Scott Webb (Host): Asthma is common and treatable, provided we've been diagnosed and do our part to avoid irritants as much as possible. And as we'll learn today from Tawanda LeFlore, Board Certified Nurse Practitioner with Franciscan Health, keep our asthma action plans handy in the event of an asthma attack.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Tawanda, it's so nice to have you here today. We're going to talk about asthma, and I think that asthma is one of those things that for those of us who don't have asthma, we think we understand. But maybe we don't. So just as we get rolling here, just tell us about asthma. What is asthma?

Tawanda LeFlore, NP: So thanks for having me, Scott. Asthma is a chronic disease that affects the airways of your lungs. Your airways are the breathing tubes that carries oxygen in and out of your lungs. There's two main problems with asthma; swelling, and increased mucus, which is inflammation in the airways and squeezing of the muscles around the airways, which is a bronchospasm. These two problems can make it very difficult for someone to breathe.

Host: Generally, what are the causes of asthma?

Tawanda LeFlore, NP: Well causes is genetic. The simple cause is inflammation. We have these white blood cells called eosinophils and there are a lot of them in the immune system. Too many in the airway, and that causes a asthma attack. With asthma, there's always a bit of swelling inside the airways, which causes asthma. Irritants can cause asthma, pets, pollen, dogs, spray, perfumes. Smoking is one of the major ones that contributes to the asthma attack or asthma.

Host: Yeah. And, uh, I want to ask you about sort of the quality of life for folks suffering with asthma. My sense of it is, is that one of the troubling things about asthma is that you never know necessarily when it's going to be triggered, what it's going to be triggered by. And so let's talk about that for folks who have asthma, what are their lives like?

Tawanda LeFlore, NP: So it is expected for a patient to be well-controlled with asthma. Should it be precipitated, it can affect one's ability to work, go to school, playing sports, breathe well. So later on quality of life can be very debilitating.

Host: Yeah. And as I was saying, I think that that's one of the big issues is that it, it does affect folks and is there an age range? Are generally children diagnosed and then it's about sort of managing it along the way over the years? Or can asthma really affect anybody at any age?

Tawanda LeFlore, NP: So what studies have shown is children the age of 10 and younger accounts for half of the cases of asthma. In most cases, asthma developed before the age of five, and in more than half of those cases, they developed by the age of three.

Host: So by and large, when it strikes people, when they're affected by it, it does seem to happen when they're younger and they're diagnosed younger and presumably treatment starts younger. Are there other diseases that can sort of exacerbate asthma, make asthma worse?

Tawanda LeFlore, NP: Yeah, there are many diseases. COPD can make asthma worse. Anaphylactic reactions can make asthma worse. That's me. People with other comorbidities like hypertension, diabetes, someone who smokes, like obesity, nasal polyps, all these things can make asthma worse. Even pregnancy.

Host: All right, so you mentioned that there's a strong family history or genetic component to this, so let's talk about that. If, if folks know that asthma just runs in their family and then now they're going to have a family, is that something that you can sort of get out in front of a little bit in terms of just sort of making doctors aware and preparing for it because it seems inevitable?

Tawanda LeFlore, NP: Yeah. So here's the way it goes. If both mother and father have asthma, then it's a 50% chance that the child would have asthma. If only one parent has it, then there's a 25% chance that the child can have asthma. And we also want to look at being exposed to other irritants like cockroaches and mice and stuff like that, living in a city, especially where there's low economical groups. So those things also affects asthma too. And we can talk to the parents and providers about that as well.

Host: Right. So we look at the family history, genetics, sort of behavior, lifestyle, socioeconomics. There's a, a lot to factor in here. And, uh, yeah. So let's talk about the treatment options. I don't know if they're different for children versus adults, but in general, how do you treat asthma?

Tawanda LeFlore, NP: Well, asthma first, we want to prevent any asthma attacks, but just to treat it, we want to maintain it. We want to decrease exposure as much as possible, so you treat it. Usually we start off with something like Albuterol. It's an inhaler, and if you're too young to use an inhaler, we do like a nebulizer treatment with albuterol in it, and as asthma progresses, then we get into some of the other medications like steroids and mood stabilizers, mass cell stabilizers, and sometimes patients even progress to needing oxygen on a regular basis, on a full-time basis. So we start off in a stepwise approach. We also use oral prednisone to treat asthma exacerbation. So there's a multiple different treatment options for asthma.

Host: Yeah, and as you say, the first line of defense, if you will, is to try to prevent asthma. So when I think about asthma, I think about, you know, there's just so many things that could set it off. So many irritants. How do folks prevent an asthma attack?

Tawanda LeFlore, NP: We can only kind of control as much as possible because we cannot take away pollution from our air. We can't take away all the carpet and fibers in our house. We can't remove the pets that we love unless you really need to. So it's all about prevent it as much as possible, making sure you're taking your controller inhaler to keep those, you know, irritants down and out of your lungs and make sure you're healthy. Eating and drinking well, hydration is very important. Not being in an extreme heat or a cold is very important as well.

Host: Yeah, so of course medications and drugs and all of that, family history, genetics, but also we have to do our part, and I'm sure that's something that comes up when you, when you're counseling and advising new patients who've been diagnosed, whether it's the parents or children, whomever. What kind of advice do you give them as they're facing a new diagnosis of asthma?

Tawanda LeFlore, NP: That's funny. The first thing I tell patients is don't worry until I tell you to worry.

Host: Oh, okay.

Tawanda LeFlore, NP: And the second piece of advice, I'm here to help you manage your asthma, keep you as healthy as possible. And I tell patients, do not search on Dr. Google because they're going to give you a lot of different information and I want to send you to the right resources.

So let me provide those resources for you. Resources that I know studies have been done on and confirmed. So let me provide that for you.

Host: Yeah, rely on the expertise of experts, of course. And one of the things I want to talk about today was, what they call an action plan, right? An action plan for asthma. So those days, as you say, when the environment isn't great, isn't in our favor, whether it's the air quality, pollution, ozone, wildfires, so, in general, take us through that. What is an action plan for asthma?

Tawanda LeFlore, NP: So an action plan is a personalized written documentation that we provide instructions for patients to follow at home. This plan helps the patient to understand and to clarify for them their medication regime should the patient have a asthma attack or if the asthma is not well controlled, that it guides them through treatment adjustments in response to change in symptoms and home measurements. So essentially it's a written plan for someone to know, if I get in trouble here, what am I to do? Where am I to start with my medication?

Host: As we wrap up here, just want to talk a little bit about how athletes can manage asthma but you know, still remain healthy and active and competitive.

Tawanda LeFlore, NP: So with that, you want to make sure that you have that in your action plan as well. Even for our younger population, our children, you want to make sure that you pre-medicate, you want to medicate several minutes before any activity start, and one of the best preventative measures in athletes is they pre-medicate, usually 15 minutes before any activity. They medicate with their albuterol, which is their fast acting inhaler.

Host: Yeah, I see what you mean. And obviously you'd want to let coaches know, trainers know, do your part right, as you say premedicate before you start sports. And you know, kids will be kids and kids will forget. And that's why it's good to have that action plan and make sure that everybody knows, oh, Scott has asthma. Don't forget right?

Tawanda LeFlore, NP: Yes. Yes, exactly.

Host: That's great. Well, nice to meet you today. Nice to learn more about asthma. I hope that this helped listeners. We hope that things like this, podcasts like this, we, you know, really educate. And if folks think that they may have asthma or their children may be suffering from asthma, obviously reach out to their own providers, be referred to specialists like you. So thanks so much. You stay well.

Tawanda LeFlore, NP: I will too. Thank you, Scott, for having me.

Host: And to learn more about asthma action plans, go to franciscanhealth.org/asthma.

 And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.