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Preventing Asthma Exacerbations

Asthma is a common ailment, affecting about 8% of the US population, and its prevalence is rising.  It is unpleasant, can limit activity levels, can lead to missed days of school and work, might require hospitalization and can even cause death.  In fact, about 10 people a day die from asthma exacerbations!

Fortunately, asthma is treatable, and most asthma related deaths can be prevented with proper treatment and early recognition of the need for immediate medical intervention.  Below are some steps asthmatics can take to improve their quality of life and avoid serious consequences.

Identify and avoid asthma triggers

Asthma is a condition of exaggerated inflammation and reactivity of the airways.  Exacerbations occur when an asthmatic is exposed to a condition (trigger) that causes this exaggerated response.  Triggers can vary, but the most common triggers include:

Obviously, identifying and avoiding a person’s triggers is essential to avoiding exacerbations.  However, some of the triggers can be particularly difficult to eliminate from our environment. For example, the closer one lives to a major freeway, the more likely they are to have exacerbations.  Those who live in cities with more polluted air in general have more exacerbations. While moving farther from a road or to another city may not be practical, there are other steps that can be taken including:

  • Stop smoking and don’t allow others to smoke near you or in your home
  • Keep dust to a minimum, including avoiding carpets and curtains and enclosing mattresses and pillows in impermeable covers.
  • Eliminate roaches and other household insects
  • Use a dehumidifier to lower mold levels
  • Use a HEPA filter to reduce dust and other allergens in the air
  • Eliminate pets
  • Avoid exercise during cold weather.

Follow your doctor’s recommendations

Maintaining a good relationship with your doctor is essential.  Working consistently with your doctor will result in better control of symptoms and fewer exacerbations.  Your doctor can help you identify your triggers, recommend lifestyle changes to avoid them and prescribe medications to prevent and treat exacerbations.  Unfortunately, there really are no over the counter medications that improve asthma. But nearly all patients can achieve satisfactory control if they work closely with their physician who can prescribe the appropriate medications when needed.

Follow your treatment plan

Once you and your doctor have identified a treatment plan, following those recommendations is essential.  Treatment usually falls into 3 categories:

  • Lifestyle changes based on your particular triggers
  • Maintenance or preventative medications.  There are several categories of these, but the most common are inhaled corticosteroids, long acting bronchodilators and leukotriene inhibitors.  These are almost always used daily and greatly decrease symptoms and exacerbations.
  • “Rescue” medications are used for any symptoms that develop despite the above actions.  When used properly, early in the course of an exacerbation, these can prevent the need for a visit to the ER or worse.  One of the most common mistakes made with these medications is an underappreciation for their importance at interrupting an exacerbation and not using them aggressively enough to get the needed benefit.

While most asthma can be relatively easily controlled, exacerbations happen.  If your asthma is progressively worsening, in spite of following your doctor’s recommendations, early evaluation by your doctor or an ER will decrease your misery and reduce the chances of a tragic outcome.