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Asthma and Allergies

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Title: Asthma and Allergies


1
Asthma and Allergies
  • Pamela Amelung, MD
  • Mini-Med School Fall 2006
  • University of Maryland
  • School of Medicine

2
Topics Covered
  • What is asthma?
  • Asthma facts and statistics
  • Who is most at risk to get asthma?
  • Symptoms and triggers, including
  • allergies
  • Management of asthma
  • How to avoid triggers and attacks

3
What is Asthma ?
  • Chronic inflammatory disorder of the medium and
    small airways.
  • These airways are hypersensitive to certain
    triggers in the environment.
  • Intermittent and recurrent episodes of...
  • Wheezing
  • Shortness of breath
  • Chest tightness
  • Cough - night, early morning
  • Usually reversible
  • Asthma cannot be cured but its symptoms can be
    controlled with proper environmental changes and
    medication.

4
The facts about Asthma
  • About 17 million Americans have asthma
  • Most common chronic childhood disease, affecting
    about 5 million children (6 of children under
    18)
  • 14 people die each day from asthma
  • Nearly 2 million emergency room visits each year

5
How many people have Asthma ?
17
  • The number of Americans diagnosed with asthma has
    risen.
  • Self-reported prevalence increased 75
  • Close to 21 million Americans have been diagnosed
    with asthma in their lifetime.

13.7
Millions of individuals diagnosed
MMWR December 04, 1998 / 47(47)1022-1025
6
The cost of Asthma !
14.5 billion
  • Asthma costs billions of dollars each year and
    the cost is rising.
  • The estimated annual cost of asthma in 2000 was
    14.5 billion.

6.2 billion
1990 2000
www.cdc.gov
7
The cost of Asthma !
  • 3 million lost work days
  • 10 million lost school days each year from
    asthma

8
The cost of Asthma !
  • Deaths from asthma have increased more than 50
    in the past 20 years, and have increased more
    than 75 in children under 19

CDC MMWR April 24, 1998 / 47(SS-1)1-28
9
Race and asthma Mortality
10
Asthma MortalityFemale vs. Male
11
Risk factors for Asthma
  • Allergy / Atopy
  • Family history of asthma/allergy
  • Perinatal exposure to tobacco smoke
  • Viral respiratory infections
  • Low birth weight
  • Male gender - pre-adolescence
  • Low-income, urban residents
  • Obesity

12
Classification of Asthma
  • Intermittent -
  • Asthmatics who have symptoms that occur with a
    cold from time to time.
  • They often grow out of the disease.
  • Persistent -
  • Asthmatics having symptoms at least twice a week
    during the day and twice a month during the night
  • These asthmatics are further classified as mild,
    moderate, or severe.

13
Symptoms of Asthma
  • Coughing
  • Wheezing
  • Chest tightness
  • Shortness of breath

14
Asthma Triggers
  • For people with asthma, exposure to certain
    substances they are sensitive to can lead to an
    asthma attack or exacerbation.
  • These substances are known as triggers.
  • Not all people with asthma have the same triggers
    that will cause an asthma attack.

15
Indoor air Triggers
  • Environmental tobacco smoke (ETS)
  • Cockroaches
  • Dust mites
  • Animal dander
  • Mold, mildew
  • Strong scented products (perfumes, scented
    cleaners)

16
Why indoor air is Important
  • All of the common asthma triggers are found
    indoors
  • Americans spend about 90 time indoors
  • Reducing exposure to indoor allergens and
    irritants can reduce asthma symptoms
  • Prevention is an important asthma management tool

17
Secondhand Smoke
  • Contains more than 4,000 substances (over 40 are
    carcinogenic)
  • Is particularly harmful to young children
  • Can trigger asthma attacks and cause young
    children to develop asthma

18
Dust Mites
  • Found in most homes
  • Live in soft bedding
  • Feed on skin flakes
  • Mites and mite droppings can be asthma triggers
  • Most common asthma trigger in adults and kids

19
Pets
  • Skin flakes, urine and saliva of warm blooded
    animals can be asthma triggers.
  • Triggers can remain in the home for several
    months after a pet is removed, even with cleaning.

20
Molds
  • Can be found almost anywhere.
  • Key to mold control is moisture control.
  • Clean up the mold and get rid of excess water or
    moisture, this also helps reduce other triggers,
    such as dust mites and cockroaches.

21
Cockroaches and other Pests
  • Droppings or body parts can be asthma triggers.
  • Cockroaches likely contribute significantly to
    asthma problems in inner city area.
  • Asthmatic children allergic to cockroaches are
    three times more likely to be hospitalized if
    exposed in the home.

22
Outdoor air Triggers
  • Ozone
  • Particulate matter
  • Sulfur dioxide
  • Nitrogen dioxide - vehicle exhaust
  • Outdoor pollens and mold

23
Additional Triggers
  • Viral upper respiratory infections
  • Exercise
  • Aggravating conditions - gastric reflux,
    sinusitis, rhinitis
  • Diet, medication
  • Cold air
  • Changes in weather
  • Menstrual cycle, pregnancy

24
What causes an Asthma Attack ?
  • An allergic reaction to triggers or exposures
  • Airways swell and fill with mucus and secretions
  • The muscles around the airways contract and
    spasm
  • Airways can collapse, causing classic symptoms,
    even death

25
Indications of a severe Attack
  • Breathless at rest
  • Hunched forward
  • Talking in words rather than sentences
  • Agitated
  • Peak flow rate is less than 50 of normal

26
Management of Asthma
  • Asthma is one condition that, when treated with
    timely and effective regular outpatient care,
    prevents hospitalization and ED visits.

27
Managing Asthma
  • Consult with a physician to develop an asthma
    management plan, which includes
  • Medication
  • Education identification of asthma triggers
    ways to reduce/avoid exposure to your asthma
    triggers
  • Peak flow monitoring
  • Emergency plan

28
Goals of asthma Management
  • Control chronic asthma symptoms and asthma
    attacks during the day and night
  • no sleep disruption due to asthma
  • no missed school or work because of asthma
  • no or minimal need for emergency care or
    hospitalizations
  • Avoid attacks or exacerbations
  • Maintaining normal activity levels, including
    exercise and other daily activities
  • Having normal or near-normal lung function
  • Avoid side-effects of medications
  • Prevent asthma mortality

29
Avoiding secondhand Smoke
  • Choose not to smoke in your home or car and do
    not allow others to do so either.

30
Avoiding dust Mites
  • Wash sheets and blankets once a week in hot water
  • Choose washable stuffed toys-- keep stuffed toys
    off beds
  • Cover mattresses and pillows
  • Vacuum often (when asthmatic is not present)
  • Maintain low indoor humidity, ideally between
    30-50 

31
Avoiding pet Triggers
  • Consider keeping pets outdoors or even finding a
    new home for your pets, if necessary.
  • Keep pets out of the bedroom at all times.
  • Keep pets away from fabric-covered furniture,
    carpets, and stuffed toys.

32
Avoiding mold Triggers
  • Wash mold off hard surfaces and dry completely,
    absorbent materials (ceiling tiles and carpet)
    may need to be replaced.
  • Use exhaust fans or open windows in kitchens and
    bathrooms when showering, cooking, or using the
    dishwasher.
  • Maintain low indoor humidity (between 30-50
    relative humidity).
  • Fix leaky plumbing or other sources of water.
  • Keep drip pans in your air conditioner,
    refrigerator, and dehumidifier clean and dry
  • Clean bathrooms frequently.

33
Pest Avoidance
  • Free your home of places for pests to hide and
    sources of food and water
  • Regular, careful cleaning - kitchen
  • Daily trash removal
  • Store food in airtight containers
  • Extermination - baits, gels (not sprays)

34
Prevent outdoor Triggers
  • Ozone - advisories, stay indoors
  • Pollens and Molds (if allergic)
  • Close windows, doors
  • Use air conditioners, clean filters regularly
  • Dry clothes indoors
  • Avoid raking leaves, gardening
  • Outside - less breezy, after gentle rain

35
Peak expiratory flow (PEF) Meters
Allows the patient to assess the status of his or
her asthma
36
Peak flow Chart
  • People with moderate or severe asthma should take
    readings
  • Every morning and evening
  • After an exacerbation
  • Before inhaling certain medications

Source What You and Your Family Can Do About
Asthma by the Global Initiative For Asthma
Created and funded by NIH/NHLBI
37
Management of Asthma
  • Quick-relief medications used to treat asthma
    attacks and acute symptoms
  • Relievers
  • Long-term control medications reduce the airway
    inflammation that causes these symptoms
  • Controllers

38
Asthma Medications
  • Quick-relief medications
  • Short-acting bronchodilators
  • Relax smooth muscle around the airways
  • Long-term Medications
  • Steroids
  • Inhaled, tablets
  • Anti-inflammatory
  • Long acting bronchodilators
  • Relax smooth muscle
  • Leukotriene inhibitors
  • Anti-inflammatory

39
Asthma action Plan
National Heart, Lung, and Blood Institute
40
Asthma is Increasing
  • Why the increase?
  • Increased recognition, diagnosis-shifting
  • Environmental allergens - indoor, outdoor
  • Energy-efficient buildings, carpet
  • Exposure to mothers tobacco smoke
  • Psychosocial and socioeconomic factors
  • More time indoors
  • Overcrowding
  • Access to care

41
Hygiene Hypothesis Are we too clean ?
T0
  • Immune Response
  • Th1
  • Responds to harmless bacteria, dirt, animal
    droppings after birth
  • Not activated in sterile birth environment
  • Subdues the more hyperactive Th2
  • Th2
  • Not as effective as Th1
  • Fight allergens, cause allergies

T2
T1
42
Hygiene Hypothesis Are we too clean ?
  • Less allergies and asthma
  • 1990 East vs. West Germany
  • Farm vs. city children
  • Daycare before 6 months of age vs. later
  • Older siblings vs. none
  • Failure to develop balanced immune system
  • Detergents/chlorine, antibiotics, vaccines,
    antibacterial soaps

43
Healthy people 2010Objectives
  • Reduce asthma deaths
  • Reduce hospitalizations for asthma
  • Reduce hospital ED visits for asthma
  • Reduce activity limitations - reduce of
    school/work days missed
  • Increase proportion who receive formal patient
    education
  • Increase proportion who receive appropriate
    asthma care
  • Establish in ?25 states a surveillance system for
    tracking asthma

http//www.health.gov/healthypeople
44
Conclusions
  • Asthma affects 5-10 of the population and the
    prevalence is rising in developed countries.
  • Allergies often play a key role in asthma and act
    as triggers for asthma symptoms.
  • Asthma can not be cured but can usually be well
    controlled in most people.
  • Controlling asthma involves patient education,
    lung function monitoring, avoidance of triggers,
    and in many, medications.
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