Asthma Education Series: Asthma mythbusting

Okay, so. As part of my asthma education series, I’m gonna drop a bit of asthma mythbusting on you. Here’s 9 myths and one actual fact. The statement that’s actually true might surprise you. If you have more myths you’d like fact checked, drop them in the comments – I’m perfectly happy to post a sequel post.

  1. Most kids with asthma outgrow asthma: FALSE. While some do outgrow asthma, latest evidence suggests that up to half of those who initially seem to outgrow it relapse later in life (often in middle age). As well, kids with more severe asthma are less likely to even get a remission. In all, only about 20% of asthmatic kids will outgrow asthma entirely.
  2. If someone is having an asthma attack, you should move them somewhere cold: FALSE. While some first aid information for asthma says to move someone to clear air if there’s an airborne trigger (smoke, etc), cold air is actually an asthma trigger and is likely to make the flareup worse.
  3. Asthmatics don’t need their inhalers, what they need is willpower: FALSE. Asthma is a physiological condition with measurable obstruction to airways. You cannot will yourself past being unable to breathe.
  4. Kids who always get asthma attacks in gym class are just being lazy. FALSE. Exercise is an asthma trigger in 50% of cases. Flare-ups in response to exercise are thus a sign of inadequate asthma control, not of laziness.
  5. “When I was a kid, there didn’t seem to be as much asthma.” ACTUALLY TRUE. Asthma rates are increasing. They have been increasing since at least the 1950s, especially in the developed world, even controlling for improvements in screening and diagnosis. There didn’t seem to be as much asthma when you were a kid because there actually wasn’t. That said, increase in asthma rates nowadays does not mean that those who have asthma now are somehow faking or invalid in their diagnosis, it’s simply more common now than 30, 40, or 50 years ago.
  6. If you use your medicine “too much,” you’ll build a tolerance to it and then it won’t work. FALSE. Asthma medicines are not addictive and the body does not build a tolerance to them. What can happen, however, is that a person can use their rescue (reliever) medication to cover up a worsening of their overall asthma without actually treating the underlying cause of the symptoms (inflammation) which is just getting worse and worse. Eventually, this can lead to a very serious asthma attack that medicine doesn’t work for. This is why it’s important to apply your asthma action plan and talk with your doctor if you’re having more flare-ups and symptoms than normal.
  7. If you have asthma, you can’t do well in sports. FALSE. 20% of the Canadian Olympic Team has asthma.
  8. Kids/people with asthma shouldn’t exercise. FALSE. Exercise is associated with improved asthma control.
  9. Steroids used to treat asthma will make me bulk up. FALSE. You’re thinking anabolic steroids, which are the type used by athletes in doping scandals. The steroids used to treat asthma are corticosteroids, which work in a very different manner on a very different set of pathways. Additionally, most cases of asthma are treated with very low doses of inhaled steroids, which substantially lowers the risk of side-effects.
  10. An asthmatic complaining about my perfume/smoking/cleaning products is just being dramatic. FALSE. Many asthmatics are triggered by airborne irritants, including perfumes, cigarette smoke, and cleaning products. This induces asthma symptoms that may range from merely unpleasant (chest pain and coughing) to serious and potentially life threatening (severe difficulty breathing). An asthmatic who complains to you about your scented product is not being dramatic, they’re suffering. Be considerate of their condition and stop exposing them to a trigger. Reactions to triggers can sometimes be delayed, so even if someone doesn’t look like they’re suffering now, that doesn’t mean that they won’t be up all night coughing.

The previous post in this series is here.
The next post in this series is here.

Astham Education Series: Asthma equipment. Part 1: Med delivery systems

As I hinted in my last post in the series, this is going to be a post about all the different gadgets an asthmatic might have. The post will include links and descriptions, but as I have none of the rights to images, I won’t be using them directly here. Instead I’ll link to an article or image of one somewhere else and direct traffic to the person who created the image.

There are a few major categories that I’ll separate everything into just to keep stuff organized and a bit easier to follow: There are medication delivery systems – nebulizers, spacers, metered dose inhalers, dry powder inhalers, and the like. There are at home testing supplies – peak flow meter, pulmonary function testers, and pulse oximeters. There are accessories – specialized ways of carrying around your meds and equipment. Lastly, there are bookkeeping tools for keeping a symptom log – I’ll explore both hardcopy and software options.

This post, for the purpose of length, is going to be split into 3 parts: Medication delivery systems, at-home testing supplies, and accessories and bookkeeping supplies. This is the first part: Medication delivery systems.

What I call a medication delivery system is just a tool that lets you get your meds where they need to be. For people with injected drugs, this would be needles and syringes and suchlike. For asthmatics, they tend to be things that help you inhale stuff into your lungs (although some asthmatics, mostly extremely severe asthmatics, do use auto-injectors and injection pumps, so I’ll include those in this post, too).

The most recognizable medication delivery system is the metered dose inhaler (MDI). MDIs are a way of turning asthma medicine into a mist of fine particles small enough to get into your lungs. A good description of how they work can be found here. In short, the canister contains a mixture of propellant (a liquified, nontoxic and chemically inert gas), medicine, and one or more stabilizers.* The canister is connected to a valve which can only dispense a certain amount of the mixture at a time. When you squeeze the inhaler, the valve is opened briefly and the propellant expands rapidly, forcing the medicine out and into the air as a fine mist, which is then inhaled. Taking an MDI is a bit of an exercise in coordination. Instructions on how to use them properly are provided in detail by reliable medical websites such as Medline, or you can speak with a doctor, nurse, nurse practitioner, respiratory therapist, or pharmacist, all of whom should be able to instruct you in proper inhaler technique. In short, take the cap off, shake the inhaler, hold it about the width of two fingers in front of your mouth, breathe out gently and completely, then squeeze the canister down into the plastic holder as you inhale. Then hold your breath for 10 seconds, and breathe out slowly. It will take some practice to get the hang of the hand-lung coordination.

If you have trouble with taking an MDI properly, or if you are prone to severe attacks, you and your doctor may decide it’s a good idea to add a valved holding chamber or spacer. These are long, hollow, antistatic bubbles or tubes designed to eliminate the hand-lung coordination aspect of MDI use. How to use a spacer varies slightly depending on the design and brand, but typically you insert the MDI into one end, and either put the mask over the face of the person using it (if it has a mask) or put your mouth around the mouthpiece, then the medication is taken as directed by the spacer manufacturer. Spacers tend to be bulky and obvious, so it will usually attract attention and questions if you have or use one.

Let’s say you need a medicine that doesn’t come in a metered dose inhaler, or that you can’t do the breathing necessary to use one, even with a spacer. This is where nebulizers come in. Nebulizers are machines designed to make a mist of your medicine, which you then inhale. Because they tend not to be airtight, they’re not nearly as efficient with the medicine as MDIs or spacers, and as a result, you will have to use more medicine for the same effect. Like with spacers, proper nebulizer use varies a bit from device to device, but if you have one, you can speak to your pharmacist about how to use it. They are fairly straightforward once you know how to set them up, but they’re noisy and time-consuming relative to inhalers.

Next up is dry powder inhalers (DPIs). DPIs are a good alternative for those who don’t like noise or those who find they’re sensitive to propellants or stabilizers (of which I am one – certain brands of rescue puffer have a stabilizer that results in my asthma attack getting worse, not better, so I have to be careful which rescue inhalers I buy). DPIs do not have stabilizers or propellants. Instead they’re use dry, finely ground powder compounded with a bulking agent (usually lactose) contained in a capsule. Using the DPI properly pierces the capsule, and then you inhaling medicine from the inhaler carries it into your lungs. For DPIs to be appropriate for you, you need to be able to make a certain minimum inhalation force because otherwise the powder won’t get carried into your lungs, and so your doctor will usually give you a practice unit which will make noise when you inhale properly. If you’re unable to inhale strongly enough, DPIs are not an option for you.

The last two medication delivery devices are relatively rare for asthmatics. They are infusion pumps and auto-injectors. Infusion pumps for asthma are only used by those with very severe asthma, who need a constant supply of bronchodialator drug (often salbutamol or terbutaline) in their blood system. Often, they use subdermal infusion pumps similar to those used by people with diabetes. I’ve never been severe enough to need one, so I don’t know what they’re like, but they come with many of the same hazards of an insulin infusion pump, and hygiene is very important to avoid infection. Auto-injectors are used by those asthmatics who are prone to status asthmaticus and anaphylaxis. These auto-injectors are exactly the same as those used to treat severe allergic reaction and use the exact same drug (epinephrine) because in many cases, severe asthma attacks are severe allergic reactions. Information on how to use these auto-injectors properly is available from any manufacturer or first aid course.

That’s pretty much it for medication delivery devices for asthma. I haven’t covered any of the out-of-date and obsolete forms of asthma medication delivery devices, though I might examine that history in a later post. In my next post of this series, I’ll talk about home testing devices.

*As an aside, a lot of MDIs contain ethanol as a stabilizer, and this has been known to cause false positives on breathalyzer tests when the breathalyzer is performed shortly after taking your inhaler.

The previous post in this series is here.
The next post in this series is here.

Asthma Education Series, Lifestyle for Asthma Control, part 2: Exercise.

So, I kind of got incredibly busy for the rest of June and had to leave my asthma education month stuff on its own for a while. Which is unfortunate. However, i don’t want to wait until next year to finish the posts I had planned, so I’ll just continue the asthma education series and post whenever I feel like it.

So. This post was a hard one to write without coming off as being elitist or body shaming. If I am, please let me know so I can rewrite it, because that’s not the vibe I want to give here at all.

Moving on: The other hand of the lifestyle coin, when it comes to asthma control, is exercise. Exercise is associated with improved asthma control, according to the best available data. Exercise has a number of other benefits, including healthier cardiovascular system, improved mental health, improved lung capacity, and improved exercise tolerance. For this reason, it’s been advised since the 1980s for people with asthma to exercise.

I will not lie: Exercise can trigger your asthma, and that can range from merely unpleasant to downright scary. However, if you work with your doctor, a plan can usually be devised to allow you to exercise without attacks. Some asthmatic people (myself included) have to take some medicine before we do certain types of exercise. Other asthmatic people find that just having a longer, slower warmup helps.

I will also not lie on the next point: If you are sedentary and you have exercise-triggered asthma, exercise will not be comfortable. It probably will induce symptoms. The best available evidence, however, suggests that if you keep at it, your exercise-induced asthma will gradually become less severe, your exercise tolerance will increase, and your overall asthma control will improve.

(note that this is not the case for exercise-induced bronchospasm, which is thought to be a type of lung repetitive strain injury from high-performance exercise and unlike asthma, is not inflammatory or chronic. EIB will tend not to improve without treatment, even if you push through it with your exercise)

Since exercise can be for many people a trigger, exercising with very poorly controlled asthma or during a flareup can be dangerous. As well, starting a new exercise plan without consulting your doctor might be dangerous. If you want to increase your fitness level, talk to your doctor about what to do and when if you want to exercise but are an asthmatic who is triggered by exercise. Get a plan for how much asthma symptoms are safe for you to tolerate and how soon you can return to exercise once a flare is under control.

There is no hard evidence on what, if any, exercises are better for people with asthma, though many asthmatics (myself included) find that sustained, high-intensity exercises like endurance running to be hard on us while exercises that vary in intensity or which require careful control of breathing like martial arts or swimming to be easier on us. Try out many things and see what is easier on you.

Exercise is not a silver bullet for asthma – it will not replace your daily control medicine, nor will you ever stop an attack in its tracks with some jumping jacks. However, evidence is mounting that regular exercise plays an important role in asthma control and quality of life for people with asthma. If it’s possible for you, starting a new exercise routine may be a good idea for helping your overall health and asthma control.

In my next post in the series, I’ll talk a bit about asthma gear – what gadgets people with asthma can carry, what they’re used for, and how they work.

The previous post in this series is here.
The next post in this series is here.

Asthma: How it works

So, before we get into the meat of the posts that I’ve planned for the month, I want to lay down a foundation of knowledge that further posts will build on. To do this, I have to discuss what asthma actually is – for many people, this will be review.

Asthma is a chronic lung condition where people have episodes (called attacks or flares) of difficulty breathing. Their breathing may or may not return to normal between these attacks, but it is always better between attacks than during attacks. In asthma, lungs are often irritated. This irritation causes swelling and redness, and in medical terms is called inflammation. The problem with lung swelling is that your lungs are a series of progressively-smaller, ever-branching tubes called airways. Air goes from your trachea, to your left and right bronchi (large airways), and from there the airways branch into smaller and smaller airways, eventually becoming the small airways, or bronchioles. When the bronchioles are so tiny that they’re microscopic, they stop at little sacs called alveoli. At the alveoli is where all your air exchange occurs, with carbon dioxide leaving your blood and oxygen entering.

In order for your lungs to work, you need to be able to get air from outside of your body all the way down to your alveoli and back again. You do this every time you breathe: Your diaphragm contracts, creating a slight vacuum in your chest cavity, which makes your lungs inflate and suck air into them. That’s inhaling. When you breathe out, called exhaling, your diaphragm just relaxes and the air flows out of your lungs passively.

Or, at least, that’s how it should happen.

In asthma, things sometimes work a bit differently. Remember when I mentioned about the inflammation? Well, the problem with swelling inside your lungs is that it blocks the airways a bit. In medical terms, this is called airway obstruction. This can make it hard to move air. As well, your airways are coated in a type of muscle called smooth muscle. If your airways get inflamed, the smooth muscle gets twitchy and sometimes can go into a spasm. This is called a bronchospasm. It’s like a muscle spasm in your hand, except when your airways spasm, it clamps your airways shut even more. So now you have obstruction because of the inflammation and more obstruction because of the bronchospasm, and this is an asthma flare or an attack. Airway obstruction makes it hard to breathe, and is the direct cause of all the asthma symptoms I’ll discuss in later posts. In asthma, airway obstruction is reversible, meaning that between attacks, your airways are not as blocked up as they are during attacks. The obstruction can be fully reversible, where people breathe normally between attacks, or only partially reversible, where people always have at least a little breathing trouble, depending on how bad a person’s asthma is.

So, the point of this post was to explain a bit about what asthma is and how it works. If I’ve done my job right, you should now know that asthma is a condition of reversible airway obstruction, the names of different types of airways, and the role of inflammation and bronchospasm in asthmatic airway obstruction. Tomorrow, I will talk about asthma symptoms.

The previous post in this series is here.
The next post is here.