Asthma For Dummies

William E. Berger, MD, MBA, has been diagnosing and treating patients with allergies and asthma for over 25 years and has served as president of the American College of Allergy, Asthma, and Immunology.

Foreword xxi

Introduction 1

About This Book 1

Foolish Assumptions 2

How This Book Is Organized 2

Part I: Asthma Basics 3

Part II: Understanding Asthma Triggers 3

Part III: Treating Your Asthma 3

Part IV: Controlling Asthma with Medications 3

Part V: Special Asthma Conditions 4

Part VI: The Part of Tens 4

Appendix 4

Icons Used in This Book 4

Where to Go from Here 5

Part I: Asthma Basics 7

Chapter 1: Knowing What’s Ailing You 9

Understanding the Relationship between Asthma and Allergies 10

Triggering Asthma and Allergic Reactions 13

Sensitizing your immune system 13

Developing an allergic reaction 13

Previewing Asthma and Related Conditions 15

Asthma: Breathing and wheezing 15

Allergic rhinitis: Running away with your nose 16

Atopic dermatitis: Scratching your itch 17

Food hypersensitivities: Serving up allergens 17

Drug hypersensitivities: Taking the wrong medicine 18

Anaphylaxis: Severe systemic symptoms 19

Managing Asthma Effectively 20

Chapter 2: The Basics of Treating and Managing Your Asthma 23

Understanding Who Gets Asthma and Why 23

Identifying triggers, attacks, episodes, and symptoms 25

Realizing that asthma isn’t in your head 25

Uncovering the Many Facets of Asthma 26

Allergic asthma 27

Non allergic asthma 27

Occupational asthma 28

Exercise-induced asthma (EIA) 28

Aspirin-induced (and food-additive-induced) asthma 28

Asthma and Your Airways 28

The inflammatory response 29

How airway obstruction develops 30

Diagnosing Asthma 32

Taking your medical history 32

Examining your condition 34

Testing your lungs 34

Considering other possible diagnoses 37

Classifying asthma severity 38

Referring to a specialist for diagnosis 38

Managing Your Asthma: Essential Steps 39

Going over the basics 39

Determining your asthma therapy goals 40

Handling emergencies 41

Managing asthma at school 42

Chapter 3: Dealing with Doctor Visits 43

Preparing for Your First Visit 44

Doing your homework 44

Filling out forms ahead of time 46

Telling your story 46

Recording your symptoms and medications 48

Focusing on foods 49

Taking your family history 49

Knowing What Tests Your Doctor May Perform 49

Looking for signs of asthma and allergies 50

Testing for asthma and allergies 50

Following Up: Second and Subsequent Visits 53

Getting a diagnosis: What happens next? 53

Considering allergy shots 54

Paying for Your Care 54

Dealing with insurance issues 55

Gatekeeping and your treatment 55

Getting the care you need and deserve 56

Working Well with Your Doctor 56

Chapter 4: Managing Asthma Long-Term 57

Seeing What a Long-Term Management Plan Includes 57

Focusing on the Four Levels of Asthma Severity 59

Using the Stepwise Approach 60

Stepping down 63

Stepping up 63

Treating severe episodes in stepwise management 64

Assessing Your Lungs 64

What your doctor should do: Spirometry 65

What you can do: Peak-flow monitoring 65

Taking Stock of Your Condition 68

Keeping symptom records 69

Tracking serious symptoms 69

Monitoring your medication use 70

Evaluating your inhaler technique 70

Understanding Self-Management 71

Working with your doctor 71

Evaluating for the long term 72

Becoming an expert about your asthma 72

Improving Your Quality of Life 73

Expecting the Best 73

Part II: Understanding Asthma Triggers 75

Chapter 5: Knowing Your Asthma Triggers 77

Recognizing What Triggers Your Asthma 78

Evaluating triggers 78

Testing for allergic triggers 80

Controlling Inhalant Allergens 81

Clearing the Air at Home 82

Household irritants 83

No smoking, please 83

Filters and air-cleaning devices 83

Working Out Workplace Exposures 84

Targeting workplace triggers 85

Diagnosing and treating workplace triggers 85

Avoiding Drug and Food Triggers 87

Aspirin sensitivities 87

Beta-blockers 88

Sensitivities to sulfites and other additives 88

Food allergies 89

Other Medical Conditions and Asthma 89

Rhinitis and sinusitis 89

Gastroesophageal reflux disease (GERD) 90

Viral infections 91

Chapter 6: Understanding Asthma and the Role of Allergies 93

Protecting Your Health: How Your Immune System Works 94

Classifying Immune System Components and Disorders 95

Protecting and serving in many ways 98

Distinguishing between immune deficiencies and allergic conditions 99

Immunizing and immunology 100

Classifying Abnormal Immune Responses 101

IgE-mediated reactions (Type I) 101

Cytotoxic reactions (Type II) 101

Immune complex reactions (Type III) 102

Cell-mediated reactions (Type IV) 102

Developing an Immediate Hypersensitivity 102

Setting the stage for allergic reactions 102

Reacting to allergen exposures 104

Doing it one more time: The late-phase reaction 106

Becoming hyperresponsive 106

Reacting nonspecifically 107

Reaping the Benefits of Immunology 107

Chapter 7: Hay Fever and Asthma: The United Airway 109

Catching Up with Your Runny Nose 110

Classifying Types of Hay Fever 112

Seasonal allergic rhinitis 113

Perennial allergic rhinitis 113

Occupational allergic rhinitis 114

What Makes Noses Run? 115

Getting a Medical Evaluation 115

Understanding that sneezy, itchy, and runny feeling 115

Seeing red: Allergic conjunctivitis 116

All that drips isn’t allergic 117

Knowing what the doctor’s looking for 119

Doing your part 120

Managing Rhinitis 121

Avoiding allergens 121

Treating with medications 121

Treating the cause of your allergies 122

Considering special cases 122

Chapter 8: Food Allergies and Asthma 125

Types of Adverse Food Reactions 126

Allergic Food Hypersensitivities 127

How allergic food hypersensitivities develop 129

Gastrointestinal tract allergies 129

Hives and other food-related skin reactions 130

Anaphylaxis and allergic food reactions 131

Non allergic (Non-IgE) Food Hypersensitivities 134

Understanding the Differences between Food Allergy and Food Intolerance 135

Lactose intolerance 135

Metabolic food reactions 135

Pharmacologic food reactions 136

Food additive reactions 136

Food poisoning 137

Diagnosing Adverse Food Reactions 137

Keeping a food diary 138

Considering atopic causes 138

Eliminating possible food culprits 138

Testing for food allergens 139

Avoiding Adverse Food Reactions 140

Chapter 9: Asthma and Exercise 141

Understanding EIA 141

Keeping Fit Despite EIA 142

Diagnosing EIA 142

Controlling EIA with medications 143

Athletes and EIA 143

Breathing competitively: Nose versus mouth 143

Warming up and cooling down to prevent EIA 144

Part III: Treating Your Asthma 145

Chapter 10: Avoiding Allergens That Cause

Respiratory Symptoms 147

Pollens 148

Pollen particulars 148

Counting your pollens 150

Allergens in the grass 153

Wheezy weeds 153

Can’t sneeze the forest for the trees 154

Molds 155

Spreading spores 155

Moldy matters 156

House Dust 156

Dust mites 157

What else is in my house dust? 158

Dust gets in your eyes or nose, throat, and lungs 158

Avoidance and Allergy-Proofing 159

Why avoidance matters 159

Knowing your limits 161

Crossing the line 161

Table of Contents xv

The Great Indoors 162

Indoor air pollution: Every breath you take can hurt you 162

Allergens on the barbie? 163

Allergy-Proofing Begins at Home 163

Controlling the dust in your house 164

Ridding your house of dust mites 165

Controlling dust mites in the bedroom 165

Regulating pet dander 166

Controlling mold in your abode 167

Pollen-proofing 168

Chapter 11: Getting Allergy Tested and Allergy Shots 171

Diagnosing with Skin Tests 172

Pins and needles 172

Skin tests and antihistamines: Not a good mix 173

Starting from scratch: Prick-puncture procedures 174

Getting under your skin: Intracutaneous testing 175

Skin test side effects 176

Blood testing for allergies 176

Reviewing Immunotherapy 177

Seeing how immunotherapy works 177

Deciding whether immunotherapy makes sense for you 178

Getting shots 179

Considering side effects 182

Looking at Future Forms of Immunotherapy 182

Chapter 12: Relieving Your Nasal Allergies 185

Getting Familiar with Pharmacology 186

Blocking Your Histamines: Antihistamines 187

Histamine hints 187

A dose of prevention 188

First-generation OTC antihistamines 188

Newer antihistamines 190

Antihistamines and children 194

Antihistamine nasal sprays 194

Decongesting Your Nose 195

Oral decongestants 195

Nasal decongestants 196

Two for the Nose: Combination Products 197

Analyzing the upside and downside 198

One size fits all may not suit your condition 199

Using Nasal Corticosteroids 199

Cromolyn Sodium 202

Reducing Mucus with Anticholinergic Sprays 203

Treating Rhinitis with Leukotriene Modifiers 204

Keeping an Eye out for Allergic Conjunctivitis 204

Chapter 13: Treating Your Ear, Nose, and Throat Symptoms 207

Complicating Your Allergies and Asthma: Sinusitis 208

Recognizing common causes 208

Sinus science 209

Practical sinus 210

How long has this been goin’ on? 211

Diagnosing sinusitis 212

Determining the best course of treatment 213

An ounce of prevention 215

Otitis Media 216

Revealing common causes 216

Getting an earful 217

Acute otitis media (AOM) 219

Otitis media with effusion (OME) 220

Diagnosing ear infections 221

Taking preventive measures 221

Part IV: Controlling Asthma with Medications 223

Chapter 14: Knowing Asthma Medications 225

Taking Your Medicine: Why It’s Essential 227

Looking at asthma’s changing dynamics 227

Tracking your asthma condition 227

Getting the Long and Short of Asthma Medications 229

Controlling asthma with long-term medications 230

Relieving asthma episodes with quick-relief products 231

Taking asthma medications prior to surgery 232

Delivering Your Dose: Inhalers and Nebulizers 233

Using a metered-dose inhaler 234

Using holding chambers 236

Using a dry-powder inhaler 236

Using a multidose-powder inhaler 239

Using nebulizers 240

Cleaning your medication delivery system 242

Chapter 15: Looking at Asthma Controller Drugs 243

Controlling Airway Inflammation with Corticosteroids 244

Inhaled corticosteroids 244

Oral corticosteroids 248

Preventing Respiratory Symptoms with Mast Cell Stabilizers 250

Cromolyn 251

Nedocromil 251

Prepping for mast cell stabilizers with other drugs 252

Knowing when mast cell stabilizers may not be enough 252

Dilating Your Airways with Long-Acting Bronchodilators 253

Combining two drugs: Advair 254

Understanding timing: Why long-acting products may not always be enough 254

Enhancing anti-inflammatory effectiveness 255

Relieving Nighttime Asthma with Theophylline 255

Watching out for theophylline’s undesirable side effects 256

Bad combinations: Adverse interactions with theophylline 257

Reducing Respiratory Symptoms with Leukotriene Modifiers 257

Understanding the importance of leukotrienes in asthma 259

Watching out for adverse side effects 259

Introducing the Newest Therapy on the Block: IgE Blocker 260

Chapter 16: Treating Asthma Episodes 263

Relieving Symptoms with Short-Acting Bronchodilators 264

Using short-acting bronchodilators effectively 268

Avoiding potential adverse side effects of short-acting bronchodilators 269

Introducing new and improved bronchodilation 270

Reversing Airflow Obstruction with Anticholinergics 272

Looking at Short-Term, Rescue Use of Oral Corticosteroids 273

Chapter 17: Future Trends in Asthma Therapy 275

Getting Better All the Time 276

Improving inhaled corticosteroids 276

Combining for complementary effect 276

Special delivery: More effective devices 277

Under Your Tongue: Swallow Immunotherapy 278

Blocking IgE: A Biotech Breakthrough 279

Exploring the Frontiers of Asthma Therapy 280

Inhibiting interleukins 280

Toll-like receptors (TLRs) 281

Gene therapy 282

Keeping Research Alive: Clinical Trials and You 282

Part V: Special Asthma Conditions 285

Chapter 18: Asthma during Childhood 287

Understanding Your Child’s Asthma 288

Inheriting asthma 289

Identifying children’s asthma triggers 289

Controlling — not outgrowing — asthma 290

Treating early to avoid problems later 290

Identifying Childhood-Onset Asthma 290

Taking your child’s medical history 291

Examining your child for signs of asthma 292

Testing your child’s lungs 292

All That Wheezes Isn’t Asthma 293

Focusing on Special Issues Concerning Childhood Asthma 293

Teaming up for the best treatment 295

Managing asthma in infants (newborns to 2 years old) 295

Treating toddlers (ages 2 to 5 years): Medication challenges 297

Peak-flow meters and school-age children (ages 5 to 12) 298

Using inhalers: Teens and asthma 299

Handling Asthma at School and Daycare 300

Indoor air quality (IAQ) at school and daycare 301

Participating in PE — exercise and asthma 302

Chapter 19: Pregnancy and Asthma 303

Identifying Special Issues with Asthma during Pregnancy 304

Your hormones and your asthma 304

The basics of managing asthma while pregnant 304

Breathing for Two 305

Avoiding asthma triggers, allergens, and irritants during pregnancy 306

Undergoing allergy testing and immunotherapy during pregnancy 306

Managing nasal conditions associated with pregnancy 307

Exercising with asthma during pregnancy 308

Assessing your asthma during pregnancy 309

Monitoring your baby’s condition 309

Taking asthma medications while pregnant 309

Handling asthma emergencies while pregnant 311

Chapter 20: Asthma and the Elderly 313

Recognizing Asthma Later in Life 314

Taking Asthma Medications When Older 315

Using more effective delivery devices 315

Watching out for adverse side effects 316

Part VI: The Part of Tens 317

Chapter 21: Ten Tips for Traveling with Asthma 319

Planning a Safe, Healthy Trip 320

Adjusting Treatment for Travel 321

Taking Medications and Other Essentials 321

Getting Medications and Medical Help Abroad 322

Flying with Allergens and Irritants 322

Considering Allergy Shots and Travel 323

Reducing Trigger Exposures in Hotels and Motels 323

Avoiding Food Allergies during Your Trip 324

Finding Help in Case of Emergencies 324

Traveling with Your Asthmatic Child 325

Chapter 22: Ten Famous Folks with Asthma 327

Augustus Caesar 328

Peter the Great 328

Ludwig van Beethoven 328

Charles Dickens 329

Teddy Roosevelt 330

John F Kennedy 331

Leonard Bernstein 332

Liza Minnelli 333

Kenny G 333

Jackie Joyner-Kersee 334

Appendix: Asthma Resources 335

Organizations 335

Asthma and Allergy Environmental-Control Products 337

Suppliers 337

Manufacturers of asthma and allergy products 338

Other Writings and Media about Asthma and Allergies 338

Books 339

Periodicals 339

Index 341