elderly with asthma

7/30/2019 Elderly With Asthma

1/72

1

Elderly with asthma

Except for some precautions, goal of asthma treatment in elderly is same as that in other age group.

The main points to remember and consider in elderly people suffering with asthma are discussed

below.

1. Elderly asthmatics are usually suffering from few other medical conditions that may interfere with

asthma treatment. This includes hypertension, IHD, diabetes mellitus and other related diseases.

2. Elderly do not respond as well to drug treatment as young people, so drugs must not be overused

as they may aggravate other medical conditions like cardiac disease, arthritis etc.

3. Patient should tell his doctor which medicines he/she is taking for which disease. Medicines that

may aggravate asthma like aspirin (commonly used in cardiac conditions and arthritis) and beta-

blockers (atenolol) are to be avoided.

4. It is important not to misdiagnose asthma as COPD because asthma has a different natural history

and a better prognosis with treatment. COPD is mainly a disease of smokers. Read more aboutCOPD.

5. Dyspnea (breathlessness) in elderly occurs due to many causes that include congestive heart

failure and other forms of chronic heart and lung diseases.

6. Smoking or exposure to tobacco smoke should be avoided.

7. When doingspirometryin elderly, a consistent pattern of decreasing FEV1 in tests repeated during

the session is suggestive of asthma.

8. Depression is very common in elderly and can decrease their compliance to thetreatment of

asthma. Depression is also one of the most treatable problems in the elderly so should not be

ignored.

9. Indoor allergens or triggers (dust mite, molds etc.) may be more important to evaluate than

outdoor allergens since most elderly people spend more time in their homes than outside. The

specific allergen will vary by geographic region. Allergy testing can identify the offending allergen.

10. Diseases that mimic asthma in elderly are:

a. Chronic Obstructive Pulmonary Disease.

b. Interstitial Lung Disease.c. Bronchiectasis.

d. Cardiac Disease (Angina, IHD and Congestive Heart Failure).

e. Upper Airflow Obstruction (Encroaching tumors, vocal cord paralysis, and thyroid enlargement).

f. Pulmonary Embolism.

g. Bronchogenic carcinoma.

h. Aspiration.

i. Gastroesophageal Reflux.

back to top
http://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/elderly-asthma.htmhttp://www.asthmahelpline.com/elderly-asthma.htmhttp://www.asthmahelpline.com/elderly-asthma.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/COPD.htm


2/72

2

11. Elderly patients withasthmacan also have chronic, persistent airflow obstruction with poor

bronchodilator responsiveness; a trial of therapy with corticosteroids for 15 days or more may be

necessary to establish that there is reversible airflow obstruction.

12. Coexisting conditions (e.g., respiratory infections, gastroesophageal reflux) may exacerbate

asthma, hinder effective therapy, and reduce asthma control.

13. Someasthma medications(e.g., theophylline, beta-adrenergic bronchodilators) can elicit adverse

responses (e.g., cardiac ischemia or arrhythmia, drug toxicity, gastroesophageal reflux) in susceptible

patients with coexisting disorders (e.g., ischemic heart disease, congestive heart failure, acute

myocardial infarction, gastroesophageal reflux).

14. Nonselective beta-adrenergic blocking agents (like Timolol, atenolol), even in minute quantities

as present in ophthalmic solutions, should not be prescribed for patients with asthma, because they

can produce severe bronchospasm and perhaps anaphylaxis.

15. System corticosteroids, thiazide diuretics and beta2-agonists may contribute to hypokalemia

(decreased potassium in blood) therefore routine monitoring of serum potassium and magnesium for

early detection of electrolyte imbalance should be done.

16. Many elderly patients with asthma have concurrent rhinitis or sinusitis for which they take

antihistamines (terfenadine and astemizole) which have the potential to produce prolongation of the

QTc interval that could lead to ventricular arrhythmias such as Torsade de Pointes

17. Angiotensin-Converting-Enzyme (ACE) Inhibitors. can produce chronic cough in some patients.

18. Review of patient technique in taking medications is also important; not infrequently, a failure torespond adequately to therapy is a result of improper medication/inhaler technique.

19.Peak flow meter: The effectiveness of home peak flow monitoring among the elderly has not

been clearly established.

20. Allergy Tests: Allergy skin tests or studies of specific IgE need not be routinely performed because

allergens seem to play a less important role for elderly patients than younger patients.

21. Respiratory infections and medications for other diseases are the most common asthma triggers

in elderly patients.

22. Measures to avoid or controlasthma triggersshould be specific to the patients asthma and

allergy history.

23. Avoidance of exposure to allergens and tobacco smoke, both active and passive, is important as

with asthma patients of any age.
http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/index.htm


3/72

3

What is asthma

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements

play a role: in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and

epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing,

breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These

episodes are usually associated with widespread but variable airflow obstruction that is often

reversible either spontaneously or with treatment. The inflammation also causes an associated

increase in the existing bronchial hyperresponsiveness to a variety of stimuli. Reversibility of airflow

limitation may be incomplete in some patients with asthma.

"Guidelines for the Diagnosis and Management of AsthmaFull Report, 2007

Asthma is often linked to allergies, heredity and environment. In a normal individual, various

airborne allergens (triggers) stimulate the production of antibodies and other chemicals in controlled

quantity, which destroy the allergen but dont harm the body. But in allergic individual who have

asthma there is over production of antibodies and other chemicals which cause inflammation of theairways, which is hallmark of asthma.

Prevalence of asthma

Asthmais considered as a major public health problem in many countries. It is one of the most

common chronic disease affecting both adults and children. According to world health organization

there are at least 300 million people suffer from asthma worldwide and more than 180,000 people

die from it each year. Despite the availability increasingtreatment, asthma-related morbidity and

mortality continues to rise. The prevalence of asthma is increasing in developed as well developing

countries through the world. The current prevalence of asthma is estimated to be 5 to more than10%.

Defining features and symptoms of asthma

- Cough - Wheezing - Dyspnea or breathlessness.

moulds, cold air

and allergic disease like eczema, allergic rhinitis, allergic conjunctivitis.
http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/


4/72

4

Symptoms of asthma are due to intermittent reversible obstruction of airways caused by airway

inflammation, airway hyper responsiveness and muscle spasm.

Clinical hallmark of asthma include following symptoms:

1. Episodic wheezing,

2. Breathlessness or shortness of breath,

3. Cough specially at night and sputum production.

4. Chest tightness, pain or pressure.

Between the episodes of asthma symptoms improve or may disappear completely. Asthma

symptoms can vary from mild to severe. Before the attack of asthma occur, there are some early

warning signs or symptoms that can tell the person that the asthma attack is about to occur.

Early warning signs of asthma attack:

Full-blownasthmaattack is usually preceded by certain signs and symptoms. They are as follows:

1. Loosing you breath easily or shortness of breath.

2. Feeling tired or weak.

3. Wheezing or coughing after exercise.

4. Decrease in PEFR reading in Peak flow meter or lung functions measured by

spirometer.

5. Signs of cold or allergies like itchy throat, running or stuffy nose, headache.

6. Trouble sleeping.

7. Chest tightness.

8. Change in amount, color and thickness of mucus.

According to the American College of Emergency Physicians, recognizing and responding to the

following warning asthma signs and symptoms can help people avoid anasthma emergency:

-relief inhaler more than twice a week;

activity;
http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/


5/72

5

Go to your doctor immediately if you have any of these symptoms because there is a need for urgent

or emergency care.

Asthma symptoms during asthma attack:

Full blown attack of asthma usually has following symptoms which are usually episodic:

1.Wheezing. A high pitched whistling sounds produced when breathing out especially in children.

Lack of wheezing and a normal chest examination do not exclude asthma.

2. Coughing (specially in night).

3. Recurrent breathlessness or Shortness of breath.

4. Tightness of the chest, pain or pressure.

Asthma symptoms vary from person to person. Some may have all the above asthma symptoms and

some may have few of them. Severity of asthma symptoms may vary in each attack.

Asthma symptoms getting worse:

Inasthma attackairways become narrow, thus making difficult for the patient to breath air in andout of the lungs. The main cause of airway narrowing are:

1. The muscles surrounding the airways tighten. This narrowing of airway due to muscle spasm is

called bronchospasm.

2. Inflammation of airways causing further narrowing.

3. Excessive mucous production, which fill the airways with mucous.

All of these factors bronchospasm, inflammation, and mucus productioncause asthma symptoms

such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performingnormal daily activities.

Other symptoms of anasthma episodeinclude some or all of the below:

1. Severe wheezing when breathing both in and out.

2. Coughing that won't stop.

3. Very rapid breathing and nasal flaring (the nostril size increases with each breath, a sign that

person is working harder to take each breath.

4. Chest pain or pressure.
http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/index.htm


6/72

6

5. Tightened neck and chest muscles, called retractions.

6. Trouble focusing and talking.

7. Feelings of anxiety or panic.

8. Pale, sweaty face.

9. Cyanosis causing blue lips or finger nails.

The symptoms of status asthmaticus (Acute severe asthma) may include:

1. Persistent shortness of breath,

2. Inability to speak in full sentences,

3. Patient may be breathlessness even while resting,

4. Patient chest may feel closed,

5. Lips and/or finger nails may have a bluish tint,

6. In acute severe asthma patient may feel agitated, confused, or an inability to concentrate.

7. Patient may hunch his shoulders, sit or stand up to breathe more easily, and strain the abdominal

and neck muscles.

8. These are signs of an impending respiratory system failure.

9. Silent chest i.e. no wheezing and coughing is ominous sign of asthma.

Very severe asthma attacks such as status asthmaticus may constrict the airways so much that there

is very less flow of air in and out of the lungs. Thus there may be no wheezing sound or coughing

(silent chest).

Unusual symptoms of asthma:

Being easily fatigued, and unable to exercise properly may be a sign orsymptom of asthma. Other

unusual symptoms of asthma are:

-variant asthma),


7/72

7

rating,

Symptoms of asthma occur or become worsen in the presence of:

-dust mites (in mattresses, pillows, upholstered furniture, carpets),

,

Symptoms ofasthmamay occur or become worsen at night, making the patient to awake.

Symptoms of asthma are due to intermittent reversible obstruction of airways

caused by airway inflammation, airway hyper responsiveness and muscle spasm.

Clinical hallmark of asthma include following symptoms:

1. Episodic wheezing,

2. Breathlessness or shortness of breath,
http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/


8/72

8

3. Cough specially at night and sputum production.

4. Chest tightness, pain or pressure.

Between the episodes of asthma symptoms improve or may disappear completely. Asthma

symptoms can vary from mild to severe. Before the attack of asthma occur, there are some earlywarning signs or symptoms that can tell the person that the asthma attack is about to occur.

________________________________________

Early warning signs of asthma attack:

Full-blown asthma attack is usually preceded by certain signs and symptoms. They are as follows:

1. Loosing you breath easily or shortness of breath.

2. Feeling tired or weak.

3. Wheezing or coughing after exercise.

4. Decrease in PEFR reading in Peak flow meter or lung functions measured by

spirometer.

5. Signs of cold or allergies like itchy throat, running or stuffy nose, headache.

6. Trouble sleeping.

7. Chest tightness.

8. Change in amount, color and thickness of mucus.

________________________________________

According to the American College of Emergency Physicians, recognizing and responding to the

following warning asthma signs and symptoms can help people avoid an asthma emergency:

Wheezing and/or coughing that disturbs sleep at night;

Having to use a quick-relief inhaler more than twice a week;

Taking time off from work or school due to breathing problems;

Consistently having trouble breathing during physical activity;

Inability to take part in normal, everyday activities;

Go to your doctor immediately if you have any of these symptoms because there is a need for urgent

or emergency care.

________________________________________


9/72

9

Asthma symptoms during asthma attack:

Full blown attack of asthma usually has following symptoms which are usually episodic:

1. Wheezing. A high pitched whistling sounds produced when breathing out especially in children.

Lack of wheezing and a normal chest examination do not exclude asthma.

2. Coughing (specially in night).

3. Recurrent breathlessness or Shortness of breath.

4. Tightness of the chest, pain or pressure.

Asthma symptoms vary from person to person. Some may have all the above asthma symptoms and

some may have few of them. Severity of asthma symptoms may vary in each attack.

________________________________________

Asthma symptoms getting worse:

In asthma attack airways become narrow, thus making difficult for the patient to breath air in and

out of the lungs. The main cause of airway narrowing are:

1. The muscles surrounding the airways tighten. This narrowing of airway due to muscle spasm is

called bronchospasm.

2. Inflammation of airways causing further narrowing.

3. Excessive mucous production, which fill the airways with mucous.

All of these factors bronchospasm, inflammation, and mucus productioncause asthma symptoms

such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing

normal daily activities.

Other symptoms of an asthma episode include some or all of the below:

1. Severe wheezing when breathing both in and out.

2. Coughing that won't stop.

3. Very rapid breathing and nasal flaring (the nostril size increases with each breath, a sign that

person is working harder to take each breath.

4. Chest pain or pressure.

5. Tightened neck and chest muscles, called retractions.

6. Trouble focusing and talking.

7. Feelings of anxiety or panic.

8. Pale, sweaty face.


10/72

10

9. Cyanosis causing blue lips or finger nails.

________________________________________

The symptoms of status asthmaticus (Acute severe asthma) may include:

1. Persistent shortness of breath,

2. Inability to speak in full sentences,

3. Patient may be breathlessness even while resting,

4. Patient chest may feel closed,

5. Lips and/or finger nails may have a bluish tint,

6. In acute severe asthma patient may feel agitated, confused, or an inability to concentrate.

7. Patient may hunch his shoulders, sit or stand up to breathe more easily, and strain the abdominal

and neck muscles.

8. These are signs of an impending respiratory system failure.

9. Silent chest i.e. no wheezing and coughing is ominous sign of asthma.

Very severe asthma attacks such as status asthmaticus may constrict the airways so much that there

is very less flow of air in and out of the lungs. Thus there may be no wheezing sound or coughing

(silent chest).

________________________________________

Unusual symptoms of asthma:

Being easily fatigued, and unable to exercise properly may be a sign orsymptom of asthma. Other

unusual symptoms of asthma are:

Chest tightness and difficulty breathing in the early morning hours,

Dry hacking cough (cough-variant asthma),

Constant sighing,

Rapid breathing,

Difficulty sleeping,

Anxiety; difficulty concentrating,

Asthma symptoms can present as vomiting after bout of coughing in a child.

________________________________________


11/72

11

Symptoms of asthma occur or become worsen in the presence of:

Exercise,

Viral infection,

Animals with fur or hair,

House-dust mites (in mattresses, pillows, upholstered furniture, carpets),

Mold,

Smoke (tobacco, wood),

Pollen,

Changes in weather,

Strong emotional expression (laughing or crying hard),

Airborne chemicals or dusts,

Menstrual cycles

,

Symptoms of asthma may occur or become worsen at night, making the patient to awake.

Causes or triggers of asthma

There are various mechanisms that cause asthma and vary among population groups and

even individuals. It is seen that many asthma sufferers also have allergies. Not all people

with allergies have asthma; however, not all cases of asthma can be explained by allergic

response.

Asthmais most likely a result of genetic susceptibility, which probably involves several

genes and various environmental factors.

An asthma attack can be induced by direct irritants (allergens or triggers) to the lungs such

as:

House dust mite, specifically mite faces.

Pollen.

Molds and fungi.

Animal dander.

Cockroach.

Pollution.
http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/house-dust-mite.htmhttp://www.asthmahelpline.com/house-dust-mite.htmhttp://www.asthmahelpline.com/large%20photos/POLLEN-2.jpghttp://www.asthmahelpline.com/large%20photos/POLLEN-2.jpghttp://www.asthmahelpline.com/large%20photos/fungus%20new.jpghttp://www.asthmahelpline.com/large%20photos/fungus%20new.jpghttp://www.asthmahelpline.com/photos%20site/COCKROACH.jpghttp://www.asthmahelpline.com/photos%20site/COCKROACH.jpghttp://www.asthmahelpline.com/photos%20site/air%20pollution.jpghttp://www.asthmahelpline.com/photos%20site/air%20pollution.jpghttp://www.asthmahelpline.com/photos%20site/air%20pollution.jpghttp://www.asthmahelpline.com/photos%20site/COCKROACH.jpghttp://www.asthmahelpline.com/large%20photos/fungus%20new.jpghttp://www.asthmahelpline.com/large%20photos/POLLEN-2.jpghttp://www.asthmahelpline.com/house-dust-mite.htmhttp://www.asthmahelpline.com/


12/72

12

Cigarette smoking can cause both asthma andCOPD.

Food allergies.

Occupational triggers.

Exercise.

Infections.

Hormones.

Cold air.

Extreme emotions.

Drugs.

Gastro esophageal reflux disease (GERD).

Types of Asthma

Asthma of any cause is a chronic inflammatory disease of the airways.Asthmacan be

classified in following categories:

Extrinsic asthma:

It is the most common form ofasthma in all age group. It usually affect young age group.

When any foreign particle either an allergen or an antigen enters into the body, the immune

system of the body overreacts and forms antibodies and other chemicals to defend the

body. This is a natural process of the body. The production of antibodies and the other

chemicals bring specific changes in the airways which leads asthma.

Various inhaled allergens like pollens, animal dander and dust mites are most common

causes to develop extrinsic asthma.

Extrinsic asthma is also known as atopic asthma orallergic asthma.

People with allergic asthma and their family members frequently have other allergy related

problems such as fever, skin rashes, hives, eczema, and rhinitis.

Intrinsic asthma:

The intrinsic asthma is not related with the allergies. In fact it is caused by inhalation of
http://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/asthma-causative-agents.htmhttp://www.asthmahelpline.com/asthma-causative-agents.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/asthma-causative-agents.htmhttp://www.asthmahelpline.com/COPD.htm


13/72

13

certain chemical such as cigarette smoke, fumes of motor vehicles and factories, strong

odors, intake of certain medicines like aspirin; chest infections, stress, laughter, exercise,

cold air, food preservatives like azinomoto or a myriad of other factors.

Antibodies are not produced by the body and the cause of developing intrinsic asthma maybe the irritation of the nerves or muscle in the airway.

Back to top

Mixed asthma:

It is mixture of allergic asthma and intrinsic asthma. These people react to some allergies but

their asthma is also triggered by other things also. For example symptoms are aggravated in

an asthmatic while facing the chest infection.

Apart from above classification of asthma you can further categorize asthma. Your condition

may have been given one of the following labels.

Cough variant asthma:

Cough may be the sole manifestation of asthma or a distressing symptom. Although chronic

cough can be a sign of many health problems, it may be the principalor only

manifestation of asthma, especially in young children. This has led to the term cough

variant asthma. Monitoring of PEF or methacholine inhalation challenge, to clarify whether

there is bronchial hyperresponsiveness consistent with asthma, may be helpful in diagnosis.

The diagnosis of cough variant asthma is confirmed by a positive response to asthmamedication. Treatment should follow the stepwise approach to long-term management of

asthma.

(Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report

2007)

Back to top
http://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htm


14/72

14

Nocturnal asthma:

The patients presents themselves with the symptoms likewheezing, cough, breathlessness

in the night in between 2.00am to 4.00am. Such night time symptoms disturb sleep andimpair the quality of life. Nocturnal asthma is defined as an overnight fall of more than 20%

in the FEV1 or PEFR. Sometimes this may be the sole manifestation of asthma or an

important indicator of poorly controlled day time asthma. This night time propensity is due

to a number of reasons:

e to dust mite, animal dander.

-esophageal reflux.

off.

Back to top

Gastro-esophageal asthma:

Asthma may be caused or worsened by to gastro-esophageal reflux. The symptoms of GERD

are common in both children and adults who haveasthma. Reflux during sleep can

contribute to nocturnal asthma. Treatment with a proton pump inhibitor was reported to

reduce nocturnal symptoms, reduce asthma exacerbations, and improve quality of life

related to asthma. Surgical treatment has been reported to reduce the symptoms of asthma
http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/types-of-asthma.htmhttp://www.asthmahelpline.com/index.htm


15/72

15

and the requirement for medication.

For patients who have poorly controlled asthma, particularly with a nocturnal component,

investigation for GERD may be warranted even in the absence of suggestiveasthma

symptoms.

medical management of GERD be instituted for patients who have asthma and complain offrequent heartburn or pyrosis, particularly those who have frequent episodes of nocturnal

asthma.

Medical management of GERD includes:

- to 8-inch blocks.

For patients who have persistent reflux symptoms following optimal therapy, further

evaluation

is indicated and surgical treatment may be advised.

Exercise Induced Asthma:

Exercise induced asthmaonly refers to asthma that occurs only with exercise.

Before exercise pulmonary functions tends to be normal, but within 5 to 10 minutes of

exercise they tend to fall. Pulmonary functions comes back to normal after rest but some

times tend to remain low for a longer time.

The mechanism is not clear; increased blood flow and mediator release due to change in

osmotic pressure have been proposed as probable causes.

How is asthma diagnosed?

The diagnosis of asthma is based on the patient's medical history, physical examination, and

laboratory test results. To establish a diagnosis of asthma, the clinician should determine

that:
http://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htm


16/72

16

e.

Recommended methods to establish the diagnosis of asthma are:

Physical examination.

Physical examination focusing on the upper respiratory tract, chest, and skin.

triggers the asthma symptoms or when the asthma symptoms get worse

.

Investigations likeSpirometryto demonstrate obstruction and assess reversibility, including

in children 5 years of age or older. Significant reversibility is indicated by an increase of > 12

percent and 200 mL in FEV1 after inhaling a short-acting bronchodilator (American Thoracic

Society 1991). A 2 to 3 week trial of oral corticosteroid therapy may be required to

demonstrate reversibility. Spirometry is necessary for diagnosis of asthma.

Differential diagnosis of asthma:

INFANT AND CHILDREN:

Upper airway diseases

Allergic rhinitis and sinusitis.

Obstructions involving large airways

Foreign body in trachea or bronchus. Vocal cord dysfunction. Vascular rings or laryngeal webs. Laryngotracheomalacia, tracheal stenosis, or bronchostenosis.
http://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htm


17/72

17

Enlarged lymph nodes or tumor.

Obstructions involving small airways

Viral bronchiolitis or obliterative bronchiolitis. Cystic fibrosis. Bronchopulmonary dysplasia. Heart disease

.

Other causes

Recurrent cough not due to asthma. Aspiration from swallowing mechanism dysfunction or gastroesophageal reflux

.

ADULT:

COPD (e.g., chronic bronchitis or emphysema). Congestive heart failure. Pulmonary embolism. Mechanical obstruction of the airways (benign and malignant tumors). Pulmonary infiltration with eosinophilia. Cough secondary to drugs (e.g., angiotensin-converting enzyme (ACE) inhibitors). Vocal cord dysfunction.

Medical history for asthma diagnosis:

Doctors ask about the family history ofasthma, allergies including allergic rhinitis,eczema.

Children who have family history of allergies, asthma have greater chances ofhavingasthma.

History of recurrent and persistent cough and cold following exposure to cold air,changing seasons.
http://www.asthmahelpline.com/vocal-cord-dysfunction.htmhttp://www.asthmahelpline.com/vocal-cord-dysfunction.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/vocal-cord-dysfunction.htm


18/72

18

Exercise limited by breathing problem and wheezing Occupational history for exposure to gases, fumes, chemicals etc. Any history of emergency room visits or hospitalization following breathing problem. In the children diagnosis is mainly clinical. Doctor determines when the parents first

noticed child developing breathing problem, itchy eyes, nasal stiffness, eczema.

Asthma diagnosis is suspected in all adult and children whose have following sign and

symptoms:

Recurrent Wheeze which is a high-pitched whistling sounds when breathing outespecially in children. (Lack of wheezing and a normal chest examination do not

exclude asthma.)

Cough, worse particularly at night Recurrent breathlessness or difficulty in breathing Recurrent chest tightness Recurrent lower respiratory tract infections (LRTI) Exercise induced cough/wheeze

Physical examination for diagnosis of asthma:

Physical examination includes listening to breath sounds over the chest for possible ronchi or

wheeze or rales, examination of nasal passage for evidence of allergic rhinitis like nasal

polyps and deviated nasal septum.

Peak flow meter:

Peak flow meter is a small portable hand held instrument used to measure peak flow rates,

or how well the airways are open. Asthma is suspected when there is more than 20% diurnal

variation on 3 days or more in a week or for 2 weeks in a PEF diary.

For more information clickPeak Flow Meter.

Lung function testing (Spirometry):

If symptoms and the patients history points towards the diagnosis of asthma, the physician

will perform spirometry to confirm the diagnosis of asthma.

Spirometeris used to access the airflow obstruction. For asthma diagnosis airflow

obstruction should be at least partially reversible.
http://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/exercise-asthma.htm


19/72

19

To establish airflow obstruction physician uses spirometer to measure (FEV1, FVC, FEV1/FVC)

before and after the patient inhales a short-acting bronchodilator.

For Obstruction to be present:

1. FEV1 should be less than 80 percent predicted.

2. FEV1/FVC should be 70 percent or below the lower limit of normal.

Establish reversibility: FEV1 increases 12 percent or more and at least 200 ml after using a

short-acting inhaled beta2-agonist (e.g., albuterol, terbutaline).

NOTE: Older adults may need to take oral steroids for 2 to 3 weeks and then take the

spirometry test to measure the degree of reversibility achieved.

Spirometry is generally valuable in children over age 4; however, some children cannot

conduct the maneuver adequately until after age 7.

Challenge tests:

If there are no signs of airflow obstruction and asthma is still suspected, the doctor may

perform a challenge test by administrating histamine or methacholine (a substance which

causes airways to contract in asthmatic individual), or may perform exercise challenge test.

These tests are used mainly in clinical laboratories to evaluate airway hyper responsiveness.

A trial use of asthma medication:

Ifasthmamediications are taken and there is improvement in the symptoms, this further

supports the diagnosis of asthma.

Skin allergy tests:

Skin tests are main tool in diagnosing allergies all over the world. It is out patient procedure

and patient can go to school or office after the test. Each and every patient has different

allergy profile which can be known by the skin allergy tests.

Identification of allergen triggers can assist in formulating an avoidance strategy. A trial ofallergen avoidance may be diagnostic and therapeutic.

Mechanism of skin allergy testing:

Cells and antibodies which are responsible for allergies are present under the skin as well as

other parts of the body. If an allergen to which patient is allergic is applied to the skin a

reaction occur and a wheal is formed. The size of the wheal is measured to grade the

severity of allergy.

There are number of ways to perform skin tests:
http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htm


20/72

20

Patch test ( used mainly for diagnosing contact dermatitis) Scratch test Skin prick test Intradermal test Skin end point titration Parasite- kustner test ( Passive transfer test)

RAST (Radio allegrosorbent technique):

This test detects allergen specific IgE in the serum of the patients. The results of the tests

correlate well with the skin allergy tests. One sample of the serum can be used to test many

allergens. This test has many benefits over the conventional skin allergy tests. It can be used

where the skin allergy tests cannot be performed like young children, severe atopic

dermatitis, dermatographism, history of extreme sensitivity, patients afraid of multiple

injections.

The result of RAST is not influenced by drugs while skin tests are suppressed by anti allergic

drugs and steroids.

There is no risk of anaphylaxis with RAST.

Back to top

Complete Blood Count (CBC):

CBC is done to rule out tropical pulmonary eosinophilia and other infections.

Chest X-Ray:

Chest X-ray is done if there is suspicion of presence of some other disease like infection,

large airway lesions, obstruction by foreign object or heart disease. It is also done if a patient

is not improving after taking asthma medication.

Echocardiogram (ECG):

This test is used if congestive heart failure is suggested based on history and physical

examination findings.

Gastroesophageal reflux assessment:

A barium swallow and 24-hour pH probe is done to diagnose gastroesophageal reflux disease

(GERD), especially if a patient is not responding to asthma therapy.

If a patient has prominent symptoms of GERD, medical therapy is often tried without

performing these tests.
http://www.asthmahelpline.com/diagnosis-asthma-3.htmhttp://www.asthmahelpline.com/diagnosis-asthma-3.htmhttp://www.asthmahelpline.com/diagnosis-asthma-3.htm


21/72

21

Nasal examination:

Nasal examination is also done if they are suspected of contributing to the asthma severity.

Procedures:

1. Direct and indirect laryngoscope is indicated if any laryngeal abnormality is suggested.

2. Cardiopulmonary exercise testing is indicated if the cause of dyspnea (breathlessness)

cannot be determined.

Newer tests for the diagnosis of asthma

Impulse osillometery (IOS)

Impulse Osillometery is a newer technology that uses small amplitude pressure oscillations

to determine the resistance of the airway. It is largely independent of effort does not require

coordination, but does requires cooperation of the child. To perform IOS child holds a mouth

piece in place over a 30 second period of time while breathing normally. Sound impulses of

various frequencies from 5 to 35 Hz are applied to the airway through the mouth piece with

total respiratory system resistance (Rrs) and reactance (Xrs) determined at various

frequencies. Change in Rrs and Xrs is noted after inhalation of a beta-agonist. Young children

with asthma show significant change in Rrs following beta-agonist inhalation. Till now IOS ismainly used as a research tool.

Exhaled Nitric Oxide test

NO is produced in discrete concentrations in the healthy human airway where it is important

in physiological functions such as maintaining airway patency. NO is over produced in

asthmatic individuals. It is responsible for airway inflammation (swelling) and is also the

product of airway inflammation.

Nitric oxide analyzers are used to measure exhaled nitric oxide (FENO). In 2003 Aerocrine

exhaled nitric oxide monitoring system NIOX was granted clinical approval by USFDA for age

of 4 to 65 years.

The analyzer measures Nitric oxide by a chemiluminescent reaction with ozone. NO is drawn

into the chamber and is combined with ozone. The reaction yields NO2, O2 and a photon,

which is captured by the photomultiplier tube that analyzes and reports a proportional value

of Nitric oxide. FENO is measured as part per billion (ppb) in asthmatic patient.

Normal values vary with the patient, but it is considered that 20 to 30 ppb in the steroid

naive patient is indicative of inflammation.


22/72

22

Potential of FENO to predict exacerbations of asthma was recently examined and levels were

found to be elevated before the fall in lung functions or the development of clinical

symptoms of asthma exacerbations.

There are two methods of collecting exhaled nitric oxide.

An offline technique, where Nitric oxide is collected in special reservoir, that allows storage

and subsequent analysis of nitric oxide content.

An online nitric oxide techniques use continuous sampling and quantification during

exhalation for dynamic measurement and flow analysis.

Ingestion of foods containing nitrates, smoking status, ambient nitric oxide level,

nasopharyngeal contamination, airway infections and drugs such as leukotrienes modifiers

may effect the actual collection and quantification of exhaled nitric oxide. Patients are asked

to take nothing by mouth for one hour before sample collection.

Childhood Asthma

Childhood Asthma is number one chronic diseases of childhood, and is the most common

cause of emergency room visit and hospitalization for the children under the age of 18

years.

The cost of asthma related illness accounts to about $ 10 billion worldwide.

Asthma is the most common cause of school absenteeism due to chronic disease and also

causes parents to miss days at work. Asthma often goes unrecognized in the children. Many

children have more subtle symptoms including a night time cough, a cough that worsens

with exercise or activity, or only a chronic cough that won't go away. In these children

especially for infants and toddlers asthma can be hard to diagnose. Asthma cannot he cured,

it can almost always be controlled.

A child can live an active life if asthma is controlled properly.

THE RESPIRATORY SYSTEM

The Respiratory system is basically concerned with the exchange of gases between the air

we inspire and the blood. Lungs provide surface for transfer of gases through which bloodgets rid of carbon dioxide and absorb oxygen which is vital for living. Lung is a cone shaped


23/72

23

structure situated in the thorax; it is where the exchange of gases takes place.

As the air passes through the nose and mouth, it is rapidly warmed and moistened. The nose

and airways trap large particles (dust, pollen, molds bacteria) and chemicals (smoke. sprays,

odors) which could cause serious injury to the lungs. The air is then transported through

smaller airways. These airways branch like a tree forming millions of small airways that carryoxygen to the tiny air sacs called alveoli. The alveoli have network of capillaries around

them. The gas exchange takes place here.

The airways have a delicate cellular lining (mucosa), which is coated with a thin layer of

mucous. Foreign particles are trapped by the sticky mucus and are removed by the normal

cleansing process present in the airways.

The process is assisted by the movement of millions of tiny whip like structures called cilia.

Cilia are present on the inner lining cells of the airways. Cilia move the mucus and trapped

foreign particles up toward the mouth and nose where they, are coughed and sneezed out

or swallowed.Bundles of muscles surround the airways and the contraction of these muscles allows

airways to selectively direct the flow of air.

Back to top

WHAT IS ASTHMA?

Asthma is a chronic inflammatory condition of the bronchial (lung) airways. This

inflammation causes the airways to become over-reactive to various stimuli, thus producing

increased mucus, muscle swelling and muscle contractionThese changes produce airway obstruction, chest tightness, coughing and wheezing. If

severe this can cause severe shortness of breath and low oxygen levels in the blood. This

obstruction is partially or completely reversible with or without treatment.

Each child suffers a different level of severity. All children with asthma enjoy a reversal of

symptoms until something triggers the next episode.

WHAT IS THE CAUSE OF ASTHMA?

Childhood asthma is a disorder with genetic predisposition and is caused by complexinteraction between genetic and environmental factors. Approximately 75 to 80 percent of

children with asthma have significant allergic problem. As stated earlier asthma is a chronic

inflammatory disease of the airways. Every asthmatic patient has some degree of

inflammation of airways of the lungs. This inflammation is produced by many factors mainly

allergy, viral respiratory infections and airborne irritants.

Studies indicate that allergic reactions produce both immediate and late phase (delayed)

reactions. Research indicates that approximate half of the immediate allergic reactions to

inhaled allergens are followed by a late phase reaction.This late phase reaction produces more serious injury and airway inflammation. This airway
http://www.asthmahelpline.com/childhood-asthma.htmhttp://www.asthmahelpline.com/childhood-asthma.htmhttp://www.asthmahelpline.com/childhood-asthma.htm


24/72

24

inflammation leads to Irritability or hyper responsiveness of the airways. In addition,

prolonged airways, inflammation can cause scarring.

Back to top

WHAT ARE THE SIGNS AND SYMPTOMS?

The common asthma symptoms are wheezing, coughing, chest tightness, shortness of

breath, faster or noisy breathing.

Wheezing though characteristic of asthma, is not its most common symptom. Coughing is

noted with even "hidden" asthma when wheezing may not be apparent to childs family

members or the physician.

Any child who has frequent coughing or respiratory, infections (pneumonia or bronchitis)

should be evaluated for asthma.

The child who coughs after running or crying may have asthma. Coughing from asthma isoften worse at night or early in the morning, making it hard to sleep. Infants who have

asthma often have a ratty cough, rapid breathing and an excessive number of respiratory

infections, episodes of bronchitis or chest colds. Obvious wheezing episodes might not

be noted until after 18 to 24 months of age.

Chest tightness and shortness of breath are other symptoms of asthma that may occur alone

or in combination with any of the above symptoms. Since these symptoms call occur for

reasons other than asthma, other respiratory diseases must always be considered.

In a young child the discomfort or chest tightness may lead to unexplained irritability.

Note: If your child has frequent coughing or respiratory infections (pneumonia or bronchitis)

he or she should be evaluated for asthma.

During an acute episode, symptoms vary according to the severity.

Mild episode: Child may be breathless after physical activity such as walking. They can talk in

sentences and lie down, and they may be agitated.

Moderate severe episode: Child is breathless while talking. Infants have feeding difficulties

and a softer, shorter cry.

Severe episode: Child is breathless during rest, are not interested in feeding, sit upright, talk

in words (not sentences), and are usually agitated.

Symptoms with imminent respiratory arrest

(In addition to the above symptoms), the child is drowsy and confused. However,

adolescents may not have these symptoms until they are in frank respiratory failure.

Absence of wheezing in severe asthma is associated with most severe airway obstruction

and is a serious emergency situation.
http://www.asthmahelpline.com/childhood-asthma.htmhttp://www.asthmahelpline.com/childhood-asthma.htmhttp://www.asthmahelpline.com/childhood-asthma.htm


25/72

25

What IS hidden ASTHMA?

Many times diagnosis of asthma is missed due to absence of classical signs of asthma i.e.

wheezing, rapid breathing and coughing become obvious. The condition of many children

with asthma will go undetected if careful examination is not done. These children with

asthma usually suffer some degree of airway obstruction: and unless it is brought under

control, the children may suffer respiratory illness more frequently.

Hidden asthma however can produce so few recognizable symptoms that even the physician

might not be able to distinguish abnormal breath sounds with his or her stethoscope.

Pulmonary function testing usually reveals these cases of airway obstruction.

Children with family history of atopy and allergy and who are also having recurrent cough

and respiratory infections must be suspected for having asthma. Parent's input can be vital

for diagnosing asthma.

What usually triggers ASTHMA?

Episodes of asthma often are triggered by some condition or stimulus.

Some common triggering factors are:

Air pollution.

House dust mites.

Molds indoor and outdoor.

Cockroaches.

Environmental factors (cold air, fog, ozone, sulfur dioxide, cigarette smoke, dieselfumes).

Changing weather and temperature.

Pollens from flowers of grass and trees.

Exercise

Irritant dust and fumes and strong odors from fresh paints and cooking.
http://www.asthmahelpline.com/house-dust-mite.htmhttp://www.asthmahelpline.com/house-dust-mite.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/house-dust-mite.htm


26/72

26

Food addictives and preservatives (monosodium glutamate, tartarzine,metabisulfite).

Warm blooded pets (like dogs, cats, birds, and small rodents).

Pharmacological agents (aspirin, other NSAIDs, beta blockers).

Viral infections.

Strong emotions such crying and laughing.

CLICK: How to control asthma triggers

Back to top

Exercise

Exercise induced asthmais a subset of asthma which is initiated by exercise. Running can

trigger an episode in over 80 percent of children with asthma. Swimming is the most asthma

friendly exercise. Exercise induced asthma can be prevented by the use of short acting beta-

2 agonist like Salbutamol (albuterol) inhaler 15 minutes before exercise. If child is engaged in

almost daily exercise schedule, long acting beta-2 agonists are preferred.

IRRITANTS

Air pollution, cigarette smoke, strong odors, aerosol sprays and paint fumes, strong odors

are same the substances which irritate the tissues of the lungs and upper airways.Cigarette smoke is highly irritating and can trigger asthma. Cigarette smoking certainly

should be avoided in the home of any child with asthma. Parents must be persuaded to quit

smoking. It has been shown that when the parents of a child with asthma stop smoking, the

child's asthma often improves. Irritants must be recognized and avoided.

Back to top

Weather

There are number of climatic conditions that trigger asthma in children. Cold air is a common
http://www.asthmahelpline.com/control-asthma-triggers.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/control-asthma-triggers.htmhttp://www.asthmahelpline.com/control-asthma-triggers.htm


27/72

27

trigger for asthma. Pulmonary function studies demonstrate that breathing cold air provoke

asthma in most of asthmatic children.

Precautions may be necessary to avoid inhalation of cold air. A heavy scarf, warn loosely

over the nose and mouth will also help avoid cold air induced asthma. Wearing a special ski

mask designed for this purpose also helps.The weather affects outdoor inhalant allergens (pollens and molds). On a windy day more

allergens will be scattered in the air, while a heavy rainfall will wash the air clean of

allergens. On the other hand, a light rain might wash (just pollen but actually increase mold

concentration.

Moving to a new area may not always help in reducing asthma severity. There may be short

term improvement but in long term this benefit vanishes. There does not seem to be one

best climate for all children with asthma.

Back to top

Emotions

Emotional factors are not the cause of asthma as many believe but emotional stress can

infrequently trigger asthma.

A child's asthma might only, be noticeable after laughing, crying or yelling in response to an

emotional situation. These emotional' responses involve rapid and deep breathing that

cools and dry the airway which in turn can trigger asthma.

Emotional stress itself (anger, anxiety, frustration) also can trigger asthma but only in allergic

or a topic children who are already suffering from asthma.Emotions can aggravate asthma. Many children with asthma suffer from severe anxiety

during an episode as a result of suffocation produced by asthma. The anxiety and panic can

then produce rapid breathing or hyperventilation, which further triggers the asthma.

For this reason, anxiety and panic should be controlled as much as possible during the

episode. The parent should remain calm, encourage the child to relax and breathe easy and

give appropriate medication.

Treatment should be aimed at controlling the asthma. When asthma is controlled other

emotional factors can then be dealt with more effectively.As with any other chronic illness asthma is also associated with secondary psychological

problems. Severe psychological problems require a specialist to help the child and his or her

family.

Is my child suffering from asthma?

Recurrent chest problems in your child may be due to childhood asthma. Go to the

questioner and answer the questions in yes and no. If the answer is yes it may be asthma.

Consult your family physician for further analysis.
http://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htmhttp://www.asthmahelpline.com/childhood-asthma-2.htm


28/72

28

Diseases mimicking childhood asthma (differential diagnosis)

Upper airway diseases.

laryngeal webs.

Obstructions involving small airways.

Recurrent cough not due to asthma.

Recent advances in diagnosis of childhood asthma:

Impulse osillometery (IOS)

Impulse Osillometry is a newer technology that uses small amplitude pressure oscillations to

determine the resistance of the airway.Read More

Exhaled Nitric Oxide test.

NO is produced in discrete concentrations in the healthy human airway where it is important in

physiological functions such as maintaining airway patency. NO is over produced in asthmatic

individuals. It is responsible for airway inflammation (swelling) and is also the product of airway

inflammation
http://www.asthmahelpline.com/asthma-diagnosis-4.htmhttp://www.asthmahelpline.com/asthma-diagnosis-4.htmhttp://www.asthmahelpline.com/asthma-diagnosis-4.htmhttp://www.asthmahelpline.com/asthma-diagnosis-4.htm


29/72

29

Elderly with asthmaExcept for some precautions, goal of asthma treatment in

elderly is same as that in other age group. The main points to remember and

consider in elderly people suffering with asthma are discussed below.

1. Elderly asthmatics are usually suffering from few other medical conditions

that may interfere with asthma treatment. This includes hypertension, IHD,

diabetes mellitus and other related diseases.

2. Elderly do not respond as well to drug treatment as young people, so drugs

must not be overused as they may aggravate other medical conditions like

cardiac disease, arthritis etc.

3. Patient should tell his doctor which medicines he/she is taking for which

disease. Medicines that may aggravate asthma like aspirin (commonly used in

cardiac conditions and arthritis) and beta-blockers (atenolol) are to be

avoided.

4. It is important not to misdiagnose asthma as COPD because asthma has a

different natural history and a better prognosis with treatment. COPD is

mainly a disease of smokers. Read more aboutCOPD.

5. Dyspnea (breathlessness) in elderly occurs due to many causes that include

congestive heart failure and other forms of chronic heart and lung diseases.

6. Smoking or exposure to tobacco smoke should be avoided.

7. When doingspirometryin elderly, a consistent pattern of decreasing FEV1

in tests repeated during the session is suggestive of asthma.

8. Depression is very common in elderly and can decrease their compliance to

thetreatment of asthma. Depression is also one of the most treatable

problems in the elderly so should not be ignored.

9. Indoor allergens or triggers (dust mite, molds etc.) may be more important

to evaluate than outdoor allergens since most elderly people spend more

time in their homes than outside. The specific allergen will vary by geographic

region. Allergy testing can identify the offending allergen.
http://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/COPD.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/spirometer.htmhttp://www.asthmahelpline.com/COPD.htm


30/72

30

10. Diseases that mimic asthma in elderly are:

a. Chronic Obstructive Pulmonary Disease.

b. Interstitial Lung Disease.

c. Bronchiectasis.

d. Cardiac Disease (Angina, IHD and Congestive Heart Failure).

e. Upper Airflow Obstruction (Encroaching tumors, vocal cord paralysis, and

thyroid enlargement).

f. Pulmonary Embolism.

g. Bronchogenic carcinoma.

h. Aspiration.

i. Gastroesophageal Reflux.

11. Elderly patients withasthmacan also have chronic, persistent airflow

obstruction with poor bronchodilator responsiveness; a trial of therapy with

corticosteroids for 15 days or more may be necessary to establish that there

is reversible airflow obstruction.

12. Coexisting conditions (e.g., respiratory infections, gastroesophageal

reflux) may exacerbate asthma, hinder effective therapy, and reduce asthma

control.

13. Someasthma medications(e.g., theophylline, beta-adrenergic

bronchodilators) can elicit adverse responses (e.g., cardiac ischemia or

arrhythmia, drug toxicity, gastroesophageal reflux) in susceptible patients

with coexisting disorders (e.g., ischemic heart disease, congestive heart

failure, acute myocardial infarction, gastroesophageal reflux).

14. Nonselective beta-adrenergic blocking agents (like Timolol, atenolol),

even in minute quantities as present in ophthalmic solutions, should not beprescribed for patients with asthma, because they can produce severe

bronchospasm and perhaps anaphylaxis.

15. System corticosteroids, thiazide diuretics and beta2-agonists may

contribute to hypokalemia (decreased potassium in blood) therefore routine

monitoring of serum potassium and magnesium for early detection of

electrolyte imbalance should be done.
http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/index.htm


31/72

31

16. Many elderly patients with asthma have concurrent rhinitis or sinusitis for

which they take antihistamines (terfenadine and astemizole) which have the

potential to produce prolongation of the QTc interval that could lead to

ventricular arrhythmias such as Torsade de Pointes

17. Angiotensin-Converting-Enzyme (ACE) Inhibitors. can produce chronic

cough in some patients.

18. Review of patient technique in taking medications is also important; not

infrequently, a failure to respond adequately to therapy is a result of

improper medication/inhaler technique.

19.Peak flow meter: The effectiveness of home peak flow monitoring among

the elderly has not been clearly established.

20. Allergy Tests: Allergy skin tests or studies of specific IgE need not be

routinely performed because allergens seem to play a less important role for

elderly patients than younger patients.

21. Respiratory infections and medications for other diseases are the most

common asthma triggers in elderly patients.

22. Measures to avoid or controlasthma triggersshould be specific to the

patients asthma and allergy history.

23. Avoidance of exposure to allergens and tobacco smoke, both active and

passive, is important as with asthma patients of any age.

Occupational Asthma

Introduction of occupational asthma:

Are you often getting sick at your job? Answer the following questions in yes

and no. If the answer of any one is yes then you may be suffering

from Occupational asthma:

Do you experience coughing, wheezing or shortness of breath at work? Do you have itchy red eyes or running nose at work?
http://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/peak-flow-meter.htm


32/72

32

Does the problem goes when you are away from work and comes backwhen you return to work?

Occupational Asthma is the most commonoccupational lung diseasein most

part of the world. It is responsible for 2 % to 15 % of the asthma prevalence.The frequency varies widely between different occupations and within industry

at different level of exposure.

Occupational asthma is a respiratory disease caused by the exposure to a

trigger at the work place (be it dust, gases, vapors, fumes or chemicals). When

inhaled these triggers irritate the airways and may cause Coughing, sneezing,

chest tightness, pain in chest, difficulty in breathing. It may be associated with

skin, eye and other allergies.

Types of Occupational asthma:

Generally two types ofasthma attackoccur:

Occupational asthma without latencyAsthmaattack brought on immediately by exposure to extremely high levels of

irritant gases such as ammonia, sulfur dioxide, chlorine. This is also known as

Reactive Airways Dysfunction Syndrome (RADS)

Occupational asthma with latency (Long term sensitization)Body develops an allergy from continuous exposure to a specific substance,

sometimes over the period of months and years. Symptoms of OA occur when

body develops allergic response to the substance

Due to exposure to thetrigger asthma attackis precipitated. The walls of the

airways become inflamed and swollen. Lot of mucous is secreted blocking the

airways. This makes it difficult for the air to be exhaled or pushed out of the

lungs.

Substances causing Occupational Asthma:

Substances which causeOccupational Asthmaare commonly known as

triggers. At least 240 substances are known to cause Occupational asthma

when inhaled. They are classified in 5 categories.
http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/asthma-causes.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/


33/72

33

Respiratory irritants:

Like smoke, sulfur dioxide, chlorine gas, ammonia.

Grain flour and food allergens:

Like Grain dust and flours (like wheat & rye), proteins of cereal grains, sea food,egg processing, green coffee beans, castor beans, ispaghula.

Animal allergens & proteins:

These are found in hairs, furs, dander, scales, saliva and other body wastes like

excreta.

Enzymes:

Enzymes are used in pharmaceuticals, detergents, flour conditioners, etc.

Chemicals:

1. Acid anhydrides, isocyanides, complex platinum salts, poly amines,

2. Reactive dyes, units manufacturing paints, varnishes, adhesives,

3. Laminates, soldering fluxes, resins used in soldering.

Industries at risk for occupational asthma:

Most of the triggers are found widely in almost all industries and work places.

But not every one will develop asthma after exposure to them. Some people

are more susceptible to asthma than others. OA is more common in susceptible

individual working in following industries:

y


34/72

34

with animals

The development of occupational asthma depends on:

1. Family history of asthma & allergy

2. Amount of allergen exposure

3. Frequency of exposure to the trigger

4. Cigarette smoking (smoking doubles the chances of having occupational

asthma)

Cigarette smoking doubles the risk of occupational asthma, possibly by

recruiting the inflammatory cells into the lungs where they are available to

react with the irritants and sensitizers.

Repeated exposure over several months causes steady deteoration of lung

functions. Clinical features then become indistinguishable from chronic

obstructive lung disease. Common irritants like cold air, smoking can

precipitate asthma attack.

Symptoms Of Occupational Asthma

The most characteristic feature in the medical history is symptoms of asthma

that worsen on week days and improve in holidays and rest days.

The following are the most common symptoms of occupational asthma. Person

may have few or all of them

Coughing


35/72

35

Wheezing Chest tightness Breathlessness Chest pain Excessive fatigue

In addition to the above symptoms, many other allergic symptoms can also

occur. They show presence of irritants (allergens) in the air

Skin- itchy, red (urticaria) or irritated.

Nose- Itchy, blocked or stuffy, sneezing

Eyes- Red, itchy, burning or watery.

In most people symptoms appear at work or within several hours after leaving

work. Theasthma symptomsimprove on weekends, vacations, or when away

from work or chemical causing symptoms. Usually improvement occurs

immediately after the cessation of exposure but some times it takes more than

2 days to recover. Thus true relationship between occupation andasthmacan

only be ascertained after prolonged cessation of the exposure allowing

sufficient time for the lungs to recover. Reappearance of the symptoms

immediately after the patient returns to work almost confirms the diagnosis.

When to see a doctor:

If you get asthma or related symptoms at work, and the symptoms get better

when you are away from work on leave or vacation, contact doctor for

evaluation.Occupationalasthmais totally controllable and preventable disease if person

gets right medical attention at right time. Prolonged exposure can cause

permanent lung damage, and some amount of pulmonary functions may be

lost for ever.

If you have occupational asthma you must have an emergency asthma action

plan prepared by your doctor. Emergency medicines must be available at the

factory or unit.
http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/


36/72

36

If you have attack, ask a friend to take you to the nearest hospital emergency

department or call for an emergency ambulance service.

Diagnostic tests and evaluation for occupational asthma:

During the evaluation for occupationalasthma the doctorwill inquire about

your respiratory symptoms and type of work. He will then try to establish the

relation between them. Clearly describe in detail all the symptoms and when

and how frequently they occur. How they are relieved.

Also describe your job and job conditions. Chemicals and other substances you

are exposed to ( like gases, dust, fumes, vapors, animal products, chemicals and

other irritants).

Proper diagnosis is essential to ensure that most appropriate treatment is

given.

Gold standard for the diagnosis of OA in the pulmonary laboratory is a specific

inhalation challenge using the suspected agent.

Following breathing tests will be done to determine the condition of the lungs.

Spirometry: All patients with suspected occupational bronchial asthma should

have and assessment to the response to bronchodilators. Spirometer is adevice which measures the air flow rates in different parts of the airways.

Peak flow meters:Peak flow meteris a small portable device used to measure

how forcefully a person can blow the air out of the lungs. This test can also be

done at the workplace during the asthma attack.

Blood examinations including blood gas analysis during attack.

Skin test and serology: They may be used in identifying the suspected irritant.

However selection and preparation of the agent for skin testing is difficult. The

positive test indicates previous exposure to the agent, but cannot confirm that

the same agent is responsible for the OA.

X-Ray Chest-PAV: Chest radiograph is usually done to rule out causes other

than OA.

Treatment of occupational asthma

The goals of treatment are same as with asthma of any other cause:
http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/peak-flow-meter.htmhttp://www.asthmahelpline.com/index.htm


37/72

37

According to NHLBI,asthma therapyhas following components:

1.Patient education.

2.Control of factors contributing to severity.

3.Drug therapy.

4.Access the severity of disease and monitor the therapy.

The keystone of effective treatment is cessation of further exposure to the

offending agent.

However this is not always possible. In mild OA, avoiding the exposure to the

triggers relieves the symptoms. You may be advised to wear mask or respirator

during work.

In moderate disease avoiding triggers and medication are usually helpful.

In severe OA people may be required to consider switching to different job

where the particular allergen is not present.

Patient education:

Patient education is an integral part of the asthma therapy. It should begin as

soon as asthma is diagnosed and should be integrated in every step of the

asthma management plan. Patient should ask their treating doctor about the

written asthma treatment (action) plan.

Monitoring the asthma:

Periodic assessment and monitoring asthma in patients is a important part of

anyasthma management plan. There are two ways of monitoring asthma in

patients, Periodic assessment by the treating doctor and self assessment by the

patient himself. The patient should know when the asthma is controlled and

when it is worsening. Monitoringasthmashould include:

A peak flow meter

Apeak flow meteris a device used to measure how well the air move out of
http://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/use-peakflowmeter.htmhttp://www.asthmahelpline.com/use-peakflowmeter.htmhttp://www.asthmahelpline.com/use-peakflowmeter.htmhttp://www.asthmahelpline.com/use-peakflowmeter.htmhttp://www.asthmahelpline.com/http://www.asthmahelpline.com/index.htmhttp://www.asthmahelpline.com/treatment-asthma.htm


38/72

38

the lungs. Airways narrow during the asthma episode causing decreased air

flow. The peak flow meter can measure these changes and can warn about the

imminent asthma attack days or even weeks before it actually happen. Peak

flow readings can help patients recognize if asthma is properly controlled or

not.

A diary

Patient should keep a diary to record his dailyasthma symptomsand the

environmental factors that bring on the asthma attack or make the symptoms

worse. He should note what work he was doing when the attack was

precipitated. The exposure of chemical agent before attack.

DRUG TREATMENT:

There are two types of drug therapies:

1.Oral therapy.

2.Inhaled therapy.

Oral medication include tablets and capsules of bronchodilators like

salbutamol, terbutaline, theophyllines, newer medicines like leukotriene

pathway inhibitors (zafirlukast, montelukast, zileuton). Anti inflammatory

medications include predisolone, methylprednesolone etc.

Inhaled medication includes reliever and preventer medication.

Reliever medications are those which are given for immediate relief and

control of the asthma symptoms. They include short acting (salbutamol,

terbutaline, bitolterol, pirbuterol) and long acting (formaterol, Salmeterol)

bronchodilators.

Preventer medicines are anti inflammatory agents given to reverse the

pathological process causing asthma. They include triamcinolone, fluticasone,

budesonide, beclomethasone.
http://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htmhttp://www.asthmahelpline.com/asthma-symptoms.htm


39/72

39

Exercise Induced Asthma (Exercise Induced Bronchospasm)

Exercise Induced Asthma (EIA) or Exercise Induced Bronchospasm(EIB)

or exercise induced bronchoconstriction refers to asthma that occurs only with

exercise. The reported incidence of EIA varies between 5% and 20% of the

general population.

During start of exercise pulmonary functions tends to be normal, but within 5

to 10 minutes symptoms of asthma such as wheezing, breathlessness, tightness

of chest appear. Patient may also feel extreme fatigue. After a rest period, the

symptoms subside. But sometimes symptoms may become worse for a longer

time.

Hyperventilation and airway cooling are the two most important triggers of EIA.

People with exercise induced asthma have airways that are sensitive towards

changes of temperature and humidity. Hyperventilation during exercise is the

primary event which causes cascade of events leading to EIA. Hyperventilation

causes drying of the airway surface epithelium where by causing dehydration

of the airway cells and increased intracellular osmolarity. The increasedosmolarity results in the release of mediators from mast cells and damage

airway epithelial. The mediators released during EIA include histamine,

leukotrienes, cytokines, etc. All these events are called inflammatory reaction

which is the root cause of asthma.

Other but less important cause of EIA is the airway cooling that is found with

hyperventilation during exercise. During rest we breath through nose. Nose has

a temperature and humidity control mechanism that makes air humid and atbody temperature. When we exercise we breath through mouth, our

respiration becomes rapid (hyperventilation). This forces cold and dry air into

the airways. After the exercise is over, the small bronchiolar vessels around the

tracheobronchial tree warm up, and this reactive hyperemia leads to exudation

of serum into the interstitial fluid and release of mediators that subsequently

causes airway muscles to contract and also walls of airways become inflamed

resulting in narrowing of airways.


40/72

40

How is exercise induced asthma diagnosed?

Diagnosisof EIA can easily be made symptomatic. Person is usually normal

before exercise. During exercise he experiences shortness of breath and/or

chest tightness, wheezing, and cough.After a period of rest , the symptoms subside. Sometimes symptoms such as

prolonged cough after exercise, chest pain and fatigue may last longer.

The diagnosis of EIB can also be confirmed by a variety of tests, such as exercise

challenge, methacholine challenge, or eucapnic voluntary hyperpnea. The

International Olympic Medical Commission recommends any or all of these

tests, but in most cases the Eucapnic Voluntary Hyperventilation (EVH) test is

the easiest to perform. If exercise challenge is to be performed, then this

should be done in the athlete's sport.

"Pure" EIA and persistent asthma with an exercise exacerbation can be

differentiated by spirometry. During rest if the forced expiratory volume in 1

second (FEV1) is not normal, patient is administered an inhaled beta-agonist

and test is repeated after 15 minutes. If the FEV1 improves 12% or more, that is

an indicator of mild persistent asthma, and the patient should be treated for

the persistent asthma in addition to the EIA.

A 15% drop in FEV1 after 6 minutes of running or other exercise can be

diagnostic of exercise induced asthma.

Back to top

What is the treatment of exercise induced asthma?

Treatmentof EIA is same as that of asthma. Short-acting beta-agonists, such as

albuterol (salbutamol) are use full before exercise. Albuterol should be taken

15 minutes before exercise to reduce chances of EIA.

Inhaled steroids are also very effective for EIA but must be given daily and take

about 2 weeks for effectiveness. Cromolyn and nedocromil can be given just

prior to exercise like albuterol and work quite well.
http://www.asthmahelpline.com/asthma-diagnosis.htmhttp://www.asthmahelpline.com/asthma-diagnosis.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/treatment-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/asthma-diagnosis.htm


41/72

41

Leukotriene modifiers, such as montelukast, are given as a daily pill and do help

reduce EIA, but they are not as effective as the inhaled products. Some patients

may benefit from anticholinergics, such as Ipratropium.

Many patients may require two or three medicines to treat EIA successfully.

High-intensity warm-up before the exercise is helpful for reducing the EIA. A

low-salt diet and fish oil supplementation are other nonpharmacologic

therapies that have been shown to reduce airway inflammation and reduce

EIA.

What is the precaution I can take to prevent the attack?

With proper control of asthma, most adults and children with asthma call

participate fully in physical activities. If needed you should take 2 puffs of short

acting reliever (one with blue cap) inhaler 15 minutes prior to exercise. This

usually prevents the attack.

Back to top

Is exercise beneficial for EIA patients as with rest of people?

Exercise reduces the risk of cardiovascular disease, diabetes, obesity and other

health related problems in asthmatic person as in any other person.

Aerobic exercise programs have shown to reduce airway responsiveness in

patients who do them regularly. Studies also suggests that asthma sufferers

who exercise regularly have fewer exacerbations, use less medication, and missless time from work and school.

What are the exercise goals for asthma patients?

The exercise goal for people who have asthma, as for most people, should be

20 to 30 minutes of activity that raises heart rate to 60% to 85% of maximum,

four or five times a week.
http://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htmhttp://www.asthmahelpline.com/exercise-asthma.htm


42/72

42

Which sports/ games are more suitable for EIA patients?

Aerobic exercises like swimming, running or biking or which exposes the

exerciser to warm, humid and moist air that tempers the effect on the airways

are more suitable for asthmatic patients. The sports that require short bursts ofactivity interspersed with breaks, are least likely totrigger asthma attack.

Some of the sports that are least likely to induce EIA are:

-distance running and track/field events,

.

Yoga may help manage asthma. Sahaja yoga is a type of meditation basedon yoga principals that was found to be somewhat effective in managing

moderate-to-severe asthma.

On which days I should skip exercise?

If you are wheezing, when allergies are particularly troubling, or when peak

flow testing suggests a decline in lung function. These are signs that you havehigher chances of having exercise induced asthma on that particular day.
http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/http://www.asthmahelpline.com/


43/72

43

Back to top

Is it risky to exercising when pollen counts are high in the environment?

EIA is believed to be inflammatory in nature but another stimulus an allergic

asthmatic reaction due to inhaled airborne allergens in the EIA patient with

inhalant allergies may also be present. These two stimuli (exercise and inhaled

allergens) may be additive or synergistic.

Exercising when pollen counts are high may cause more severe EIA in EIA

patients allergic to pollens.

Also read

Which is the most common condition mimicking EIA?

Vocal cord dysfunction is a disease that mimics EIA. Invocal cord

dysfunctionthe patient has inspiratory stridor because of partially closed vocal

cords. Patients complain of throat tightness rather than a chest tightness.

These patients also have the major symptom of dyspnea with little or nowheezing or cough.

In these patients the usual medications for EIA are not helpful. The diagnosis is

best made by rhinolaryngoscopy after exercise, showing closure of the cords on

inspiration. But vocal cord dysfunction may coexist with EIA making diagnosis

difficult.

Winners With Exercise Induced Asthma:

What do Jackie Joyner-Kersey, Dominique Wilkins, Nancy Hogshead, , Bill Koch,

Greg Louganis, Jim Ryun and marathon runner and world record holder Haile

Gebrselassie have in co

elderly with asthma

Documents