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Medical Information
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Asthma- a disease for all seasons!
Asthma control in Winter
Many people think of asthma as being seasonal with flare-ups occurring during the times of the year when certain pollens are present in the air. To be sure, those with allergic asthma who experience a seasonal increase in symptoms may notice more problems in the April-May time of year if they are allergic to trees, in June and July if they are allergic to grass, in August through early October if they are allergic to weeds and ragweed and throughout the summer if they are allergic to molds. Many people also have year-round symptoms related to dust mite allergy or sensitivity to feather and/or to pets in the house, particularly to cat and dog. All of these are well-documented allergic causes of asthma, but many others may also be present.
During the cold and flu season a definite increase in asthma flares is noted. This is first seen in late September when children return to school after summer vacation. They bring with them the viruses they have acquired during their time away from school and share them with their classmates. They then take them home to share with their families who take them to the work place to share with co-workers, and the cycle continues.
Additional flares can be seen at times when people travel and come together at Thanksgiving, Christmas, New Years and Easter. This provides an opportunity for viruses to travel all over the country, if not the world. Viral respiratory infections are one of the most common precipitating factors for asthma flares. People with asthma cannot think of a cold in the same way non-asthmatics do. The viral-induced cough that begins innocently may cause an inflammatory process to begin in the airways which can lead to bronchospasm. The cough symptoms may last for two weeks or longer in the asthmatics. Eventually they may clear on their own, but, more commonly, symptoms increase leading to nocturnal waking with wheezing which requires the use of inhaled bronchodilator.
Patients may also note increasing chest symptoms associated with physical activities that were previously well tolerated, or the need to use rescue inhaled medications more often-sometimes with less effect. These complaints are common with a flare of asthma, and they frequently indicate a need for oral steroids to control the inflammation occurring in their lungs. A lack of understanding of the seriousness of these symptoms in asthmatics can lead to progressive respiratory difficulties and, occasionally, hospitalization if appropriate intervention is not started. There are still about 4500 asthma-related deaths in this country on an annual basis and this can be one of the most common scenarios.
What do asthma sufferers need to do?
Even patients with seasonal asthma may have some symptoms in the winter. Controller medications, such as inhaled steroids, combination steroid/long acting bronchodilator, and leukotriene inhibitors, need to be continued on a regular basis, and rescue medications can still be used if needed. Avoidance of allergic triggers such as pets, dust mite and feathers must be continued during the winter months. If symptoms flare with a respiratory infection causing nocturnal waking with cough or wheezing, decreased exercise tolerance, and/or increased use of inhaled bronchodilators, patients need to act quickly and need to be seen by their physician so that intervention can be started. This will help to prevent further symptoms which, if left untreated, could lead to an emergency room visit or even hospitalization. The longer the patient delays additional treatment after symptoms begin, the greater the stress on the patient, the more likely the episode will progress, and the more likely the result will be serious.
Patients with asthma should all receive flu vaccine on an annual basis. There are 36,000 flu-related deaths in this country on a yearly basis and 200,000 flu-related hospitalizations. This is a preventable occurrence. Only those who have a clear-cut contraindication to flu vaccine should avoid it. The injectable form of the vaccine is a killed virus and does not cause clinical illness. Since the recommendation is to give it to the very young, the very old and those with serious medical problems, why would anyone suggest giving that vulnerable group any vaccine that has a chance of making them ill? The nasal spray form of the vaccine is used for children and may cause mild symptoms, but it is felt they are able to tolerate this.
With avoidance, vigilance and medications, winter asthma episodes can be controlled and your health maintained.
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Tips about common indoor allergens and ways to minimize your exposure to them.
Dust Mites
These thrive in house dust, which is composed of plant and animal material. Their droppings are the most common trigger of perennial allergy and asthma symptoms.
Change and clean cooling and heating system filters once a month.
Have your home, car and office vacuumed and dusted frequently.
Get rid of extra clutter in your home that may be collecting dust, such as stacks of books, knick-knacks, stuffed animals or collectibles.
Put mattresses, box springs and pillows in special plastic cases that are allergy-proof or non-allergenic.
Wash blankets, sheets and pillowcases in 130-degree water and dry in a hot dryer every week.
Try to regularly wash your curtains and throw rugs.
Molds
These are microscopic fungi. Their spores float in the air like pollen and are present throughout the year in many states. Molds can be found indoors in attics, basements, bathrooms, refrigerators and other food storage areas, garbage containers, carpets and upholstery.
Keep bathroom and kitchen surfaces dry; fix leaks that leave surfaces wet and allow mold to grow.
Clean moldy surfaces, such as the corners of showers or under the sink. Use a cleaning solution that is 10 parts water to one part bleach.
Never put carpeting on concrete or damp floors, and avoid storing clothes, papers or other items in damp areas.
Reduce humidity in damp areas by using a dehumidifier. Clean dehumidifiers once a week.
All rooms, especially basements, bathrooms and kitchens, require ventilation and consistent cleaning to deter mold and mildew growth. Use a cleaning solution containing 5% bleach and a small amount of detergent.
Pets
People are not allergic to their pets' hair, but to a protein found in the saliva, dander (dead skin flakes) or urine of an animal with fur. These proteins are carried in the air on small, invisible particles and can trigger allergy sympyoms.
Keep pets out of the bedroom by keeping your bedroom door closed.
Keep pets out of other common rooms where people with allergies spend a great deal of time.
Wash your hands after touching pets.
If you have a cat or dog, it might help reduce household allergens by washing your pet once a week.
Vacuum and mop your floors regularly to remove excess animal dander.
Cockroaches
These live in warm, tropical climates, but various species dwell in the offices and homes of humans living a variety of climates. A protein found in their droppings can trigger allergy and asthma symptoms.
Vacuum or sweep the floor after meals and take the garbage out frequently.
Keep food in containers with tight lids.
Wash dishes immediately after using them with hot, soapy water, and wipe off counter tops and stoves.
Clean under stoves, refrigerators or toasters where loose crumbs can accumulate.
Thoroughly and frequently clean to remove dust and cockroach byproducts.
Block areas where cockroaches could enter the home, like wall cracks, window or floor cracks, cellar doors and outside drains. Consider a professional exterminator to eliminate cockraoches.
Making changes to your indoor environment can take time and commitment, but it is necessary if you want to reduce your allergy symptoms. To begin, you may want to create a priority list. Progressive changes and a deep cleaning will produce an indoor environment that is less allergenic and healthier for the whole family. Contact an allergist/immunologist for more information on treatment options and tips on reducing your allergen exposure. An allergist/immunologist is the best qualified medical professional trained to manage the prevention, diagnosis and treatment of allergies and asthma.
Reprinted from The American Academy of Allergy, Asthma and Immunology
When should I see an Allergist/Immunologist?
- Need to confirm the diagnosis of asthma.
- Have asthma and see your symptoms get worse after a new pet has been introduced into the home.
- Have a history of seasonal or persistent asthma, to evaluate your sensitivity to inhaled allergens and provide instructions
regarding avoidance measures.
- Need education on asthma and guidance in techniques for self-management.
- Need for daily asthma reliever medications.
- Are not using medications as prescribed, and this is limiting your ability to control your asthma.
When to see an Allergist for Allergic Symptoms:
The AAAAI's "How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines-Citing the Evidence" provides information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
- Have prolonged or severe symptoms of rhinitis.
- Have symptoms interfering with quality of life and/or ability to function.
- Have experienced allergic symptoms (urticaria, angiodema, itch, wheezing, gastrointestinal responses) in association with food exposure.
- Have limited their diet based upon perceived adverse reactions to foods or additives.
- Experience an itchy mouth from raw fruits and vegetables.
- Have found medications to be ineffective or have had adverse reactions to medications.
- Are a child with allergic rhinitis, because immunotherapy may potentially prevent the development of asthma.
Information provided by Dr. Steven Cohen and The American Academy of Allergy, Asthma and Immunology
The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the AAAAI has more than 6,000 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information through its Web site at www.aaaai.org.
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