slideshow widget

Tuesday, January 23, 2007

Asthma/ allergy Lexicon

Asthma Definitions:

Asthma: According to National Heart, Blood and Lung Institute, "Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning. Asthma affects people of all ages, but it most often starts in childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children."

Bronchospasm: This is when the bronchioles of the lungs (the air passages) become inflammed, produce excess secretions, and constrict. This narrowed airway makes it difficult to get air out of the lungs, and often results in air trapping. It is the key component of asthma and COPD.

Asthma prognosis: The life expectency for mild and moderate asthmatics is the same as that for non-asthmatics.

Asthma gene: It is believed that in order to develop asthma one has to have this gene, and something has to happen to "turn it on." Approximately 10% of Americans have this gene. Many asthma experts believe the age a person is when this gene is "turned on" determines whether one has childhood-onset or adult-onset asthma. Others think it's always "turned on" during the first few months of life, regardless of when one first has asthma symptoms.

Childhood-onset asthma: This is when a person first shows signs of asthma during childhood, or under the age of 18. Most common triggers of this are allergies, respiratory infections, and exercise induced asthma.

Adult-onset asthma: This is when a person first shows signs of asthma during adulthood. Most common triggers of this are relocation and GERD.

AcuteIt's happening right now.

ChronicIt's going on all the time. Permanant.

Acute Asthma: This is shortness-of-breath due to narrowing of the air passages in your lungs that is occuring right now. The most common way of treating this is with rescue medicines (see below).

Chronic asthma: This refers to the underlying inflammation that is always prevalent in the lungs of asthmatics. The degree of this inflammation is what determines the severity of your asthma when exposed to your asthma triggers. The best way of treating this is with asthma controller medicines (see below).

Severe Asthma: May be associated with decreased lung function with a loss of response to bronchodilator. Patients with the greatest degree of reversibility in response to rescue medicine (Albuterol) may be at the greatest risk of developing fixed airflow obstruction and have the greatest loss of lung function.

Poorly controlled asthma: This refers to about 5% of asthmatics who have frequent symptoms and exacerbations despite use of high-dose systemic corticosteroids. Patients who have a poor response to appropriate therapy require referral to and consultation with an asthma specialist.

Resistance to therapy: See poorly controlled asthma.

Asthma triggers: These are normally non-threatening things like dust mites, molds, stress and smells that "trigger" asthma symptoms. While these things are normally non-threatening, the immune systems of asthmatic lungs treat these things the same way it treats bad bacteria and parisites. Air passages that have a greater degree of inflammation are more sensitive to these triggers, and may result in "more severe" asthma attacks.

Twitchy airways: This usually occurs in children who have smaller air passages than adults. It occurs when the air passages are very inflammed and thus extremely sensitive to asthma triggers. Asthmatics with twitchy airways are often referred to as Brittle Asthmatics.

Brittle Asthma: These asthmatics have severely inflammed air passages that are highly sensitive to triggers. Even the simplest exposure can set off a major attack. In most cases today, brittle asthma can be prevented by compliant use of your asthma controller medications. In some instances asthma is so severe that even controller medicines don't controll asthma. I refer to these asthmatics as hardluck Asthmatics.

Airway remodelling: (synonym: lung scarring) This is irreversible changes that can occur in your lungs if your asthma is not diagnosed in a timely manner and treated agressively. This can make asthma more difficult to control. This is one great reason why it is extremely important to see your doctor regularly and take your asthma medicines exactly as prescribed.

Rescue medicines: These "quick relief" asthma medicines dilate and relaxe the air passages in your lungs. The most common ones used in the U.S. are Ventolin and Xopenex.

Asthma Action Plan: The asthma guidelines recommend all asthmatics develop a partnership with their doctors to create a plan to help them understand when to take action (use rescue inhaler, call physician or go to the ER). The guidelines note that
"either peak flow monitoring or symptom monitoring, if taught and followed correctly, may be equally effective."

Asthma Symptoms: These are "symptoms" an asthmatic experiences when an asthma attack is impending (early warning signs) and when an attack is ongoing (Asthma attack symptoms).

Peak flow meter: This is a device used to determine "how well your lungs are functioning," according to National Jewish Health. This is recommended as part of the asthma action plan for children and anyone who has difficulty perceiving asthma symptoms. It should be noted that peak flows are a great tool for monitoring asthma status, but should not be used to diagnose.

Spirometry: click here for PFT lexicon and here for everything asthmatics need to know about PFTs

Controlled Asthma: Controlled Asthma: This is the ultimate goal of all asthma doctors for all their asthmatic patients. Asthma control is determined by the following:
  • Decreased use of rescue inhalers for quick relief (or, ideally, the need to use them less than 2 days a week),
  • Fewer school days or days of work missed (or no days missed)
  • ability to engage in normal daily activities or in desired activities
  • Improved ability to exercise without having asthma symptoms
  • Improvement in FEV1 in a pulmonary function test (PFT), or maintaining a normal PFT.
  • Reduction in exacerbations
  • Fewer emergency room visits and hospital stays for asthma
  • Fewer nighttime awakenings due to asthma
  • Optimal asthma meds with minimal adverse effects
  • You're expectations are met or exceeded
  • You're satisfied with your asthma care
Controller medicine: (synonym: preventative meds). These are asthma medicines, if taken correctly and as directed, that are meant to prevent one from having an asthma attack, limit severity of attacks, and help one maintain good control of asthma. The best of this type of medicine are Advair, Symbicort, and Singulair.

Asthma Symptoms: These are symptoms that are synonimous with an asthma attack. They include: Wheezing, Coughing, Shortness of breath, Tightness in the chest, Peak flow numbers in the caution or danger range (usually 50% to 80% of personal best).

Early signs of asthma: These are signs an asthma attack is imminent, and one must take action quickly to prevent the attack, such as use a rescue inhalr or call a physician. They include:
Breathing changes, Sneezing, Moodiness, Headache, Runny/stuffy nose, Coughing, Chin or throat itches, Feeling tired, Dark circles under eyes, Trouble sleeping, Poor tolerance for exercise, Downward trend in peak flow number.

Signs of severe asthma: According to national Jewish Health, "Severe asthma symptoms are a life-threatening emergency. If any of these severe asthma symptoms occur, seek emergency medical treatment right away, since these symptoms indicate respiratory distress. Examples of severe asthma symptoms include: Severe coughing, wheezing, shortness of breath or tightness in the chest, Difficulty talking or concentrating, Walking causes shortness of breath, Breathing may be shallow and fast or slower than usual, Hunched shoulders (posturing), Nasal flaring (nostril size increases with breathing), Neck area and between or below the ribs moves inward with breathing (retractions), Gray or bluish tint to skin, beginning around the mouth (cyanosis)
Peak flow numbers in the danger zone (usually below 50% of personal best)

Dyspnea tolerance: According to the asthma guidelines, "these patients have unconsciously accommodated to their symptoms, or perhaps they have mistakenly attributed these symptoms to other causes, like aging, obesity, or lack of fitness, so they do not report them readily." These patients have been short of breath so long they have developed a "tolerance" to it, and are incapable of determining degree or severity of their dyspnea. Therefore, the best method of managing their asthma is by using spirometry and peak flow measurements. These asthmatics tend to be Martyr Asthmatics and Hardluck Asthmatics.

Psychological consequences of asthma: These are the undesirable effects asthma can have on a child who has uncontrolled, severe-persistant, or hardluck asthma. This is particularly associated with children who are unable to perform certain activities, whose asthma struck at a very young age, and who have poor family and social support. These consequences include, but are not limited to: Poor self confidence, Embarrassment that you have it, embarrased to take medicine in public and anxiety.

Causes:  Things that might cause one to develop asthma

Triggers:  Things that result in or "trigger" an asthma attack or exacerbation.

Intrinsic asthma:  Non allergic asthma.

Extrinsic asthma:  Allergic asthma.  Most of your asthma triggers are from outside your body, such as allergens, cigarette smoke, pollution, inhaled chemmicals, etc.

Exacerbation:  Acute asthma attack.  Most of your asthma triggers are from inside your body, such as gastrointestinal reflux.

Non allergic asthma:  See Intrinsic asthma

Allergic asthma:  See extrinsic asthma.

Gastrointestinal reflux (GERD):  When the esophageal sphyncter relaxes and stomach contents ride up the esophagus and into the lungs.  It's a common cause and trigger of asthma.

Dust mite:  Microscopic bugs that live on dust particles and are a common allergen

Cockroach urine:  A common allergen

Molds:  A common allergen

Inflammation:  Swelling

Animal dander:  Material shed from animals, such as fur, skin, feathers, etc.  It's a common allergen.

Mold spores:  A common allergen.

Pollen:  Microscopic coarse powder released from seed plants.  It consists of a hard coat covering a sperm cell.  Once it lands on a plant it germinates and a flower develops.  The pollen is carried by wind and can be inhaled by humans.  It should be safe for most people, but some develop sensitization to pollen and it can become an allergen.

Ragweed pollen:  A common pollen produced by the ragweed genus of plant that is carried by the wind adn is considered a common allergen.

Sensitizing:  When your immune system recognizes an allergen as an enemy and sets off the immune response in an effort to rid your body of this so called enemy.

Allergy(Synonym: atopy) It's estimated 75 percent of asthmatics also have this. It's an abnormal reaction to an allergen. A normal reaction would be no reaction at all. The first time your body comes into contact with the allergen (dust mites for example) your body develops a defense against it. When the allergen is reintroduced your body attacks it the same as it would an enemy bacteria or virus. The reaction includes inflammation of the respiratory tract, eyes or skin. This often results in nasal congestion, itchy eyes, runny nose, wheezing (asthma), and skin rash.

Allergen: Anything that induces an allergic reaction. Common ones include dust mites, cockroach urine, molds, fungus, and animal dander. For a more detailed list of allergens and asthma triggers, check out this link.

Hypersensitivity: Extremely sensitive, as in sensitive to an allergen. The air passages (bronchioles) of asthmatic lungs are often hypersensitive to various asthma triggers, and they may become acutely inflamed (swollen) as a result of such contact. See allergy.  This increased sensitivity may also be due to chronic inflammation of the air passages (which can be improved with corticosteroids).

Inflammation: Swelling and redness caused by some irritation. In asthma there is some chronic swelling of the air passages, and when exposed to asthma triggers this inflammation may become worse, or acute. Acute asthma is your asthma attack.

Rhinitis: (Synonym: hay fever) Inflammation (swelling) of the mucus membrane inside the nasal passage.

Sinusitis: (Synonym: sinus infection) Inflammation of the sinus passages

Beta Agonist: (Synonym: bronchodilator, rescue medicine) This is a medicine that has an affinity to beta receptors that line the respiratory tract, particularly the bronchioles. Once attached to the beta receptors a reaction occurs that relaxes the bronchiole muscles and opens up the air passages. This makes breathing easier. Examples include Ventolin and Xopenex.

Long Acting Beta Agonist (LABA): These work the same as Beta Agonists only the medicine can last up to 12 hours. Common examples are Serevent (a component in Advair) and Formoterol (a component in Symbicort).

Corticosteroids: (Synonym: steroids, glucocorticosteroid) A medicine often used to reduce inflammation in the air passages. Common examples include Flovent (a component in Advair) and Budesonide (a component in Symbicort).

Metered Dose Inhaler (DPI): (Synonym: puffer, inhaler, breather, rescue inhaler, atomizer) An easy to use and convenient to carry device used to aerosolize asthma medicine such as beta agonists and inhaled corticosteroids. It consists of the medicine mixed with a propellant held under pressure inside a metal cannister and a plastic sleeve with a little mouthpiece. When you press the canister medicine is sprayed and can be inhaled. For more information click here.

Dry Powdered Inhaler (DPI): The medicine is in powder form and usually comes in a device such as a discus or other device. The medicine is usually held inside a capsule that is crushed when you twist the device. The powder is inhaled when the patient places his mouth over the mouthpiece and inhales. For more information click here.

Nebulizer: (Synonym: Updraft therapy, Aerosol, Magic Mist, breathing machine, breathing treatment, peace pipe) This is a small cup that you put liquid medicine into, and once hooked up to an air source (like an air compressor) and pressurized air causes the liquid to become aerosolized and reduced to a fine mist that can be inhaled. Such treatments usually last five to 10 minutes. This is ideal for anyone who has trouble using an MDI. For more information click here.

Allergic reaction:

Chest tightness:

Frogged up:

Shortness of breath:  See short of breath, SOB, dyspnea.


Cardiac wheeze:


Stuffy nose:

Nasal congestion:

Postnasal drip:

Atopic dermatitis:



Occupational asthma:

Exercise induced asthma:

Beta adrenergic:  See bronchodilator

Airway edema:

Airway congestion:

Nasal congestion:

No comments: