Asthma, Controlling Your (cont.)

MEMBER QUESTION:
Is there data available on the long-term side effects of inhaled steroids such as Azmacort? I used four puffs, four times daily until a year ago when I reduced to three puffs, four times daily.

ENRIGHT:
There are more than eight types of inhaled corticosteroid inhalers. The daily dose of inhaled corticosteroids determines the risk of long-term side effects. High and sometimes medium daily dose corticosteroids are much more likely to cause problems like thinning of the bones, shorter growth for children and occasional adrenal gland suppression.

The dose of Azmacort that you have been taking is considered a low daily dose and therefore is unlikely to cause long-term side effects. Some patients get a thrush infection in their throat, but this is not considered a serious side effect and can be avoided in most cases by rinsing the mouth after the inhalation or treated with antifungal lozenges by your physician.

MEMBER QUESTION:
My doctor told me I have intrinsic asthma. How do you control reaction to triggers with intrinsic asthma?

ENRIGHT:
Intrinsic asthma and extrinsic asthma are old terms used to describe asthma that is caused by external things. Extrinsic asthma is caused primarily by pollens and allergens while intrinsic asthma triggers are smoke, dust, inhaled chemicals, fumes, respiratory viruses and perhaps acid reflux.

While treatment of allergic asthma should include avoiding the primarily indoor and sometimes outdoor allergens to which the patient has become sensitized, treatment of intrinsic asthma is aimed at avoiding respiratory infections (viral infections, colds, influenza and all contact with smoke and fumes).

MEMBER QUESTION:
What is the relationship between chronic
sinusitis and asthma? I had sinus surgery about eight months ago for chronic sinusitis and I have a history of asthma.

ENRIGHT:
The connection is allergies. Sinusitis is often, but not always, caused by allergic rhinitis or hay fever, which when poorly controlled, results in closure of the tube which drains the sinuses.

There is concern that poorly controlled sinusitis leads to poor control of asthma, perhaps by inflammatory markers or inflammatory cytokines, such as histamine, entering the lungs by gravity.

"Stormy weather is known to cause more people with asthma to go to local emergency rooms, probably due to an increase in airborne mold levels."

MEMBER QUESTION:
Do air cleaners help control asthma? What are the best ways to control asthma for a 6-year-old who wants to run around and jump and do things that a 6-year-old normally wants to do?

ENRIGHT:
Asthma can be controlled very well using appropriate measures of avoiding asthma triggers and using asthma-controller medication.

Room air cleaners placed in a child's bedroom can be helpful if there is a resident cat or if the child is exposed to secondhand smoke in the home and perhaps with other allergens. Choose a HEPA air cleaner and avoid electrostatic air cleaners, which create ozone as a side effect. Ozone causes airway inflammation in everyone with hay fever and asthma and should be avoided.

MEMBER QUESTION:
I have noticed that in the past three weeks my asthma has been worse. I assume it is because of the rainy conditions as of late. I had to use my rescue inhaler three times last week and twice already this week, along with my allergy meds. I don't want to have to stay indoors, but have had to do so. What else can I be doing to help control these flare-ups?

ENRIGHT:
You should follow the written asthma action plan given to you by your doctor. If she has not given you one, print one from WebMD and send one to her to fill out for you. It should tell you how to increase your asthma-controller medication when you have an exacerbation like you are experiencing now.

Stormy weather is known to cause more people with asthma to go to local emergency rooms, probably due to an increase in airborne mold levels.

MEMBER QUESTION:
My 4-year-old was recently diagnosed with asthma. His pediatrician has him on inhaled albuterol and inhaled Pulmicort. He has also been on antibiotics for weeks to try to get rid of a sinus infection. Is he a candidate for Singulair and do you recommend taking him to an ENT specialist or an allergist?

ENRIGHT:
If he has never had allergen skin testing, then that would be worthwhile so that you know which indoor allergens may be contributing to his asthma. Whether or not he would respond to Singulair can only be determined by trying it.

Pediatricians are generally very good at treating the allergic rhinitis that leads to sinusitis. Consider purchasing a good book about sinusitis. The one I recommend is The Sinus Cure by Murray Grossan, MD.