Did you know that approximately 20 million Americans suffer from asthma? Every day, about 40,000 of them miss school or work because of this condition. Each day, approximately 30, 000 experience an asthma attack. About 5000 patients end up in the emergency room. Asthma is also the most common chronic condition among children. Can there by any doubt it is a very serious and potentially deadly medical condition that needs equally serious understanding and attention? The good news is that with proper education and treatment, most asthmatics have active and productive lives.
Bronchospasm and inflammation: the key features of asthma
This chronic airway disease has two primary features: bronchospasm and inflammation. Bronchospasm refers to the mechanism by which airways become narrower. In asthmatic patients, the muscle within the wall of the airway contracts, thus narrowing the lumen (a cavity or channel within a tubular structure) of the airway and causing respiratory obstruction. Inflammation refers to the process by which the wall of the airway becomes thicker in response to inflammation, which also causes the lumen to narrow and produce respiratory obstruction. Bronchospasm is usually treated with bronchodilators such as Albuterol; whereas, airway inflammation is treated with corticosteroids. These two characteristics vary from patient to patient. Most asthma patients have elements of both bronchospasm and inflammation.
If you suffer from asthma, keep in mind that you are the one who best understands just how your problem manifests. You alone are in the best position to provide information to health care providers in order to alert them about a possible asthma exacerbation. This is particularly true when one considers that a physician may have relatively poor knowledge regarding management practices, social background and trigger factors of asthma, among other things. In part, the difficulty in diagnosing asthma stems from the wide variability in its presentation. Any given patient with this condition can have some or all of the classic asthma symptoms. Asthmatics can have mild deterioration or a severe attack and anything in between. Therefore, if you have asthma, you must be proactive and communicate all the information you can to your health care provider. To help you have “talking points” when you are having this discussion, you may want to consider including the following topics the next time you see a doctor about your asthma:
1. Appreciate Your Unique Symptoms
Asthmatic patients will often present with a cough, chest congestion/chest tightness, wheezing, and shortness of breath. Some of these symptoms may be more pronounced than others. The symptoms can change or get worse over time. Some patients may present with only a cough. Depending on the severity of the asthmatic attack, some patients may even present with normal vital signs. On other occasions, some patients could have normal breath sounds and no wheezing or shortness of breath. For these reasons, you must carefully identify those symptoms, which are characteristic of your asthma exacerbation.
2. Give Your Physician a Complete History
Once you have identified what defines your asthma attacks, make sure to communicate the complete history of your symptoms to nurses and physicians taking care of you. Tell them when you began to experience symptoms. If you think you are having an asthma attack, say so. If you had been experiencing asthma symptoms, but which happen to be gone at the time of your doctor’s visit, talk about your recent problems as well. If you are taking asthma medications, identify all medications, the dosage, and the method by which you administer those medications (inhaler vs. nebulizer), your frequency of use, and most importantly, advise your doctor if your symptoms are relieved when you use those medications. Talk about each of your symptoms, identifying their pattern, triggers, severity, and whether they are relieved by any medications. Tell your doctor if the quality of your life is impacted by your asthma symptoms. You may also want to inform your doctor about previous asthma exacerbation, how they presented, and whether you sought medical attention. Whatever you do, don’t assume that the nurse or the doctor will spend the time to question you extensively and get this very important information from you. Take the time and the initiative to tell them yourself.
3. If You Are Concerned About Your Condition, Ask For a Peak Flow Measurement
If you present with symptoms and your doctor rules out asthma without utilizing some objective measure of your respiratory ability, you should be very concerned. Remember that many of the symptoms of asthma can be associated with other non-asthma medical conditions. For example, a cough can be associated with asthma, but it can also be indicative of a cold. To avoid any ambiguity in what you may be suffering from, your doctor should perform a peak flow test. This test is performed with a peak flow meter, which measures a person’s maximum speed of expiration (breathing out). It is a non-invasive test extremely easy to perform. The test can objectively identify a respiratory obstruction. Demand this test if you are concerned about your condition! It could save your life.
4. If You Are Found to Have a Respiratory Obstruction, Don’t Leave Without Getting Treatment
If you are found to have a respiratory obstruction of any kind, do not leave your doctor’s office or the emergency department without receiving medical attention. Generally speaking, you should be given albuterol, which is a bronchodilator. Your peak flow should then be reassessed after each albuterol treatment. Frequently, Albuterol is administered several times per hour with peak flow measurements taken after each treatment to determine your response to the medication. If you continue with a respiratory obstruction, corticosteroids should be considered and administered where indicated. If you persist with a respiratory obstruction, additional steroids and bronchodilators may also be needed. You may even need to be hospitalized. Whatever you do, don’t leave your doctor or the emergency room if you continue to have a respiratory obstruction.
What’s your story?
If you have asthma, share with our readers the unique pattern of your symptoms. Your information may well help others who suffer from this condition. Remember, there is not a uniform pattern of signs and symptoms with asthma. They can very widely from patient to patient.
If you would like to learn more about asthma, I strongly recommend reading the Asthma Prevention Guidelines published by the National Heart Lung and Blood Institute. This publication is comprehensive and very informative. As we always say- the more informed you are about your own health, the better your chances will be in getting the right care.
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