Did someone say asthma?

It’s that time of year.  The fall 🍂 and spring 🌷and winter ❄ can trigger asthma. So basically all year. What the heck is actually going on in the lungs though? Asthma is a chronic condition that is made up of two main problems happening behind the scenes:

  1. People with asthma are often allergic to something. Mold, dust, seasonal allergies, pet dander, air pollution if living in busy cities, and even roaches and mice (ewww, I know, but they are the worst!). Whatever it is they are allergic to gets into the lungs as they breath, and causes inflammation in the airways of the lungs without them even noticing! Over time, this can build up into thick mucus, or what I like to call “gunk.” Yup, it’s the technical term. 😂 This gunk can hang out in the lungs and create the perfect environment for bad asthma flares (aka “asthma attacks”). This is why steroid (aka “controller”) inhalers are so important. See more about this below.  These controller inhalers work only to keep the inflammation down over time. They DO NOT work acutely, as it takes time to remove the “gunk.”
  2. Now that the lungs have some “gunk” in them, all of a sudden a certain trigger will hit that causes the muscles in the lungs of the airways to spasm.  Yup, your lungs have muscles in them. Sounds bad right? Well, it kinda is. Now the lungs have some “gunk” in them, and the muscles are spasming/tightening/swelling. This causes the airways in the lungs to really have a hard time getting oxygen to the place we need it to go. Check out this great illustration from the National Institutes of Health. Here is where “rescue” inhalers, for example, Albuterol come in handy to help calm the muscles down. They DO NOT remove the “gunk” (see above). 

Asthma triggers can vary greatly, but most people get asthma attacks from upper respiratory infections, often just common colds. Other triggers include seasonal allergies, environmental allergies, abrupt cold weather, and even sports. Everyone is different and can have various triggers. Asthma causes shortness of breath, difficulty breathing, coughing, wheezing and chest tightness. 😷   Here is what you need to know.

Allergy induced asthma

One example of allergy-induced asthma is seasonal allergies. When fall and spring arrive, the pollen falls. If you have an allergy or sensitivity to pollen and ragweed, these particles in the air can cause more irritation in the lungs, triggering more “gunk” to build up, and eventually an attack. Asthmatics begin to cough and wheeze when things reach a certain threshold that the body can’t tolerate anymore. 

The idea is pretty similar for environmental allergies causing asthma. Instead of pollen, household mold, perfumes, air freshener sprays, pet dander, or even rodents can trigger the asthma attack. If you live in a big city where there are lots of cars and buses, your asthma may be worse during times of high automobile traffic. 

Asthma can be hard to control and is a serious medical condition. It’s important to identify your asthma triggers and control your asthma for optimal health. Have you talked to your primary provider about your asthma and your asthma triggers? Certain cities have programs in place to help people keep their homes clean and allergen free. Some even provide free HEPA filters for vacuums. Check out HUD’s website to learn more about steps you can take to decrease allergens in your home. Oh, and if you smoke (even just outside the home), it can be super irritating to lungs, especially those of little children! Need help quitting? It’s free!

Asthma medications

There are various medications for the treatment and control of asthma. Asthma is a chronic condition. There are many different medications to help keep asthma under control. Most are listed here on this great resource from the Mayo clinic.  You will usually be prescribed one rescue inhaler and one controller inhaler. 

Your provider should review these medications as well as your asthma action plan (“AAP”). Your AAP helps you to know when you should start your controller medications or take your rescue medication, which symptoms to look for and when to seek medical care. Each person is different, and you should have a plan that your provider makes specifically for you. Asthma can be overwhelming, but let’s see if we can make it easier to understand. 😊

Asthma controller medications

You may have heard the term asthma controller medicine.  Long term asthma CONTROLLER medications are key to keeping asthma under control (get it!?) and prevent asthma exacerbations (aka “attacks”). 😩 Controller medications usually contain a small dose of steroids that reduces the inflammation/swelling, mucus, and “gunk” in your lungs’ airways. 

Controller medications work best when taken every day. Why? Well, if you have mucus build up in your lungs due to allergens in your environment, then that means every day you are exposed to allergens that put you at risk for worsening asthma symptoms. So doesn’t it make sense to take the controller medication every day to help keep this inflammation down? Use the controller medication daily, and slowly but surely you will keep the mucus away. Stop using it, and the mucus will build up again. Sadly, this medication does not work right away. So if you haven’t taken it for a while and start feeling like an attack is coming on, the controller medication will not help you much the same day, or even the next day. This medication needs to be used daily to work! 

Daily use keeps asthma symptoms at a minimum and decreases the risk of severe asthma attacks and death. Examples of controller medications include inhaled corticosteroids such as Flovent, Adviar, Pulmicort, Qvar as well as a daily oral medication called Singular, to name a few. They work best when they are taken daily.  They are long acting and will not provide quick relief. They are extremely important in keeping daily symptoms at bay and lower the risk for asthma attacks. They won’t help much during an asthma attack so be sure to travel with your fast acting rescue inhalers, too. 

Fast acting rescue medications

Fast acting medications (aka “rescue inhalers”) are used for quick relief.  They open up the lungs and relax the airways within minutes. They can stop or reduce symptoms of an asthma attack. Fast acting medications work within minutes. These fast acting medications are not intended for daily use. That’s what controller medications are for.  

Fast acting medications should be used for quick action and rescue.  If you are using your rescue inhaler daily, or more than your provider recommends, you should have a follow up to discuss your uncontrolled asthma.  Uncontrolled asthma puts you at risk for a serious asthma attack, and you probably need the addition of a controller medication (see above). 

Common rescue inhalers include Proair, Albuterol, Xopenex and Atrovent. If you use your rescue inhaler and it doesn’t help with your difficulty breathing, call 911 or get to a hospital immediately.  🏥

Oral steroids

Oral steroids can sometimes be necessary when people have moderate to severe asthma symptoms that are not responding well to the asthma action plan. Long term use of these oral steroids 💊can come with side effects.  Having good control of your asthma by using your controller medications helps prevent your asthma from getting so bad that you need an oral steroid. 

It might sound like taking a controller medication every day is way too much medication. Hey, I get it, I don’t like taking medications either 🙄. BUT, it’s better to take a controller inhaler with steroids in it every day for a year than having your asthma flare up and needing to take a single course of oral steroids. How is that possible? 

Well, inhaled steroid medications are low dose and mostly just go straight to your lungs, while oral steroids go everywhere in your body in much higher doses even though the rest of your body doesn’t really need them. Take your inhaled controller medication as recommended by your provider and you will likely prevent asthma attacks and the need for oral steroids. If at any point you stop your inhaled controller medication without the consent of your provider, make sure to start it back up if you are having an increase of asthma symptoms. It never hurts to talk to your provider and check-in about your asthma, especially if you are having daily symptoms! Of course Nurse-1-1 is here to help answer your questions as well.

What are the symptoms of asthma

Everyone with asthma is different.  Some people have mild symptoms on occasion, while others have more severe symptoms that interfere with daily life.  Coughing and wheezing can occur daily, only with exercise, or with the onset of illness. Coughing and wheezing can increase at night, and interfere with sleep.  😴 Some people just have a chronic, pesky cough that will not go away! Yup, this could be an asthmatic cough and you don’t even know! 

Asthma symptoms in children– when to get checked

Asthma symptoms in children can be subtle. Sometimes, if children have severe wheezing, the only symptom they may have is labored breathing. Labored breathing in a baby 👶 or child is usually noticed when the parent thinks the breathing looks “off.”  Often the child’s belly is puffing in and out and they are taking short small breaths. Something called retractions happen in children when they are having difficulty breathing. 

Retractions occur when someone is working hard to breathe. These retractions can be seen around the neck and chest as skin gets pulled around the bones due to difficulty breathing. In babies you may notice that they are reaching their head back, and their nose may be flaring as they struggle to take in more air.  These symptoms need to be seen emergently.  

Babies and young children will eventually tire out from this kind of breathing and will need support such as oxygen that can be provided in the doctor’s office, urgent care, or emergency room. On the other hand, some children might have such mild symptoms that all you notice is they get “winded” faster than other players during sports (this could be sports-induced asthma). 

When to seek emergency treatment in adults

Severe asthma attacks can be life-threatening. Don’t hesitate to call 911 if you have difficulty breathing. An asthma action plan can help you when you aren’t sure what to do. Always feel free to chat with us if you are feeling well enough to text.🤳

Signs of an asthma emergency can include wheezing or shortness of breath that suddenly feels worse, increased use of your rescue inhaler (such as albuterol or proair) or no improvement after use of your inhaler.  If you feel shortness of breath while sitting around, or while asleep, it’s important to get checked out right away. 🏥

Want to learn more about asthma? Chat with us anytime!

–Kim Liner, RN, MSN, CPNP

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