Asthma varies a great deal from one person to another. Symptoms can range from mild to moderate to severe and can be life threatening. The episodes can come only occasionally or often. The symptoms of asthma are a major cause of time lost from school and work and sleep disturbances. However, with proper treatment these symptoms can almost always be controlled.

Asthma cannot be cured, but it can be controlled with proper treatment. People with asthma can use medicine prescribed by their doctor to prevent or relieve their symptoms, and they can learn ways to manage episodes.

They also can learn to identify and avoid the things that trigger an episode. By educating themselves about medications and other asthma management strategies, most people with asthma can gain control of the disease and live an active life.

What causes asthma?

The basic cause of the lung abnormality in asthma is not yet known. Through research, scientists have established that this lung abnormality is a special type of inflammation of the airway that leads to contraction of airway muscle, mucus production, and swelling in the airways.

The airways become “twitchy,” overly responsive to environmental changes. This results in wheezing and coughing. Some researchers think that the wheezing and coughing may be set off by an abnormal reaction of sensory nerves in part of the overall inflammation reaction.

A variety of known triggers can set off an asthma episode. They include:

Allergens (substances to which some people are allergic) such as pollens, foods, dust, mold, feathers, or animal dander (small scales from animal hair or feathers);

Irritants in the air such as dirt, cigarette smoke, gases and odors;

Respiratory infections such as colds, flu, sore throats, and bronchitis;

Too much exertion such as running upstairs too fast or carrying heavy loads;

Emotional stress such as excessive fear or excitement;

Weather such as very cold air, windy weather, or sudden changes in the weather;

Medication such as aspirin or related drugs and some drugs used to treat glaucoma and high blood pressure.

Each person with asthma reacts to a different set of triggers. Identifying one’s own triggers is a major step towards learning to control asthma attacks. Although episodes can sometimes be brought on by strong emotions, it is important to know that asthma is not caused by emotional factors such as a troubled parent-child relationship.

Some people believe that asthma is “all in one’s head” and therefore not a “real” illness. That could not be further from the truth. Asthma is a disease, not a psychosomatic illness or a sign of emotional disturbance.

Who gets asthma?

Asthma has been diagnosed in nearly 10 million Americans; of these 3 million are children under the age of 18. About the same number of men and women have asthma. Slightly, a higher percent of blacks have asthma than whites; 4.4 percent of American blacks have asthma, while 4.0 percent of American whites have the disease. The reported number of cases of asthma is increasing. This increase is occurring in all age, race, and sex groups.

How is asthma diagnosed?

Asthma is sometimes hard to diagnose because it can resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. For that reason, it is under-diagnosed; many people with the disease do not know they have it; and therefore are under-treated. Sometimes the only symptom is a chronic cough, especially at night. Or, coughing or wheezing may occur only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of a medical history, a thorough physical examination, and certain laboratory tests. These tests include spirometry (using an instrument that measures the air taken into and out of the lungs), peak flow monitoring (another measure of lung function), chest X-rays, and sometimes blood and allergy tests.

Is there any warning of an asthma episode?

Usually, certain signs occur hours or days before audible wheezing or before an episode is fully in progress. These early signs vary a great deal among individuals. Some people have an itchy chin or throat or a dry mouth. Others may feel very tired or grouchy. Common warning signs include light wheezing or coughing pain or a tight feeling in the chest, shortness of breath, or restlessness. Becoming aware of these signals helps patients use self-management techniques as soon as possible. This early action may ward off a severe episode.

To sum up, here are a few general guidelines that may help prevent or lessen episodes:

Identify and avoid personal asthma triggers. However, if exercise is a trigger, consider medication before exercise.

Take prescribed medicines on time, in the correct way, and in the correct dose.

Recognize early warning signs of asthma.

Take peak flow meter readings to monitor lung function.

Take action when warning signs occur.

Have a personal plan for managing attacks, worked out with a physician.

Try to stay calm if an episode may be coming on and know what to do, and do it.

Do not wait too long to get a doctor’s help if needed.

Stay healthy and get enough rest, eat properly, drink plenty of liquids, and exercise regularly.

Do not become accusatory when an attack happens. Social situations are hard for a person with Anxiety, even worse when it becomes a Panic Attack, which often lead to phobias that you cannot understand.

Signs and Symptoms

Here are some of the symptoms a person experiencing an attack may have, usually all or majority exists during an attack. Feelings of numbness in hands, arms and legs, rapid, heartbeat, tightness in chest and throat, complaints of inability to swallow or feeling of lump in throat, hyperventilation, stomach upset, butterflies, weakness, fatigue (lethargy), tremors or “shakes”, dizziness, sweaty, racing thoughts, confusion, inability to concentrate, feeling of detachment, muscle tension, and finally the most important is the fear of dying or impending doom.

Causes

Many factors can cause these attacks. PSTD (Post Traumatic Stress Disorder) this can be from something that happened from childhood to adulthood many abused women have this disorder, OCD Obsessive Compulsive Disorder, Manic Depressive Illness, Generalized Depression, Menopause due to change in hormones and Mitral Value Prolapse to name a few.

Treatment

There are many other resources available to help cope with a family member with this disorder. Check your local Mental Health Center for support groups. Often a Psychologist and Psychiatrist will work together to help the patient live a normal life. This may or may not include family counseling. Medications commonly used to treat this disorder are Xanax, Tranxene, Elavil, Prozac, Paxil, Zoloft, Ativan, and Buspar are just a few. Each year there are new medications that become available. The problem with using some of these medications is that they can become habit forming.

25 million Americans suffer from allergic reactions to molds, most of them don’t even realize that when they’re sneezing and sniffling the cause could be molds. Many molds produce airborne toxins that can cause serious breathing difficulties, memory and hearing loss, dizziness, flu-like symptoms, and bleeding in the lungs. Common ailments from mold—including allergies, asthma and bruising—usually can be treated and reduced after people leave their contaminated environment. But other health problems may remain permanently, such as brain damage and weakened immune systems.

Fungus reproduces into spores that come in many different sizes, shapes and colors. The spores will reproduce and germinate into new mold growth which in turn can produce millions of more spores. Molds are most prevalent from spring through late fall, but,in warm climates, molds thrive all year and can cause year-round problems.

Molds can be found wherever there is moisture, oxygen, warmth and something to feed on. In the fall they grow on rotting logs and fallen leaves, especially in moist, shady areas. In gardens, they can be found in compost piles and on certain grasses and weeds. Molds grow in our homes in moist warm areas like damp basements, closets, and bathrooms. Also molds can grow in places where fresh food is stored, refrigerator drip trays, house plants, humidifiers, garbage pails, mattresses, upholstered furniture, or foam rubber pillows. Molds can grow inside the walls and flooring of our homes, wherever there are wet cellulose materials they can feed on, such as wood, ceiling tiles, or plasterboard.

Molds come in at least a thousand different varieties, but only a few are the offenders that invade our homes. Alternaria and Cladosporium are the molds most commonly found both indoors and outdoors throughout the United States. Aspergillus, Penicillium, Helminthosporium, Epicoccum, Fusarium, Mucor, Rhizopus, and Aureobasidium are also common. The most dangerous mold strains are: stachybotrys (pronounced Stack-ee-BOT-ris). This black fungus releases toxic, microscopic spores that cause the worst symptoms that are usually irreversible.

In some individuals, a minor exposure to mold can cause an allergy that can lead to asthma or to a lung disease. The symptoms are wheezing, low-grade fever, and coughing up of brown mucus. You will need to be seen by a doctor is you suspect that your allergies, bronchitis or asthma are related to mold spores. If you have any unexplained severe health problems, you may want to determine if you have been exposed to a dangerous strain of mold spores.

In some people, symptoms of mold allergy can be worsened by eating foods, such as cheeses, that are processed with fungi. Other foods like mushrooms, dried fruits, and foods containing yeast, soy sauce, or vinegar can also produce allergic symptoms. Avoid these foods if you suspect any mold allergies.

To rid your house of mold clean counters, showers, tubs, sinks, window sills or anywhere there is mold with bleach. Fix leaking faucets or pipes that could be dampening walls. Install air conditioning in your home because this dries the air out, making it more difficult for mold to survive. Check houseplant soil, make sure it is not always very damp. Keep firewood outside. Keep your basement as dry as possible. You may want to keep an air purifier in your basement. Clean the bottom of your refrigerator, and underneath it. Clean up all water damage quickly. If your carpet, walls or any flooring is in a flood get an experienced flood specialist to dry it up for you. Any dampness left can cause mold to grow in your walls or under your carpet. When water is left to sit, for even 24 hours, common molds can begin to grow. If water continues to sit and areas become completely saturated, more lethal molds, such as Stachybotrys, can begin to grow.

The tricky thing about these airborne molds is, you may not realize how it has affected your health for quite sometime after you have been exposed. It is important to not live, work or stay for long periods of time in a place that smells mildewy or moldy. If you have done all you can to clean molds that are visible, maybe there is mold under the carpet or in the walls.

If you suspect that the air quality in your home is being compromised by mold spores you can have the air tested, but it can be quite expensive. It’s worth it if it helps save your health.

The situations which cause apprehension vary among people with agoraphobia. Standing in line at the supermarket or bank, getting stuck in traffic, or merely sitting in a movie theater or restaurant — these are a few of the many situations that can cause discomfort and even terror in the agoraphobic. The fear is caused not so much by the particular situations or places, but rather the fear and dread that agoraphobic experiences there.

Many people with agoraphobia experience anxiety attacks (or panic attacks) which may occur only occasionally, or frequently during the course of the day. If allowed to continue untreated, the intensity and frequency of the anxiety attacks can become all-consuming and debilitating, and the sufferer’s “safe” radius is gradually decreased until he or she becomes a prisoner at home, unable to leave his or her home for fear of another attack.

A full-blown case of agoraphobia can often be traced to a single incident: an illness, injury or other stress-provoking situation. Seemingly out of the blue, the symptoms of panic appear: heart palpitations, shortness of breath, dry mouth, clammy hands, dizziness, a profound feeling of impending doom, or a frightening sense of unreality. The victim of these alarming sensations may begin to associate his or her panic with the specific place at which it occurred, and thus begins the pattern of avoidance.

Many sufferers of panic attacks and agoraphobia have rushed to their doctors’ offices or emergency rooms displaying various symptoms of anxiety, only to be dismissed by perhaps concerned yet puzzled caregivers who can’t find anything “wrong” with their patients. Recently, however, many health care providers have become increasingly able to recognize the symptoms of this condition, and after a thorough examination to eliminate any possible physical causes for the symptoms, can recommend a course of action toward releasing the agoraphobic from the prison of his own fear.

There are many effective methods of treating agoraphobia, including cognitive restructuring, or “reprogramming” the negative thoughts which can feed anxiety, behavioral therapy, and pharmacological treatment, or medication therapy. Many doctors agree tend to agree that a greater overall level of improvement can be achieved when a combination of these treatments is implemented. The caregivers and patients ultimately decide together what will work best in individual cases.

Health Issues for the Epileptic:

The most important thing that you can do if you suspect you have a seizure disorder is to give your doctor a detailed medical history, and report any “odd feelings” or instances where you noticeably did not feel like yourself.

Typical symptoms of adults with epilepsy may include mood swings, depression, and loss of memory (particularly short-term memory, like walking into a room to get something and forgetting what it is). More noticeable physical symptoms (specifically, outward symptoms that other people will notice) are repetitive blinking, staring, head nodding, and involuntary muscle jerks.

Drugs Commonly Used to Prevent Epileptic Seizures

Neurologists and family practice doctors commonly prescribe these drugs, listed by brand name (chemical names are in parentheses) to treat seizure patients. (Drug Information for the Health Care Professional; subsections and page numbers for each drug indication accompany the following information.) Adult medicines come in dry pill or capsule form. Medicines like Dilantin are available in syrup form for children with epilepsy. The side effects vary depending on which medication your doctor prescribes.

When you have been diagnosed with epilepsy, and when your physician initiates a regimen of medication, remember that these are powerful drugs that have to be started slowly. Your doctor will most likely give you a baseline dose, and you will gradually increase to the maximum amount of the prescribed dosage so the doctor can assess any side effects that you may experience.

For the sake of these drug descriptions and their meanings, an absence seizure shall be defined as a sudden lapse of consciousness in the victim, accompanied by a blank expression and the occasional lip-smacking. These attacks usually last for a few seconds up to a minute, there is no fall, and the victim can resume activity shortly after. The victim may not realize that they have even had such an attack. (Taber’s Medical Cyclopedia, p12) Another name for these is “petit mal” seizures.

Tonic-clonic (Taber’s, pp608-610) seizures involve a chronic twitching or spasms of various muscles. Typically, these are also called “grand mal” seizures.

Seizure Drugs:

Depakene (valproate)

Side effects: Upset stomach, altered bleeding time, liver toxicity, hair loss, weight gain (prevalent in women), tremor

Indications: Best when used as monotherapy (i.e., as the only medication used to treat seizures, not as one used in combination with a second anticonvulsant). Depakene is prescribed to treat simple and complex absence seizures. (Valproic Acid, Systemic; Drug Information for the Health Care Professional, pp3086-3090)

Depakote (divalproex sodium)

Side effects: Upset stomach, altered bleeding time, liver toxicity (lack of hepatic function), hair loss, weight gain (prevalent in women), tremor (typically in arms and hands), constipation

Additional note: Using Depakene and Depakote in conjunction with other seizure drugs may lead to hepatic toxicity (liver failure). It is not a good idea to start taking either of these if you already have impaired liver function.

Dilantin (phenytoin; one of the oldest anticonvulsants on the market)

Side effects: Clumsiness, insomnia, motor twitching, nausea, rash, gum overgrowth, excessive body hair growth, thickening of features

Indications: Dilantin may actually make absence seizures worse. It works better for prevention of grand mal seizures or mixed seizure patterns, and it is very effective when used in conjunction with phenobarbital and some other anticonvulsants, as long as those drugs do not have any contraindications for using them with hydantoin substances.

Phenobarbital (brand name and clinical name are the same)

Side effects: Drowsiness, irritability, hyperactivity

Indications: (American Hospital Formulary Service Drug Information [AHFS DI]; “Uses and Dosage” section for Phenobarbital; American Society of Health-System Pharmacists)

Tegretol (carbamazepine)

Side effects: Drowsiness, irritability, headache, restlessness, dizziness, and vertigo; more severe but less common are blurred or double vision.

Indications: Adults and children may take Tegretol for partial seizures, grand mal seizures, or for mixed seizure patterns. The drug does not work quite as well to treat petit mal seizures or myoclonic and akinetic seizures. Tegretol is sometimes used with other anticonvulsants such as Dilantin, phenobarbital, or primidone. (American Hospital Formulary Service Drug Information [AHFS DI]; “Uses and Dosage” section for Tegretol; American Society of Health-System Pharmacists)

Topamax (topiramate)

Side effects: drowsiness, irritability, headache, restlessness, dizziness, and vertigo.

Indications: Approved by the FDA in 1999 for treating partial onset seizures in adults and children ages two and up. (Approval letter NDA 20-844, Food and Drug Administration, October 26, 1998).

Other side effects include blurred vision or double vision when combined with drugs like Celontin (classified as a succinimide substance) or hydantoin derivatives like Dilantin. Patients taking Topamax may experience a sense of mental dullness when taking any form of topiramate with phenobarbital or phenytoin. (American Hospital Formulary Service Drug Information [AHFS DI]; “Adverse Effects” section for Topiramate; American Society of Health-System Pharmacists)

Many of these substances and other anticonvulsants cause other GI (gastrointestinal) symptoms such as nausea and vomiting, indigestion, loss of taste, constipation, diarrhea, and appetite loss (anorexia is also not uncommon).

For more detailed information on these drugs, other available anticonvulsants, and their side effects, consult the American Medical Association or the Food and Drug Administration.

Ongoing Treatment of Epilepsy

Your doctor or neurologist may want to schedule visits to monitor your condition, as well as seizure frequency. One tool that they use to do this is regular blood testing. Doctors need to assess your “therapeutic level” (i.e., the level of medication that has benefits to reduce your seizures without creating toxicity in your organs, as all medications pass through your stomach, kidneys, and liver). These blood tests may include basic liver and kidney panels to make sure these organs have not been damaged as a result of the medication.

Safety

Many everyday activities that most people perform without giving it a second thought can be more hazardous to epileptic adults.

First and foremost, epileptics must overcome the obstacle of not being able to drive if their neurologist has not given them the go-ahead. According to the Epilepsy Foundation of America, epileptics are required to submit a letter of approval from their attending physician (most likely a neurologist) to their local Department of Motor Vehicles before they are allowed to obtain a license. Some states also require the epileptic driver to submit periodic reports that they are fit to drive, and to also report any seizures that they have to the DMV.

The Epilepsy Foundation also states that some neurologists are required by the state to report lapses of consciousness to the DMV; for the most part, EFA opposes this (The Answer Place; Driving). According to Dr. Gregory Berkley, a neurologist affiliated with EFA, “An aura is still a seizure.” Obviously, auras can be considered a gray area.

In “Driving Safely with Epilepsy,” an article published in the June 28, 1999 issue of HealthNews (Massachusetts Medical Society), epileptics must be especially careful to avoid factors that lower their threshold of control if they wish to drive. Missing a dose of medication, coping with illnesses like the flu (or any sickness that makes you faint), vomiting (which can thin the amount of medicine in your bloodstream), loss of sleep, and drinking alcoholic beverages are all contraindicated for epileptics that drive.

Epileptics who experience prolonged auras that warn them of an imminent seizure may have more luck pulling over and stopping the car before they crash. In the same issue of HealthNews, 26 percent of seizure victims with “reliable” auras still crashed because they couldn’t pull over in time. What we can take from this is that there may be no such thing as a completely “reliable” aura.

Other Safety Considerations

For the epileptic, some sports are best left alone. The “Lifestyle Changes Imposed by Epilepsy” (Epilepsy Education Association, Inc.) information booklet recommends that people with epilepsy avoid sports that cause any noticeable metabolic changes in the body that could lower your seizure threshold. This may be hard for the adult athlete that thinks he or she is invincible. Scuba diving and mountainclimbing may limit the athlete’s available oxygen and lead to a loss of consciousness. Sports with a high risk for head injury, or that allow for repeated blows to the head (i.e., boxing) are also contraindicated for the epileptic athlete. A few other sports described as risky for epileptics in this booklet were bungee jumping, skydiving, surfing, and hang gliding.

By the same token, jobs that involve the risk of losing consciousness or operating large and heavy equipment may not be suitable for employees with epilepsy. Some examples include flying a commercial plane or driving a diesel truck. A high-altitude occupation like skyscraper construction involves the same risks as a sport like skydiving.

Social Issues

Depression in epileptic adults is a common phenomenon. From 1975 to 1995, the prevalence of depression in adult epileptics has fluctuated from 34 to 78 percent (Journal of the American Academy of Child and Adolescent Psychiatry; Sept 1999; David W. Dunn). Along with depression, these same patients are known to have mood swings, irritability, and explosive bursts of anger. This may make it difficult for epileptics to get along with their peers, or for someone else to understand why they are behaving this way.

In light of the tendency of the epileptic person to stare and “space out”, whether it is because of the medicine they are taking or their disorder itself, their peers might gather the impression that they are “not entirely there.”

The labeling on most anticonvulsants (Depakote, Tegretol, and phenobarbital in particular) will tell the consumer not to mix them with alcohol. This may place a damper on the social lives of people who frequent parties or other places where alcohol is easily available or being imbibed all around them.

People who have epilepsy will do well to inform their immediate manager or supervisor of their condition, and of any medical precautions in the event that they have an attack on the job. It is wise to enter this information on job applications when you first apply in the section where it asks you if you have a disability. However, it is also wise to explain that this “disability” will not prevent you from doing the job to the best of your ability.

The choice to wear an emergency identification bracelet is up to the person with the disorder, not their employer or their physician. While it is helpful for someone to know that you are epileptic or that you are taking a certain medication when you have a seizure, only you can assess whether you want someone else to know about your condition as “matter of fact” information.

In keeping with the emphasis that we have placed on epileptics driving with discretion and increased caution (if at all), parents with epilepsy must remain resourceful if they have to get their children back and forth to school, doctor’s appointments, and day care. Carpooling, transit buses, and taxis are some options; in lieu of these options, the epileptic parent may want to arrange to work from home as a means of not sacrificing their “reliability” in the workplace. Look in any classified ad in the newspaper, and you may find “Must have own transportation and clean DMV.” Epileptics who have lost their license due to seizure activity will not meet these criterion.

If adolescents that have just begun to learn to drive place a lot of importance on getting a license, and on feeling like an adult because they can finally drive, then many epileptic adults have to accept that just because they cannot drive does not mean they are not grownups by the classic definition.

Helpful Foundations

The Department of Motor Vehicles (Consult them for driving regulations specific to your state).

Epilepsy Foundation of America (you may also find individual chapters of EFA for each state)

American Medical Association

Epilepsy Education Association, Inc.

The Charlie Foundation

Problems associated with this illness affect the nervous system, lungs, muscles and heart. Below 7,000 feet effects are few. At 9,000 feet or more effects are common with rapid ascent. Most people can adjust to the changes within a few days up to 10,000 feet. Altitudes beyond 10,000 feet may take days or weeks to acclimate.

Symptoms

Common symptoms may be a dry, continuous cough, shortness of breath at rest which increases during daily activities, sleeping difficulty, rapid pulse, loss of appetite, nausea or vomiting, confusion, fatigue, or coughing up blood. Twenty percent of people have severe headaches. Sometimes the headache is severe enough to awaken one from sleep. The headache can be aggravated by lying down or sitting up, sneezing, straining or lifting.

Additional symptoms include transient vision problems, unilateral (one side) eye drooping, facial swelling, swelling around the eye sockets, and/or unilateral pupil enlargement.

Symptoms of confusion, withdrawn behavior or swelling of lower extremities are also possible. A bluish tint to the skin (cyanosis) is common due to lack of oxygen in the blood.

Complications

High Altitude Pulmonary Edema:

This is a more serious illness that can follow an episode of acute mountain sickness. It occurs when fluid accumulates in the lungs. Shortness of breath is present with the slightest effort made, a tickling dry cough may turn loose and bubbly with production of phlegm which is pink or blood tinged.

High altitude pulmonary edema may worsen quickly and become life threatening within just a few hours.

High Altitude Cerebral Edema

This is the most serious of all complications and needs to be treated promptly. It usually develops within 24 to 96 hours after arriving at higher altitudes. High altitude cerebral edema may be preceded by acute mountain sickness or high altitude pulmonary edema.

Fluid accumulates in the brain causing difficulty walking (ataxia). The ataxia is accompanied by clumsy hand or finger movements. Headaches will be more severe than with acute mountain sickness, hallucinations may develop as the condition progresses. The higher the altitude, the greater the impairment of function and perception will be. This condition can also progress from mild to life threatening very quickly.

Treatment

Most people recover from acute mountain sickness quickly after being moved to a lower altitude. Increased oxygen to the body helps to relieve symptoms. Mild acute mountain sickness is usually treated by replacing fluids lost during sweating and rapidly breathing dry, thin air. Persons with high altitude pulmonary edema need to be observed closely. Usually bed rest and oxygen therapy are enough. If this doesn’t relieve symptoms, the person should be taken to a lower altitude at once. High altitude cerebral edema is a serious condition,. People suffering this should be moved to a lower altitude immediately. Delaying the move will worsen the condition. After descent the condition improves quickly.

Prevention

It is best to make a climb gradually. Try to take at least two days to reach 8,000 feet and another day for each 1,000 to 2,000 additional feet. Camping midway reduces the risk of acute mountain sickness. Once altitude is reached, avoiding strenuous activity for a day or two will reduce risks. Avoid alcohol and tobacco consumption, extra fluids, salt and medications that cause sleeplessness. Extra sleep is not helpful because it slows the breathing.

When climbing over 8,000 feet symptoms of acute mountain sickness should be carefully watched for. Each person in the party should be evaluated at the end of each day of climbing. Performance, level of fatigue, weakness or shortness of breath, lung function and heart rate should be checked after a few hours of rest.