Understand and Control Your Asthma
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Contents
Preface v\\
Acknowledgments ix
1 Introduction 3
2 The Respiratory System and Asthma s
THE RESPIRATORY SYSTEM 5
WHAT IS ASTHMA? 7
SYMPTOMS AND PHYSICAL SIGNS 8
DIAGNOSIS 9
RECORDING YOUR SYMPTOMS 10
WHAT WILL HAPPEN TO ME IF I HAVE ASTHMA? 15
REVIEW: THE RESPIRATORY SYSTEM AND ASTHMA 16
3 The Triggering Factors 1?
ENVIRONMENTAL FACTORS 18
PERSONAL FACTORS 27
REVIEW: THE TRIGGERING FACTORS 29
4 Medication 31
U S I N G M E D I C A T I O N 31
PRINCIPLES FOR USE 31
MAIN TYPES OF MEDICATION 31
USING INHALERS 32
BRONCHODILATORS 41
INHALED BRONCHODILATORS 41
BRONCHODILATORS IN TABLET FORM 45
B R O N C H I A L ANTI-INFLAMMATORY DR U G S 48
STEROIDS (CORTICOSTEROIDS, CORTISONE DERIVATIVES) 47
NON-STEROIDAL BRONCHIAL ANTI-INFLAMMATORY DRUGS
(CHROMONE DERIVATIVES) 52
OTHER D R U G S 54
ANTIBIOTICS 54
ANTIHISTAMINES 55
ZADITEN® 55
C O N T R O L L I N G Y O U R ASTHMA ss
LEVELS OF ASTHMA TREATMENT 55
CRITERIA FOR SATISFACTORY ASTHMA CONTROL 56
WHEN SHOULD THE TREATMENT BE CHANGED? 57
ACTION PLAN 58
REVIEW: MEDICATION AND MANAGING ASTHMA 61
5 A Healthy Lifestyle and Asthma 63
DIET 63
FLUIDS 64
SLEEP 66
CAN I STILL EXERCISE? 66
RELAXATION 67
REVIEW: A HEALTHY LIFESTYLE AND ASTHMA 72
Appendices 73
APPENDIX 1 - MYTHS AND CONTROVERSIES 75
APPENDIX 2 - EMPHYSEMA AND CHRONIC BRONCHITIS 78
APPENDIX 3 - ASPIRIN INTOLERANCE 79
APPENDIX4-ASTHMAAND DIABETES 81
APPENDIX5-ASTHMAAND SURGERY 82
APPENDIX 6 - ASTHMA DURING PREGNANCY AND BREAST-FEEDING 83
APPENDIX7-OCCUPATIONALASTHMA 86
APPENDIX 8 - ALLERGIC RHINITIS AND CONJUCTIVITIS 87
APPENDIX9-TRAVELLING 91
APPENDIX 10-ALTERNATIVEMEDICINE 92
APPENDIX 11 - RESOURCES 93
APPENDIX 12 - ANSWERS TO REVIEW QUESTIONS 95
DIARY FORMS 99
Glossary 103
Suggested Reading 109
Preface
This manual was written in response to requests from patients
attending the Asthma and Allergy Clinic at Laval Hospital. It is
intended for people with asthma, people living or working with
asthma sufferers, and others who are interested in knowing
more about this condition.
The approach proposed is based on the principles described
in recent reports of national and international consensus
symposia on the management of asthma, and on the findings
of recent studies.
Although this book was written in Canada and some
aspects of treatment or available medication may differ from
one country to another, the information provided will be useful
in other countries as well. Specific information on medications
used in the United States and Great Britain has been included.
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Acknowledgments
We wish to thank Mrs Helene Armstrong for her help with
the translation of this book. We would also like to thank Mr
Francois Gignac, psychologist, and (at Laval Hospital) Ms
Marie Guimond, dietician, Ms Ann Lalumiere, pharmacist, and
Mr Mario Grandmond, head of the Audiovisual Department,
for their invaluable advice. As well, we thank Ms Avivah Wargon,
the editor of the English edition, and all those people near and
far who contributed to this book.
We are indebted to Drs James G. Martin, Frederick E.
Hargreave, and Jerry Dolovich, and also to the members of
the Asthma Committee of the Canadian Thoracic Society
(Medical Section of the Lung Association). We would like to
express our sincere gratitude for their most relevant and use-
ful comments. We also thank the Asthma Committee for its
endorsement of this book.
Finally, we wish to thank Astra Pharma, Inc. for their
contribution to this book in providing an educational grant
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Understand and Control Your Asthma
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C H A P T E R 1
Introduction
Asthma is a common illness that can affect people of all ages.
It is also a variable and unpredictable disease that should not
be underestimated. If inadequately treated, asthma under-
mines the sufferer's quality of life.
Thanks to medical research, knowledge of asthma has
greatly improved in recent years. Unfortunately, no cure has
yet been found. However, in most people asthma symptoms
can be controlled. If you have asthma, you can play an impor-
tant role in the treatment of your disease; by becoming more
involved, you can help improve your quality of life and your
pulmonary function.
The purpose of this manual is to increase your indepen-
dence with respect to your asthma. By following the steps
suggested here, you can
• improve your knowledge of asthma;
• learn how to improve the quality of your environment and
adopt a healthy lifestyle;
• contribute actively to your own treatment through a better
understanding of asthma and by knowing what to discuss
with your doctor;
• become aware of the resources available;
• test your knowledge and analyse your attitudes toward
asthma by completing the review questionnaires at the
end of most chapters.
Since this is a general manual with practical goals, it cannot
answer all questions. You should discuss with your doctor any
questions that may arise from reading this book.
3
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C H A P T E R 2
The Respiratory System and Asthnu
THE RESPIRATORY SYSTEM
To understand asthma, we must first understand the different
parts of the respiratory system (its anatomy) and how it
works (its physiology).
Air enters through the nose and mouth, and descends into
the throat until it reaches the larynx, where the vocal cords
are located. The air then enters the trachea, which is located
below the larynx.
Figure 1
THE RESPIRATORY SYSTEM
5
The lungs are like an inverted tree with the trachea as its
trunk. The trachea is about 2.5 cm (just under 1 inch) in diam-
eter in adults. It is divided into two primary bronchi, one on
the right and one on the left. The lungs are covered by a mem-
brane called the pleura, and housed in the ribcage, which is
made up of ribs, muscles, and ligaments. The lungs are sepa-
rated from the abdomen by a powerful muscle called the
diaphragm. Each time we breathe in the diaphragm contracts,
allowing air to enter the lungs. When we breathe out, the
diaphragm relaxes, allowing the air to leave the lungs.
Each primary bronchus is divided about twenty-five times
into smaller bronchi called bronchioles (the tree branches).
The bronchioles are connected to small air sacs called alveoli
(the leaves). The alveoli are surrounded by very small blood
vessels.
The lungs supply the oxygen (02) that is necessary for the
body's survival. Inhaled oxygen moves from the alveoli to the
blood vessels and is transported by the blood to the cells in
our bodies. Carbon dioxide (CCh), a waste product constantly
being generated by our bodies, is exhaled through the lungs.
Carbon dioxide passes from the blood vessels into the alveoli
and is then exhaled.
Figure 2
GAS EXCHANGE
6
WHAT IS ASTHMA?
Asthma is characterized by overly reactive bronchi (increased
"twitchiness"). This increased responsiveness, doctors and
researchers believe, is due to underlying bronchial inflammation.
The walls of the bronchi contain muscles, and the interiors
are lined with a membrane (mucous membrane) that secretes
mucus, or phlegm. In people with asthma, the bronchi decrease
in size when they come in contact with certain triggering
factors. The bronchi in young children, which are smaller, are
more easily obstructed.
During an asthma attack, the following changes take place
in the bronchi and bronchioles:
1. the muscles encircling the bronchi contract, their interior
diameter (lumen) narrows and air cannot reach the lungs
as easily (in medical terms, this phenomenon is called
bronchospasm);
2. the membrane lining the inside of the bronchi becomes
inflamed and swollen, making it even more difficult for air
to pass through (this is inflammation);
3. excess secretions can lead to the formation of mucus
plugs, which reduce the air passages even more.
Figure 3
ILLUSTRATION OF A NORMAL BRONCHUS AND AN INFLAMED BRONCHUS
NORMAL BRONCHUS INFLAMED BRONCHUS
