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Asthma: Take Control - Don’t Let Asthma Control You!

Asthma: Take Control- Don't Let Asthma Control You!

A diagram of the human respiratory system

When you breathe, air travels through tubes (bronchi , bronchioles) in your lungs
to reach tiny air sacs (alveoli) so that your body can get the oxygen it needs.

What Causes Asthma?

Asthma is a chronic condition in which the lining of the airways, or bronchial tubes, is inflamed and overly sensitive to many factors which "irritate" them. Exposure to one of these irritating factors can cause symptoms in a person with asthma.

What Are "Asthma Triggers"?

Factors which irritate the airways and cause asthma symptoms arc called "asthma triggers." Many substances or events can trigger chest tightness, coughing, and wheezing. Some triggers are common for many people including:

  • Respiratory infections
  • Exercise
  • Cold Air
  • Cigarette smoke
  • Odors, perfumes, aerosols
  • Air pollution
  • Allergens
  • Emotional stress
  • Fatigue
  • Weather changes
  • Gastroesophagcal Reflux Discasc/LPR

What are Early Warning Signs?

Many patients notice a variety of symptoms that occur before the onset of chest symptoms. Examples include:

  • Fatigue
  • Irritability
  • Itching of chin or back
  • Dark circles under the eyes
  • A drop in your peak flow values

It is important to identify and recognize these early warning signs and to intervene before asthma symptoms progress.

How Do My Asthma Medications Help?

Medications used to treat asthma can be grouped into two broad categories based on how they work to relieve or prevent asthma symptoms.

Quick -Relief (Rescue) Medications: Bronchodilators

Rescue medications open the airways by relaxing the muscles surrounding the bronchial tubes.

  • Beta-agonists: inhaled short acting beta-agonists include albuterol (Proventil HFA, Ventolin HFA, ProAir), pirbuterol (Maxair), levalbuterol (Xopenex HFA) and alupent. These are taken "as needed" for quick relief of asthma symptoms and may be used before exercise to prevent exercise induced symptoms.
  • Anticholinergics ( e.g., Atrovent=ipratropium bromide): Used to open the airways and are many times used with beta agonist to improve bronchodilation. May also be helpful when cough is prominent symptom.

Long-term, Controller Medications:

Anti-inflammatory Drugs: control inflammation of the bronchial tubes. Prevent asthma symptoms by reducing the ever- present inflammation of the airway lining. They take time to work, and must be used on a regular basis. There are three families of anti inflammatory drugs.

  • Steroids: Inhaled steroids are "cortisone like" steroids which work locally in the lungs to decrease inflammation. (e.g., Asmanex, Azmacort, Vanceril, QVAR, Aerobid, Flovent, Pulmicort). Systemic steroids (e.g. prednisone, Medrol) are strong inflammatory drugs most often used in short courses (about 3-7 days).
  • Leukotriene blockers: Medications which block the receptors for leukotrienes (Accolate, Singulair) or block the synthesis of leukotriense (Zyflo ). Leukotrienes are cellular mediators which lead to bronchial inflammation and narrowing, and cause an increase in mucus production in the bronchial tubes.
  • Combination Inhaled steroid/ Long-acting Bronchodilator (e.g. Advair Diskus, Advair HF A, Symbicort)
  • Cromolyn (Intal) and nedocromil (Tilade)

Bronchodialators:

  • Long-acting bronchodilators ( e.g. Serevent, Foradil) Should not be used as "rescue" medication or alone as controller.
  • Theophylline (e.g. , Theo-24, Uniphyl ): oral bronchodilator to be taken on a regular, longterm basis.

Potential Side effects

  • Bronchodilators: increased heart rate, jitteriness
  • Inhaled steroids: thrush, hoarseness
  • Long-acting bronchodilators: potential increased risk of rare, serious life threatening asthma attacks
  • Oral steroids (short term use) increased appetite, weight gain, water retention, moodiness, irritability, insomnia, stomach upset
  • Oral steroids (long term use), growth suppression, cataracts, glaucoma, osteopenia/osteoporosis

What Happens During An Asthma
Flare-Up?

Asthma symptoms occur when there is blockage of the bronchial tubes, causing a whistling noise called "wheezing", cough, shortness of breath, and/or chest tightness. This blockage is caused by three things:

  • Swelling or "edema": the lining of the bronchial tubes swells, expanding inward, making the size of the airway smaller. This swelling is caused by increased inflammation of the bronchial tube lining.
  • Mucus secretion: the tissues that line the bronchial tubes secrete extra mucus which can plug the narrowed air passages even further.
  • Bronchospasm: the muscles that surround the bronchial tubes tighten and make the airway even smaller.

Together, the swelling, mucus, and bronchospasm in the airways make it harder to move air through the bronchial tubes. The person with asthma must work harder and breathe faster to move air through these narrowed airways.

How Can I Prevent Asthma Symptoms From Becoming More Severe?

  • A void the asthma triggers that may be causing the symptoms.
  • Learn to recognize early warning signs
  • Stop what you are doing, rest, and take slow deep breaths.
  • Sip warm fluids to help relax
  • Take two puffs of your bronchodilator inhaler to help relieve your symptoms
  • Follow your asthma management plan

When Do I Call the Doctor's Office?

Sometimes asthma episodes become more severe despite your best efforts to treat them early. A change or increase in medications or further medical treatment may be needed. Call your doctor's office or seek medical help if:

  • Asthma symptoms continue or worsen despite all treatment steps that your physician has given you
  • The medicines are not helping or not lasting as long as they should.
  • You have any doubt about the severity of an attack

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Pregnancy and Allergies

A woman’s body experiences many changes when pregnant. Some women may develop allergies during pregnancy. It’s more common for women to already have allergies before conception.

Can allergies worsen during pregnancy?

About one-third of moms-to-be find their allergy symptoms get worse during pregnancy. The same number of women said their allergies stayed the same. Another one-third found their symptoms actually improved during pregnancy.

Common Symptoms

Symptoms are basically the same for those not pregnant which includes: itchy, watery eyes; sneezing; sore or itchy throat; runny nose and sinus congestion.

Stuffy Nose

Many pregnant women can develop stuffy noses. Nasal congestion normally starts in the second trimester cause mucus membranes to swell and soften. Some doctors call it pregnancy rhinitis.

Pregnancy rhinitis can feel like a cold or an allergy. It can also cause nosebleeds during pregnancy and even a post nasal drip that can cause coughing and even gag at nighttime. Typically, pregnancy rhinitis goes away after the pregnancy ends.

What is the difference between allergies and pregnancy rhinitis? For those who have allergies, symptoms experienced included congestion, coughing, sneezing and itchy eyes. If itchiness and sneezing isn’t causing issues, it could be hormone-related pregnancy congestion. Discuss any issues you are having with your doctor.

Allergy Medicines for Pregnant Women

Women need to be very careful taking any medications during pregnancy and most importantly during the first trimester. It’s important to discuss any allergy medications with your doctor. Reducing allergens in the home without using medications could be a first line of defense for the mom-to-be. Allergy proofing the home, avoiding allergy triggers and trying a saline nasal spray, nasal irrigation or nasal strips.

After the first trimester – oral antihistamines treat nasal and eye allergy symptoms of allergic rhinitis.

Considered safe for pregnancy according to multiple studies – Loratadine and cetirizine are second-generation antihistamines. These drugs do not cause drowsiness like first-generation oral antihistamines do – chlorpheniramine, diphenhydramine and tripelennamine.

Corticosteroid nasal sprays are mostly safe and can be prescribed to pregnant women with moderate to severe allergy symptoms that last more than a few days. Budesonide is considered the safest. Mometasone and fluticasone are also considered safe.

Decongestant nasal sprays can cause issues. Some studies point to a risk of birth defects when pregnant women use these products. They are not recommended during pregnancy especially in the first trimester.

Pregnant women should avoid any antihistamine nasal sprays since there is not enough research to prove their safety.

Always discuss which nasal spray might be right and any medication risks to the pregnant woman and her baby with her physician.

Allergy Shots during Pregnancy

Women can continue allergy shots that began before they were pregnant. They should stay at the current dose during pregnancy and if there are any reactions, the allergist may reduce allergy shot dosage. Generally, it is best not to begin allergy shots during pregnancy which can trigger changes in an already-changing immune system and may cause a systemic reaction.

Anaphylaxis treatment is the same during pregnancy as for non-pregnant women with food, insect venom or latex allergy. Use epinephrine at the first sign of symptoms.

Breastfeeding and Allergy Medications

Medications used during pregnancy can be continued while nursing. The baby gets less medicine through the breast mile than in the womb. Your allergist can discuss the best medications for nursing moms to use.

Do Allergies Cross Over to the Baby while Pregnant?

Allergy symptoms experienced by the mom during pregnancy are not believed to have an impact on the baby and developing allergies. Genetics play a major factor in developing allergies. For children with a parent or sibling with allergies, they have an increased risk of getting allergies.

A pregnant mother’s diet can be a factor in developing the child’s allergic rhinitis, food allergies, asthma or eczema. One study found that moms who ate plenty of food-based vitamin D reduced the child’s risk of developing allergic rhinitis. Foods with lots of vitamin D include dairy products, cereals, fish, eggs and mushrooms.

Reducing Allergy Symptoms without Taking Medications

Stay away from people who are smoking which can make allergies worse. Plus, secondhand smoke is not good for mom or her baby.

Pollen Allergies – stay inside as much as possible. Try wearing wrap-around sunglasses to keep pollen out of the eyes. Coming back inside, take off shoes, washing hands and face and changing clothes will help keep the pollen off. Put clothes in the wash. Shower and wash hair before bedtime to reduce nighttime symptoms.

Dust allergies – have someone clean the home regularly (if possible) and use a HEPA filter vacuum. A wet mop and a sweeper can help avoid stirring up the dust. Microfiber is better than a duster to trap the dust.

Pet allergies – for those allergic to their own pets, try to make one room that is pet-free.

Avoidance diets do not prevent allergic disease according to the American Academy of Pediatrics. This means that pregnant women shouldn’t worry about avoiding common food allergens such as peanuts, tree nuts, milk or wheat. Studies have shown that consuming peanuts, milk and wheat in the first and second trimesters can reduce the risk of a child developing a peanut allergy, allergic rhinitis and asthma. Unfortunately, no specific diet or food can prevent allergic disease.

Always discuss with your doctor before making any changes in diet during pregnancy.

The post Pregnancy and Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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