Allergy children

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Allergy children

Asthma You may not think of asthma as a killer disease. Allergies to evista. Yet nearly 500,000 Americans are hospitalized annually and more than 5,000 die annually of asthma. Asthma is a chronic condition that occurs when the main air passages of your lungs, the bronchial tubes, become inflamed. The muscles of the bronchial walls tighten and extra mucus is produced, causing your airways to narrow. This can lead to everything from minor wheezing to severe difficulty in breathing. In some cases your breathing may be so labored that an asthma attack becomes life-threatening. Yet asthma is a treatable disease, and most flare-ups and deaths can be prevented. In the past 20 years, scientists have gained a better understanding of asthma's cause. New drugs have been developed to replace standard medications. Greater emphasis also is now put on managing your own condition, much as people manage their diabetes with insulin. Together, you and your doctor can work to gain control over your symptoms, reduce the risk of severe attacks and help maintain a normal life. Allergy Center Mechanism of asthma (click to enlarge) Signs and Symptoms Back to Top Asthma symptoms can range from mild to very severe. You may experience only occasional episodes of asthma with moderate, short-lived symptoms such as wheezing. You might also cough and wheeze most of the time or find that your symptoms become much worse after exposure to an asthma trigger such as pollen, mold or tobacco smoke. In severe cases, an asthma attack leaves you gasping for air. All asthma attacks give a warning. Learning to recognize warning signs and treating symptoms early can help prevent attacks or keep them from becoming worse. Warning signs for adults can include: Increased shortness of breath or wheezing Disturbed sleep caused by shortness of breath, coughing or wheezing Chest tightness or pain Increased need to use bronchodilators - medications that open up airways by relaxing the surrounding muscles A fall in peak flow rates as measured by a peak flow meter, a simple and inexpensive device that allows you to monitor your own lung function Warning signs for children may include: An audible whistling or wheezing when your child exhales Coughing, especially if the cough is frequent and occurs in spasms Waking at night with coughing or wheezing Shortness of breath, which may or may not occur when your child exercises A tight feeling in your child's chest Children's Health Center Peak flow meters: How do they predict asthma attacks? Causes Back to Top You're more likely to develop asthma if you have an inherited predisposition to the condition and are sensitive to allergens or irritants in the environment. In fact, the inflammation that causes asthma makes your airways overly sensitive to a wide range of environmental triggers. Asthma can develop at any age - even well into your 70s and beyond. If you're younger than age 30, your asthma is probably triggered by allergies. Many people older than 30 with asthma are also allergic to airborne particles. For the rest of adults with asthma, particularly older adults, respiratory allergies don't seem to play a role. Instead, exposure to any irritant - from a virus and cigarette smoke, to cold air, and even emotional stress - can trigger wheezing. In most cases though, asthma results from a combination of allergic and nonallergic responses. You may react to one or more of the following triggers: Allergens, such as pollen, cockroaches and molds. Air pollutants and irritants. Smoking and secondhand smoke. Respiratory infections, including the common cold. Physical exertion, including exercise. Cold air. Certain medications, including beta blockers such as propranolol (Inderal, Betachron), aspirin and other nonsteroidal anti-inflammatory drugs. Sulfites - preservatives added to some perishable foods. Emotional stress. Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your food pipe (esophagus). GERD may trigger an asthma attack or make an attack worse. Sinusitis. Video: An asthma attack Asthma and the cockroach connection Cold Heartburn Acute sinusitis Chronic sinusitis Risk Factors Back to Top For reasons no one quite understands, the number of asthma cases has risen dramatically in the past decade, especially among children living in the inner city. Approximately 11 million Americans have an asthma attack each year, including about 3.8 million children. In fact, asthma is the most common chronic illness of childhood. Among young children, asthma is more common in boys than in girls. But after puberty asthma becomes more common in girls. Researchers have identified a number of factors that may increase your chances of developing asthma. These include: Living in a large urban area, especially the inner city, which may increase exposure to many environmental pollutants. Exposure to secondhand smoke. Exposure to occupational triggers, such as chemicals used in farming and hairdressing, and in paint, steel, plastics, and electronics manufacturing. Having one or both parents with asthma. Respiratory infections in childhood. Low birth weight. Obesity. Gastroesophageal reflux disease (GERD). Children's Health Center Occupational asthma: Wheezing at work Obesity When to Seek Medical Advice Back to Top Three key circumstances may lead you to talk to your doctor about asthma: If you think you have asthma. Wheezing, difficulty breathing, pain or tightening in your chest, or coughing without any other symptoms may all be signs of asthma. Wheezing, especially, is a frequent symptom of asthma in children. Yet some children with asthma never wheeze. Instead, they have recurrent, spasmodic coughs that are often worse at night. If you or your children have frequent coughs that last more than a few days or any other signs or symptoms of asthma, see your doctor. If you've received the diagnosis of asthma. If you've received the diagnosis of asthma, talk to your doctor about ways to manage your condition. Working as a team, you and your doctor can develop a plan to help you control symptoms, prevent an attack or stop an attack in progress. Don't try to treat asthma yourself. Most asthma deaths result from a lack of proper treatment. If your medication isn't working. Sometimes your medications may not offer the relief you need. Be sure to contact your physician right away if a prescribed dosage of medication doesn't work for you. In some cases you may not be using your metered-dose inhaler (MDI) correctly. Don't try to solve the problem by taking more medication though - overusing inhalers or taking too much medication can be dangerous. Asthma inhalers Screening and Diagnosis Back to Top Diagnosing asthma can be difficult. Symptoms can range from mild to very severe and are often similar to those of other lung conditions. One illness that may mimic asthma is vocal cord dysfunction (episodic laryngeal dysfunction). Signs and symptoms of this condition, which mainly affects women between the ages of 20 and 40, may include shortness of breath, wheezing, coughing and chest tightness. Yet vocal cord dysfunction is typically characterized by an acute onset of severe shortness of breath. If asthma has been diagnosed in you, and your treatments - especially use of a bronchodilator to open your airways - aren't controlling your symptoms, it's possible you may have vocal cord dysfunction. It's also possible that you have both conditions. Emphysema and early congestive heart failure also may cause symptoms similar to those of asthma. In order to rule out these and other possible conditions, your doctor will likely use several different evaluation methods to arrive at a diagnosis. In most cases you'll be asked to give a complete medical history and have a physical exam. You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. One of the simplest lung function tests uses a peak flow meter to measure the rate at which you can expel air. You can also use a peak flow meter at home to help detect subtle increases in airway obstruction before you notice symptoms. If the readings are lower than usual, it's a sign your asthma may be about to flare up. Your doctor can give you instructions on how to deal with low readings. Lung function tests are usually done before and after taking a medication known as a bronchodilator to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma. In some cases your doctor may do a methacholine bronchial challenge. If you have asthma, inhaling the methacholine will cause mild constriction of your airways, which can be measured with a lung function test. Emphysema Congestive heart failure Complications Back to Top Asthma accounts for millions of missed school days and workdays annually. It's also a frequent reason for emergency room visits and hospitalizations. You can reduce your risk of severe attacks by making sure your asthma is well controlled and by knowing how to recognize and treat attacks before they occur. If your asthma attacks are worse at night, you're not alone; many attacks occur between 2 a.m. and 4 a.m. If you wake up in the middle of the night wheezing or short of breath, talk to your doctor about changing or intensifying your treatment. The long-term use of oral and intravenous corticosteroids to treat asthma attacks may have serious side effects. The use of inhaled corticosteroids, which have fewer side effects, can help you reduce the need for other forms of these drugs. If you have asthma, you're more likely to be bothered by stomach acid backing up into your esophagus (acid reflux). In some cases acid reflux or gastroesophageal reflux disease (GERD) may actually cause your symptoms. To help prevent this problem, don't eat or drink for several hours before going to bed. You may also find it helpful to elevate the head of your bed. Heartburn Treatment Back to Top Your doctor will recommend a course of treatment based on you or your child's age and on how persistent the symptoms are. In general, three types of medical treatments are available for asthma: Bronchodilator medications that relieve acute symptoms or prevent flare-ups Corticosteroids and other medications that suppress airway inflammation over days, weeks or months Immunotherapy or allergy desensitization shots In June 2002, the National Asthma Education and Prevention Program (NAEPP) issued updated asthma treatment guidelines recommending inhaled corticosteroids as a safe, effective and preferred first-line therapy for both children and adults who have persistent asthma. NAEPP is supported and coordinated by the National Heart, Lung and Blood Institute and the National Institutes of Health. The NAEPP also found that an inhaled corticosteroid plus a long-acting inhaled bronchodilator may work better than inhaled corticosteroids alone for some people with moderate, persistent asthma. The updated guidelines continue to recommend a "stepwise" approach in which your doctor adjusts the type and the dosage of your medications up or down based upon either improvement or worsening of symptoms over time. National Asthma Education and Prevention Program: Guidelines for the Diagnosis and Management of Asthma A variety of medications are available for acute and longer-term treatment of asthma. Acute symptom relief Bronchodilators are medications that open up constricted airways and provide temporary relief of asthma symptoms. Bronchodilators may be short acting or long acting and include: Beta-2 agonists. Short-acting beta-2 agonists begin working within minutes and last 2 to 4 hours. Long-acting beta-2 agonists last up to 12 hours. The short-acting medications are typically prescribed for relief or prevention of asthma symptoms or flare-ups. The most common drugs, such as albuterol (Proventil, Ventolin) and pirbuterol (Maxair), act quickly to relieve symptoms and can be used as a prevention measure before you exercise or breathe cold air. Prescribed as needed, they may relieve your symptoms for up to 6 hours. Inhaled beta-2 agonists won't correct underlying inflammation, however, and can easily be overused. Ipratropium (Atrovent). This bronchodilator is an anticholinergic that isn't typically recommended for the immediate relief of asthma symptoms. Salmeterol (Serevent) and formoterol (Foradil). These long-acting bronchodilators relieve airway constriction for up to 12 hours. They're generally used to prevent symptoms, especially at night. They aren't recommended as a "rescue" medication that can be used for immediate relief during an asthma attack. You usually use salmeterol or formoterol with an anti-inflammatory medication such as inhaled corticosteroids. Theophylline (Slo-Bid, Theo-Dur). This type of bronchodilator is taken in pill form every day. It's especially helpful for relieving nighttime symptoms of asthma. But theophylline may cause side effects, including nausea and vomiting, severe abdominal pain, diarrhea, confusion, fast or irregular heartbeat, and nervousness. It can also promote GERD or acid reflux by relaxing the lower esophageal sphincter muscle. If you're taking theophylline, get regular blood tests to make sure you're getting the correct dosage. Long-term anti-inflammatory treatment Anti-inflammatory drugs are the mainstay medications for asthma. These drugs are taken continually to prevent attacks. Anti-inflammatory drugs reduce inflammation in your airways and prevent blood vessels from leaking fluid into airway tissues. The most widely used of these drugs include: Corticosteroids. These drugs are the most effective medications for asthma. They're completely different from the steroids that some athletes abuse. Different kinds of corticosteroids include prednisone, prednisolone, cortisone, triamcinolone, hydrocortisone and others. They help decrease the frequency of attacks and lower the dosage of other medications needed to calm symptoms. Long-term use of oral or intravenous corticosteroids can cause serious side effects, however, including decreased resistance to infection, loss of bone mineral (osteoporosis), muscle weakness, high blood pressure and thinning of the skin. Inhaled corticosteroids deliver medication directly to your airways and so have fewer side effects. They're also very effective at controlling most forms of asthma. These medications may include beclomethasone (Vanceril, Beclovent), fluticasone (Flovent), budesonide (Pulmicort), and flunisolide (Aerobid). Advair Diskus is a combination inhaler containing fluticasone and salmeterol. If you're using a metered-dose inhaler form of inhaled corticosteroids, be sure to use a spacer and gargle with water after use to rinse your mouth out. It's important to then spit out this water. This helps reduce the amount of drug that is swallowed and absorbed into the body by way of the stomach. It also reduces side effects such as mouth and throat irritation and oral yeast infections (thrush). Also, because inhaled corticosteroids may affect some children's growth, children taking these medications should have their growth rate regularly monitored. Long-term use of inhaled corticosteroids may increase the risk of cataracts. Leukotriene modifiers. Introduced in 1996, leukotriene modifiers were the first new class of prescription asthma medications to become available in 20 years. They include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). These drugs work by reducing the production, or blocking the action, of leukotrienes - substances released by cells in your lungs during an asthma attack. Leukotrienes cause the lining of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucus production. By themselves, leukotriene modifiers are about as effective as theophylline and cromolyn, but used in conjunction with other medications, they may help prevent more attacks. Although generally not as effective as inhaled corticosterioids, leukotriene modifiers are an option. Other drugs. Although they're not effective for everyone, daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) may help prevent attacks of mild to moderate asthma. In some cases they may also help prevent asthma triggered by exercise if taken an hour before any vigorous activity. Cataracts Immunotherapy If you have allergic asthma that can't be easily controlled by avoiding triggers and using medication, allergy desensitization shots (immunotherapy) may help. You'll have skin tests to determine the allergens that cause you the most trouble, followed by a series of injections containing small doses of those allergens. Injections are generally given once a week for a few months, then once a month for a period of 3 to 5 years. Over time, you should lose your sensitivity to the allergens. Immunotherapy isn't for everyone, however. You're most likely to benefit if it's clear you have allergic asthma. In addition, immunotherapy carries the risk of an allergic reaction to the shot. Life-threatening reactions are rare, but can occur. Corticosteroids: Inhaled, intranasal drugs for asthma and allergies Steroid use: Balancing the risks and benefits Allergy shots Prevention Back to Top The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants. That's easier said than done, however, because thousands of outdoor allergens and irritants - ranging from pollen and mold to cold air and air pollution - can trigger an attack. A number of indoor allergens, including dust mites, cockroaches, some pets and mold, can do the same. The most common irritant overall is tobacco smoke. Even if you reduce indoor and outdoor allergens and irritants, managing asthma can be challenging. It often takes ongoing communication and teamwork with your doctor. But by working together, you and your doctor can design a step-by-step plan for living with your condition. In addition to knowing and avoiding your triggers, adopt the following behaviors: Develop an action plan. With your doctor and health care team, write a detailed plan for taking maintenance medications and managing an acute attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs to be regularly monitored and treated. In addition, taking control of your treatment can make you feel more in control of your life in general. Monitor your breathing. Like many people, you may recognize your own signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any symptoms, regularly measure your peak airflow with a home peak flow meter. Treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms. When your peak flow measurements alert you to an impending attack, take your medication as instructed and stop any activity that may have triggered the attack right away. If your symptoms don't improve, be sure to get medical help as directed in your action plan. Helping your child manage asthma Self-Care Back to Top Although many people with asthma rely on medications to relieve symptoms and control inflammation, you can do several things on your own to maintain overall health and lessen the possibility of attacks: Exercise. You don't have to be sedentary if you have asthma. Regular exercise can strengthen your heart and lungs so that they don't have to work so hard. It can also help you lose weight and lower your risk of developing other serious diseases, including cardiovascular disease and diabetes. Aim for 30 minutes of exercise on most days. If you've been inactive, start slowly and try to gradually increase your activity over time. Keep in mind that cold-weather exercises, such as skiing, are more likely to cause wheezing. If you do exercise in cold weather, wear a face mask to warm the air you breathe. And don't exercise if the temperature is below zero. Activities such as golf, walking and swimming are less likely to trigger attacks, but be sure to discuss any exercise program with your doctor. Use your air conditioner. This helps reduce your exposure to airborne pollen from trees, grasses and weeds. Air conditioning also lowers indoor humidity and can reduce your exposure to dust mites. If you don't have air conditioning, try to keep your windows closed during pollen season. Decontaminate your decor. To minimize dust that may aggravate nighttime symptoms, encase mattresses, pillows and box springs in dustproof covers that can be removed and cleaned frequently. Replace bedding made of down, kapok or foam rubber with synthetic materials such as Dacron. Wash sheets, pillowcases and mattress pads weekly in hot water. Replace synthetic pillows every 2 to 3 years. Maintain optimal humidity. Keep humidity low - 40 percent to 50 percent - in your home and office. If you live in a damp climate, talk to your doctor about using a dehumidifier. Keep indoor air clean. Have a utility company check your air conditioner and furnace once a year. Change the filters in your furnace and air conditioner according to the manufacturer's instructions. Also consider installing a small-particle filter in your ventilation system. If you use a humidifier, change the water daily. Reduce pet dander. If you're allergic to dander, avoid pets with fur or feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings. Clean regularly. Clean your home at least once a week. Because cleaning stirs up dust, however, wear a mask or, if you can, have someone else clean. Limit use of contacts. Try substituting eyeglasses for your contact lenses when the pollen count is high. Pollen grains can become trapped under the lenses. Coronary artery disease Diabetes Asthma and exercise Asthma Program Exercise Program Coping Skills Back to Top Asthma presents many physical challenges, but it can also cause other kinds of distress. You may sometimes become frustrated, angry or depressed because you need to cut back on your usual activities to avoid environmental triggers. You may also feel hampered or embarrassed by the symptoms of the disease and by complicated management routines. But asthma doesn't have to be a limiting or depressing condition. The best way to overcome anxiety and a feeling of helplessness is to understand your condition and take control of your treatment. Here are some suggestions that may help: Identify the things that trigger your symptoms. This can be one of the most important ways to take control of your life. Also take peak flow measurements regularly and follow your action plan for using medications and managing attacks. Pace yourself. Take breaks between tasks and avoid activities that make your symptoms worse. Make a daily to-do list. This may help you avoid feeling overwhelmed. Reward yourself for accomplishing simple goals. Talk to others with your condition. Chat rooms and message boards on the Internet or support groups in your area can connect you with people facing similar challenges and let you know you're not alone. If you have a child with asthma, be encouraging and supportive. Focus attention on the things your child can do, not on the things he or she can't do. Involve teachers, school nurses, coaches, friends and relatives in helping your child manage an asthma condition

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