Asthma

Introduction

In this free educational guide on asthma, we provide you with a general discussion about this severe medical condition, and review what evidence or tests are needed to help prove that you are eligible for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI).

For your general knowledge about this medical condition, we have included in this guide helpful information about what the disease is, symptoms, diagnosis, common treatment, and where you can find more help and information for this medical condition. This guide may also provide information about current legal issues that may be of value to you. This guide is not intended as legal advice or as a legal opinion.

After reading this guide, if you still have questions or would like to discuss your case with us, please call Chad Brown Law at (336) 962-5373. We are here to help you get the benefits you deserve.

1. What is asthma?

Asthma is a condition in which your airways narrow and swell, producing extra mucus. This can make breathing difficult and cause coughing, wheezing, and shortness of breath. Coughing mostly occurs later in the evening or during the early morning. People with asthma suffer from the condition all the time, but appear symptom-free until something irritates the lungs, causing what is known as an “asthma attack.”

Doctors have yet to determine what exactly causes asthma, and it may be different for every person. Currently, there is no cure for asthma, but there are several treatments that can help relieve symptoms and improve quality of life for people with asthma.

Asthma can develop in people of all ages, but is most commonly diagnosed during childhood. Children whose parents or siblings have a history of asthma are more likely to develop the condition themselves. There are an estimated 25 million people in the United States who suffer from asthma, and as many as 7 million are children.

For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

1a. Understanding Asthma

Asthma impairs function of the airways which in turn impairs the ability of the lungs to function and transfer oxygen into the bloodstream. The airways in the human body carry the air inhaled and exhaled through the mouth and nose into your lungs. Asthma inflames the airways, making the walls swell up and become sensitive to inhaled irritants.

When the swollen airways react to irritants, the muscles around the airways tighten, narrowing the path for air. This causes less airflow into the lungs and can result in increased swelling which in turn tightens the airways even further. Swollen and tightened airways can cause the cells in the airway walls to secrete more mucus than usual. Mucus, a thick, sticky liquid present in the airways and lungs in small amounts, can further narrow the airways if it accumulates too much.

This chain reaction of swelling, muscle tightening, and mucous production results in asthma symptoms. The severity and type of symptoms can change from attack to attack, with some symptoms being mild and going away with light treatment from an asthma medicine such as an inhaler. More severe symptoms can progress and build up to a full asthma attack. The earlier symptoms are treated, the less likely an attack will occur. Allowing minor symptoms to progress into a full attack can be life-threatening and require emergency intervention to resolve.

 

1b. Causes of Asthma and Preventions

There are several different events and substances that can trigger asthma symptoms and attacks. The types of asthma triggers from which each person suffers are different and can change over time. Part of learning to control your asthma is to learn what triggers symptoms and attacks and avoiding those triggers as much as possible. Some of the common asthma triggers include the following:

Smoke – Smoke from any source, especially cigarettes, contains irritating particles that can cause asthma symptoms. People with asthma should refrain from smoking completely, and try to avoid being around people who are smoking (secondhand smoke). You may also need to avoid non-cigarette smoke sources such as BBQ grills and bonfires.

Dust mites – Dust mites are microscopic creatures that exist in almost every living space. Special allergen-blocking pillow cases and mattress covers can create a protective barrier between yourself and your mattress and pillows. Avoid using down-filled pillows and bedding materials, as down draws more mites than other common bedding materials. Also try to remove fabric and stuffed items from your room that are not necessary, such as stuffed animals. When washing bedding, stuffed toys, and clothing, use the hottest water setting to help remove dust mites.

Air pollution – Poor air quality in your neighborhood or indoor environment can trigger asthma attacks. People with asthma who live near factories, heavy automobile traffic, and densely populated areas are likely to live in poorer outdoor air quality. Watch the local weather reports for air pollution warnings and try to limit outdoor activities during high pollutant days. For indoor air quality improvement, make sure air conditioning filters are changed on a regular basis and avoid burning candles, incense, and cigarettes indoors.

Cockroaches – Cockroaches can create irritants with their droppings and spread of contaminants, causing allergic or asthmatic reactions. Use roach bait traps and poisons or call an exterminator to treat your home for roach infestations. If you know you have an area that is prone to attracting roaches such as dark storage areas, under sinks, and in kitchen cupboards, sweep or vacuum those areas every two to three days to reduce the amount of cockroach remnants.

Pets – Man’s best friend could also be the cause of asthma symptoms. This doesn’t mean you have to necessarily get rid of your pets, but it does mean you should take preventative measures. If your pets are a known trigger, try keeping the pets out of the asthmatic person’s bedroom. Giving your pet regular baths can help keep dander and hair from irritating your airways. Vacuum up pet fur and damp mop hard floors every week to keep loose pet hair and dander from accumulating. If your pet’s fur and dander are known to cause serious symptoms, you may have to find your pet a new home for the sake of your health.

Mold – Mold is a more common issue in homes in humid climates, but it can grow anywhere with high humidity levels such as showers and kitchens. You may need a professional company to remove any mold currently present in your home. To help keep your rooms mold-free, use an air conditioner or dehumidifier to keep humidity levels low (no higher than 50 percent). Fixing water leaks and condensation issues on pipes and other surfaces can help reduce the amount of moist areas that allow mold to grow unseen behind walls and underneath flooring.

Other Illnesses – Some types of illnesses such as the flu, the common cold, sinus infections, and respiratory viruses can make asthma symptoms worse and trigger an asthma attack.

Chemical Fumes – Cleaning chemicals, air fresheners, even perfume can all produce irritants that can trigger asthma symptoms and attacks. Avoid any types of fumes, pleasant or not, if you know they cause your asthma symptoms to worsen.

Other Causes – Some people notice that physical exercise, certain types of weather (thunderstorms, high humidity, etc), breathing in cold, dry air, and certain foods or food additives trigger their asthma symptoms.

2. Common Medical Terms Associated with Asthma

Airways – Tubes in the chest that let air in and out of the lungs.

Asthma – An illness that causes shortness of breath, wheezing, and inflammation of the airways.

Asthma Attack – The airways react to an asthma trigger by swelling and creating more mucus than usual, all of which reduces air into and out of the lungs and causes shortness of breath.

Asthma Triggers – Things that you breathe in that causes an asthma attack.

Secondhand Smoke – Tobacco smoke that comes from a smoker and breathed by another person.

Spirometry – A breathing test that measures how well your lungs are working.

3. Asthma Symptoms

Everyone experiences asthma symptoms in a different ways. Depending on the type of trigger and the severity of the exposure, symptoms may include one or more of the following:

• Coughing – Asthma-related coughing fits occur most commonly during the evening or early morning.
• Shortness of breath – Feeling “out of breath” or being unable to breathe comfortably can be signs of asthma symptoms. You may feel as if you cannot take in enough air or get enough air out of your lungs.
• Tightening of the chest – This symptom makes it feel as if you have a weight on your chest, making it difficult or painful to inhale and exhale.
• Wheezing – Making a whistling or squeaking noise when breathing normally is known as wheezing and it can be caused by restricted airways due to asthma triggers.

These are just a few examples of the common symptoms related to asthma. Not all people who have been diagnosed will experience these symptoms, and symptoms may vary between attacks. These are also symptoms of many other respiratory conditions, so they are not definite indicators that you have asthma. The best way doctors have to diagnose asthma is to use a lung function test (spirometry), ask about medical history (type and frequency of symptoms), and do a physical exam.

4. How is asthma diagnosed?

Because the symptoms of asthma can be triggered by so many variables and are similar to many other respiratory diseases, thorough examinations and tests are required to diagnose asthma. It can be especially difficult to diagnose asthma in children under 5 years old whose immune systems and respiratory systems are still developing.

Diagnosing asthma starts with a visit to your primary doctor. Your doctor will perform a routine physical exam, including listening to your breathing, heart, and lungs. Be sure to tell your doctor about any problems you have with chronic coughing, especially at night or early in the morning. Describe any patterns you notice about what makes breathing harder such as after physical activity or when you visit a friend with pets.

Your doctor should ask you about any asthma-like episodes, including colds that last more than 10 days and respiratory illnesses. He or she should also factor in your family history of asthma, allergies, and other breathing problems such as sleep apnea. You may be asked questions about your home conditions, work environment, and when you notice breathing difficulties during certain activities or near certain places or things.

Perhaps the best method of testing for asthma is a breathing test called spirometry. During this test, you will be instructed to blow into a mouthpiece that is connected to a computer. You will take a deep breath and then exhale as much as you can. The spirometer can then measure how much airflow is produced before and after any type of asthma treatment.

5. What is the Common Treatment for Asthma?

After a physician has diagnosed you with asthma, you will receive treatment options and suggestions for controlling your symptoms and reducing attacks. Your physician should help you develop a comprehensive plan for prevention, treatment, and emergencies. Remember that everyone will have different medications and treatment methods and you may need to switch treatments over time as new medications become available or you develop tolerance to your current treatment.
Your asthma treatment plan will often include two different types of medication:

1. Quick-relief medication – When inhaled, these medications are known as “rescue” inhalers. These medications provide quick relief of asthma symptoms and help the airway muscles relax to allow more airflow in and out of the lungs.
2. Long-term control medication – These types of medications are for long-term management of symptoms and serve as more of a preventative medication than a sudden treatment option. These medications WILL NOT help if you are already having an asthma attack.

The overall goal of treating asthma is to control the disease so it has the least amount of impact on the quality of your daily life. Good asthma control should:

• Help maintain good lung function.
• Prevent chronic symptoms that cause poor quality of life.
• Allow you to maintain normal activity levels during the day and sleep without breathing troubles at night.
• Prevent severe asthma attacks that require emergency room intervention or hospital stays.
• Reduce your need for your quick-relief medications.

When your doctor prescribes a quick-relief medication you should take notice if you start to use it on a more regular basis. If you find you are using it more and more on a daily basis, you should discuss with your doctor to see if you need to change the type of medication.

5a. Medications for Asthma

Inhaled Corticosteroids (Long-term control medications)
Corticosteroids are also known as anti-inflammitory drugs and are the most commonly used medications for effectively controlling asthma symptoms in the long-term. Inhaled corticosteroids help reduce the swelling in the airways and relax the tightened muscles. It may take several days of use before realizing the maximum benefits of the medication. Some common types of inhaled corticosteroids used for asthma treatment include:

• Beclomethasone (Qvar)
• Budesonide (Pulmicort)
• Ciclesonide (Alvesco)
• Fluticasone (Flovent Diskus)
• Mometasone (Asmanex Twisthaler)

Long-Acting Beta Agonists (LABAs)
LABAs are only prescribed when an asthma patient is already taking an inhaled corticosteroid as mentioned above. These medications are bronchodilators, meaning they dilate the airways and reduce the swelling that impairs breathing. These medications can provide relief for up to 12 hours and are typically used to provide nighttime relief. People with moderate to severe asthma are often given LABAs to use on a regular schedule with their corticosteroids. Examples include:

• Formoterol (Foradil, Perforomist)
• Salmeterol (Serevent)

Combination inhalers: Corticosteroids and long-acting beta agonists
Your doctor may prescribe a combination inhaled corticosteroid and LABA contained in a single inhaler. A single dose can provide the benefits of both medications and comes in several combinations, including the following:

• Budesonide and formoterol (Symbicort)
• Fluticasone and salmeterol (Advair Diskus)
• Mometasone and formoterol (Dulera)

Quick Relief (Rescue) Inhalers
These inhalers are used for sudden onset of symptoms and are not meant to be used on a regular basis unlike the previously mentioned medications. Quick relief inhalers are used to stop airway spasms, severe shortness of breath, and wheezing. Some examples currently being prescribed include:

• Albuterol (ProAir HFA, Ventolin HFA, others)
• Levalbuterol (Xopenex HFA)
• Pirbuterol (Maxair)

 

Leukotriene Modifiers
Leukotrienes are chemicals naturally occurring in your immune system that can cause asthma symptoms. Leukotriene modifiers block the effects of those chemicals and can help prevent asthma symptoms for up to 24 hours with a single dose. Three of the common leukotriene modifiers in use today are:

• Montelukast (Singulair)
• Zafirlukast (Accolate)
• Zileuton (Zyflo)

Theophylline
Unlike the previous three of medications, Theophylline is administered in pill form rather than inhaled. This daily pill is used to treat mild asthma and is sold under the name Theo-24, Elixophyllin, and other brand names. Theophylline relaxes the airways, helps prevent the lungs’ reaction to asthma triggers, and reduces nighttime asthma symptoms.

Medications for Treatment of Allergen-Triggered Asthma
The trigger for many people with asthma is allergies. There are several medications that treat allergy triggers that can also provide relief from asthma symptoms triggered by those allergens. The following are examples of allergy medications that may be part of asthma treatment.

Allergy shots – Also known as immunotherapy, allergy shots may provide relief from allergy-triggered asthma symptoms if you cannot avoid certain triggers. Allergy shots typically consist of a series of injections given once a week for a period of a few months. After the initial course of shots, you will receive another shot once a month for three to five years. This process, known as desensitization, may take more or less time, depending on the severity of your allergy.

Xolair injections – Xolair is an allergy medication sometimes used to treat asthma triggered by allergies. People with allergies have immune systems that produce antibodies to attack the allergy-causing substances. These antibodies are the cause of your allergy symptoms, as they are attacking substances like pollen or pet dander that generally do not cause harm to your immune system. Taking Xolair can block the action of the antibodies and reduce the immune system’s reaction that causes your asthma symptoms. Xolair is given by injection at your doctor’s office every two to four weeks.

 

Other allergy medications – You can obtain over-the-counter medications that block mild allergy symptoms, and in some cases your doctor will prescribe prescription-strength versions of these medications. You may require antihistamines, decongestants, corticosteroids, and cromolyn in oral or nasal sprays. Some may also come in pill or tablet form. These medications help reduce inflammation and block allergy responses by your immune system.

6. Asthma – What has to be proven for you to be considered disabled by Social Security?

Social Security maintains a list of medical conditions that are so severe they automatically mean that you are disabled. This list of conditions are ones that are expected to be permanent, or expected to result in death, or have a certain length of time that it must last. Each medical condition on this list has a complete description of what symptoms or conditions that has to be present with your medical condition for you to “meet” this listing. The medical listing for Asthma, medical listing 3.03, is found on this Social Security Administration website and is printed below for discussion:

https://www.socialsecurity.gov/disability/professionals/bluebook/3.00-Respiratory-Adult.htm#3_03

(If you do not “meet” this listing, you may still be considered disabled if you are not able to do your past relevant work or you are not able to do any other work that you may have the education or experience to do.)

6a. Social Security’s Rules for Asthma

“3.03 Asthma. With:

A. Chronic asthmatic bronchitis. Evaluate under the criteria for chronic obstructive pulmonary disease in 3.02A (Chronic obstructive pulmonary disease due to any cause, with the one-second forced expiratory volume ( FEV1 ) equal to or less than the values specified in table I corresponding to the person’s height without shoes. (In cases of marked spinal deformity, see 3.00E.);

Table I

Height without Shoes (centimeters)	Height without Shoes (inches)	FEV1 Equal to or less than (L,BTPS)
154 or less	60 or less	1.05
155-160	61-63	1.15
161-165	64-65	1.25
166-170	66-67	1.35
171-175	68-69	1.45
176-180	70-71	1.55
181 or more	72 or more	1.65

OR

B. Attacks (as defined in 3.00C), in spite of prescribed treatment and requiring physician intervention, occurring at least once every 2 months or at least six times a year. Each in-patient hospitalization for longer than 24 hours for control of asthma counts as two attacks, and an evaluation period of at least 12 consecutive months must be used to determine the frequency of attacks.”

6b. Chad Brown’s Explanation of Social Security’s Rules

For you to qualify for Social Security disability benefits, you must have:

A. Asthma with chronic asthmatic bronchitis, and for this to be evaluated under the rules for chronic obstructive pulmonary disease. (You must have test results for FEV1, ((which is called one-second forced expiratory volume)) that are equal to or less than the values in the right side of the table below. This special test requires that you rapidly blow out your breath into a device which measures the amount of air coming out of your lungs. The results are measured against your height without shoes). For example, if you are 6 feet or more (72 inches), you will be found disabled if your FEV1 is equal to or less than 1.65.

Table I

Height without Shoes (centimeters)	Height without Shoes (inches)	FEV1 Equal to or less than (L,BTPS)
154 or less	60 or less	1.05
155-160	61-63	1.15
161-165	64-65	1.25
166-170	66-67	1.35
171-175	68-69	1.45
176-180	70-71	1.55
181 or more	72 or more	1.65

OR

B. Asthma attacks (wheezing with bronchial spasms) that last one or more days and require intensive treatment, such as intravenous bronchodilator, or antibiotics prescribed, or prolonged inhalational bronchodilator therapy in a hospital, emergency room or similar setting. These attacks occur in spite of medical treatment and physician care, occurring at least once every 2 months or at least six times a year. Each hospitalization that lasts longer than 24 hours for control of asthma counts as two attacks. The evaluation period of at least 12 consecutive months must be used to determine the frequency of attacks.

7. Internet Resources for Asthma

For other general information about Social Security and Supplemental Security Income disability programs and how the law firm of Chad Brown Law can help you, visit:

https://chadbrownlaw.com/

For a complete listing of conditions that Social Security considers disabling, go to the Social Security’s website at:

https://www.socialsecurity.gov/disability/professionals/bluebook/AdultListings.htm

For helpful information about all aspects of Asthma, visit The American Lung Associations’ website:

https://www.lung.org/lung-disease/asthma/learning-more-about-asthma/

8. Community Resources for Asthma

North Carolina residents with asthma can find help and information, go to this website:

https://www.lung.org/get-involved/in-your-community/?radius=100&zip=28625&x=15&y=3#tabs