Asthma Control: Know Your Score

Asthma Attack Treatment

Asthma Control: Know Your Score

WebMD Live Events Transcript

Pittsburgh Steelers' All-Pro running back Jerome "The Bus" Bettis knows firsthand what can happen when your asthma gets out of control. Bettis and Norman Edelman, MD, from the American Lung Association, joined us on March 30, 2005 to answer quesitons about your asthma control rates and how you can improve it.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, gentlemen. Thank you for joining us today.

BETTIS:
Thank you for having us.

EDELMAN:
It's a pleasure to be here.

MODERATOR:
Jerome, you thought you had your symptoms under control for years. Then in 1997, in a nationally televised game, you suffered a severe asthma attack. What happened?

BETTIS:
The asthma went uncontrolled for so long. I thought everything was fine. The game was a very, very humid and hot game, and it caused me to have an asthma attack on the field. It was a very frightening experience, to say the least. From that day, I have been dedicated to asthma and asthma awareness and trying to get the message out, which brings us to the Asthma Control Test.

"The American Lung Association wants everybody with asthma to know that many of them can and should feel better than they do."

MODERATOR:
Dr. Edelman, tell us about the Asthma Control Test.

EDELMAN:
The American Lung Association wants everybody with asthma to know that many of them can and should feel better than they do. The way to start is by taking the Asthma Control Test, understanding how well you're doing and understanding what can be improved.

The Asthma Control Test is five simple questions: It asks:

  • If you miss work or school because of your asthma.
  • If you're awakened at night because of the asthma.
  • How long you've used your medications.
  • If you wheeze or cough during the day.
  • If you feel generally well and how controlled your asthma is.

Based on the results, the person with asthma can get a sense of whether they are functioning as well as they should be, which should be close to absolutely normal.

Whatever the score, they should take the results of the test to their physician and discuss it. And it may be -- it's likely to be actually -- that the physician and the patient with asthma will find ways to improve their care. This may involve adjustment of medications; it may involve a modification of the asthma action plan, such as better strategies to avoid triggers. It may be found in many cases that people's asthma control can be improved.

MODERATOR:
Do many people with asthma think they have better control of their asthma than they really do?

EDELMAN:
Yes. In a recent survey we found that many people with asthma felt they had satisfactory control when they actually don't. And what we found also, and this is very important, is that there's very poor communication. People with asthma don't communicate their problems to their doctors and children with asthma don't communicate their problems to their parents. It's an all-around lack of communication and lack of understanding. Most people with asthma should be able to do virtually anything they want to do.

BETTIS:
The misconception of people with asthma is, I am an asthmatic, so part of my frequent symptoms are normal - the coughing, the wheezing, waking up in the middle of the night and using my inhaler more than twice a week. We assume that is normal because we are asthmatic.

The reality is that does not have to be the norm. Until we get people who have asthma to understand that normal breathing is possible, then there's going to always be the lack of communication because the assumption is that this is normal because "I'm an asthmatic."

"One of the most important things patients can do is understand the importance of preventer or controller medication."

MODERATOR:
Jerome, what did you change about how you dealt with your asthma?

BETTIS:
After the incident I got educated about asthma, understood what asthma was and what it did. At that point I got with my doctor and we developed a game plan. That's something that I deal with daily in terms of the medicine, but also I do check with my doctor fairly regularly about where the asthma is and making sure it is under control as each test comes in.

Quick GuideAsthma Symptoms, Causes, and Medications

Asthma Symptoms, Causes, and Medications

EDELMAN:
One of the most important things patients can do is understand the importance of preventer or controller medication. Asthma is an inflammatory disease -- the airways of the lungs are inflamed. If they are inflamed a lot, attacks come on easily. If they are inflamed just a little bit, it's hard for triggers to cause attacks. The inflammation is controlled by anti-inflammatory drugs, usually inhaled, which we call controller or preventer medications. Too many people either don't use them or stop using them when they are feeling well despite the fact that their doctors recommend that they take them continually.

MEMBER QUESTION:
Jerome, how are you controlling your asthma now? What medications do you take?

BETTIS:
I take Advair.

MODERATOR:
Dr. Edelman, is that a controller medicine?

EDELMAN:
Advair is a combination of two medications. There is an anti-inflammatory that reduces the inflammation and a long-acting bronchodilator that relaxes the muscles of the airways for long periods of time.

MODERATOR:
What are the common controller meds?

EDELMAN:
The controller meds are anti-inflammatories, and for the most part these are inhaled corticosteroids. Now, the word steroids should not upset people; they are totally different from the performance-enhancing steroids in the newspapers recently.

There are some other medications out there that also function as controller medications; one is chromalin sodium and there are two or three medications that work differently on the inflammatory system, called the leukotriene modifiers.

MODERATOR:
Well, anyone who has seen "The Bus" play knows that Jerome doesn't need performance-enhancing drugs.

EDELMAN:
That's right, and I have to make it clear: The American Lung Association is not promising people that they will become strong professional athletes like Jerome Bettis. But we are promising people that many of them -- most of them -- can perform better.

"It seems that the more overweight people are, in general, the worse their asthma is."

MEMBER QUESTION:
Jerome, how does asthma affect you playing football? Are you worried about having another big attack while practicing or playing? Go Steelers!

BETTIS:
No, I don't worry about the asthma because it's under control. But I do understand there are limitations that I have, and I'm very conscious of that. The doctors and the trainers know that I am asthmatic and so we deal with it accordingly.

EDELMAN:
It's important to point out, and the American Lung Association tries to point this out often, that although Jerome Bettis is a great example of what you can do to control the asthma, he is not the only one. The last time the survey was done, it turned out that about 10% of Olympic athletes had asthma of some form or other. All of them learned to control their asthma to the point where they could become world class athletes.

MEMBER QUESTION:
Dr. Edelman, does weight affect asthma? I'm thinking of how big football players are.

EDELMAN:
That's a very interesting question. There has been a lot of scientific investigation about the effect of weight and asthma, and it turns out the answer is yes. It seems that the more overweight people are, in general, the worse their asthma is. In some cases, some doctors have said being overweight may cause asthma, but we're not clear about that. There's no question though that gaining extra pounds makes asthma worse.

Now, Jerome Bettis may be different because his big frame is muscle and not fat and that may make a difference. But for those of us who put on pounds through fat, it tends to make our asthma worse and harder to control.

MEMBER QUESTION:
Does weight and asthma together affect the heart?

EDELMAN:
Well, weight certainly affects the heart. One of the major complications of being significantly overweight is a stress on the heart. Asthma by itself does not affect the heart unless it's prolonged and severe over many, many years. However for people who already have heart disease from another cause, asthma may cause a risk of having an adverse event.

MODERATOR:
Where can people find the Asthma Control Test online?

BETTIS:
You can go to www.asthmacontrol.com or call 800-990-4100.

MODERATOR:
Dr. Edelman, what are the basic steps everyone with asthma should take to get their disease under control?

EDELMAN:
We should start at the beginning. The first thing people must do is learn whether they have asthma or not. Studies have shown that as many as one-third of children with asthma don't know it. That is, their parents don't know it. So we have to have what we call a high index of suspicion. Suspect asthma if you have a child who is coughing unexplainably every night, a child who gets short of breath playing games before the other kids get short of breath, or sometimes, for young children, irritability. It may be the only sign that a child is having difficulty breathing. The first thing is to do is understand if you're not breathing right, if you're waking up coughing without explanation night after night, get yourself tested, have your doctor make sure that you don't have asthma.

The second thing is to understand that control of asthma involves many, many elements. What people need is an asthma action plan. They ought to do this with their physician or other health care provider. The action plan includes many things. The corner stone, of course, is the right medication. But also important is the understanding of what your asthma triggers are, perhaps allergies or cigarette smoke or sometimes even exercise, and learning how to deal with or avoid the triggers. An important part of your action plan is knowing what to do in an emergency: what to do when you have an attack. Patients ought to know exactly how to adjust their medication and when to ask for help. For children at school, part of an asthma action plan is communicating with teachers, especially physical education teachers. Children with asthma should not be made to sit on the bench. Teachers should know exactly how to tailor their program to those children.

I guess the last thing is, remember that the American Lung Association wants everybody with asthma to know that just living with it, just accepting symptoms, is not necessary. Most people can feel better and function better.

"In general, the kinds of exercise that do trigger asthma attacks are bursts of intense activity."

Quick GuideAsthma Symptoms, Causes, and Medications

Asthma Symptoms, Causes, and Medications

MEMBER QUESTION:
I have asthma related to exercise only. I'm a baseball player and when I run in certain weather conditions I suffer attacks, but this is rare. I hate the idea of taking medicine all of the time when I know I will only have an attack under certain conditions. Can I just take medication before practicing or playing in adverse conditions?

EDELMAN:
The answer is yes. Consult your doctor and work out the right regiment for yourself. Many people get asthma just when they exercise. Frequently exercise in cold weather makes it worse. I know Jerome is one of the people who has a harder time exercising in humid weather. But it is possible to take medication prior to exercise which will help prevent an asthma attack during exercise.

MEMBER QUESTION:
I am on all the right meds, but still cannot attain enough control to exercise. Is exercise a particular challenge for asthmatics?

EDELMAN:
The answer is yes. For many people with asthma, exercise itself is a trigger for the asthma. We're not sure we understand the mechanism, but it may be that when you exercise and breathe rapidly the air in your lungs is not fully humidified, and dry air is an asthma trigger.

One of the best things you can do is find the best exercise for you. It's been found, for example, that swimming is a great exercise for most people with asthma (not all -- occasionally they are sensitive to the chlorine in the pools.) For many people swimming is a superb exercise that does not trigger an asthma attack.

In general, the kinds of exercise that do trigger asthma attacks are bursts of intense activity. You might try and tailor your exercise to something different.

Again, consult with your physician and make sure the medications are optimized. Keep trying. Don't give up.

MODERATOR:
Bursts of intense activity -- that sounds like Jerome!

EDELMAN:
It sounds like football, and Jerome is a great success story because he can do it all. Just by keeping his inflammation under control, he can do anything.

MODERATOR:
Jerome, do you have a plan to deal with the possibility of another attack on the field?

BETTIS:
Hopefully that's not the plan! But we have a game plan in terms of the trainers and doctors, in terms of treating it. I take a nebulizer treatment before each game to help open the airways before the game, along with the daily medication. I believe that gives me the best chance.

EDELMAN:
I want to say that it's important for people with asthma to exercise and keep their muscles in good shape. If the muscles are not in good shape they can exercise less and it takes less exercise to make them feel short of breath. So, it's a kind of vicious circle. It's important for people with asthma to discover what kind of exercise they can do and keep their muscles in good shape.

MODERATOR:
But it points up the need to get a plan of control.

EDELMAN:
Absolutely, an asthma action plan is critical. It ought to be done with a health care provider and very carefully and ought to be updated periodically.

BETTIS:
You can start it all by taking the Asthma Control Test and consulting with your doctor and developing that asthma action plan.

"Patients ought to stand up for themselves, they ought to know that they are entitled to the best possible asthma control and they ought to be able to ask their health care provider to help them achieve that."

MEMBER QUESTION:
I keep needing prednisone and now my muscles are weak and my bones in pain. I am 37 years old. I used to exercise a lot but after a few life-threatening attacks, it seems my lungs are too weak. What's the best way to start?

EDELMAN:
The best way to start exercise is by setting limited goals. Only do what you can and increase the level of exercise very, very slowly. The key is not to lose patience. Be very patient. You may only be able to walk around the block twice for a month and then you may try three times and then four times. It may take months to gradually build up your exercise tolerance, but it's always worth doing.

MODERATOR:
We are almost out of time. Before we wrap things up for today, do you have any final words for us?

BETTIS:
Take the Asthma Control Test if you're an asthmatic and give yourself the best chance to live without the frequent symptoms of asthma.

EDELMAN:
Patients ought to stand up for themselves, they ought to know that they are entitled to the best possible asthma control and they ought to be able to ask their health care provider to help them achieve that.

MODERATOR:
Jerome, what's the good word on the Steelers for next year?

BETTIS:
Super Bowl, that's the key word.

MODERATOR:
Super Bowl winners. That's the keyword -- winners .

BETTIS:
Exactly!

MODERATOR:
Our thanks to Jerome Bettis and Dr. Edelman for joining us today. And thanks to you, members, for your great questions. I'm sorry we couldn't get to all of them. For more information, please visit the American Lung Association online at www.asthmacontrol.com or call 1-800-990-4100.

The American Lung Association "Asthma Control Test" is sponsored by GlaxoSmithKline.



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Reviewed on 6/15/2005 2:30:20 PM

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