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.
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
|
●Shortness of breath
|
Treatment
Acute Inhalers* |
Goals |
Common Side Effects |
Emergency Inhalers*
|
●Maintain oxygen levels for proper lung functions
|
●Throat irritation
|
Oral Steroids
|
●Provide immediate relief of asthma symptoms
|
●Swollen Hands
|
Preventative Inhalers** |
Goals |
Common Side Effects |
Inhaled Corticosteroids (ICS)
|
●Reduce use of emergency inhalers to <2 days a week
|
●Nausea
|
Leukotriene Modifiers
|
●Decrease the frequency of asthma attacks
|
●Diarrhea
|
*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).