Page 1
Introduction
Asthma occurs when the main air passages of your lungs, the
bronchial tubes, become inflamed. The muscles of the bronchial
walls tighten, and cells in the lungs produce extra mucus
further narrowing your airways. This can cause minor wheezing to
severe difficulty in breathing. In some cases, your breathing
may be so labored that an asthma attack becomes
life-threatening.
Asthma is a chronic but treatable condition. You can manage your
condition much like someone manages diabetes or heart disease.
You and your doctor can work together to control asthma, reduce
the severity and frequency of attacks and help maintain a
normal, active life.
Signs and symptoms
Asthma signs and symptoms can range from mild to severe. You may
have only occasional asthma episodes with mild, short-lived
symptoms such as wheezing. In between episodes you may feel
normal and have no difficulty breathing. Some people with asthma
have chronic coughing and wheezing punctuated by severe asthma
attacks.
Most asthma attacks are preceded by warning signs. Recognizing
these warning signs and treating symptoms early can help prevent
attacks or keep them from becoming worse.
Warning signs and symptoms of asthma in adults may include:
-
Increased shortness of breath or wheezing
-
Disturbed sleep caused by shortness of breath, coughing or
wheezing
-
Chest
tightness or pain
-
Increased need to use bronchodilators medications
that open up airways by relaxing the surrounding muscles
-
A fall
in peak flow rates as measured by a peak flow meter, a
simple and inexpensive device that allows you to monitor
your own lung function
Children often have an audible whistling or wheezing sound when
exhaling and frequent coughing spasms.
Causes
Asthma is probably due to a combination of environmental and
genetic factors. You're more likely to develop asthma if it runs
in your family and if you're sensitive to environmental
allergens or irritants. Early, frequent infections and chronic
exposure to secondhand smoke or certain allergens may increase
your chances of developing asthma.
Exposure to various allergens and irritants may trigger your
asthma symptoms. The following are common things that trigger
asthma symptoms:
-
Allergens, such as pollen, animal dander or mold
-
Cockroaches and dust mites
-
Air
pollutants and irritants
-
Smoke
-
Strong
odors or scented products or chemicals
-
Respiratory infections, including the common cold
-
Physical exertion, including exercise
-
Strong
emotions and stress
-
Cold
air
-
Certain
medications, including beta blockers, aspirin and other
nonsteroidal anti-inflammatory drugs
-
Sulfites, preservatives added to some perishable foods
-
Gastroesophageal reflux disease (GERD), a condition in which
stomach acids back up into your esophagus. GERD may trigger
an asthma attack or make an attack worse.
-
Sinusitis
Risk factors
Approximately 14 million adults and 6 million children in the
U.S. have asthma. In fact, asthma is the most common chronic
illness of childhood and a common reason for missed school days.
Asthma is more common in boys than in girls. But after puberty
asthma is more common in females.
A number of factors may increase your chances of developing
asthma. These include:
-
Living
in a large urban area, especially the inner city, which may
increase exposure to environmental pollutants
-
Exposure to secondhand smoke
-
Exposure to occupational triggers, such as chemicals used in
farming and hairdressing, and in paint, steel, plastics, and
electronics manufacturing
-
Having
one or both parents with asthma
-
Respiratory infections in childhood
-
Low
birth weight
-
Obesity
-
Gastroesophageal reflux disease (GERD)
When to seek medical advice
Three key circumstances may lead you to talk to your doctor
about asthma:
-
If
you think you have asthma.
Wheezing, difficulty breathing, pain or tightening in your
chest, or coughing are common signs and symptoms of asthma.
Wheezing, especially, is a frequent sign of asthma in
children. However, some people with asthma never wheeze.
Instead, they have recurrent, spasmodic coughs that are
often worse at night. If you or your children have frequent
coughs that last more than a few days or any other signs or
symptoms of asthma, see your doctor.
-
If
you know you have asthma.
If you know you have asthma, talk to your doctor about ways
to manage your condition. Working as a team, you and your
doctor can develop a plan to help you control your signs and
symptoms, prevent an attack or stop an attack in progress.
Don't try to treat asthma yourself. Many asthma deaths
result from a lack of proper treatment.
-
If
your medication isn't working.
Sometimes your medications may not offer the relief you
need. Be sure to contact your doctor right away if a
prescribed dosage of medication doesn't work for you. In
some cases you may not be using your inhalers correctly.
Don't try to solve the problem by taking more medication
without consulting your doctor overusing inhalers or
taking too much medication can be dangerous.
Screening and diagnosis
Diagnosing asthma can be difficult. Signs and symptoms can range
from mild to very severe and are often similar to those of other
conditions, including emphysema, early congestive heart failure
or vocal cord problems.
In order to rule out these and other possible conditions, your
doctor will likely use several tests to arrive at a diagnosis.
In most cases you'll be asked to give a complete medical history
and have a physical exam. You may also be given lung (pulmonary)
function tests to determine how much air moves in and out as you
breathe.
The two most common tools to measure lung function are:
-
Spirometer.
A spirometer is used by a medical professional to measure
narrowing of your bronchial tubes. This device measures the
volume of air you can exhale after you've taken a deep
breath. A spirometer also shows how quickly you can get air
out of your lungs.
-
Peak
flow meter.
A peak flow meter can be used at home to help detect subtle
increases in airway obstruction before you notice symptoms.
If the readings are lower than usual, it's a sign your
asthma may be about to flare up. Your doctor can give you
instructions on how to deal with low readings.
Lung function tests often are done before and after taking a
medication known as a bronchodilator to open your airways. If
your lung function improves with use of a bronchodilator, it's
likely you have asthma.
If there is uncertainty about a diagnosis of asthma, your doctor
may also recommend a methacholine bronchial challenge. If you
have asthma, inhaling a known asthma trigger called methacholine
will cause mild constriction of your airways, which can be
measured with a lung function test. A positive methacholine test
supports a diagnosis of asthma.
How asthma is classified
The results of your physical exam and diagnostic tests can help
your doctor classify how severe your asthma is, which helps
guide how it should be treated. The four main classifications of
asthma are:
-
Mild
intermittent.
This is the mildest form of asthma. Generally, people with
mild intermittent asthma have mild symptoms up to two days a
week and up to two nights a month.
-
Mild
persistent.
You have mild persistent asthma if you have asthma symptoms
more than twice a week, but no more than once in a single
day.
-
Moderate persistent.
If you have asthma symptoms once a day and more than one
night a week, you may have moderate persistent asthma.
-
Severe persistent.
This is the most severe form of asthma, causing symptoms
throughout the day on most days and frequently at night.
Complications
Asthma accounts for millions of missed school days and workdays
each year. It's also a common reason for emergency room visits
and hospitalizations. You can reduce your risk of severe attacks
by making sure your asthma is well controlled and by knowing how
to recognize and treat attacks before they occur.
Controlling your asthma can also help you avoid serious side
effects from long-term use of some medications used to stabilize
severe asthma. Using inhaled corticosteroids, which have fewer
side effects than oral corticosteroids, can help you reduce the
need for emergency treatment of asthma.
Treatment
There are several types of medications available for treating
asthma. Most people use a combination of long-term control
medications and quick relief medications. Your doctor can help
you decide which option is best for you based on your age and
the severity of your symptoms. In general, the main types of
asthma medications are:
-
Long-term-control medications.
These are used regularly to control chronic symptoms and
prevent asthma attacks.
-
Quick-relief medications.
You use these as needed for rapid, short-term relief of
symptoms during an asthma attack.
-
Medications for allergy-induced asthma.
These decrease your body's sensitivity to a particular
allergen and prevent your immune system from reacting to
allergens.
Long-term control medications
These medications are usually taken every day on a long-term
basis, to control persistent asthma.
Corticosteroids help decrease the frequency of your attacks and
reduce the need for other medications you may use to control
your symptoms. Because inhaled corticosteroids control most
forms of asthma by delivering medication directly to your
airways, they have a lower risk of side effects than are
associated with oral corticosteroids. Inhaled corticosteroids
include fluticasone (Flovent),
budesonide (Pulmicort),
triamcinolone (Azmacort),
flunisolide (Aerobid) and
beclomethasone (Qvar).
Advair Diskus is a combination inhaler
containing fluticasone and
salmeterol.
Side effects associated with inhaled corticosteroids can include
hoarseness or loss of voice, oral yeast infections (thrush), and
cough. Long-term use of inhaled corticosteroids may slightly
increase the risk of skin thinning, bruising, osteoporosis, eye
pressure and cataracts. In children, inhaled corticosteroids may
slow growth.
If you're using a metered-dose-inhaler form of corticosteroid,
be sure to use a spacer and rinse your mouth with water after
each use. This reduces the amount of drug that can is swallowed
and absorbed into your body. It also reduces side effects, such
as mouth and throat irritation and oral yeast infections
(thrush).
-
Long-acting beta-2 agonists (LABA's).
These medications are part of a group of medications called
bronchodilators, which open up constricted airways.
Long-acting beta-2 agonists, such as
salmeterol (Serevent
Diskus) and
formoterol (Foradil), last at least 12 hours.
They're used to control moderate and severe asthma and to
prevent nighttime symptoms. Salmeterol or formoterol are
used on a regular schedule along with inhaled
corticosteroids and should not be used as the main treatment
for asthma.
On Nov. 18, 2005, the Food and Drug Administration (FDA) issued
a public health advisory for three LABA medications, stating the
medications may increase the risk of severe asthma episodes and
possibly death if a severe asthma episode occurs. The three
asthma medications included in the advisory are:
Advair Diskus,
Foradil Aerolizer and
Serevent Diskus. If you experience asthma
attacks and you're taking one of these medications, you'll need
to talk with your doctor to determine the best course of action.
-
Leukotriene modifiers.
These drugs reduce the production or block the action of
leukotrienes substances released by cells in your lungs
during an asthma attack. Leukotrienes cause the lining of
your airways to become inflamed, which in turn leads to
wheezing, shortness of breath and mucus production.
Leukotriene modifiers include
montelukast (Singulair) and
zafirlukast (Accolate).
Leukotriene modifiers are used with other medications such as
inhaled corticosteroids to help prevent asthma attacks.
Although generally not as effective as inhaled corticosteroids,
leukotriene modifiers are an option if you have mild asthma and
want to avoid corticosteroids.
-
Cromolyn and
nedocromil.
Although they're not effective for everyone, daily use of
inhaled cromolyn (Intal) or nedocromil (Tilade) may help
prevent attacks of mild to moderate asthma. They may also be
used to help prevent asthma triggered by exercise.
-
Theophylline.
You take this bronchodilator in pill form every day. It may
be helpful for relieving your nighttime symptoms of asthma.
But theophylline may cause side effects, such as nausea and
vomiting, severe abdominal pain, diarrhea, acid reflux,
confusion, fast or irregular heartbeat, and nervousness. If
you're taking theophylline, get regular blood tests to make
sure you're getting the correct dosage.
Quick-relief medications
Short-acting bronchodilators often called "rescue" or
"quick-relief" medications stop the symptoms of an asthma
attack in progress. You take these medications when you begin to
have symptoms, such as coughing, wheezing, chest tightness or
shortness of breath. You may also use short-acting
bronchodilators to prevent an asthma attack when your peak flow
meter shows that your readings are lower than normal.
-
Short-acting
beta2 agonists.
These bronchodilators begin working within minutes and last
four to six hours. But they can't keep symptoms from coming
back. The most commonly used short-acting bronchodilator for
asthma is albuterol.
-
Ipratropium (Atrovent).
Your doctor might prescribe this anticholinergic for the
immediate relief of your asthma symptoms.
-
Oral
and intravenous corticosteroids for asthma attacks.
These corticosteroids including
prednisone,
methylprednisolone,
hydrocortisone and others may be taken
to treat acute asthma attacks or very severe asthma. They
may take a few hours or a few days to be fully effective.
Long-term use of these medications can cause serious side
effects, including cataracts, loss of bone mineral
(osteoporosis), muscle weakness, decreased resistance to
infection, high blood pressure and thinning of the skin.
Asthma attacks can be life-threatening and should be managed
by a doctor.
Medications for asthma triggered by allergies
Other medications focus on treating allergy triggers for asthma
and include:
-
Immunotherapy.
Allergy-desensitization shots (immunotherapy) may help if
you have allergic asthma that can't be easily controlled by
avoiding triggers. You'll begin with skin tests to determine
which allergens trigger your asthma symptoms, followed by a
series of therapeutic injections containing small doses of
those allergens. You generally receive injections once a
week for a few months, then once a month for a period of
three to five years. Over time, you should lose your
sensitivity to the allergens. Immunotherapy isn't for
everyone, though. You're most likely to benefit if it's
clear you have allergic asthma. In addition, immunotherapy
carries the risk of an allergic reaction to the shot.
Life-threatening reactions are rare but possible.
-
Anti-IgE monoclonal antibodies.
If you have allergies, your immune system produces
allergy-causing IgE antibodies to attack substances that
generally cause no harm, such as pollen, dust mites and pet
dander. If you have allergic asthma that's difficult to
control, omalizumab (Xolair) may reduce the number of asthma
attacks you experience by blocking the action of these
antibodies. That way your immune system isn't prompted to
react and cause the inflammation that makes breathing
difficult.
Xolair is used in children over 12 years old and adults with
moderate to severe asthma caused by an allergy, if all other
treatments have failed.
Xolair is delivered by injection every two to four weeks. Risks
include the possibility of a severe reaction within two hours of
receiving the shot, blood-clotting problems, and a possible link
to cancer. That link is currently being studied. Also, if you're
pregnant or breast-feeding, tell your doctor beforehand.
Treatment by severity for better control
Treatment based on asthma severity can help you control your
asthma. According to guidelines from the American Academy of
Allergy, Asthma & Immunology and the American College of
Allergy, Asthma & Immunology, asthma therapy should be flexible
and based on changes in symptoms, which should be assessed
thoroughly each time you see your doctor. Then, treatment can be
adjusted accordingly.
For example, if your asthma is well controlled, your doctor may
prescribe less medicine. If your asthma is not well controlled
or getting worse, your doctor may increase your medication and
recommend more frequent visits.
Prevention
The best way to prevent asthma attacks is to identify and avoid
indoor and outdoor allergens and irritants. That's easier said
than done because thousands of outdoor allergens and irritants
ranging from pollen and mold to cold air and air pollution can
trigger your attacks. A number of indoor allergens, including
dust mites, cockroaches, pet dander and mold, can do the same. A
common asthma irritant is tobacco smoke.
Even if you reduce indoor and outdoor allergens and irritants,
managing asthma can be challenging. It often takes ongoing
communication and teamwork with your doctor. But by working
together, you and your doctor can design a step-by-step plan for
living with your condition. In addition to knowing and avoiding
your triggers, develop an action plan, monitor your breathing
and treat attacks early.
-
Develop an action plan.
With your doctor and health care team, write a detailed plan
for taking maintenance medications and managing an acute
attack. Then be sure to follow your plan. Asthma is an
ongoing condition that needs regular monitoring and
treatment. Taking control of your treatment can make you
feel more in control of your life in general.
-
Monitor your breathing.
You may learn to recognize warning signs of an impending
attack, such as slight coughing, wheezing or shortness of
breath. But because your lung function may decrease before
you notice any signs or symptoms, regularly measure your
peak airflow with a home peak flow meter.
-
Treat attacks early.
If you act quickly, you're less likely to have a severe
attack. You also won't need as much medication to control
your symptoms. When your peak flow measurements decrease and
alert you to an impending attack, take your medication as
instructed and immediately stop any activity that may have
triggered the attack. If your symptoms don't improve, get
medical help as directed in your action plan.
Self-care
Although many people with asthma rely on medications to relieve
symptoms and control inflammation, you can do several things on
your own to maintain overall health and lessen the possibility
of attacks:
-
Exercise.
You don't have to be sedentary if you have asthma. Regular
exercise can strengthen your heart and lungs so that they
don't have to work so hard. Aim for 30 minutes of exercise
on most days. If you've been inactive, start slowly and try
to gradually increase your activity over time. Keep in mind
that exercising in cold temperatures may trigger symptoms.
If you do exercise in cold temperatures, wear a face mask to
warm the air you breathe. And don't exercise in temperatures
below zero. Activities such as golf, walking and swimming
are less likely to trigger attacks, but be sure to discuss
any exercise program with your doctor.
-
Use
your air conditioner.
Air conditioning helps reduce the amount of airborne pollen
from trees, grasses and weeds that finds its way indoors.
Air conditioning also lowers indoor humidity and can reduce
your exposure to dust mites. If you don't have air
conditioning, try to keep your windows closed during pollen
season.
-
Decontaminate your decor.
Minimize dust that may aggravate nighttime symptoms by
replacing certain items in your bedroom. For example, encase
pillows, mattresses and box springs in dust-proof covers.
Remove carpeting and install hardwood or linoleum flooring.
Use washable curtains and blinds.
-
Maintain optimal humidity.
Keep humidity low in your home and office. If you live in a
damp climate, talk to your doctor about using a
dehumidifier.
-
Keep
indoor air clean.
Have a utility company check your air conditioner and
furnace once a year. Change the filters in your furnace and
air conditioner according to the manufacturer's
instructions. Also consider installing a small-particle
filter in your ventilation system. If you use a humidifier,
change the water daily.
-
Reduce pet dander.
If you're allergic to dander, avoid pets with fur or
feathers. Having pets regularly bathed or groomed also may
reduce the amount of dander in your surroundings.
-
Clean regularly.
Clean your home at least once a week. Because cleaning stirs
up dust, however, wear a mask or, if you can, have someone
else clean.
-
Limit use of contact lenses.
Try substituting eyeglasses for your contact lenses when the
pollen count is high. Pollen grains can become trapped under
the lenses.
-
Control heartburn and gastroesophageal reflux disease
(GERD).
It's possible that the acid reflux that causes heartburn may
damage lung airways and worsen asthma symptoms. If you have
frequent or constant heartburn, talk to your doctor about
treatment options.
Coping skills
Asthma can be challenging and stressful. You may sometimes
become frustrated, angry or depressed because you need to cut
back on your usual activities, to avoid environmental triggers.
You may also feel hampered or embarrassed by the symptoms of the
disease and by complicated management routines. Children in
particular may be reluctant to use a metered dose inhaler in
front of their peers.
But asthma doesn't have to be a limiting condition. The best way
to overcome anxiety and a feeling of helplessness is to
understand your condition and take control of your treatment.
Here are some suggestions that may help:
-
Identify the things that trigger your symptoms.
This can be one of the most important ways to take control
of your life. Also take peak flow measurements regularly and
follow your action plan for using medications and managing
attacks.
-
Pace
yourself.
Take breaks between tasks and avoid activities that make
your symptoms worse.
-
Make
a daily to-do list.
This may help you avoid feeling overwhelmed. Reward yourself
for accomplishing simple goals.
-
Talk
to others with your condition.
Chat rooms and message boards on the Internet or support
groups in your area can connect you with people facing
similar challenges and let you know you're not alone.
If you have a child with asthma, be encouraging and supportive.
Focus attention on the things your child can do, not on the
things he or she can't do. Involve teachers, school nurses,
coaches, friends and relatives in helping your child manage an
asthma condition.
