Asthma is a serious condition that needs careful management under a doctor’s care.

The blue puffer (salbutamol) is for emergency relief.

By Willow Morris

You wake up choking in the middle of the night. You’re out of breath after walking half a block and the breathlessness doesn’t subside when you are at rest. You have coughing fits for no apparent reason. You wheeze. Your chest feels tight.

All of these could be symptoms of asthma, a serious chronic condition that affects the airways. Untreated, it can cause hospitalization and even death. In Canada it causes ten deaths per week.

If your asthma is associated with allergies, you may also experience itching and watering eyes, running nose, nasal congestion and sneezing.

Less common symptoms of asthma can include rapid breathing, sighing, difficulty sleeping, anxiety, and a chronic cough without wheezing or you may have chronic congestion leading to coughing.

Two things occur with asthma: constriction of the airways and inflammation.

Nobody knows for sure what causes an asthma attack, but we can pinpoint some of the triggers. Inflammatory triggers include pollens, molds, dust mites, animals, and cockroaches, viral infections and other air pollutants. Other triggers that do not cause inflammation but can cause constriction of the airways include smoke, cold air, exercise, strong smelling odours such as perfumes or chemicals, and some food additives such as sulfites. Even stress or deep emotion can trigger asthma.

The treatments for asthma vary with the patient. On the first line of defence are the constriction relievers, the salbutamol (sold under the brand name Ventolin) types. These should be used in emergencies. Side effects can cause symptoms such as increased heart rate, restlessness, tremors and shakiness.

The other class, the anti-inflammatory drugs, include inhaled steroids such as  Pulmicort, Flovent, Alvesco and QVAR. Their side effects can be hoarse voice, sore throat and mild thrush infections of the throat. These are the most commonly used brand name drugs in the treatment to control inflammation.

There are more powerful, long lasting drugs for more difficult cases. If you are really in trouble, you may be put on a short term course of oral corticosteroids such as prednisone, taken by mouth. While prednisone can stop a serious asthma attack, it has a long list of negative side effects including water retention, puffy face, weight gain, bruising, stomach irritation, mood changes and fractures.

If you’re lucky enough to be among the percentage of the population that responds well to treatment with leukotriene receptor antagonists (LTRAs), you may be able to live almost symptom-free. These controllers are taken by pill (chewable forms are available) and work by blocking the chemical reaction that leads to inflammation. These are sold as Singulair and Accolate. Occasional side effects include headache and nausea.

Do not take asthma symptoms lightly and do expect the most from your medication. The goal is to stop symptoms or, at the very least, keep them to an occasional bout.

If you are using your asthma inhalers more than four times a week, see your doctor and insist on seeing a specialist who may recommend an alternative therapy.