Preventing Asthma Attacks

Asthma never really goes away -- it just seems as though it does. If you have the condition, your airways are often inflamed and may become swollen and clogged with mucus. Despite all that, you probably breathe easily and feel great most of the time. The trick is to keep things that way.

Asthma can't be cured, but it can be controlled. By managing your disease with medications and avoiding the triggers that bring on attacks, you can keep your airways open. Best of all, you can keep feeling great.

What medications can help prevent asthma attacks?

Most people with asthma need daily medications to keep the condition in check. One very effective weapon is a corticosteroid such as beclomethasone, budesonide and others. This type of medication, which is taken through an inhaler, can ease inflammation in your bronchial tubes. As a result, your airways become less sensitive to their surroundings and are less likely to go into spasms. These drugs are generally very safe, although doses above 1 milligram a day can cause side effects to the adrenal glands, skin, bones, eyes, and blood sugar. (Check with your doctor if you notice any unusual reactions.)

Other types of corticosteroids, including prednisone and prednisolone, are available in tablets or syrups. These drugs are highly effective and may be easier for some people to take. However, when used for a long time, they can cause thinning of the bones, obesity, diabetes, and other serious side effects.

Leukotriene modifiers, such as montelukast and zileuton, are another option for long-term control of asthma. They reduce inflammation and decrease mucus production.

Cromoglycate and nedocromil are relatively mild drugs that can reduce inflammation with few or no side effects. However, they aren't as powerful as the corticosteroids and are not a good choice for people with severe asthma.

Drugs known as bronchodilators can prevent attacks by widening the airways. Long-acting drugs such as salmeterol and formoterol, taken through an inhaler, can keep you breathing freely for at least 12 hours and usually have few side effects. However, the U.S. Food and Drug Administration requires that these drugs carry its strongest caution, a black-box warning, because studies have shown an increased risk of asthma-related deaths, especially among African Americans, while taking salmeterol. If you do use them, the latest government guidelines stress that they should not be prescribed as the first-choice medicine to treat asthma, and they should only be added to your treatment plan if other medications do not control your symptoms.

So-called quick relief bronchodilators such as albuterol and pirbuterol can open your airways within minutes and prevent attacks for about two hours with few side effects. You can inhale these medications whenever you feel an attack coming on, or, better yet, monitor yourself with a peak-flow meter and inhale them whenever it shows you need help. You can also use them as a hedge against situations that might cause an attack. For instance, if cold air or exercise makes you wheeze, you should take albuterol or a similar drug, according to your doctor's instructions, 15 minutes before working out.

How can I avoid asthma triggers?

While medications bring your disease under control, you can do your part by avoiding the things that irritate your lungs and trigger attacks. One of the worst offenders is tobacco smoke. People with asthma should shun cigarettes and stay away from smoke-filled rooms. If someone else in your household smokes, urge him or her to quit. At the very least, the smoker should take the habit outside.

Many people with asthma have allergies that can set off attacks. The dust mites that live in mattresses and pillows are common culprits. You may be able to improve your breathing dramatically by washing your bed linens and blankets once a week, enclosing pillows and mattresses in zippered airtight covers, and removing carpets from the bedroom.

If you're allergic to cat dander, ask yourself if you really need a cat in your life. If you can't live without one, keep the pet out of your bedroom, bathe it regularly, wash your hands after petting it, and keep the kitty litter box in a room that you don't frequent.

You can control pollen allergies by keeping your windows closed during pollen season and installing a special allergy filter in your air conditioner. If you're allergic to molds, clean damp areas frequently and consider buying a dehumidifier to keep the air dry. (A special allergy filter can also help filter mold spores in the air.)

If you are extremely allergic and it's impossible to avoid dander, pollen, or other things that cause allergic reactions, talk to your allergist about immunotherapy. This treatment involves small injections of the proteins that trigger your allergies. After a while, your body may become less allergic to the proteins.

In general, it's wise to avoid asthma triggers, but there's one big exception to the rule. If exercise causes asthma attacks, DON'T give up on exercising. As already mentioned, keep an inhaler within easy reach. A bronchodilator taken before the workout can prevent an attack, and a warm, humid exercise environment can help. You may need to take a break on days when your asthma is particularly troublesome, but you can still make exercise an enjoyable -- and healthy -- part of your life.

Further Resources

American Academy of Allergy, Asthma, and Immunology 800-822-ASMA http://www.aaaai.org

American College of Allergy, Asthma, and Immunology 800-842-7777 http://acaai.org

American Lung Association 800-LUNG USA http://www.lungusa.org

Asthma and Allergy Foundation of America 800-7-ASTHMA http://www.aafa.org

References

Johns Hopkins Health Alerts. Why popular asthma drugs got the Black Box warning. http://www.johnshopkinshealthalerts.com/reports/lung_disorders/1833-1.html

American Academy of Allergy, Asthma, and Immunology. Tips to Remember: Asthma Triggers and Management. www.aaaai.org/public/publicedmat/tips

National Heart, Lung, and Blood Institute. Your Asthma Can Be Controlled: Expect Nothing Less.

National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

Food and Drug Administration. FDA Public Health Advisory: Serevent Diskus (salmeterol xinafoate inhalation powder), Advair Diskus (fluticasone propionate & salmeterol inhalation powder), Foradil Aerolizer (formoterol fumarate inhalation powder). http://www.fda.gov/cder/drug/advisory/LABA.htm

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