The exhaled nitric oxide test is one of the many that may be used to test the presence and severity of asthma in a person. As the name suggests this test measures the amount of nitric oxide present in one’s breath that can indicate airway inflammation – which is one of the unmistakable signs of asthma.

Though all of us produce some amount of nitric oxide, the levels of this gas in our exhalations is elevated when the airways are inflamed.

The test is usually administered to make a diagnosis of asthma or to measure the efficacy of asthma medications that a person may be on.

It is one way of determining how well controlled a person’s asthma is as well as a way to determine the type of medication that may work best for the person.

The test is usually administered by asking the person to exhale into a device that is later connected to an analyzer.

There are however concerns regarding this type of asthma testing – as to its efficacy and its usefulness as a diagnostic tool.

Limitations of the exhaled nitric oxide test

There are certain factors that limit the efficacy and use of this type of asthma testing according to some experts. Some experts are of the opinion that the test is not so useful for diagnosing asthma per se, as it is for ruling out bronchial asthma.

As yet the test is not standardized to the extent that its results are reliable enough to be acted upon. This is not a very widely accepted test since there can be a wide variation in what is considered ‘normal’ as regards levels of nitric oxide and degree of inflammation of the airways.

What can also make the test results go awry is the fact that there are other reasons why levels of nitric oxide may increase in one’s exhalations. For instance acidity in the airways can increase levels and in a sense offer a false positive.

A study conducted by Johan C. de Jongste, M.D., Ph.D., at the Erasmus University Medical Center-Sophia Children’s Hospital in the Netherlands and published in the American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society also shed light on the acceptability and helpfulness of the Test.

The study found that the exhaled nitric oxide test is not of much use for children with asthma. The study looked at the impacts of daily monitoring of nitric oxide levels of children on improved and more effective medications. The researchers wanted to see if this offered better information than the simple monitoring of symptoms.

However it was found that whether the test was used or not did not make much of a difference to the improvement of symptoms. Researchers found however that regular monitoring of symptoms itself (with or without the nitric oxide test) was found to be very helpful.

LABA medications and how they work

Salmeterol (Serevent), Arformoterol (Brovana), Formoterol (Foradil)and Bambuterol are some of the commonly used and prescribed long acting beta agonists and are most often used for controlling nocturnal asthma or preventing the triggering of exercise-induced asthma. LABAs are described as adjunctive treatment for asthma.

These medications work by preventing asthma attacks by working over a longer period and are not useful for controlling an actual attack and require taking daily regardless of the appearance of symptoms.

They can help to prevent the tightening of the muscle bands that surround airways and also prevent scarring and inflammation.

Proper use of LABAs help to prevent attacks of exercise-induced asthma, can improve lung function, reduce asthma symptoms and number of attacks, and even lesser reliance on inhalers.

Are LABAs unsafe?

There is the apprehension expressed about the safety of these medications – in some cases they have actually exacerbated asthma symptoms and make them more severe and are even thought to increase risk of dying from asthma.

Studies conducted in respect of LABAs have demonstrated as much and the warning on the product label is itself enough to cause apprehension.

However the above negative reactions occur only when the LABA medications are improperly used. Experts as well as the FDA recommend that LABAs can safely and effectively be used in the following manner -

• LABAs should never be used alone, but should always be used along with medications such as inhaled corticosteroids or in conjunction with asthma controller medications.
• They are suitable for longer term use.
• They are suitable for those asthma patients for whom other asthma control medications are not adequate or effective.
• LABAs should be used for the shortest possible duration, or as little time as required to adequately control one’s asthma. After the asthma is adequately controlled the LABAs should be discontinued in favor of other asthma control medicines if possible.
• It is recommended that younger asthmatics such as children and adolescents should use a combination product that contains both the LABA element as well as the inhaled corticosteroid element to ensure compliance of the above guidelines.

The bottom line with LABAs is that their use should be curtailed and kept as limited as possible in order that the possible complications that they are associated with do not occur.

It is also important to remember to take the medication not as a rescue medication but as a daily dose that is never to be used alone but in conjunction with inhaled corticosteroids or other asthma control medications.

Dosages and manner of using them should be in compliance with guidelines and warnings on the box. When it comes to pediatric use of LABAs, extra caution should be exercised and combination LABAs are best to use.

Metered dose inhalers

These are the most common types of asthma inhalers. These devices use a pressurized canister to deliver medication.

The medication could be in the form of a suspension or a propellant and is administered to the lungs by using a plastic actuator that is operated by hand and usually made from plastic.

The device is held to the mouth after exhaling breath to the fullest extent and then a fixed dosage of the medication is inhaled in aerosol form. The mechanism of the inhaler is pressed to release the medication.

The correct way to use this inhaler is to first expand the breath from the lungs fully and then inhale into the lungs and hold the breath for a period of 10 seconds – this is to help the medication to settle properly into the constricted airways to help free them. For young children a metered dose inhaler with spacer can be used.

Dry powder inhalers

They administer the medication in a dry powder form, are used not just for asthma but also conditions such as COPD, emphysema and even for helping to treat diabetes. The administering of the dry medication has to be controlled carefully since a bigger dose will cause coughing.

This type of inhaler uses manual loading or capsule form instead of the aerosol. This device may not be suitable for those who are not able to inhale deeply, since it relies on the inhalation force of patient to reach the lungs, and may not be used for younger children.

The Nebulizer

This inhaler for asthma creates a mist of the medication to enable it to reach the lungs, and could be used in conditions such as COPD, cystic fibrosis as well as other respiratory problems. Nebulizers use vaporized water mixed with the medication to create a mist that reaches the lower, narrower airways of 1-5 micrometers or less. The problem most often noted with nebulizers is that they are sometimes ineffective in delivering medication properly to the lungs.

Analgesic Inhalers or Analgizers

These are disposable inhalers that a patient can use for self administration. The device delivers methoxyflurane to the patient and has been seen to be safe and effective for use in cases even such as childbirth, for those who have suffered fractures and dislocations and for burn patients.

Inhalers for asthma are generally safe to use and cause no side effects so long they are used in accordance with directions, since the drug is in small doses. However some discomfort may arise when using steroid inhalers – sore throat or thrush infection may be noted. Different types of asthma inhalers or devices can be used to figure out what is suitable for a person’s requirements.

It is vital to react appropriately when an attack occurs and also to control asthma in a way that an asthma sufferer can live a fuller, better life. Recognize if asthma symptoms are getting worse or more frequent or if they disturb daily activities and sleep.

Recognize an asthma attack

An asthma attack occurs when the body’s airways going into spasm and the person finds breathing difficult and it could be a moderate, severe or life threatening attack.

A moderate attack is characterized by breathlessness, wheezing and feeling tired, and should be relieved by 4-6 puffs of an inhaler, but a doctor should be consulted nevertheless.

A severe attack is characterized by difficulties in speaking, gasping for air, and accelerated pulse and will require immediate medical attention. A life threatening attack is characterized by a bluish tint around the lips, erratic or slow pulse, fainting and being unable to use an inhaler.

Have an asthma attack treatment plan

Asthma attacks give little or no warning. So a reaction plan should be chalked out in advance, in consultation with a doctor. A treatment plan is important since it enables one to recognize the build-up to an attack and perhaps halt its progress.

Peak flow meter

A peak flow meter is an essential part of a person’s preparation against asthma. This device lets you record normal breathing patters and know if there is an alteration in that. Taking a reading from the peak flow meter can warn a person of any inconsistencies so that preventive or early treatment can help prevent a full blown asthma attack.

Emergency inhalers

This is something else that asthmatics should include in their arsenal against the debilitating condition. These are the sort that you carry around with you wherever you go and which can be used when there is any wheezing. They can also help prevent an asthma attack. The device also gives you a danger warning – when the body doesn’t respond by recovering after a few puffs, it is a warning sign that medical attention and intervention may be required.

Use correct inhaler technique

In order to get the most benefit from an inhaler or asthma attack medication in other form, it is important to use and administer the medication correctly. After the first puff it is best to wait a minute or so before the second puff. Also it is important to exhale completely before inhaling and then inhaling long enough for the medicine to reach the airways.

Recognizing when to rush to ER

When several puffs of the inhaler seem to give no relief, it may be sign of danger. This could mean that there is a danger of suffocation, and even death!

So to recap, it is important to monitor and try prevent asthma attacks, to take any preventive medication as prescribed and act swiftly and quickly as required when an attack presents itself.

Researchers from the University of Maryland School of Medicine found that lungs respond in an unexpected manner to a bitter taste – the airways actually open up in response to the bitter taste it was found.

Dr Stephen Liggett and his colleagues expected that the response to the bitter taste would be that of “fight or flight”, and that coughing and chest tightness would result from the bitterness.

However, to their surprise it was found that the bitterness actually acted in the opposite way, and ended up opening the airways more effectively than “any known drug that we have for treatment of asthma or chronic obstructive pulmonary disease.”

Quinine and chloroquinine (anti malarial drugs) were used in conjunction with saccharine which also has a bitter aftertaste, in the study. Researchers are hopeful that appropriate drugs with requisite modifications may be aerosolized and inhaled into the lungs by way of an inhaler to offer a unique and hitherto unavailable asthma solution.

There are three known types of breathing exercises used in alternative medicine and they are:

Buteyko:

This breathing exercise theorized by the late Dr. Konstantin Buteyko was based on the principle that asthmatic patients tend to over breathe while having an attack.

So this exercise will help patients how to do controlled breathing during attacks therefore minimizing the amount of carbon dioxide in the body and improving the function of airway smooth muscles.

Papworth:

Developed in Papworth Hospital in England during the 1960’s this breathing exercise focuses on nasal breathing, abdominal breathing and the patient’s individual breathing pattern.

The objective of this principle is for the patient to have a control on what type of breathing pattern to do to cope up with various activities making them able to deal with the environment and temperature changes, exposure to pollutants & allergens and various emotional responses.

Pranayama:

Originated in India, this is a type of yoga that is more focused on breathing techniques that incorporates exercises that improve lung functionality and promote relaxation.

Pranayama utilizes breathing methods to expand the lung capacity improving circulation and giving asthmatics more control of their breathing pattern.

Although these breathing exercises have proven benefits in gaining control of one’s reaction to asthma triggers and being able to cope up with considerable amount of stress, medications could not be done away with.

In fact a study made by researchers from the Department of General Practice and Primary Care at the University of Aberdeen in Aberdeen, UK stated that the quality of life of patients who performed breath training exercises was significantly improved.

Feelings of anxiety and depression during asthma attacks were decreased with breath training exercises which were associated with better control of asthma attacks.

Another finding stated that the peak expiratory flow rate of these same patients did not show significant changes after doing breath training exercises.

As a conclusion therefore, breathing exercises may help improve the quality of life of patients who are already debilitated by the condition, but, does not necessarily mean that symptoms are relieved and that the need for medication is minimized.

Corticosteroids are very effective in asthma treatment because of its immediate effect by suppressing airway inflammation, through the use of synthetic like hormones just like what the adrenal glands do.

A serious side effect in the use of this drug is the suppression of the immune system which places the patient in a compromised condition.

Other side effects include: fluid retention causing swelling of the lower legs, increased blood pressure and intracranial pressure, weight gain and mood swings.

Long term use is associated with conditions like: Cataracts, Worsened Diabetes due to high blood sugar level, various infections due to compromised immune system, risk for Osteoporosis and fracture due to calcium loss, menstrual irregularities, and suppressed adrenal gland function, easy bruising and poor wound healing.

The bottom line is, although corticosteroids have various side effects it remains to be the most effective means of asthma control. What you can do is to discuss with your health care provider the options on how to minimize these side effects without compromising the significant effect of the drug.

Here are some ways you can do to reduce the risk of corticosteroid side effects:

• Discuss with your health care provider about low-dose, short-term intermittent dosing of corticosteroid. So you have an option to take it every other day rather than daily.
• Ask about the use of inhaled corticosteroids which, reaches the lung directly without having to pass through the other systems of your body leading to fewer side effects.
• Make healthy choices during therapy like minimizing your caloric intake to minimize excess weight gain, involve yourself in a regular exercise or physical activity that is allowed by your health care provider and take Vitamin D and Calcium supplements to counter the calcium loss and the incidence of Osteoporosis.
• Keep in mind that discontinuing corticosteroid therapy needs time and should be tapered gradually over time to give your adrenal glands some time to recover and to function normally again.

Jeff Craddock is an asthma sufferer whose job was such that he used to have a rescue inhaler between 3 and 5 times a day.

He had tried medication but it failed and he finally decided to give Bronchial thermoplasty a try.

In this procedure, a tube is inserted through the mouth or nose into the lungs of the asthmatic, whose airways are typically restricted and this inserted tube acts as a catheter that emits radio frequency energy to the muscles around the windpipe.

This energy or heat emitted prevents the muscles from constricting or narrowing which is what creates that typical breathlessness of an asthma attack. This therapy has been able to offer up options to people such as Craddock that were not available to him before.

This is not an asthma cure; it was clarified by David R. Duhamel M.D. Director of the Pulmonary Special Procedures Unit at Virginia Hospital Center, but that it can help asthma sufferers literally breathe easier and it helps them to lead a better quality of life.

Homeopathy for asthma has been met with varying degrees of success. This is because the physiology of each person’s asthma and also their respective triggers are different.

The basic principle of homeopathy is to offer a medication dose in a very small quantity and thereby encourage the body’s own immune strengthen itself and resist attacks in the form of infection etc.

So in homeopathy, factors such as triggers, allergens, frequency and severity of attacks are all considered before formulating a strategy for curing the underlying problems that cause asthma in a given person.

The homeopath will ideally seek to find a cure for a person’s asthma by trying to balance and reinforce the person’s immune system, and consequently help them combat their asthma.

An exhaustive patient history recording exact symptoms and kind of attack and their frequency would be prepared and then medication is administered.

Hence many find that their asthma is very well controlled by homeopathy, while others find that the converse is true.

The new therapy made from human protein, was seen to significantly decrease disease signs in mice, making it possible for new treatments to emerge for those people who do not respond to or cannot benefit from currently available steroidal treatment.

The study conducted on mice used a protein; an insulin-like growth factor binding protein-3 that was seen to uniquely inhibit certain precise physiological symptoms of asthma. The study could have significant implications not just for asthma but also other inflammatory diseases.