Asthma

Asthma Overview

Asthma is a disease that affects the breathing passages of the lungs (bronchioles). Asthma is caused by chronic (ongoing, long-term) inflammation of these passages. This makes the breathing passages, or airways, of the person with asthma highly sensitive to various "triggers."

When the inflammation is "triggered" by any number of external and internal factors, the passages swell and fill with mucus.


Muscles within the breathing passages contract (bronchospasm), causing even further narrowing of the airways.


This narrowing makes it difficult for air to be breathed out (exhaled) from the lungs.


This resistance to exhaling leads to the typical symptoms of an asthma attack.

Because asthma causes resistance, or obstruction, to exhaled air, it is called an obstructive lung disease. The medical term for such lung conditions is chronic obstructive pulmonary disease, or COPD. COPD is actually a group of diseases that includes not only asthma, but also chronic bronchitis and emphysema.

Like any other chronic disease, asthma is a condition you live with every day of your life. You can have an attack any time you are exposed to one of your triggers. Unlike other chronic obstructive lung diseases, asthma is reversible.
Asthma cannot be cured, but it can be controlled.


You have a better chance of controlling your asthma if it is diagnosed early and treatment begun right away.


With proper treatment, people with asthma can have fewer and less severe attacks.


Without treatment, they will have more frequent and more severe asthma attacks and can even die.

Asthma is on the rise in the United States and other developed countries. We are not sure exactly why this is, but these factors may contribute.
We grow up as children with less exposure to infection than did our ancestors, which has made our immune systems more sensitive.


We spend more and more time indoors, where we are exposed to indoor allergens such as dust and mold.


The air we breathe is more polluted than the air most of our ancestors breathed.


Our lifestyle has led to our getting less exercise and an epidemic of obesity. There is some evidence to suggest an association between obesity and asthma.

Asthma is a very common disease in the United States, where more than 17 million people are affected. A third of these are children. In 2002, 478,000 hospitalizations and 4,657 deaths were attributed to asthma.
Asthma affects all races and is slightly more common in African Americans than in other races.


Asthma affects all ages, although it is more common in younger people. The frequency and severity of asthma attacks tend to decrease as a person ages.


Asthma is the most common chronic disease of children.

Asthma has many costs to society as well as to the individual affected.
Many people are forced to make compromises in their lifestyle to accommodate their disease.


Asthma is a major cause of work and school absence and lost productivity.


Asthma is one of the most common reasons for emergency department visits and hospitalization.


Asthma costs the US economy nearly $13 billion each year.


Approximately 5000 people die of asthma each year in this country.

The good news for people with asthma is that you can live your life to the fullest. Current treatments for asthma, if followed closely, allow most people with asthma to limit the number of attacks they have. With the help of your health care provider, you can take control of your care and your life.


Asthma Causes

We do not know exactly what causes asthma.
What all people with asthma have in common is chronic airway inflammation and excessive airway sensitivity to various triggers.

Research has focused on why some people develop asthma while others do not.

Some people are born with the tendency to have asthma, while others are not. Scientists are trying to find the genes that cause this tendency.

The environment you live in and the way you live partly determine whether you have asthma attacks.

An asthma attack is a reaction to a trigger. It is similar in many ways to an allergic reaction.
An allergic reaction is a response by the body's immune system to an "invader."

When the cells of the immune system sense an invader, they set off a series of reactions that help fight off the invader.

It is this series of reactions that causes the production of mucus and bronchospasms. These responses cause the symptoms of as asthma attack.

In asthma the "invaders" are the triggers listed below. Triggers vary by the individual.

Because asthma is a type of allergic reaction, it is sometimes called reactive airway disease.

Each person with asthma has his or her own unique set of triggers. Most triggers cause attacks in some people with asthma and not in others. Common triggers of asthma attacks are the following:
Exposure to tobacco or wood smoke

Breathing polluted air

Inhaling other respiratory irritants such as perfumes or cleaning products

Exposure to airway irritants at the workplace

Breathing in allergy-causing substances (allergens) such as molds, dust, or animal dander

An upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis

Exposure to cold, dry weather

Emotional excitement or stress

Physical exertion or exercise

Reflux of stomach acid - What medical professionals call gastroesophageal reflux disease, or GERD

Sulfites - An additive to some foods and wine

Menstruation: In some, not all, women, asthma symptoms are closely tied to the menstrual cycle.

Risk factors for developing asthma
Hay fever (allergic rhinitis) and other allergies - The single biggest risk factor

Eczema - Another type of allergy affecting the skin

Genetic predisposition - A parent, brother, or sister also has asthma

Asthma Symptoms

When the breathing passages become irritated or infected, an attack is triggered. The attack may come on suddenly or slowly over several days or hours. The main symptoms that signal an attack are as follows:
Wheezing

Breathlessness

Chest tightness

Coughing

Difficulty speaking

Symptoms may occur during the day or at night. If they happen at night, they may disturb your sleep.

Wheezing is the most common symptom of an asthma attack.
Wheezing is a musical, whistling, or hissing sound with breathing.

Wheezes are most often heard during exhalation, but they can occur during breathing in (inhaling).

Not all asthmatics wheeze, and not all people who wheeze are asthmatics.

Current guidelines for the care of people with asthma include classifying the severity of asthma symptoms, as follows:
Mild intermittent - Includes attacks no more than twice a week and nighttime attacks no more than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies, but there are no symptoms between attacks.

Mild persistent - Includes attacks more than twice a week but not every day, and nighttime symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular activities.

Moderate persistent - Includes daily attacks and nighttime symptoms more than once a week. More severe attacks occur at least twice a week and may last days. Attacks require daily use of quick-relief (rescue) medication and changes in daily activities.

Severe persistent - Includes frequent severe attacks, continual daytime symptoms, and frequent nighttime symptoms. Symptoms require limits on daily activities.

Just because a person has mild or moderate asthma does not mean that he or she cannot have a severe attack. The severity of asthma can change over time, either for better or for worse.


When to Seek Medical Care

If you think you or your child may have asthma, make an appointment with your health care provider. Some clues pointing to asthma include the following:

Wheezing

Difficulty breathing

Pain or tightness in your chest

Recurrent, spasmodic cough that is worse at night

If you or your child has asthma, you should have an action plan worked out in advance with your health care provider. This plan should include instructions on what to do when an asthma attack occurs, when to call the health care provider, and when to go to a hospital emergency department.
Take 2 puffs of an inhaled beta-agonist (a rescue medication), with 1 minute between puffs. If there is no relief, take an additional puff of inhaled beta-agonist every 5 minutes. If there is no response after 8 puffs, which is 40 minutes, your health care provider should be called.

Your provider also should be called if you have an asthma attack when you are already taking oral or inhaled steroids or if your inhaler treatments are not lasting 4 hours.

These are general guidelines only. If your provider recommends another plan for you, follow that plan.

Although asthma is a reversible disease, and treatments are available, people can die from a severe asthma attack.
If you are having an asthma attack and have severe shortness of breath or are unable to reach your health care provider in a short period of time, you must go to the nearest hospital emergency department.

Do not drive yourself to the hospital. Have a friend or family member drive. If you are alone, call 911 immediately for emergency medical transport.


Asthma Treatment

Since asthma is a chronic disease, treatment goes on for a very long time. Some people have to stay on treatment for the rest of their lives. The best way to improve your condition and live your life on your terms is to learn all you can about your asthma and what you can do to make it better.

Become a partner with your health care provider and his or her support staff. Use the resources they can offer--information, education, and expertise--to help yourself.

Become aware of your asthma triggers and do what you can to avoid them.

Follow the treatment recommendations of your health care provider. Understand your treatment. Know what each drug does and how it is used.

See your health care provider as scheduled.

Report any changes or worsening of your symptoms promptly.

Report any side effects you are having with your medications.

These are the goals of treatment:
Prevent ongoing and bothersome symptoms

Prevent asthma attacks

Prevent attacks severe enough to require a visit to your provider or an emergency department or hospitalization

Carry on with normal activities

Maintain normal or near-normal lung function

Have as few side effects of medication as possible


Self-Care at Home

Current treatment regimens are designed to minimize discomfort, inconvenience, and the extent to which you have to limit your activities. If you follow your treatment plan closely, you should be able to avoid or reduce your visits to your health care provider or the emergency department.

Know your triggers and do what you can to avoid them.

If you smoke, quit.

Do not take cough medicine. These medicines do not help asthma and may cause unwanted side effects.

Aspirin and nonsteroidal anti-inflammatory drugs, such as ibuprofen, can cause asthma to worsen in certain individuals. These medications should not be taken without the advice of your health care provider.

Do not use nonprescription inhalers. These contain very short-acting drugs that may not last long enough to relieve an asthma attack and may cause unwanted side effects.

Take only the medications your health care provider has prescribed for your asthma. Take them as directed.

Do not take any nonprescription preparations, herbs, or dietary supplements, even if they are completely "natural," without talking to your health care provider first. Some of these may have unwanted side effects or interfere with your medications.

If the medication is not working, do not take more than you have been directed to take. Overusing asthma medications can be dangerous.

Be prepared to go on to the next step of your action plan if necessary.
If you think your medication is not working, let your health care provider know right away.


Medical Treatment

If you are in the emergency room, treatment will be started while the evaluation is still going on.
You may be given oxygen through a face mask or a tube that goes in your nose.

You may be given aerosolized beta-agonist medications through a face mask or a nebulizer, with or without an anticholinergic agent.

Another method of providing inhaled beta-agonists is by using a metered dose inhaler or MDI. An MDI delivers a standard dose of medication per puff. MDIs are often used along with a "spacer" or holding chamber. A dose of 6-8 puffs is sprayed into the spacer, which is then inhaled. The advantage of an MDI with a spacer is that it requires little or no assistance from the respiratory therapist.

If you are already on steroid medications, or have recently stopped taking steroid medications, or if this appears to be a very severe attack, you may be given a dose of IV steroids.

If you are taking a methylxanthine, such as theophylline or aminophylline, the blood level of this drug will be checked, and you may be given this medication through an IV.

People who respond poorly to inhaled beta-agonists may be given an injection or IV dose of a beta-agonist such as terbutaline or epinephrine.

You will be observed for at least several hours while your test results are obtained and evaluated. You will be monitored for signs of improvement or worsening.

If you respond well to treatment, you will probably be released from the hospital. Be on the lookout over the next several hours for a return of symptoms. If symptoms should return or worsen, return to the emergency department right away.

Your response will likely be monitored by a peak flow meter.

In certain circumstances, you may need to be put in the hospital. There you can be watched carefully and treated should your condition worsen. Conditions for hospitalization include the following:
An attack that is very severe or does not respond well to treatment

Poor lung function on spirometry

Elevated carbon dioxide or low oxygen levels in your blood

A history of being admitted to the hospital or placed on a ventilator for your asthma attacks

Other serious disease that may jeopardize your recovery

Other serious lung illnesses or injuries, such as pneumonia or pneumothorax (a "collapsed" lung)

If your asthma has just been diagnosed, you may be started on a regimen of medications and monitoring. You will be given 2 types of medications:
Controller medications: These are for long-term control of persistent asthma. They help to reduce the inflammation in the lungs that underlies asthma attacks. You take these every day regardless of whether you are having symptoms or not.

Rescue medications: These are for short-term control of asthma attacks. You take these only when you are having symptoms or are more likely to have an attack--for example, when you have an infection in your respiratory tract.

Your treatment plan will also include other parts:
Awareness of your triggers and avoiding the triggers as much as possible

Recommendations for coping with asthma in your daily life

Regular follow-up visits to your health care provider

Use of a peak flow meter

At your follow-up visits, your health care provider will review how you have been doing.
He or she will ask you about frequency and severity of attacks, use of rescue medications, and peak flow measurements.

Lung functions tests may be done to see how your lungs are responding to your treatment.

This is a good time to discuss medication side effects or any problems you are having with your treatment.

The peak flow meter is a simple, inexpensive device that measures how forcefully you are able to exhale.
Ask your health care provider or an assistant to show you how to use the peak flow meter. He or she should watch you use it until you can do it correctly.

Keep one in your home and use it regularly. Your health care provider will make suggestions as to when you should measure your peak flow.

Checking your peak flow is a good way to help you and your health care provider assess what triggers your asthma and its severity.

Check your peak flow regularly and keep a record of the results. Over time, your health care provider may be able to use this record to improve your medications, reducing dose or side effects.

Peak flow measures fall just before an asthma attack. If you use your peak flow meter regularly, you may be able to predict when you are going to have an attack.

It can also be used to check your response to rescue medications.

Together, you and your health care provider will develop an action plan for you in case of asthma attack. The action plan will include the following:
How to use the controller medication

How to use rescue medication in case of an attack

What to do if the rescue medication does not work right away

When to call the health care provider

When to go directly to the hospital emergency department