Background

Asthma is primarily a chronic inflammatory disease of the airways in the lung that results from genetic and environmental conditions. In the United States, it is estimated that 25.7 million people have asthma (1). It is one of the most common chronic diseases of childhood, in which most patients are diagnosed by 5 years of age. A survey taken in California found that 13.1% of adults and 12.5% of children had been diagnosed with asthma (1,3). However, around 30% to 70% of children with asthma will improve or become symptom free by adulthood.

Emergency room visits for asthma symptoms rose by about 18% for California children ages 5-17 (4). In the Central Valley, the ER visits more than doubled: Sacramento rose by 48%, and Los Angeles county increased by 17% (4). Although the number of ER visits have been increasing, the number of asthma deaths have been decreasing over the past 10 years, with a death rate of 0.14/1000 persons with asthma reported in 2009.

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Common Triggers for Asthma

 

Respiratory Infection	Respiratory syncytial virus (RSV), rhinovirus, influenza, Chlamydia
Emotions	Anxiety, stress, laughter
Exercise	Cold/dry climates
Drugs/Preservatives	Aspirin, Ibuprofen, Naproxen (NSAIDS), Propranolol, Nadolol
Occupational Stimuli	Flour dust, hay mold, plastics, rubber, and wood (formaldehyde, western cedar)

Signs & Symptoms of Asthma

Signs	Symptoms
●Wheezing ●Dry hacking cough ●Allergic rhinitis and/or eczema	●Shortness of breath ●Chest tightness ●Coughing (particularly at night)

Treatment

Acute Inhalers*	Goals	Common Side Effects
Emergency Inhalers* (Proair, Ventolin, Proventil, Xopenex ++)	●Maintain oxygen levels for proper lung functions ●Reduce & eliminate internal/external airflow obstructions ●Formulate an alternative strategy to prevent recurrence	●Throat irritation ●Cough ●Bad taste ●Headache
Oral Steroids (Prednisone, Prelone, Medrol, Cortel)	●Provide immediate relief of asthma symptoms ●Prevent hospitalization for adults and children ●Reduce inflammation in airways	●Swollen Hands ●Itching or hives ●Dizziness ●Eye Pain

Preventative Inhalers**	Goals	Common Side Effects
Inhaled Corticosteroids (ICS) (Qvar, Flovent, Pulmicort, Symbicort ++)	●Reduce use of emergency inhalers to <2 days a week ●Prevent relapse and rehospitalization ●Prevent the loss of lung function ●Maintain a normal lifestyle	●Nausea ●Sinusitis ●Rhinitis ●Oral Candidiasis (oral thrush)
Leukotriene Modifiers (Singulair, Accolate, Zyflo CR) (Prednisone, Prelone, Medrol, Cortel)	●Decrease the frequency of asthma attacks ●Reduce inflammation in airways ●Provide relief in allergy-like symptoms	●Diarrhea ●Restlessness ●Stomach Pain ●Ear ache

*Children <2 years of age respond better to nebulized albuterol solutions in ER visits
**Never used to stop asthma, only used in prevention

Conclusion

Asthma has a wide variety of symptoms that may not show up during examination. There are acute and preventative treatments. Identifying the signs and symptoms of asthma and proper inhaler technique can are essential in treating asthma. While the emergency inhalers (Ventolin, Proair, and Proventil) are the most effective first line treatment used to “stop” an asthma attack, inhaled corticosteroids (Qvar, Flovent, Advair, Symbicort, etc) are used to prevent asthma attacks. By adulthood, 30%-70% of children will have outgrown their asthma or have their symptoms greatly reduced (2).

References

(1) “Asthma and Air Pollution.” Asthma and Air Pollution. Air Resources Board, n.d. Web. 24 July 2017.
(2) DiPiro, Joseph T. Pharmacotherapy: A Pathophysiologic Approach 9e. New York: McGraw-Hill Medical, 2014. Electronic.
(3) Milet Meredith, Lutzker L, Flattery J. Asthma in California: A Surveillance Report. Richmond, CA: California Department of Public Health, Environmental Health Investigations Branch, May 2013. https://www.cdph.ca.gov/programs/ohsep/Documents/Asthma_in_California2013.pdf
(4) Ostrov, Barbara F. “Asthma Sending More Kids To California ERs  .” Kaiser Health News. Kaiser Family Foundation, 28 May 2015. Web. 24 July 2017. http://khn.org/news/asthma-visits-rising-among-kids-in-california-ers/