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TEENS AND ASTHMA

Asthma affects about one in seven teenagers. In California alone, more than half a million teens reported having been diagnosed with asthma at some point in their lives. If you’re a young person with asthma, you probably already know a great deal about it. By understanding and managing your asthma, you can keep it under control and prevent it from affecting your study, sport and social activities.

With the help of our Asthma Collaborative, we have compiled the answers to some of the most commonly asked asthma questions.

Where does asthma come from?

Asthma is a chronic lung disease that results from more than one factor. Heredity and your family's health history play a role in the development of asthma. If both of your parents have asthma, you and your siblings are much more likely to develop it. The environment also plays a role. For example, air pollution can increase the number of people who develop asthma in the community. Allergies also play a role in the development of asthma. Allergic children are more likely to develop asthma, compared to those without allergies. There is even a theory - only a theory - that allergies and asthma are increasing because we are too clean and don’t get sick enough! Another theory blames worsening allergies and asthma on wall to wall carpeting, and another blames TV.  While dust mites and lack of exercise may contribute to asthma, not all theories should be taken too seriously - but, they are fun to think about.

How is asthma diagnosed?

If you think you might have asthma, talk to your doctor for proper diagnosis. Be sure to let your doctor know about your warning signs, which are also known as symptoms. They can include coughing, wheezing, shortness of breath, or chest tightness that come on suddenly. Symptoms may occur often or only happen during certain times of the year or season. Tell your doctor if you have noticed anything that seems to cause your symptoms and/or make them worse. Allergy tests are sometimes given to find out if you are allergic to anything that may be triggering your symptoms. Also, make sure to tell your doctor if you have taken any medication for your breathing that did not help, or if you have had a cold that “goes to the chest” and/or takes more than 10 days to get over. Your doctor may give you a Spirometry (speh-ROM-et-er) breathing test or chest x-ray to check how your lungs are working and eliminate any other possible causes of your symptoms. However, this is not usually needed for “typical” asthma.

How common is asthma?

Asthma is one of the most common chronic diseases in childhood. It affects 9 million children under the age of 18 years and approximately 12% of children have had a diagnosis of asthma at some point in their life. There is evidence to suggest that early, aggressive management of allergies, and asthma might minimize, or even prevent, the progression to severe asthma!

What can trigger an asthma attack?

Several things can trigger an attack and they are different for everyone. We recommend discussing allergy testing with your doctor.

        • Irritant triggers - change of weather, cold dry air, smog, secondhand smoke, air pollution
        • Outdoor allergen triggers - grass, tree, and weed pollens and mold spores, are common
        • Indoor allergens – cats, dogs, birds, dust, molds, dust mites
        • Infection triggers - ear infections, sinus infections, lung infections, influenza and the common cold can cause asthma flare-ups
        • Exercise triggers - activities that cause you to have physical activity such as sports
        • Medication triggers - medications such as aspirin or Motrin
        • Food triggers - may cause an asthma attack, especially if there is a skin reaction, such as eczema (scaly itchy skin) or hives with the attack

What parts of the lungs are involved in asthma?

Asthma occurs in the airways, particularly the smaller ones. Think of your lungs as an upside down tree. Indeed, it is often called the bronchial tree. The Trunk is the Trachea (the large airway in the middle), and the Branches are the smaller Bronchi, which narrow even further to Bronchioles. These parts are needed for transportation, in both directions – oxygen and nutrients in trees, and air (oxygen and carbon dioxide) for airways. So when the airways are narrowed, you can’t move enough air. Leaves and alveoli, of the lungs, are the parts that do the actual work of respiration, and both are found at the ends of the small branches. Leaves, which produce oxygen, are analogous to the alveoli, where oxygen and carbon dioxide (CO2) are exchanged. That is, we take in oxygen and dump the CO2.

How do I know what type of asthma I have?

There are 2 types of asthma: intermittent and persistent. 

Intermittent Asthma: Symptoms (including a cough, wheezing and chest tightness) occur no more than 2 times per week and night symptoms less than 2 times a month.

Persistent Asthma: Symptoms of asthma occur more than twice per week and may also appear at night.

Does it matter what type of asthma I have?

Other than helping to anticipate seasons and possibly asthma triggers, you probably don’t need to worry too much about it, but your doctor must have this information. Of course, more severe asthma means more risks, and you should take it more seriously, but even people with “mild” asthma can die from it. Fortunately, asthma related deaths are rare. Your asthma severity also gives your doctor a starting point for when, how much, and which medicines to use. More severe asthma, or a less than great response to your medicines may indicate looking for more triggers, other illnesses (sinus infection, gastroesophageal reflux), or even another diagnosis (like panic attacks, hyperventilation, not taking medicines correctly, cystic fibrosis).

Why should I care about how well my asthma is controlled?

In most people with asthma, the airways close down during an attack, but open up to your normal size when the asthma is treated. But not everybody!  For some people with poorly controlled asthma, scar tissue develops in the airways (called airway remodeling, but it is not a nice makeover). Also, poorly controlled asthma is like walking along the edge of a cliff – just a little push, and you are over the edge into a full blown asthma attack (and that shade of blue just doesn’t look good on most people).

How can I determine the severity of my asthma and better control it?

To determine the severity of your asthma, ask yourself these simple questions:

  • Does your asthma prevent you from exercising?
  • Does your asthma wake you up at night more than twice in a month?
  • Do you have to use your quick acting "rescue" inhaler more than twice a week (not including the pretreatment of exercise)?
  • Do you miss more than a week of school each year due to your asthma?

If you answered “yes” to ANY of these questions, your asthma is out of control and you should contact your doctor.

How do I know if I am just short of breath or actually having an asthma attack?

Feeling short of breath is a normal process, which drives the process of breathing. When you cannot get enough air (oxygen) for your activity level, you increase your rate and depth of breathing. There is little difference, but asthma may present with shortness of breath, chest tightness, wheezing or cough.

What are the differences between a panic attack and an asthma attack?

Sometimes it can be difficult to distinguish asthma from a panic attack, or hyperventilation. All can be associated with stressful situations or feelings. If you are having an asthma flare up or attack, your airways become narrowed, inflamed, and full of mucus. Interestingly, this is mainly difficulty getting the air out of the lungs and that’s why it is harder to breathe. Understandably, if you can't breathe, you are likely to feel anxious. In addition, when an asthmatic is struggling to breathe, their heart rate usually increases. If you are having a panic attack your heat may be racing and you may be breathing fast, but you won’t have trouble breathing. The fast breathing may cause dizziness or numbness and tingling in the lips or hands. This is usually described as difficulty getting enough air, or difficulty filling the lungs. If a doctor checks a person's peak flow rate or lung function during an attack, it should be normal during a panic attack, and low during an asthma attack.

How do I manage my asthma?

The first thing you should do is identify and avoid your asthma triggers. Get the influenza vaccine every year (unless you are severely allergic to egg), and consider getting the pneumonia shot. If you have “persistent” asthma, take your preventative medication every day. Know your warning signs (early symptoms), and pay attention to them. If you have a peak flow meter, know your ranges and use is regularly. With the onset of symptoms and/or a drop in your peak flow from your personal best, think about why, and then start your ACTION PLAN! (You have one, don’t you?  If not, contact your doctor and develop a plan, preferably in writing. It could be as simple as “increase your preventative inhaler from one puff once a day to two puffs twice a day.”) When you have asthma symptoms, start using your rescue inhaler if needed. Are you using your canister (metered dose inhaler –MDI) correctly? How many puffs do you use, and are you aware that the direction in the package, (putting the inhaler in your mouth) is way out of date?  More later! If your attacks are exercise induced, pre-medicate ten to fifteen minutes prior to exercise with your reliever (bronchodilator) inhaler.

Are all asthma medications the same?

No. There are two types of asthma medications: Controllers (also called preventers or maintenance medications) and Relievers (also called rescue medications).

Controllers include:

Inhaled corticosteroids (ICS) - reduces swelling, inflammation, and mucus in the airways. They are the most effective preventative treatment for long term control of asthma. Controllers DO NOT provide rapid relief of asthma symptoms. They take several hours to start working, and may take up to six weeks to work best. In many people they work so well that you feel like you don’t need it any more! There are several available.  Some of the more potent ones might be used at only one puff, one time a day once the asthma is well controlled. 

Inhaled Long Acting Bronchodilators - used to assist the inhaled corticosteroids to control asthma and keep airways open for about 10-12 hours. They should not be used alone (with rare exceptions), but help the ICS work better at the lower dosages.   

Leukotriene Modifiers - block response to some triggers. These are not as powerful or versatile as the ICS, but are useful in some patients. They also can’t be “stepped up” in case of worsening asthma. 

Theophylline – is not used much any more because of the side effects, and has been replaced by the much safer and more powerful inhaled corticosteroids. 

Relievers include:

Short acting bronchodilators - rapid relief of asthma symptoms relaxes the muscle bands and dilates the airways around the breathing tubes. Then the air passages open and breathing becomes easier within minutes. They can be used to prevent exercise induced asthma. You do know where your inhaler is, don’t you?

Additional treatment:
Oral Corticosteroids - reduce the inflammation that causes an asthma attack.  They are used for several days to reverse a moderate to severe asthma attack. Oral corticosteroids should NEVER be first line treatment, and should extremely rarely be used as a preventative!!! People with severe asthma should have some available. The risks and side effects are terrible, but it beats not breathing! One side effect can be weight gain and this can be emotional for you, therefore make sure do discuss the issues with your doctor.

Do I need to take certain medications? For how long?

Your doctor will inform you what medications are best to take. Asthma control requires daily use of medications during times when the triggers such as allergens are present.  Corticosteroids, (anti-inflammation) medications are usually taken daily, all year, and bronchodilators (rescue medications) are used for the relief of symptoms to treat an asthma attack.  Exceptions would be seasonal treatment of symptoms and/ or exercise induced asthma (bronchodilator is administered 10-15 minutes prior to activity). Most asthma experts would suggest that six weeks of being without symptoms and not being trigger season is a bare minimum before medication can be stepped down. Contact your doctor’s office or pharmacist for more information.

What do the side effects of medications really mean?

Side effects are adverse effects of medications. One example is beta agonist (your rescue inhaler, such as albuterol) can cause speeding of the heart and anxiety. Fortunately, by using your inhaler with a good technique, these side effects are very uncommon. A mild, very infrequent tremor is not uncommon. Corticosteroid inhalers can possibly decrease your body’s resistance so you can get a mild fungus infection. This can be eliminated, or at least minimized, with good inhaler technique and doing a rinse and spit.  

Will I get big muscles if I use a steroid medicine to control my asthma?

Sorry, wrong steroids!  “Steroid” is just a class of a chemical, and also includes birth control pills. The corticosteroids used in your inhaled medications are different from anabolic steroids and DO NOT build up your muscles or help you perform better than your peer and work in a different way. Inhaled “steroid” medications are not the type that is banned in sports. The medications for asthma go down into your airways to prevent inflammation (swelling and mucus), causing asthma symptoms. You usually only need a small dose for it to be effective. At times you may have to take corticosteroid tablets for a certain amount of days to control a bad episode of asthma. The use of corticosteroid can cause you to gain weight. Please make sure you discuss your feelings; do not hold those feelings in.

What is the difference between corticosteroids and anabolic steroids?

Anabolic steroids are chemicals - the most commonly known is testosterone - that build up muscles. This hormone increases facial hair and other male characteristics. These chemicals and similar forms of it are most commonly referred to in the news as “steroids” and are sometimes used by athletes to assist in large muscle development. Corticosteroids have none of these effects, and are used to decrease inflamed tissue mainly in the lungs such as seen in asthma or on the skin as in poison oak reactions. The most common medications in this class are hydrocortisone and prednisone.

Can alcohol effect my asthma medications? 

Probably not. Alcohol by itself does not have any drug interactions with the medications used to treat asthma. One advantage of inhaled medicines is the minimal risks, side effects, and drug interactions. However alcohol can trigger or worsen an attack by causing dilation of blood vessels and therefore swelling of tissues. This can cause restriction of the airways. Allergies to ingredients in mixed drinks and sulfites in wine can cause allergic reactions and airway constriction. Alcohol can trigger gastroesophageal reflux (GERD) which is a notorious and sneaky asthma trigger. Note the antihistamines used to treat allergies and thus assist with asthma control should not be taken with alcohol because of increased sedation. Studies have shown taking an antihistamine can cause the same amount of drowsiness as 2 oz of alcohol.

How often should I check my peak flow meter?

Not everybody with asthma needs to have a peak flow meter, but they can be useful to help measure your asthma. In many people it can be more accurate than just how you feel. The number can be particularly useful after an asthma attack to help manage “stepping down” your treatment, but there are many ways the peak flow meter can be used. Ask your doctor. Once you have determined your personal best, you have a start. If it is not your personal best – why not? Some people use a zone approach, green, yellow, and red, where the green zone is considered safe, ranging down 20% from your personal best.

How should I use my inhaler?

I thought you would never ask! The first thing is to throw away the package directions because they are a couple of decades out of date. Over twenty years ago, some interesting studies were done. Inhaler canisters were loaded with radioactive labeled materials, then inhaled from per the package directions with the canister in the mouth. When the volunteers were scanned, over 95% of the radioactivity was found in the mouth and down into the stomach. Less than 5% was in the lungs. Worse than that, this small amount did not make it deep into the small airways where the asthma takes place. When inhaled through a spacer or holding chamber, over 20% was delivered into the lungs, and even into the smaller airways. That is more than a four fold increase in drug delivery. At the same time, less than 40% was in the mouth and stomach, were it would only give side effects and no benefit. Talk about a win-win situation!

Directions: Shake the canister, place it about an inch from your mouth and inhale slowly and deeply, and hold it in for at least 5 seconds (some say more than 10 seconds) before letting your air out. For rescue medication, more than 2 puffs a minute apart are often recommended, but there is no agreement to the maximum number of puffs.

Is it okay for inhalers to be used for asthma at school?

A resounding, YES! Not only is it okay for inhalers to be used for asthma at school, California state law states that schools must allow the use of inhalers as long as there is written permission by the health care provider and the parent/guardian. However, if the inhaler is misused (for example, shared with another student or sprayed at another student) the school may take disciplinary action. You may carry the inhaler on your person if your health care provider and parent/guardian agree on the permission form that you are mature enough. An inhaler may be stored in the office. Having an extra inhaler in the office will insure that your inhaler is at school in case you forget to bring it. If you are comfortable, you can tell a friend or one of your teachers where you keep your inhaler (pocket, backpack, etc.) to help you in case of an emergency.

Can inhalers be shared?

In general, the answer is no. You should not take medicines prescribed for somebody else. This is particularly important if you don’t know for certain what they do, or what the doses are.

Can inhalers be more user friendly?

Fortunately there are several ways to carry your inhaler. Purses, belt holders, fanny packs, and now the small cases used for cell phones can all be used. Dose counters are a great addition but they are not on all inhalers. The main thing, however, is that you should rarely need it. Think about it like your fire extinguisher: you sure want to have one handy! (You do have a fire extinguisher, don’t you?)

What do I do if I have an asthma attack without an inhaler?

If you are having an attack and do not have an inhaler, get help as soon as possible. How far away is your inhaler?  (It is not generally recommended to share medicines, but…..)  The sooner you treat your attack, the less chance of asthma becoming severe. If you wait too long it can be too late - this is how people die from asthma. Twenty-five percent of deaths from acute asthma happen within one hour of the onset of the attack. Once you determine that you are in the early stages of an attack, begin treatment according to your predetermined "Asthma Action Plan." Your Asthma Action Plan should include removing or reducing the exposure of any trigger that is contributing to the attack, if possible. Remember to remain calm because asthma worsens with panic. Some people find sitting near open windows makes them feel less panicky. Stop what you are doing. Try to take small slow breaths to slow your breathing down as much as you can by using the pursed lip breathing technique (breathing in through your nose and out of your mouth). Not only will this help you relax but will also conserve your strength. Sit in a position that you find comfortable, but lying down is not recommended. Your diaphragm (breathing muscle below the lungs) moves upward when you lie down and can make it more difficult to breath. Go quickly to your doctor's office or an emergency room. The sooner you see a doctor, the faster you get the help you need. Keep a card in your wallet and by your telephone at home with your doctor's name and telephone number. Also keep the ambulance or emergency number on the card. Call 911 for emergency care and if you are having difficulty talking, call and keep the line open and they will come to you.

How can I tell if my inhaler (MDI) is empty?

This is a good question, without a good answer. Counting the number of puffs is probably the only accurate method. Floating the inhaler canister is not accurate and may clog your inhaler if you try to use this method, which is no long endorsed.

Are there other health issues that can come from asthma?

If you control your asthma well, probably not! If you control your asthma (which most people can do - easily), you should be able to live a pretty normal life. It can interfere with normal activities such as school, work or exercise. You may need to limit your exercise, and some people need to avoid animals, or watch for other asthma triggers. Weight gain is possible from some of the medicines used when the asthma gets out of control, and from lack of exercise. People with asthma frequently have allergies (like “hay fever” or nasal congestion), and as such are prone to more colds, sinus, and ear infections, and marked seasonal changes with your asthma.

What about allergy shots? 

Ask you doctor. If you have significant allergy triggers (not foods), especially if they are hard to avoid, this may be an option. The more severe your asthma, the more you should consider shots, but they are a lot of work. The asthma meds we use now are so safe and powerful that most people don’t need shots any more.

Is there a relationship between clean air and asthma?

Dirt and fumes are constantly added to the air you breathe. Depending on where you live, most of the pollution comes from automobiles. The cleaner the air, the better you breathe. Dirty air or smog irritates the lungs as you breathe it in the air. Some studies show that some particles in the air stay in your lungs and are associated with asthma and lung damage. You should avoid exposure outside on “Spare the Air” Days for high pollutants.  You can obtain more information at www.sparetheair.com.

How does smoking tobacco affect asthma?

Your lungs are more irritated when you smoke, and therefore are more sensitive to other triggers. Tobacco smoke does not let your cilia (hair like structure in the trachea and airways that normally sweep upward) remove mucus. Smoking or exposure to secondhand smoke can trigger an asthma attack. You may require more medication to keep your asthma under control due to the exposure to the smoke.

Do the different forms of smoking make a difference (cigarettes, marijuana, hookah pipe, etc.)?

All types can be hazardous but there are some differences. Cigarette and marijuana smoke is a lot hotter as you inhale and cause damage to the lungs. The smoke can irritate and possibly cause damage to already hypersensitive airways. Your lungs receive different amounts of smoke due to differences in inhaling. Smoke inhaled through a hookah pipe is cooler, so you inhale the smoke deeper. All smoke has carbon monoxide and it binds with your hemoglobin creating less room for oxygen on your red blood cells. As you breathe in the burning tobacco, you have the potential to breathe in 4,000 chemicals that are harmful to your lungs and the rest of your body. Tobacco products are the only products, which when used at the usual and recommended dosage, are known to cause cancer.

Are there any long term effects from smoking if you have asthma?

There can be long term effects for anyone who smokes, ranging from shortness of breath, to additional respiratory complications, to hazards to your heart and lung disease. Asthmatics may have an earlier onset of complications or symptoms that need to be treated. There is also significant effect on lung function. Remember, poorly controlled asthma, or smoking, can cause emphysema. An asthmatic who smokes has a double whammy. What color oxygen tank would you like to match your wheelchair?

How does second hand smoke affect asthma?

Secondhand smoke is a strong respiratory irritant and can cause or worsen respiratory conditions. With asthma, any smoke is a serious trigger. Smoking in any room in the home, in the car and/or smoke odor on clothing, skin and hair (ever notice how bad a smoker smells close up?) can be enough to cause asthma symptoms. Studies have shown that children with asthma who are exposed to secondhand smoke require more asthma medicines, have more emergency room visits and have lower lung function.

How can I get past the fears and reluctance of telling others that I have asthma?

Fortunately, for most people, once your asthma is well controlled, you shouldn’t need to tell many people about your asthma. You may need to inform people about your asthma triggers, such as animals or foods, if you are going to visit them. You may fell it important to tell someone if you have repeating symptoms and taking medications on a regular basis.

Are there any key words and phrases that will help me talk about my asthma?

Chest tightness, cough, shortness of breath, exercise tolerance, nocturnal (night time) cough, wheezing and trouble breathing.

What can friends or family members do to help when I have an asthma attack?

If you are having an attack, they can assist you if necessary. It is okay to use more than two puffs, and it may help if the puffs are spaced several minutes apart to help open up the airways, so that the next puffs can get deeper into the lungs. Remember that when the studies were done, to determine the dose of the inhalers, they were using the old-fashioned technique. That technique had much more side effects. We can’t say what the maximum number of puffs is, but four puffs, five or ten minutes apart, works as well as a nebulizer for rescue, with less side effect – if your inhaler technique is good! If you are having trouble walking or talking due to shortness of breath or lips or fingernails are gray or blue, they can call 911 to get help immediately. After they have called for help, they can remove or reduce the exposure of any trigger that is contributing to your attack, if possible.

What information can I share with my parents so that I can assert independence when it comes to other activities?

You can show independence by taking responsibility for your asthma. Keep it under control, use your medications correctly without reminders, keep track of when the medication needs to be refilled, understand and follow your Asthma Action Plan, stay away from triggers and be honest about you asthma. You can also demonstrate responsibility during other activities that impact asthma such as sports, staying over night at friends and going on trips. You can also share written materials on asthma that encourage participating in a full range of activities with your parents. You can also discuss this issue with your parents and doctor. In other words, you want to have a say in what you can do.

What are some key words and phrases that can help teachers and coaches better understand asthma?

  • “Exercise triggers my asthma. I need to use my inhaler before PE so I can breathe better and need to keep my inhaler with me to run/exercise/play better.”
  • “The permission letter for carrying my inhaler is in the office.”
  • “I have asthma. It is more difficult for me to breathe when I am around my triggers (animals, strong smells, chalk dust, whatever trigger is in the classroom). May I sit further from the board? Can the animal be removed? Etc.”
  • “I can get a letter from my health care provider documenting my asthma.”
  • “I am having trouble breathing. Can someone go with me to see the nurse?”
  • “I need a break, I need to sit down and/or I need my asthma medication.”      

How can I feel empowered to share this information about asthma with my teachers and coaches?

Your school nurse should be able to educate your coaches and teachers and write an “Emergency Health Plan.” Either your school nurse or your doctor can provide written info for school staff. A copy of your Asthma Action Plan can be given to school staff. You should be knowledgeable about your asthma and can go with friends to talk to teachers and coaches.  A note from your doctor should help. 

How many asthma related deaths are there each year?

In 2003 in the US, over 4,099 deaths were attributed to asthma. However, deaths due to asthma are rare among children. The number of deaths increases with age. In 2003, 154 children in the US under 15 died from asthma compared to 671 adults over 85. (http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=44352)

Is asthma related death more of a risk for teens?

No. Within the last few years, mortality and hospitalizations due to asthma have decreased and asthma prevalence has stabilized, possibly indicating a better level of disease management, such as increased use of inhaled steroids.  Asthma death rates increase with age usually after the age of 85. (http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=44352)

Will my asthma ever go away? Will I grow out of it? Can it be cured?

There is no cure for asthma: at least not yet. Some young children appear to stop having symptoms but the asthma could come back. The development of an allergic trigger is a primary reason for persistence of symptoms. Asthmatics have hypersensitive airways and may have dormant periods.

For more information about asthma, contact Cassie Gardener at (916) 444-5900 ext. 215 or cgardener@sacbreathe.org.

 

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