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For Better Control of Asthma, Take the Test


Ask any emergency room physician what it's like to treat asthma, and you'll hear horror stories about patients rushed to the hospital with life-threatening breathing problems. You'll also hear that many of these patients were taking the asthma medications prescribed by their personal physicians.

So why do they suffer such severe breathing problems? In many cases, it's because they are not taking appropriate medications.

People with asthma have difficulty breathing because their airways are narrowed. The narrowing occurs, in part, because of inflammation that causes the wall of the airway to swell. The problem is aggravated further by spasms in the muscles that surround the airways. When inflammation and spasms are present, obstruction of the airflow can reach a point where the body cannot get enough oxygen to meet its needs.

Until fairly recently, most asthma problems were blamed on the muscle spasms; the important role that inflammation played was unappreciated. As a result, the treatment of asthma relied almost entirely on prescription medications called bronchodilators, or "reliever drugs," which relaxed the muscles and opened the airways. While these medications usually provided rapid relief of symptoms, the effects often were temporary because the underlying inflammation persisted.

We now know that airway inflammation is chronic, present even when there are no obvious symptoms. The severity of symptoms, when they do occur, is usually related to the amount of inflammation. And we now have drugs that can control the inflammation and prevent symptoms.

When adequately treated with these drugs, known as "controller medications," people with asthma remain symptom-free on most days and are able to lead normal lives. Some examples of controller medications are Aerobid, Azmacort, Flovent and Vanceril. The medications help them sleep through the night without coughing or wheezing and let them exercise and participate in normal activities during the day.

Unfortunately, many people with asthma are not receiving these controller medications, or they are receiving insufficient doses to control inflammation.

These patients are then forced to use reliever drugs to open up their airways whenever symptoms become uncomfortable or intolerable.

Asthma sufferers who experience even mild symptoms such as cough or chest tightness more than two days a week or two nights a month should consider the possibility that uncontrolled inflammation is responsible. Proper use of controller medications will help decrease the need for reliever medications.

Which asthma medications to use depends, in large part, on the severity of the disease. People with mild, infrequent symptoms generally do not need to use controller medications on a regular basis. Those with more frequent symptoms, or symptoms severe enough to affect their activity level, often require one or more controller medications.

To help physicians and patients choose appropriate therapy, an expert panel convened by the National Heart, Lung and Blood Institute created four asthma severity categories and corresponding treatment recommendations. The four categories are listed below in order of decreasing asthma severity.

Answering yes to any one of the questions in a category is sufficient to place you in that category. Put another way, you do not have to answer yes to all of the questions in a category to be placed there.

Asthma patients can help their physician manage and treat their asthma symptoms by answering the following questions and sharing the results.

Severe persistent

* Do you have continual symptoms during the daytime?

* Do you experience severe symptoms almost every day? Do you experience nighttime symptoms almost every night?

* Do you have symptoms that cause you to limit your activity level?

Moderate persistent

* Do you have symptoms every day?

* Do you experience severe symptoms twice a week or more?

* Do you experience nighttime symptoms more than once a week?

* Is your activity level regularly affected by your severe symptoms?

* Do you use quick-relief medications every day?

Mild persistent

* Do you have symptoms more than twice a week but less than once a day?

* Do you experience nighttime symptoms more than twice a month?

* When your symptoms are most severe, is your activity level ever affected?

Mild intermittent

* Do you have symptoms twice a week or less?

* Do you experience nighttime symptoms twice a month or less?

* Are you free of symptoms between more severe episodes?

* When you have symptoms, are they brief, lasting less than a few days?


Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached by e-mail at Our Health runs the second and fourth Mondays of each month.

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