Category: Allergies

Jul 03

What Is Asthma?

Asthma is a chronic lung disease characterized by inflammation and narrowing of the airways, leading to breathing difficulties. It affects a significant number of people worldwide, with an estimated 262 million individuals living with asthma. This condition can occur at any age and is believed to result from a combination of genetic and environmental factors. Allergens, respiratory infections, and physical exertion are common triggers for asthma symptoms. Symptoms of asthma often include difficulty breathing, wheezing, coughing, and a sensation of tightness in the chest. Diagnosing asthma typically involves a thorough physical examination, review of medical history, lung function tests, and sometimes allergy testing. Although asthma can significantly impact a person’s life, there are various effective treatments available. Medications and lifestyle modifications can help control symptoms and reduce the risk of asthma attacks, which are sudden and potentially life-threatening exacerbations of asthma symptoms. With proper management, individuals with asthma can lead active and fulfilling lives. Types Asthma is a complex condition that can manifest in various forms, categorized based on the underlying cause and triggers. Identifying the specific type of asthma a person has can aid healthcare providers in tailoring an appropriate treatment plan. The most common types of asthma include: 1. Allergic asthma: This type is triggered by exposure to allergens like dust mites, pollen, mold, or pet dander. Allergic reactions provoke the airway inflammation and narrowing. 2. Non-allergic asthma: Unlike allergic asthma, this type is not primarily triggered by allergens. It can be caused by irritants such as smoke, air pollution, strong odors, cold air, or respiratory infections. 3. Occupational asthma: This form of asthma is caused by exposure to harmful substances in the workplace. Prolonged contact with irritants like chemicals, dust, fumes, or gases can lead to the development of occupational asthma. 4. Exercise-induced bronchoconstriction: Some individuals experience asthma symptoms during or after physical activity. Exercise-induced bronchoconstriction occurs due to the loss of heat and/or water from the airways during exercise, resulting in airway narrowing and breathing difficulties. 5. Pediatric asthma: This type of asthma specifically affects children and often has genetic and environmental factors as underlying causes. It requires specialized management to address the unique needs of young individuals. It’s important to note that individuals with asthma may experience a combination of these types, as asthma is a complex and heterogeneous condition. Proper diagnosis and understanding of the asthma type can guide healthcare professionals in developing personalized treatment strategies. Asthma Symptoms Asthma symptoms can vary from person to person, with some experiencing mild and occasional symptoms, while others may have more severe and persistent symptoms. Here are some common symptoms associated with asthma: What Causes Asthma? Asthma is a complex condition influenced by a combination of genetic and environmental factors. While the exact cause of asthma is not fully understood, there are several known factors that contribute to its development: In addition to these factors, certain risk factors can increase the likelihood of developing asthma: It’s important to note that having these risk factors does not necessarily mean that someone will develop asthma. It is a complex interplay of factors, and individual experiences may vary. Diagnosis To determine if you have asthma, your healthcare provider will assess your symptoms, medical history, and may conduct various diagnostic tests. The process typically involves the following steps: Treatments for Asthma While there is currently no cure for asthma, there are various treatment options available to effectively manage the condition and control symptoms. The primary goals of asthma treatment are to: Medications Asthma medications are available in different forms and are used to control symptoms, reduce inflammation, and keep the airways open. The types of medications used to treat asthma include: Lifestyle Modifications Lifestyle modifications play a crucial role in managing asthma and reducing the frequency of asthma attacks. Here are some important lifestyle modifications for asthma management: How to Prevent Asthma Attacks While it is not possible to completely prevent asthma, there are measures you can take to minimize the occurrence and intensity of asthma attacks. Asthma Action Plan After receiving an asthma diagnosis, you and your healthcare provider will collaborate to create an asthma action plan (AAP) tailored to your specific needs. The AAP serves as a guide to help you identify the factors that trigger your symptoms and provides clear instructions on how to manage and prevent asthma attacks. In addition to outlining your personalized medication regimen and the correct administration methods, the AAP will also specify when it is necessary to seek emergency medical care in the event of severe symptoms. Furthermore, your AAP may include the baseline results of peak flow monitoring, which helps gauge the effectiveness of your asthma management. Use a Peak Flow Meter A peak flow meter is a compact handheld device that measures the rate at which air flows out of your lungs when you exhale forcefully into it. By regularly using a peak flow meter, you can monitor your lung function and detect any narrowing of the airways even before asthma symptoms manifest, providing an early warning system. Monitoring your peak flow readings enables you to determine when it’s necessary to use your quick-relief medications and serves as an indicator of how well your asthma is being managed. This information is crucial for optimizing your asthma treatment plan and ensuring that your condition remains under control. Comorbid Conditions There are several health conditions that can coexist with asthma, known as comorbid conditions, which can worsen asthma symptoms and make asthma management more challenging. It is common for individuals with asthma to have one or more of the following comorbid conditions: 1. Allergies: Allergic reactions to substances like pollen, pet dander, mold, or certain foods can increase the risk of asthma and trigger asthma symptoms. 2. Chronic obstructive pulmonary disease (COPD): COPD is a chronic lung disease that shares similar symptoms with asthma, such as difficulty breathing and coughing. 3. Rhinitis: Inflammation of the nose can result in excess mucus production, leading to postnasal drip. This can irritate the airways and

Jul 03

Can You ‘Outgrow’ Asthma Symptoms?

Numerous Americans are diagnosed with asthma each year. According to the Asthma and Allergy Foundation of America (AAFA), over 25 million Americans have asthma. That’s about one in every 13. Women have a higher risk of developing asthma than males do, and the AAFA reports that more children than any other chronic ailment are affected by asthma. But can you “outgrow” your asthma, and does it ever really go away? The answer is yes, sort of and occasionally. Although this is more common in children, some adults also experience remission of their asthma symptoms and go on to have normal, symptom-free lives. It’s not always possible to “outgrow” asthma, though. Symptoms may return on their own accord, sometimes even years later. Learn more about asthma, how symptoms improve, and who has the best chance of seeing remission in this informative article. What Is Asthma? Asthma is indeed a chronic lung condition characterized by inflammation and narrowing of the airways. This inflammation and constriction can lead to various symptoms, including wheezing, coughing (particularly during specific times of the day), chest tightness, and shortness of breath. The severity and frequency of these symptoms can determine the type of asthma a person has. The classifications of asthma include intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma. Each type is characterized by different symptom patterns and their impact on daily life. While asthma cannot be cured, it can be effectively managed with appropriate treatments. Inhalers are the most commonly prescribed form of treatment. Reliever inhalers provide immediate relief by relaxing the airway muscles, while preventer inhalers are used regularly to control inflammation and prevent symptoms. Combination inhalers contain both a reliever and a preventer medication. In more severe cases of asthma, medications such as steroids may be prescribed to reduce inflammation. Certain surgeries or procedures may also be considered as treatment options. So Does Asthma Ever Go Away Completely? It is possible for children to outgrow asthma symptoms as they age. Some children, particularly those who started wheezing at a young age, may see their symptoms improve or completely resolve over time. However, it is not entirely clear why this happens in some children and not others. Similarly, in adults, asthma symptoms can become less frequent or transition from persistent to intermittent. The persistence of asthma in adults is influenced by various factors, and the individual nature of the condition makes it difficult to predict how it will progress in each person. While some individuals may experience remission or a decrease in symptoms, it’s important to note that asthma is a chronic condition, and for many people, it remains a lifelong condition that requires ongoing management. Regular monitoring, adherence to prescribed medications, and avoidance of triggers are still crucial for individuals with asthma, even if their symptoms have improved. What Is Asthma Remission? Remission in asthma refers to a period of time when symptoms decrease or disappear entirely for at least 12 months. There are two main types of remission: symptomatic remission and total or complete remission. It is indeed possible for asthma to naturally go away on its own, particularly for those who developed asthma during childhood. Studies have reported varying rates of spontaneous remission, ranging from 2% to 52% of individuals experiencing a resolution of asthma symptoms without treatment. However, it’s important to note that even individuals who have outgrown asthma may still experience relapse later in life. The exact reasons why some people experience remission while others do not are not fully understood. It could be influenced by various factors, including genetics, environmental exposures, and individual immune responses. It is essential for individuals who have experienced remission of their asthma symptoms to continue monitoring their respiratory health and maintain regular follow-ups with their healthcare provider. Asthma can be a complex and unpredictable condition, and proper management is crucial even during periods of remission to ensure the best possible long-term outcomes. Who Is Most Likely To Achieve Remission? Achieving remission in asthma is not guaranteed, but certain factors have been identified to increase the likelihood of being symptom-free, as highlighted in a 2022 European Respiratory Journal study: The study also reported that certain medications, such as biologics (monoclonal antibodies) and macrolide antibiotics like azithromycin, may aid in achieving remission. While these medications are known to be effective for other conditions like rheumatoid arthritis, their potential to control asthma symptoms and potentially slow down airway remodeling requires further research. Additionally, a treatable traits approach focusing on managing underlying conditions, including comorbidities, smoking, anxiety and depression, physical inactivity, and obesity, can improve asthma symptom management and potentially enhance the chances of remission. Early intervention and seeking medical help upon the first onset of asthma symptoms were highlighted as essential in the study. Timely treatment can help mitigate the progression of airway remodeling in the early stages, potentially promoting remission. A Quick Review While some individuals may experience complete remission of asthma symptoms and no longer require inhaled treatments, others may see their symptoms become less frequent. According to Dr. Li, the diagnosis of asthma may still remain with the patient, as there is a risk of symptom recurrence. However, if the symptoms are intermittent or mild, daily controller therapy may not be necessary. As of November 2022, there is limited research available regarding who is likely to achieve remission and who should continue with asthma treatment. Therefore, it is important to maintain contact with an asthma specialist and seek their guidance before making any decisions to discontinue treatments. Dr. Li advises individuals to consult with a specialist to determine the type of asthma they have and develop an appropriate treatment plan. With personalized therapy and regular follow-up, an individual’s asthma action plan can be tailored to their specific needs. It is crucial to note that asthma is a complex condition, and its management should be done under the guidance of healthcare professionals who can provide individualized recommendations based on each person’s unique circumstances.

Jul 03

Experts Explain Ways to Beat Pet Allergies From Cats and Dogs

Pollen, mold spores, and other allergens found outside can attach to a pet’s hair or fur in addition to dander. Whether you’ve had cat or dog allergies before or not, there are steps you may do to alleviate your symptoms. Pet allergies can be found in the animal’s fur, skin, and saliva, per the American College of Allergy, Asthma & Immunology (ACAAI). According to the American Academy of Allergy, Asthma & Immunology (AAAAI), the proteins in pet dander, skin flakes, saliva, and urine can trigger allergic reactions or exacerbate asthma symptoms in certain people. Be Prepared Alejandra Soto, who has allergies to various animals, shared her personal approach to managing her allergies when visiting homes with pets. She mentioned that she takes an antihistamine pill approximately 20 minutes before going to someone’s house to help alleviate her allergy symptoms. Since she cannot always predict if someone has a pet, she always carries an antihistamine in her purse to be prepared. Soto emphasized that it is rare for her to be exposed to pet allergens without prior knowledge, as she takes precautions to manage her allergies effectively. Don’t Choose the Soft Chair The American Academy of Allergy, Asthma & Immunology (AAAAI) recommends avoiding exposure to the allergens causing pet allergy symptoms as the best way to manage them. In households with cats or dogs, upholstered furniture can trap pet dander, which is a common allergen. To minimize exposure, it is advised to avoid sitting on upholstered furniture and opt for hard wooden chairs instead. Even if you cannot visibly see any animal hair on a couch, it is still recommended to refrain from sitting on it to reduce the risk of allergen exposure. Take Antihistamines Non-drowsy antihistamines like loratadine (Claritin) can be effective in keeping you symptom-free and alert when visiting households with pets that trigger your allergies. Taking loratadine or other oral antihistamines can help manage allergy symptoms caused by pets, according to the Asthma and Allergy Foundation of America (AAFA) and the American College of Allergy, Asthma & Immunology (ACAAI). Additionally, steroid nasal sprays and other oral medications may be recommended by an allergist based on your specific allergy triggers. If you are planning an extended visit to a home with cats or dogs, it may be advisable to consult a healthcare provider about starting medication a few weeks prior to the visit to better manage your symptoms. Practice Hand Hygiene In addition to managing pet allergies, it is important to follow basic hygiene practices to minimize exposure to pet allergens. Washing your hands regularly and refraining from touching your face are essential habits recommended by the National Institute of Environmental Health Sciences (NIEHS). If you come into contact with pet allergens, such as after playing with a pet, it is advised to wash your hands and launder your clothes to remove the allergens. Even minimal contact with pets can trigger allergic reactions, so it is cautioned by the American Academy of Allergy, Asthma & Immunology (AAAAI) to avoid hugging, kissing, or close contact with pets if you are allergic to them. Pet dander can easily be transferred to surfaces, so washing your hands before touching your face or eyes is important to prevent triggering allergy symptoms. By practicing good hygiene habits, you can help reduce exposure to pet allergens and minimize allergic reactions. Have Air Filter, Will Travel If you frequently visit households with pets but find that they don’t have a HEPA air purifier in the room where you’ll be staying, it might be worth considering investing in a portable HEPA air purifier of your own. HEPA (High-Efficiency Particulate Air) air purifiers are known for their ability to effectively remove allergenic particles from the air. These small yet powerful devices can be purchased for under $200 and can also be used to clean the air in your car. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), HEPA air purifiers are beneficial not only for pet allergens but also for pollen, mold, and dust mite allergens. Having a HEPA filter can be a valuable addition to your allergy management strategy, providing cleaner air and potentially reducing allergic reactions in various environments. So, if you frequently encounter pet allergens or other allergens in your surroundings, consider investing in a portable HEPA air purifier to create a cleaner and more allergen-free environment for yourself. When You Get Home To minimize the spread of pet allergens and avoid bringing them into your home, it’s recommended to wash your clothes in hot water, especially after a visit to a household with cats or dogs. Pet allergens can easily become airborne and settle on various surfaces, including carpets and furniture, where they can persist for months. Additionally, these allergens can hitch a ride on clothing and be transported to areas without pets. To ensure thorough removal of allergens, Angel Waldron suggests washing everything you’ve brought from the pet-inclusive environment. It’s advisable to use water that is at least 130 degrees Fahrenheit to effectively eliminate allergens. By washing your clothes in hot water, you can help reduce the presence of pet allergens and minimize the potential for allergic reactions in your own living space. HEPA at Home To reduce the presence of allergens in your home, the Asthma and Allergy Foundation of America (AAFA) suggests several strategies. Installing air cleaners with HEPA filters in your heating and air conditioning systems can help minimize the circulation of allergens. It is recommended to run the air cleaners for at least four hours a day to ensure their effectiveness. When vacuuming, opt for a vacuum cleaner equipped with a HEPA filter to trap allergens more efficiently. It is also advisable to wear a dust mask while vacuuming to minimize your exposure to airborne allergens. Instead of dry dusting, use a damp cloth to trap dust and prevent it from becoming airborne. Maintaining a clean and tidy home is essential in reducing allergen levels. Dust and clutter can harbor allergens, so regular cleaning is

Jul 03

Common Things That Can Cause or Trigger Asthma

You’ve certainly heard of some of the various causes of asthma attacks, which include wheezing, coughing, and difficulty breathing. Pollen, physical exertion, psychological strain, and other factors can all serve as triggers. However, asthma triggers are not the same thing as the true causes of asthma. Researchers have been unable to pin down the root reasons. But here’s what we know about the triggers for asthma, and the treatments that may help. Genetics Asthma, like many other diseases, is influenced by both genetic and environmental factors. Research suggests that genetics play a significant role in asthma, with approximately 50% or more of cases being attributed to inherited genes. According to Traci Gonzales, a spokesperson for the American Lung Association and a nurse practitioner with UTHealth McGovern Medical School Houston, there are identified genetic traits associated with asthma. If parents have asthma, there is an increased likelihood that their children will also develop the condition. Having a family history of allergies further increases the risk of developing asthma. This genetic predisposition to asthma and other allergic conditions is known as atopy. Scientists have already identified numerous genes that may be involved in asthma, and it is likely that there are many more yet to be discovered. Some of these genes are related to the functioning of the immune system, while others are associated with the functioning of the airways. However, it is important to note that genes alone are unlikely to be the sole cause of asthma. Rather, it is a combination of inheriting certain genes and being exposed to specific environmental triggers that can lead to the development of asthma. Allergies In some cases, asthma triggers and causes can overlap, particularly in adult-onset asthma. Allergy-related factors, such as exposure to dust mites or mold, can contribute to the development of asthma. While it may not be possible to predict which specific allergy will lead to asthma, managing symptoms can be achieved by avoiding triggers. Identifying your specific allergens can be done with the help of an allergist, who can conduct tests to pinpoint the substances that trigger your allergic reactions and potentially contribute to your asthma symptoms. By knowing your triggers, you can take proactive measures to minimize exposure and better manage your asthma. Respiratory Infections Respiratory infections, especially in young children, can be a trigger for asthma development. Children have developing immune systems, and the effects of infections can sometimes lead to long-term outcomes, including the onset of asthma. Respiratory syncytial virus (RSV) and parainfluenza are common viral infections that can cause symptoms similar to a cold and potentially contribute to the development of asthma. While it may not be possible to completely prevent infections, taking preventive measures can help reduce the risk. This includes getting appropriate vaccinations, such as the seasonal flu vaccine, and practicing good hand hygiene by regularly washing hands. These steps can help minimize the likelihood of respiratory infections and potentially decrease the chances of asthma development or worsening symptoms. Air Pollution and Smoke There is evidence to suggest that both air pollution and secondhand smoke exposure may contribute to the development of asthma in individuals who do not already have the condition. Research indicates that exposure to cigarette smoke, particularly during childhood or before birth (via maternal exposure), may play a role in asthma development. This exposure can have indirect effects by making a child more susceptible to infections, which in turn increase the risk of asthma. It may also have direct effects on the immune system or the development of the respiratory system. While there is a correlation between smoking exposure and asthma, the exact mechanisms are not fully understood. It is unclear whether the exposure is from secondhand smoke or in utero exposure, or if individuals who smoke themselves have a higher incidence of asthma. It is important to note that cigarette smoking itself does not seem to directly cause adult-onset asthma. However, smoking can exacerbate symptoms in individuals who already have asthma. Quitting smoking and minimizing exposure to secondhand smoke are crucial steps in managing asthma symptoms and improving overall respiratory health. Your Job Occupational asthma is a type of asthma that is caused by exposure to irritants, such as fumes, dust, or gases, in the workplace. Certain occupations, such as baking, farming, and jobs in chemical or plastic manufacturing, are associated with a higher risk of developing occupational asthma. While some individuals may develop asthma symptoms immediately upon exposure to a specific toxin in their work environment, it is more common for symptoms to develop gradually after chronic exposure over time. It’s important to note that not everyone who is exposed to occupational irritants will develop asthma. Individual susceptibility can vary, and some individuals may be more prone to developing the condition due to genetic or other factors. If you suspect that your asthma symptoms are work-related, it is crucial to seek medical attention and inform your healthcare provider about your occupational exposure. They can help evaluate your symptoms, conduct relevant tests, and determine if there is a connection between your asthma and workplace environment. Taking appropriate measures to minimize exposure to workplace triggers, such as using protective equipment or modifying work processes, may be necessary to manage and prevent further exacerbation of occupational asthma symptoms. Obesity Obesity is a known risk factor for asthma, and individuals who are obese have a higher prevalence of asthma compared to those with a healthy body mass index (BMI). According to the American Lung Association, the rate of asthma is approximately 11% among individuals who are obese, compared to 7% among adults with a healthy BMI. This association is particularly pronounced in obese women, with almost 15% of them experiencing asthma. The exact reasons behind the link between obesity and asthma are not fully understood. However, obesity is known to contribute to chronic inflammation throughout the body, and this inflammation may play a role in the development or exacerbation of asthma symptoms. Additionally, individuals who are obese often face challenges in effectively

Jul 03

What Causes Asthma?

The airways become irritated and restricted due to asthma, a chronic lung condition. Exercise, exposure to allergens and irritants, and respiratory infections can all bring on asthma symptoms including shortness of breath, wheezing, and chest tightness. Genetics, allergies, exposure to lung irritants, and immune system malfunction have all been linked to an increased chance of developing asthma, while the actual origin of the condition remains unclear.1 This article will examine the various causes and triggers of asthma, as well as the biological processes that contribute to asthma symptoms. Theories The development of asthma is a complex process that varies from person to person. While the exact cause(s) remain elusive, asthma is commonly triggered by specific factors. Individuals with asthma have airways that are hyperresponsive, meaning they are more sensitive to certain triggers. When exposed to these triggers, the airways become inflamed, leading to swelling and narrowing. This inflammation causes the surrounding muscles to constrict, further obstructing the airway passages and resulting in symptoms like shortness of breath, wheezing, coughing, and chest tightness. Additionally, the inflammation can stimulate excess mucus production, worsening the symptoms. Extensive research is ongoing to unravel the precise causes of asthma. It is widely accepted that a combination of genetic and environmental factors contributes to the development of asthma. Genetic predisposition plays a role, as asthma often runs in families. Specific genes related to immune function, airway reactivity, and inflammation have been identified, but the interplay of multiple genes and their interaction with environmental influences is believed to be responsible for asthma susceptibility. Environmental factors also play a crucial role in triggering asthma. Exposure to allergens such as pollen, dust mites, and pet dander, as well as irritants like tobacco smoke, air pollution, and chemical fumes, can provoke asthma symptoms. Respiratory infections, physical activity, and changes in weather conditions can also act as triggers. Occupational exposure to certain substances can lead to the development of occupational asthma. Understanding the complex interplay between genetic predisposition, environmental triggers, and immune system responses is crucial in managing and preventing asthma. Personalized treatment plans, trigger avoidance strategies, and ongoing research efforts aim to improve the management and quality of life for individuals with asthma. Exposure to Allergens There is a strong association between allergies and asthma, and individuals with allergies are at a higher risk of developing asthma compared to those without allergies. When people with allergies come into contact with allergens like pollen, pet dander, mold, or dust, their immune system perceives these substances as harmful and triggers an exaggerated response. This immune response leads to inflammation in the airways, causing symptoms associated with asthma, such as shortness of breath and chest tightness. This specific type of asthma triggered by allergies is referred to as allergic asthma. The immune system’s overreaction to allergens in allergic asthma involves the release of chemicals, such as histamines, which further contribute to airway inflammation and constriction. Allergic asthma can be diagnosed through specific allergy tests that identify the specific allergens triggering the immune response. Viral Respiratory Infections Viral respiratory infections, including the common cold and influenza, have been identified as potential triggers for the development of asthma. When a viral infection occurs, the immune system activates a response to combat the virus, involving the production of immune cells and the release of chemicals. In certain individuals, this immune response can lead to inflammation and constriction of the airways, resulting in asthma symptoms. Studies have shown that some children who experience viral or bacterial respiratory infections during their early years may go on to develop chronic asthma. This could be attributed to the fact that the immune system and lungs are still in the developmental stage during infancy and early childhood, rendering them more vulnerable to damage and inflammation caused by respiratory viruses. While not all viral infections lead to asthma, it is important to recognize the potential link between respiratory infections and the development of asthma in susceptible individuals, especially in children. Early prevention and management of viral infections, along with appropriate asthma treatment strategies, can help reduce the risk and impact of asthma triggered by respiratory infections. Exposure to Lung Irritants Exposure to lung irritants is considered a potential factor in the development of asthma. The impact of exposure to these irritants can vary depending on the specific irritant, duration of exposure, and individual factors such as genetics and underlying health conditions. Prolonged exposure to certain irritants, particularly in occupational settings, has been associated with an increased risk of asthma due to chronic exposure. When inhaled, lung irritants can lead to inflammation and constriction of the airways, contributing to the development of asthma symptoms. Examples of lung irritants include air pollution, cigarette smoke, specific types of dust (such as industrial or wood dust), chemical fumes, and vapors. These irritants can trigger an immune response and result in airway inflammation and subsequent asthma symptoms. Is Asthma Hereditary? Asthma has a strong genetic component, and its occurrence within families indicates a significant genetic link. Individuals who have family members with asthma are more prone to developing the condition, and the risk is significantly higher if one of their parents has asthma. Extensive research has identified more than 100 genes associated with asthma, many of which are involved in the functioning of the immune system and lungs. These shared genetic factors explain why individuals with asthma often exhibit heightened sensitivity to allergens and environmental irritants compared to those without asthma. Additionally, these genetic risk factors overlap with other conditions related to immune system overactivity, such as allergic rhinitis and eczema. It is important to note that having a genetic predisposition to asthma does not guarantee its development. The interplay between various genes, as well as the interaction with environmental factors, plays a crucial role in asthma development. Further research is necessary to understand the complex mechanisms through which genetic and environmental factors contribute to the manifestation of asthma. Who Gets Asthma? Asthma can affect individuals of all ages, genders, and ethnicities, although certain factors can

Jul 02

Things To Do if You’re Having an Asthma Attack—Tips To Prevent an Attack

An asthma attack, also known as an asthma exacerbation, is characterized by a sudden worsening of asthma symptoms due to the constriction of the muscles surrounding the airways. However, it’s important to note that asthma attacks can vary among individuals. The experience of an asthma attack can differ from person to person, as each individual may have different levels and manifestations of symptoms. According to Dr. Melinda Rathkopf, an expert in allergy, asthma, and immunology, what constitutes an attack for one person may be different for another. Although individual attacks may present with varying symptoms or levels of severity, they share a common factor: a rapid deviation from one’s normal asthma symptoms, which, with proper management, may be minimal or absent. Dr. Marilyn Li, an associate professor of pediatrics, emphasizes the sudden and distinct nature of an asthma attack. It represents a notable event characterized by a swift onset of symptoms that deviates from a person’s usual symptom pattern. Asthma Symptoms and Triggers During an asthma attack, individuals may experience various symptoms, including difficulty breathing, wheezing, coughing, increased mucus production, shortness of breath, chest tightness or pressure, and in severe cases, blue lips or nails due to hypoxia. However, the latter symptoms are considered extreme and less common, according to Dr. Rathkopf. Triggers for asthma attacks can vary from person to person, but the two main causes are allergies and infections, as explained by Dr. Rathkopf. Allergic asthma triggers commonly include pollen (particularly during specific seasons), mold, dust mites, cockroaches, and pet dander, especially from cats. Cat dander, in particular, tends to stick to the airways, exacerbating asthma symptoms. Upper respiratory infections like the common cold, flu, or sinusitis can also serve as triggers for asthma attacks. Additional potential triggers include cigarette smoke, perfumes or fragrances, stress and strong emotions, cold air, physical exercise, acid reflux, and adverse weather conditions. Certain weather events, such as high winds, can worsen asthma symptoms by dispersing airborne elements like pollen and dust into the air, which can then trigger an attack. Dr. Li mentions that during Santa Ana winds in California, airborne particles like pollen and dirt become more prevalent due to the wind blowing them off surfaces. This increased presence of airborne allergens can easily enter the airways and contribute to an asthma attack. Prevention for Asthma Attacks Some periods of asthma last only a few minutes, while others can be quite severe and require emergency medical attention. Many cases of minor assaults are manageable at home. Try the following. 1. Avoid Your Triggers If you are aware of your asthma triggers, it is advisable to avoid them as much as possible in order to prevent asthma attacks. However, there may be instances where avoiding triggers is not feasible. In such cases, if you find yourself experiencing an asthma attack and you know the trigger, take immediate action to remove yourself from the source. For example, if you enter a house with a cat and notice symptoms of an asthma attack, it is recommended to leave the environment and get some fresh air. Similarly, if you are outdoors in cold weather and the cold air is triggering your symptoms, seek shelter indoors or cover your mouth with a scarf to help warm the air you breathe. Taking prompt action to remove yourself from the trigger can help minimize the severity of the asthma attack and potentially prevent it from worsening. 2. Follow Your Action Plan It is essential for every asthma patient to have an asthma action plan provided by their doctor. These personalized plans outline the recommended steps to take during an asthma attack. Being prepared is crucial because asthma attacks can occur unexpectedly. This applies to everyone, even individuals who have never experienced an asthma attack before. As Dr. Rathkopf explains, some people may mistakenly believe they cannot have asthma because they have never had an attack. However, the absence of previous attacks does not eliminate the possibility of having asthma. The first course of action after removing yourself from the trigger, or if avoidance is not possible or the trigger is unknown, is typically to use medication. 4. Take Your Rescue Inhaler It is recommended that every individual with asthma have a rescue medication, typically an albuterol inhaler or similar bronchodilator, readily available at all times. These medications work quickly to open up the airways and facilitate easier breathing. Even if you haven’t needed to use the medication for an extended period, it is still important to carry it with you as a precautionary measure. In cases of severe asthma, injectable epinephrine may be prescribed by doctors, although this is relatively uncommon. During an asthma attack, it is generally advised to take two to four puffs of the rescue medication, as suggested by Dr. Li. It is crucial to follow the specific instructions provided by your healthcare provider or outlined in your asthma action plan. 5. Stay Calm During an asthma attack, it can be beneficial to consciously relax your upper body and focus on slowing down your breathing. It’s important to avoid panicking, as this can exacerbate the situation. While panic attacks and asthma attacks are distinct, they can sometimes occur simultaneously. By remaining calm and composed, you can help manage the symptoms and navigate through the asthma attack more effectively. Get Medical Help If you’ve experienced an asthma attack in the past, you may have a sense of how the current attack will progress. It’s important to note that individuals with a history of severe asthma attacks are at a higher risk of experiencing another severe attack. Previous symptoms can serve as a predictive factor for future reactions. If you don’t experience improvement after using your rescue inhaler as directed, you may need to repeat the process according to your asthma action plan. However, if your symptoms persist or worsen, it’s crucial to seek medical attention. This can involve visiting the emergency room or contacting your doctor’s office, especially if you have a respiratory infection. While

Jul 02

How Is Asthma Diagnosed?

Asthma is a chronic respiratory disease characterized by the inflammation and narrowing of the airways, leading to symptoms such as shortness of breath, wheezing, coughing, and chest tightness. It affects a significant number of individuals worldwide, with an estimated 226 million people living with asthma. To diagnose asthma, a thorough medical evaluation is conducted, which involves a physical examination, review of medical history, and diagnostic tests. Lung function tests, including spirometry, are commonly performed to assess lung capacity and airflow and provide an accurate diagnosis and evaluation of asthma severity. While primary care providers and pediatricians often diagnose asthma, specialists such as allergists and pulmonologists are also qualified to diagnose and manage asthma and other respiratory conditions. If you experience symptoms suggestive of asthma, it is crucial to seek medical attention from a healthcare professional. Asthma is a chronic condition that typically requires ongoing treatment. Obtaining an early diagnosis allows for the initiation of appropriate treatments to control symptoms and reduce the risk of complications associated with asthma. Diagnostic Criteria The diagnostic criteria for asthma involve a comprehensive assessment of symptoms, medical history, physical examination findings, and lung function tests. Two commonly used criteria are the Global Initiative for Asthma (GINA) criteria and the National Asthma Education and Prevention Program (NAEPP) guidelines. According to the GINA criteria, the diagnosis of asthma is based on the following several key aspects. These diagnostic criteria help healthcare providers establish a diagnosis of asthma and differentiate it from other respiratory conditions. By considering symptoms, lung function tests, airway responsiveness, and ruling out alternative diagnoses, a more accurate diagnosis can be made to guide appropriate management and treatment strategies. Medical History During a thorough evaluation of your medical history, your healthcare provider will consider various factors to help diagnose or rule out asthma. These factors may include: Physical Examination As part of the diagnostic process, your healthcare provider will conduct a physical examination to assess for signs and symptoms of asthma. During the examination, they will listen to your lungs using a stethoscope while you breathe. This allows them to detect any abnormal sounds such as wheezing or decreased breath sounds. Additionally, your healthcare provider will evaluate your respiratory rate, observing for any signs of rapid or shallow breathing. They may also use a pulse oximeter, a device placed on your finger, to measure the oxygen saturation level in your blood. This helps assess the efficiency of your breathing and oxygen exchange. Lung Function Tests Lung function tests, or pulmonary function tests, measure different aspects of your respiratory health to confirm or rule out asthma. These tests include spirometry, peak flow meter test, fractional exhaled nitric oxide (FeNO) test, and bronchial provocation Tests. Spirometry Spirometry is a non-invasive test that measures lung function by assessing the amount of air you can breathe in and out and how quickly you can exhale. The test involves taking a deep breath and exhaling forcefully and rapidly into a spirometer machine. The results of spirometry include the following parameters: Your healthcare provider will compare your spirometry results to the expected values for individuals of similar age, gender, height, and race. In asthma, the FEV1 measurement may be lower than the average expected value. The results obtained from spirometry can also be used to calculate the FEV1/FVC ratio. This ratio represents the percentage of your lung capacity that you can exhale in one second. For children, a low FEV1/FVC ratio is considered less than 85%, while for adults, it is considered less than 70%. By analyzing spirometry results, your healthcare provider can assess the severity of airflow limitation and help confirm a diagnosis of asthma. Peak Flow Meter A peak flow meter is a handheld device used to measure the maximum airflow rate during a forceful exhale. During a peak flow meter test, you will take a deep breath and exhale forcefully into the device. The meter then measures the speed of your exhale, providing a score that can indicate whether your airways are narrowing. The peak flow meter scores are categorized into three zones: 1. Green zone: If you can exhale at 80-100% of your usual peak flow rate, it indicates that your asthma is currently under control. 2. Yellow zone: If you can exhale at 50-80% of your usual peak flow rate, you are in the cautionary range. It is important to take action and seek appropriate medical attention to prevent worsening symptoms. 3. Red zone: If you exhale at 50% or less of your usual peak flow rate, you are in the medical alert range. It is crucial to seek immediate medical attention as your asthma may be severely compromised. It’s important to note that individual results can vary depending on technique and other factors. To obtain the most accurate results, it is recommended to regularly monitor your peak flow and establish a baseline for your normal values. This helps you identify any significant deviations from your usual respiratory function and allows for timely intervention. Regular peak flow monitoring is a valuable tool in managing asthma and monitoring its control over time. FeNO Test The fractional exhaled nitric oxide (FeNO) test is a diagnostic tool used to measure the level of exhaled nitric oxide in your breath. Nitric oxide serves as a marker for a specific type of airway inflammation. During the FeNO test, you will exhale slowly and steadily into a device that measures the concentration of nitric oxide in your breath. Inflammation of the airways, a characteristic feature of asthma, leads to increased production of nitric oxide. Higher levels of nitric oxide indicate greater airway inflammation, which is often seen in conditions like asthma. The FeNO test is particularly useful in diagnosing a specific subtype of asthma called eosinophilic asthma. This subtype is characterized by elevated levels of eosinophils, a type of white blood cell associated with allergic inflammation. By measuring nitric oxide levels, the FeNO test helps identify the presence and degree of airway inflammation associated with eosinophilic asthma. The FeNO test plays

Jul 02

Steroids Commonly Used for Asthma and Allergies Linked to Changes in Brain Structure, Study Shows

The white matter of the brain and cognitive impairment have been linked to glucocorticoids, a common steroid used to treat inflammation related to asthma and allergies. The latest study, published in BMJ Open, indicated that both inhaled and orally administered glucocorticoids had similar effects on brain structure. The authors of the study noted that it was the largest of its type to date. “Both systemic and inhaled glucocorticoid use were associated with reduced white matter integrity,” the study concluded. White matter is the connective tissue between brain cells and the rest of the nervous system, and it may be found in the deeper brain tissues. Damage to white matter has been linked to difficulties with learning, memory, and gait. Depression, anxiety, and even bipolar disease have all been related to white matter damage. The implications of this result and how it affects glucocorticoid use are discussed in further detail below. Oral and Inhaled Glucocorticoids Both Trigger Brain Decline Glucocorticoids, commonly prescribed drugs with immunosuppressive properties, are widely used to treat conditions such as allergies, asthma, and autoimmune disorders. However, a recent study examined the effects of glucocorticoid use on the brain and found a link between the medication and reduced white matter. The study analyzed data from individuals who used oral or inhaled glucocorticoids and compared it to a control group of individuals who did not use these medications. The participants underwent cognitive and mental health tests as well as brain MRIs. The results revealed that taking either oral or inhaled glucocorticoids was associated with a reduction in white matter in the brain. This reduction in white matter has the potential to lead to neuropsychiatric side effects, especially in individuals who use these medications regularly. The study noted that the impact on white matter was more significant in those who used glucocorticoid tablets or injections over a long period of time, while those who used inhalers or nasal glucocorticoids experienced a smaller impact. The exact reasons behind the impact of glucocorticoids on white brain matter are not yet clear, according to the study’s lead author. However, the findings suggest that chronic exposure to glucocorticoids may have detrimental effects on white matter in various organs of the body, including the brain. Further research is needed to better understand the underlying mechanisms and implications of these findings. In the meantime, it is important for healthcare professionals to consider the potential neuropsychiatric effects of glucocorticoid use, especially with long-term or high-dose administration. Are the Findings Cause for Concern? While the recent study suggests a link between glucocorticoid use and reduced white matter in the brain, experts have emphasized that the results should not cause undue concern. According to Dr. Kesari, white matter can potentially repair itself even in the presence of glucocorticoids, and the brain appears to recover when patients are taken off these medications. It is important to note that the study did not specifically investigate the long-term impacts of glucocorticoid use on white brain matter. Previous research has associated long-term oral glucocorticoid use with brain shrinkage in certain areas and changes in brain structure. Mental health issues have also been linked to this class of drugs. The consequences of the observed changes in white matter and their impact on patients are still unknown. The reversibility of these changes remains to be determined. As Jamie Alan, PhD, an associate professor of pharmacology and toxicology, pointed out, there is still much to learn about the effects of glucocorticoids on the brain. What Should You Do if You Use Glucocorticoids? Given the minimal changes observed in white matter, Van der Meulen advised against patients abruptly changing their medication based on the study findings. The small structural changes found in the study are likely to have no significant functional side effects for many individuals with asthma. Other medical professionals echoed similar advice. They emphasized the importance of using glucocorticoids for the shortest duration possible due to their known side effects. The study supports the clinical guideline of minimizing the use of glucocorticoids when feasible. Dr. Kesari acknowledged the beneficial anti-inflammatory properties of glucocorticoids and their widespread use in treating various conditions. He highlighted the need for a better understanding of their side effects and more effective mitigation strategies. If a person is on a high dose of glucocorticoids for an extended period, Dr. Kesari suggested discussing with their doctor the possibility of reducing the dosage or exploring alternative treatments that may have less impact on the body and brain. However, it is important to note that van der Meulen strongly advised against making changes to medication without consulting a healthcare provider. If a person requires the medication, they should continue taking it as prescribed until they have discussed any concerns with their doctor.

Jul 01

What Is Exercise-Induced Asthma—And How Do You Know if You Have It?

Feeling out of breath when exercising is a common occurrence and typically a good indicator of how hard you’re working. That’s because it may mean you’re making the effort necessary to keep or enhance your fitness level. However, it’s not always a good sign if your workout leaves you gasping for air. Why? Possible symptoms of exercise-induced asthma, which is easily diagnosed and treated but can be life-threatening if left unchecked. So, how can you distinguish between the typical breathlessness of an exercise and anything more concerning? This is the information you require. What is Exercise-Induced Asthma? Exercise-induced asthma, also known as exercise-induced bronchoconstriction or exercise-induced bronchospasm (EIB), occurs when physical activity triggers the narrowing or spasming of the muscles around the airways, leading to breathing difficulties. EIB is relatively common, affecting approximately 5 to 20% of individuals. It is often seen in people who already have chronic asthma triggered by other factors such as allergies, pollution, or respiratory infections. However, about 20% of individuals with EIB do not have chronic asthma and only experience asthma symptoms during exercise, according to Dr. Purvi S. Parikh, an allergist and immunologist at NYU Langone Health. Although EIB may sound concerning, it is a highly manageable condition. With proper treatment and care, EIB is unlikely to significantly affect your exercise routine. In fact, many elite athletes, including Olympians, have successfully managed their EIB and continue to excel in their sports, as noted by Dr. Parikh. Symptoms of Exercise-Induced Asthma During or after your workout, symptoms of exercise-induced asthma (EIB) may arise. While these symptoms may initially resemble the normal response to exercise, there are important distinctions to be aware of. Recognizing these differences is crucial in order to halt your workout if you suspect an asthma attack. Dr. Parikh emphasizes the danger of continuing to exercise with compromised breathing. Uncontrolled exercise-induced asthma, as well as any form of asthma, can be life-threatening. Dr. Parikh advises individuals experiencing the following symptoms to immediately cease exercising and promptly consult their doctor for an EIB diagnosis. It is particularly important to seek evaluation since other serious conditions, including heart problems, can mimic EIB. Symptoms of EIB include: 1. Difficulty breathing: This goes beyond mild breathlessness associated with exercise. It can feel as if you are trying to breathe through a straw and may persist even after you’ve finished exercising. 2. Coughing: Occasional coughing is typically harmless, but excessive coughing during or after your workout may indicate EIB. 3. Chest tightness and pain: More intense than the usual exercise-induced chest tightness, this sensation involves a squeezing feeling in the chest, ribs, and possibly back. It may persist after you’ve stopped exercising. 4. Wheezing: Characterized by a whistling or rumbling sound during breathing. 5. Dizziness: This is a more severe symptom of EIB and occurs when the airway is significantly constricted, leading to inadequate oxygen intake. What Are the Causes or Risk Factors Individuals with chronic asthma and allergies are at a higher risk of developing exercise-induced asthma (EIB), although the exact reasons why some people develop EIB while others do not remain unclear. Genetic factors may contribute to its occurrence, according to Dr. Parikh. Various factors can trigger EIB in those who have the condition. While any form of exercise can potentially induce EIB, activities that are more cardio-focused and intense, such as running, HIIT workouts, swimming, and heavy weightlifting, are more likely to elicit symptoms, explains Dr. Parikh. Additionally, endurance sports that involve sustained effort, like soccer and long-distance running, are more commonly associated with EIB compared to activities involving intermittent high-intensity bursts, like baseball and football, as stated by Dr. Smart. Weather conditions can also play a role in triggering EIB. Cold weather exercise, such as cross-country skiing, ice skating, or winter running, can prompt symptoms due to the irritation caused by cold, dry air, leading to the constriction of airway muscles, according to Dr. Anand. Conversely, for some individuals, exercising in hot and humid weather can trigger EIB, as mentioned by Dr. Parikh. Other triggers for EIB include pollution, allergies, and irritants like chlorine. How is Exercise-Induced Asthma Diagnosed? The process of diagnosing exercise-induced asthma (EIB) can vary depending on the individual, but typically doctors will begin by gathering information about your medical history to assess the possibility of EIB. They may then conduct a pulmonary function test, during which you blow into a tube connected to a computer that measures your lung function and detects any inflammation in the airways. The results of this test can help determine whether asthma is present, as explained by Dr. Parikh. In some cases, your doctor may also have you exercise on a treadmill and then assess your lung function afterwards to determine if there was a significant drop, which would indicate the presence of EIB, according to Dr. Smart. If your doctor suspects that allergies may be contributing to your symptoms of EIB, they may recommend allergy tests. Alternatively, if they suspect that another underlying condition, such as a heart condition, is causing symptoms similar to EIB, they may order further evaluations, as mentioned by Dr. Parikh. The diagnostic approach may vary based on individual circumstances to ensure an accurate and comprehensive evaluation. What Are the Treatment Options? As previously mentioned, exercise-induced asthma (EIB) is a manageable condition that should not hinder your ability to engage in physical activity when properly treated. Seeking medical attention is crucial if you suspect you have EIB, as it can be effectively managed with appropriate interventions. The most common treatment for EIB involves using a fast-acting asthma medication, such as albuterol, through inhalation before exercising. Albuterol helps relax the muscles surrounding the airways, preventing EIB symptoms. Taking albuterol approximately 15 minutes before a workout is typically effective in preventing EIB symptoms altogether. Some individuals, particularly those with chronic asthma, may require daily use of anti-inflammatory medications like Singulair or inhaled steroids. In certain cases, a combination of long-acting asthma medication and steroids may be necessary. Consulting with your primary

Jul 01

How Is Asthma Treated?

Asthma is a chronic lung condition characterized by inflammation and narrowing of the airways, leading to symptoms ranging from mild to severe, such as difficulty breathing and tightness in the chest. While asthma cannot be cured, it can be effectively managed through various treatment options. These treatments aim to prevent and alleviate symptoms, reduce the frequency and severity of asthma attacks, and maintain optimal lung function. Inhaled medications, including corticosteroids to reduce inflammation and bronchodilators to relax the airway muscles, are commonly used to control asthma symptoms. Lifestyle modifications, such as identifying and avoiding triggers that can exacerbate asthma, also play a crucial role in managing the condition. The management of asthma may involve a collaborative approach, with healthcare professionals such as primary care physicians, allergists, and pulmonologists overseeing your care. They will work together to develop a personalized treatment plan tailored to your specific needs, considering factors such as your symptoms, medical history, and individual circumstances. Regular monitoring, adjustments to medication dosages as needed, and ongoing communication with your healthcare team are important aspects of managing asthma effectively. Medications Medications play a vital role in the treatment of asthma by reducing inflammation, relaxing the airways, and managing symptoms. There are four main categories of asthma medications: quick-relief medications, long-term control medications, combination quick-relief and controller medications, and biologics. Asthma medications can be taken through different methods. Inhalers, also known as puffers, deliver medication directly into the lungs as a spray mist. Nebulizers, on the other hand, convert liquid medication into a mist that is inhaled through a mask or mouthpiece. Injections or infusions are used for administering biologics, while oral medications are taken by mouth in the form of capsules, pills, or liquids. Quick Relief Medicines Quick-relief medications, also known as rescue or short-acting medications, provide immediate relief of asthma symptoms during an asthma attack. They are particularly useful for individuals with mild asthma or exercise-induced asthma. These medications work by relaxing the muscles surrounding the airways, helping to open them up and alleviate symptoms. It is recommended to carry a quick-relief inhaler at all times in case of an asthma attack. Common quick-relief medications for asthma include: 1. Short-acting beta2-agonists (SABAs): SABAs rapidly open the airways by relaxing the surrounding muscles and clearing mucus from the lungs. 2. Short-acting anticholinergics: These medications relax the muscles around the airways, making breathing easier. Anticholinergics may be prescribed to individuals who cannot tolerate SABAs or may be used in combination with SABAs during emergencies. 3. Oral corticosteroids: These medications are taken by mouth in the form of capsules or liquid for a short period to reduce airway inflammation and swelling when symptoms persist for several days and other medications do not provide sufficient relief. Long-term Control Medicines Long-term control medications, also known as maintenance medications, are taken regularly to prevent and manage asthma symptoms over the long term. These medications are used even when asthma symptoms are not present, as they help reduce inflammation and keep the airways open. By doing so, they reduce the frequency and severity of asthma attacks and improve lung function. Common long-term control medications for asthma include: Combination Quick-Relief and Control Medicines Quick-relief, controller, and combination medications combine a bronchodilator and a long-acting drug in a single inhaler to provide rapid relief and sustained control, respectively. Asthma sufferers with moderate to severe cases are often administered combination inhalers for both short- and long-term symptom alleviation and inflammation management. Current clinical recommendations for the treatment of asthma encourage the use of combination drugs; however, the FDA has not yet authorized such medicines for this purpose. Biologics Biologic medications are used to treat severe asthma that does not respond well to standard treatments. These medications target specific cells and antibodies in the body that are involved in triggering inflammation in response to asthma triggers. By targeting these specific pathways, biologics help to reduce the frequency of asthma attacks and the severity of symptoms. Biologic medications are typically administered through injections or intravenous (IV) infusions, and they are usually given in a doctor’s office every few weeks. There are several biologic drugs available for the treatment of asthma: To determine the most effective biologic for your condition, your healthcare provider may order blood tests or conduct other assessments to evaluate your specific needs and response to treatment. It’s important to work closely with your healthcare provider to find the most appropriate biologic medication and to monitor your asthma symptoms and overall response to the treatment. Bronchial Thermoplasty Bronchial thermoplasty (BT) is a medical procedure that may be recommended for individuals with severe, uncontrolled asthma. Over time, the muscle tissue lining the airways can thicken in severe asthma cases, leading to narrowed airways and worsening symptoms. During a BT procedure, a thin bronchoscope tube is inserted through the mouth and into the airways. Once the tube is properly positioned, a small, heated electrode is used to apply heat to the smooth muscle tissue in the airways, effectively removing excess tissue. Typically, BT is performed in three separate sessions, with each session targeting a different area of the lungs. The goal of BT is to open the airways, reduce the frequency of asthma attacks, and alleviate other related symptoms. Immunotherapy Immunotherapy is a treatment approach that involves controlled exposure to allergens that trigger asthma symptoms, specifically in individuals with allergic asthma. Before starting immunotherapy, allergy testing is conducted to identify the specific allergens that provoke your symptoms and ensure the effectiveness of the treatment. Immunotherapy typically consists of a series of injections or sublingual tablets containing gradually increasing doses of the allergens. The purpose is to build tolerance and desensitize the immune system to these allergens, thereby reducing allergic reactions. The duration of immunotherapy varies based on individual response, but it can span several years until allergy symptoms are minimized or eliminated. Complementary and Alternative Medicine Some CAM (complementary and alternative medicine) treatments have shown promise in symptom management. While complementary and alternative medicine (CAM) therapies cannot replace conventional medical