MODULE 4

DRUGS FOR RESPIRATORY DISORDERS

RESPIRATORY DISEASE

 Any of the diseases and disorders of the airways and the lungs that affect human respiration.

Diseases of the respiratory system may affect any of the structures and organs that have to do with
breathing, including the nasal cavities, the pharynx (or throat), the larynx, the trachea (or windpipe),
the bronchi and bronchioles, the tissues of the lungs, and the respiratory muscles of the chest cage.

The respiratory tract is the site of an exceptionally large range of disorders for three main
reasons:

(1) It is exposed to the environment and therefore may be affected by inhaled organisms,
dusts, or gases;

(2) It possesses a large network of capillaries through which the entire output of the heart has
to pass, which means that diseases that affect the small blood vessels are likely to affect the
lung;

(3) It may be the site of “sensitivity” or allergic phenomena that may profoundly affect function.
TOPIC 1
Asthma and its Causes, Symptoms and Diagnosis and its treatment
 The respiratory system plays a vital role in the exchange of the respiratory gases, oxygen, and
carbon dioxide.

 Functionally, the respiratory system consists of a series of anatomical tubes [trachea, bronchi,
bronchioles, and alveolar ducts] that conduct air to and from the air sacs [alveoli] of the lungs.

 Any disease process or condition that interfere with respiratory exchange causes serious
alterations in the levels of the gases in the blood plasma. One of the common ailments of this
system is Asthma and you can describe its characteristics.

 ASTHMA
o is a condition in which your airways narrow and swell and may produce extra mucus. This can make
breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and
shortness of breath.

o Is a chronic inflammatory disorder of the airways.

o Chronically inflamed airways are hyperresponsive; they become obstructed and airflow is limited
(by bronchoconstriction; mucus plugs; and increased inflammation) when airways are exposed to
various risk factors.

o cannot be cured, but its symptoms can be controlled. Because asthma often changes over time, it's
important that you work with your doctor to track your signs and symptoms and adjust your
treatment as needed.

Diagnosis
1. SPIROMETRY
2. PEAK EXPIRATORY FLOW (PEF)

Drug Treatment of Asthma

RELIEVERS:

1. SHORT ACTING BETA 2 AGONIST

 TERBUTALINE
 ALBUTEROL, / SALBUTAMOL
 FENOTEROL
 LEVALBUTEROL
 METAPROTERENOL
 PIRBUTEROL

S/E:
 tachycardia, skeletal muscle tremor, headache and irritability
 at very high dose - hyperglycemia; hypokalemia
2. ANTICHOLINERGICS
 IPRATROPIUM BROMIDE
 OXITROPIUM BROMIDE

S/E:
 mouth dryness

3. SHORT ACTING THEOPHYLLINE, AMINOPHYLLINE 9 THEOPHYLLINE + ETHYLENEDIAMINE 2:1)

 inhibits phosphodiesterase-----increase cAMP-----bronchodilation

S/E: nausea, vomiting, headache, at higher serum concentration: seizures, tachycardia, and
arrhythmia

Therapeutic range: 5-15 mcg/ml

CONTROLLERS:

1. GLUCOCORTICOSTEROIDS
Inhaled:
 BECLOMETHASONE
 BUDESONIDE
 CICLESONIDE
 FLUNISOLIDE
 FLUTICASONE
 MOMETASONE
 TRIAMCINOLONE

tablets or syrups:
 HYDROCORTISONE
 METHYLPREDNISOLONE
 PREDNISOLONE
 PREDNISONE

Inhaled high daily doses maybe associated with skin thinning and bruises, and rarely adrenal
suppression.

Local side effects are: hoarseness and oropharyngeal candidiasis

Low to medium doses have produced minor growth delay or suppression in children.

2. MAST CELL STABILIZER

 CROMOLYN SODIUM
 NEDOCROMIL SODIUM

minimal side effects: cough may occur upon inhalation

3. ANTILEUKOTRIENES/ LEUKOTRIENE MODIFIERS
o LT receptor antagonists:
 MONTELUKAST
 PRANLUKAST
 ZAFIRLUKAST

o lipoxygenase inhibitor:
 ZILEUTON (ZYLO)

S/E: elevated liver enzymes, inhibits metabolism of warfarin and theophylline (zileuton)

4. LONG-ACTING B2 AGONISTS
 FORMOTEROL
 SALMETEROL

5. COMBINATION THERAPY
 FLUTICASONE+ SALMETEROL (SERETIDE)
 BUDESONIDE+ FORMOTEROL (SYMBICORT)

6. IMMUNOMODULATORS
 OMALIZUMAB
 -anti-IgE-antibody

CAUSES OF ASTHMA
1. respiratory irritants [dust and noxious chemicals]
2. Exercise [particularly in cold weather]
3. Respiratory Tract infections
4. aspirin and related drugs
5. Allergy to foreign proteins [pollen and animal dander]

SYMPTOMS
1. Wheezing sound (of breathing)
2. History of any of the following

 Cough worse particularly at night

 Recurrent wheeze
 Recurrent difficult breathing
 Recurrent chest tightness

3. Symptoms occur or worsen at night, awakening the patient.

4. Symptoms occur or worsen in a seasonal pattern.
5. The patient also has eczema, high fever, or a family history of asthma or atopic
diseases.
6. Symptoms occur or women in the presence of:
 Animals with fur
 Aerosol chemicals
 Changes in temperature
  Domestic dust mites
 Drugs (aspirin, beta blockers)
 Exercise
 Pollen
 Respiratory viral infection
 Smoke
 Strong emotional expression
7. Symptoms respond to anti-asthma therapy
8. Patients cold will go to the chest or take more than 10 days to clear up.

ASTHMA is a chronic lung disorder that can make breathing difficult.

 It features narrow, inflamed airways (bronchial tubes).

 "Asthma" is an ancient Greek word meaning "short breath," and as the name implies, it can leave
you gasping for air.
 One of the telltale signs of an asthma attacks is wheezing with difficulty breathing. Other asthma
symptoms include chest tightness, coughing, and shortness of breath.
 When the breathing tubes of the lungs become chronically inflamed, they can become sensitive
to inhaled environmental allergens and irritants that can trigger asthma. These environmental
triggers include pollen, pollution, and tobacco smoke. Exercise can also be an asthma trigger for
some.

Who Gets Asthma?

About 25 million people in the U.S. have asthma; about 6 million of these are children. The condition
affects men and women equally. In the Philippines as well, this is one among the top conditions
that affect the Filipinos.

Asthma Can Be Deadly

Asthma causes over 14 million visits to doctors each year and nearly 2 million emergency room visits.
And, tragically, asthma can kill. Most people who die from asthma are over age 50, but children
sometimes die of the condition.
 ASTHMA TREATMENT:

INHALERS

 Asthma inhalers and nebulizers have advantages over oral medications and injections in that
they deliver medicine directly to your airways. They also have fewer side effects than other
forms of asthma medication.

The most common treatment for asthma involves a device called an inhaler.

An inhaler is a small device that delivers asthma medicine directly to the airways. Inhalers come in
two types:

 Metered Dose Inhalers (MDI): MDIs are the most common type of inhaler. They spray
medicine from the inhaler like an aerosol can.
 Dry powder inhalers: Dry powder inhalers deliver a powdered medicine that does not spray
from the inhaler. Instead, the user must inhale the medicine quickly and forcefully.

Sometimes MDIs are used along with a device called a spacer. Spacers help coordinate breathing
with the release of the asthma medicine, and use smaller droplets of medicine, making it easier to
breath them in.

NEBULIZERS

 An inhaler cannot be used for babies and very young children. For them, a nebulizer can be used.
Nebulizers are powered by electricity to turn asthma medicine into a fine mist.
THE RESPIRATORY SYSTEM:

 How It Should Work

 Respiration is the process by which our bodies inhale oxygen and express carbon dioxide. This
process becomes more difficult during an asthmatic attack.
 When you inhale, air passes through your windpipe (trachea). Meanwhile your diaphragm
contracts and moves downward creating air space in your chest cavity. The air enters your lungs,
passing through the bronchial tubes and finally into tiny air sacs (alveoli).
 Oxygen from the air passes from the alveoli and into the bloodstream through tiny blood vessels
called capillaries. Capillaries deliver this oxygen-rich blood to pulmonary veins, which pass it to
the left side of your heart. The heart then pumps the oxygen-rich blood to the rest of your body.
 When you exhale, air that is rich in carbon dioxide (CO2) passes out of your lungs, through your
windpipe, and out your body through your nose and/or mouth.

How Does Asthma Affect Breathing?

During an asthma attack, airways become inflamed and sensitive. Swelling narrows the airways,
making breathing difficult, often leading to panting and gasping fits.

Three factors cause this narrowing:

 Inflammation
 Bronchospasm
 Hyperreactivity (Asthma Triggers)
CAUSES OF ASTHMA

 INFLAMMATION

 is the main cause of airway narrowing during asthma episodes. It makes airways more
swollen and sensitive. When airways are inflamed, air has a smaller passageway. In addition,
the surrounding muscles of the airways may tighten during an asthma attack, further
narrowing the opening for airflow.

 When airways react to inflammation, they also produce more mucus. This thick, sticky liquid
can clump together and also narrow air passages.
 Moreover, certain allergy and inflammation cells (white blood cells, including eosinophils)
accumulate at the site of the inflammation, causing tissue damage further narrowing airways.
This chain reaction causes the breathing difficulty associated with an asthma attack.

 BRONCHOSPASM

 The larger tubes that split off from your trachea and into your lungs are called your bronchial
tubes. These tubes are surrounded by muscles.
 When the muscles of your bronchial tubes contract in asthma, they obstruct your airways, a
process referred to as bronchospasm.

Coughing and wheezing may be symptoms of bronchospasm, and

bronchospasm can occur when the airways are irritated by cold air.

Bronchospasm may come on suddenly. It can be treated by medicines called bronchodilators

ASTHMA TRIGGERS

People with asthma may become overly sensitive (hyperreactive) to certain inhaled allergens
or irritants. These are called triggers of asthma, and these triggers can cause inflammation and
narrowing of your airways. This occurs because some people's bodies are immunologically inclined to
overreact to certain substances. The precise substance that may cause such a reaction varies from
person to person.

ASTHMA TRIGGER TYPES:

Things that can initiate an asthma attack are referred to as "triggers." Not everyone with
asthma has the same triggers. Triggers can be allergens or irritants. People with asthma need to
learn what their triggers are to optimally manage and avoid them.

Recognizing and avoiding triggers can help you prevent further asthma attacks. Allergists and
immunologists are medical doctors who specialize in helping patients identify irritants and allergies
that cause problems like asthma. They can help develop a plan to avoid asthma triggers to optimize
daily health.

 ALLERGENS

Asthma can have both allergic and nonallergic triggers. Allergic asthma triggers include many
allergens.

Some of these allergens include:

 Pollen
 Dust
 Mold
 Pets
 Some foods, including peanuts, egg, dairy, soy, and fish
 Sulfites
 Latex
 IRRITANTS

 Nonallergic asthma triggers include many irritants.

Some of these come from environmental toxins, including:

 tobacco smoke, smog, and various chemicals, dusts, and occupational gases. They can
also come from medications, such as over-the-counter painkillers and beta-blockers.
Sometimes respiratory infections can trigger asthma, and so can GERD. Exercise can also
bring on asthma attacks.

ASTHMA SYMPTOMS IN ADULTS AND KIDS

 Asthma can develop at any age. However, asthma does tend to start in children ages 2-6. At this
age, asthma is commonly triggered by allergens such as dust mites, tobacco smoke, and
dust mites. In young children, asthma may first be diagnosed as reactive airway disease
(RAD).
 Adults can also develop asthma, and only about 30% of adult-onset asthma triggers are related to
allergies. Risk factors for adult-onset asthma include being female, obesity, hormonal
fluctuations such as those experienced during or after pregnancy or menopause, and viral
or other infections.

TYPES OF ASTHMA:

 ALLERGIC (EXTRINSIC)

Allergic (extrinsic) asthma

 is the type triggered by an allergic reaction.

 This is an example of your immune system responding to an irritant.
 Allergic asthma is the most common form, affecting more than half of all sufferers.
 It can often be managed with medication, and tends to be less severe than other forms.
 NON-ALLERGIC (INTRINSIC)

Non-allergic (intrinsic) asthma

 is caused by factors other than allergies, such as exercise, stress, inhaling cold air, smoke,
viral infections, and other irritants.
 This type of asthma is less common, develops more often in adults, and is more difficult to
treat than allergic (extrinsic) asthma.
 In many cases this type seems to be more severe.

OTHER TYPES OF ASTHMA

 ADULT-ONSET ASTHMA. Asthma can start at any age, but it is more common in people younger
than 40.
 STATUS ASTHMATICUS. These long-lasting asthma attacks do not go away when you
use bronchodilators. They’re a medical emergency that needs treatment right away.

 ASTHMA IN CHILDREN. Symptoms can vary from episode to episode in the same child. Watch for
problems like:

o Coughing often, especially during play, at night, or while laughing. This may be the only
symptom.
o Less energy or pausing to catch their breath while they play
o Fast or shallow breathing
o Saying their chest hurts or feels tight
o A whistling sound when they breathe in or out
o Seesaw motions in their chest because of trouble breathing
o Shortness of breath
o Tight neck and chest muscles
o Weakness or fatigue

 EXERCISE-INDUCED BRONCHOCONSTRICTION. You might hear this called exercise-induced

asthma. It happens during physical activity, when you breathe in air that’s drier than what’s in your
body, and your airways narrow. It can affect people who don’t have asthma, too. You’ll notice
symptoms within a few minutes after you start to exercise, and they might last 10 to 15 minutes after
you stop.
 ALLERGIC ASTHMA. Things that trigger allergies, like dust, pollen and pet dander, can also cause
asthma attacks.
 NONALLERGIC ASTHMA. This type flares in extreme weather. It could be the heat of summer or
the cold of winter. It could also show up when you’re stressed or have a cold.
 OCCUPATIONAL ASTHMA. This usually affects people who work around chemical fumes, dust, or
other irritating things in the air.
 EOSINOPHILIC ASTHMA. This severe form is marked by high levels of white blood cells called
eosinophils. It usually affects adults between 35 and 50 years old.
 NOCTURNAL ASTHMA. Your asthma symptoms get worse at night.
 ASPIRIN-INDUCED ASTHMA. You have asthma symptoms when you take aspirin, along with
a runny nose, sneezing, sinus pressure, and a cough.
 COUGH-VARIANT ASTHMA. Unlike with other types, the only symptom of this kind of asthma is a
long-term cough.

SYMPTOMS AND SIGNS OF ASTHMA

Different people experience asthma in different ways. When asthma is under control, you may have
fewer symptoms or no symptoms. Symptoms of asthma are the same for both allergic and non-
allergic types.

They include

 Shortness of breath
 Wheezing
 Coughing
 Chest tightness
 Heavy mucus production

Not everyone with asthma will experience every symptom, and the severity of symptoms can vary
depending on the individual—even in an individual symptoms may vary over time.

CLASSIFICATION OF ASTHMA:

 MILD TO SEVERE

The National Asthma Education and Prevention Program classifies asthma based on a patient's
symptoms and lung function tests into these four categories:

 Mild intermittent
 Mild persistent
 Moderate persistent
 Severe persistent
 ACUTE ASTHMA ATTACK

An asthma attack is an acute worsening of asthma symptoms. During an acute asthma attack,
there is inflammation, bronchospasm, and excess mucus production.

These can lead to symptoms such as:

 Difficulty breathing
 Shortness of breath
 Wheezing
 Coughing
 Interference with daily activities

Frequently, asthma attacks can be controlled with inhalers (inhaled bronchodilators). When that is
ineffective, the patient should call 911 or be taken to an emergency room immediately. When asthma
does not respond to initial treatment it can result in a life-threatening reaction called status
asthmaticus.
ASTHMA EXAMS & TESTS

There are several tests that can determine whether you have asthma and how severe it is.

 LUNG (PULMONARY) FUNCTION TESTS

 measure how functional your lungs are.

 These may include spirometry or peak flow meter tests.

 A BRONCHIAL CHALLENGE TEST

 helps the doctor determine how reactive your lungs are to environmental triggers.
 This testing includes a methacholine challenge test, a histamine challenge test, and
bronchoprovocation.

 BLOOD TESTS

 measure the IgE antibodies that are released during an allergic reaction.
 Other tests may be used to rule out other causes of shortness of breath, including acid reflux
and sleep apnea.
 Sometimes chest x-rays or EKGs are performed to detect a foreign object in the lungs or
another condition.
Medical Treatment of Asthma

Asthma medications are classified as either for long-term control, or quick relief. Most are inhaled
rather than taken in tablet or liquid form, to act directly on the airways where the breathing problems
start.

Long-term control medications include:

 Montelukast, oral medicine that helps prevent wheezing and shortness of breath
 Inhaled corticosteroids
 Cromolyn, taken using a nebulizer or inhaler
 Omalizumab (anti-IgE), given as an injection
 Long-acting beta2-agonists (bronchodilators)
 Leukotriene modifiers, taken by mouth
 Theophylline, taken by mouth

Quick-relief medications include:

 Albuterol and other short-acting beta2-agonists (bronchodilators)

Asthma Medications

Common medications used with inhalers and nebulizers include the following three types:

 INHALED CORTICOSTEROIDS:

 Inhaled corticosteroids reduce airway inflammation. Sometimes these medicines are used
even for people who don’t have any asthma symptoms, as they can help prevent future
asthma attacks.

 SHORT-ACTING BRONCHODILATORS:

 Bronchodilators have no steroids. They work by relaxing the tiny muscles that can tighten
airways during asthma attacks. Short-acting bronchodilators relieve asthma symptoms quickly.
  LONG-ACTING BRONCHODILATORS:

 Long-acting bronchodilators are taken daily to help control asthma and prevent future asthma
attacks. Types of long-acting bronchodilators include salmeterol and formoterol.

 Asthma is a chronic lung disorder that can make breathing difficult. It causes inflammation,
swelling, and narrowing of the airways (bronchial tubes
 Asthma is diagnosed based on the physical exam and the patient's history. It is confirmed with
breathing tests.
 Asthma is caused by three major factors: inflammation, bronchospasm, and
hyperreactivity.
 Allergy plays a role in some, but not all asthma cases.
 Allergens and irritants can cause asthma attacks. When they do, they are called "triggers."
 The best way to manage asthma is to try to avoid triggers, which are different for everyone
with asthma.
 Medications can reverse or prevent bronchospasm.

Asthma and Your Diet: Foods That Help and Hurt

MAY HELP:

 Fruits and Veggies

There's no specific asthma diet that can get rid of your breathing troubles. But certain foods
may have benefits. Fruits and veggies are a good place to start. They're full of chemicals called
antioxidants like beta carotene and vitamins E and C. These help stop particles called "free
radicals" that damage cells and could inflame and irritate your lungs.

 Vitamin D

You get most of it from sunshine, but it's also in some foods. The top choice is fatty fish like salmon
and swordfish, followed by milk, eggs, and orange juice, which are often "fortified" with vitamin D.
The nutrient strengthens the response of the immune system -- your body's defense against germs --
and could lessen swelling in your airways. Having low vitamin D levels can lead to more asthma
attacks.

 Nuts and Seeds

They've got lots of good things in them, but one in particular that might be good for asthma is
vitamin E. Almonds, hazelnuts, and raw seeds are good sources, as well as cruciferous vegetables
like broccoli and kale. Vitamin E has tocopherol, a chemical that could help cut how much you
cough and wheeze from your asthma.

 Mediterranean Diet

It's made up of lots of fruits, vegetables, whole grains, beans, and nuts. You eat fish and chicken at
least twice a week, and limit your red meat. Instead of butter, you cook with olive or canola oil, and
you flavor with herbs instead of salt. There's even a bit of optional red wine for adults. People who eat
this way have fewer asthma attacks and are less likely to get the condition in the first place.

 Fish

It's all about the omega-3 fatty acids, especially in fatty fish like salmon, herring, tuna, and sardines.
They help lessen the amount of IgE your body makes. That's an antibody that causes breathing
problems in some people with asthma. But the high doses of oral steroids that some people use to
treat serious asthma can block much of this helpful effect.

 Tomatoes

Foods made from tomatoes seem to help people with asthma. Scientists think it may be the lycopene
that helps most, but more research is needed. Some studies show they can keep you breathing better
over the long term. Spaghetti marinara, anyone?

 Variety

There's no single "magic bullet" food that will cure you of asthma. You need a wide range of
nutrients and vitamins to keep your body healthy enough to handle attacks when you get them or to
keep them away altogether. Talk to your doctor about any big changes in the way you eat, because
they could affect your condition as well as your medication.

MAY HURT:

 Dried Fruit

There are some foods you may want to avoid if you have asthma, and dried fruits are among them.
Though fresh fruit, especially oranges and apples, can help control your asthma, the sulfites that help
preserve dried fruit could make the condition worse for some people. Alcohol (especially red wine),
shrimp, pickled vegetables, maraschino cherries, and bottled lemon juice also often have sulfites.

 Beans

It's all about the gas they give some people. It can bloat your belly and make it harder to breathe. It
may even trigger an asthma attack. Beans are the most famous candidate. Soak them for a few hours
and change the water a couple or so times to lessen this effect. Other gassy culprits are garlic,
onions, fried foods, and carbonated drinks.

 Coffee

Salicylates are chemicals that occur naturally in coffee, tea, herbs, spices, and even in anti-
inflammatory pills, like aspirin. Though most people don't react to them, they could make it harder to
breathe, especially if you already have asthma. You may be able to improve these symptoms if you
cut as many as you can from your diet.

 Food Allergies

You're more likely to have a food allergy if you have asthma. And a food reaction could cause
wheezing and other asthma symptoms. In some cases, it is worse if you exercise after you eat certain
foods. Try to notice what does it and avoid it. Typical triggers are nuts, dairy, wheat, and shellfish,
though everyone is different.
 Too Much Food

When you eat more calories than you burn, your body stores the extra in fat cells. You can really start
to pack on the pounds if you do that too much. If you become obese (BMI greater than 30), you're
more likely to get asthma and it could make your symptoms worse. In addition, you may not respond
as well to typical treatments like inhaled steroids that stop an asthma attack.

 Supplements

As a general rule, supplements don't work as well as nutrients from food to protect you from asthma.
So get your veggies! (And nuts. And fish. And fruit). You may have heard that "soy isoflavone"
supplements, in particular, can ease asthma symptoms. Unfortunately, studies seem to show that this
simply isn't the case. Talk to your doctor about any supplements you take because they can affect
your medication.

 Liquid Nitrogen

Some people call it "nitro puff," but there are other names. You might notice a stream of smoky
coldness that spirals from a fancy cocktail, a new frozen dessert at the mall, or other foods. It may
look like fun, but it's best to avoid it. It could cause breathing problems, especially if you have asthma,
as well as serious injury to skin and even internal organs.
If you have asthma, you know how important it is to take your medication as prescribed by your
doctor. That often means using a long-term control drug every day and keeping a quick-relief inhaler
handy. But managing asthma isn't only about medication. You can do several other things to help you
breathe as freely and easily as possible.

Grab an Espresso

While coughing, wheezing, and trouble breathing call for your rescue inhaler, you might
consider a caffeinated drink if your symptoms are mild. Caffeine is a weak bronchodilator, which
means it opens your airways a bit. More research is needed, but some studies suggest that it may
help your lungs work better for up to 4 hours.

Hit the Steam Room

Many people with asthma find warm air soothing. A steam bath -- in a sauna or your shower at home
-- can help clear out mucus that can make it hard to breathe. One word of caution: Some people find
that heat makes their asthma worse, so it's important to know your personal triggers.

Add Spice to Your Life

Garlic and ginger have anti-inflammatory compounds that might ease your asthma symptoms. Start
with fresh garlic cloves and ginger root. You can steep either one in boiling water and drink it like tea
after the water has cooled, or just use these spices more often in your cooking.

Learn to Decompress

When you're stressed, all the muscles in your body tense up, including the ones in your chest.
Managing that tension may mean fewer asthma flare-ups. Meditation and yoga are good options, as
is tai chi, an ancient, gentle Chinese martial art. Research suggests that it can help control asthma
symptoms in some people.

Keep Moving

Exercise can make your lungs stronger, but it can also be an asthma trigger, especially if you're out in
cold weather. To stay safe, talk to your doctor before starting a new routine and ask if you should take
medication before you get moving. Also be sure to work your way up slowly (think walking, then
jogging, then running). And heed the weather: If it's cold out, cover your mouth and nose or move
your workout indoors.

Eat the Rainbow

Colorful produce is rich in antioxidants like beta-carotene and vitamins C and E that help fight
inflammation in your body, including in your lungs. And while you're watching your diet, be careful
with sulfites, a type of preservative that triggers asthma symptoms in some people. You'll often find
them in wine, dried fruit, pickles, and shrimp.

Let the Sun Shine

Many Americans are low in vitamin D, and people with severe asthma might be more likely to have
this issue. Ask your doctor to test your levels. If you don't have enough, milk, eggs, and bony fish like
canned salmon can help. Your body also makes vitamin D when you're in sunlight. Just remember to
use sunscreen, and don't stay out too long or you could raise your chances of skin cancer.

Take Deep Breaths

Special breathing exercises can help your lungs work better. Pursed lip breathing is one option:
Breathe in through your nose, then breathe out at least twice as slowly through pursed lips.
Diaphragmatic breathing, also called belly breathing, is another useful technique. If you need help
with these, your doctor can refer you to a specialist.

Watch the Weather

Cold or dry air may make your symptoms worse. When the mercury dips, you might drape a scarf
around your mouth and nose to make it easier to breathe. Your indoor air matters, too. A
dehumidifier or humidifier can help make sure your air isn't too humid or too dry. And remember to
keep windows closed and run the air conditioner during allergy season to keep pollen out.
Mind the Scale

Extra fat around your chest and belly can make it harder to breathe, and fat cells can cause
inflammation that may affect your airways. Cutting back on calories and fat and walking each day can
help.

Know Your Triggers

Many people with asthma also have allergies, and common allergens like pollen, dust mites, and pet
dander can make your asthma symptoms flare if you're sensitive to them. If you haven't recently been
tested for allergies, see an allergist so you can find out exactly what bothers you and try stay away
from it.