Asthma in pregnancy

During pregnancy, the severity of asthma often changes and patients may require close follow-up and adjustment of medications. Studies have suggested that during pregnancy asthma become worse in approximately one-third of women.
One-third become less severe and in other one-third asthma remains unchanged.

Although concern exist with the use of medications in pregnancy, poorly controlled asthma can have an adverse effect on the fetus, resulting in increased perinatal mortality, increase prematurity and low birth weight. The overall perinatal prognosis for children born to women with well-managed asthma during pregnancy is comparable to that for children born to women without asthma. For this reason, using medication to obtain optimal control of asthma is justified even when their safety in pregnancy has not been unequivocally proven. For most drugs used to treat asthma and rhinitis, with the exception of alpha-adrenergic compounds, brompherinamine, and epinephrine - there is still little to suggest an increase risk to the fetus. Appropriately monitored theophylline, sodium cromoglycate, inhaled beclomethasone dipropionate, and inhaled beta2 agonist are not associated with an increased incidence of fetal abnormalities. Inhaled steroids have been shown to prevent exacerbations of asthma spesifically in pregnancy.

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Exercise Induced Asthma

For a majority of patients with asthma, phisical activity is an important trigger of asthma exacerbations. For some patients it is the only trigger. Exercise induced asthma (EIA) is the conditions, in which postexertional airflow limitation resolves spontaneously within 30 - 45 minutes following physical activity. Some forms of exercise, such as running are more potent triggers. EIA may occur in any climate condition, but it increases substantially in breathing dry, cold air and is less common in hot, humid climates.

EIA is not a special form of asthma. It is one expression of airway hyperresponsiveness. It is often indicates that the asthma is not well controlled, therefore, appropriate anti-inflamamtory therapy generally results in the reduction of exercise-related symptoms. For patients who still experience EIA despite appropriate therapy and for those in whom EIA is the only manifestation of asthma, the inhalation of rapid-acting beta2-agonist before exercising is the most efective treatment for preventing exacerbations. Training and sufficient warming up also reduce the incidence and severity of EIA. In asthma patients, physical training can improve cardiopulmonary fitness without changing lung function.

Because the treatment of EIA is so effective, there is no need for patients to avoid physical activity. Instead a goal of asthma management is to enable patients to participate in any activity they choose without experiencing symptoms. In a well trained subject with EIA, experiences postexertional symptoms only at a higher degree of physical activity than before training. Therefore it's important to recommend that sports and physical activity should not be avoided in patients with EIA.

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Occupational Asthma

According to GINA (Global Initiative for Asthma), Asthma acquired in the work place is a diagnosis that is frequently missed unless the health care professional is made aware of the possibility. Many inhalant chemicals are now known to produce asthma in the occupational environment. They range fro highly reactive small molecular weight chemicals such as isocyanates to known immunogens such as platinum salts, as well as to complex plant and animal biological products. Because of its insidious onset, occupational asthma is often misdiagnosed as chronic bronchitis or some form of COPD (chronic obstructive pulmonary disease) and is therefore either not treated at all or treated inappropriately. The diagnosis requires a defined occupational history, especially in relation to exposure to sensitizing agents, absence of asthma symptoms before beginning employment, and a documented relationship between development of symptoms at the workplace and reduction of occupational asthma may be successfully achieved by lung function measurement, such as serial measurement of PEF at work (single measurements are less sensitive than serial measurements), and spesific bronchial provocation testing. The increasing recognition that occupational asthma can persist, or continue to deteriorate, even in the absence of continued exposure to the offending agent, emphasizes the need for an early diagnosis, appropiate strict avoidance of further exposure and farmacologic intervention.

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Diet in allergic and asthmatic patients

In allergic patients, especially in food allergic patients, many alternative practitioners recommend cutting down or eliminate dairy productfrom their diet. It is because they increase mucus secretion and are the sources of food allergies. The recommendation also include avoiding processed food, refined starches and sugars and foods with artificial additives.Diet in allergic patients shoud be high in vegetables, fresh foods, whole grain and low salt. In some studies vegan diet which is contain of zero animal products have shown to be effective. Vegan diet also eliminates a fatty acid called arachidonic acid which is usually found in animal product and believed to contributed to allergic reaction. In 1985 a swedish study showed that 92% of patient with asthma improved significantly after one year of vegan diet. But in some people they feel weaker in vegan diet. Inaddition many people are alergic in vegetables rather than to meat.

Drinking much water is also advised to asthma patients to keep the lung passages moist. Onion and garlic contain quarcetin that inhibits the release of histamine and should be a part of asthmatic diet. Vitamin A, C and E seem important. And also B complex vitamins, especially B6 and B12 may be helpfull for asthma as well as selenium, magnesium and omega 3 fatty acid.

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The danger of cortico steroid

Corticosteroid is an anti inflammation drugs mostly used to treat asthma and asthma attack. Steroids appear to be a miracle medicine. Patients with arthritis or asthma especially in attack condition seem to be instantly better on steroids.The wheeze, the swelling, the pain go away.

Steroid - prednisone has been used widely because of its effectiveness in treating everything from asthma and rheumatoid arthritis to kidney disease and organ transplants. But unfortunately long-term use may cause side effects such as bloating, weight gain, and depression. Steroid can be used as injected meanly for arthritis and bursitis. But they are progressively less effective. Repeated injection can damage joints and induce osteoporosis. Steroids can cause over-activity of adrenal hormones, which produces Cushing's disease. They can also cause muscle wasting, hyperglycemia, water retention, bruising, insomnia, serious mood changes, menstrual problems, impotence, loss of libido, or allergic shock and diabetes.
The major side effects of anabolic steroids can include liver tumors and cancer, icteric (yellowish pigmentation of skin, tissues, and body fluids), fluid retention, high blood pressure, increases in LDL (bad cholesterol), and decreases in HDL (good cholesterol). Other side effects include kidney tumors, severe acne, and trembling. There are also some gender-specific side effects:

For men : those are shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer.

For women : those are growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice.

For adolescents : those are growth halted prematurely through premature skeletal maturation and accelerated puberty changes. It means that they have risk in remaining short for the remainder of their lives if they take anabolic steroids before the typical adolescent growth spurt.

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Asthma can be prevented

Asthma can be prevented by eliminating the main trigger. As we know, asthma is an inflammation disease of the lung that can be triggered by air pollutant, house dust mite, pollens, mold, dust, animal dander, chemicals, food, exercise or temperature changes. These triggers can produce symptoms of allergy and asthma. Many doctors and researchers agree that the most important thing parents can do to prevent their child from asthma is to eliminate or significantly reduce dust mite in the home. Dust mite allergens are known to play a major role in asthma development. Other important allergens (after dust mites) that also need to be eliminated from the home are cats, certain type of mold, dogs, cockroaches and tobacco smoke. Asthma is a severe and potentially life-threatening illness that should be taken seriously. Long term use of steroid is not recommended and has serious side effect. A preventative environmental changes is much more viable, healthy and preferable alternative.

Dust mites are microscopic spider-like insect that live in bedding, pillows, mattresses, blanket carpets etc. They live off of dead skin cells and produce an allergen from excrement, which is easily airborne and then inhaled. All home contain dust mites. Dust mites allergens must be reduced to at least 2 mcg/g dust or mite populations decreased to 100/g dust to have any significant benefit. These are we can do to eliminate or reduce dust mites:
1. Changing the relative humidity and temperature of the home: keeping relative humidity less than 50% is proven to greatly reduce the dust mite population. Mechanical ventilation with a heat recovery unit has proved to be the most effective to reduce humidity in the home.
2. Using air cleaner that have HEPA (High Efficiency Particulate Air) filters, will also eliminate other allergens pollens and animal dander.
3. Cleaning using a vacuum with a HEPA filter and steam cleaning rug and upholstery regularly.
4. washing all bedding in hot water (60 degrees C, 130 degrees F) on a weekly basis is known to kill dust mites.
5. Drying bedding in a hot dryer.
6. Dry cleaning quilts and blankets will also kill dust mites.
7. Placing plastic casings spesifically made for dust mite control on pillows and mattresses.
8. Chemicals used on carpets and upholstery, which are known to kill dust mites include benzyl benzoate, permethrin, primiphos methyl common household disinfectant, combination of these and insect growth regulators. (Note: some chemicals can also trigger asthma and allergy reaction).

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Occupational asthma

shortness of breath, wheezing, cough, chest tightness

Occupational asthma is an asthma caused by various agents found in work place. Like other asthma attack, it is characterized by shortness of breath, wheezing, prolonged exhalation and cough. The symptoms due to spasm of the smooth muscle lining the airways. many agents in work place can cause occupational asthma. These include protein molecule such as: wood dust, grain dust, animal dander and fungi. And also chemicals agents espescially di-isocyanate. These workers are at high risk : plastics worker, metal worker, millers, bakers, farmers, woodworkers, drug manufactures, detergent manufactures, laboratory workers and grain elevator workers.
Symptoms usually occurs soon after exposure to the agent (allergent) and improve or disappear when the affected person leaves the work place.

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