Treatment for asthma varies with age – KPCnews.com

The Centers for Disease Control and Prevention (CDC) estimate that U.S. prevalence of asthma is 22 million, including 6.5 million children younger than 18 years, with deaths from asthma episodes estimated at 4,000 per year. It is one of our most common health problems.

Therefore, guidelines for asthma management have been developed to focus on four main areas: Measures to evaluate and monitor asthma control, patient education outside the healthcare provider’s office, control of environmental exposures known to trigger or worsen asthma symptoms, and treatment with medicines and oxygen.

Some of the specific recommendations are:

• Self-monitor and manage asthma. This should include a written asthma action plan for each patient, which should include instructions for daily treatment as well as strategies to detect and manage asthma episodes.

• Treat chronic diseases including nasal inflammation, sinusitis, gastroesophageal reflux (GERD), overweight or obesity, obstructive sleep apnea, stress, and/or depression.

• A stepwise approach is needed to control asthma, increasing medication dosages and types as needed, and decreasing them whenever possible, based on the level of asthma control. This includes guides for asthma treatment in three age groups: 0 to 4 years, 5 to 11 years, and 12 years or older. Emerging evidence supports differences in response to anti-asthma drugs between children and adults.

• Patients with persistent asthma, defined as daytime symptoms more than twice weekly or nighttime symptoms more than twice monthly, should have a two-pronged approach to asthma control. This includes medications to control asthma and prevent asthma attacks during the long-term, as well as fast-acting medications to control sudden symptoms of asthma attacks on an as-needed basis.

• For all age groups, inhaled corticosteroids are the most effective medication for long-term control. Newer treatment options include leukotriene receptor antagonists (Singulair and Accolate) and cromolyn (Intal), as well as long-acting bronchodilators combined with inhaled corticosteroids (Advair and Symbicort). Omalizumab (Xolair) is reserved for severe asthma.

• For sudden asthma episodes, albuterol, levalbuterol (Xopenex), and corticosteroids are recommended. Urgent medical care in the emergency department should also include oxygen, inhaled ipratropium (Atrovent), and, in a few cases, intravenous magnesium sulfate and/or helium/oxygen.

In an effort to control the things that trigger allergies (allergens), patients with persistent asthma should have allergy testing and treatment.

Patients with asthma of any severity should avoid allergens, cigarette smoke, fireplaces, and strong odors, especially formaldehyde and volatile organic compounds. They should also reduce exertion outdoors when air pollution is high and avoid sulfite-containing foods.

They should even consider allergen immunotherapy, commonly called “allergy shots.” These should only be offered in a physician’s office, where a life-threatening reaction can be managed. This is because the shots are injections of gradually increasing amounts of the things that actually cause the allergic reaction, allowing the patient to gradually build up a tolerance to the allergens.

Patients with persistent asthma, nasal polyps, or sensitivity to aspirin should avoid aspirin and nonsteroidal anti-inflammatory agents, like ibuprofen (Advil, Motrin, and others) or naproxen (Aleve, Anaprox, Naprosyn).

Use of humidifiers or vaporizers is not recommended in homes of patients with asthma sensitive to house-dust mites or mold.

Although influenza vaccine does not reduce the frequency or severity of asthma attacks during the flu season, it is still recommended that all asthma patients receive the flu shot unless they have had a previous adverse reaction or have another reason for avoiding the vaccine.