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Spokane, Washington  Est. May 19, 1883

Reduce triggers and use meds to control asthma

Dr. Bob Riggs, MD

I remember waking in the night as a kid to a creepy repetitive whistling noise. It scared me. Years later I figured out that it was my brother wheezing. He started smoking in his teens, which made his asthma worse, and died of asthma in his 40s. Hence, I am pretty passionate about helping patients control asthma as best they can.

One in 13 people in the United States has asthma. Asthma attacks make breathing difficult as the airways narrow and swell and produce excess mucus. Coughing, wheezing and shortness of breath are the most common symptoms.

Luckily, asthma can be controlled so that you can breathe normally most of the time and rarely have an asthma attack. The first steps to controlling asthma are to avoid asthma triggers and to remove environmental triggers from your home. Common triggers include smoke, dust mites, air pollution, dog and cat dander and mold.

If you have asthma and smoke, stop smoking. It is not easy but there are medications and resources available to help. I cannot stress enough how important it is to make environmental changes, even when that means no longer snuggling in bed with Fido.

The front line medication for asthma is albuterol, usually by an inhaler, sometimes by a nebulizer machine. It causes tight airways to relax. You use it as needed for asthma and before exercise if that is your trigger.

If, after making environmental changes, you have asthma symptoms more than twice a week, a daily asthma controlling medication may be needed.

Inhaled corticosteroids are the most effective asthma-controlling medications. They act on tissues in your airways to reduce the swelling and inflammation that make breathing difficult. They need to be used every day to work. They do not work if you wait until you have symptoms to use them. Rinse your mouth out with water after using your corticosteroid inhaler to avoid an unpleasant yeast infection. I tell patients who have difficulty remembering this to put the inhaler next to their toothbrush, so that they use the inhaler and then brush their teeth.

Long-acting beta-agonists are inhaled and act directly on your airways to reduce swelling. They must be used daily and should only be used in combination with an inhaled corticosteroid. Used alone they have been linked to asthma deaths because patients have tried to use these as rescue inhalers during a severe asthma attack. They are not for emergency use.

Allergy shots and/or antihistamines can help control asthma when allergies are your trigger. Both help your body to become less responsive to allergens. Allergy shots and antihistamines have the added bonus of reducing other allergy symptoms like itching, runny nose and watery eyes. Allergy shots can take 4 to 6 months before you start to see a difference.

Your asthma can change over time, so your medication needs can change, too. Often children with asthma find that as adults they have less frequent symptoms. The opposite can happen, and people who have never had asthma can develop it as an adult. Either way, you need to pay attention to your triggers and symptoms and take your asthma controlling medication(s) as prescribed for easy breathing.

If you need to be on a controlling medicine for asthma, use it daily. Waiting until you are in trouble is dangerous.

You can use the Asthma Control Tests available at www.asthma.com to help you determine if your asthma symptoms are well controlled. There is a test for kids ages 4 to 11 and one for people ages 12 and older.

Dr. Bob Riggs is a family medicine physician practicing at Group Health’s Riverfront Medical Center.