More than 30 million Americans live with lung disease, including lung cancer, emphysema, asthma and chronic bronchitis. According to the American Lung Association more than 87 percent of lung cancer cases as well as most cases of emphysema, chronic obstructive pulmonary disease and chronic bronchitis are caused by tobacco smoke. Air pollution, both indoor and outdoor can also harm the lungs.
Asthma is a chronic inflammatory disease of the airways that affects about 20.3 million Americans; at least 6.2 million are children under the age of 18, according to the American Lung Association. In 2000, according to the BRFSS data Maine was ranked 1st for Asthma prevalence with a rate of 8.9% and Waldo County is included in a region with the second highest rate in Maine with a rate of 9.9%. The Maine Asthma Council provides the following data sets. Overweight and obese adults are more likely to have asthma than adults who are a healthy weight. Low income and minority populations experience substantially higher rates of fatalities, hospital admissions and emergency room visits due to asthma. People with asthma miss about 14 million days of school, 14.5 million days of work, experience 100 million days of restricted activity each year. Asthma related healthcare costs are estimated at 14 billion dollars annually. There is no cure for asthma, but it can be controlled. Through proper disease management, persons with can live healthy, active, productive lives.
Asthma symptoms include coughing, wheezing, chest tightness or heaviness, shortness of breath and faster breathing or noisy breathing. Coughing from asthma is often worse at night or early in the morning, making it hard to sleep. Wheezing is a whistling or squeaking sound when you breathe. Some people say they cannot catch their breath, or the feel breathless or out of breathe, they may feel like they cannot get enough air in or out of their lungs. People with asthma may have symptoms when they have a cold or other illness, exposed to cold air, allergens, irritants, medications such as aspirin and beta blockers, sulfites in food (dried fruit) or beverages (wine), GERD (gastroesophageal reflux disease), prolonged crying or laughing or exercise. Not all people have these symptoms and symptoms vary from one asthma attach to another. Symptoms can differ in how severe they are: sometimes symptoms may be mildly annoying, other times they may be serious enough to cause one to stop what they are doing and sometimes they can be so serious that they are life threatening.
The four levels of severity for asthma are based on when symptoms are not controlled, the classifications are mild intermittent, mild persistent, moderate persistent and severe persistent. With mild intermittent asthma symptoms occur twice a week or less during the day and twice a month or less at night. Mild persistent asthma is when symptoms occur more than twice a week, but no more than once in a single day and more than twice a month at night. Asthma is classified as moderate persistent when symptoms occur every day and more than once a week at night. Asthma attacks may affect activity levels. Severe persistent asthma is when symptoms occur throughout the day on most days and suffer at nighttime often. Physical activity is often limited. With proper treatment ideally one should be free of asthma symptoms, have fewer attacks, need to use fast acting bronchodilators less often and be able to do normal activities without having symptoms. Treatment includes reduce exposure to what brings on or worsen symptoms and medication. There are two types of medication quick relief or rescue inhaler and long-term anti-inflammatory controller or maintenance medication. Environment controls to limit exposure to allergens and irritants are important, these include tobacco smoke, pet dander, dust mites, mold, sprays, strong odors, and smoke from wood stoves and kerosene heaters.
The National Heart, Lung and Blood Institute’s (NHLBI) National Asthma Education and Prevention Program has identified four key components for effective asthma management
- Assessment and Monitoring
- Controlling Factors that Contribute to Asthma Severity
- Pharmacologic Therapy, and
- Patient Education.
An important part of monitoring asthma is a patient’s management plan; it is an individual action plan with specific management goals for the patient. The plan creates a partnership with the physician and the patient and helps educate family members and school personnel of plans of action. An Asthma management plan identifies and addresses obstacles and concerns, asks for agreement and plans for actions, encourages or enlists family involvement, requires follow up; at each physician visit performance of agreed upon, actions are reviewed, and it assesses the influences of the patient’s cultural beliefs and practices that might affect asthma care. A good self management plan is simple to ensure adherence, convenient to fit in with normal daily routines, encourages self-reliance so the patient knows what to do, understood by the patient, seen as effective by the patient and is culturally appropriate.
This written management plan should specify daily dosage of long term preventive medication to control and prevent the patient’s symptoms, what to do to prevent symptoms and attacks, what to do in case of when an asthma attack occurs, list the specific asthma triggers for the patient to avoid-environmental controls, and what to do if asthma worsen. This information should include the name and dose of the bronchodilator to be take immediately for quick relief of asthma symptoms, how to recognize decreasing control, including what symptoms and peak expiratory flow changes to note such as increasing cough, chest tightness or difficulty breathing; waking with symptoms at night; quick-relief medicine used more often or less effective than usual.
The Maine Asthma Council has developed two versions of a written asthma plan, one is called the Maine Asthma Action/Management Plan for the individual and family the second is referred to as the Maine School Asthma Plan for the child and the school. These forms were adapted from the NHLBI guidelines and are available by contacting the American Lung Association of Maine at 1-800-499-LUNG (5864) or the Healthy Living Project at 930-2650 (Belfast). Both forms are complete in partnership with the physician. The school plan is very important for many reasons, it helps educate the student’s teacher and school nurse of the child’s care plan to help manage the disease and is helpful with the implementation of a state law permitting students to carry and use inhaled medicines and Epi-pens who demonstrate appropriate use of the devices to the school nurse. To learn more about asthma or other lung diseases visit
- The National Heart, Lung and Blood Institute website at www.nhlbi.nih.gov
- The American Lung Association website at www.lung.org
- The Center for Disease Control at www.cdc.gov/neh/asthma