Asthma

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Asthma

Unless you happen to be lovestruck, that sudden bout of breathlessness is more likely to be caused by asthma than by Cupid's trusty arrow. A snort of dust or smoke or a whiff of the "wrong" flower, pet dander or perfume can instantaneously start you--along with one in ten other Americans--wheezing, coughing and gasping for air. Besides these allergens and irritants, other common asthma triggers include exercise, pollution or smog, a drastic change in weather or a cold or another infection in the airways.

Sure, an asthma attack is scary. But it doesn't mean you have to move to the desert or forever live in fear of your "twitchy" airways. Besides taking your doctor-prescribed medication, there are plenty of ways to avoid or treat asthma attacks. As a first step, it's a good idea to guard against dust mite allergies and hay fever (see pages 181 and 257). Then add the following actions to your anti-asthma repertoire.

Take up yoga. Practicing a simple yoga breathing technique in which you exhale for twice as long as you inhale can protect you from future attacks by building resistance. This technique has been found effective when practiced daily.

When to See the Doctor Although asthma can usually be kept under control by following a doctor's advice, each year several thousand people in the United States die from asthma attacks. To manage asthma, you need to control your environment as much as possible and use preventive medications, according to Peter S. Creticos, M.D., medical director of asthma and allergic diseases at the Johns Hopkins Asthma and Allergy Center in Baltimore. In conjunction with this regimen, other tools such as your bronchodilator inhaler (or tablets) are often needed to optimize control or to treat wheezing episodes. But pay special attention if you find you have to use your bronchodilator much more frequently or if you are having attacks more "easily" than in the past. For instance, if you normally took a couple of puffs of your inhaler in a week but are now taking that much in a day, see your doctor as soon as possible, suggests Dr. Creticos. Of course, any time that you have more severe difficulty breathing or an asthma attack that you can't control, go to the nearest hospital immediately.

"The improvement in asthma control from this type of breathing is similar to what you would find using a corticosteroid inhaler," says Mary Schatz, M.D., a pathologist at Centennial Medical Center in Nashville, Tennessee, and a certified yoga instructor.

If you want to try this technique, the steps are "elegantly simple," as explained by Dr. Schatz in her book Back Care Basics: A Doctor's Gentle Yoga Program for Back and Neck Pain Relief.

1. Close your eyes.
2. Inhale naturally.
3. Exhale naturally.
4. Pause without holding your breath for one or two seconds before your next inhalation. This will allow the exhalation to come to a natural completion.

Don't try to breathe slowly or deeply. But if you feel the need to inhale deeply, do so until you can return to the breathing exercise.

Enjoy Exercise without Asthma Attacks Just because you have asthma doesn't mean you can't enjoy a regular workout. But you do need to exercise some good judgment. Swimming is probably the ideal exercise, because the high humidity of pools won't dry out your throat, says California allergist William Ziering, M.D., instructor of health sciences at Fresno State University and a past president for the Section on Allergy of the California Medical Association. Sports that require continuous, vigorous activity in dry air, such as running, are no longer discouraged if, under a doctor's supervision, special precautions are taken. According to Dr. Ziering, these involve using a "rescue inhaler" containing albuterol (prescribed by your doctor) 5 to 15 minutes before starting, taking a 5- to 10-minute warm-up and starting the activity at a slow pace for the first 5 to 15 minutes. Also good are sports that require shorter bursts of exercise, such as baseball, doubles tennis and golf. If you must exercise in the cold, wear a mask or scarf over your face. And always have a warm-up period: By doing warm-ups, you may avoid asthma symptoms that typically occur during the first 15 minutes of exercise.

Avoid night noshing. Going to sleep on a full stomach might also feed your asthma.

"Asthma can be caused by stomach reflux," explains Peter S. Creticos, M.D., medical director of asthma and allergic diseases at the Johns Hopkins Asthma and Allergy Center in Baltimore. Reflux occurs when stomach acid backs up into the esophagus.

"Stomach contents may leak out and actually regurgitate into your mouth and then drip down into your airways while you're lying down or sleeping," he says. "Besides avoiding snacks, you could also take an antacid before bedtime to cut down on your stomach's acidity." Theophylline medications, which are sometimes prescribed to help control asthma, may actually aggravate your condition by increasing stomach reflux, says Dr. Creticos. If you are taking this medication and are having reflux problems, be sure to check with your doctor, so the dosage level can be adjusted.

Prop up your bed (or yourself). Besides cutting out midnight snacks, other ways to prevent reflux-induced asthma include elevating the head of your bed by placing it on bricks or wood blocks. Or prop yourself up with pillows to prevent acid's moving from your stomach to your esophagus, suggests H. James Wedner, M.D., chief of clinical allergy and immunology at Washington University School of Medicine in St. Louis.

Be sensitive to food sensitivity. Eating or even smelling foods that cause a reaction can trigger an asthma attack. "Some of the most common types of foods that trigger asthma are milk, eggs, nuts and seafood," says allergist John Carlston, M.D., associate professor of medicine at Eastern Virginia Medical School in Norfolk.

Go the fish route. Since Eskimos get asthma about as often as they get heatstroke, some theorize that a fish-rich diet may help prevent asthma. Although tests aren't conclusive, Walter Pickett, Ph.D., senior research biochemist/group leader of the Medical Research Division at Lederle Laboratories in Pearl River, New York, says it is conceivable that eating sardines, herring, mackerel and other fish rich in omega-3 fatty acids at least once a week may help lessen asthma's impact.

Beware of Aspirin If you have asthma and suffer from sinusitis and nasal polyps, you should get your pain relief from acetaminophen, not from aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil). "Taking aspirin or NSAIDs could make your asthma worse or may even be life-threatening," warns Peter S. Creticos, M.D., medical director of asthma and allergic diseases at the Johns Hopkins Asthma and Allergy Center in Baltimore. Acetaminophen products such as Tylenol, Aspirin-Free Anacin and Panadol are considered safe, he says. Also, if you have arthritis as well as asthma, Dr. Creticos recommends seeing your doctor before taking any of the usual medications to ease pain and inflammation. Ask the doctor to prescribe an anti-inflammatory medication that will help the symptoms without causing asthma problems.

Multiply your vitamins. Taking a good multivitamin/mineral supplement and eating plenty of fruits and vegetables may also help, since some nutrients have been found to lessen symptoms associated with asthma attacks. Reviewing data from more than 9,000 people, researchers found that those with reduced levels of vitamin C and zinc suffered more from wheezing and other bronchial problems. Good food sources of vitamin C include citrus fruits, broccoli and peppers. Oysters, beef and crab are among the foods highest in zinc.

Get relief from caffeine. Although coffee has been shown to contribute to some health problems, it may be more helpful than harmful for many people with asthma. Caffeine, it turns out, has nearly the same effect as theophylline.

"A couple of cups of strong, regular black coffee will have a beneficial effect on asthma," says allergist Allan Becker, M.D., an associate professor of medicine in the Section of Pediatric Allergy and Clinical Immunology at the University of Manitoba in Winnipeg who tested the effects of caffeine on asthma. But don't use caffeine as a substitute for--or in combination with--your medication, he advises, because it is good only for emergency use. "In an emergency, when you don't have your medication around, two cups of strong, regular black coffee (sugar and milk slow absorption) can provide effective temporary relief until your regular medication is available," says Dr. Becker. Relief can also be provided--but the effect will be slower--with two cups of hot cocoa or eight ounces of milk chocolate candy.