Title: Asthma and Allergies
1Asthma and Allergies
- Pamela Amelung, MD
- Mini-Med School Fall 2006
- University of Maryland
- School of Medicine
2Topics 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
3What 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.
4The 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
5How 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
6The 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
7The cost of Asthma !
- 3 million lost work days
- 10 million lost school days each year from
asthma
8The 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
9Race and asthma Mortality
10Asthma 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
12Classification 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.
13Symptoms of Asthma
- Coughing
- Wheezing
- Chest tightness
- Shortness of breath
14Asthma 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.
15Indoor air Triggers
- Environmental tobacco smoke (ETS)
- Cockroaches
- Dust mites
- Animal dander
- Mold, mildew
- Strong scented products (perfumes, scented
cleaners)
16Why 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
17Secondhand 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
18Dust 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
19Pets
- 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.
20Molds
- 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.
21Cockroaches 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.
22Outdoor air Triggers
- Ozone
- Particulate matter
- Sulfur dioxide
- Nitrogen dioxide - vehicle exhaust
- Outdoor pollens and mold
23Additional Triggers
- Viral upper respiratory infections
- Exercise
- Aggravating conditions - gastric reflux,
sinusitis, rhinitis - Diet, medication
- Cold air
- Changes in weather
- Menstrual cycle, pregnancy
24What 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
25Indications 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
26Management of Asthma
- Asthma is one condition that, when treated with
timely and effective regular outpatient care,
prevents hospitalization and ED visits.
27Managing 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
28Goals 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
29Avoiding secondhand Smoke
- Choose not to smoke in your home or car and do
not allow others to do so either.
30Avoiding 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
31Avoiding 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.
32Avoiding 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.
33Pest 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)
34Prevent 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
35Peak 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
37Management 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
38Asthma 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
39Asthma action Plan
National Heart, Lung, and Blood Institute
40Asthma 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
41Hygiene 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
42Hygiene 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
43Healthy 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
44Conclusions
- 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.