Asthma Definitions:
Asthma: According to National Heart, Blood and Lung Institute, “Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning. Asthma affects people of all ages, but it most often starts in childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.”
Bronchospasm: This is when the bronchioles of the lungs (the air passages) become inflammed, produce excess secretions, and constrict. This narrowed airway makes it difficult to get air out of the lungs, and often results in air trapping. It is the key component of asthma and COPD.
Asthma prognosis: The life expectency for mild and moderate asthmatics is the same as that for non-asthmatics.
Asthma gene: It is believed that in order to develop asthma one has to have this gene, and something has to happen to “turn it on.” Approximately 10% of Americans have this gene. Many asthma experts believe the age a person is when this gene is “turned on” determines whether one has childhood-onset or adult-onset asthma. Others think it’s always “turned on” during the first few months of life, regardless of when one first has asthma symptoms.
Childhood-onset asthma: This is when a person first shows signs of asthma during childhood, or under the age of 18. Most common triggers of this are allergies, respiratory infections, and exercise induced asthma.
Adult-onset asthma: This is when a person first shows signs of asthma during adulthood. Most common triggers of this are relocation and GERD.
Acute:Â It’s happening right now.
Chronic:Â It’s going on all the time. Permanant.
Acute Asthma: This is shortness-of-breath due to narrowing of the air passages in your lungs that is occuring right now. The most common way of treating this is with rescue medicines (see below).
Chronic asthma: This refers to the underlying inflammation that is always prevalent in the lungs of asthmatics. The degree of this inflammation is what determines the severity of your asthma when exposed to your asthma triggers. The best way of treating this is with asthma controller medicines (see below).
Severe Asthma: May be associated with decreased lung function with a loss of response to bronchodilator. Patients with the greatest degree of reversibility in response to rescue medicine (Albuterol) may be at the greatest risk of developing fixed airflow obstruction and have the greatest loss of lung function.
Poorly controlled asthma: This refers to about 5% of asthmatics who have frequent symptoms and exacerbations despite use of high-dose systemic corticosteroids. Patients who have a poor response to appropriate therapy require referral to and consultation with an asthma specialist.
Resistance to therapy: See poorly controlled asthma.
Asthma triggers: These are normally non-threatening things like dust mites, molds, stress and smells that “trigger” asthma symptoms. While these things are normally non-threatening, the immune systems of asthmatic lungs treat these things the same way it treats bad bacteria and parisites. Air passages that have a greater degree of inflammation are more sensitive to these triggers, and may result in “more severe” asthma attacks.
Twitchy airways: This usually occurs in children who have smaller air passages than adults. It occurs when the air passages are very inflammed and thus extremely sensitive to asthma triggers. Asthmatics with twitchy airways are often referred to as Brittle Asthmatics.
Brittle Asthma: These asthmatics have severely inflammed air passages that are highly sensitive to triggers. Even the simplest exposure can set off a major attack. In most cases today, brittle asthma can be prevented by compliant use of your asthma controller medications. In some instances asthma is so severe that even controller medicines don’t controll asthma. I refer to these asthmatics as hardluck Asthmatics.
Airway remodelling: (synonym: lung scarring) This is irreversible changes that can occur in your lungs if your asthma is not diagnosed in a timely manner and treated agressively. This can make asthma more difficult to control. This is one great reason why it is extremely important to see your doctor regularly and take your asthma medicines exactly as prescribed.
Rescue medicines: These “quick relief” asthma medicines dilate and relaxe the air passages in your lungs. The most common ones used in the U.S. are Ventolin and Xopenex.
Asthma Action Plan: The asthma guidelines recommend all asthmatics develop a partnership with their doctors to create a plan to help them understand when to take action (use rescue inhaler, call physician or go to the ER). The guidelines note that
“either peak flow monitoring or symptom monitoring, if taught and followed correctly, may be equally effective.”
Asthma Symptoms: These are “symptoms” an asthmatic experiences when an asthma attack is impending (early warning signs) and when an attack is ongoing (Asthma attack symptoms).
Peak flow meter: This is a device used to determine “how well your lungs are functioning,” according to National Jewish Health. This is recommended as part of the asthma action plan for children and anyone who has difficulty perceiving asthma symptoms. It should be noted that peak flows are a great tool for monitoring asthma status, but should not be used to diagnose.
Spirometry: click here for PFT lexicon and here for everything asthmatics need to know about PFTs
Controlled Asthma: Controlled Asthma: This is the ultimate goal of all asthma doctors for all their asthmatic patients. Asthma control is determined by the following:
- Decreased use of rescue inhalers for quick relief (or, ideally, the need to use them less than 2 days a week),
- Fewer school days or days of work missed (or no days missed)
- ability to engage in normal daily activities or in desired activities
- Improved ability to exercise without having asthma symptoms
- Improvement in FEV1 in a pulmonary function test (PFT), or maintaining a normal PFT.
- Reduction in exacerbations
- Fewer emergency room visits and hospital stays for asthma
- Fewer nighttime awakenings due to asthma
- Optimal asthma meds with minimal adverse effects
- You’re expectations are met or exceeded
- You’re satisfied with your asthma care
Controller medicine: (synonym: preventative meds). These are asthma medicines, if taken correctly and as directed, that are meant to prevent one from having an asthma attack, limit severity of attacks, and help one maintain good control of asthma. The best of this type of medicine are Advair, Symbicort, and Singulair.
Asthma Symptoms: These are symptoms that are synonimous with an asthma attack. They include: Wheezing, Coughing, Shortness of breath, Tightness in the chest, Peak flow numbers in the caution or danger range (usually 50% to 80% of personal best).
Early signs of asthma: These are signs an asthma attack is imminent, and one must take action quickly to prevent the attack, such as use a rescue inhalr or call a physician. They include:
Breathing changes, Sneezing, Moodiness, Headache, Runny/stuffy nose, Coughing, Chin or throat itches, Feeling tired, Dark circles under eyes, Trouble sleeping, Poor tolerance for exercise, Downward trend in peak flow number.
Signs of severe asthma: According to national Jewish Health, “Severe asthma symptoms are a life-threatening emergency. If any of these severe asthma symptoms occur, seek emergency medical treatment right away, since these symptoms indicate respiratory distress. Examples of severe asthma symptoms include: Severe coughing, wheezing, shortness of breath or tightness in the chest, Difficulty talking or concentrating, Walking causes shortness of breath, Breathing may be shallow and fast or slower than usual, Hunched shoulders (posturing), Nasal flaring (nostril size increases with breathing), Neck area and between or below the ribs moves inward with breathing (retractions), Gray or bluish tint to skin, beginning around the mouth (cyanosis)
Peak flow numbers in the danger zone (usually below 50% of personal best)
Dyspnea tolerance: According to the asthma guidelines, “these patients have unconsciously accommodated to their symptoms, or perhaps they have mistakenly attributed these symptoms to other causes, like aging, obesity, or lack of fitness, so they do not report them readily.” These patients have been short of breath so long they have developed a “tolerance” to it, and are incapable of determining degree or severity of their dyspnea. Therefore, the best method of managing their asthma is by using spirometry and peak flow measurements. These asthmatics tend to be Martyr Asthmatics and Hardluck Asthmatics.
Psychological consequences of asthma: These are the undesirable effects asthma can have on a child who has uncontrolled, severe-persistant, or hardluck asthma. This is particularly associated with children who are unable to perform certain activities, whose asthma struck at a very young age, and who have poor family and social support. These consequences include, but are not limited to: Poor self confidence, Embarrassment that you have it, embarrased to take medicine in public and anxiety.
Causes: Â Things that might cause one to develop asthma
Triggers: Â Things that result in or “trigger” an asthma attack or exacerbation.
Intrinsic asthma: Â Non allergic asthma.
Extrinsic asthma: Â Allergic asthma. Â Most of your asthma triggers are from outside your body, such as allergens, cigarette smoke, pollution, inhaled chemmicals, etc.
Exacerbation: Â Acute asthma attack. Â Most of your asthma triggers are from inside your body, such as gastrointestinal reflux.
Non allergic asthma: Â See Intrinsic asthma
Allergic asthma: Â See extrinsic asthma.
Gastrointestinal reflux (GERD): Â When the esophageal sphyncter relaxes and stomach contents ride up the esophagus and into the lungs. Â It’s a common cause and trigger of asthma.
Dust mite: Â Microscopic bugs that live on dust particles and are a common allergen
Cockroach urine: Â A common allergen
Molds: Â A common allergen
Inflammation: Â Swelling
Animal dander: Â Material shed from animals, such as fur, skin, feathers, etc. Â It’s a common allergen.
Mold spores: Â A common allergen.
Pollen: Â Microscopic coarse powder released from seed plants. Â It consists of a hard coat covering a sperm cell. Â Once it lands on a plant it germinates and a flower develops. Â The pollen is carried by wind and can be inhaled by humans. Â It should be safe for most people, but some develop sensitization to pollen and it can become an allergen.
Ragweed pollen: Â A common pollen produced by the ragweed genus of plant that is carried by the wind adn is considered a common allergen.
Sensitizing: Â When your immune system recognizes an allergen as an enemy and sets off the immune response in an effort to rid your body of this so called enemy.
Allergy:Â (Synonym: atopy) It’s estimated 75 percent of asthmatics also have this. It’s an abnormal reaction to an allergen. A normal reaction would be no reaction at all. The first time your body comes into contact with the allergen (dust mites for example) your body develops a defense against it. When the allergen is reintroduced your body attacks it the same as it would an enemy bacteria or virus. The reaction includes inflammation of the respiratory tract, eyes or skin. This often results in nasal congestion, itchy eyes, runny nose, wheezing (asthma), and skin rash.
Allergen: Anything that induces an allergic reaction. Common ones include dust mites, cockroach urine, molds, fungus, and animal dander. For a more detailed list of allergens and asthma triggers, check out this link.
Hypersensitivity: Extremely sensitive, as in sensitive to an allergen. The air passages (bronchioles) of asthmatic lungs are often hypersensitive to various asthma triggers, and they may become acutely inflamed (swollen) as a result of such contact. See allergy. Â This increased sensitivity may also be due to chronic inflammation of the air passages (which can be improved with corticosteroids).
Inflammation:Â Swelling and redness caused by some irritation. In asthma there is some chronic swelling of the air passages, and when exposed to asthma triggers this inflammation may become worse, or acute. Acute asthma is your asthma attack.
Rhinitis:Â (Synonym: hay fever) Inflammation (swelling) of the mucus membrane inside the nasal passage.
Sinusitis:Â (Synonym: sinus infection) Inflammation of the sinus passages
Beta Agonist:Â (Synonym: bronchodilator, rescue medicine) This is a medicine that has an affinity to beta receptors that line the respiratory tract, particularly the bronchioles. Once attached to the beta receptors a reaction occurs that relaxes the bronchiole muscles and opens up the air passages. This makes breathing easier. Examples include Ventolin and Xopenex.
Long Acting Beta Agonist (LABA): These work the same as Beta Agonists only the medicine can last up to 12 hours. Common examples are Serevent (a component in Advair) and Formoterol (a component in Symbicort).
Corticosteroids: (Synonym: steroids, glucocorticosteroid) A medicine often used to reduce inflammation in the air passages. Common examples include Flovent (a component in Advair) and Budesonide (a component in Symbicort).
Metered Dose Inhaler (DPI): (Synonym: puffer, inhaler, breather, rescue inhaler, atomizer) An easy to use and convenient to carry device used to aerosolize asthma medicine such as beta agonists and inhaled corticosteroids. It consists of the medicine mixed with a propellant held under pressure inside a metal cannister and a plastic sleeve with a little mouthpiece. When you press the canister medicine is sprayed and can be inhaled. For more information click here.
Dry Powdered Inhaler (DPI): The medicine is in powder form and usually comes in a device such as a discus or other device. The medicine is usually held inside a capsule that is crushed when you twist the device. The powder is inhaled when the patient places his mouth over the mouthpiece and inhales. For more information click here.
Nebulizer: (Synonym: Updraft therapy, Aerosol, Magic Mist, breathing machine, breathing treatment, peace pipe) This is a small cup that you put liquid medicine into, and once hooked up to an air source (like an air compressor) and pressurized air causes the liquid to become aerosolized and reduced to a fine mist that can be inhaled. Such treatments usually last five to 10 minutes. This is ideal for anyone who has trouble using an MDI. For more information click here.
Allergic reaction:
Chest tightness:
Frogged up:
Shortness of breath: Â See short of breath, SOB, dyspnea.
Wheezing:
Cardiac wheeze:
Sneezing:
Stuffy nose:
Nasal congestion:
Postnasal drip:
Atopic dermatitis:
Hypersensitivities:
Anaphylaxis:
Occupational asthma:
Exercise induced asthma:
Beta adrenergic: Â See bronchodilator
Airway edema:
Airway congestion:
Nasal congestion:
Types of Asthmatics:
Bronchodilatoraholic: A person who takes more than two puffs twice a week of a rescue inhaler. Some are bronchodilator abusers, and some are simply Hardluck Asthmatics. You can read my experience here and and take the test to see if you are one by clicking here.
Bronchodilator Abuser: A person who abuses his rescue inhaler when what he should be doing is checking in with his asthma physician. Overuse of an inhaler is the #1 sign of uncontrolled asthma.
Hardluck Asthma: Despite all the best asthma medicines and wisdom, these asthmatics continue to have trouble with their asthma. I wrote about one such asthmatic here and here, and I wrote about my experience here. Plus you can click on “my story” under the banner to read more of my story growing up with Hardluck Asthma.
Gallant Asthmatic: She is the asthmatic who does everything right, and has great control of his asthma. He avoids his asthma triggers, has worked with his doctor on an Asthma Action Plan, and follows it to a tee. He is also very compliant with his asthma medicines and sees his asthma physician at least twice a year, but ideally twice a year. I write about Gallant Asthmatics often, such as this post and this post.
Goofus Asthmatic: He’s the asthmatic who does everything wrong. He fails to go out of his way to avoid his asthma triggers, only goes to see his doctor when he has to, and does not have an asthma action plan. If he does have one he doesn’t follow it. He is not compliant with his medicines, as he takes them only when he is feeling symptoms. He is the asthma type who is most likely to be seen in the ER. On a similar note, since his asthma is so out of control and since he is not on his controller meds, he is most likely to be admitted to the hospital. I write about Goofus Asthmatics on occasion, such as this post.
Phlegmatic Asthmatic: She’s the calm, cool and collected asthmatic who takes everything in stride. He could be having an asthma attack right in front of you and you’d never know it (unless you had a keen eye for asthma.) How do you know you’re dealing with a phlegmatic asthmatic? You won’t unless they tell you they have asthma. These are the zen asthmatics who appear to be accepting of their condition, don’t lose their cool and quietly deal with breathing trouble. I am a phlegmatic asthmatic
Actor Asthmatic: He is the asthmatic who always seems to have trouble breathing when you need him most. If it’s time to haul in wood for the fire, his asthma flares. If he’s dreading going to work he might run laps around the living room to ignite his asthma. When it’s time to haul in the groceries he’ll be seen puffing on his inhaler. He’ll do anything to get out of work and avoid stress. Synynom: Exaggeration of Asthma. The actors are fun to write about.
Martyr Asthmatic:They could by dying and they still don’t go to the ER. They are usually tough, macho adult men who only go to the ER at the insistence of their spouses. Their biggest fear, although they won’t admit it, is that they will be told their asthma is all in their head, and then they’ll feel stupid. So, they think it’s easier just to pretend they are fine.
Recovered Asthmatic: Child asthmatics who grow up and no longer have asthma symptoms so they do some unwise things — like smoke. When their asthma comes back, they are in a world of hurt.
Doubting Thomas: These are mostly adult-onset asthmatics who, all of a sudden, develop mild asthma symptoms, but don’t want to admit they have asthma. They would rather suffer at home than seek treatment. But when the RT gives them a treatment they will say, “Wow, I didn’t even realize I was short-of-breath.” Famous Olympic swimmer Dara Torres may have been this kind of asthmatic. But now, I’m sure, she is a Gallant asthmatic.
Sometimer Asthmatic: Synonym: Asthmatics in Denial: They live normal lives, feel good 95% of the time, and so are in denial about their asthma and don’t take their preventative medicines. These are your adult asthmatics who sometimes have mild symptoms, and when they do they take a puff or two or three or four of their inhaler until they feel better.
Poor Patient Asthmatic: These asthmatics would be okay is they had different doctors. We RTs hate to bad mouth doctors, but we know that since this patient has been in the ER 10 times in the last year, he should be on some type of preventative, anti-inflammatory medicine and not just a bronchodilator. Poor patients may also be children whose parents don’t have a clue how to manage the asthma.
Bronchodilatoraholic: These are people who use a bronchodilator frequently. Some may be abusing their medicine, but many are gallants who simply have hard luck asthma.Abusers don’t work with their doctor on an asthma action plan and they may not bother with controller, anti-inflammatory medications. For them, puffing away is like a bad habit – like biting your fingernails. In contrast, some hard-luck asthmatics may just need their bronchodilator frequently – many times a day, every day.We’ll learn more about bronchodilatoraholics on another post.
Unfortunate Asthmatic: These asthmatics don’t have access to a healthcare provider, and cannot affort to get their prescriptions refilled. They give the appearance of Goofus Asthmatics, although they are not. Many live in downtrodden city homes filled with allergens they cannot escape. Their homes are often exposed to the elements due to things like a leaky roof, flooded and musty basement, broken windows covered with plastic and duct tape, broken plaster and peeling paint. They have poor ability to remove asthma triggers from clothing due to lack of washer and drier, or inibility to afford to pay the water bill. They are often exposed to second hand smoke due to inibility to choose their surrounding environment. Good asthma control may be hard to come by no matter hard they try.
Best asthma you can be: This is the more realistic asthma type. They strive to be the best they can be, although they are not perfect because, if you think about it, perfection is not achievable. Normal asthmatics will miss an occasional dose of medicine, and will take an occasional extra puff on their inhaler, and may even use their rescue inhaler without a spacer.
Gallant Asthma Physician: This doctor knows how to take care of your asthma the right way. He keeps up to date on asthma wisdom, and goes out of his way to make sure you are well educated and on all the best medicines for you. He also works with you on a good Asthma Action Plan, and makes sure you feel comfortable knowing you can call him at any time. He also makes sure you schedule an appointment to see him every six months. Asthmatics who see Gallant doctors have the best chance of having well-controlled asthma. Thankfully, a majority of asthma doctors are this type.
Goofus Asthma Physician: Whatever he learned in school umpteen years ago is exactly what he uses to care for you today. He’s either too busy, lazy or sometimes simply too arrogant to stay up-to-date on the latest asthma wisdom. He will allow you to walk out of his office with only a rescue inhaler. Asthmatics who have Goofus doctors are Poor Patient Asthmatics who have a tendency to make unscheduled office visits, or trips to the ER, and are often mistaken as Goofus Asthmatics.
Strong, Silent Type Physician: She never gets excited, and has a ho hum or gloomy disposition. She often has a finger on her forehead and says, “Hmmm, I wonder…” She is well kempt, organized, jots a lot of notes and knows her stuff. She is very quiet and doesn’t like to participate in small talk, but when it comes to asthma or your health she’ll talk fluently. She’ll assess you thoroughly while remaining taciturn. You might be intimidated by the silence, but she doesn’t mean for you to feel uncomfortable. She’s very friendly and polite, but also straightforward. She may also ask for your opinion, which may have you wondering if she knows what she’s talking about. However, her intention is to involve you in the decision making. She will make sure you are well prepared and cared for upon leaving her office, but once she finishes the job, she will up and leave without shaking your hand or saying good-bye. While she’s socially gauche with poor bedside manners, if you like a knowledgeable doc, she’s the one for you.
Big-Hearted Bully Physician: Although he has the bedside manner of a rock and refuses to participate in small talk, he might simply be the best doctor in the world. He is focused and the key for you is to put up with his bluntness and his seeming arrogance. He does not go into detail as he expects you to do your own homework. He usually answers questions with one or two words and, sometimes, he simply grunts. If you annoy him with your petty questions, he’ll grimace and moan. If you try to make suggestions, he’ll intimidate you with his stare. Yes, you will get a thorough workup and he will take good care of you. If you call him with an asthma concern, he will go out of his way to meet you at the office. He’s the only doctor type who will never write a prescription without seeing you first. His decisiveness and stubbornness may impress you, or it may vex you. Overall, if you are the kind of patient who likes a doctor to take control, he’s your doc.
Columbo Physician: She has a very friendly, nonchalant disposition and quite often has ruffled hair, with an overall disheveled disposition like the 1970s TV detective Columbo (collars up, tie crooked, spot of jelly on white lab coat). When things go wrong she scratches her head with an unreadable expression. She’ll slouch in her chair with her legs crossed. She’s been known to say things like, “Well, what do you suggest we do today?” Or, “What medicines would you like to try?” When you call her, she’s the doc who asks, “Do you think you should come in to see me?” Or, if she meets you in the ER, she may ask, “Do you think you should be admitted?” After a while, you wonder if you are the doctor or if she is. On the other hand, if you are the kind of patient who likes to have more control, this might be the ideal doctor for you.
Buddy Physician: He’s the doctor who is often late for your appointments. Even though your irritation level reaches its peak, when he finally does arrive, he cracks a joke you can’t help laughing at. He’s an amazingly happy person and has a knack for telling stories, especially when you are in an inconvenient position (like on the colonoscopy table, or with your mouth stuffed in the dentist chair). He has a positive disposition and can get you excited even about diseases you might have — like asthma. He often downplays severity by saying things like, “Oh, you’ll be fine,” or, “I wouldn’t worry about it if I were you.” You might catch him saying something goofy like, “Well, today we’re going to come up with the perfect concoction to fix you.” Yet, if you can tolerate his sunny disposition, you’ll participate in an awesome discussion unrelated to asthma. You may actually leave the office feeling like you learned more about his life than about asthma. Despite his quirks, you know he’s taking great care of your asthma. So, if you like a friendly, upbeat person, he’s your doc.
Vulnerability: (1)A feeling you get when you realize you’re not going to live forever. It most often occurs when you require prolonged or frequent stays in a hospital. (2) The realization if you want to live a long, healthy life you have to take care of your self, which may include making some changes (like quitting smoking, avoiding allergens, etc.
Vulnerability: (1)A feeling you get when you realize you’re not going to live forever. It most often occurs when you require prolonged or frequent stays in a hospital. (2) The realization if you want to live a long, healthy life you have to take care of your self, which may include making some changes (like quitting smoking, avoiding allergens, etc.
Bronchodilator anxiety: The feeling of anxiety because you don’t have your rescue inhaler on your posession. This may bring about an asthma attack just because you don’t have it.
Asthma forgetfulness: The tendency of some asthmatics to forget they have asthma because they are feeling well, and do things that they shouldn’t. Examples: quit taking meds, rake leaves, clean musty basement, etc.
Increasing provider compliance with the Joint Commission’s three quality measures for children’s inpatient asthma care by use of a standardized care process model (CPM) can significantly reduce hospital readmissions for asthma, according to a new study. Because the first two quality measures (CAC-1, percentage of patients who received beta agonists, and CAC-2, percentage of patients who received systemic steroids) were already achieved in at least 99 percent of cases in the study at baseline, only the implementation of care process changes to increase patient discharges with a home management plan of care (CAC-3) reduced 6-month asthma rehospitalizations.