Asthma is a chronic ailment in which inflammation of the airways, or bronchi, affects the way air enters and leaves the lungs, thereby disrupting breathing. When allergens or irritants come into contact with the inflamed airways, the already sensitive airways tighten and narrow, making it difficult for the person to breathe. Progressively severe symptoms can lead to an asthma attack. In asthma attacks, the overproduction of mucus lining the airways further narrows the airways, limiting oxygen intake and making it more difficult to breathe. Asthma affects 5 million children in the United States and 15 million people total. Currently, there is no cure, but there are medications and lifestyle changes that can help alleviate the symptoms so that one can lead a productive life.
The symptoms associated with asthma differ from person to person. Most people experience severe coughing in the early morning hours or at night. The wheezing and tightening of the chest, other symptoms suffered by asthmatics, causes shortness of breath. Asthma can be triggered by allergens or induced by external irritants. Allergen-induced asthma normally appears in individuals before the age of 35. Non-allergic asthma occurs later, usually at middle age, and is triggered by exercise, weather changes, or viral infections.
The early exposure to allergens or irritants is thought to be an important cause of asthma. Heredity also plays a role in predisposing certain groups of the population to the chronic condition. The allergens that can trigger an asthma attack include animal dander, pollen, mold, and dust. Irritants like cigarette smoke, air spray products and perfumes, and changes in the weather can also trigger attacks. The best way to minimize the symptoms is to avoid the triggers. Changing bed and pillow coverings once a month, avoiding mold, staying away from pets, and avoiding the outdoors during windy days are some of the lifestyle changes a person can make to eliminate the triggers.
Asthma is a commonly occurring condition which can be serious and life threatening if not dealt with properly. With the correct medications, lifestyle accommodations, and proper treatment, a person can live a healthy and active life.
The exact cause of asthma is not known. 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 an asthma attack. In asthma, the "invaders" are the triggers listed below. Triggers vary among individuals. 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 known as gastroesophageal reflux disease, or GERD,
sulfites, an additive to some foods and wine, and
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 -- this is the single biggest risk factor;
eczema: another type of allergy affecting the skin; and
genetic predisposition: a parent, brother, or sister also has asthma.
Asthma symptoms range from minor to severe and vary from person to person. You may have mild symptoms and asthma attacks may be infrequent. Between asthma flare-ups you may feel normal and have no trouble breathing. You may have symptoms primarily at night, during exercise or when you're exposed to specific triggers. Or you may have asthma symptoms all the time. Asthma signs and symptoms include:
Shortness of breath
Chest tightness or pain
Trouble sleeping caused by shortness of breath, coughing or wheezing
An audible whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu
Signs that your asthma is probably getting worse include:
More frequent and bothersome asthma signs and symptoms
Increasing difficulty breathing (this can be measured by a peak flow meter, a simple device used to check how well your lungs are working)
An increasingly frequent need to use a quick-relief inhaler
For some people, asthma symptoms flare up in certain situations:
Exercise-induced asthma occurs during exercise. For many people, exercise-induced asthma is worse when the air is cold and dry.
Occupational asthma is asthma that's caused or worsened by breathing in a workplace irritant such as chemical fumes, gases or dust.
Allergy-induced asthma. Some people have asthma symptoms that are triggered by particular allergens, such as pet dander, cockroaches or pollen.
These key circumstances may lead you to talk to your doctor about asthma:
If you think you have asthma. If you have frequent coughing that lasts more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early, especially in children, may prevent long-term lung damage and help keep the condition from worsening over time.
To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good long-term asthma control not only helps you feel better on a daily basis, but also can prevent a life-threatening asthma attack.
If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't seem to ease your symptoms or you need to use your quick-relief inhaler more and more often. Don't try to solve the problem by taking more medication without consulting your doctor. Overusing asthma medication can cause side effects and may even make your asthma worse.
To review your treatment. Asthma changes over time. Meet with your doctor on a regular basis to discuss your symptoms and make any needed adjustments to your treatment.
Severe asthma attacks can be life-threatening. Work with your doctor ahead of time to determine what to do when your signs and symptoms worsen — and when you need emergency treatment. If your quick-relief medications don't relieve symptoms of a severe asthma attack, seek emergency help right away. Signs of an asthma emergency include:
Rapid worsening of shortness of breath or wheezing
No improvement even after using a quick-relief inhaler such as albuterol
Shortness of breath when you are doing minimal physical activity
The aim of treatment is to get your asthma under control and keep it that way. Everyone with asthma should be able to lead a full and unrestricted life. The treatments available for asthma are effective in most people and should enable you to be free from symptoms.
Your doctor or nurse will tailor your asthma treatment to your symptoms. Sometimes, you may need to be on higher levels of medication than at other times.
You should be offered:
care at your GP surgery provided by doctors and nurses trained in asthma management
full information about your condition and how to control it
involvement in making decisions about your treatment
regular checks to ensure that your asthma is under good control and your treatment is right for you (which should be at least once a year)
a written personal asthma action plan agreed with your doctor or nurse
As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse. If you have been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home.
The action plan should include information about your asthma medicines and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack.
Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.
As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms.
Asthma medicines are usually given by inhalers, which are devices that deliver the drug directly into the airways through your mouth when you breathe in. Inhaling a drug is an effective way of taking an asthma medicine as it goes straight to the lungs, with very little ending up elsewhere in the body. However, each inhaler works in a slightly different way. You should have training from your GP or nurse in how to use your device. This should be checked at least once a year.
Some inhalers emit an aerosol jet when pressed. These work better if given through a spacer, which can increase the amount of medication that reaches the lungs and reduce the side effects. Some people find using inhalers difficult, and spacers can help them. However, spacers are often advised even for people who use inhalers well as they improve the distribution of medication in the lungs. Spacers are large plastic or metal containers with a mouthpiece at one end and a hole for the inhaler at the other. The medicine is ‘puffed’ into the spacer by the inhaler and it is then breathed in through the spacer mouthpiece. Spacers are also good for reducing the risk of thrush in the mouth or throat, which can be a side effect of inhaled asthma medicines.
Reliever inhalers are taken to relieve asthma symptoms quickly. The inhaler usually contains a medicine called a short-acting beta2-agonist. It works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless they are over used. However, they should rarely be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed. Everyone with asthma should be given a reliever inhaler, also known simply as a reliever. It is often blue.
Preventer inhalers work over time to reduce the amount of inflammation and ‘twitchiness’ in the airways and prevent asthma attacks occurring. You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the reliever inhaler (usually blue) to relieve symptoms, but if you continue to need them often, your treatment should be reviewed. The preventer inhaler usually contains a medicine called an inhaled corticosteroid.
Preventer treatment is normally recommended if you:
have asthma symptoms more than twice a week
wake up once a week due to asthma symptoms
have to use a reliever inhaler more than twice a week
Smoking can reduce the effects of preventer inhalers.
Inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so rinse your mouth thoroughly after inhaling a dose.
If your asthma does not respond to treatment, the dose of preventer inhaler can be increased in discussion with your healthcare team. If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long acting beta2-agonist or LABA) to take as well. Or you may be given an inhaler combining an inhaled steroid and a long-acting bronchodilator in the one device, called a ‘combination’ inhaler. These work in the same way as short-acting relievers, but they take longer to work and can last up to 12 hours.
Only use your long-acting reliever inhaler in combination with the preventer inhaler and never by itself. Studies have shown that using only a long-acting reliever can increase the chance of an asthma attack and can even increase the risk of death.
If treatment of your asthma is still not successful, additional preventer medicines will be tried. Two possible alternatives include:
leukotriene receptor antagonists (montelukast): tablets that block part of the chemical reaction involved in inflammation of the airways
theophyllines: tablets that help widen the airways by relaxing the muscles around them
If your asthma is still not under control, you may be prescribed regular oral steroids (steroid tablets). This treatment is usually monitored by a respiratory specialist (a specialist in asthma). Long-term use of oral steroids has possible serious side effects, so they are only used once other treatment options have been tried.
Most people only need to take a course of oral steroids for one or two weeks. Once your asthma is under control, you can be 'stepped-down' to your previous treatment.