What is asthma?
Asthma is a chronic lung disease marked by acute flare-ups of inflammation and swelling of the airways in the lungs. Asthma is one of the most common childhood diseases, but it also affects adults. According to the Centers for Disease Control and Prevention, more than 17 million adults and 7 million children are living with asthma in the United States. Seventy five percent of new asthma cases are diagnosed before the 7th birthday.
Asthma affects the bronchioles, small hollow passageways in the lungs, and the alveoli, which are attached to the bronchioles. The alveoli are tiny sac-like structures where oxygen is absorbed into the bloodstream.
During an asthma attack, the bronchioles and alveoli overreact to certain triggers and become inflamed, irritated, and swollen. This hinders the flow of air into the lungs and causes wheezing, chest tightness, difficulty breathing, and coughing. The smooth muscles surrounding the airways react by tightening, further blocking airflow. Mucus production increases, further exacerbating breathing troubles.
Minor shortness of breath can be treated at home by following your treatment plan or at a doctor’s office. If you have trouble breathing, with or without chest tightness or wheezing, after taking your medications according to your treatment plan, contact your health professional. More severe asthma attacks can quickly progress from minor shortness of breath to a life-threatening situation.
What are the symptoms of asthma?
Symptoms of asthma include shortness of breath, cough, chest tightness, and wheezing. Wheezing is a "whistling" noise that occurs while breathing. It can be heard through a stethoscope or, in certain cases, by the naked ear. Early signs of an asthma flare-up can be subtle and include restlessness, anxiety, and wheezing that cannot be heard by the naked ear. It may also be difficult to hear wheezing in extreme asthma flare-ups because the airways have become so narrow that there is not enough air moving through them to create a sound. Physicians are particularly concerned when patients are experiencing poor air movement through their lungs.
Common symptoms of asthma
You may experience asthma symptoms daily or just once in a while. At times any of these asthma symptoms can be severe:
Anxiety and restlessness
Breathing difficulty and shortness of breath
Flared nostrils, especially in children
Need to sit upright
Persistent cough or cough that is worse at night
Rapid breathing (tachypnea) and rapid pulse (tachycardia)
Serious symptoms that might indicate a life-threatening condition
More severe asthma attacks can quickly progress from minor shortness of breath to a life-threatening situation. Symptoms that may indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting include:
Fast heart rate
Pale or bluish coloration of the lips or fingernails (cyanosis)
Severe difficulty breathing
What causes asthma?
The exact cause of asthma is not known, but it likely involves a combination of genetic and environmental factors. When asthma is associated with allergies, the disease is referred to as allergic asthma or allergy-induced asthma. Asthma caused by breathing irritating or toxic chemicals encountered on the job is called occupational asthma. Exercise-induced asthma is caused by rigorous physical activity.
Symptoms of asthma are due to an oversensitivity and overreaction of the lungs to certain triggers, resulting in inflammation and swelling of the airways.
Asthma triggers vary from person to person, as well as season to season:
Allergens, such as pollen, dust, mold, animal dander, cockroaches, and dust mites
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Sulfites found in certain foods, such as beer, wine and seafood
What are the risk factors for asthma?
A number of factors are thought to increase your chances of developing asthma. Common risk factors include:
Being born with low birth weight
Being exposed to irritating chemicals or air pollution
Being exposed to secondhand smoke, or having a mother who smoked during pregnancy
Having a parent or sibling with asthma
Having frequent colds or other respiratory infections, such as bronchitis, especially in children
How is asthma treated?
Although there is no cure for asthma, you can control it with regular medical care and by consistently following your treatment plan. Asthma treatment plans use a multifaceted approach and are individualized to the type and severity of your asthma.
In addition to medication, a treatment plan for asthma generally includes lifestyle modifications to minimize and eliminate exposure to triggers, such as allergens, air pollution, and smoke. Allergy testing also may be recommended to determine if you are allergic to any specific substances.
Medications to treat asthma include long-term control medications and quick-relief “rescue” medications. Most asthma drugs work by reducing airway inflammation (anti-inflammatories, such as corticosteroids) and/or by opening the airways (bronchodilators).
Long-term control asthma medications
Long-term control medications are inhaled or taken orally every day to control and prevent symptoms. Generally, the most effective long-term control medications are inhaled corticosteroids.* Long-term control medications include:
Immunomodulators: Omalizumab (Xolair)
Inhaled corticosteroids: Budesonide (Pulmicort Flexhaler, Pulmicort Respules); flunisolide (Aerobid Aerosol); fluticasone propionate (Flovent HFA); triamcinolone acetonide (Azmacort Inhalation Aerosol)
Leukotriene modifiers: Montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo CR)
Long-acting beta agonists (bronchodilators): Salmeterol (Serevent Diskus); formoterol (Foradil Aerolizer); albuterol sulfate (VoSpire ER Extended-Release Tablets)
Combination medications: Advair Diskus, Symbicort
Quick-relief asthma medications
"Rescue" or quick-relief medications treat acute symptoms and are generally inhaled through a device called an inhaler. Rescue medications are used on the spot when a person feels a sudden onset of asthma symptoms. Fast-acting asthma medications include:
Anticholinergics: Ipratropium bromide HFA (Atrovent); tiotropium bromide (Spiriva)
Oral or intravenous corticosteroids: Methylprednisolone
Short-acting beta agonists (bronchodilators): Albuterol sulfate (ProAir, Proventil, Ventolin, AccuNeb Inhalation solution); levalbuterol HCl (Xopenex); pirbuterol (Maxair)
Combination medications: Ipratropium bromide/albuterol sulfate (Combivent Inhalation Aerosol)
Many inhalers look alike but contain different quick-relief medications. Therefore it is very important not to share asthma medications.
Other treatments for asthma
Other methods for controlling asthma include alternative treatments and more emergent care:
Allergy medications and shots
Intubation and ventilation (for exhaustion or respiratory arrest due to severe asthma)
What you can do to improve your asthma
In addition to reducing your exposure to asthma triggers, you can also prevent or limit asthma attacks by:
Avoiding cold air
Avoiding or eliminating exposure to triggers, such as smoke, air pollution, animal dander, and dust
Dehumidifying the air
Eating a diet rich in fruits and vegetables
Losing excess weight
Quitting smoking today
Reducing your stress levels
What are the possible complications from asthma?
Complications of untreated or poorly controlled asthma can be serious and even life-threatening. They include: