Asthma - How to Participate in Managing Your Asthma

Cockroaches

Allergy to cockroaches is thought to stem from exposure to the feces, saliva, and bodies of these insects. These substances are commonly found in house dust, particularly in urban locations. A recent study of asthma occurring in a large city found a strong connection between allergy to cockroaches and the number of asthmatic attacks. The increased frequency of asthma as well as fatal asthmatic attacks in the United States has been predominantly in innercity residents. As many as 60 percent of urban asthmatics are allergic to cockroaches. All asthmatics should be aware of this potential allergy and if cockroaches are present in their homes, invoke control measures. These measures should include control of sources of food and water, routine cleaning, and regular use of insecticides such as hydramethylnon and avermectin in the form of bait.

Reducing Indoor Pollution

Asthma attacks may be precipitated indoors by airborne irritants that are not allergens. In the home, commonly found irritants include tobacco smoke, strong odors, and pollutants from gas stoves, wood stoves, and fireplaces.

Active Smoking

Patients with asthma who smoke do not have to look far to find a reason to stop. Cigarette smoking is the leading cause of respiratory illness and death in the United States. All of these illnesses and deaths are preventable. Cigarette smoking may cause permanent damage in the lung, leading to emphysema and chronic bronchitis. It should be clear to the individual with asthma who smokes that this habit may change a reversible disease (asthma) to an irreversible and often fatal disease (emphysema). In addition, cigarette smoking has been shown to increase "irritability" of the bronchial tubes and may therefore be considered a cause of asthma. It has been documented that smoking affects the immune system and the defense of the lung against infection. Smokers have higher rates of sinus and bronchial infection than do nonsmokers. These infections may trigger asthmatic attacks.

Despite these facts and many others that link cigarette smoking to cancer of the lung and other organs, many patients with asthma continue to smoke. Some stop during attacks and resume when they feel better.

How to Stop Smoking

There is no foolproof method of stopping, but some measures have proved helpful. A patient should work closely with a physician, reviewing pulmonary function tests that may already show permanent changes, supporting the decision to quit. It also helps to review the benefits of stopping. Studies have documented that patients who stop smoking have a marked reduction in cough, wheezing, expectoration, and shortness of breath. This may occur as soon as one month after stopping. Reports also show that there are fewer infections and improvement in pulmonary function tests after smoking cessation. It is often helpful to demonstrate with a peak flow meter that smoking one cigarette can produce a drop in air movement. The next step is to set a "stop date." It can also help to sign a stop smoking contract with the physician.

A great deal of information has documented the powerful addictive properties of nicotine. Your physician can help you assess the degree of physical addiction and the role of psychological dependence. For patients with physical addiction, replacement therapy with nicotine in the form of chewing gum or a patch may be helpful. A low dose of an antidepressant medication, bupropion (Zyban), has also been found to be helpful in smoking cessation. Other measures can be recommended if this is not successful. A psychological dependence can also be treated successfully. In every patient the message must be clear: "You must stop smoking."

Allergy to cockroaches is thought to stem from exposure to the feces, saliva, and bodies of these insects. These substances are commonly found in house dust, particularly in urban locations. A recent study of asthma occurring in a large city found a strong connection between allergy to cockroaches and the number of asthmatic attacks.

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