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Subject:	A colleague recommends Asthma: Taking Control
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During the upcoming summer months, when there are hot days with poor air quality, patients with asthma may have special needs. When "Spare the Air" days are announced, it's best to remain indoors, avoid vigorous exercise, and use medications prescribed by your doctor to control asthma. Seek medical attention if breathing becomes more difficult than usual and does not respond to your physician's advice.

What is Asthma?

Asthma is a condition of hyperreactive airways to any number of elements in daily life. Unpredictable attacks of wheezing alternate with periods of relatively normal breathing. In an asthma attack, muscles of the bronchial tree tighten and the linings of air passages become swollen. Reduced airflow produces wheezing.

When does asthma develop?

Asthma can develop at any age. Breastfeeding infants appears to provide them with some protection. Children who will develop it usually do so between the ages of three to six months and six years. Some seem to "outgrow" the illness, but underlying conditions can remain without symptoms.

The first signs of asthma may be a lingering cough and wheezing after a viral infection. Physicians advise that if this occurs, your child's doctor should be asked about the possibility of asthma. The condition, which can be life-threatening, is often underdiagnosed and undertreated. Asthma can be the most frequent cause of hospitalization and missed school days.

According to Michael Cohen, M.D., director of respiratory care services at John Muir Medical Center, "The goal would be to stay out of the hospital and the E.R. by consistently taking prescribed medications. If inhalers do not control the symptoms, then a patient may need to go on to more intense treatment-and they should contact their physician right away if they are not getting enough relief."

Parents must be alert to sudden attacks, and ready to handle them. When symptoms are serious, a small child can be treated with a machine that administers medication to relieve coughs or wheezing, or they can be placed in a treatment chamber.

Many physicians agree that over the long term, allergy desensitization shots are not helpful for the majority of children with asthma.

What are common symptoms?

• Wheezing
• Cough with phlegm or mucus
• Shortness of breath, aggravated by exercise or other triggers
• Tight feeling in the chest
• Anxiety

What commonly triggers attacks?

Allergies to substances such as molds, animal dander, or house dust are often involved. Flare-ups can also occur spontaneously or be triggered by respiratory infections, exercise, cold air, smoke or other air pollutants, and food or drug allergies. Even stress or anxiety can cause a sudden attack. And inherited genes can play a role. Smoking cigarettes doesn't cause asthma, but it makes it worse.

"Recent data reveals that the rates of Emergency Department visits for asthma have increased, with the greatest increase in children 10 to 17. Children under five accounted for the highest rates of Emergency Department visits," says pulmonologist Richard Kops, M.D., director of respiratory care at John Muir Medical Center, Concord Campus. "More than 2.3 million Californians have asthma. In the Contra Costa, Solano and Alameda counties alone, it is estimated that 30 percent of the 144,000 asthmatics are children."

How is asthma diagnosed?

Physicians diagnose asthma by taking a medical history, listening to the chest, and performing a pulmonary function test which measures air flow and the response, if any, to bronchodilator medications. A peak flow meter is an inexpensive device that may be used to monitor airway function at home by testing the speed of air leaving the airways. Some physicians find that daily use of a peak flow meter may help to determine the need to adjust medications.

How is asthma managed?

Treatment is aimed at avoiding known allergens and using medications to control symptoms. Two main types of medications are prescribed. Inhaled anti-inflammatory ("long term control") medicines are taken regularly to prevent symptoms. Bronchodilators ("quick relief medications") are used for asthma attacks. Vapor treatments can be given in emergency cases when metered dose inhalers aren't working.

"It's important for patients, loved ones and their families to become educated about asthma," Dr. Kops emphasizes. "All should thoroughly understand asthma and have an action plan for when to call a physician or seek emergency care. Individuals with asthma must learn to manage this condition themselves, as they may have it for life."

He adds that a doctor or other health care professional will recommend the appropriate medications and dosages. They should also educate patients as to how these medications work, when to use them, and how to properly use inhalers. He cautions, "If you have asthma, you should always have your medications with you."

Looking toward the future, many physicians are optimistic that current genetic research may lead to new classes of medications, and even the possibility of preventing asthma.