WebMD Live Events Transcript
How well controlled is your asthma? We learned how to take charge with tips and answers from WebMD's asthma expert, Paul Enright, MD when he joined us on May 11, 2005.
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, Dr. Enright. Thank you for joining us today.
ENRIGHT:
You're welcome.
MODERATOR:
How would you
define well-controlled asthma ?
ENRIGHT:
Respiratory problems do not interfere with things you want to do that day and don't wake you up at night.
MEMBER QUESTION:
My doctor told me that I have allergic asthma, how do I know if this is true and what are the symptoms?
ENRIGHT:
About 80% of people with allergic asthma also have an allergic nose and hay fever -- often that's been lifelong. If you have hay fever and asthma, your asthma is probably allergic. The way to confirm this is through allergen skin testing or a RAFD blood level or eosinophil count from your blood.
MEMBER QUESTION:
I went to the doctor due to persistent nighttime coughing that keeps me awake. I was told that I either have allergies, asthma, or reflux. I was prescribed Zyrtec and an inhaler. The Zyrtec I take twice a day and the inhaler should be taken "as needed." What is "as needed"?
ENRIGHT:
The Zyrtec is an antihistamine and the doctor feels that if your cough is due to allergic rhinitis or hay fever it may be causing postnasal drainage and that's causing the cough. You can see if you have postnasal drainage, by getting a flashlight and looking at the back of your throat in the mirror. If there is white, yellow or green material then you have postnasal drainage and the Zyrtec may work well.
If acid reflux is the cause of your nighttime cough, then a stomach acid blocker taken every day for one month will determine whether or not you have GERD.
"As needed" albuterol is a bronchodilator for asthma treatment and if you awaken from cough and take two puffs of the albuterol then the cough should resolve within 10 minutes, otherwise it was probably not due to bronchospasms or asthma. There are much better asthma medicines than albuterol, however.
| "There are more than eight types of inhaled corticosteroid inhalers. The daily dose of inhaled corticosteroids determines the risk of long-term side effects." |
MODERATOR:
What would those be?
ENRIGHT:
For people who have asthma symptoms more than twice a week an asthma-controller medication is indicated. These include inhaled corticosteroids, Singulair, and long-acting bronchodilators.
MODERATOR:
What factors determine which medication you should be on?
ENRIGHT:
Your parents. The response to each of the three types of asthma controller medications is genetically determined.
About 5 out of 10 patients respond to Singulair; about 8 out of 10 respond to inhaled corticosteroids; and about 9 out of 10 respond to long-acting bronchodilators; however, they may cause side effects and should not be used by themselves.
There is no way to predict whether an individual patient will respond to these three types of asthma-controller medications. You just have to work with your doctor to try each one to see what works for you .
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." |
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.
MEMBER QUESTION:
Is Singulair a good asthma medication for a 6-year-old? Are there any side effects?
ENRIGHT:
Singulair works for about half of children and half of adults for asthma and for rhinitis. Whether or not it works for your child can only be determined by trying it. It can be prescribed all the way down to age 2.
MEMBER QUESTION:
I was wondering what your thoughts were on Xolair. My doctor seems reluctant for me to try it due to my tendencies toward reactions. Also I recently read that it my not be as effective as was first thought.
ENRIGHT:
Xolair is a very expensive medication that reduces blood levels of IgE. It is considered when asthma is allergic in origin with high blood levels of IgE and not controlled with chronic use of all other asthma medications, including prednisone. It's impossible to predict which patients will respond well to Xolair After the doctor approves it and the insurance company approves it, then it must be tried for several months to determine whether it works for you.
MEMBER QUESTION:
I think I may be seven weeks pregnant. My asthma has started deteriorating. Before the last few weeks, I had only used my inhaler three times in six months. What can I do? I am afraid of taking corticoids in case it harms the baby.
QUESTION
Asthma is a chronic respiratory disease. See AnswerENRIGHT:
Two very large
studies of pregnant women have reported in the last two years that inhaled
corticosteroids are safe for both the mother and fetus. Avoiding low oxygen
levels due to an asthma attack is very important during pregnancy. Call your doctor to discuss these issues.
| "All asthma people must avoid inhaling smoke, whether from cigarettes, fireplace, candles or incense." |
MEMBER QUESTION:
I always have feelings that my left bronchial "tree" is more "wheezy" than the right as well as it always produces more sputum. After prednisone for seven days I almost stopped wheezing but I couldn't stop coughing. With cough-variant bronchial asthma, is there any different approach to treatment? Are there any efficient mucolytics available? Is it possible that I have bronchospasm more prominent on one side than on the other?
ENRIGHT:
Asthma may be distributed in patches throughout the lungs; however, the treatment remains the same. The presence of wheezing and the loudness of wheezing is a very poor guide to asthma control.
Cough-variant asthma is merely asthma where the predominant symptom is cough and not wheezing or chest tightness or shortness of breath. The treatment of cough-variant asthma is identical to the treatment of wheezing asthma.
MEMBER QUESTION:
What else can I do with my asthma when I already use Advair Diskus, Singulair, albuterol and theophylline? I still have symptoms and wheezes when something triggers me off which is most often at least once a day.
ENRIGHT:
You should become a sleuth to determine all of the triggers of your asthma symptoms and then take measures to minimize those asthma triggers. All asthma people must avoid inhaling smoke, whether from cigarettes, fireplace, candles or incense.
MEMBER QUESTION:
Is there any risk for a kid with asthma to have tonsillitis/adenoids surgery? My daughter is 3 years old. What is your opinion?
ENRIGHT:
Whenever surgery is planned, asthma should be well controlled. Be sure to work with his pediatrician and the anesthesiologist to minimize his risk of an asthma attack after the surgery.
MEMBER QUESTION:
My son was diagnosed as having asthma at age 2. For the most part, the first two years of his life he coughed at night. We were finally referred to an allergy and asthma specialist when he was 2 and they said he had asthma. He's now 3 and a half and we've been giving him nebulizer treatments of Pulmicort for 1.5 years every night before we put him to bed. Sometimes we add albuterol and Xopinex if his cough has flared up. Is it safe for him to be on Pulmicort for this long? And how much longer can or should he be on it? Even if we miss a day or two of treatments he coughs at night. He also takes Singulair and Zyrtec for his allergies. The high pollen counts now really seem to be triggering him to cough.
ENRIGHT:
Pulmicort is a very good inhaled corticosteroid which is effective at reducing airway inflammation to the lungs. Like most medications, it does have side effects and can at medium to high daily doses for more than a year result in a reduced growth rate in toddlers. Therefore, the risks associated with poorly controlled asthma need to be balanced against the risk of side effects from inhaled corticosteroids. The other medications that he is taking are very unlikely to cause long-term side effects.
MEMBER QUESTION:
It was determined that my daughter is allergic to dogs. Is there anything we can do to minimize her allergic reaction to dogs without getting rid of our dog?
ENRIGHT:
No. If a child or an adult has asthma which requires medication to control and if they are also sensitized or allergic to a pet that lives in the home, there are no measures which can be taken to effectively reduce their allergen exposure. Only finding another home for the pet will be effective.
MEMBER QUESTION:
How long would you have to go without flaring up before you can consider stepping down meds? I have been on Advair 250 for two years but I have months at a time that I do well and wonder if I could step back to Advair 100 and leave the 250 for more difficult times. Or is the 250 what's keeping me doing so well?
ENRIGHT:
Good question. After about three months of good asthma control (in the green zone) you should work with your physician to step down your therapy. This may involve eliminating the long-acting bronchodilator which is in Advair or reducing the daily dose of inhaled corticosteroids. Keep a daily diary of your asthma symptoms' peak flow or FEV1 to show your doctor as evidence of your asthma control. My advice is always to work with your physician to change your medications.
MEMBER QUESTION:
I noticed that in the past three weeks I am having asthma attacks more frequently. I do have seasonal allergies; I live in Texas and pollen has been high. I am using my inhaler twice a week now. I have made an appointment to see my doctor about this. Is the allergy problem contributing to these flare-ups?
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ENRIGHT:
Almost certainly. Calling your doctor soon and ask her about an appointment this week or the value of starting asthma-controller medication.
| "What's important to realize is that of the asthma-controller medications available, some patients do not respond to each type, and therefore if you're not responding you need to discuss with your doctor trying a different asthma-controller medication." |
ENRIGHT:
Fewer than 2% of adults with allergies are allergic to foods. Those foods are usually peanuts or foods that contain aspirin-type chemicals. Ask your doctor if she believes you are aspirin sensitive. Avoiding milk or dairy products is usually of no help for adults with asthma.
MEMBER QUESTION:
My doctor gave me Advair 100/50 to take and I noticed I'm having problems sleeping through the night. Is there something that would be better without a lot of side effects?
ENRIGHT:
Yes. Ask your doctor about giving you Flovent or Pulmicort, which does not have the long-acting bronchodilator in it -- which is usually the cause of side effects of Advair. The side effects can be insomnia, shakiness, muscle cramps, etc.
MODERATOR:
What do you see on the horizon for asthma treatment?
ENRIGHT:
There is no new class of asthma medications that will be introduced in the next three to five years that are substantially different from those already available. Xolair or anti IgE therapy for very poorly controlled asthma is the most important new asthma medication.
What's important to realize is that of the asthma-controller medications available, some patients do not respond to each type, and therefore if you're not responding you need to discuss with your doctor trying a different asthma-controller medication.
MODERATOR:
Dr. Enright, we are almost out of time. Before we wrap things up for today, do you have any final words for us?
ENRIGHT:
- If you have asthma and smoke, stop.
- If you smoke cigarettes and your child has asthma, stop smoking.
- See WebMD for help.
- Learn your asthma triggers and know the good and bad effects of your asthma medication.
- Keep asking lots of questions.
MODERATOR:
Our thanks to Paul Enright, MD for joining us today. For more discussion on this topic, be sure to visit the WebMD message boards to ask questions of our online health professionals, such as Dr. Enright, and to share questions, comments, and support with other WebMD members.
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