___________________________________________________________ Asthma: Diagnosis and Management
Medications Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) It is important to realize, as mentioned before, that at least some patients with asthma are particularly sensitive to NSAIDs, which are used to treat pain and inflammation. Several of these medications, such as aspirin, naproxen, ibuprofen, and ketoprofen, are available over the counter. NSAIDs available by prescription only include [35; 60]: • Diclofenac sodium
For very sensitive patients, even the slightest exposure to dander can result in airway constriction. The situation can become dangerous for a child with allergies who keeps rodents in a bedroom or sleeps with a dog or cat. In fact, those with asthma may react whether or not the animal is in the room because dander and/or other allergens may remain in the air for long periods of time [8; 47]. Cat dander is one of the smallest allergens; most of the par- ticles are less than 2.5 microns and the smallest may be only 0.5 micron. A sensitive individual would require a very good dust mask or high efficiency particulate air (HEPA) filter to eliminate these particles in a contaminated indoor area. It should be noted that, in many cases, dander can linger in house dust for approximately six months after a pet has been removed from the environment [8; 47; 48]]. Other, less common pets may produce allergens through shedding of fur or dander. For example, horses are known to produce very powerful allergens. In the case of small mammals, such as mice or guinea pigs, urine is usually the main cause of allergic and asthmatic reactions. Proteins in the urine become airborne and are carried throughout the environment. Allergic reactions to reptiles and amphibians are extremely rare; how- ever, cases of reactions have been documented [62]. With pet insects and snakes, lizards, and other reptiles, the allergens are found in tiny skin particles that float in the air. In addition, live grasshoppers and other insects used to feed reptiles may cause allergic reactions. Because reptiles and amphibians are known to carry Salmonella, which can cause life-threatening infection in young children, the CDC recommends against keeping them in homes with children younger than 5 years of age [8; 47; 48]. Dust Mites, Cockroaches, and Rodents Allergy research reveals that dust mites play an important role in the development of asthma symptoms. The dust mite aller- gen provokes immune cells, and after an allergy to dust mites has developed, other allergies become more likely. It should also be noted that researchers have demonstrated that 18% of children in urban areas in the United States have an allergic reaction to mice, and this can surely contribute to asthma. Cockroaches are another significant cause of asthma symptoms in urban environments. Meticulous cleaning to combat cockroach allergen is advisable, as even slightly reducing exposure can be of great benefit to individuals with asthma. One study of children with asthma who were allergic to cockroaches concluded that the levels of the allergen in the homes were directly related to the severity of the asthma symptoms; children exposed to the highest levels of cockroach allergen were more likely to be hospitalized for asthma, miss more school due to asthma, and have sleepless, wheezy nights [8; 47; 63].
• Indomethacin • Meclofenamate
• Naproxen • Piroxicam • Sulindac • Tolmetin
Known NSAID sensitivity should be noted in a patient’s record, as prescribing any of these medications may be extremely hazardous. Other medications, such as paracetamol, may be prescribed instead. Beta Blockers The beta-adrenergic system includes the neurologic system, which relaxes the smooth muscle of the bronchial tree and stimulates the heart. Blockage of this system can calm the heart but may also constrict the muscles of the bronchi. This bronchoconstrictive tendency can occur in an exaggerated form in patients with asthma. Beta blockers are used in treat- ing a number of conditions, including hypertension, cardiac arrhythmias, glaucoma (as ophthalmic drops), and migraines. Medications within this category include propranolol, labet- alol, atenolol, and timolol [35; 60]. Patients with asthma should be educated regarding the risks of beta blockers and instructed on the appropriate steps to take if they begin to experience asthma symptoms after taking these agents.
Common Household Triggers Pets
The number of household pets is on the rise; surveys indicate that there are 62 million dog-owning households in the United States and 37 million cat-owning households [61]. These domestic animals, as well as mice, guinea pigs, and even horses and sheep, give off saliva, fur, and dander as they live their normal lives—rubbing against or licking their owners or other individuals. Exposure to any of these elements may trigger asthma symptoms in sensitive individuals. Certain breeds of dogs and most cats shed clumps of fur throughout the year; saliva holds and spreads dander and fur throughout a house. Further, animals that explore outdoors bring pollen and mold spores indoors on their fur, another potential problem for those with asthma[8; 47].
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