Famador o. Genaldo, Md, Rn
Transcript of Famador o. Genaldo, Md, Rn
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ASTHMASTHMAFAMADOR O. GENALDO, MD, RNFAMADOR O. GENALDO, MD, RN
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DEFINITIONDEFINITION
is ais a diseasedisease of theof the respiratory systemrespiratory system ininwhich thewhich the airwaysairways constrict, becomeconstrict, becomeinflamed, and are lined with excessiveinflamed, and are lined with excessiveamounts of mucus, often in response toamounts of mucus, often in response toone or more "triggers," such as exposureone or more "triggers," such as exposureto an environmental stimulant (orto an environmental stimulant (or allergenallergen), cold air,), cold air, exerciseexercise, or emotional, or emotional stressstress..
http://en.wikipedia.org/wiki/Diseasehttp://en.wikipedia.org/wiki/Diseasehttp://en.wikipedia.org/wiki/Respiratory_systemhttp://en.wikipedia.org/wiki/Respiratory_systemhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/Stress_%28medicine%29http://en.wikipedia.org/wiki/Stress_%28medicine%29http://en.wikipedia.org/wiki/Stress_%28medicine%29http://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Respiratory_systemhttp://en.wikipedia.org/wiki/Disease -
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CHARACTERISTICSCHARACTERISTICS
The disorder is aThe disorder is a chronicchronic or recurringor recurringinflammatoryinflammatory condition in which thecondition in which the
airwaysairways develop increased responsivenessdevelop increased responsiveness
to various stimuli, characterized byto various stimuli, characterized by
bronchialbronchial hyper-responsiveness,hyper-responsiveness,inflammationinflammation, increased, increased mucusmucusproduction, and intermittent airwayproduction, and intermittent airway
obstructionobstruction
http://en.wikipedia.org/wiki/Chronic_%28medicine%29http://en.wikipedia.org/wiki/Chronic_%28medicine%29http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Bronchushttp://en.wikipedia.org/wiki/Bronchushttp://en.wikipedia.org/wiki/Allergic_Inflammationhttp://en.wikipedia.org/wiki/Allergic_Inflammationhttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Allergic_Inflammationhttp://en.wikipedia.org/wiki/Bronchushttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Chronic_%28medicine%29 -
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EtiologyEtiology
It is not clear exactly what makes theIt is not clear exactly what makes the
airways of people with asthmaairways of people with asthma
inflamed.inflamed.
New research suggests that beingNew research suggests that beingexposed to things like tobaccoexposed to things like tobacco
smoke, infections, and somesmoke, infections, and some
allergens early in your life mayallergens early in your life mayincrease your chances of developingincrease your chances of developing
asthma.asthma.
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There are things in the environmentThere are things in the environment
that bring on your asthma symptomsthat bring on your asthma symptoms
and lead to asthma attacks.and lead to asthma attacks.
Some of the more common thingsSome of the more common things
include exercise, allergens, irritants,include exercise, allergens, irritants,
and viral infections.and viral infections.
Some people have asthma only whenSome people have asthma only when
they exercise or have a viralthey exercise or have a viralinfection.infection.
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There are seven categories of stimuli:There are seven categories of stimuli:
allergensallergens, typically inhaled, which include, typically inhaled, which include
waste from common household insects,waste from common household insects,
such as thesuch as the house dust mitehouse dust mite andand
cockroachcockroach,, grass pollengrass pollen,, mouldmould spores andspores andpetpet epithelial cellsepithelial cells;;
medicationsmedications, including, including aspirinaspirin andand-adrenergic antagonists-adrenergic antagonists (beta blockers);(beta blockers);
http://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/House_dust_mitehttp://en.wikipedia.org/wiki/House_dust_mitehttp://en.wikipedia.org/wiki/Cockroachhttp://en.wikipedia.org/wiki/Cockroachhttp://en.wikipedia.org/wiki/Pollenhttp://en.wikipedia.org/wiki/Pollenhttp://en.wikipedia.org/wiki/Mouldhttp://en.wikipedia.org/wiki/Mouldhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Mouldhttp://en.wikipedia.org/wiki/Pollenhttp://en.wikipedia.org/wiki/Cockroachhttp://en.wikipedia.org/wiki/House_dust_mitehttp://en.wikipedia.org/wiki/Allergen -
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air pollutionair pollution, such as, such as ozoneozone,,nitrogen dioxidenitrogen dioxide, and, and sulfur dioxidesulfur dioxide,,which is thought to be one of the majorwhich is thought to be one of the majorreasons for the high prevalence ofreasons for the high prevalence ofasthma in urban areas;asthma in urban areas;
various industrial compounds and othervarious industrial compounds and otherchemicals, notablychemicals, notably sulfitessulfites;; chlorinatedchlorinatedswimming pools generateswimming pools generate chloramineschloraminesmonochloramine (NH2Cl), dichloraminemonochloramine (NH2Cl), dichloramine(NHCl2) and trichloramine (NCl3)in the(NHCl2) and trichloramine (NCl3)in theair around them, which are known toair around them, which are known toinduce asthma.induce asthma.
http://en.wikipedia.org/wiki/Pollutionhttp://en.wikipedia.org/wiki/Pollutionhttp://en.wikipedia.org/wiki/Ozonehttp://en.wikipedia.org/wiki/Ozonehttp://en.wikipedia.org/wiki/Nitrogen_dioxidehttp://en.wikipedia.org/wiki/Nitrogen_dioxidehttp://en.wikipedia.org/wiki/Sulfur_dioxidehttp://en.wikipedia.org/wiki/Sulfur_dioxidehttp://en.wikipedia.org/wiki/Sulfiteshttp://en.wikipedia.org/wiki/Sulfiteshttp://en.wikipedia.org/wiki/Chlorinehttp://en.wikipedia.org/wiki/Chlorinehttp://en.wikipedia.org/wiki/Chloraminehttp://en.wikipedia.org/wiki/Chloraminehttp://en.wikipedia.org/wiki/Chloraminehttp://en.wikipedia.org/wiki/Chlorinehttp://en.wikipedia.org/wiki/Sulfiteshttp://en.wikipedia.org/wiki/Sulfur_dioxidehttp://en.wikipedia.org/wiki/Nitrogen_dioxidehttp://en.wikipedia.org/wiki/Ozonehttp://en.wikipedia.org/wiki/Pollution -
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early childhoodearly childhood infectionsinfections, especially, especially viralviralrespiratory infectionsrespiratory infections. However, persons of. However, persons of
any age can have asthma triggered byany age can have asthma triggered bycolds and other respiratory infections evencolds and other respiratory infections even
though their normal stimuli might be fromthough their normal stimuli might be from
another category (e.g. pollen) and absentanother category (e.g. pollen) and absent
at the time of infection.at the time of infection.
exerciseexercise, the effects of which differ, the effects of which differ
somewhat from those of the other triggerssomewhat from those of the other triggers
emotional stressemotional stress, which is poorly, which is poorly
understood as a triggerunderstood as a trigger
http://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/URTIhttp://en.wikipedia.org/wiki/URTIhttp://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/Stress_%28medicine%29http://en.wikipedia.org/wiki/Stress_%28medicine%29http://en.wikipedia.org/wiki/Stress_%28medicine%29http://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/URTIhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Infection -
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PathophysiologyPathophysiology
The mechanisms behind allergic asthmaThe mechanisms behind allergic asthma
i.e., asthma resulting from ani.e., asthma resulting from an
immune responseimmune response to inhaledto inhaled allergensallergensareare
the best understood of the causal factors.the best understood of the causal factors.
In both asthmatics and non-asthmatics,In both asthmatics and non-asthmatics,inhaled allergens that find their way to theinhaled allergens that find their way to the
innerinner airwaysairways areare ingestedingested by a type of cellby a type of cell
known asknown as antigen presenting cellsantigen presenting cells, or APCs., or APCs.
http://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/Bronchiolehttp://en.wikipedia.org/wiki/Bronchiolehttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Antigen_presenting_cellhttp://en.wikipedia.org/wiki/Antigen_presenting_cellhttp://en.wikipedia.org/wiki/Antigen_presenting_cellhttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Bronchiolehttp://en.wikipedia.org/wiki/Allergenhttp://en.wikipedia.org/wiki/Immune_response -
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APCs then "present" pieces of the allergenAPCs then "present" pieces of the allergen
to otherto other immune systemimmune system cells. In mostcells. In most
people, these other immune cells (people, these other immune cells (TH0 cellsTH0 cells) "check" and usually ignore the) "check" and usually ignore the
allergen molecules. In asthmatics,allergen molecules. In asthmatics,
however, these cellshowever, these cells transformtransform into ainto a
different type of cell (TH2), for reasonsdifferent type of cell (TH2), for reasonsthat are not well understood.that are not well understood.
The resultant TH2 cells activate anThe resultant TH2 cells activate an
important arm of the immune system,important arm of the immune system,
known as theknown as the humoral immune systemhumoral immune system..The humoral immune system producesThe humoral immune system produces
antibodiesantibodies against the inhaled allergen.against the inhaled allergen.
http://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/T_helper_cellhttp://en.wikipedia.org/wiki/T_helper_cellhttp://en.wikipedia.org/wiki/Differentiationhttp://en.wikipedia.org/wiki/Differentiationhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Humoral_immunityhttp://en.wikipedia.org/wiki/Differentiationhttp://en.wikipedia.org/wiki/T_helper_cellhttp://en.wikipedia.org/wiki/Immune_system -
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Later, when an asthmatic inhales the sameLater, when an asthmatic inhales the same
allergen, these antibodies "recognize" itallergen, these antibodies "recognize" itand activate aand activate a humoral responsehumoral response..
InflammationInflammation results: chemicals areresults: chemicals are
produced that cause the airways toproduced that cause the airways to
constrict and release more mucus, and theconstrict and release more mucus, and thecell-mediated arm of the immune systemcell-mediated arm of the immune system
is activated.is activated.
The inflammatory response is responsibleThe inflammatory response is responsible
for the clinical manifestations of anfor the clinical manifestations of an
asthma attack.asthma attack.
http://en.wikipedia.org/wiki/Humoral_immune_responsehttp://en.wikipedia.org/wiki/Humoral_immune_responsehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Humoral_immune_response -
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In essence, asthma is the result of anIn essence, asthma is the result of anabnormalabnormal immune responseimmune response in thein thebronchialbronchial airways.airways.
The airways of asthmatics are "The airways of asthmatics are "hypersensitivehypersensitive" to certain triggers, also" to certain triggers, alsoknown as stimuli.known as stimuli.
In response to exposure to these triggers,In response to exposure to these triggers,thethe bronchibronchi (large airways) contract into(large airways) contract into
spasmspasm (an "asthma attack").(an "asthma attack").
InflammationInflammation soon follows, leading to asoon follows, leading to afurther narrowing of the airways andfurther narrowing of the airways and
excessiveexcessive mucusmucus production, which leadsproduction, which leads
http://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Immune_responsehttp://en.wikipedia.org/wiki/Bronchialhttp://en.wikipedia.org/wiki/Bronchialhttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Mucushttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/wiki/Bronchialhttp://en.wikipedia.org/wiki/Immune_response -
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Signs and SymptomsSigns and Symptoms
Coughing.Coughing.
Coughing from asthma is often worse atCoughing from asthma is often worse atnight or early in the morning, making itnight or early in the morning, making ithard to sleep.hard to sleep.
Wheezing.Wheezing. Wheezing is a whistling or squeakyWheezing is a whistling or squeaky
sound when you breathe.sound when you breathe.
Chest tightness.Chest tightness.This can feel like something is squeezingThis can feel like something is squeezing
or sitting on your chest.or sitting on your chest.
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Shortness of breath.Shortness of breath.
Some people say they can't catch theirSome people say they can't catch their
breath, or they feel breathless or out ofbreath, or they feel breathless or out ofbreath.breath.
You may feel like you can't get enoughYou may feel like you can't get enough
air in or out of your lungs.air in or out of your lungs.
Faster breathing or noisy breathing.Faster breathing or noisy breathing.
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Medical ManagementMedical Management
Symptomatic control of episodes ofSymptomatic control of episodes ofwheezing and shortness of breath iswheezing and shortness of breath is
generally achieved with fast-actinggenerally achieved with fast-acting
bronchodilatorsbronchodilators. These are typically. These are typically
provided in pocket-sized, metered-doseprovided in pocket-sized, metered-doseinhalersinhalers (MDIs).(MDIs).
NNebulizerebulizerwhich provides a larger,which provides a larger,continuous dosecan also be used.continuous dosecan also be used.
Nebulizers work by vaporizing a dose ofNebulizers work by vaporizing a dose of
medication in a saline solution into amedication in a saline solution into a
steady stream of foggy vapour, which thesteady stream of foggy vapour, which the
http://en.wikipedia.org/wiki/Bronchodilatorhttp://en.wikipedia.org/wiki/Bronchodilatorhttp://en.wikipedia.org/wiki/Inhalerhttp://en.wikipedia.org/wiki/Inhalerhttp://en.wikipedia.org/wiki/Nebulizerhttp://en.wikipedia.org/wiki/Nebulizerhttp://en.wikipedia.org/wiki/Nebulizerhttp://en.wikipedia.org/wiki/Inhalerhttp://en.wikipedia.org/wiki/Bronchodilator -
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MedicationsMedications
Short-acting, selectiveShort-acting, selectivebeta2-adrenoceptor agonistsbeta2-adrenoceptor agonists, such as, such as salbutamolsalbutamol(albuterol(albuterol USANUSAN),), levalbuterollevalbuterol,, terbutalineterbutaline andandbitolterolbitolterol - inhaled delivery, which allows the drug- inhaled delivery, which allows the drugto target the lungs specifically;caution againstto target the lungs specifically;caution against
using these medicines too frequently, efficacyusing these medicines too frequently, efficacymay decline, producingmay decline, producing desensitizationdesensitization resultingresultingin an exacerbation of symptoms which may leadin an exacerbation of symptoms which may leadto refractory asthma and death.to refractory asthma and death.
http://en.wikipedia.org/wiki/Beta2-adrenergic_receptor_agonisthttp://en.wikipedia.org/wiki/Beta2-adrenergic_receptor_agonisthttp://en.wikipedia.org/wiki/Salbutamolhttp://en.wikipedia.org/wiki/Salbutamolhttp://en.wikipedia.org/wiki/United_States_Adopted_Namehttp://en.wikipedia.org/wiki/United_States_Adopted_Namehttp://en.wikipedia.org/wiki/Levalbuterolhttp://en.wikipedia.org/wiki/Levalbuterolhttp://en.wikipedia.org/wiki/Terbutalinehttp://en.wikipedia.org/wiki/Terbutalinehttp://en.wikipedia.org/wiki/Bitolterolhttp://en.wikipedia.org/wiki/Bitolterolhttp://en.wikipedia.org/wiki/Desensitizationhttp://en.wikipedia.org/wiki/Desensitizationhttp://en.wikipedia.org/wiki/Desensitizationhttp://en.wikipedia.org/wiki/Bitolterolhttp://en.wikipedia.org/wiki/Terbutalinehttp://en.wikipedia.org/wiki/Levalbuterolhttp://en.wikipedia.org/wiki/United_States_Adopted_Namehttp://en.wikipedia.org/wiki/Salbutamolhttp://en.wikipedia.org/wiki/Beta2-adrenergic_receptor_agonist -
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Older, less selectiveOlder, less selective adrenergic agonistsadrenergic agonists,,
such as inhaledsuch as inhaled epinephrineepinephrine andand ephedrineephedrine
tablets - inhaled epinephrine has beentablets - inhaled epinephrine has been
shown to be an effective agent toshown to be an effective agent to
terminate an acute asthmaticterminate an acute asthmatic
exacerbationexacerbation
AnticholinergicAnticholinergic medications, such asmedications, such as
ipratropium bromideipratropium bromide - can be used in- can be used in
patients with heart disease; however, theypatients with heart disease; however, they
take up to an hour to achieve their fulltake up to an hour to achieve their full
effect and are not as powerful as the 2-effect and are not as powerful as the 2-
adrenoreceptor agonistsadrenoreceptor agonists
http://en.wikipedia.org/wiki/Adrenergic_receptorhttp://en.wikipedia.org/wiki/Adrenergic_receptorhttp://en.wikipedia.org/wiki/Epinephrinehttp://en.wikipedia.org/wiki/Epinephrinehttp://en.wikipedia.org/wiki/Ephedrinehttp://en.wikipedia.org/wiki/Ephedrinehttp://en.wikipedia.org/wiki/Anticholinergichttp://en.wikipedia.org/wiki/Anticholinergichttp://en.wikipedia.org/wiki/Ipratropium_bromidehttp://en.wikipedia.org/wiki/Ipratropium_bromidehttp://en.wikipedia.org/wiki/Ipratropium_bromidehttp://en.wikipedia.org/wiki/Anticholinergichttp://en.wikipedia.org/wiki/Ephedrinehttp://en.wikipedia.org/wiki/Epinephrinehttp://en.wikipedia.org/wiki/Adrenergic_receptor -
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Nursing ManagementNursing Management
The most effective treatment for asthma isThe most effective treatment for asthma is
identifying triggers, such as pets oridentifying triggers, such as pets oraspirin, and limiting or eliminatingaspirin, and limiting or eliminating
exposure to them.exposure to them.
DesensitizationDesensitization to allergens has beento allergens has been
shown to be a treatment option for certainshown to be a treatment option for certain
patients.patients.
Smoking cessation and avoidance ofSmoking cessation and avoidance of
secondhand smoke is strongly encouragedsecondhand smoke is strongly encouraged
in asthmatics.in asthmatics.
http://en.wikipedia.org/wiki/Desensitizationhttp://en.wikipedia.org/wiki/Desensitizationhttp://en.wikipedia.org/wiki/Desensitization -
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For those in whom exercise can trigger anFor those in whom exercise can trigger an
asthma attack (asthma attack (exercise-induced asthmaexercise-induced asthma),),
higher levels of ventilation and cold, dryhigher levels of ventilation and cold, dryair tend to exacerbate attacks.air tend to exacerbate attacks.
For this reason, activities in which aFor this reason, activities in which a
patient breathes large amounts of cold air,patient breathes large amounts of cold air,
such as skiing and running, tend to besuch as skiing and running, tend to be
worse for asthmatics, whereas swimmingworse for asthmatics, whereas swimming
in an indoor, heated pool, with warm,in an indoor, heated pool, with warm,humid air, is less likely to provoke ahumid air, is less likely to provoke a
responseresponse
http://en.wikipedia.org/wiki/Exercise-induced_asthmahttp://en.wikipedia.org/wiki/Exercise-induced_asthmahttp://en.wikipedia.org/wiki/Exercise-induced_asthma -
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Monitoring your asthma so that you canMonitoring your asthma so that you can
recognize when your symptoms arerecognize when your symptoms are
getting worse and respond quickly togetting worse and respond quickly toprevent or stop an asthma attack.prevent or stop an asthma attack.
Avoiding things that bring on your asthmaAvoiding things that bring on your asthma
symptoms or make your symptoms worse.symptoms or make your symptoms worse.
Doing so can reduce the amount ofDoing so can reduce the amount of
medicine you need to control your asthma.medicine you need to control your asthma.
Advise to carry quick-relief inhaler withAdvise to carry quick-relief inhaler with
you at all times in case of an asthmayou at all times in case of an asthma
attack.attack.