, the muscles in and around the airways constrict and cause narrowing, and there may be excessive mucous production. These three mechanisms result it obstructed airways that make it difficult to breathe. As the airways become more swollen and irritated, asthma symptoms worsen.
Common symptoms include coughing (especially at night), shortness of breath, chest tightness or pressure and wheezing (sometimes, but not always). Not every person with asthma has the same symptoms in the same way. Some may not have all of the symptoms, may have different symptoms at different times or may go for extended periods without having any symptoms.
Gomez said, even if you’re not sure if what you or your child is experiencing is asthma, seek help from your provider.
Communication between provider and patient is key in diagnosing and managing asthma, added Nancy Radebaugh, clinical pharmacist and certified asthma educator for CRDAMC. While testing lung function is important, there is no single test to diagnose asthma. Children under 5 years old usually aren’t able to perform spirometry, the most common lung function test, so careful observation of symptoms and the environment is crucial.
“Tell your provider your family history, what medications you’re taking and any other medical conditions you may have,” Gomez said. “Also, you need to describe your lifestyle and what you’re doing when your symptoms get worse. Infants and toddlers can’t express themselves, so it’s up to the parents to describe in detail about the child’s symptoms and reactions.”
Most asthma attacks are mild and inhalers or relievers restore breathing by opening airways within a few minutes, while severe attacks are less common but last longer and require immediate medical help. The CDC stated that about 1 in 2 people (12 million) with asthma had an asthma attack in 2008, but many asthma attacks could have been prevented.
Education is another important factor in helping keep asthma under control and prevent attacks.
“With a better understanding of the disease, providers can more readily diagnose asthma in patients and make better decisions in treating it,” Gomez said. “The more informed patients are about such things as proper use of inhalers and the importance of taking medications regularly, the better their chances of preventing asthma attacks.”
Gomez and Radebaugh follow the “Rule of Twos” guidance from Baylor Health Care System to help determine if a patient’s asthma is under control,
“If you have daytime symptoms more than twice a week or nighttime symptoms more than twice a month, your asthma is not controlled. If you are using your reliever frequently, your asthma is not controlled,” Gomez explained.
They also hand out National Institute of Health’s Asthma Control Test sheets, a quick test for adults and children 4 to 11 years old that provides a numerical score to assess asthma control.
It is not known what specifically causes asthma, but it is known that there is a hereditary component and that environmental factors are a contributing source to the condition.
Since she knew asthma is heredity, Cara Holloway said she was not surprised when her daughter Alanna, 7, was diagnosed with asthma.
“I’ve had asthma since I was 6 years old. So I expected my children would also have it,” Holloway said. “We have the same triggers, too, which are weather changes and exercise.”
Typical triggers that can cause asthma symptoms include air pollution, weather changes, mold, colds and flu, reflux/acid stomach, dust mites, pet dander, allergies and eczema. Strong emotions can also trigger asthma symptoms.
But the number one trigger is cigarette smoke, Radebaugh and Gomez said, emphasizing the importance of not smoking, especially around children.
“Smoking and second-hand smoke are terrible for asthma. If you can’t quit smoking, never smoke in your house or in your car at all. Even if you do smoke outside, be far enough away so that smoke can’t filter in,” Radebaugh said. Health care providers encourage the use of “smoking jackets” to be worn while smoking outdoors, removed and left outdoors before entering the home.
As part of their treatment when patients are diagnosed with asthma, CRDAMC providers are required to complete a written Asthma Action Plan, which describes actions patients should take during all phases of their asthma. Plans are usually separated into zones that range from green (no symptoms), to yellow (some symptoms"use caution) and red (severe, requiring emergency treatment).
“Catching an asthma attack early allows you to take actions at home and may help avoid a visit to the emergency room,” Gomez said.
Asthma attacks can happen at any time though, and Holloway stated she is always on the alert.
“We’ve have had a couple close calls with Alanna. In one incident, she had to be rushed to the ER and it took three to four breathing treatments to get her under control,” she said.
The primary goal is getting people to follow their action plans and adhere to guidelines developed for them, according to the CDC, which reports that many adults who were taught how to avoid triggers, did not follow most of the advice. Not following the plan can lead to serious consequences, as the CDC further states that185 children and 3,262 adults died from asthma in 2007; many of the deaths were preventable.
“Many patients don’t follow their plans or see their providers regularly. They think, ‘oh, I’ve been okay for awhile, I don’t need to take my medicine.’ Or they have some false beliefs about the types of medicines used to treat asthma. Pregnant women often decide to stop their medication for fear it will harm their baby, but all the national guidelines state that good asthma control is key in pregnancy and that asthma medications should be continued.” Gomez said. “Many don’t take any action to avoid their triggers. They continue to smoke or keep the pet that’s giving them allergies. But if you don’t control your asthma, you’re just putting yourself more at risk for an attack.”
The whole idea of controlling asthma is that you should have a quality of life that allows you to enjoy the things you’ve done before, Radebaugh and Gomez said.
“We are actually seeing more and more cases where Soldiers with asthma are retained on active duty and have deployed multiple times. They can pass PT (Army Physical Fitness Test) and function as normal,” Radebaugh said. “It is a misconception that if you have asthma, you can’t be outdoors or play sports. But with proper treatment and control action, asthma sufferers can remain active.”
Holloway agreed, stating asthma has not slowed Alana down at all as she is still active, “very, very active.”
“It doesn’t really bother me at all. I know that if I run around too much, I can have trouble. So when I go out for recess or PE (physical education), I use my inhaler. I can play and do everything the other kids do,” Alanna said.
In addition to the individualized asthma action plan, providers prescribe the appropriate medication for patients.
Asthma medicines come in two types"quick relief and long-term control. Quick-relief medicines, bronchodilators, relax the muscle bands that tighten around the airways Many long-term medicines contain "corticosteroids,” which reduce swelling and mucus production in the airways. Asthma treatment can vary from inhalers to oral medications.
Asthma medicines can have side effects, but they are usually minor and manageable when used correctly Radebaugh said, stressing that all asthma medicines are safe and effective.
“We know the medications work. The benefits far outweigh any risks,” Radebaugh added. “Since the medicine is inhaled, it goes directly to the airway with minimal systemic absorption.”
Gomez added that everyone should know how to properly use a reliever with spacer and always have it available with them, plus one for school or work, and one at home.
As May is Asthma Awareness Month, Gomez and Radebaugh are promoting asthma education and awareness. They said they are always available to help patients with asthma, not just during the awareness month. They offer many classes throughout each month for all ages that educate patients about asthma, proper ways to treat it and correct use of the different types of inhalers. Patients are normally referred by providers but self-referrals are taken and family members and caregivers are encouraged to attend with the patient.
In addition to adult classes, they offer “Wee Wheezers” for the caregivers of infants and children up to 5 years old and “Peds Class” for 6 to 10 year olds.
Call (254) 288-8136 for more information.