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The aim in treating asthma should be prevention. Owing to triggers like infection, allergy or direct irritation, the airways of people susceptible to asthma become inflamed. This causes the release of chemical messengers like histamine, which bring about airway swelling, increase production of secretions and cause spasm of the muscle that is part of the airways. The swelling, secretions and muscle spasm result in narrowed airways that cause the typical asthmatic symptoms of coughing, shortness of breath, chest tightness and wheezing.

Treatment should start by identifying and eliminating triggers. No asthmatic should be smoking. For that matter, no one should be smoking.

Vacuum regularly

If specific triggers like the presence of birds cause you to wheeze, find your budgie another home and either avoid the birdhouse at the zoo or take medicine before visiting it. While this seems reasonable, in many circumstances it wouldn’t work. For example, though I’d like to believe the contrary, if it was a choice between me and our two cats, my wife would be packing my suitcases. People become attached to pets and don’t want to give them up. Nor is it practical to get rid of all the wool in a household. Even more difficult is ridding one’s home and worksite of dust.

Still, environmental manipulation where possible is a first step in treatment. You can vacuum regularly, keep your house free of things that collect dust (like stuffed animals), get rid of plants, and even wear a mask when doing household chores.

Determining whether your occupation is contributing to the asthma is not only important in preventing further attacks. Thanks to workers’ compensation boards, if you can prove that your ability to work is impaired to the point where your income is affected, you might be eligible to collect money. Establishing a cause and effect relationship can be tricky because often symptoms begin or worsen after you’ve gone home from work. One clue: if symptoms don’t occur on weekends or during vacation. However, in some cases, unless the problem is diagnosed and the exposure to the cause ended, the condition may worsen so that coughing and wheezing that began 12 hours after work eventually occurs anytime, including days off.

Some occupations are notorious for precipitating asthma in susceptible workers. Examples include jobs where isocyanates are present: involving automobile spray-painting, foundries, or foam insulation like the stuff used in appliance manufacturing. Various metals, such as nickel and platinum, can prime people for asthmatic reactions. Exposure to shellfish or wheat can sensitize fish factory workers and bakers.

If you suspect that your asthma has been caused by or is being aggravated by something at work, report your hunch to the company and your family doctor. Don’t get panicky and quit your job because, after a thorough investigation, the compensation board may decide the asthma is not work-related. Make sure that you’re sent to a specialist who is familiar with diagnosing occupational asthma. Until things are cleared up, come to some arrangement with the employer to have you moved to another area of the workplace where exposure to what you think is causing the problem is lessened. While all the doctors are trying to figure out the cause, remind them to give you some medication, when necessary, to treat the symptoms. Sometimes, strangely enough, treatment is forgotten while the professionals are preoccupied with finding the cause.

Drug treatment of asthma should be tailored to the individual. If symptoms only occur when you visit Aunt Martha because she has cats, then don’t visit her or take some preventive medication. For many people, when a specific allergy seems to be triggering the asthma, an antihistamine is effective.

Another preventive drug is sodium cromoglycate. Some asthmatics find that a couple of puffs before exercise will ward off an exercise-induced attack. It may effectively control seasonal allergy- associated attacks, as well. For example, if ragweed is your problem, using a cromoglycate inhaler regularly during the season may prevent or reduce attacks.

Acute attacks

Beta agonists such as salbutamol, fenoterol and terbutaline can be used to quickly end an attack, to prevent exercise or cold- induced attacks and to control the frequency of attacks. They are available in puffers, pills, liquids and powders. When necessary, some can be given effectively using a nebulizer and home air- compressor.

Ipratoprium bromide by inhalation seems to help some people with acute attacks. It does not work as quickly as the beta agonists. In addition, it may be used to prevent exercise-, cold- or stress- induced attacks. If coughing is a predominant symptom, it is worth trying.

Theophylline drugs are taken by mouth and have more potential side effects associated with them than all the other treatments I’ve mentioned.