Conditions

• Asthma • Pulmonary Hypertension • Sleep Disorders • Chronic Obstructive Pulmonary Disorder (COPD) • Lung Cancer • Alpha-1 Antitrypsin Deficiency

Asthma
More than 17 million Americans suffer from asthma, making it the sixth leading chronic condition in the nation. New York State has the second highest incidence of asthma. Asthma is most prevalent in urban areas, especially among the low-income population. In response to these alarming statistics, the division has dedicated its resources to educate the metropolitan community about asthma self-care, preventive guidance, and treatment options.

More specific components of asthma patient education at the division include:

• Understanding asthma
• Knowing the difference between "quick-relief" medications and "controller" medications
• Learning how to use a metered-dose inhaler and other medications correctly
• Teaching asthma management, including how to monitor using a peak flow meter
• Knowing what to do when an attack occurs
• Learning how to identify triggers and how to avoid them
• Learning about stress and nutrition management

The division strives to help and educate patients in asthma management, especially for newly diagnosed adults. We help new patients make the transition to management and self-care through education and support.

Call (212) 523-5471 for more information.

What is adult asthma?
Asthma is a disease that makes it hard to breathe. It can be intermittent or chronic. Intermittent means you get an asthma attack from time to time. Chronic means that there is some asthma all the time, but some of the time you don't know it's there.

Today, asthma can be controlled. Millions of people have asthma. It is not contagious; you cannot catch it from someone who has it. You must learn to control it with proper treatment and medication and avoid the things that trigger asthma attacks.

Normal Breathing: Normally when you breathe in, air goes in through your nose and mouth, into your windpipe, through airway tubes called bronchial tubes and into the air sacs. When you breathe out the stale air goes out the same way.

Breathing is difficult because asthma causes the airway tubes to be narrow from:

• Inflammation
• Thick mucus
• Tightening of the muscles around the airways

In recent years, there have been new approaches that have greatly improved the care of people with asthma. Instead of thinking of asthma as something that happens only when an "asthma attack" occurs, we now know that asthma may be a chronic condition and that there may always be some inflammation in the airways of people with chronic asthma. The inflammation causes the airways to be hyper-irritated and they respond by producing more mucus and going into spasm.

Spasm means that the muscles around the airway tubes tighten and make it harder for air to move in and out. This inflammation needs to be treated in addition to the acute attacks.

Anyone with chronic asthma has hyper-irritated, "twitchy" or very sensitive airway tubes which react very easily to many irritants, or "triggers." These "triggers" include:

• Dust
• Pollen
• Dogs
• Cats
• Respiratory infections
• Cold weather

There are others as well. When you come in contact with one of these "triggers" it causes your airway tubes to become narrower and also to produce more mucus. This narrowing and extra mucus makes it difficult for air to get in and out.

An acute attack is caused by contact with a "trigger" such as:

• Allergic triggers: (animal dander from dogs, cats, cockroaches, molds, weeds and pollen from trees or grass, house dust)
• Irritants like smoke, dust, perfumes, hair spray, strong smelling household solutions, such as ammonia, paint, air pollution
• Colds or respiratory infections
• Exercise, such as running (especially without warm-up exercise)
• Drugsm, such as aspirin or Motrin (NSAIDS)
• Food additives, such as sulfites
• Changes in weather - breathing in cold air
• Emotions, such as laughing or crying

Chronic asthma has three parts:

• Chronic airway inflammation means that the airway passages are always somewhat inflamed. This is what makes them so overly sensitive.
• Overly sensitive airways react very easily to irritants such as dust, pollen, respiratory infections, smoke, animals, etc.
• Airway obstruction (narrowing) occurs when you are exposed to one of the irritants. The walls of the airways swell, which also makes the tubes more narrow. More mucus is produced which makes the tubes even more narrow. The airway muscles around the airway tubes tighten up and squeeze shut.

Signs of Asthma:

• Coughing - as you try to clear out extra mucus
• Wheezing - whistling sound as air tries to get out through the narrowed airways
• Fast Breathing or shortness of breath - as you try to get air in and out through the narrowed and congested airways
• Chest tightness

Preventive measures:

• Put mattresses, box springs and pillows in dust-proof covers
• Remove rugs and stuffed furniture from your bedroom
• Vacuum and dust often
• Remove stuffed animals that can collect dust or wash them often or cover with plastic
• Keep bathrooms dry and clean to prevent mold and use a dehumidifier if necessary
• Replace filters in air conditioners because they collect dust
• Avoid feather pillows and use synthetic materials such as dacron
• Avoid visits to homes with animals and do not have one in your home.
• Select pets such as fish that have no dander

About colds and respiratory infections

• Washing hands frequently is one good way to prevent catching a cold
• Avoid unnecessary exposure to colds; avoid visiting a sick friend
• Get a flu and pneumonia shot if your doctor recommends it

About exercise
Exercising should not be avoided but there are some precautions that should be taken.

Use pre-medication or warm-up exercises especially in cold weather when an asthma attack is more likely to develop. You should work out a plan to get enough exercise without triggering asthma attacks. This can be done by using the right medication before exercising and doing warm up exercises beforehand.

Swimming is a good sport but even more vigorous ones are possible for you.

Asthma medications (adults)
In recent years the treatment of asthma has changed a great deal. It is easier to control with the new medications that are available. It is important to work with your doctor closely to develop the best and easiest plan for yourself.

• Anti-inflammatory medicine or "controller medicine"

One type of medicine is called anti-inflammatory medicine. It is often prescribed as the main medicine to help prevent asthma attacks. When taken every day, it controls the inflammation in the airways and decreases swelling and mucus production. This reduces the sensitivity of the airways and leads to fewer or less severe asthma episodes.

Anti-inflammatory medicines are called "controller" medicine and have to be taken every day to control or prevent your asthma attacks -- you should not stop taking it when you feel better. Talk to your doctor before you stop taking it.

• Bronchodilators or "rescue medicine"

Another type of medicine, called a bronchodilator, has a different purpose. It is used to stop the asthma attack once it has started. At the first sign of an asthma attack, a bronchodilator is used to relax and open the airways, so that more air can flow through and you can breathe easier. These are called "rescue" medications. They are also helpful before exercise to prevent shortness of breath.

Be sure you understand:

• How they should be taken
• How often they should be taken
• What are the side effects
• When to contact your doctor