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ALLERGIES & ASTHMA

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ALLERGIES    & ASTHMA

Asthma is a chronic condition that causes inflammation and narrowing of the bronchial tubes, the passages that allow air to enter and leave your lungs.It is caused by genetic as well as environmental factors like pollution. Exposure to air pollution early in life contributes to the development of asthma throughout childhood and adolescence. Traffic-related air pollution in particular is associated with the development of asthma in school children. Air pollution exposure is thought to potentially cause asthma in children by impacting the developing lung and immune system. Even if a pregnant mother is exposed to pollution the child will have a higher risk of developing asthma.

Asthma may be triggered by many different things, but common asthma triggers include exercise (This is called exercise-induced bronchoconstriction), illness and allergens such as dust mites, pollen or pet fur. Others can be the weather, stress, smoke and even some foods as well as certain medications which include aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and beta-blockers (used for blood pressure and migraine).

Smoking can also make asthma worse; and smokers are particularly likely to suffer from a combination of both asthma and COPD (Chronic Obstructive Pulmonary Disease).

There are two types of asthma:

  •    Allergic. This type is triggered by exposure to an allergen, such as fungus or pet dander.
  •    Allergic asthma often shares the same allergic triggers as allergic rhinitis.
  •    It is important to consider allergy and asthma as the manifestations of a hypersensitive “UNITED AIRWAYS.”
  •    The second National Heart, Lung, and Blood Institute (NHLBI) guideline on allergic rhinitis & asthma management recommends that all allergic rhinitis & asthma patients who require daily or weekly therapy be evaluated for allergens as possible contributing factors.10 They also note that, in selected patients with asthma at any level of severity, specific allergy testing may be indicated as a basis for allergen avoidance or immunotherapy.
  •    Non-allergic. This is brought on by factors such as stress, exercise, illness, extreme weather, irritants in the air and certain medications.

Symptoms of asthma :

  •    Coughing
  •    Wheezing
  •    Shortness of breath

Asthma Diagnosis

An allergist diagnoses asthma by taking a thorough medical history and performing lung function tests tests to measure the oxygen carrying capacity of the lungs. One of these tests is called spirometry. You will take a deep breath and blow into a sensor to measure the amount of air your lungs can hold and the speed of the air you inhale or exhale. This test diagnoses asthma severity and measures how well treatment is working.

FeNO test or exhaled nitric oxide test, in patients with allergic or eosinophilic asthma, is a way to determine how much lung inflammation is present and how well inhaled steroids are suppressing this inflammation. With allergic or eosinophilic asthma, sometimes you may feel your breathing is fine, but when you measure your exhaled nitric oxide, it may still be significantly elevated, and you might do better in the long-term using slightly more of your inhaled steroid to suppress this inflammation.

allergy testing may be advised as many people with asthma also have allergies, so treating the underlying allergic triggers for your asthma will help you avoid asthma symptoms.

Asthma Medications

Asthma is a chronic disease, so it requires ongoing management. This includes using proper medications to prevent and control symptoms and to reduce airway inflammation.

There are two general classes of asthma medications, quick-relief and long-term controller medications. Your allergist may recommend one or a combination of two or more of these medications.

Quick-relief medications are used to provide temporary relief of symptoms and, at times, used before exercise. These rescue medicines are bronchodilators, which help to open up the airways so that more air can flow through. Bronchodilators are primarily short-acting beta-agonists administered by an inhaler or a nebulizer machine. Another type of medicine called an anticholinergic may be used at times.

Long-term controller medications are important for many people with asthma, and are taken on a daily basis to control airway inflammation and treat symptoms in people who have frequent asthma symptoms.

Inhaled corticosteroids and leukotriene modifiers can help control the airway inflammation occurring in most people who have asthma. Inhaled long-acting beta-agonists are symptom controllers that open your airways. Current recommendations are for them to be used only along with inhaled corticosteroids.

Long acting inhaled anticholinergic medications may also be added to long-term controller therapy.

Theophylline can help open the airways and may have a mild anti-inflammatory effect. Blood levels of theophylline need to be monitored.

Omalizumab is an injectable drug class called Biologics that helps reduce allergic inflammation. It is used in certain patients with severe persistent allergic asthma.

Mepolizumab, reslizumab, benralizumab and dupilumab are injectable medications that reduce inflammation by targeting cells called eosinophils and other allergic pathways. They are indicated in the treatment of eosinophilic or oral-steroid dependent asthma.
Additionally, since Asthma is also associate with allergic rhinitis, it may be necessary to control the symptoms of rhinitis in order to aid the control of Asthma. Nasal allergy medications that don't make you sleepy (like over-the-counter generic Fexofenadine), saline rinses, and decongestant nasal sprays (but only for a few days) can help. If these don't work, use nasal steroid sprays and stronger antihistamines. If none of this helps, it may be time to talk to a doctor about allergy Immunotherapy.

If your asthma is triggered by an allergy or if in spite of repeated medication there is no improvement, Allergen immunotherapy is a useful treatment modality in the control of mild to moderate asthma and is now a part of the global standard guidelines used by specialists for the management of asthma.

Immunotherapy reduces asthma symptoms and use of asthma medications and improves bronchial hyper-reactivity.  One trial found that the size of the benefit can even possibly be comparable to inhaled steroids1. 

In many cases Immunotherapy is very effective in relieving allergy symptoms and in some cases can actually cure your allergy. It works by introducing small amounts of the allergen in gradually increasing amounts over time. Over time, allergy immunotherapy gradually reduces your immune system reaction (allergic reaction) to specific allergens, (pollens, dust mite, pets, mould), thus building up a tolerance to the effects of the allergen, and thus eventually reducing and can even eliminating your allergy symptoms.
The treatment can be either by injectable subcutaneous immunotherapy (SCIT), which involves injection of small amounts of the purified allergen extract over time, or Sub-lingual Immunotherapy, which involves introducing the purified allergen extract by mouth. This is much more convenient, especially for children.

Bronchial Thermoplasty is an outpatient procedure that reduces the smooth muscle around the airways. It may be considered in patients with severe asthma.

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Your allergist can help guide you to choose the correct medication and will help create a treatment plan which will best help you control your symptoms.

Pregnancy may affect the severity of your asthma symptoms. One study showed that asthma symptoms were worse in 35% of pregnant women, improved in 28% and remained the same in 33% of pregnant women. Asthma has a tendency to get worse in the late second and early third trimesters.

Uncontrolled asthma symptoms can cause a decrease in the amount of oxygen in your blood supply. The fetus gets its oxygen from your blood. Since a fetus needs a constant supply of oxygen for normal growth and development, managing asthma symptoms is very important to allow you and your baby to get enough oxygen.

Is it safe to take asthma medications during pregnancy? The risks of asthma flare-ups are greater than the risks of taking necessary asthma medications. Studies show that most inhaled asthma medications are safe for women to use while pregnant. However, oral medications (pills) should be avoided unless necessary to control symptoms. 




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