Sunday, December 14, 2008

Bronchial Asthma in General, Children and Adult

Asthma is a condition that affects the air passages of the lungs. It is a two-step problem:

· When a person has asthma, the air passages are inflamed, which means that the airways are red and swollen.
· Inflammation of the air passages makes them over extra-sensitive to a number of different things that can "trigger," or bring on, asthma symptoms.
During breathing, air is normally brought in through the nose where it is warmed, filtered, and humidified. It then passes through the throat and into the windpipe, called the trachea (TRAY-kee-a). The trachea divides into two large tubes called the right bronchus (BRONG-kus) and left bronchus. These then split up into much smaller tubes, which in turn branch into thousands of very small airways called bronchioles (BRONG-kee-olz). It is the large and small bronchi that are generally affected in asthma.

When a person is exposed to one of these irritants, or triggers, the oversensitive air passages react by becoming narrower, swollen, and even more inflamed. This obstructs airflow to and from the lungs and makes it very difficult for the person to breathe.

Is All Asthma The Same?
Asthma is a chronic condition. This means that while it often looks like it goes away for awhile, the inflammation of the air passages remains present all the time. However, in some instances, this inflammation may go unnoticed for long periods of time. As long as the air passages are inflamed, asthma can flare up at any time. This is one of the reasons that an awareness of the triggers that cause the flare-ups is so important in preventing asthma episodes.

Allergic asthma - Allergic asthma is most common in children and adolescents. Usually, but not always, the allergies that cause the asthma appear before the age of 35. An asthma attack or episode occurs when a person comes into contact with something to which he or she has developed an allergy.

· Nonallergic asthma - This type of asthma is most common in middle-aged adults. Asthma attacks may occur in response to triggers such as exercise, cold air, or respiratory infections. The allergic mechanism is not responsible for the asthmatic reaction.

What Is An Asthma Episode (Asthma Attack)?

Asthma symptoms can vary from very mild to very severe. Some adults with asthma have only seasonal bouts of symptoms. Some have symptoms only after exercise or after exposure to something to which they are allergic, such as a dog or cat. Others have a chronic form of the disease and experience asthma symptoms almost daily.

In an "asthma episode," also known as an "asthma attack," the symptoms develop because the oversensitive airways of the lung react by becoming more inflamed and narrows, thus obstructing the normal flow of air through the air passages.
The reduced size of the air passages occurs because:
· The muscles around the airways tighten
· The linings of the airways become swollen
· The normal secretion of the airways (called mucus) becomes "trapped," thus clogging the airways

As the airways become narrower and more obstructed, it takes extra effort to breathe and force air through them. The air may make a whistling or wheezing sound as it goes past the narrowed parts of the air passages. A person having an asthma attack may also cough a lot and spit up a lot of very sticky mucus.
SO one or more of the following symptoms may occur once the airways have narrowed in response to a trigger:

· Coughing. Coughing is often a sign of asthma, but is easily overlooked. As a general rule, healthy people don't cough unless they have something in their throats or have a cold.
· Wheezing. Wheezing is a whistling noise heard during breathing, as if something is "caught" in one of the breathing passages.
· Tightness of the chest. Many adults with asthma describe a tightness of the chest, an uncomfortable feeling caused by over-inflation of the lungs due to difficulty in pushing air out through the narrowed airways.
· Shortness of breath. Shortness of breath is the feeling that a breath is barely finished before another is needed. It has been described as "air hunger" by some people.
· Mucus production. Many people with asthma produce excessive, thick mucus that obstructs the airways, which can lead to coughing.

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For many people, asthma symptoms are worse at night and in the early morning or after exercise. Furthermore, an asthma episode often gives early warning signs, thus giving the person time to act.

Q. What makes my breathing passages so sensitive to triggers?

A. The underlying cause of the sensitivity in the airways is inflammation. Inflamed airways are highly reactive to triggers. In other words, they are easily irritated and respond by contracting, swelling, and filling with thick mucus. Some of the breathing passages don't have much supporting cartilage in their walls the way the windpipe does. As a result, they are not very "stiff" and are easily squeezed closed. Think of them as tiny tubes with thin muscle fibers wrapped around them like "rubber bands." If the "rubber bands" (airway muscle) tighten, the thin-walled passages are more easily choked off, making you short of breath.
Are Asthma Episodes Dangerous?

Most of the time asthma episodes are mild, and the airways will open up in a few minutes to a few hours in response to medication. But some attacks can be severe, lasting for a long time and not responding to the regular medication. And they can be very dangerous. A very severe, prolonged attack can threaten a person's life. Such an episode requires immediate emergency attention in a hospital.

Learning to recognize signals and take action to prevent asthma symptoms from becoming worse is an important step in the long-term control of asthma. So is managing an episode if it does occur.
Learning all about asthma will ultimately help a person have fewer and milder episodes and reduce the risk of a more serious attack.

This includes understanding about:
· The way your lungs work
· The things that cause asthma episodes
· The ways you can avoid those things
· The medicines that help prevent and control symptoms

What Does "Good Asthma Control" Mean?
The long-term goal in asthma management is "good asthma control." In fact, because of a better understanding of the disease and the development of newer drugs, drug treatments are so effective that many adults with asthma can go for long periods of time without symptoms.

Good asthma control includes the following goals:
· There is no wheezing, coughing, or shortness of breath.
· Nighttime sleep is not interrupted by asthma symptoms.
· Exercise and daily activities can be carried out normally.
· Reliever medication is used less than three times per week.

Facts About Asthma
· The process of moving air into and out of the lungs is something most people take for granted. But for as many as 15 million Americans living with asthma, this simple activity requires significant effort.
· Asthma cannot be cured, but with proper treatment it can be effectively controlled. Good asthma control allows most adults to live full, active, trouble-free lives.
· Without satisfactory control of asthma, long-term damage can occur in the respiratory system. Poorly controlled asthma can lead to reduced physical activities, missed work, and extra visits to the emergency department.
· For most adults with asthma, a reduced quality of life doesn't have to happen. Arming yourself with information is an important step in maintaining a healthy life.

What Causes Asthma?
We don't know what causes asthma. But we do know that:
· Asthma and allergies are likely to run in families and may be inherited.
· Children who have allergies at a young age may be at greater risk for developing asthma as adults.
· Some adults with asthma also had asthma as teenagers and as children. In some individuals, the condition may become less severe over time, but in others, the reappearance of symptoms in adulthood occurs. A respiratory infection sometimes sets it off, but often there is no apparent reason for the reoccurrence or increase in symptoms.

Certain conditions seem to make asthma worse. And for some it seems to be worse on certain days and at different times of the year. Asthma symptoms occur when sensitive lungs overreact to certain factors called triggers. These irritating factors are part of the environment in which we live and are different for different people.
· Allergies are a common asthma trigger.
· Other asthma triggers range from dust to air pollution, from exercise to weather changes.

Because everyone with asthma responds to different triggers, an important step in gaining control of asthma is to identify the factors that trigger asthma episodes in your lungs. Once you have discovered your own personal triggers, you will be able to work better with your doctor to prevent and control asthma attacks.

Asthma Caused By Allergies

In some people, an asthma episode is brought on by an allergy to something in the environment. Allergies occur when the body reacts to common harmless substances that normally don't trigger a response in another person. These substances are called allergens.
In the person with allergic asthma, a flare-up of the airways can occur when the allergen is introduced to the body. At first, reactions may be very minor, barely noticeable. But repeated exposure gradually increases sensitivity.
In an allergic reaction, certain body cells release various chemicals. In an asthma attack brought on by an allergen, these chemicals irritate the already inflamed air passages and cause the reactions that make the airways narrow and breathing difficult.

Common things that can trigger allergic asthma include tiny particles in the air derived from:

House Dust Mites

House dust mites are extremely small organisms that live in dust and feed on skin cells that have been shed by people. Products of dust mites are a common cause of allergies. They look like very tiny insects but are actually distant cousins of spiders. House dust mites thrive in warm, damp climates and are commonly found in mattresses, pillows, bedding, carpets, and upholstered furniture.
Ways to reduce exposure to dust mites:
Dust mites cannot be entirely avoided. But you should aim to lessen your exposure to them, particularly in the bedroom:
· Put plastic zippered covers on mattresses and pillows.
· In the bedroom, move out anything that collects dust (including the carpet if possible) and avoid upholstered furniture and clutter.
· Wash all bedding each week in hot water (at least 130º F).
· Linoleum, tile, and hardwood floors are best for minimizing both dust and dust mites.
· If possible, try to have someone who does not have allergic asthma do the vacuuming when you are not in the bedroom.
· Vacuuming will not get rid of mites, and in fact spreads them up into the air for several minutes before they settle again. Try to use a vacuum cleaner with a HEPA air filter (which stands for "high efficiency particle arresting") or a double-layer collecting bag.
· Keep the humidity in the room low, around 35% if possible (never over 50%), because high humidity encourages dust mite growth.
· Curtains should be laundered often; it is better to avoid heavy curtains and use window coverings such as easy-to-clean blinds.


The dried-up body parts of dead cockroaches are a very potent stimulator of asthma in those allergic to them. Regular cockroach control is essential to good control of asthma for people allergic and exposed to them. This can be a particular problem in big cities.


Mold is the greenish, gray, or black material that grows in damp places. Molds or fungi release microscopic particles called spores for their reproduction. These spores can float through open windows into the house, especially on cool nights in the spring and fall. Asthma attacks may also be triggered by the type of mold that grows in the house.
Ways to reduce exposure to molds include:
· The use of air conditioners and dehumidifiers to reduce humidity. (They must be cleaned often to prevent mold growth.)
· Regular ventilation of the kitchen, bathroom, basement, and other damp areas of the house. (Exhaust fans in the kitchen and bathrooms work well.)
· Cleaning out mold from damp places in the house such as shower stalls, and clearing out moldy objects from closets. Use a spray cleaner with a fungicide in it.
· Keeping bedroom windows closed to keep out mold spores and pollen.
· Keeping drainage from rain water away from the house, in order to decrease humidity in the basement.


Pollen are microscopic particles released by plants for their reproduction. Pollen is more a cause of hay fever than asthma. But there are some people with allergic asthma who clearly have problems with ragweed and other typical plant pollens that can cause a flare-up in their asthma.
Make note of whether your episodes of asthma are worse when the pollen count is high.
To prevent allergic reactions due to pollens:
· Pay attention to the pollen count in your area. Whenever necessary, keep the windows shut.
· Air conditioning can be very helpful in minimizing pollen entry into the house and in keeping the humidity down. But check with your doctor before purchasing expensive equipment.
· On days of high mold and pollen counts, if you have been outside for a prolonged period, take a shower and wash your hair before bedtime (to get the pollen and mold out). Also, leave your outdoor clothes out of the bedroom.
· Change pillowcases every two to three days.

Animal Hair and Dander

Many people are allergic to a substance in the saliva and on the skin of furry animals. This substance, called dander, is a powerful allergen. It gets on a dog's or cat's coat and is spread into the air and onto surfaces.
Dander can float through the air for hours. Cat allergen particles, for example, are only about one-tenth the size of dust mite allergen particles and can escape the filtration system on most vacuums. Cat dander can still be found in the dust of a house even months after a pet has left.
Hamsters, gerbils, mice, and rats can produce the same problem. In some individuals, fine particles on feathers may also set off an allergic reaction. Animal allergens are a potent stimulator of asthma. It is very likely that frequent asthma symptoms in someone living with a furry pet are caused by the pet.

To prevent allergic reactions due to exposure to animals:
· The best way to deal with pet allergy is to find the pet another home.
· If this is out of the question, the pet should be kept outdoors as much as possible and never allowed into the bedroom.
· Frequent washing (twice weekly at least) of the pet may also reduce the presence of animal dander in the home. Dog washing does not present any major problems when animal shampoo and lukewarm water are used. Cats present a greater challenge but can be slowly accustomed to the ritual by associating a positive experience such as feeding with the bath. Shampoo is not needed nor is it necessary to immerse the cat in water. A gentle wiping with a damp cloth will help remove some of the cat dander.
· Deciding what to do about a pet is not easy, but if its presence really worsens the asthma condition, making the hard decision is the right thing to do.

Do some foods cause asthma?
Foods are rarely implicated as a cause of regular asthma. Asthma in some people can be triggered by an allergy to certain foods, but the asthmatic symptoms are usually part of a serious reaction called anaphylaxis.
Other Asthma Triggers
A host of other things can bring on an asthma attack in susceptible people. These include:

Respiratory Infections
Asthma can be made worse by common colds, sinusitis, and influenza (the flu). Viral infections are known triggers of asthma attacks. Antibiotics don't work against viral infections, but medication to open up the air passages can help.

To prevent asthma episodes triggered by respiratory infections:
· Ask your doctor for flu and pneumonia shots for yourself and your family.
· Stay healthy with daily exercise, nourishing foods, and enough sleep.
· Avoid contact with people who have upper respiratory infections.
· Wash your hands frequently.
If you notice one of the following changes, suspect a respiratory infection:
· Fever or chills, sore throat, muscle aches, runny nose, cough
If you have a respiratory infection and experience signs that indicate you are losing control of your asthma, call your doctor as soon as possible. These signs include:
· Shortness of breath or wheezing
· Cough that is getting worse
· Production of a large amount of mucus, or mucus that is thicker than usual or is changed in color
· Awakening at night with asthma
· Increased need for your rescue inhaler
Follow your doctor's instructions and your asthma should quickly be brought under control again:
· Take whatever medicine your doctor prescribes, exactly as directed.
· Don't stop taking the medicine unless your doctor tells you to, even if you feel better.
· Follow directions for clearing your lungs of mucus.
· Keep your doctor informed of any change in your condition.

Common products in the home can trigger an asthma episode. For example, inhaled fumes from a variety of common household products can irritate the sensitive airways of people with asthma and trigger episodes.
These products include:
· Cleaning solvents
· Paints, thinners, stains, varnish, and shellac
· Liquid chlorine bleach
· Sprays such as furniture polish and oven cleaners
· Personal products with strong smells such as hair sprays, perfumes, spray deodorants, and cosmetics
To prevent asthma episodes triggered by irritants:
· Keep strong-smelling chemicals out of the house, or try to stay out of areas where household cleaners and other substances with strong odors are being used.
· Rooms where hobbies are performed that produce strong smells should be aired thoroughly and often.
Industrial Fumes And Dusts At Work

Reactions to industrial irritants may occur suddenly or take years to develop. Substances known to trigger asthma episodes in susceptible people do so through either an immune response or through irritation of air passages.
Industrial substances causing an immune response include:
· Wood products (western red cedar)
· Dusts (flour, cereal)
· Metals (platinum, chromium, soldering fumes)
· Mold (decaying hay)
Industrial substances causing an asthma response because of irritation include:
· Dusts (cotton)
· Gases (sulfur dioxide, chlorine gas)
Because of the nature of many industrial jobs that bring workers into contact with these known asthma triggers, avoidance is usually not possible. The best protection is the use of approved personal protection and safety equipment associated with your job:

· Protective eyewear (glasses, goggles, hoods)
· Masks and respirators with approved filtration devices
· Proper ventilation and filtration of air in the work area
Air Pollution
There are certainly some "bad days" when it comes to air quality in some of the larger cities. Fine particles, gases, vapors, and smoke are added to the air near industrial areas. These substances can serve as powerful irritants of the sensitive and inflamed airways of some people with asthma. Inhaled pollutants that can act as asthma triggers include:

· Oxides of nitrogen
· Ozone
· Fine particles
· Sulfur dioxide
Cigarette smoke is a common indoor pollutant that can aggravate inflamed air passages.
To prevent asthma episodes triggered by substances in the air:
· Avoid breathing secondhand smoke from cigarettes, pipes, and cigars.
· Make sure no one smokes in your house or car.
· Always look for non-smoking sections in public areas.
· Insist on your right to clean air. No one has a right to create a health hazard for you.
· If possible, avoid places with dirty, congested air such as smoke-filled rooms, parking garages, dusty work areas, and traffic jams.
· Avoid smoke from barbecues and outdoor fires.
· Check the ventilation in your home. Modern, airtight homes often trap indoor pollution.
· Make sure that all fuel-burning appliances such as wood stoves and gas fireplaces are properly adjusted and vented.
· During days of heavy air pollution, check the news for air quality and pollution alerts.
· On really bad days, stay indoors and use the air conditioning if you have it.
· Avoid strenuous outdoor activities on days of poor air quality if air pollution is identified as one of your asthma triggers.

Exercise can bring on an asthma episode in some people. Symptoms of asthma may begin after several minutes of exercise or after the exercise is over. They may last for a few minutes to an hour and usually get better by just stopping the exercise, but can continue even with resting.
These symptoms may limit play and interfere with performance. The severity of the asthma episode will depend on how intense and for how long the person has exercised. The symptoms are not caused by the physical effort itself, but by the loss of heat and moisture from the air passages that occurs when dry, cold air is inhaled rapidly.

Q: Can I still play the same sports I used to?
Most A. adults with asthma under good control can play sports if a good treatment plan has been worked out. Swimming is particularly encouraged by many physicians, but stick with the sports you most enjoy. Exercise and sport is most definitely encouraged for people with asthma.
Remember that one of the goals of asthma control is to allow normal activities to be enjoyed. Exercise is important for both general health and for the health of the lungs. Therefore, if the exercise you enjoy seems to be acting as an asthma trigger for you, ask your doctor about taking medicine before exercise so that the episode can be prevented.

To prevent asthma episodes triggered by exercise:
· Work out a plan with your doctor. This may mean taking medication 10 to 15 minutes before exercising to prevent symptoms while exercising or playing sports.
· Appropriate warm-up is important in reducing symptoms and can be very important for competitive athletes.
· Drink lots of fluids and adjust your activities accordingly on hot, humid days.
· If asthma symptoms occur during sports, take a short rest and then continue if possible. Medication may need to be taken when symptoms occur.


Asthma symptoms that occur at night are part of nighttime asthma, or nocturnal asthma, a very common condition for many people with asthma. Sleep is not the actual trigger, but while we sleep the airways tend to narrow and mucus tends to build up in the airways, often triggering a bout of coughing. There are many causes of nocturnal asthma, including:
· At night there are changes in body chemicals, which allow airway inflammation to increase.
· The drop in body temperature at night causes airway cooling and narrowing.
· Allergens encountered in the daytime may produce a delayed response three to eight hours later, just in time for nighttime sleep.
· Increased drainage from the sinuses while lying down may trigger a reaction in sensitive airways.
· Lying horizontally may allow some of the stomach contents to rise up into the esophagus. This is called reflux and may trigger an asthma episode in sensitive individuals.
To help prevent nighttime asthma symptoms:
· Check with your doctor if you have symptoms of nighttime asthma. Nocturnal asthma often responds to asthma medicines taken before bedtime.
· If reflux of stomach contents is the cause of your nighttime asthma symptoms, they may be minimized by antacids taken before bedtime, raising the head of the bed, or avoiding meals and alcohol just before bedtime.

The onset of asthma may be seasonal. Weather affects different people in different ways. For example:
· Heat, humidity, air pollution, and pollen counts in the summer can trigger an asthma episode in some people.
· In others, the wet conditions of the spring and fall may encourage the growth of certain molds that can trigger an attack.
· For others, the buildup of smoke, animal dander, and mites in a sealed house in the winter can aggravate asthma. Or, the cold temperature outside may serve as a trigger during physical activity.
To prevent asthma episodes triggered by weather:
· When the air quality is poor, try to limit outdoor activity.
· Try to eliminate sources of dampness in the home that may encourage mold growth.
· Replace furnace and air conditioner filters.
· Clean humidifiers and dehumidifiers to limit mold growth.
· Breathe through the nose when outside in cold weather. Cover the nose and mouth with a scarf on extremely cold days.
· Moving to a different climate with different weather won't cure asthma. Different triggers are found in different places, but asthma is quite common in all parts of the country. Remember that it is the sensitivity of the airways that is responsible for asthma episodes. The environmental trigger is simply the irritant that starts the process.

Emotions do not cause asthma, but sometimes laughing, crying, and yelling stimulates nerves that cause the tiny muscles in the walls of airways to tighten in sensitive lungs.
People with asthma can become angry or frustrated with their condition and may refuse to take the medicines that will help them. Thus, in an indirect way, emotions such as anger may contribute to asthma symptoms.

To help minimize asthma symptoms due to emotions:
· Ask your doctor about taking extra medication if you are under severe stress. Do not change your dose on your own.
· When you start to feel excited, try to concentrate and relax your breathing.
· Always follow your doctor's instructions so that you can gain control of your asthma. With control of the situation, frustration and fear will be reduced.
Hormonal Changes
In some women, asthma symptoms increase at a particular time of their menstrual cycle, usually just before their periods. Asthma symptoms may become better or worse during pregnancy, because they may be influenced by hormonal changes.

Health Problems
Asthma symptoms can be triggered by a variety of health-related factors such as:
· Respiratory infections such as the common cold and flu
· Sinusitis (inflammation of the linings of the sinus cavities). Excess mucus production from the nose and sinuses ("postnasal drip") may drain into the throat and airways. This drainage combined with the release of body chemicals from inflamed sinus linings may act as trigger to irritate the linings of the airways, especially at night.

· Allergies (pollen, mold, dander)
· Gastro esophageal reflux disease (GERD) is a disorder in which the acid contents of the stomach enter the lower part of esophagus. In sensitive individuals, this may cause the asthma to worsen. Heartburn and nighttime asthma symptoms may indicate GERD disease. Inform your doctor of your nighttime difficulty with breathing and your heartburn symptoms. The doctor will prescribe medication that will reduce the symptoms of GERD and provide you with greater asthma control.

Medications Used To Treat Asthma
There are two completely different types of asthma medications, and they are used for completely different purposes:
· Medications to prevent asthma symptoms from developing
· Medications to relieve asthma symptoms once they've started
Asthma medications come in many forms - liquids, tablets, injections, powders, vapors and herbs too - so that it can always be taken in the most appropriate way.

Asthma medicines are tailored to a persons individual needs. Some adults with asthma only need an occasional dose of medication, while others need asthma medication on a regular basis.

Medications To Prevent Asthma Attacks
Knowing how airway inflammation prompts asthma symptoms, researchers have developed powerful "preventer medicines" for asthma that halt inflammation in a number of ways, including:

Stopping the production of chemicals in the body that cause inflammation
Blocking the release of these harmful chemicals from the cells that make them
Competing with these harmful chemicals so as to prevent them narrowing of the airway

Anti-Inflammatory Medicines

These medications prevent asthma attacks by:
. Reducing the swelling of the lining of the airway
. Reducing the narrowing of airways due to tightening by the surrounding muscle
. Reducing mucus formation in the airways

Anti-inflammatory medications are taken on a regular basis every day to prevent symptoms, even when you feel well.

. They are slow-acting (They take hours or weeks before they become effective).
. They do not provide immediate relief of symptoms

Regular use should decrease the need for your reliever medication.
Contact your doctor if you still have symptoms after two weeks

The main anti-inflammatory preventer drugs are inhaled corticosteroids. Examples of inhaled corticosteroids are:

1- AeroBid; Bronalide (flunisolide)
2 -Advair (fluticasone + salmeterol)
3 -Azmacort (triamcinolone) (has a built-in spacer device)
4 -Beclovent; Vanceril (beclomethasone)
5 -Flovent (fluticasone)
6 -Pulmicort (budesonide)

Corticosteroids are the most effective anti-inflammatory drugs for the prevention of asthma symptoms.

The corticosteroids used in asthma treatment are not the same as the anabolic steroids used by some athletes to build muscle mass and "bulk up."

Using a spacer with inhaled steroids reduces the risk for mouth and throat irritation. Gargling and rinsing the mouth with water after using the inhaler also is recommended.

At the usual doses inhaled steroids are well absorbed in the lung and produce few side effects. At higher doses, side effects may include:

. Hoarseness
. Cough
. Thrush (yeast infection in the mouth)

Other Preventer Medications

Sometimes the long-term control and prevention of asthma symptoms requires the use of other medicines in addition to, or in place of, inhaled corticosteroids. Your doctor will tell you exactly what to do if a dose adjustment in your inhaled steroid is required or if other asthma medicines are to be added.

Other preventer drugs that can help control asthma symptoms include:

Long-Acting Beta2-Bronchodilators
These medications include Foradil (formoterol) and Serevent (salmeterol). These are inhaled medications that are used in addition to inhaled anti-inflammatory steroids. They should not be used alone.

The amount of other preventer medicines you take may be adjusted by your doctor after you start taking long-acting bronchodilators. Do not change dosages of any asthma medicines on your own.

Long-acting beta2-bronchodilators are much more potent than short-acting beta2-bronchodilators such as albuterol. Do not take more than your doctor ordered.

These very potent and long-acting drugs relieve airway constriction for a long period of time (about 12 hours) but are not indicated for the relief of symptoms during an acute asthma attack.

If your action plan instructs you to take a short-acting reliever drug such as albuterol during an asthma attack, continue using your long-acting medication as directed.

Theophylline Bronchodilators
These include Theo-Dur, Theolair (theophylline). They are oral bronchodilator drugs (tablet or syrup) that work in a different way than the beta2-bronchodilators to relieve muscle spasm of the airways.

Long acting and useful for nighttime asthma symptoms.

Effectiveness in controlling asthma symptoms is related to the amount of drug in
Regular blood tests to determine the blood level of theophylline are required.
The blood level of theophylline can be increased by many different drugs such as erythromycin (an antibiotic) and conditions such as cirrhosis of the liver. The blood level of theophylline can be decreased by other drugs such as benzodiazepine (a tranquilizer) and factors such as cigarette smoking.

At higher doses, side effects may include nausea and vomiting, headache and dizziness, nervousness and irritability, and insomnia.
When theophylline is used properly and monitored under a doctor's care, it is a safe and useful drug in the management of asthma symptoms.

1 - Oral Corticosteroids

These include:

. Delta-Cortef (prednisolone)
. Deltasone (prednisone)
. Medrol; Solu-Medrol (methylprednisolone)

These steroids are related to cortisone produced in our bodies. They are sometimes required to control more severe episodes of asthma.

If used for more than a few weeks, the dose must be gradually reduced if the drugs need to be withdrawn

Long-term use of oral steroids can produce significant side effects such as high blood sugar, weight gain, fluid retention, high blood pressure, muscle weakness, and slow wound healing.

Your doctor may try to minimize these side effects by prescribing a very low dose of oral steroids, having you take the medicine every other day, or some combination of instructions.

2 - Nonsteroidal Antiallergics

These include Intal (cromolyn) and Tilade (nedocromil). Cromolyn and nedocromil are not related to the corticosteroids.
These drugs work by blocking the release of inflammatory chemicals from certain cells in the body.

They are useful in protecting the airways from exposure to allergens or to the irritating effect of exercise or cold air.

They may reduce the need for inhaled corticosteroids and bronchodilators.
The nonsteroidal antiallergics must be taken continually for maximum protection.

3 - Leukotriene Modifiers

These include:

. Accolate (zafirlukast)
. Singulair (montelukast)
. Zyflo (zileuton)

Leukotriene modifiers (or antileukotrienes) are the first new class of prescription asthma medication to be introduced in 20 years. The drugs control leukotrienes, which are inflammatory chemicals released by cells in the lung during an attack.
Leukotrienes cause lung tissue to become inflamed, mucus to be secreted, and smooth muscle around the airways to contract. These changes lead to asthma symptoms such as wheezing and shortness of breath.

Zafirlukast and montelukast control asthma symptoms by blocking the action of leukotrienes on the airways. Zileuton blocks the actual production of leukotrienes.

When used in combination with inhaled corticosteroids, the leukotriene modifiers may be helpful in preventing more attacks.
All of the leukotriene modifier drugs are oral medications, making them easier to take than most other asthma medicines that are taken into the lungs by inhaler.
Side effects may include headache and nausea.
Q: Can I cure or treat my asthma with a special diet?

A: There is no cure for asthma. And there is no diet treatment that can serve as an alternative to taking asthma medications and following the asthma control plan worked out with your doctor. A wholesome, nourishing diet helps promote general health, which is essential in the overall control of asthma.

Medications To Relieve An Asthma Attack

Asthma medications that relieve the muscle spasms responsible for narrowing of the airways are called reliever medicines. The medications that best accomplish this are the bronchodilators. ("Bronchodilate" means to open up the airway, and that's exactly what these medications do.)

Points to keep in mind concerning the bronchodilator drugs include:

They relax the airway spasms to provide immediate relief.
Bronchodilators are used before exercise or before exposure to triggers such as cold air.

They are to be kept with you at all times.
You should contact your doctor if you are not getting immediate relief from your symptoms.

Bronchodilators should not be used every day unless prescribed by your doctor.
A number of different inhaled drugs are available that relieve asthma symptoms.

They include:

. Short-Acting Beta2-Bronchodilators
. Anticholinergic Bronchodilators

Bronchodilators are commonly used medications that immediately relax the muscle of airways that are in spasm during an asthma episode and generally provide prompt relief. Side effects can include:

. Tremors
. Fast or pounding heartbeat
. Nervousness
. Dizziness

When taken as directed by your doctor, these reliever medications do not cause long-term side effects.

4 - Short-Acting Beta2-Bronchodilators

This group of inhaled short-acting reliever drugs includes:

. Brethaire; Bricanyl (terbutaline)
. Maxair (pirbuterol)
. Tornalate (bitolterol)
. Ventolin; Proventil (albuterol in the U.S.; salbutamol in the U.K. and Canada)

If you need to use these medications too frequently, or they don't appear to be as effective as they used to be, this can be a signal that your asthma is not being controlled effectively and may be an early warning signal of an asthma episode. These drugs are not recommended for long-term daily treatment of asthma. Always carry a short-acting beta2-bronchodilator for fast relief during an asthma episode.

5 - Anticholinergic Bronchodilators

One example of an anticholinergic bronchodilator is Atrovent (ipratropium).
It relaxes airway muscle by blocking the nerves that cause constriction of the airways.

It is sometimes used in combination with a short-acting beta2-bronchodilator.
It should be used with caution if you have glaucoma. Accidental spraying of the mist in the eyes can worsen the eye problem.
It is not fast-acting enough to be used as "front-line" reliever medicines during an asthma attack.

Common side effects include dry mouth, dry throat, dry nose, and headache.

Your Asthma Medication Checklist

Currently there are eight classes of drugs available to treat asthma:

Trade names and Generic names

Preventer drugs and drugs to control persistent asthma symptoms

1. Inhaled corticosteroids - These medications block the production or release of inflammatory chemicals in the body. Few side effects are produced by the inhaled drugs because of their local action in the lung.

- AeroBid; Bronalide flunisolide
- Advair fluticasone + salmeterol
- Azmacort triamcinolone
- Beclovent; Vanceril beclomethasone
- Flovent fluticasone
- Pulmicort budesonide

2. Long-acting beta2-bronchodilators - These cause relaxation of the muscle fibers surrounding the airways, thus opening up the narrowed passageways. These drugs are slowly cleared from the body; therefore, their bronchodilating effects last for a long time (about 12 hours).
- Serevent salmeterol
- Foradil formoterol

3. Theophylline bronchodilators - These cause relaxation of constricted airways by blocking the action of chemicals that cause contraction of muscles surrounding the airways. Oral, slow-release theophylline drugs are commonly used in asthma maintenance therapy. (A fast-acting intravenous form of theophylline is also available for emergency room treatment of severe asthma episodes.)
- Theo-Dur; Theolaire theophylline

4. Oral corticosteroids - These medications block the production or release of inflammatory chemicals in the body. Oral administration of corticosteroids for a prolonged time can produce several undesirable side effects.
- Delta-Cortef prednisolone
- Deltasone prednisone
- Medrol; Solu-Medrol methylprednisone

5. Nonsteroidal antiallergics - These medications block the release or action of inflammatory chemicals in the body, thus reducing the symptoms of inflammation, including relief of airway constriction.
- Intal cromolyn
- Tilade nedocromil

6. Leukotriene modifiers - These block the production or action of inflammatory chemicals called leukotrienes, thus reducing inflammation, relaxing the airways, and reducing mucus production.
Accolate zafirlukast
Singulair montelukast
Zyflo zileuton

Rescue medication for use during an asthma attack.

7. Short-acting beta2-bronchodilators - These medications cause the muscle fibers surrounding the airways to relax, thus opening up the narrowed passageways. These drugs are rapidly cleared from the body, therefore, their effects last for a relatively short time (about 3 to 4 hours).

Brethaire; Bricanyl terbutaline
Maxair pirbuterol
Tornalate bitolterol
Ventolin; Proventil albuterol

8. Anticholinergic bronchodilators - These medications block the nerve responses that normally cause narrowing of airways. They are commonly used in combination with a beta2-bronchodilator such as albuterol
Atrovent ipratropium

Using Inhalers
Many of the drugs given to prevent and treat asthma are inhaled. Inhaled medications do not have to be processed in any way by digestive organs in order to start working. Instead, they travel directly to the lungs, produce their effects quickly, and cause relatively few side effects.

Several different inhaler devices are available to suit the needs of different people with different kinds of asthma. All of them have their own advantages and disadvantages. Your doctor will decide which ones are best for you.

Our Herbal medication for asthma

1 - Verbascum thapsus (Bullock's Lungwort)

2 - Coltsfoot (Tussilago farfara)

3 - Thyme (Thymus vulgaris)

4 - Oroxylum seeds (Indian trumpetflower)

5 – Lobelia inflata (Indian Tobacco)

200 gram packages of drayed herbs ready to use as herbal tea to alleviate asthma symptoms and keep it in the bay.
Our herbs are gentle in action, safe to use for all ages, easy to use all the times.

The Asthma Action Plan
An asthma action plan is a written plan developed by your doctor to help in the management of asthma episodes. It is a customized plan that tells you what to do based on changes in your symptoms and peak flow numbers. It is also called a crisis intervention plan, asthma self-management instructions, or written guidelines for asthma.

Asthma action plans can be organized in any number of ways, but the important thing is that your individualized action plan gives you and your family information that can be invaluable in an asthma emergency. Action plans may include:

· A list of the triggers responsible for your asthma and how to avoid them.
· A list of peak flow meter readings and zones based on your personal best.
· A list of routine symptoms such as coughing, wheezing, tightness in the chest, shortness of breath, and excess mucus production, and what you should do if these symptoms occur.

· What you should do if nighttime asthma symptoms awaken you.
· A list of more serious asthma symptoms such as decreased effectiveness of your reliever medicine and breathlessness, and what you should do if these symptoms occur.
· The name and dose of the preventer medication that needs to be taken, even when there are no symptoms, and the name and dose of the reliever medication that needs to be taken when you are having an asthma attack.
· Emergency telephone numbers and locations of emergency care.
· Instructions about when to contact your doctor, whom to call if your doctor is unavailable, and a list of where to get emergency treatment.
· Information about asthma organizations and support groups.
Keep your action plan handy and keep it current. Action plans should be reviewed with your doctor at least once a year. Changes in the plan may be needed because of changes in your peak flow numbers or the medications you are taking.
Warning Signs Of An Asthma Attack

Asthma is an unwelcome intruder in a person's life. It is a chronic lung disease and it can't be cured. But there are several unique features of the disease that are not found with most other respiratory diseases.

· Asthma is reversible. With good treatment, the damage to the lung can be reversed or minimized.
· It can be controlled by avoiding asthma triggers and taking the right medicines.
· Asthma attacks usually can be predicted. Asthma episodes normally do not occur suddenly, without warning (although it may seem that way at times). They develop over a period of time, providing a chance to start countermeasures to ward off an attack.

What Conditions May Bring On An Asthma Attack

Changes in the external environment may signal an increase in the irritating effect of certain triggers for some people with asthma:
· Decrease in the environmental air quality (increasing pollution index)
· Increase in the pollen count
· Windy, dusty conditions
· High humidity and high temperature
· Low humidity and low temperature

The best course of action on such days is to avoid them if at all possible by staying indoors where the environment can be better controlled.

If Symptoms Get Worse

Early warning signs of an asthma episode may include symptoms such as:
· Runny, stuffy nose
· Sneezing
· Chin or throat itchiness
· Headache
· Feeling or looking tired
· Reliever drug being used more often than usual
· Difficulty sleeping because of symptoms such as coughing
· Physical activity brings shortness of breath

What to do: Follow your action plan and take your medications as per the plan.

Signs that your asthma is becoming severe:

· Awakening at night, unable to sleep
· Reliever drug is bringing little relief
· Breathlessness is getting worse

What to do: Contact your doctor immediately.

Signs that you asthma has become dangerous:
· Reliever drug brings no relief
· Peak flow stays in the red zone after using rescue medication
· Difficulty speaking
· Walking is difficult
· Feeling of fright
· Faint-headed

What to do: Go to the closest hospital emergency department immediately.

What To Expect At The Emergency Department

· Fast-acting beta2-bronchodilators that open the airways will probably first be given to you with a small-volume nebulizer. Nebulizers produce a fine mist of medication that can be inhaled through a facemask or mouthpiece and require no "coordination" between breathing in and the delivery of drug to the lungs.
· You will also probably receive additional asthma medications, possibly through an intravenous (IV) line that delivers drug directly to the bloodstream.
· Steroid medication may be necessary to quickly reduce the inflammation in the air passages.
· Oxygen will probably be delivered through a facemask or through small tubes that fit under your nose.
· In more serious cases of asthma, intubation may be required. In this procedure a breathing tube is placed into the throat so that oxygen can be delivered directly to the lungs.

What Should I Do During An Asthma Attack?

Ideally, your early warning signs such as a feeling of tightness in your chest, wheezing, coughing, and restlessness while trying to sleep will have given you the extra time you need to take the steps outlined in your personal action plan.

If the episode is just beginning:
1. Follow the instructions in your action plan. Take the medicines your doctor has prescribed to keep the episode from getting worse.
2. Pay close attention to the type of medication being taken. Because of the feeling of urgency and distress during an asthma attack, people sometimes mistakenly use their preventer medicine. This will not help the symptoms of an asthma attack. The reliever drug at the dose prescribed is what is needed. Make note of the color of the two different kinds of inhalers and make sure you use the one containing the reliever medicine.
3. Relax your breathing.
4. Use pursed-lip breathing.
5. Cough to loosen mucus in the airways and cough again to bring it up. Spit out the mucus into tissues.
6. Call your doctor if the attack is getting worse and you have taken the proper medicine and done everything else you can think of. This is not a time to feel embarrassed or ashamed. If you have followed the action plan and you are still having an asthma episode, it's time to seek medical attention. Don't wait too long to get a doctor's help when needed.
Need To Know:
Your preventer medication will not be of help in a severe asthma attack. Be sure you are using the reliever medication, not the preventer medication.

Relaxing in order to breathe more easily is not easy in a situation where fear, anxiety, and anger are natural feelings. But it can be done with practice:

· Start by sitting comfortably in a chair. Do not lie down.
· Relax your shoulders and neck. Concentrate on not gasping for air as you drop your shoulders.
· Breathe in slowly through your nose. Concentrate.
· Purse your lips together tightly the way a trumpet player does, and blow out slowly through your mouth. Take as much time as possible to exhale in this way.
· Relax. Keep using the pursed-lip breathing until the breathless feeling goes away. Rest between breaths if you feel dizzy.

Pregnancy And Asthma

If you are pregnant and have asthma, you should try to learn all you can about the drugs you are taking to control your asthma. Good asthma control is essential to provide the oxygen your body and the fetus needs. Your doctor will work out the asthma plan best suited to your needs while you are pregnant.

You must also communicate with everyone involved. Make sure your obstetrician knows that you have asthma and what you are doing about it. Also, you must keep the doctor who looks after your asthma informed about your pregnancy and the medications you may be taking. Your doctors will usually be well informed and experienced in treating asthma in pregnant women.

· As a general rule, your doctor will try to determine the lowest amount of medication required to control your asthma. It is important to keep your asthma well controlled during pregnancy so that you and your baby will be in the best possible condition for the birth.
· The drugs used for control and relief of asthma symptoms are not tested on pregnant women because of ethical reasons. (In fact, proof of safety during pregnancy is not established for most drugs.) However, limited studies of asthma medications in pregnant animals, and the routine use of such drugs in pregnant women with asthma, suggest the drugs are safe. There is little to suggest an increased risk to the fetus. Therefore, there is wide acceptance by experts that the usual asthma drugs should be used to control asthma symptoms in pregnant women. Maintaining adequate oxygen supply to the fetus is essential. Because some drugs have not been tested in pregnant women does not mean that they are harmful. It means that a medical decision must be made regarding their use during pregnancy, and that the dosage and effects be closely monitored by your doctors.
· Always ask your doctor about the use of over-the-counter (OTC) medicines during pregnancy and never change the dosage of your asthma medicines without directions from your doctor. Follow your action plan.
Nice To Know:
Interestingly, the fetus protects itself against low oxygen levels by producing a special type of hemoglobin in its red blood cells. (Hemoglobin molecules carry oxygen in the bloodstream.) This special hemoglobin makes the baby's red blood cells very efficient in receiving oxygen from the mother. In fact, even in women who have moderate to severe chronic asthma, the fetus usually receives enough oxygen for its needs.

Frequently Asked Questions

Here are some frequently asked questions related to asthma in adults.
Q: What breathing exercises can help me during an asthma attack?

A: Pursed-lip breathing involves closing the lips tightly and blowing air out past them the way you would when blowing out a candle. This action helps keep the airways open during exhalation by keeping the pressure in them a little higher. Pursed-lip breathing acts like a "splint" to keep the airways open a little longer and allow stale air to be blown out of the lungs. Remember that fresh air can't be drawn into the lungs if stale air is still there. Practicing relaxed breathing and the pursed-lip technique will give you the confidence to handle almost any emergency situation. Of course, the best time to practice such exercises is when you are not having an attack. That way, you can strengthen the respiratory muscles without the panic of being short of breath. Strong respiratory muscles will help you if another attack should come.

Q: What are the biggest "mistakes" that people with asthma make?

A: During the panic and agitation of an asthma attack it is easy to make mistakes:
· Taking tranquilizers or sedatives. Drugs such as Valium should never be taken to control the anxiety associated with shortness of breath during an attack. These drugs depress breathing.
· Taking the wrong medicine during an attack. Remember, it is only the short-acting beta2-bronchodilators that produce immediate relaxation of your airways. Know which of your asthma medicines are your reliever medications, carry them with you, and know the dose your doctor wants you to take during an attack. On their own, the preventer inhalers and oral drugs will not help an attack. Always follow your personalized asthma action plan. Seek emergency treatment when you are instructed to do so by your personalized plan.
· Overmedication. Taking more than the prescribed dose of a reliever medication will not help relieve the attack. The side effects will only be made worse. Follow the emergency plan worked out with your doctor. If he or she has instructed you to take additional beta2-bronchodilators during an attack, follow those instructions but do not exceed the dosage.
· Undermedication. Some people with asthma make the mistake of waiting too long to follow their action plan. Know and be sure of the correct dose of your asthma medicines and take them faithfully. Don't try to take the least possible dose and don't try to "tough it out" if an asthma attack starts. Follow your action plan and seek emergency help when it is wise to do so.
· Failure to avoid triggers. With more effective drug control of asthma symptoms, some people with asthma may take fewer precautions when it comes to avoiding their known triggers. Don't fall into this habit. Identify and remove or avoid situations and conditions that you know may cause your asthma to flare up. Elimination of known triggers is an important step in the long-term management of asthma.

Q: I know that my breathing passages are constricted during an asthma attack. Can I use any bronchodilator drug as a reliever to relax the airways?

A: Although relaxation of airways is needed in a severe asthma episode, some bronchodilators work too slowly to be of any immediate benefit. Short-acting beta2-bronchodilators such as albuterol, terbutaline, pirbuterol, and bitolterol work quickly to relax airway muscle that is in spasm and are, therefore, called "rescue" medications. Other bronchodilators such as long-acting beta2-bronchodilators, anticholinergic bronchodilators (ipratropium), and theophylline may be useful in the treatment of an asthma episode, but should not be used in place of short-acting beta2-bronchodilators for treatment of acute symptoms.

Q: I love to cross-country ski but I'm worried about a flare-up in my asthma. Should I stop exercising?

A: First of all, check with your doctor to make sure this type of exercise is suitable for your asthma condition. You may have two triggers involved here: cold weather and physical exertion. Drying of the linings of the airways due to cold air, exercise, or both, may trigger an episode. For many people, pretreatment with a beta2-bronchodilator 10 to 15 minutes before activity allows them to exercise without experiencing asthma symptoms. Ask your doctor if pretreatment medicine would help you stay active. Some of the preventer medicines used to control persistent asthma symptoms are also useful in controlling exercise-induced and cold air-induced asthma. The benefits of exercise in persons with asthma cannot be overemphasized.

Q: Why is my chest so tight during an asthma attack when I try to breathe out?

A: Because the airways are swollen and narrowed they close earlier in expiration. This "traps" air in the lungs that would normally be exhaled. Therefore, breathing occurs at a higher lung volume than normal, causing a feeling of "tightness" of the chest due to over-distended lungs.

Q: What is the link between triggers, inflammation, and asthma?

A: Triggers are irritating factors that make asthma worse, and they are usually different for different people. Because the airways of people with asthma are chronically inflamed, the airways are sensitive or reactive to triggers. Know what your triggers are and how best to avoid them.

Q: I'm allergic to ragweed, which makes my eyes and nose runny and itchy for most of the summer. My doctor calls it "seasonal rhinitis." Will it give me asthma?

A: Not necessarily. Not all people with asthma have allergies, and not all people with allergies develop asthma. It depends. There are complex factors at work here, such as your genetic make-up, the reactivity of your airways, and the success you have in controlling your "hay fever" condition. Pollens and other things can trigger asthma in susceptible people, and there's nothing you can do about your genetic background. Therefore, the best approach is to work with your doctor to control your seasonal allergy.

Q: What's the difference between corticosteroids and anabolic steroids? I don't want to "pump up," I just want to control my asthma.

A: Although the term "steroids" is used widely, there are many types of steroids with many different effects. In fact, our bodies actually produce steroids for beneficial effects of various kinds. The types of steroids that body-builders may abuse are called anabolic steroids. The types of steroids used to control asthma symptoms are called corticosteroids, and they do not have the same effects as the anabolic steroids. Corticosteroids are taken because they help control inflammation in the body. They have virtually no muscle-building or performance-enhancing effects like those produced by the anabolic steroids.

Q: My wife really wants a pet. She doesn't seem allergic to pets and skin tests show she's not allergic to dogs or cats. How about it?

A: As you've stated, your wife is not allergic to dogs or cats. Having a pet in the house is only a problem if the person is allergic to that animal. However, the problem here is that she may become allergic over time with regular exposure to the animal. If that occurs, the airways remain slightly irritated. This may set her up for asthma attacks triggered by other factors.

Q: I forgot to refill the prescription for the inhaler that gets rid of my wheezing on bad days. Can I just use my other inhaler - the one with the steroid I normally use every day for asthma control?

A: No. You really need to get your prescription filled as soon as possible. The medications in the two inhalers are quite different and are not interchangeable. The inhaled steroid is the "preventer" drug. It normally does a great job of preventing the symptoms of asthma by controlling the inflammation that triggers it. The "rescue" inhaler contains the drug you may need to counter the tightness and wheeze that can occur if the "preventer" drug isn't able to block your symptoms.

Q: Should we consider moving to a different climate?

A: Moving to a different climate will probably not help in cases of allergic asthma. Asthma is quite common in all parts of the country. Generally, families that move to a new area find that asthma symptoms continue to occur, usually because of different triggers in the new environment. Nonallergic asthma may improve with a move to a different climate having less pollution or warmer temperatures if triggers such as industrial pollution or cold air temperatures were responsible for the asthma episodes. Check with your doctor.

Q: Can "allergy shots" help if I have allergic asthma?

A: Once your personal "troublemakers" have been identified, your doctor may try some different approaches to control inflammation and your response to these triggers, including:
• Avoidance. This is the simplest approach, but not always easy to carry out. If strong chemical odors are suspected as a trigger, avoid such irritating substances. But if your personal trigger is the pollen released from a particular tree or weed, not much can be done to avoid it.
• Injections. These injections, commonly called "allergy shots," may make you less sensitive to the trigger substance. In this treatment, very small amounts of the trigger substance are injected in doses that are slowly increased over time to increase your tolerance. (The treatment works best for allergies to pollen, dust mites, and cat dander.)
• Drugs to prevent asthma episodes. Certain preventer drugs are used to control inflammation and asthma symptoms even though allergies are still present.

Q: What are the most important things I can do to help improve my asthma?

A: Three actions are most important: check the environment, keep lines of communication open with your doctor, and understand your treatment plan. Removing a trigger from the environment can often do wonders. For example, if you are allergic to cat dander, you can survive the presence of a cat by inhaling corticosteroids to control asthma, but you would probably be far better off if the cat went to another home. Generally speaking, the more triggers you can remove, and the less medicine you have to take as a result, the better off you will be in the long run. Good communication between you and your doctor is essential in identifying and minimizing triggers and developing your personal asthma action plan.

Putting It All Together
Here is a summary of the important facts and information related to asthma in adults.

• Asthma is a condition in which extra-sensitive lungs overreact to certain irritating conditions called "triggers."
• In asthma, the air passages of the lung are chronically inflamed, meaning they are red and swollen. When an asthma attack occurs, the muscle in the walls of the air passages may contract, causing the airways to narrow.
• The signs of an asthma attack or episode include difficulty in breathing because of narrowed airways caused by tightened muscles around the airways, swelling of the inner linings of the airways, and mucus that is clogging the airways.
• Symptoms of asthma may include coughing, wheezing, tightness in the chest, shortness of breath, and excess mucus production.
• "Good asthma control" means that one does not experience wheezing, coughing, shortness of breath, and interruption of sleep, that exercise and daily activities are carried out normally, and that reliever medicines are used less than three times per week.
• We don't know why some adults get asthma, but many have a history of childhood allergies, asthma, or both.
• Asthma is a chronic condition that cannot be cured but can be successfully treated.
• Both allergic and non-allergic types of asthma exist.
• Asthma symptoms usually develop over a period of time and may be triggered by changes in the external environment such as very hot or cold weather, and by changes in the pollution and pollen levels in the air.
• Managing asthma episodes includes taking the correct medications, using breathing relaxation and pursed-lip breathing exercises, and coughing and mucus removal.
• Medications to manage asthma come in various forms, such as tablets and inhaled forms.
• Using a peak flow meter as the doctor recommends can help you determine if an asthma attack is coming, even if you feel fine at the time.

Please watch the following video sites.

Thursday, December 4, 2008

Stroke ... Brain attack

Stroke or Brain attack

A stroke is a "brain attack" that happens when a part of the brain experiences a problem with blood flow. This disruption in blood flow cuts off the supply of oxygen to the cells in that part of the brain, and these cells begin to die.

Damage to the brain can cause loss of speech, vision, or movement in an arm or a leg, depending on the part of the brain that is affected.
Stroke is the major form of cerebrovascular disease, or CVD, a term that sometimes is used interchangeably with stroke.
There are two main types of stroke:

· Stroke caused by a blockage in the artery supplying blood to a particular region of the brain (called cerebral infarction) This is the most common type of stroke.
· Stroke caused by bleeding within the brain (called intarcerberal hemorrhage)
· Mini-stroke, in addition, some people experience brief warning signals that a major stroke is going to happen in the future. The medical term to describe these symptoms is transient ischemic attack or TIA. Sometimes called “mini-stroke”, TIAs are exactly like a stroke, but they last only a few minutes (or sometimes as long as an hour) and leave no disability.

In many cases, a stroke will affect only one side of the body:
. A stroke that damages the right side of the brain will affect the left side of the body.
. A stroke that damages the left side of the brain will affect the right side of the body.

1. Stroke Caused By Blocked Blood Flow
About 85 percent of all strokes happen because not enough blood gets to the brain. Blood flow stops when an artery carrying blood to the brain becomes blocked. The technical name for this type of brain attack is cerebral infarction. It is also called ischemic stroke. "Ischemic" refers to a condition caused by a decreased supply of oxygenated blood to a body part.
The blockage can be caused either by a blood clot that forms in an artery in the brain, or by a blood clot formed elsewhere in the body that travels through the bloodstream to the brain. If this clot becomes stuck in an artery in the brain, a stroke can result.
Clots are more likely to form in arteries that are damaged by atherosclerosis, also called "hardening of the arteries," due to the buildup of cholesterol and other thick, rough, fatty deposits in the arteries.

The blockage also can be caused by a small piece of tissue, usually a blood clot, that has traveled through the bloodstream from elsewhere in the body.

In ischemic stroke, one of two major arteries is usually involved:

The carotid artery (most commonly involved site)

The basilar artery

The carotid arteries start at the aorta (just above the heart) and lead up through the neck, around the windpipe, and into the brain. The basilar artery is formed at the base of the skull from the arteries that run up along the spine, and branches off in the brain.

2. Stroke Caused By Bleeding In The Brain
The other 15 percent of strokes happen when an artery carrying blood to the brain bursts suddenly. The bursting can happen because of a weak spot in the wall of an artery called an aneurysm. This type of brain attack is called a hemorrhagic stroke.

Two kinds of stroke are caused by bleeding in the brain:

A subarachnoid hemorrhage occurs when a blood vessel on the brain bursts and bleeds into the fluid-filled space between the brain and the skull. This type of stroke can happen at any age.

An intracerebral hemorrhage occurs when an artery bursts inside the brain, flooding the surrounding brain tissue with blood. This type of stroke is often associated with high blood pressure.

What Are "Mini-Strokes"?

A "mini-stroke" is exactly like a stroke, but it lasts only a short time and leaves no disability. The term for this event is transient ischemic attack or TIA.
A TIA happens when a blood clot clogs an artery temporarily, cutting off blood flow and, consequently, the supply of oxygen to cells. But the difference between a TIA and a stroke is that, with TIA, the blood clot dissolves on its own and blood flow is restored before permanent damage to the brain can occur.
TIAs are an extremely important warning sign for stroke and should never be ignored.
About 10 percent to 15 percent of strokes are preceded by TIAs ('mini-strokes'), which can happen days, weeks, or even months before a major stroke. However, not everyone who experiences a TIA will have a stroke in the future.

General recovery guidelines for stroke show:
· 10 percent of stroke survivors recover almost completely
· 25 percent recover with minor impairments
· 40 percent experience moderate to severe impairments requiring special care
· 10 percent require care in a nursing home or other long-term care facility
· 15 percent die shortly after a stroke

Facts About Stroke:
· Nearly 4 million people in the United States have survived a stroke and are living with the after-effects.
· Each year, more than 500,000 Americans have a stroke.
· Although stroke is still the third leading killer in the United States, the death rate from strokes has been cut nearly in half over the last two decades.
· A stroke is always serious. Cells in the brain that become damaged cannot be repaired or regenerated. But other areas of the brain may take over the work of the damaged portion.
· Most people know they should seek emergency medical help immediately if they are having symptoms of a heart attack. But the average stroke patient waits more than 12 hours before going to a hospital emergency department, losing precious time that could be critical to treatment.
· Stroke was first recognized more than 2,400 years ago by Hippocrates, the father of medicine, who described a condition marked by the sudden onset of paralysis.
· There are steps you can take to help prevent a stroke. Healthy living is very important in stroke prevention. There also are successful treatments if it does happen.
What Are The Signs Of A Stroke?
The warning signs of stroke are:

. Sudden weakness or numbness of the face, arm, and leg on one side of the body
. Sudden loss of vision or dimmed vision, particularly in one eye
. Loss of speech, or trouble talking or understanding speech
. Sudden, severe headaches with no apparent cause
. Unexplained dizziness, unsteadiness, or sudden falls, especially if accompanied by any of the previous symptoms

Most severe headaches are not a sign of stroke. Migraine, which can cause quite severe and sometimes alarming headaches, is very common and affects about one in five people.

How-To Information:
If you experience migraines, how can you tell if your headache is just another migraine - or a sign of stroke?

A headache caused by a stroke:
Will come on very suddenly, without the aura that sometimes precedes migraines Has been described by stroke survivors as "the worst headache of my life"
Will build up to a peak within a minute or two
May be accompanied by vomiting and a stiff neck

What Do Different Parts Of The Brain Do?

The brain is a very complicated organ. Although it is a relatively small part of the body, it uses one-quarter of the blood supply.
When a person is right handed, the left side of the brain is dominant. About 90 percent of left-handed people have the right side of the brain dominant.

Nice To Know:

In general, the right side of the brain processes:

In general, the left side of the brain processes:

What Increases The Risk For A Stroke?
Anybody can have a stroke, but certain factors place a person at higher risk. Some factors that increase the risk of stroke cannot be changed, while others are linked to lifestyle.

Risk Factors That Cannot Be Changed
Some risk factors for stroke cannot be changed:
· Age - The older a person gets, the greater the risk of stroke.
· Sex - Men are more likely to have a stroke than women are.
· Race - Blacks have a greater risk of stroke than whites do.
· Diabetes- People with diabetes mellitus are more at risk.
· A history of migraine headaches- Recent studies indicate that women who experience migraines are at higher risk for ischemic stroke (stroke caused by a blockage in a blood vessel).
· A prior stroke -Someone who has had a stroke has a slightly increased risk for another.

Risk Factors That Can Be Changed With Medical Treatment
The major risk factors for stroke that medical treatment can change are:

· High blood pressure- High blood pressure has no warning signs, so regular blood pressure checks are important. The condition can be easily and successfully controlled with medication.
· TIAs, or "mini-strokes" - A surprising number of people ignore the symptoms of TIAs, which are warning signs that a stroke may be about to happen. But people who have had TIAs can take steps to help prevent a major stroke.
· Berry aneurysms - These are small, sac-like areas within the wall of a cerebral artery. Some people are born with berry aneurysms. They occur most often at the junctures of vessels at the base of the brain. Berry aneurysms may rupture without warning, causing bleeding within the brain.
· Cardiovascular disease - Certain disorders of the heart and/or blood vessels, such as atherosclerosis and atrial fibrillation, can produce blood clots that may break loose and travel to the brain.
How is stroke connected to cardiovascular disease ?
Atrial fibrillation is a heart disorder in which the heart beats quickly and in an irregular manner. As a result, the heart's chambers do not completely empty themselves of blood. Blood that remains in these chambers can become stagnant, and clots can form. These clots can then travel in the bloodstream to the brain and cause a stroke.Individuals with atrial fibrillation often need to take anticoagulant drugs ("blood-thinners"). These medications help prevent the formation of blood clots.

Atherosclerosis is also called "hardening of the arteries." Cholesterol plaque and other fatty substances build up on the inner walls of arteries, causing them to narrow. Pieces of plaque from deposits on the inner walls of arteries can break off and travel throughout the body. They can cause a stroke if they block blood flow to the brain.
Atherosclerosis can be especially dangerous if it affects the arteries in the neck, called the carotid arteries, because any clots that might break off will not have far to travel before reaching the brain.

Risk Factors That Can Be Changed By Lifestyle Modifications
Risk factors for stroke than can be controlled by changes in lifestyle are:
.High blood cholesterol levels - Studies have shown that lowering cholesterol levels can reduce the risk of stroke by as much as 30 percent. Keeping cholesterol low can reduce the risk of blood clots and buildup within the walls of an artery in the brain.
· Cigarette smoking - Cigarette smoking has been linked to heart attacks, strokes, artery disease in the legs, and lung cancer. Nicotine raises blood pressure, carbon monoxide reduces the amount of oxygen the blood can carry to the brain, and cigarette smoke makes the blood thicker and more likely to clot. It is never too late to give up smoking.
· Taking birth control pills if you are a smoker - Research has proven that smoking and taking birth control pills significantly increases a woman's risk for stroke. Together, they can cause blood clots to form. Women who take birth control pills should not smoke.
· Drinking large amounts of alcohol - Frequent intoxication can make a person more likely to experience bleeding in the brain. Also, alcohol in large amounts can raise blood pressure.
· Obesity - Being overweight increases your risk of having a stroke, along with other health problems.
· Lack of exercise - Moderate exercise can help keep blood pressure and cholesterol levels within normal ranges.
· Poor diet - A diet high in fat can cause conditions within the body that can contribute to a stroke
How Is A Stroke Treated?
A stroke is a medical emergency, regardless of whether it is a major stroke or a short-lasting TIA. A person suffering a stroke should be taken immediately to a hospital emergency department.

The ability to pinpoint quickly the precise location of a stroke and determine the extent of damage is critically important in treatment decisions. A stroke caused by a blocked artery is treated in an entirely different way than a stroke caused by bleeding within the brain.
The key to survival and recovery is prompt medical treatment.
How-To Information:

If a stroke is caused by a blocked artery, medications are now available to reverse damage to the brain and significantly increase the odds of survival. However, these medications are effective only if they are given within a few hours of the time when the first stroke symptoms begin.

Tests That May Be Performed At The Hospital
Scans of the brain are performed to confirm a diagnosis of stroke and to determine the type of stroke. This is important since the treatment of different types of stroke differs.
These tests include:
· Computed tomography scan (CT scan) is generally the first diagnostic test done after a person suspected of having a stroke arrives in the emergency department. The test uses low-dose x-rays to take pictures of the inside of the brain.
· Magnetic resonance imaging (MRI) is an advanced diagnostic tool that uses the principals of magnetism to view the inner body. An MRI of the brain can show small blood vessels that may be blocked or bleeding. .
· Transcranial doppler (TCD) is a new, noninvasive ultrasound procedure that uses a small probe placed against the skull to track the blood flow through the vessels in the brain.
· SPECT imaging uses low doses of a harmless radioactive substance injected into a vein in the arm, then uses a specialized camera to view the blood flow in the brain.

Medicines To Treat Stroke
If the stroke is caused by a blockage:
· Drug therapy is a relatively recent approach to the treatment of stroke. If the
stroke is caused by a blockage in an artery, medications called thrombolytic drugs can be used. The only drugs approved by the FDA for treatment of stroke are tissue plasminogen activators (TPA drugs). Popularly referred to as "clot-busting" drugs, these medications have been used for years to treat heart attacks.
Some studies have indicated that if TPA drugs are given to stroke patients within three hours of the onset of symptoms, more than half of them will make a full recovery in a matter of months.
Not all hospitals, however, have the ability to give TPA drugs to people having a stroke. Before these drugs can be given, doctors must be certain that the stroke is the result of a blockage in the artery and not due to bleeding from an artery. This is determined through imaging procedures such as computed tomography (CT) scans and magnetic resonance imaging (MRI). But not all hospitals have around-the-clock imaging services.
If a stroke is caused by bleeding:
Medication can be given to reduce swelling of brain tissue.
Surgical Procedures
If the stroke is caused by a blockage:
A procedure called carotid endarterectomy can be used to remove a buildup of plaque from inside the carotid artery, one of the major sources of blood to the head and neck. Carotid endarterectomy can be used to treat people who have had a stroke and also as a preventive measure for people at risk for stroke.

If the stroke is caused by bleeding:
An artery within the brain sometimes can be "clipped" to prevent further bleeding.
If the bleeding has occurred in the subarachnoid space, pooled blood (hematoma) can dangerously increase pressure on the brain and damage delicate tissue. If it is feasible, surgery may be necessary to drain blood from within the area of damaged brain tissue.

Other Procedures
Several types of interventional radiology also are available to treat stroke. These procedures have been in existence for some time, but they have been improved and refined in recent years. However, not all hospitals are equipped to offer interventional radiology.
Interventional radiology is performed by inserting a long, thin, flexible tube called a catheter into blood vessels. The insertion point is usually in the groin, and the incision is about the size of the tip of a pencil. The catheter is guided to various parts of the body while a computer tracks it and records images of the blood vessels. This procedure creates a precise road map of even the tiniest vessel in the body.
· The catheters can be guided to areas of bleeding and used to effectively close off the leaking vessels.
· The catheters can be used to widen areas of blood vessels that have become narrowed because of a buildup of plaque.
· The catheters can be used to place stents made of a fine, tubular wire mesh to hold a blood vessel open.
What To Expect During A Hospital Stay
After the initial tests to determine the type of stroke and the best treatment, other procedures may be necessary to find the cause of the stroke. These procedures may include tests of the heart or the arteries to the brain.
The length of the stay in the hospital and the type of treatment will depend on the severity of the stroke. Many people need some form of therapy to help their brain relearn skills lost because of the stroke.

Q: My father had all the signs of a stroke, but he waited more than six hours before getting to the hospital. Even though his stroke was caused by a blocked artery, doctors did not give him "clot-busting" medicines. Why not?

A: TPA drugs are powerful blood thinners that can help dissolve a clot and restore blood flow, but the FDA requires that they be given within three hours after stroke symptoms first begin. When TPA is given more than three hours after stroke onset, there is a greater risk that it will cause uncontrollable bleeding. It is very important that this guideline is followed and that everyone is made aware of the critical importance of seeking help immediately if experiencing stroke symptoms.
Effects Of A Stroke
A stroke affects different people in different ways. While some people make a full recovery, others may find that some problems do persist. These may include:
Speech Changes
Some people have difficulty with speech. When stroke has damaged the part of the brain that controls the muscles used to produce speech, speech may become slurred. The survivor understands words and conversation but cannot speak distinctly. This condition is called dysarthria.
When stroke has damaged the part of the brain that controls language, the survivor may lose the ability to speak and understand speech. The ability to read and write can be affected. The person may have difficulty finding the right word or may use an incorrect word. He or she may find, when reading, that some words make no sense. This condition is called aphasia.
Some tips for caregivers of people with speech or language difficulties:
· Avoid distractions. Do not have many other people in the room, turn off the television or radio when someone is speaking.
· Have a one-on-one conversation. Do not allow more than one person to speak at one time.
· Give the person a lot of time to speak.
· Allow the person to speak for himself or herself if someone else asks a question; don't try to answer it yourself.
Vision Changes
Stroke may affect vision on one side (usually the same side that has been weakened by the stroke). When talking to someone with impaired vision, always stand or sit on the "good" side. Consider that the person may ignore people or objects on the other side and may bump into them.
Memory And Concentration Difficulties
Memory and concentration may be affected after a stroke. In the early stages, individuals may not be able to concentrate for very long and may become easily distracted. They may have problems with particular tasks, such as finding the way about the house or getting dressed, yet have no other major difficulties.
Stroke frequently causes paralysis on one side of the body. This condition is called hemiplegia. The paralysis may affect only the face, an arm, or a leg; or it may affect one entire side of the body and face.
· A person who suffers a stroke in the left side of the brain may show right-sided paralysis.
· A person who suffers a stroke in the right side of the brain may show paralysis on the left side of the body.

Weakness And Stiffness
Paralyzed limbs may recover their strength but may remain clumsy or stiff. Some types of muscular stiffness (a condition called spasticity) can be helped with medication. People with weak hands often are given a soft ball to squeeze to help improve their grip.
Difficulty Eating And Swallowing
Damage to certain areas of the brain can cause difficulty eating and swallowing. This condition is called dysphagia. Therapy to help the brain relearn these skills has shown great success. Until a person is able to eat again, he or she can receive sustenance intravenously (with an IV that delivers nourishment directly into the bloodstream). Most people who have had a stroke will recover their ability to swallow safely.
Mood Changes
The days and months after experiencing a stroke are a stressful time. The stroke survivor may be unable to return to work immediately and may lose independence for a while. After the immediate shock, a stroke survivor may feel anxiety, anger, and frustration. A lack of information may contribute to the anxiety. Anxiety and frustration can be reduced by support from doctors, therapists, and other caregivers.

Q: My wife just hasn't been herself since her stroke. She seems to have lost interest in many things and no longer seems to be enjoying life, even though her recovery is progressing well. What could be wrong?

A: Your wife could be suffering from depression. After recovery from a stroke, many people do feel depressed. This depression is normal, and usually disappears within three months after the brain attack. Medication is available to relieve symptoms of depression.
Personal Relationships
Many people worry that sexual intercourse may bring on another stroke. This is not true. A person who has recovered from a stroke can return to all normal activities, including sexual relations. Even people who are still experiencing some difficulties related to a stroke can resume normal loving and intimate relationships.
Open discussion and careful consideration of each other's needs is the secret to maintaining a successful relationship after stroke. Restoring a warm, loving relationship with a partner is an important step in returning to a normal life.
Other Challenges To Face

Because a stroke affects each person differently, there may be other physical challenges:
· The sensitivity of the skin may be altered after a stroke. Some people experience numbness while others feel as if their skin is extra sensitive.
· Certain individuals experience pain, uncomfortable numbness, or strange sensations after a stroke. These sensations may be caused by many factors, including damage to the sensory regions of the brain.
· Control of bowels and bladder may be lost temporarily after a stroke, but most people do recover function
Recovering From A Stroke
Many people begin to recover from a stroke almost immediately after it has occurred.

The recovery process is most rapid in the first three months after a stroke, but improvement will continue for six months or a year. Many stroke survivors report that they slowly continue to regain function for years after their brain attack. It is very important not to lose hope.
Everyone's recovery is different, but some general rules hold true. Simple skills will be recovered first:
· The ability to sit up and balance while sitting, then
· The ability to stand, and then
· The ability to walk.
· The leg usually starts to improve before the hand.
Some people will notice that "things do not work so well" when they are tired or get a minor illness such as a cold. For example, a person's speech may get more hesitant toward the end of a busy day, or the person may become more unsteady after the flu. These ups and downs are to be expected and are not a sign that another stroke is about to occur.
The Importance Of Rehabilitation Therapy
Successful recovery after a stroke depends on the extent of brain damage, the person's attitude, the skill of the medical team, and the cooperation of family and friends. Not all people recover on their own. For them, rehabilitation therapy can be invaluable.
Rehabilitation can teach new skills to replace old skills that may have been lost. It involves teaching other areas of the brain to take over the work of the damaged portions.
One of the first rules of successful rehabilitation is that it must begin as soon after a stroke as possible. Therefore, it usually starts in the hospital and is continued as long as necessary after the person goes home. The goal of therapy is to improve function so that the person who has had a stroke can become as

Rehabilitation - teaching an individual certain skills that might have been lost - can consist of one or more of the following:
· Physical therapy - Teaches walking, sitting, and lying down, switching from one type of movement to another.
· Occupational therapy - To relearn eating, drinking, swallowing, dressing, bathing, cooking, reading, writing, toileting.
· Speech therapy - To relearn language and communication skills.
· Psychological/psychiatric therapy - To help relieve some mental and emotional problems.

Depending on the severity of the stroke, rehabilitation options include:
· A rehabilitation unit in the hospital
· A subacute care unit
· A rehabilitation hospital
· Home therapy
· Home with outpatient therapy
· A long-term care facility that provides therapy and skilled nursing care

Avoiding Another Stroke
Many survivors are afraid that they will have another brain attack. However, with proper medical treatment, it is quite unlikely that a person who has had a stroke will experience another. The risk of a second stroke is higher for people who are not receiving proper medical treatment for their first stroke.
Effective treatment to reduce the risk of another stroke includes making lifestyle changes to decrease risk factors and taking medication, such as aspirin, as directed by a doctor.

Q: I had a stroke nearly a year ago, and I still have a strange sensation of pain on my left side. My doctor has tried a variety of drugs, but nothing seems to work. What else can I do?

A: This type of pain, called central post-stroke pain, is uncommon and can be difficult to deal with. There are a variety of medications you can try, including antidepressants and anticonvulsants. You also may want to consider complementary therapies such as acupuncture. Other options include transcutaneous nerve stimulation (TENS), which is a small device that sends an electrical current to a certain area of the body in order to block the sensation of pain. Surgery to interrupt the nerves that carry this abnormal sensation (stereotactic surgery) also is a possibility, but it does have some risk.

Preventing A Stroke

The best way to prevent stroke is to reduce your risk factors and take control of your own health:

· Lower your cholesterol level if it is elevated - some people can do this by modifying diet; others need to take medication. Lowering cholesterol levels has been proven by researchers to reduce the risk of stroke. .
· If you smoke, stop smoking - Many excellent smoking cessation programs are available today; your doctor can advise you about tools you can use, such as the nicotine patch. .
· Drink alcohol in moderation - A drink or two a day is considered acceptable.
· Keep your weight within normal limits.
· Get a moderate amount of exercise at least five days a week.
· Eat a healthy diet that is high in fruits and vegetables and low in fats.
· If you have cardiovascular disease, work with your doctor to treat it. Certain types of problems with the heart and blood vessels, such as atherosclerosis and atrial fibrillation can cause blood clots to form. These clots can block an artery in the brain and cause a stroke (or can block a blood vessel in the heart and cause a heart attack).
· If you have diabetes, keep it under good control.
· If you have high blood pressure be sure to take your medication regularly.
· Know the warning signs of TIAs and strokes, and get help right away if you experience them.

Medications For Prevention

Certain medications have been shown to reduce the risk of stroke. These drugs fall under two major categories. They aim to prevent the formation of dangerous blood clots:

. Antiplatelet agents such as aspirin - These drugs work by preventing or reducing platelet aggregation in the bloodstream. Platelets are tiny blood cells that cause blood to coagulate or clot. When a blood vessel is damaged or injured, platelets will migrate to the area to begin a healing process. However, large numbers of platelets can clump together or aggregate and form a clot that is essentially a plug in an artery. Antiplatelet agents help prevent this clumping.
· Anticoagulants - These drugs work by thinning the blood and preventing clotting. Common anticoagulants are heparin and warfarin.

Antiplatelet and anticoagulant drugs can also be used to treat heart disease, so taking one medicine can help reduce your risk of both heart attack and brain attack. Your doctor can advise you on what medications are right for you.
The medical community first became aware of aspirin's protective effects for stroke in 1978, and since then, several large studies have shown that aspirin reduces the risk of stroke. But aspirin isn't the only antiplatelet medicine available. If you can't take aspirin because of allergy or the risk of stomach ulcers, other drugs are available.

Surgery For Prevention

Carotid endarterectomy - the same procedure that can sometimes be used to treat strokes caused by a blockage - can also be used to help prevent such strokes from happening in the first place.
The procedure involves removing plaque buildup in the carotid artery . It is performed when the artery is blocked by more than 70 percent.

· It has been proven that for certain individuals who have had minor strokes or TIAs, and the carotid artery in the neck is more than 70 percent blocked (i.e. severely blocked), this procedure can reduce the risk of future strokes.
· It also is beneficial for individuals with blocked carotid arteries who have not had previous symptoms of stroke.

Carotid endarterectomy takes about an hour to perform. A tube is placed to transport blood around the area to be treated. After the surgeon has scraped away the built-up plaque, the artery is sewn back together and blood flow is restored.

Currently, carotid endarterectomy is available only at major treatment centers in the U.S. Among the risks is the possibility of experiencing a stroke during the procedure itself. If you are considering this procedure, you and your doctor should weigh the risks and benefits.
The Role Of Vitamin E
Research suggests that vitamin E helps prevent arteries from clogging by blocking the conversion of cholesterol into its most dangerous form. Vitamin E is also a powerful anti-clotting agent. It helps the blood flow more easily through arteries when fatty plaques are present. It also is an antioxidant, which means it helps prevent cell damage. Ask a doctor about the proper amount of this vitamin to take daily.

What Is The Long Term Outlook?
Today, the outlook for people who have had a brain attack is more hopeful than ever before. Because of advances in treatment and rehabilitation, many people can return to a fulfilling life.

A stroke survivor's family plays a vital role in recovery. Family members need to understand what the person is going through, what to expect, and how to handle problems that will arise. A person's will to recover and desire to be independent play a big part in recovery; the family can help by providing a warm, supportive, and encouraging atmosphere.
The understanding of what causes strokes and how best to treat them is still expanding. Researchers at the National Institute of Neurological Disorders and Stroke in Bethesda, Md., predict that Americans should be able to prevent 80 percent of all strokes within the next 10 years. They believe this will happen because of continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones.
Among those new therapies are drugs that make the brain less susceptible to the damaging effects of a stroke. Called neuroprotective agents, these drugs include citicoline and lazaroid compounds. They currently are under evaluation in clinical trials.

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Frequently Asked Questions
Here are some frequently asked questions related to stroke.

Q: Can a stroke just happen out of the blue?

A: A stroke, which also is referred to as a "brain attack," often does happen without any prior warning. However, the conditions that lead to a stroke have usually been present for many years. Maintaining the healthiest lifestyle possible, therefore, is very important in stroke prevention.

Q: My father suffered a stroke three months ago but insists he is capable of driving. Should I worry?

A: A stroke can affect eyesight, coordination, the movement and strength of arms and legs, balance, reaction time, concentration, speed of thought, memory, awareness of where objects are in relation to each other, and even the awareness that anything is wrong at all. A difficulty in any one of these areas carries with it the possibility of making driving unsafe. Your father's doctor can provide the best advice on whether he should be driving.

Q: Ever since his stroke, my husband has been reluctant to have sex, even though he seems to have made a full recovery. Is this normal?

A: There are many myths about having sex after a heart attack or stroke. The most common one is that sexual activity will bring on another heart attack or stroke and cause sudden death. This simply isn't true. There's no reason why someone who has had a heart attack or stroke can't resume usual sexual activity as soon as he or she feels ready to do so. For some men, fear about performance can greatly reduce sexual interest and ability to have an erection. An understanding partner, patience, and open discussion with a doctor or therapist are extremely helpful in resuming sexual intercourse.

Q: At what age should I seriously consider taking aspirin to help reduce my risk of having a stroke?

A: The need for aspirin therapy depends on individual risk factors and is different for everybody. Most health care providers suggest that after age 50, you and your doctor should make a decision about aspirin therapy. Some people benefit from taking aspirin before age 50.
Putting It All Together
Here is a summary of the important facts and information related to stroke.
• A brain attack or stroke happens when a part of the brain is damaged by a change in blood flow. This change can happen if something blocks the flow of blood to the brain or if a blood vessel bursts and causes bleeding in the brain.
• In many cases, a stroke can happen without warning. But some people do experience "mini-strokes," called TIAs, which are exactly like a stroke but last only a short time. A TIA, like a stroke, is considered a medical emergency and should never be ignored.
• The signs of stroke are sudden weakness or numbness on one side of the body, sudden loss of vision or speech, sudden severe headaches, or unexplained dizziness that comes on quickly.
• Some risk factors for stroke, such as age and race, cannot be changed. But there are steps you can take to reduce other risk factors, such as high blood pressure, high cholesterol, and cigarette smoking.
• If a brain attack does happen, medical treatments can be given in the hospital emergency department. These treatments have shown great success in minimizing damage to the brain. The key is to get medical help immediately. Too often, people having a stroke wait for hours before seeking help.
• A stroke can cause trouble speaking or seeing, memory difficulties, paralysis or weakness, difficulty eating, and mood changes. The good news is that therapies are available to help teach the brain skills it might have lost. Many people can make a full recovery and resume a fulfilling life after a stroke.
• The best way to prevent stroke is to reduce risk factors - improve diet, keep diabetes under control, quit smoking, and get enough exercise. Medication is also available to help prevent stroke. The most frequently used preventive medication is aspirin, which helps prevent blood clots.
• The long-term outlook for people who have had a stroke is more hopeful than ever before. Because of advances in treatment, more people are surviving strokes, and because of advances in rehabilitation, more people are conquering the disabilities that can be caused by a stroke.

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