Famador o. Genaldo, Md, Rn

8/14/2019 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.

Documents

Famador o. Genaldo, Md, Rn