By: Stephen Apaliski, MD
Is there a way to get back to a normal life when you have asthma?
Is it possible to give the inhaler a little rest? Is it likely to get a full night’s sleep without waking from an attack? Can you (or your child) actually get back to playing sports again? The answer is yes—all of these things are possible.
But how do you get there? Although no magic wand will make your asthma disappear, what follows is powerful information that can change your life.
Asthma Specialists Versus Generalists
Why should anyone care about how allergists treat asthma?
As it turns out, dozens of medical studies support the existence of superior outcomes for patients who have their asthma managed by an asthma specialist rather than a generalist healthcare provider. For example, patients seeing specialists report higher ratings of quality of care, improved physical functioning, and improved quality of life.
What is it about what allergists do that is different? Introducing the Seven “P” Principles. These points will to help you understand what, from a specialist’s experience, must be addressed if your asthma is to be controlled as best as it can be.
1. Understanding the Problem
If you understand the nature of asthma, you can begin to discover how to better manage it. Asthma is a chronic disease of the lungs that involves tightening of the muscles that surround the airways or breathing tubes in the lungs. Excess mucus is produced in those who have asthma, and the airways themselves become inflamed or “twitchy.” Various elements (allergens, viruses, and irritants) entering the lungs play a role in causing these reactions to occur.
In a person with asthma, the lungs are prone to functioning in a compromised state, resulting in coughing, wheezing, shortness of breath, and chest tightness. The lungs in a person with asthma tend to be more disadvantaged at nighttime.
Consider two patients with asthma as examples. Larry is an adult with asthma. From Larry’s perspective, asthma involves problems that seem to occur every month or so. He seems to get a cold followed by chest tightening, a terrible cough, and wheezing. In response, Larry treats himself with over-the-counter medicines.
Several times a year, things get so bad for Larry that he has to go to the emergency room near his home for treatment. He then takes the prescribed medications for a few days, but as soon as he feels better, he stops them. In his mind, Larry has asthma when he feels bad, and when he feels better, he doesn’t have asthma.
Now, look at Andrew, an eight-year-old boy with asthma. His disease is just as severe as Larry’s. But Andrew’s mom learned about the chronic nature of asthma. She also learned that there are medications she could give Andrew daily that would just about stop the ups and downs, and she learned to recognize early when things were getting worse for Andrew, taking action right away. Because of this, the emergency room visits stopped.
The ability to understand asthma as a chronic problem allows Andrew and his family to take the necessary steps to begin to control it and then prevent it. Because Larry views his asthma as spontaneous or episodic, he saw himself as powerless to prevent it and was left reacting to it whenever problems erupted.
2. Prevention (Avoidance)
We live in a world containing dust mites, air pollution, smoke, viruses, animals, and odors, among other irritants. To a person without asthma, these things may be a nuisance, but to the person with asthma, these things can trigger an attack.
If you can reduce exposure to tobacco, perfumes, and chemicals, as well as minimize time spent in outdoor air during periods of high air pollution, you may be able to reduce asthma attacks. The key point here is to know your asthma triggers and avoid them when possible, or at least to limit your exposure to them.
3. Pulmonary Function Tests
Ironically, a person with asthma may report feeling well when, in fact, the person’s lungs may not be doing well at all. Pulmonary Function Tests (PFTs) can be used to gather information on a person’s current lung function beyond simply asking how the person feels. Hopefully, these tests confirm that things are indeed going well; if this is not the case, the treatment plan can be adjusted as needed.
Larry rarely sees the same healthcare provider twice so his care is fragmented. Pulmonary function tests are never done and problems develop silently until he develops symptoms. Without this additional knowledge, Larry does not have the impetus he needs to stay on top of his asthma.
Andrew sees his allergist twice a year and his lung function is checked. It is typically found to be normal; this is reassurance that the treatment plan is working.
What’s the difference between these examples?
Andrew has evidence that his lung function is good and this serves as reinforcement that the treatment plan is working; Larry, who doesn’t have that information, just goes by how he feels. But we know that you can feel good and still have reduced lung function. If you are running around with reduced lung function, you risk any trigger pushing you into a full-blown severe asthma attack.
The approach here is to take the right amount of medicine needed to control asthma, nothing less and nothing more. This helps to minimize side effects and keeps the treatment regimen as simple as possible.
When it comes to pharmaceuticals, think of treating asthma as climbing stairs. Treating the mildest form of asthma requires only going up one step. That is, a bronchodilator inhaler or nebulizer is all that is needed.
If the asthma is not controlled here, you ascend to the next step—using an inhaled anti-inflammatory medicine or a pill such as Singulair. This step-up approach is repeated until the right combination of medications is found.
As of yet, there is no definitive evidence as to whether supplements can also support a person’s efforts to control asthma. However, initial studies on vitamin D, which is linked to a reduction in inflammation, raise the possibility that this particular supplement could be helpful. In addition, some patients report benefits from taking fish oil supplements (omega 3 fatty acids), which are known for their heart and brain benefits and are also linked to reduced inflammation. Then, there’s good old-fashioned vitamin C, which may help prevent the common cold, another trigger for asthma attacks.
At this point, only individual patient stories, rather than wide-scale scientific studies, have pointed to the possible positive effects of supplements. So think of supplements as one possible support method for your overall asthma care, with medicine—not too little and not too much—as the mainstay.
If you have asthma, you should always keep your short-acting bronchodilator available. But is that enough? Work with your healthcare provider to develop a plan that tells you when to seek help and take action, and what you can do when coughing, wheezing, and chest tightness occurs.
Larry’s plan is crisis-driven. When he gets sick, he just increases the number of times he uses his bronchodilator until things either improve or he has to seek emergency help. It’s a one-level plan. Clearly, his asthma is in charge here.
In contrast, Andrew’s mom knows that if he starts to get a cold or develop a certain cough, there is potential for problems. Following Andrew’s asthma action plan, she immediately starts supporting him with more acute treatment. She understands that if things quickly get better, no further action is needed; if things don’t improve or worsen, she calls her allergist so that Andrew is seen earlier in the course of the attack. Andrew’s asthma action plan tells Mom what to do and when to do it.
6. Patient-Healthcare Provider Relationship
A long-term, good relationship with the right kind of healthcare provider is a must.
Look at Larry—he’s just too busy to see a healthcare provider regularly. What he’ll do instead is see whatever healthcare provider he can at the nearest emergency room or acute care clinic. He rarely sees the same provider twice. In these settings, though, healthcare providers are more concerned about treating the acute problems Larry has and getting him over his current attack. Their purpose is not to provide the long-term care he needs to manage his chronic condition; they deal with emergencies—since that’s their job.
In contrast, Andrew and his mom have seen the same allergist for a few years now. Mom is able to relate Andrew’s history to the provider. The provider listens to her, values her input, and views her as an expert in what is currently happening with Andrew. The healthcare provider is then able to apply her own expertise as to what changes must be made to Andrew’s treatment plan to improve control.
7. Positive Mindset
The seventh principle may seem softer but it is no less important: maintaining a positive mindset. Positive mindset, in this context, is composed of optimism, ownership, and something the field of positive psychology calls grit (passion and perseverance).
Larry believes he is a victim of his asthma. This prevents him from taking responsibility for his illness. He has yet to learn that there are certain things he can do to prevent many of his attacks from even happening. Although medicines have been prescribed for him, he may take them only until he feels better and then stops. He views his asthma from the mindset of a victim, leaving him feeling somewhat hopeless and helpless.
Alternately, Andrew’s mom thinks about his asthma regularly and never puts it out of her mind completely. Andrew’s mom also understands that it’s she and Andrew who are responsible for dealing with problems as, or even before, they arise and that there are things she can do to make sure the asthma doesn’t get out of control (they “own” the asthma). She has an optimistic outlook, and Andrew has learned to adopt the same attitude. As a result, she and Andrew are not victims; they are empowered. They have a positive mindset that leads them to stay engaged and in control of Andrew’s asthma.
These seven principles make up the framework that many allergists use to help their patients beat their asthma.
For those seeking alternative practices to help support their asthma treatment, patients can consider stress-reduction activities such as yoga, biofeedback, and acupuncture. Stress has been linked to inflammation, so reducing its impact on the body may support asthma treatment. Lastly, although there are no scientific studies to support the following claim, some patients have also reported improvements in their asthma after eliminating dairy and sugar from their diet.
Treating asthma requires a multifaceted approach, from understanding the problem to maintaining a positive mindset. So, let these seven principles be a foundation to help you and your family take control of your asthma and to get back to the life you really want to live!
Stephen Apaliski, MD has been a practicing physician for over 30 years and is Board Certified in Pediatrics as well as Allergy and Immunology. His new book is Beating Asthma: 7 Simple Principles (Salveo Media, 2012) (beatingasthma.com). Follow him on Twitter: @SJApaliski.