Asthma – Information


Dr. Powlin Manuel is retired as of 1/1/2-22

Asthma – what you should know! Powlin Manuel MD, MBA, MS  

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For most of us when we think of asthma, the picture of a person having wheezing and difficulty in breathing comes up. All asthmatics do not wheeze; asthma often presents itself with cough more often than wheezing. I may start with the following questions to suspect if we suffer from asthma.

Do you feel short of breath with sports, exercise, cough, weather change and even laughter? You may be suffering from asthma. Asthma can vary from just exercise induced spasms to difficult to treat chronic asthma. For the sake of clarity for treating physicians as well as patients, asthma is classified into intermittent asthma, mild persistent asthma, and severe persistent asthma. This classification helps the physicians understand the urgency to institute an effective treatment program.

The following pointers will help to decide the severity of asthma:

Intermittent Asthma: In intermittent asthma, the symptoms occur for a duration of less than two times per week; patients wake up with symptoms less than two times per month; patients use asthma relief medications less than two times per week  If any of these numbers exceeded, then your asthma is not intermittent,  and you are suffering from persistent asthma.

Persistent Asthma: Persistent asthma is classified into mild persistent asthma and severe persistent asthma based upon the results from the lung function tests. Pulmonary function test may be normal in intermittent asthma while it decreases in persistent asthma. The nature of severity of asthma can vary depends upon certain factors: allergic asthma versus non allergic, childhood versus adult-onset, etc. Most children suffer from allergic asthma and are tremendously helped by allergen avoidance. The majority of adult asthmatics do not suffer from demonstrable allergies, rather there are other factors that contribute to inflammation and narrowing of airway tubes.

What  you should do to take control of asthma?  Taking Control of Asthma

Taking measure to control asthma starts with the understanding of what is different about the airway in patients with asthma. The discomfort experienced by a person with asthma preceding or during an attack of asthma is related to the dynamic changes taking place in the airway. The diameter of the airway tubes is not constant; rather it can change. The airway tube diameter is influenced by the elastic components of the soft tubes, the thickness of the lining of the airway, and the state of tension of the muscles of the airway. Any change in any of these control mechanisms leads to symptoms associated with asthma.

The size (diameter) of airway tubes and symptoms of asthma:

Airway changes in asthma

Airway changes in asthma

  • Tightness of chest as a symptom of asthma: the tightness of chest occurs when the external environment forces the airway to contract (shrink). This is due to an attempt by nerves of the airway to decrease the number of particles entering the airway. Chemical particles from tobacco smoke, cleansing agents such as ammonia, and allergenic particles such as dusts, molds, and pollen induce such a defense mechanism to act and impart a feeling of tightness of chest.
  • Cough and asthma: one of the most common symptoms of asthma is a cough; sometimes cough is a sign of airway irritabilityindicating that some potentially harmful particle has entered the airway, and our nervous system is inducing cough to get rid of the particle.
  • Wheezing and asthma: while tightness of chest and cough spells indicate an impending asthma attack, wheezing occurs when airway size is reduced, and the air trapping occurs in the lungs. Wheezing indicates that the dynamic forces maintaining the airway diameter have changed in favor of the forces closing the airway, thus less than the necessary quantity of oxygen is reaching the airway.




Tobacco Smoke and Asthma

Why people suffering from asthma cannot tolerate cigarette smoke?
Tobacco smoke and Asthma

Tobacco smoke and Asthma

Many individuals with asthma feel tight in the chest, start coughing, and start wheezing when they are exposed to an environment with tobacco smoke. The reason is very clear, as tobacco smoke carries many particles that are harmful, the immune system acts by triggering the closing mechanisms of the airway diameter control. While active smoking is detrimental to a healthy airway, passive smoking also contributes the unfavorable environment for anyone with reactive airway disease. Airway goes into spasm leading to the feeling of tightness in the chest; cough becomes a mechanism to get rid of the offending particles, and the state of wheezing suggest a failure of defensive mechanisms, hence distress to patients with asthma.







 Dust Allergy and Asthma

Dust mite allergy

Dust mite allergy

If you are allergic to dust the following symptoms are noticed on exposure to dust:

  • Blocked nose
  • Stuffy nose
  • Sneezing
  • Runny nose
  • Itching
  • Cough
  • Wheezing

For many individuals, suffering from asthma dust often triggers an attack of asthma. This could be due to dusts acting as a trigger from irritation of the nerve endings lining the airway tubes, as well as nostrils or an allergic reaction to different components of dust. Most of the dust particles are filtered and kept in the nose and sinuses and are thus prevented from entering the lower airway. Once trapped in the nose, sneezing is triggered resulting in forceful expulsion of dust particles. Sudden production of mucus is one way to wash away the dust particles trapped in the nasal passage. Further entry of dust particles is reduced by blockage of the nose due to swelling of the mucosal lining. Entry of dust particles in the upper airway and sinuses may induce a contraction of the lower airway leading to tightness of chest in those with asthma.

How to control symptoms due to dust allergy?

  • Avoid carpet floors if possible.
  • Avoid rugs.
  • Reduce unnecessary cushions on furniture.
  • Reduce the number of stuffed toys in your child’s room.
  • Avoid Venetian blinds
  • Keep book shelves clean and free of dust.

There are many measures you need to take in order to achieve a good control of asthma. Remember that asthma symptoms occur when the external environment forces the airway to contract (shrink). This is because the airway diameter can, at any time, based upon the exposure to offending agents, can changethis is in a way eliciting the protective mechanism to reduce the entry of offending agents into the airway.

Based on these facts the following measures will help you to prevent an asthma attack:

  1. Avoid exposure to tobacco smoke.
  2. Avoid exposure to chemical and perfume sprays.
  3. Avoid contact with pets you are allergic to.
  4. Do not use humidifiersas they increase the chance of mold and mite growth.
  5. Install ventilators in the kitchen for exhaust.
  6. Minimize the use of rugs if you are allergic to dust.
  7. Take influenza vaccine every year as any viral infection lead to increased airway sensitivity.
  8. Decrease exposure to dust mites using pillow and bed-covers that do not permit mites to cross.
  9. Decrease exposure to mites by periodic washing of toys with hot water.
  10. Decrease humidity in rooms using a dehumidifier.
  11. Wash bed-sheets every week with hot water.
  12. Avoid Venetian blinds in rooms
  13. Reduce the number of cushions in rooms
  14. Avoid lampshades that can collect dust.
  15. Reduce the number of bookshelves.
  16. Avid stuffed toys.

Dust allergy

Dust allergy








What to do when you have an asthma attack?
Many physicans provide patients with an asthma action plan to properly repond to an asthma attack; follow them carefully. If exercise is knon to induce an asthma attack use the inhalers such as albuterol prior to engaging in a strenuous exercise. A rescue inhaler needs to be kept at school. Parental permission and prescription by your physician either to self administer, or to be provided by a school nurse should be made available to the school.
For infants with asthma use your nebulizer with the prescribed dose of medications Watch for the following signs of trouble with asthma attacks and call your physician.

Blue color
Struggling to breath

Go to the emergency room if you notice any sign of trouble

For children over six years the same instructions will apply. You may use inhaler instead of nebulizers. Nebulizers can be repeated every hour for additional two more times to attain a relief.

 Asthma and Anxiety





Visit Dr. Manuel’s Blogs on difficult to treat asthma.
Links to Asthma Information