CONDITIONS

What Is Asthma

Asthma is a condition that causes the airways of the lungs to swell and narrow, according to the National Library of Medicine (NLM). This process leads to wheezing, shortness of breath, chest tightness, and coughing. In the U.S., 25 million people have asthma, and seven million of those are children.

What Causes Asthma

Asthma is caused by inflammation or swelling in the airways. As a result, the lining of the air passages swells and the muscles around the airways tighten. Because less air can pass through the passages, breathing becomes more difficult. Attacks like these are caused by a number of allergens including mold, pollen, dust mites, cockroaches, and pet dander (minute scales that fall from skin and hair). Other causes include tobacco smoke; stress; changes in weather; respiratory infections such as the common cold; medicines such as aspirin; and even exercise. For most sufferers, these attacks are intermittent, with symptom-free periods in between. When someone does have an asthma attack, it can last anywhere from minutes to days. It is especially dangerous if the airflow is seriously blocked and breathing becomes difficult.

Risk Factors For Asthma

The following factors may increase the risk of asthma:

  • Childhood respiratory infections, eczema, or allergies. According to the National Heart, Lung and Blood Institute (NHLBI), children who have respiratory infections, allergies, eczema or parents with asthma are at higher risk of developing asthma that will last beyond six years of age.
  • Family history. Children are more likely to develop asthma if both or one parent has asthma.
  • Sex. From age 0-15, asthma is more common among boys. However after age 15, asthma is more common in girls. Researchers aren’t yet sure whether gender and hormones play a part in this shift.
  • Allergies. Most people with asthma also have allergies.
  • Environmental factors. Exposure to certain chemical irritants, dust, or pollution can increase the risk of asthma.

Diagnosing Asthma

According to the Mayo Clinic, the first step in diagnosing asthma is a physical exam to rule out other possible conditions such as Chronic Obstructive Pulmonary Disease (COPD). Beyond that, there are several tests:

  • Spirometry. This test requires you to blow into a mouthpiece connected to an instrument called a spirometer. According to the National Institutes of Health (NIH), the test measures how much air you can breathe in and breathe out. It also gauges the speed at which you can blow air out. Depending on your result, your doctor may give you medicine and test you again later to see if your symptoms have improved.
  • Peak flow. Similarly to a spirometry test, this procedure uses a simple device called a peak flow meter that measures the strength of your expiration, or breathing out.

Still other procedures may be used, the NIH says, if your doctor needs more information before making an asthma diagnosis. These include:

  • Allergy testing. Your doctor may test to find out which, if any, allergens affect your breathing. Allergies are often a factor in asthma.
  • Bronchoprovocation test. This procedure uses the spirometry technique to measure your lung function after you get increasing doses of cold air or a special chemical to breathe in which may trigger asthma-like symptoms.
  • Tests to diagnose diseases with asthma-like symptoms, including reflux disease and sleep apnea.
  • A chest x-ray or an EKG (electrocardiogram). These procedures are designed to see whether your symptoms may be due to another illness.
  • Sputum eosinophils. This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils, a type of white blood cell, are present when symptoms develop.

Symptoms of Asthma

Symptoms of asthma include:

  • Coughing with or without producing phlegm
  • A pulling in of the skin between the ribs when breathing (this is referred to as intercostal retractions)
  • Shortness of breath that becomes more severe with exercise or activity and wheezing.

Beyond these symptoms, experts say that more serious signs, for which emergency help is needed, include:

  • A bluish facial or lip color (this is referred to as cyanosis)
  • Extreme breathing difficulty
  • A rapid pulse
  • Drowsiness or confusion
  • Sweating
  • Anxiety because of shortness of breath
  • Difficulty in exhaling
  • A temporary halt in breathing
  • Tightness or pain in the chest.

Prognosis

Usually, asthma is a chronic disease, but there may also be long periods of time when a sufferer shows no symptoms. According to the University of Maryland Medical Center, in mild to moderate cases, asthma may gradually improve and some patients may become symptom-free eventually. Even in some severe cases, the medical center says, adults may have improvement depending on how much their lungs are obstructed and how quickly and effectively they can be treated.

But in about 10 percent of serious, persistent cases, the medical center says, there may be actual changes in the structure of the airway walls. That in turn can lead to more serious and even irreversible problems in lung function. This can happen despite aggressive treatment.

Asthma is a relatively uncommon cause of death, the medical center says, and most deaths like that are preventable. As long as the patient is treated properly, death is extremely rare. But it is nonetheless a frightening condition that interferes with daily activities and tasks.

Living With Asthma

In addition to regular doctor visits and taking your medicine as prescribed, there are many things you can do to make life as an asthma patient much more manageable.

  • Don’t smoke – and avoid secondhand smoke. In addition to its many severe health consequences, tobacco can trigger the onset of asthma symptoms. According to the Asthma Society of Canada, you should not only try to quit yourself but should also try to avoid any place where people are smoking, such as bars or clubs.
  • Whenever possible, avoid mold spores outdoors. The Asthma Society of Canada recommends that you:
    • Have piles of grass removed from your lawn immediately after it’s mowed.
    • Have accumulated leaves raked and removed.
    • Keep garbage cans clean.
    • Don’t leave stagnant water in any outside containers.
    • When leaves accumulate on your lawn, have them raked and removed.
    • Keep garbage cans clean.
  • Avoid pollen. Airborne pollens, which come from trees and grasses, can be inhaled all too easily. The Asthma Society of Canada suggests taking the following steps:
  • Use a HEPA-filtered air cleaner to remove dust, particles, and other allergens from the air in your home.
  • Check the pollen count in your local weather forecast. If the count is high, use an air conditioner in your home and your car. Keep your windows closed as much as possible.
  • Shower and change your clothing if you’ve been outdoors on a high-pollen-count day.
  • Don’t have any trees or plants near your windows or near the air-intake of your furnace or air conditioner.
  • Get regular flu vaccinations.
  • Keep an asthma diary to see how well your medicine is working. The NIH says asthma is considered to be well controlled if you have symptoms no more than two days a week; are awakened from sleep no more than two nights a week; can do all your normal activities; have no more than one asthma attack a year that requires you to take oral corticosteroids; and your peak airflow doesn’t drop below 80 percent of your best number.

Screening

The screening process usually begins with a doctor asking you about the symptoms you have and any allergies you might have experienced. This will likely be followed by a spirometry test, in which you blow into a mouthpiece connected to an instrument called a spirometer. This test measures how much air you can breathe in and breathe out. It also gauges the speed at which you can blow air out, or exhale. Depending on your result, your doctor may give you medicine and test you again later to see if your symptoms have improved. He or she may also perform several other diagnostic tests.

Prevention

Unfortunately, there is no way to prevent asthma. But you can learn to manage it. The Mayo Clinic suggests the following:

  • Develop an asthma action plan with your health – care providers. This should cover what medications you will take, how often you will take them, and what you should do in case of an asthma attack.
  • Get regular flu vaccinations.
  • Know asthma triggers – pollen, mold, dust, pet dander – and avoid them.
  • Monitor your breathing so you know when it starts to be abnormal.
  • Treat attacks as soon as possible.

Medication And Treatment

There are a number of medicines for available for the treatment of asthma. It may take time for you and your doctor to determine which medicines work best for you, and in what dosage. Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs. Ask your health care provider to show you the right way to use an inhaler when you first start using it, and at every visit thereafter.


Quick-Relief Medicines

When an asthma attack occurs, it may be necessary to use quick-relief medications to re-open the airways and allow for regular breathing.

  • Inhaled short-acting beta2-agonists are the first choice for quick relief. These medications give immediate relief for patients experiencing asthma symptoms by relaxing tight muscles around the airways. Carry your quick-relief inhaler with you at all times, and use it when you notice symptoms. The NIH advises that you talk with your doctor if you are using this medicine more than two days a week. If your child has asthma, make sure that anyone caring for her or him has the child’s quick-relief medicine and knows how to use it and when to get medical help.

Don’t use quick relief medications instead of long-term control medicines, the NIH says, because these short-term solutions don’t reduce inflammation and may not help reduce the frequency of attacks.


Long-Term Control Medicines

Most people who have severe asthma need to take some form of regular medication to help prevent attacks. The most effective long-term medicines reduce inflammation of the airways. These medicines help prevent symptoms from starting but do not provide quick symptom relief.

  • Inhaled corticosteroids are the most commonly used medicine of this type, because they work for long-term relief of inflammation and swelling. The NIH experts say that most people find that inhaled corticosteroids greatly reduce the severity of symptoms. Generally, they’re safe when taken as prescribed. And they are not habit-forming. But they can have side effects, including thrush, a mouth infection. Like many other medicines, though, inhaled corticosteroids can have side effects. Most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risk of side effects. One common side effect from inhaled corticosteroids is a mouth infection called thrush. The NIH says this could be avoided if you use a “spacer” or “holding chamber” on your inhaler that can prevent medicine from landing in your mouth or the back of your throat. Check with your doctor to see whether that’s right for you. The NIH also suggests rinsing your mouth with water after taking inhaled corticosteroids. Asthma patients who have especially severe cases may need to take corticosteroid liquid or pills for a short time. However, if you take them for long periods, these medicines can increase risk of cataracts and osteoporosis. Your doctor may suggest taking calcium and vitamin D pills to protect your bones.

Other long-term control medicines include:

  • A device called a nebulizer sends a fine mist of medicine to your lungs as you breathe in. Like inhaled corticosteroids, it helps prevent inflammation of airways.
  • Omalizumabexternal (anti-IgE). According to the NIH, this medicine is injected once or twice a month. It blocks a reaction to asthma triggers. However, a rare but potentially dangerous reaction, anaphylaxis, might occur. Ask your doctor if you are at risk for anaphylaxis, what the signs are and what you should do if you have an attack.
  • Inhaled long-acting beta2- agonists. These medicines, which help open the airways by relaxing the tighten airway muscles, might be added to inhaled corticosteroids for improved results, the NIH says. But inhaled long-acting beta2-agonists should never be used on their own for long-term asthma control—instead, they must be used with inhaled corticosteroids.
  • Leukotriene modifiers. These oral medicines help block inflammation in the airways.
  • Theophylline. Another oral medication, theophylline helps open the airways.

The NIH experts advise that if your doctor prescribes a long-term control medicine, take it daily. If you stop, your symptoms will likely return or get worse. You should also talk to your doctor about the possible side effects of these various medications and the steps that can be taken to control or avoid them. Depending on the medication you’re taking, your doctor can check its level in your blood to determine the proper dosage. This is done with some medicines, including theophylline.

Complementary and Alternative Treatment

According to the National Center for Complementary and Alternative Medicine (NCCAM), there isn’t enough evidence to recommend any alternative remedy for the treatment of asthma. However, there have been studies that looked at acupuncture for the treatment of asthma. A few of the investigations showed some reduction in use of medication and improvement in quality of life, but most showed no difference between actual acupuncture and a sham procedure.
Several studies have looked at actual or true acupuncture – stimulation of specific points on the body with thin metal needles – for asthma. Although a few studies showed some reduction in medication use and improvements in symptoms and quality of life, the majority showed no difference between actual acupuncture and simulated or sham acupuncture on asthma symptoms. At this point, there is little evidence that acupuncture is an effective treatment for asthma.
Some researchers have examined the effect of breathing exercises that are designed to reduce hyperventilation and better balance carbon dioxide and oxygen in the blood. The NCCAM said that a review of seven randomized, controlled trials found a trend toward improvement of symptoms but not enough evidence for a definitive conclusion.

Care Guide

Here’s what the experts say you can do to manage your asthma:

  • Don’t smoke – and avoid secondhand smoke.
  • Avoid mold spores and pollen whenever possible by arranging for removal of any excess grass, leaves or standing water around your home.
  • Use a HEPA-filtered air cleaner.
  • Check the pollen count in your local weather forecast. If the count is high, use an air conditioner in your home and your car. Keep your windows closed as much as possible.
  • Shower and change your clothing if you’ve been outdoors on a high-pollen-count day.
  • Don’t have any trees or plants near your windows or near the air-intake of your furnace or air conditioner.
  • Get regular flu vaccinations.

When To Contact A Doctor

The National institutes of Health recommends getting immediate medical help in case of these symptoms:

  • Bluish color to the lips and face, which is known as cyanosis
  • Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack
  • Extreme difficulty breathing
  • Rapid pulse
  • Severe anxiety due to shortness of breath
  • Sweating
  • Other serious symptoms:
  • Abnormal breathing pattern—breathing out takes more than twice as long as breathing in
  • Breathing temporarily stops
  • Chest pain
  • Tightness in the chest

Questions For Your Doctor

The first step is to see your primary care doctor if you suspect you have asthma. He or she may be able to help you handle your asthma without need for further referral. Your doctor may recommend that you see an asthma specialist if you need special tests to help diagnose asthma; if you’ve had a severe and possibly life-threatening asthma attack; you need more than one kind of medication or higher doses; or you are thinking about getting allergy treatments.

You can find asthma specialists in your health-care network or via a professional association, The American Academy of Allergy, Asthma & Immunology. Click here to find out more.

Questions For A Doctor

The National Institute of Health recommends asking your doctor the following questions about asthma:

  • Am I taking my asthma medicines the right way?
  • What medicines (controller medications) should I be taking every day? What should I do if I miss a day?
  • How should I adjust my medicines if I feel better or worse?
  • Which medicines should I take when I am short of breath (called rescue drugs)? Is it okay to use these rescue drugs every day?
  • What are the side effects of my medicines? For what side effects should I call the doctor?
  • How will I know when my inhalers are getting empty? Am I using my inhaler the right way?
  • What are some signs that my asthma is getting worse?
  • What shots or vaccinations do I need?
  • What will make my asthma worse?
  • How can I prevent getting a lung infection?
  • How can I get help quitting smoking?
  • How do I find out when smog or pollution is worse?
  • What sort of changes should I make around my home?
  • Can I have a pet? In the house or outside? How about in the bedroom?
  • Is it okay for me to clean and vacuum in the house?
  • Is it okay to have carpets in the house?
  • What type of furniture is best to have?
  • How do I get rid of dust and mold in the house? Do I need to cover my bed or pillows?
  • How do I know if I have cockroaches in my home? How do I get rid of them?
  • Can I have a fire in my fireplace or wood-burning stove?
  • What sort of changes do I need to make at work?
  • What exercises are better for me to do?
  • Are there times when I should avoid being outside and exercising?
  • Are there things that I can do before I start exercising?
  • Do I need tests or treatments for allergies? What should I do when I know I’m going to be around something that triggers my asthma?
  • What type of planning do I need to do before I travel?
  • What drugs should I bring? How do I get refills?
  • Whom should I call if my asthma gets worse?
  • Should I have extra medicines in case something happens?

Resources

For more information on asthma, visit the following resources:

The National Heart, Lung and Blood Institute, part of the National Institutes of Health, has an excellent website that gives an overview of asthma as well as up-to-date videos on progress in research.

The Federal Centers for Disease Control provides information about asthma in children.

The Asthma and Allergy Association of America focuses on education and support groups across the country.

The American Lung Association provides strategies for keeping your environment free of asthma triggers and also keeps patients up to date on the newest asthma research.

The National Library for Medicine has a list of interactive tools consumers can use to better manage their condition.

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