A Simple Guide to Asthma

A Simple Guide to Asthma
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What is asthma?
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Asthma is a common long-lasting (chronic) inflammatory disease of the lungs and airways (bronchi) that affects 5 % adults and 20% children and causes narrowing of the airtubes.

What happens during an asthma attack?
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When your airtubes are exposed to trigger factors, inflammation of the airway results.
The breathing tubes become narrowed and clogged up with mucus making breathing difficult. Inflammation may continue even though there is minimal or no symptom of asthma.

What are the symptoms of Asthma?
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Asthma is characterised by attacks of

1. breathlessness,

2.tight chest,

3.wheezing sounds and

4.coughing

These symptoms are caused by the airways becoming narrowed and inflamed.
Some people may have these symptoms all of the time.

Others may be normal between attacks.

Who is at risk of developing asthma?
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Anybody can get it at any age but it tends to run in families.
They also have an inherited tendency to develop other allergic conditions such as eczema and allergic rhinitis.
Most children, particularly those with mild asthma will be attack free by adolescence.
A small number continue to have symptoms as adults.
Yet others have their asthma symptoms reappearing only when they reach adulthood.

What causes asthma attacks?
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Asthma results from sensitive airways that react to certain trigger factors.
These triggers may be different for different people.
Avoidance of trigger factors is important.

Some common triggers are:
1.Allergens such as house-dust mites, cockroaches, animal danders, pollen, indoor moulds and foods particularly those containing sulphite.
2.Infections such as the common cold and sinus infection

3.Weather changes due to change in temperature or humidity
4.Air pollution e.g. from tobacco smoke and haze
5.Strong odours or sprays e.g. paints, varnishes, cleaning solvent fumes, perfumes, cooking fumes
6.cold air,
7.vigorous exercise
8.stress.

Attacks may be more frequent or severe in people who have a chest infection.

Avoidance of trigger factors
1.Animal dander (fur, skin of cats or dogs) Give away pet if possible. If not, prevent pet from entering the bedroom. Bathe pet weekly.
2.House-dust mites Use protective air-tight mattress covers and pillow cases. Wash bedsheets and pillow cases weekly in hot water
3.Cockroaches Do not leave garbage uncovered. Use poison baits. Use pesticide spray only when the asthmatic is out of the house.
4.Indoor moulds Reduce dampness in the house.
5.Outdoor pollens Close doors and windows and stay indoors when pollen count is highest in the afternoon.
6.Tobacco smoke and haze Avoid tobacco smoke and haze as far as possible.
7.Medication Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and beta-blockers should be avoided.
8.Food Certain foods containing sulphites should be avoided such as shellfish and preserved foods.

What to do during an asthma attack?
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1.Stay calm. Family members or caregivers should be calm, positive and encouraging.
2.Use 2 puffs of your reliever inhaler immediately as previously instructed by your doctor.
If asthma symptoms are not relieved or wheezing returns within 4 hours, give another 2 puffs of the reliever.

3. take your asthma medications with warm water.

4. consult your family doctor if there is no improvement.
If necessary, go to the nearest hospital for help.

How serious is Asthma?
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Asthma is not generally considered by doctors to be a serious illness in most people who have it, mainly due to the mildness of symptoms and the range of very effective medicines that control these symptoms and stop asthma worsening.
Asthma does, however, have an effect on quality of life because attacks can be unpleasant and distressing and can restrict activity. Whilst most sufferers learn to live with and manage their condition, for some it can be disabling.
In exceptional cases, asthma can be life-threatening, particularly if it is not treated adequately or promptly. For some of these, an attack is so severe that it results in death.

How long does Asthma last?
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Asthma attacks come and go, with wide variation in the symptoms at different times.
Many people with asthma have problems only occasionally but others struggle with it every day. Modern medicines control and relieve symptoms and so attacks may only last a few hours or minutes, but without treatment this may go on for several days.
Some children grow out of asthma and some people are only affected at different times of the year.
However, the period of time during which people may have asthma attacks can last for many years or throughout life.

How is Asthma treated?
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There is no cure for asthma, but there are different types of medicines that will help to keep it under control and relieve symptoms.
1.Most sufferers must be given a type of medicine called a preventer, which is usually an anti-inflammatory steroid (of the glucocorticosteroid type) that treats the underlying causes of the asthma. These are usually given from an inhaler.
Even if symptoms are not present, sufferers should keep taking the preventer medicines, as this will greatly decrease the risk of suffering asthma attacks. This will help many asthmatics to live a normal active life.
Steroids can also be taken as tablets but have many side effects.
2.Another sort of medicine is called a reliever that is used during an asthma attack and may be contained in an inhaler. This contains a bronchodilator medicine that opens up the bronchial tubes of the lungs and works in a few minutes. It can also be taken as tablets. Side effects may be rapid heart beats and tremors of hands.

Can asthma be cured?
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No, there is currently no known cure for asthma.

The good news is that modern medicine is extremely effective in controlling symptoms.

You can lead a relatively normal life if you seek to understand how to control your asthma and prevent attacks from occurring.

Asthma attacks may be prevented at a reasonable cost.
It usually requires long term treatment with 'preventer medication'.

What you can do to control asthma?
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ASTHMA MANAGEMENT PLAN
Asthma is a chronic disease requiring continuous management and appropriate treatment.
If you follow your prescribed asthma management plan, you can expect to live an active, normal lifestyle.

Successful treatment of asthma is a partnership between you and your doctor.

You and your doctor should work out an asthma management plan.
This should include:
1.understanding what asthma is all about
2. having clear goals of management
3. knowing the severity of your asthma;
patients with mild asthma can do with just reliever medications to stop the attacks.
On the other hand, patients with severe asthma or those with frequent attacks should go on regular medications to prevent attacks
4.being able to recognise symptoms suggesting worsening of asthma
5.knowing your medicines (preventers and relievers) and how to use them correctly
6.using the right inhaler technique and practicing it until you get it right
7..recognising and avoiding trigger factors
8.knowing what to do during an asthma attack
9..arranging regular follow-up visits with your doctor

A Simple Guide to Osteoporosis

A Simple Guide to Osteoporosis
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What is Osteoporosis?
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Osteoporosis, which literally means porous bones, is a condition in which the bones become weak and brittle, resulting in a greater likelihood of breaking after minor trauma.
Bone is constantly being removed and replaced in our body.
Osteoporosis occurs when bone is lost faster than it can be replaced.

What are the symptoms of Osteoporosis?
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Osteoporosis is a silent disease. People with osteoporosis often do not know that they have the condition. Fractures from osteoporosis commonly occur in the wrist, spine and hip.
Persons with hip fractures suffers considerable loss of function and becomes dependent on others.

What are the risk factors of developing Osteoporosis?
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Factors that will increase the risk of developing osteoporosis are:
Female gender;
Caucasian or Asian race;
Thin and small body frames;
Family history of osteoporosis ;
Personal history of fracture as an adult;
Cigarette smoking ;
Excessive alcohol consumption;
Lack of exercise;
Diet low in calcium;
Poor nutrition and poor general health;
Malabsorption syndromes(nutrients poorly absorbed from the gastrointestinal system)
Low estrogen levels (such as occur in menopause or early surgical removal of both ovaries); Chemotherapy can cause early menopause due to its toxic effects on the ovaries;
Amenorrhea (loss of menstrual period) in young women causes low estrogen and osteoporosis;
Chronic inflammation, due to diseases (such as rheumatoid arthritis,chronic liver diseases);
Immobility, such as after a stroke, or from any condition that interferes with walking;
Hyperthyroidism, a condition with too much thyroid hormone ;
Hyperparathyroidism, a disease with excessive parathyroid hormone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis;
Vitamin D deficiency. When vitamin D is lacking, the body cannot absorb adequate amounts of calcium to prevent osteoporosis.
Certain medications can cause osteoporosis. These include long-term use of heparin (a blood thinner), anti-seizure medications phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).

How do you Screen for Osteoporosis?
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Bone Mineral Density:
Routine X-rays cannot detect osteoporosis until it is quite advanced and there is a lot of bone loss.
The best way to detect osteoporosis is to carry out a Bone Mineral Density (BMD) test to measure density (solidness) at various sites (e.g. hip, spine).
It will help to assess your risk of having a fracture.
BMD is frequently measured by dual energy X-ray absorptiometry (DXA).
It is a painless procedure.

How is osteoporosis diagnosed?
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A routine x-ray can reveal osteoporosis of the bone, which appears much thinner and lighter than normal bones. Unfortunately, by the time x-rays can detect osteoporosis, at least 30% of the bone has already been lost.
DXA measures bone density in the hip and the spine. The test takes only 5 to 15 minutes to perform, uses very little radiation and is quite precise.

Who should have bone density testing?
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All postmenopausal women below age 65 who have risk factors for osteoporosis;
All women aged 65 and older;

What are the consequences of Osteoporosis?
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Osteoporosis bone fractures are responsible for considerable pain, decreased quality of life, lost workdays, and disability.
Elderly patients can further develop pneumonia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after a hip fracture.
Some 20% of women with a hip fracture will die in the subsequent year as an indirect result of the fracture.

How is osteoporosis treated and prevented?
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The purpose of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength.
Early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture.
There is no complete cure for osteoporosis .
There is no way to completely rebuild bone that has been weakened by osteoporosis.
Therefore, prevention of osteoporosis is as important as treatment.

Osteoporosis treatment and prevention measures are:
Lifestyle Changes:
1.Exercise has a wide variety of beneficial health effects especially weight-bearing exercise, such as walking.
However, exercise does not bring about substantial increases in bone density.
The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased.
It is important to avoid exercises that can injure already weakened bones.
In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure , exercise should be monitored.
Cessation of Smoking :Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause.
Decrease regular consumption of alcohol and caffeine on osteoporosis is not as clear as with exercise and cigarette.

Medications:
1.Medications that stop bone loss and increase bone strength, such as
alendronate (Fosamax),
risedronate (Actonel),
raloxifene (Evista),
ibandronate (Boniva),
calcitonin (Calcimar);
2.Medications that increase bone formation such as teriparatide (Forteo).
3..Calcium Supplements
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes.
800 mg/day for children ages 1 to 10
1000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen
1200 mg/day for teenagers and young adults ages 11 to 24
1500 mg/day for post menopausal women not taking estrogen 1200mg to 1500 mg/day for pregnant and nursing mothers
The total daily intake of calcium should not exceed 2000 mg
Daily calcium intake can be calculated by the following method:
Excluding dairy products, the average diet contains approximately 250 mg of calcium;
There is approximately 300 mg of calcium in an 8-ounce glass of milk;
There is approximately 450 mg of calcium in 8 ounces of plain yogurt;
There is approximately 1300 mg of calcium in 1 cup of cottage cheese;
There is approximately 200 mg of calcium in 1 ounce of cheddar cheese;
There is approximately 90 mg of calcium in ½ cup of vanilla ice cream;
There is approximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice.
Additional calcium can be obtained by drinking more milk and eating more yogurt or cottage cheese, or by taking calcium supplement tablets as well from calcium-fortified foods.
Calcium supplements are safe and generally well tolerated.
Side effects are indigestion and constipation.
4.Vitamin D:
Vitamin D is important in several respects:
Vitamin D helps the absorption of calcium from the intestines.
A lack of vitamin D causes calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.
Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women.
Vitamin D comes from the diet and the skin. Vitamin D production by the skin is dependent on exposure to sunlight. Daily Vitamin D intake are:
200 IU daily for men and women 19 to 50 years old,
400 IU daily for men and women 51 to 70 years old, and
600 IU daily for men and women 71 years and older.
But if a person already has osteoporosis, it is advisable to ensure 400 IU twice per day as usual daily intake, most commonly as a supplement alongside prescription osteoporosis medication.
5.Hormone therapy (menopausal hormone therapy)
Menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) has been shown to prevent bone loss, increase bone density, and prevent bone fractures. It is useful in preventing osteoporosis in postmenopausal women.
Medications that prevent bone loss and breakdown

How do you monitor Osteoporosis?
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Repeat bone density testing (DXA scans) is NOT indicated in monitoring osteoporosis treatment or prevention on a routine basis.
Bone density changes so slowly with treatment that the changes are smaller than the measurement error of the machine.
The real purpose of osteoporosis treatment is to decrease future bone fractures.
There is no good correlation between increases in bone density with decreases in fracture risks with treatment.
In the future, however, if ongoing research brings new technology or new therapies, testing decisions will clearly change.


Added 4th October 2008
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Osteoporosis
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One way of determining the risk of Osteoporosis:
substract the weight in kg from the age in years.

If the number is less than 0 the risk is low

If the number is between 0-20 the risk is moderate

If the number is above 20 the risk is high and you should see the doctor.

A Simple Guide to Psoriasis

A Simple Guide to Psoriasis
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What is Psoriasis?
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Psoriasis is a disorder of the skin which typically consists of red patches covered by silvery-white scales especially around the trunk, elbows, knees and scalp.

What are the types of Psoriasis?
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There are five types, each with unique signs and symptoms.

1.Plaque psoriasis is the most common type of psoriasis.
About 80% of people who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scale.
These patches, or plaques, frequently form on the elbows, knees, lower back,and scalp.

2.guttate psoriasis (small, red spots on the skin),

3.pustular psoriasis (white pustules surrounded by red skin),

4.inverse psoriasis (smooth, red lesions form in skin folds)

5.erythrodermic psoriasis (widespread redness, severe itching, and pain).

Who Gets Psoriasis?
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Psoriasis occurs about equally in males and females.
Recent studies show that there may be an ethnic link.
It seems that psoriasis is most common in Caucasians and slightly less common in African Americans.
Worldwide, psoriasis is most common in Scandinavia and other parts of northern Europe.
It appears to be far less common among Asians and is rare in Native Americans.

There also is a genetic component associated with psoriasis.
About one-third of people who develop psoriasis have at least one family member with the condition.

Research shows that the signs and symptoms of psoriasis usually appear between 15 and 35 years of age.
About 75% develop psoriasis before age 40.
However, it is possible to develop psoriasis at any age. After age 40, a peak onset period occurs between 50 and 60 years of age.

About 1 in 10 people develop psoriasis during childhood, and psoriasis can begin in infancy.
The earlier the psoriasis appears, the more likely it is to be widespread and recurrent.

What causes Psoriasis?
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Its exact cause is unknown but the result is skin which grows about seven times more quickly and thicker than usual.
It is thought to be due, at least in part, to an abnormal immune reaction against some component of the skin.
Genetic factors play a part.
About half those affected know of someone else in the family with it.

The rash often seems to start after some sort of trigger. This may be emotional stress, skin injury (cuts and scratches for example), a streptococcal sore throat, hormones (it often occurs at puberty), or rarely, certain medications.
Psoriasis is not contagious.

What are the symptoms of Psoriasis?
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Itchy, raised patches of dark pink skin.
White scales on the scalp, knees, elbows and upper body.
Pitting, discolouring and thickening of the fingernails and toenails.
Red, scaly and cracked skin on the palms of the hands or on the soles of the feet.
There may be fluid oozing out of the cracks and movement may become very painful. The itching and discomfort may keep a person awake at night, and the pain can make everyday tasks difficult.

How does Psoriasis affects the Patient?
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All types of psoriasis, ranging from mild to severe, can affect a person’s quality of life.
Living with this lifelong condition can be physically and emotionally challenging.
Itching, soreness, and cracked and bleeding skin are common.
Nail psoriasis can be painful.
Even the simple act of squeezing a tube of toothpaste can hurt.
Several studies have shown that people often feel frustrated.
In some cases, psoriasis limits activities and makes it difficult to perform job responsibilities.
Studies also have shown that stress, anxiety, loneliness, and low self-esteem are part of daily life for people living with psoriasis.
It has been that thoughts of suicide are three times higher for psoriatics than the normal person.
Embarrassment is another common feeling.
What if you extended your hand to someone and the person recoiled?
How would you feel if you spent most of your life trying to hide your skin?

What is the Treatment of Psoriasis?
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Psoriasis is a chronic, meaning lifelong, condition because there is currently no cure. People often experience flares and remissions throughout their life.
Controlling the signs and symptoms typically requires lifelong therapy.
Treatment depends on the severity and type of psoriasis.
Some psoriasis is so mild that the person is unaware of the condition.
A few develop such severe psoriasis that lesions cover most of the body and hospitalization is required. These represent the extremes. Most cases of psoriasis fall somewhere in between.

Topical medications (such as steroid and tar lotions, ointments, creams, and shampoo)
Photo therapy (either ultraviolet B, or UV, radiation or psoralen with ultraviolet A, or PU VA, radiation)
Systemic therapy (oral drugs that affect the whole body system, not just the skin e.g. cyclosporins, methotrexate)

Combinations are often used. These treatments are often given in the order described -- from least to most potent -- as necessary, although the physician may choose a more powerful therapy or use combinations first if the patient's initial condition is severe.

With the emergence of several new therapies, including the biologic agents, more people are experiencing substantial improvements and reporting a greatly improved quality of life.