Asthma and Allergies
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Slide 1 :
Asthma and Allergies Pamela Amelung, MD Mini-Med School Fall 2006 University of Maryland School of Medicine
Slide 2 :
What is asthma? Asthma facts and statistics Who is most at risk to get asthma? Symptoms and triggers, including allergies Management of asthma How to avoid triggers and attacks Topics Covered
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Chronic inflammatory disorder of the medium and small airways. These airways are hypersensitive to certain “triggers” in the environment. Intermittent and recurrent episodes of... Wheezing Shortness of breath Chest tightness Cough - night, early morning Usually reversible Asthma cannot be cured but its symptoms can be controlled with proper environmental changes and medication. What is Asthma ?
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About 17 million Americans have asthma Most common chronic childhood disease, affecting about 5 million children (6% of children under 18) 14 people die each day from asthma Nearly 2 million emergency room visits each year The facts about Asthma
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How many people have Asthma ? The number of Americans diagnosed with asthma has risen. Self-reported prevalence increased 75% Close to 21 million Americans have been diagnosed with asthma in their lifetime. *MMWR December 04, 1998 / 47(47);1022-1025 13.7 17 Millions of individuals diagnosed
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The cost of Asthma ! Asthma costs billions of dollars each year and the cost is rising. The estimated annual cost of asthma in 2000 was $14.5 billion. * www.cdc.gov 1990 2000 $6.2 billion $ 14.5 billion
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The cost of Asthma ! 3 million lost work days 10 million lost school days each year from asthma
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The cost of Asthma ! Deaths from asthma have increased more than 50% in the past 20 years, and have increased more than 75% in children under 19 *CDC MMWR April 24, 1998 / 47(SS-1);1-28
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Race and asthma Mortality
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Asthma Mortality: Female vs. Male
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Risk factors for Asthma Allergy / Atopy Family history of asthma/allergy Perinatal exposure to tobacco smoke Viral respiratory infections Low birth weight Male gender - pre-adolescence Low-income, urban residents Obesity
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Classification of Asthma Intermittent - Asthmatics who have symptoms that occur with a cold from time to time. They often grow out of the disease. Persistent - Asthmatics having symptoms at least twice a week during the day and twice a month during the night These asthmatics are further classified as mild, moderate, or severe.
Slide 13 :
Coughing Wheezing Chest tightness Shortness of breath Symptoms of Asthma
Slide 14 :
Asthma Triggers For people with asthma, exposure to certain substances they are sensitive to can lead to an asthma attack or exacerbation. These substances are known as triggers. Not all people with asthma have the same triggers that will cause an asthma attack.
Slide 15 :
Indoor air Triggers Environmental tobacco smoke (ETS) Cockroaches Dust mites Animal dander Mold, mildew Strong scented products (perfumes, scented cleaners)
Slide 16 :
All of the common asthma triggers are found indoors Americans spend about 90% time indoors Reducing exposure to indoor allergens and irritants can reduce asthma symptoms Prevention is an important asthma management tool Why indoor air is Important
Slide 17 :
Contains more than 4,000 substances (over 40 are carcinogenic) Is particularly harmful to young children Can trigger asthma attacks and cause young children to develop asthma Secondhand Smoke
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Found in most homes Live in soft bedding Feed on skin flakes Mites and mite droppings can be asthma triggers Most common asthma trigger in adults and kids Dust Mites
Slide 19 :
Skin flakes, urine and saliva of warm blooded animals can be asthma triggers. Triggers can remain in the home for several months after a pet is removed, even with cleaning. Pets
Slide 20 :
Can be found almost anywhere. Key to mold control is moisture control. Clean up the mold and get rid of excess water or moisture, this also helps reduce other triggers, such as dust mites and cockroaches. Molds
Slide 21 :
Droppings or body parts can be asthma triggers. Cockroaches likely contribute significantly to asthma problems in inner city area. Asthmatic children allergic to cockroaches are three times more likely to be hospitalized if exposed in the home. Cockroaches and other Pests
Slide 22 :
Outdoor air Triggers Ozone Particulate matter Sulfur dioxide Nitrogen dioxide - vehicle exhaust Outdoor pollens and mold
Slide 23 :
Additional Triggers Viral upper respiratory infections Exercise Aggravating conditions - gastric reflux, sinusitis, rhinitis Diet, medication Cold air Changes in weather Menstrual cycle, pregnancy
Slide 24 :
What causes an Asthma Attack ? An allergic reaction to triggers or exposures Airways swell and fill with mucus and secretions The muscles around the airways contract and spasm Airways can collapse, causing classic symptoms, even death
Slide 25 :
Indications of a severe Attack Breathless at rest Hunched forward Talking in words rather than sentences Agitated Peak flow rate is less than 50% of normal
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Management of Asthma Asthma is one condition that, when treated with timely and effective regular outpatient care, prevents hospitalization and ED visits.
Slide 27 :
Consult with a physician to develop an asthma management plan, which includes: Medication Education: identification of asthma triggers & ways to reduce/avoid exposure to your asthma triggers Peak flow monitoring Emergency plan Managing Asthma
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Goals of asthma Management Control chronic asthma symptoms and asthma attacks during the day and night no sleep disruption due to asthma no missed school or work because of asthma no or minimal need for emergency care or hospitalizations Avoid attacks or exacerbations Maintaining normal activity levels, including exercise and other daily activities Having normal or near-normal lung function Avoid side-effects of medications Prevent asthma mortality
Slide 29 :
Choose not to smoke in your home or car and do not allow others to do so either. Avoiding secondhand Smoke
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Wash sheets and blankets once a week in hot water Choose washable stuffed toys-- keep stuffed toys off beds Cover mattresses and pillows Vacuum often (when asthmatic is not present) Maintain low indoor humidity, ideally between 30-50% Avoiding dust Mites
Slide 31 :
Consider keeping pets outdoors or even finding a new home for your pets, if necessary. Keep pets out of the bedroom at all times. Keep pets away from fabric-covered furniture, carpets, and stuffed toys. Avoiding pet Triggers
Slide 32 :
Wash mold off hard surfaces and dry completely, absorbent materials (ceiling tiles and carpet) may need to be replaced. Use exhaust fans or open windows in kitchens and bathrooms when showering, cooking, or using the dishwasher. Maintain low indoor humidity (between 30-50% relative humidity). Fix leaky plumbing or other sources of water. Keep drip pans in your air conditioner, refrigerator, and dehumidifier clean and dry Clean bathrooms frequently. Avoiding mold Triggers
Slide 33 :
Pest Avoidance Free your home of places for pests to hide and sources of food and water Regular, careful cleaning - kitchen Daily trash removal Store food in airtight containers Extermination - baits, gels (not sprays)
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Prevent outdoor Triggers Ozone - advisories, stay indoors Pollens and Molds (if allergic) Close windows, doors Use air conditioners, clean filters regularly Dry clothes indoors Avoid raking leaves, gardening Outside - less breezy, after gentle rain
Slide 35 :
Peak expiratory flow (PEF) Meters Allows the patient to assess the status of his or her asthma
Slide 36 :
Peak flow Chart People with moderate or severe asthma should take readings— Every morning and evening After an exacerbation Before inhaling certain medications Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI
Slide 37 :
Management of Asthma Quick-relief medications used to treat asthma attacks and acute symptoms “Relievers” Long-term control medications reduce the airway inflammation that causes these symptoms “Controllers”
Slide 38 :
Asthma Medications Quick-relief medications Short-acting bronchodilators Relax smooth muscle around the airways Long-term Medications Steroids Inhaled, tablets Anti-inflammatory Long acting bronchodilators Relax smooth muscle Leukotriene inhibitors Anti-inflammatory
Slide 39 :
Asthma action Plan National Heart, Lung, and Blood Institute
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Asthma is Increasing Why the increase? Increased recognition, diagnosis-shifting Environmental allergens - indoor, outdoor Energy-efficient buildings, carpet Exposure to mother’s tobacco smoke Psychosocial and socioeconomic factors More time indoors Overcrowding Access to care
Slide 41 :
“Hygiene Hypothesis” Are we too clean ? Immune Response Th1 Responds to harmless bacteria, dirt, animal droppings after birth Not activated in sterile birth environment Subdues the more hyperactive Th2 Th2 Not as effective as Th1 Fight allergens, cause allergies T0 T2 T1
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“Hygiene Hypothesis” Are we too clean ? Less allergies and asthma: 1990 East vs. West Germany Farm vs. city children Daycare before 6 months of age vs. later Older siblings vs. none Failure to develop balanced immune system Detergents/chlorine, antibiotics, vaccines, antibacterial soaps
Slide 43 :
Healthy people 2010 Objectives Reduce asthma deaths Reduce hospitalizations for asthma Reduce hospital ED visits for asthma Reduce activity limitations - reduce # of school/work days missed Increase proportion who receive formal patient education Increase proportion who receive appropriate asthma care Establish in ?25 states a surveillance system for tracking asthma http://www.health.gov/healthypeople
Slide 44 :
Conclusions Asthma affects 5-10% of the population and the prevalence is rising in developed countries. Allergies often play a key role in asthma and act as triggers for asthma symptoms. Asthma can not be cured but can usually be well controlled in most people. Controlling asthma involves patient education, lung function monitoring, avoidance of triggers, and in many, medications.
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