Women Genital Hygiene

Women Genital hygiene

Genital hygiene is very important for preventing infections from developing and spreading.
Many women take the issue of genital hygiene very seriously even to the extreme of becoming obsessed in cleanliness and aroma. Over cleaning of the vagina can in fact be harmful.


The inside of the vagina rarely needs cleaning with the use of soap. It has a natural balance of substances that can become disturbed by washing causing any bacteria that enter to have the potential of developing into an infection.
The external part of the vagina, the labia, should only need cleaning after toilet release using a mild soap and water. The area should also be cleaned following sexual intercourse.


Washing should be performed using a singular front to back motion to avoid bacteria around the anus from coming into contact with the vagina or urethra (the external opening to the bladder).

The anus should be the last part to be cleaned so the bath water or flannel does not become contaminated with bacteria that would be spread to other parts of the body.

Wash cloths and towels should be individual and washed after use.
Particular attention should be paid in the incidence of thrush and cystitis. All items should be single use and washed immediately, not left in the laundry basket.

There is no need to increase washing frequency whilst menstruating, as long as appropriate sanitary wear is being used. The use of stockings instead of tights and cotton underwear with good coverage rather than thongs, can help reduce the likelihood of perspiration and the transfer of bacteria from the anal region being introduced to the genital area. Perfumes and deodorants should not be directly applied to the genital region.

Once seen as a taboo subject, menstrual hygiene is now a multi-billion dollar industry with many products available giving women choices as to how they manage their personal menstrual hygiene.

Cleanliness
It is essential to maintain strict hand-washing practices before and after changing sanitary products. Any bacteria on the hands and fingers prior to fitting a sanitary product can be transferred to the vaginal canal and cause infection. Likewise, any bacteria on the fingers following the changing of a product can be transferred to other items.

Many women feel uncomfortable and unclean during their menstrual cycle and may wish to bathe more often. There are no rights and wrongs for washing and bathing and each individual will adopt practices that are acceptable to them. It should be noted though, that there is no need to clean inside the vagina during your period as this can disturb the normal body flora and increases the risk of infection. It is fine to gently cleanse around the external labia of the vagina and pat dry.

There are many feminine wipes and fresheners available for use during the menstrual cycle, though they are usually unnecessary and are used as much for their reassuring qualities than any other. They should not be used inside of the vagina as they may cause irritation.

Types of Products Available

Tampons

These are tubes of tightly packed cotton that are inserted into the vagina by either the fingers or with the use of an applicator. They are very discreet and once the correct technique of insertion has been established, they are extremely comfortable. They have the benefit of being wearable during any activities that the user wishes and are normally very reliable. The maximum time that they should be worn is eight hours, with the ideal duration between changing being four to six hours, or more frequently if necessary.

If you are likely to have a long sleep, it is not advised that they are worn overnight as the risks of developing toxic shock syndrome are higher. Toxic shock syndrome (TSS) is a potentially life-threatening condition that can arise from the prolonged use of tampons.

It is recommended that the lowest absorbency is used for each individual’s period so as to lower the risk of TSS. It is perhaps advisable to alternate the use of tampons with sanitary towels. Tampons should be avoided in the presence of a vaginal infection as the tampon provides an excellent breeding ground for bacteria and can spread the infection further.

Sanitary Towels

These are worn externally and are attached within the user’s underwear. They are less invasive than tampons, though can be more uncomfortable top the buttocks and upper thighs due to chaffing, especially in the summer months. They can be noticeable as pads designed for heavy flow tend to be bulky in some brands, so they are not ideal for use with some summer clothes.
Again these should be changed when needed and prolonged use should be avoided as they can develop noticeable odours. It is safest to use sanitary towels at night to avoid TSS.

Menstrual Cups

Menstrual cups can be either disposable or reusable and are worn internally. They collect and retain the flow, and can be emptied, cleaned and reused.
They are the best option for protecting the environment and are very cost-effective. They are discreet and the disposable variety are reported to be extremely comfortable.
All women manage their hygiene needs individually. There are no ‘correct’ practices and many of the issues surrounding menstrual hygiene are dependent of finances and cultures.

Sexually Transmitted Disease

The subject of STDs is a very important topic of discussion in modern society. With children in primary schools being taught about sexually transmitted diseases and the importance of protected sex, this subject cannot go without mention.

Types of STD
There are a multitude of diseases that can be spread from unprotected sex, some causing life threatening illnesses, others causing minor but highly irritating and embarrassing problems.
Sexually transmitted diseases can range from the extremely frightening HIV to the less problematic cystitis.

Preventing a Sexually Transmitted Disease
The most common ways of reducing the chance of transmitting an infection is by abstinence from sexual intercourse or by using condoms.

Condoms can be worn by either the male or female (Femidom), and are available in a wide range of colours, flavours, sizes and can even come with added features such as being ribbed.

Many people enjoy full sex lives without the need for having full sex by using methods of massage, touching and foreplay to enrich their lives; indeed this is particularly useful with a new partner until trust or the subject of being tested has been discussed.

There is nothing to be lost by asking a new partner for a full screen to be undertaken at your nearest clinic, but it is only fair to offer this test to be done on yourself also.
STDs can also be spread through oral sex and the use of condoms or cling film is useful to prevent this occurring.

Common Types of Illnesses

Herpes
Herpes can be found around the mouth or the genitals and can be spread easily from person to person by having unprotected sex and oral sex. Herpes results in painful sores and blisters and is a virus that once treated will continue to remain in the system through-out life.

Medications can be bought over the counter, though if these are not effective, a prescription from your GP or local GUM clinic may be necessary.
Avoid having sex whilst suffering from an outbreak and use condoms at all other times; though if sores have spread to areas outside the coverage of a condom, it can still be spread.

Gonorrhoeae
Gonorrhoeaeis a bacterial infection that can be passed by vaginal, oral or anal sex. The main consequence of Gonorrhoeae is infertility, and as it has no symptoms in its initial development it can be spread very quickly and very easily from person to person.

If left untreated for a long period of time, other parts of the anatomy may be affected and can have serious consequences. The best protection from Gonorrhoeae is the use of condoms and not having multiple partners.

Chlamydia
Chlamydia is a bacterial infection passed through intercourse and oral sex. It has no obvious symptoms and can cause urinary tract infections and infertility if left untreated.
Usually the only symptom of Chlamydia is from the urinary tract infection which can cause burning and increased frequency of urination.

Typical Symptoms of an STD
Below is a list of many of the symptoms that accompany STDs; it is worth remembering that these symptoms often occur a long while after the infection has developed so your treating doctor or nurse will want you to remember all sexual partners so that each infected person can be traced and treated.

. Discharge from the vagina or penis, often with itching.
. Pain during intercourse or when passing urine.
. Sore throat.
. Pelvic Pain.
. Sores or blisters developing that do not respond to other treatments.
. Swollen glands, fever, night sweats.

It is important to remember that by using condoms and by reducing the amount of sexual partners you have is the easiest and most effective way of protecting yourself from diseases.

It is impossible to tell from appearance who has an infection and who hasn’t. Do not be embarrassed to go and seek medical help; all appointments are confidential and you will gain respect for taking the responsibility seriously.

Thrush

is a yeast infection that occurs mainly in the mouth, vagina or with nappy rash. It is caused by a fungus that thrives in a warm, dark and moist environment, it is very common is women and is more likely to occur when pregnant, as a side-effect of certain medications, when run down or when immuno-suppressed, such as with HIV or when receiving chemotherapy. The fungal particles are usually harmlessly present in humans, but when unwell or under stress, it can multiply and become problematic.

Signs and Symptoms

Oral thrush is first seen with a redness of the tongue with the occurrence of a few small white spots. It can develop to a full coverage of the tongue with a thick whitish carpet-like appearance.
Vaginal thrush is distinguished by having a thick creamy discharge that can be odorous and itchy. The area may be red and tender with a small chance of pain when passing water.

Treatments
There a many creams and pessaries available for the treatment of vaginal thrush, and a selection of oral preparations to help eliminate oral thrush, many available as a single dose; the pharmacist at your local chemist can help select an appropriate treatment.

Prevention of Thrush

Avoid tight fitting clothes and underwear, especially in hot weather as this can increase the chances of developing thrush. If you know you are prone to thrush, try wearing stockings instead of tights and always wear cotton underwear, which should be changed at least once daily. Ensure the correct methods of sterilization of baby equipment is followed to help reduce the incidence of thrush in infants; if you are unsure, speak to your health visitor who will give advice on types of sterilization equipment available and demonstrate how to use it.

If using an inhaler of any type, always rinse the mouth after using the inhaler to prevent bacterial and fungal build-up.

Use separate towels for bathing and ensure strict hand washing techniques are employed to avoid the spread of thrush and the transfer of fungal infection from hand to mouth, especially after using the toilet or tending to menstrual hygiene. Avoid the unnecessary use of anti-biotics as this can increase the use of thrush developing.

Avoid unprotected sex, even with a long-term partner if thrush has developed as the infection can spread to partners. If thrush is a persistent problem, speak to your GP who may want to do blood and urine tests to rule out the incidence of diabetes.

If you are caring for someone with thrush, particularly the very dependent such as the elderly or mentally incapacitated ensure they have a frequent supply of clean fresh fluids and ensure teeth/dentures are cleaned thoroughly to help alleviate the symptoms.

Thrush is a very common problem and should not be confused with a sexually transmitted infection. It is a fungal infection that can develop in people of any age at any time.

Urinary tract infection or UTI

A urinary tract infection or UTI occurs when bacterial cells are found in the urine. Normally sterile before being passed from the body, urine is produced to excrete waste products from the body via the kidneys and out through the urethra. The urinary tract consists of the kidney, the ureters (tubes that connect the kidney to the bladder), the bladder, muscles and the urethra (the tube that connects the bladder to the external orifice.

If an infection is limited to the urethra, it is called urethritis, if it concerns the bladder, it is called cystitis; involving the kidneys is named pyelonephritis.
Causes of a Urinary Tract Infection
The bacteria that causes a UTI is normally found in the digestive tract, and is found to be abnormal to the bladder. As it is more common in women than men, experts believe that the reason for this is due to the shorter length and location of the urethra; it is a lot closer to the anus than in men, and it is thought that bacteria from the digestive tract migrates to the frontal area.

It can be transmitted through sexual intercourse, either from the transmission of germs from the anus, or passed on from the partner if they are suffering from a UTI themselves.

Signs and Symptoms
The most common symptom of a UTI is finding the urge to pass urine is a lot more frequent than normal. Often sufferers want to go to the toilet often, but when trying, cannot pass anything.
When able to pass water, it is often accompanied by a burning sensation that can be very uncomfortable for some. Urine may appear cloudy or even blood stained, and may cause pelvic pain. Any pain felt in the kidney area indicates the infection has reached the kidneys and needs immediate treatment, as untreated kidney infections can cause permanent damage.

Risk Factors

Being female seems to be the greatest risk factor as the incidence is much higher in women than men. There is also further increased risk if pregnant.
Those who are diabetic are more probable to develop a UTI, as are those who wear a catheter or use an intermittent catheter. Any foreign body of the urinary tract raises the chances of developing an infection; factors such as tumours or stones all increase the likelihood of an infection.
Children whom suffer from these types of infections are often found to have some degree of anatomical abnormality which will need treating.

Treatments
Increasing oral intake of fluids is useful for helping to flush toxins away and out of the bladder.

Drinking cranberry juice has been proven to help prevent the bacteria from adhering to the tissues of the urinary tract, so a daily drink of cranberry coupled with a generous intake of water will help to clear the infection.
Anti-biotics are frequently prescribed for the treatment of this infection, and the full course should be taken or symptoms may return.
Anatomical abnormalities, tumours or stones will need to be removed, often by a surgical procedure in order for the condition to be eliminated.
If pregnant, see your GP immediately who will prescribe anti-biotics, as a urine infection can complicate the pregnancy. Scientists are currently exploring the benefits of acupuncture in the treatment of a UTI.

Prevention

. Drinking plenty of fluids, including cranberry juice will help to stave off infections.

. If you are prone to infections, it may be worth considering a change in sexual practices as this may be the cause.
. When passing water make sure the bladder is fully emptied.
. When using toilet roll, always clean the area from front to back to avoid spreading the bacteria from anus to urethra.
. A diet rich in zinc and vitamin C increase the body’s immunity to infections.
. Urinary tract infections are a very common and often recurrent problem that affects more women than men. By employing some preventative measures the risk of developing a UTI may be lowered, some however will still be at significant risk of developing an infection.

Herbal medication for all women Genital Hygiene

Vagaclean powder is our herbal line of diseases and health problem prevention; it maintains healthy vagina, female organs, urinary tract, and in general good health and high female hygiene at one time.
It eradicates most resistant bacteria, virus, or fungus infection before it does any harm to your organs and your body.

Vagaclean powder is 100% organic herbs, no additives no chemical inside the formula.
It is very gentle and soft for all sensitive parts in your body. It is stringent, and would stop most of the vaginal discharges from happing, protect the urinary tract from infection, and keep your healthy organs maintained.

Package: 50 grams powder in tight container

Uses direction: use one small teaspoon in 3 cups of boiling water. Let it boil for 5 minutes, then let it to cool down or use it as little warm. Put the prepared liquid in a douche container, and start to clean the vagina and area around until the liquid is finished.
Repeat every day in the same time if you feel there is still dissatisfaction or abnormal discharge continues.

Price: 10 USA dollars or 30 RM inside Malaysia + shipping accordingly.

Insomnia, Difficulty falling asleep

What Is Insomnia?

Insomnia is a sleep disorder in which a person experiences poor sleep or has trouble sleeping. Insomnia can involve:

. Difficulty falling asleep
. Difficulty staying asleep (that is, waking up many times during the night), without necessarily having had any difficulty falling asleep
. Waking up too early in the morning
. Not feeling refreshed after a night's sleep

In any of these cases, the person feels tired the next day, or feels as if he or she did not have enough sleep.
Poor sleep for any length of time can lead to mood disturbances, lack of motivation, decreased attention span, trouble with concentration, low levels of energy, and increased fatigue.
About one-third of the average person's life is spent sleeping. Healthy sleep is vital to the human body and important for the optimal functioning of the brain and other organs.

There are three types of insomnia:

. Transient, or mild, insomnia - sleep difficulties that last for a few days; there is little or no evidence of impairment of functioning during the day
. Short-term, or moderate, insomnia - sleep difficulties that last for less than a month, that mildly affect functioning during the day, together with feelings of irritability and fatigue
. Chronic, or severe, insomnia - sleep difficulties that last for more than a month, that severely impair functioning during the day, and cause strong feelings of restlessness, irritability, anxiety, and fatigue

Need To Know:

Q: What is the right amount of sleep I should get?

A: Since everyone has different sleep needs, there is no "correct" amount of sleep. On average, most people need between seven and nine hours of good quality sleep each night in order to feel alert the next day. But some function perfectly well with only four or five hours a night. The key to healthy sleeping seems to be a consistent pattern, rather than the number of hours one sleeps.

Is Insomnia Serious?
Insomnia can have physical and psychological effects. The consequences of insomnia include:

. Impaired mental functioning. Insomnia can affect concentration and memory, and can affect one's ability to perform daily tasks.
. Accidents. Insomnia endangers public safety by contributing to traffic and industrial accidents. Various studies have shown that fatigue plays a major role in automobile and machinery accidents. As many as 100,000 automobile accidents, accounting for 1,500 deaths, are caused by sleepiness.
. Stress and depression. Insomnia increases the activity of the hormones and pathways in the brain that cause stress, and changes in sleeping patterns have been shown to have significant affects on mood. Ongoing insomnia may be a sign of anxiety and depression.
. Heart disease. One study reported that people with chronic insomnia had signs of heart and nervous system activity that might put them at risk for heart disease.
. Headaches. Headaches that occur during the night or early in the morning may be related to a sleep disorder.
. Economic effects. Insomnia costs the U.S. an estimated $100 billion each year in medical costs and decreased productivity.

Normal Sleep
Sleep is not a simple process. Many different parts of the brain control and influence sleep at different stages. There are two natural daily peak times for sleeping: at night and at mid-day, which in parts of the world is traditional "siesta" time.

Here is how the body initiates sleep:

. As light fades, cells in the retina of the eye send a signal to a cluster of nerve cells located in the hypothalamus, in the center of the brain.
. These cells in turn send a message to the pineal gland in the brain to produce the hormone melatonin, which causes a drop in body temperature and sleepiness.
. At the same time, another cluster of nerve cells in the brain is believed to deactivate three major chemical messengers in the body, that keep us alert: histamine, norephinephrine, and serotonin.

There are two distinct phases of sleep:

. Non-rapid eye movement (Non REM) sleep - The quiet or restful phase of sleep, also referred to as "slow wave sleep"; it is divided into four stages of progressively deepening sleep
. Rapid eye movement (REM) sleep - The phase of sleep in which the brain is active and dreaming occurs; it is also known as "dream sleep"

When we first go to sleep, the "brain waves" (the electrical activity normally produced in the brain) slow from a frequency of 10 cycles per second that usually occurs while we're awake, to about 6 cycles per second as our alertness decreases and we fall asleep. Then after about an hour, there is a sudden increase in brain wave activity for a few minutes when the electrical activity in the brain speeds up, similar to normal waking. This is REM sleep. During this time if the person is woken up, he will say he was dreaming.

Then the electrical activity of the brain slows down again. This cycle may be repeated several times during one night's sleep. Total REM sleep for the night is about 20% of the total sleep time. So we spend about a fifth of our sleeping time dreaming.

The phases of sleep occur in a repeated cycle of Non REM followed by REM sleep, with each cycle lasting about 90 minutes. The sleep cycle is repeated four to six times a night. It is possible to identify which stage of sleep a person is in by measuring different activities of the brain and body.
Each phase of sleep is important. Research suggests that Non REM sleep may play a role in bolstering the immune system and may also be tied to the rhythms of the digestive system. Experts believe that REM sleep is necessary for long-term emotional well-being and may help bolster memory.

Need To Know:
If your insomnia lasts longer than a few weeks and is affecting your mood, relationships, and ability to function well, it is a good idea to see a doctor, therapist, or sleep specialist.

What Are Sleep Disorders?
An estimated 40 million Americans experience some type of sleep disorder, but 95 percent of them go undiagnosed and untreated, simply because they do not realize they have a problem or because they think that nothing can be done for them.

Common sleep disorders include:

Insomnia, an inability to sleep or to remain asleep throughout the night
Obstructive sleep apnea, in which a person's breathing passages become temporarily blocked during the night; this condition is often marked by excessive snoring
. Chronic sleep apnea, a neurological condition in which the brain "forgets" to instruct the body to breathe

. Restless leg syndrome, in which a person has occasional movement and/or uncomfortable sensations in his or her legs, feet, or toes just before they fall asleep

. Hypersomnia, an increase in sleep by about one-fourth of a person's regular sleep patterns
. Narcolepsy, in which a person gets sudden attacks throughout the day and night of drowsiness and sleep that cannot be controlled
. Parasomnias, which are vivid dreams and physical activities that occur during sleep, such as sleepwalking (somnambulism) and episodes of screaming and flailing about (night terrors).

Nice To Know:
Chronic sleep deprivation - in which a person sleeps soundly, but just doesn't get enough sleep - is not classified as a sleep disorder, but it contributes greatly to our sleepy society. Experts say most of us need at least one more hour of sleep per night than we get.

Facts about insomnia:
. Studies estimate that about one-third of the adult population in the world experiences some insomnia each year.
. Experts estimate that only about 5 percent of people with insomnia seek medical help, and 69 percent never even mention the problem to their doctor.
. More than 35 million Americans suffer from long-lasting insomnia, with 20 to 30 million others experiencing shorter-term sleeplessness.
. Insomnia costs the U.S. approximately $100 billion each year in medical costs and decreased productivity.
. In the U.S., as many as 100,000 automobile accidents and 1,500 deaths from these accidents are caused by sleepiness.
. In one study, 40 percent of people with insomnia also had a psychiatric disorder.
. At least 70 percent of people with depression also experience insomnia.
. As many as 25 percent of people with anxiety disorders also experience insomnia.
. Substance abuse - especially alcohol, cocaine, and sedatives - plays a role in an estimated 10 to 15 percent of cases of chronic insomnia.

How Is Insomnia Diagnosed?
Insomnia is almost always the result of some other problem and is not an 'illness' in its own right. Discovering its cause is the most important step in relieving it. Your doctor will ask questions such as:

. How would you describe your sleep problem (for example, do you have trouble falling asleep, or is the problem waking up too early)?
. How long have you been experiencing the problem?
. Does it occur every night?
. Does it affect your daytime functioning?
. Do you snore?
. Do you have any medical conditions?
. Are you taking any medication?

Nice To Know:
Keeping a sleep diary can help your doctor make a diagnosis. You should record all sleep-related information such as how long it took you to fall asleep, how restful the sleep was, what you ate or drank before bed, how often you woke during the night, etc. Your bed partner can also help by adding observations about whether you snored, moved in your sleep, etc.

Most of the time, a physician can make a diagnosis of insomnia from the information provided by the person. But if unexplained insomnia persists, or if there is evidence that the sleep disorder is caused by a breathing problem, a doctor may suggest a sleep study at a sleep lab to identify the root of the problem.

Getting Help At A Sleep Lab
There are many excellent sleep labs throughout the U.S. that are designed to diagnose sleep disorders through a sleep study. Most require spending one or more nights in the lab. The American Sleep Disorders Association has a list of the accredited sleep labs in the United States.

Most sleep labs require a referral from your doctor. However, you may want to call and find out if you can have an evaluation done independently. Once you have made an appointment, you will receive complete instructions as to what tests will be done and what is required of you.

How-To Information:

How is a sleep study done?

A sleep study is conducted overnight. The individual arrives in the early evening and plans to spend the night in a bed in the sleep lab. Although a sleep study may look high-tech, it is pain-free and individuals are usually quite comfortable.
Electrodes will be attached with soft tape to various parts of the body, including the head, chest and legs. A belt may be placed around the abdomen and chest. These devices are linked to computerized equipment that record the body's sleep patterns through the night.

Recordings are made of brain wave activity, respiration (breathing), heart rhythm, eye movements, chest movements, arm and leg movements, and pulse oximetry, which measures the level of oxygen in the blood. In the morning, there is a wealth of data that can be analyzed.

Nice To Know:
Q: Will my insurance pay for a sleep study?

A: Most authorized sleep studies are considered medical procedures and are covered by most insurance companies, including Medicare. Check with your insurance provider to determine if your policy covers a sleep study.

How Is Insomnia Treated?
Sleep research has led to major advances in the treatment of insomnia. Many experts now consider sleeping pills to be overused, as well as dangerous because they can become addictive. They suggest that medication be used a last option, after other treatments have been tried.

Non-medicine treatment options include:
Physical Relaxation

If you are anxious about falling asleep, certain muscles in your body become tense and sometimes painful, interfering with sleep. Physical relaxation techniques can help.

. Find a quiet, peaceful place in which to practice the following technique about 30 minutes a day:
. Lie perfectly still until you find the most comfortable position for yourself. Now deliberately tense up the muscles in your arms and legs as tightly as you can. Try to hold this tension for about a minute and then let the muscles relax gradually-first your legs, and then your arms.
. Now let your whole body feel as relaxed as it possibly can. Take a rest for five minutes and then repeat the procedure twice more.
. At the end of the session, try to concentrate on the feeling of your muscles and let them go as limp and relaxed as possible for the rest of the period. Try to make your breathing slow and steady as you relax.

.This technique is designed to teach individuals how their body relaxes and how to control relaxation and tension.

Mental Relaxation

Since stress and worry, including the worry about not being able to fall asleep, are often at the core of insomnia, many people have found that mental relaxation techniques can help them to feel less anxious and therefore sleep better.

This method also requires finding a peaceful, quiet place to practice this technique for about 30 minutes a day:

. Try to relax your body first, by finding the most comfortable position for yourself. Then empty your mind of all thoughts by concentrating on one particular object in the room or a particular part of the room.
. After a minute, sit up, and then walk around for a bit. Then return to your position and repeat the exercise.
. Now think of a particularly happy time in your life that you really enjoyed. If you cannot immediately think of something, find a poster of some exotic place or beautiful scenery. Concentrate on imagining yourself in this place for about five minutes.
. Try to feel the sensations first in your neck muscles, and then in your arm and leg muscles, as they gradually become relaxed. After another few minutes, get up and walk around the room a bit. Then repeat the process.
This exercise differs from the physical technique in that it emphasizes controlling the psychological components of anxiety before attempting to relax your body.

Other Techniques
Other relaxation techniques to try include:

. Yoga or meditation
. Exercise (shown in studies to be an effective way to achieve a healthy sleep)
. Mind-body therapies such as guided imagery or hypnotherapy
. Reading while lying in a relaxed position
. Listening to music while lying in a relaxed position
. Having a soothing bath or shower before bed
. Massage, especially of the neck, shoulder, and leg muscles

Need To Know:
Some people find psychotherapy (the treatment of mental and emotional disorders with professional counseling) very helpful in relieving anxiety or depression that could be contributing to insomnia.

Can Medication Help Insomnia?

Sleep medications should not be taken lightly. Low-dose sleep medication can help short-term insomnia but is rarely helpful for long-term sleep problems. Many experts today recommend only trying medications as a last resort, after other treatments for insomnia have failed, because they can be addictive and can have serious side effects.

Hypnotics (sedatives, minor tranquilizers, and antianxiety drugs) are among the most commonly used medications for insomnia.
. Most hypnotics require a doctor's prescription because they may be habit-forming or addictive, and overdose is possible.
. Many hypnotics can lose their effectiveness once a person has become accustomed to them.
. Hypnotics also may produce withdrawal symptoms, and this can make the insomnia return. For this reason, doctor's recommend reducing the dose slowly; complete withdrawal can take several weeks.

Sleep medications are available as:

Over-The-Counter Medications
Two inexpensive medications available without a prescription that can relieve mild or occasional sleeping problems are diphenhydramine and dimenhydrinate.

. These medications can leave you drowsy the next day, but they are not addictive.
. Side effects include dizziness, blurred vision, and dry mouth.
. They should not be used be used by people with angina, heart arrhythmias, glaucoma, prostate problems, or urinary problems.

Over-the-counter medications for insomnia are purchased more than any other type of drug.

Commonly used over-the-counter sleep medications include Nytol, Sleep-Eez, and Sominex.
When sleeplessness is caused by minor pain, over-the-counter pain relievers such as acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (Advil, Motrin) can be very helpful.

Some newer medicines (such as Anacin P.M., Excedrin P.M., and Tylenol P.M.) contain both a sleeping medication and a pain reliever.
Antihistamines have a sedating effect and may be used as mild sleep inducers. They include chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl).

Need To Know:
About melatonin supplements

You may have heard about the treatment of insomnia with melatonin supplements. Despite its widespread use, little is actually known about the long-term safety of melatonin supplements. The U.S. Food and Drug Administration does not monitor melatonin, and many of the melatonin products sold in health food and supplement stores contain unknown substances.

Prescription Medications
Prescription medications for insomnia should be taken at the lowest dose possible. Various types of prescription medication include:

. Benzodiazepines. These are the most common and safest hypnotics. They include lorazepam (Ativan), alprazolam (Xanax), triazolam (Halcion), and temazepam (Restoril), among others. Side effects include respiratory symptoms, daytime drowsiness, memory loss, and odd mood states. Benzodiazepines are potentially dangerous when combined with alcohol and should not be taken by people who use the ulcer medication cimetidine (Tagamet).

. Non-benzodiazephines. These hypnotics may pose less of a risk of dependence. They include zolpidem (Ambien), zopiclone, and zaleplon. Side effects include nausea, dizziness, nightmares, agitation, and headache.

. Antidepressants. These can relieve insomnia associated with depression or early morning awakening. Newer antidepressants include trazodone (Desyrel), nefazodone (Serzone), and paroxetine (Paxil). These medications have far fewer side effects, and much less danger for overdose, than other anti-insomnia drugs.

Need To Know:

What are the ground rules for being prescribed sleeping medication for insomnia?
Simply put, the focus should be on what's causing the insomnia and not simply on giving treatment to help someone sleep. For example, is the insomnia due to a brief short-lasting worry, or is it a symptom of an underlying disorder such as depression? Sleeping pills do not relieve such an underlying disorder, whereas antidepressants usually do.

Many experts suggest the following ground rules:
. Try to avoid benzodiazepine sleeping pills and use a nonaddictive one instead.
. Try to take them only occasionally and not make a habit of it.
. Accept that the course of treatment will be short (no more than two weeks) and the prescription will not be repeated.

Nice To Know:
For women who have reached menopause, hormone replacement therapy (HRT) helps prevent insomnia caused by hot flashes, a common symptom of menopause. Studies have shown that women who take HRT seem to fall asleep faster, have fewer wakeful periods, and sleep longer than those not taking estrogen.

How Can I Avoid Insomnia?
Prevention of sleeplessness is very much dependent on your ability to relax and learn techniques for sleeping well.

How-To Information:

Here are some tips to help improve your sleep:
. Learn to use physical and mental relaxation techniques.
. Establish a regular sleep schedule. This involves setting a regular bedtime and wake-up time and making every attempt to stick to it, including on the weekends. This will help to set the body's clock in a way that will make nighttime sleep deeper and more consistent.
. Avoid taking naps, especially in the afternoon.
. Exercise regularly during the day.
. Use the bed only for sleep and sex, not reading or watching television.
. If you do not fall asleep fairly quickly, get out of bed. Do not return until you are feeling drowsy.
. Try to reduce stress in your life, or find better ways to cope with stress. .
. If it is noisy in your bedroom, introduce some form of "white noise" such as a rotating fan.
. Do not over-focus on falling asleep by watching the clock.
. Create a bedroom environment that is quiet, relaxing and peaceful.
. Set up a regular bedtime routine that revolves around an activity that helps you unwind.
. Avoid caffeine, and other stimulants, especially late in the day.
. Eliminate smoking. It has a detrimental effect on the lungs, heart, sinuses, and circulation, and it also interferes significantly with sleep, as nicotine is a stimulant that prevents the brain from resting. Cutting back on cigarette smoking may lead to nicotine withdrawal in the middle of the night, which can awaken you, so it is important to stop smoking completely.
. Avoid alcohol. Even if it helps you fall asleep quicker, it actually worsens insomnia by causing shallow, unrefreshing sleep.

Frequently Asked Questions

Here are some frequently asked questions related to insomnia.

Q: What is the right amount of sleep I should get?

A: Since everyone has different sleep needs, there is no "correct" amount of sleep. On average, most people need between seven and nine hours of good quality sleep each night in order to feel alert the next day. But some function perfectly well with only four or five hours a night. The key to healthy sleeping seems to be a consistent pattern, rather than the number of hours one sleeps.

Q: How can I tell if I am getting enough sleep?

A: Here are some simple questions to ask yourself to test for sleepiness:
Do I need to set an alarm clock in order to wake up in the morning?
If so, do I usually press the snooze button?
Do I feel like I need a nap during the day?
Do I fall asleep while watching TV?
Does reading a book make me feel sleepy?
If you answer yes to more than one of these questions, you are not getting enough quality sleep to meet your needs.

Q: What can I do to avoid insomnia?

A: Here are some rules to abide by:
Don't exercise just before going to bed.
Don't read or watch television in bed.
Don't use alcohol to help you sleep.
Don't take another person's sleeping pills.
Don't participate in stimulating activities just before bed.
Avoid all foods and drinks containing caffeine close to bedtime.
Don't lie in bed fretting. If you can't sleep, get up and do some quiet activity. Only return to bed when you are sleepy. Do this as many times in a night as necessary.

Q: Does insomnia ever go away on its own?

A: Sometimes insomnia does go away on its own. Usually this happens with short-term insomnia that is due to some temporary stress in your life. When it persists, however, it may be a sign of another illness, such as anxiety or depression, and you should seek treatment.

Q: What is REM sleep and why is it important?

A: REM sleep stands for rapid eye movement sleep. For most of the night, our eyes are still. However, every so often the eyeballs of a sleeping person will make rapid side-to-side movements under the lids. People woken up during these times report that they have been dreaming. During REM sleep the muscles of the body are very relaxed and movements are difficult. Some believe this semi-paralysis of the muscles stops us from walking around or otherwise acting out the scenes being played out in our dreams. Although adults spend only a fifth of the night in REM sleep, a newborn baby may spend half of its sleep in this stage. Some studies suggest that REM sleep is particularly useful for growth and repair of the brain itself, while the other type of deep, or slow-wave, sleep is useful for repair of the rest of the body.

Q: Why is alcohol detrimental to sleep?

A: After we have had a few drinks, alcohol often causes drowsiness and lets us get off to sleep quite easily. Later in the night, however, when the alcohol level in our blood decreases, our body's arousal mechanism is stimulated and our normal sleep pattern is impaired. In addition, one of the effects of alcohol is to stimulate the pouring of adrenalin into the bloodstream, causing arousal, sweating and palpitations. This can result in waking up half-way through the night, or earlier than normal, with the heart pounding, making it quite difficult to get to sleep again.

Q: Will my insurance pay for a sleep study?

A: Most authorized sleep studies are considered medical procedures and are covered by most insurance companies, including Medicare. Check with your insurance provider to determine if your policy covers a sleep study.

Putting It All Together

Here is a summary of the important facts and information related to insomnia.
Insomnia is a sleep disorder in which individuals experience poor sleep or have trouble sleeping.

. Poor sleep for any length of time can lead to mood disturbances, lack of motivation, decreased attention span, trouble with concentration, low levels of energy, and increased fatigue.
. Factors that increase a person's chances of developing insomnia include being female, being elderly, having certain medical conditions, taking certain medications, having had childhood fears, and having a lifestyle that includes frequent travel, smoking, or overuse of alcohol or caffeine.
. Insomnia has psychological causes (such as anxiety or depression), physical causes (such as illness or pain), and other causes (such as jet lag or environmental noise).
. The consequences of insomnia include impaired mental functioning, a higher risk for accidents, stress and depression, heart disease, and headaches.
. Treatment options for insomnia include physical and mental relaxation techniques, other techniques (such as yoga, massage, or meditation), and medications (over-the-counter or prescription).
. Prevention of sleeplessness is very much dependent on your ability to relax and learn techniques for sleeping well.

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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.

Cockroaches

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

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

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.

Irritants

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

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.

Nighttime

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.
Weather

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

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.

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