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Catching up with asthma

Dr. Drew Werner Special to the Daily

Dear Doc:

My son saw the return of his asthma problem during his cross country race a couple of Saturdays ago – cold, rainy, high altitude. He’s among the fastest runners on the team, especially in warm weather. He had to stop momentarily, use his inhaler, and then toughed out a finish that was remarkable under the circumstances but a few minutes off his potential. What can we do to help him? Thanks,

– A Concerned Mom and Dad

Dear Concerned:

Your question is a very good one and the timing is perfect. As they say, “‘Tis the season”. The term asthma originally came a Greek word meaning “difficult breathing.” Our modern use of the word encompasses a variety of conditions in which there is widespread narrowing of the airways as a result of spasms of the smooth muscles surrounding them or swelling and mucus in the lining of these airways.

The causes of asthma are many. Often several factors act at once to make the problem even worse. Asthma can occur spontaneously, without specific causes, or like your son may be triggered by something specific.

Common things that may trigger asthma include allergies, infections, exertion, cold exposure and high altitude. To make it even more complicated, allergies can come from things you eat, medicines you take and particles you breathe in.

In your son’s case, it sounds like the combination of cold air, high altitude and even possible allergies all combined to trigger his symptoms.

When we breathe, air enters our trachea and passes down through an increasingly smaller set of airways to the alveoli or air sacs, which exchange oxygen (O2) and carbon dioxide (CO2) with our blood. It is in these small airways that the spasm, swelling and excessive mucus production occurs, setting into motion an asthma attack.

The end result is not enough air gets in. It can be scary in a world full of air and not being able to get enough in! I think the Greek had it right. No matter what we know about asthma, it is simply “difficult breathing”!

Fortunately, there are things we can do. Currently, there are two basic ways to treat asthma and four common medicines to do that. First and foremost is prevention. That sounds so obvious, but can be so difficult.

Obviously my first rule is (for asthma and almost every other ailment, condition, problem and illness) DON’T SMOKE! If there is one single thing to improve your health, that is it.

Next in line are:

2) Avoid triggers: Dress warmly in the cold and breathe through a neck gater or mask; stay away from allergies including foods, animals and other avoidable environmental sources; vacuum the house, car and camper with a vacuum with a HEPA filter.

3) Don’t use over-the-counter antihistamines like Benadryl that may trigger asthma.

4) If allergies are your problem, try Claritin, which has recently gone over the counter and is a special type of antihistamine that won’t worsen asthma.

If those strategies aren’t enough, you may need medications. Sometimes people get so used to “difficult breathing” they forget what it feels like to get in a full breath of air.

If you think you have asthma or aren’t sure how bad it is, then spirometry, a special breathing test, can be used to measure the extent and severity of your asthma.

Only recently it was felt that if you had “reactive airways,” then your asthma was only a problem in certain situations or with certain exposures. Your treatment was only for those bad days. On the other hand, if you had asthma daily or persistently abnormal spirometry, then you needed a maintenance medication.

Now we know differently. Asthma attacks are damaging to our lungs and airways. The more we have, the worse it gets. After many years the recurrent asthma attacks add up and may lead up to chronic breathing problems. There is help, though!

Asthma is treated using two types of medications – rescue medicines and preventive medicines. The rescue medication used is an albuterol inhaler. This important drug rapidly dilates those constricted airways in just a few minutes, rescuing you from your asthma attack.

Preventive medications don’t work quickly, but improve our airways over time and actually prevent the damage those recurrent asthma attacks cause. These are considered “disease modifying” drugs because they help improve the asthma over time rather than let it follow its natural course of gradual worsening.

The preventive medications include inhaled steroids, long-acting beta agonists (like a long-acting Albuterol) and leukotriene receptor antagonists. That’s a complicated name for a class of oral medications that help reverse the process that causes asthma.

Don’t worry about the inhaled steroids – they won’t give you big muscles. They are actually similar to topical steroids used for rashes. They are breathed in, work topically in our lungs and then are breathed out. They are not absorbed into our blood streams and so are remarkably safe.

Finally, there are mast cell stabilizers that don’t really affect the asthma process but rather block the allergic response in people with inhaled allergies.

Why is that important? Because you (or your son!) may benefit from a preventive medication. Although they are used daily, he might only need them during his sports season. At the same time regular use may help him down the road – literally and figuratively!

Dr. Drew Werner of the Eagle Valley Medical Center writes a weekly column for the Daily. He encourages health questions. Write him c/o Editor, Vail Daily, by e-mail to editor@vaildaily.com or P.O. Box 81, Vail, 81658.


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