Asthma and Allergies
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Asthma and Allergies
Pamela Amelung, MDMini-Med School Fall 2006University of Maryland School of Medicine
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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
Topics Covered
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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.
What is Asthma ?
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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
The facts about Asthma
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0
2
4
6
8
10
12
14
16
18
1993
1998
How many people have Asthma
? 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.
*MMWR December 04, 1998 / 47(47);1022-1025
13.7
17
Mil
lion
s of
indi
vidu
als
diag
nose
d
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The cost of Asthma ! Asthma costs
billions of dollars each year and the cost is rising.
The estimated annual cost of asthma in 2000 was $14.5 billion.
* www.cdc.gov
1990 2000
$6.2 billion
$ 14.5 billion
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The cost of Asthma ! 3 million lost
work days
10 million lost school days each year from asthma
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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
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Race and asthma
Mortality
0.5
1
1.5
2
2.5
3
3.5
1979 1981 1983 1985 1987 1989 1991 1993
Black White Other
U.S
. A
ge-
Ad
just
ed
Mo
rtal
ity/
100,
000
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Asthma Mortality:Female vs. Male
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1979 1981 1983 1985 1987 1989 1991 1993
Ag
e-A
dju
ste
d M
ort
ali
ty/1
00
,00
0
FemaleMale
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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
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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.
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Coughing
Wheezing
Chest tightness
Shortness of breath
Symptoms of Asthma
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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.
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Indoor air Triggers
Environmental tobacco smoke (ETS)
Cockroaches Dust mites Animal dander Mold, mildew Strong scented products
(perfumes, scented cleaners)
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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
Why indoor air is Important
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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
Secondhand Smoke
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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
Dust Mites
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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.
Pets
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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.
Molds
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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.
Cockroaches and other Pests
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Outdoor air Triggers
Ozone
Particulate matter
Sulfur dioxide
Nitrogen dioxide - vehicle exhaust
Outdoor pollens and mold
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Additional Triggers Viral upper
respiratory infections Exercise Aggravating
conditions - gastric reflux, sinusitis, rhinitis
Diet, medication Cold air Changes in weather Menstrual cycle,
pregnancy
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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
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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
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Management of
AsthmaAsthma is one condition that, when treated
with timely and effective regular outpatient care,
prevents hospitalization and ED visits.
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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
Managing Asthma
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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
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Choose not to smoke in your home or car and do not allow
others to do so either.
Avoiding secondhand
Smoke
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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%
Avoiding dust Mites
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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.
Avoiding pet Triggers
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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.
Avoiding mold Triggers
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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)
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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
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Peak expiratory flow (PEF) Meters
Allows the Allows the patient to patient to assess the assess the status of his status of his or her or her asthmaasthma
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Peak flow Chart
People with People with moderate or moderate or severe asthma severe asthma should take should take readingsreadings—— Every morning Every morning and eveningand evening After an After an exacerbationexacerbation Before inhaling Before inhaling certain certain
medicationsmedicationsSource: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBICreated and funded by NIH/NHLBI
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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”
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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
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Asthma action Plan
National Heart, Lung, and Blood Institute
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Asthma is Increasing
Why the increase? Increased recognition, diagnosis-shifting Environmental allergens - indoor, outdoor
– Energy-efficient buildings, carpet Exposure to mother’s tobacco smoke Psychosocial and socioeconomic factors
– More time indoors– Overcrowding– Access to care
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“Hygiene
Hypothesis”
Are we too clean ? 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
T0
T2T1
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“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
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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
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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.