Asthma

Asthma

Tame Twitchy Airways

Some women describe asthma as feeling like they're trying to breathe through a straw. The description fits perfectly, because during an attack, airways in the lungs squeeze shut, making it difficult to draw in air. At the same time, the narrowed airways become inflamed and filled with mucus, stifling the airways still further.

A family history of asthma and exposure to viruses or allergens set the stage for asthma, says Sally Wenzel, M.D., associate professor at the University of Colorado School of Medicine and a pulmonary specialist at the National Jewish Center for Immunology and Respiratory Medicine, both in Denver. "Men are just as likely to develop asthma as women," says Dr. Wenzel, "although women seem to react to irritants at lower concentrations."

Asthma can be serious--even fatal. Experts speculate that the people who succumb to asthma tend to smoke cigarettes, abuse drugs and misuse their asthma medications. But if you take care of yourself, asthma isn't cause for alarm.

"Women who get proper medical care, stop smoking and use their medications correctly are unlikely to die from asthma," says Susan Pingleton, M.D., director of the Pulmonary and Critical Care Division at the University of Kansas Medical Center in Kansas City.

SELF-RESCUE FOR ASTHMA ATTACKS

Here is what doctors recommend that people with asthma do for themselves--starting with knowing how to use their medicine correctly.

Mark quick-action inhalers "rescue medicine." Most people being treated for asthma use two different kinds of prescription inhalant drugs: long-acting and short-acting, says Dr. Wenzel. If you're having an attack, you should use only a short-acting drug such as albuterol (Proventil), metaproterenol (Alupent) or pirbuterol (Maxair) and others. These drugs kick in almost immediately.

The long-acting drug salmeterol (Serevent) can take 20 to 30 minutes to work--that's long enough to die from an asthma attack, says Dr. Wenzel. According to the U.S. Food and Drug Administration, up to 20 deaths have been associated with inappropriate use of this drug.

Don't leave home without it. You should have a fast-acting inhaler with you at all times--at home, in your purse, in your pocket, in your car--anywhere you could have an attack. "It doesn't do any good if it's not right there when you need it," Dr. Wenzel says.

Ask for a spacer. For most people it's easier to get the medicine where it needs to go--deep into your lungs--by using a metered-dose inhaler with a holding chamber, also called a spacer.

This is a tubelike device that you attach to the inhaler. Sprayed medicine goes first into this chamber, allowing you to then inhale it slowly over a period of five seconds, says Dr. Wenzel. If you inhale the medicine too quickly, it hits the back of your throat and sticks there. Spacers also reduce medication side effects such as tremors or shakes.

DAY-TO-DAY CONTROL MEASURES

Once you have an attack under control, women doctors say that it's a good idea to take steps to prevent future episodes. To defend yourself on all fronts, heed these recommendations.

Max out on magnesium. This essential mineral helps relax the smooth muscles that line airways. In a study by British researchers, people who were getting the most magnesium from foods were the least likely to have wheezing and supersensitive airways.

Choose whole grains, beans, nuts and seeds as your best magnesium sources. Some women may still need to take magnesium supplements to reach the Daily Value of 400 milligrams, says Nan Kathryn Fuchs, Ph.D., a nutritionist in Sebastopal, California, and nutrition editor of the Women's Health Letter.

Consider antioxidant protection. Vitamins C and E, the trace mineral selenium and beta-carotene, a pigment found in orange and dark-green leafy vegetables, all seem to offer some protection to sensitive lungs.

"I always tell people first to start eating better, with lots of fresh fruits and vegetables, whole grains and beans, and then to add nutritional supplements as necessary," says Dr. Fuchs. You may want to consider consuming 1,000 to 2,000 milligrams of vitamin C, 400 international units of vitamin E and up to 200 micrograms of selenium a day through diet and supplements, she suggests. (Vitamin C levels above 1,200 milligrams daily may cause diarrhea in some people.)

Declare war on insects. Two kinds of bugs--dust mites and cockroaches--are well-known asthma aggravators, says Marianne Frieri, M.D., Ph.D., associate professor of medicine and pathology at the State University of New York at Stony Brook and director of the Allergy Immunology Training Program at Nassau County Medical Center in East Meadow, New York. "People actually inhale microscopic cockroach parts and dust mite feces, which sets off attacks."

It's impossible to get rid of dust mites, which are in every house and are kicked up through normal household activity. So minimize their presence by encasing mattresses and pillows in plastic covers and washing your bed linens frequently in hot water.

Banishing cockroaches can be a real hassle, too, as any urban dweller can attest. Get in a professional exterminator, Dr. Frieri advises, and then, be obsessive about putting food away. Keep food in bug-proof tins or the refrigerator, clean up crumbs immediately and never leave cat or dog food out. Fix leaks so that there are no damp spots in your house, since mites require high humidity to live.

Stop the acid. The same backflow of stomach acid into the esophagus that causes heartburn can bring on asthma, especially if you're lying down, experts say.

"People who do a lot of coughing at night are most likely to have this problem," Dr. Wenzel says. This is most likely to be an asthma trigger in adult nonsmokers with no history of lung disease or allergies. "We can do tests to determine the extent of their reflux and see if it correlates with symptoms they are having."

To avoid acid-induced asthma, you can take acid-suppressing drugs (such as Pepcid AC), forgo late-night foraging and shed excess weight, Dr. Wenzel says.

Relax with massage. In one study people with asthma who got weekly 15-minute upper body massages reported drops in chest tightness, wheezing, pain and fatigue. "Massage may make you more aware of the stress in your life, and awareness is, for most people, the first step toward reducing stress," explains Mary Malinski, R.N., of Allergy Associates in Portland, Oregon, and a licensed massage therapist. "Stress often makes asthma symptoms worse."

Breathe better with yoga. Try exhaling for twice as long as you inhale. This is a yoga breathing technique, and in one experiment, it helped reduce the number of attacks in people with asthma.

To do this easily, breathe in normally, then exhale normally, but as you come to what seems like the end of your exhalation, continue for a bit longer without forcing out the breath, says Mary Pullig Schatz, M.D., a pathologist in Nashville, a yoga instructor and author of Back Care Basics.

Turn off the fireplace. As cozy as fireplaces and woodstoves may be, they spew pollutants into indoor air. "If you're having trouble controlling your asthma, you're better off not using either of these in your house," Dr. Frieri says.

Cover up to avoid cold. Sucking in cold, dry air can set off twitchy lungs. So wrap a scarf around your mouth and nose to help warm the air before you inhale, suggests Dr. Frieri.

Because people with asthma are accustomed to feeling winded, they don't always recognize when they are having serious breathing problems. So these days, doctors have their patients measure the amount of air that their lungs can blow out--in the morning, at night and before and after they use their short-acting inhalers. They use a simple tubelike device, called a peak flow meter, that measures exhaled air.

"National guidelines on asthma recommend that if your airflow falls below 80 percent of your peak flow, you may need to take an additional dose of a short-acting inhaler and call your doctor," Dr. Wenzel says. Airflow below 50 percent of your peak flow usually warrants a prompt trip to the emergency room.

If you have noticed your symptoms worsening soon after you start taking a new drug or after increasing the dosage of a drug, check with your doctor about a possible connection, says Dr. Wenzel. Aspirin, ibuprofen and other nonsteroidal anti-inflammatory medications--both prescription and over-the-counter--and beta-blockers (used to control high blood pressure) can aggravate asthma, says Dr. Frieri.