Asthma

Definition
Asthma occurs when the airways in your lungs (bronchial tubes) become inflamed a
nd constricted. The muscles of the bronchial walls tighten, and your airways pro
duce extra mucus that blocks your airways. Signs and symptoms of asthma range fr
om minor wheezing to life-threatening asthma attacks. Asthma can't be cured, but
its symptoms can be controlled. Management includes avoiding asthma triggers an
d tracking your symptoms. You may need to regularly take long-term control medic
ations to prevent flare-ups and short-term "rescue" medications to control sympt
oms once they start. Asthma that isn't under control can cause missed school and
work or reduced productivity due to symptoms. Because in most people asthma cha
nges over time, you'll need to work closely with your doctor to track your signs
and symptoms and adjust your treatment as needed.
Symptoms
Asthma signs and symptoms range from minor to severe, and vary from person to pe
rson. You may have mild symptoms such as infrequent wheezing, with occasional as
thma attacks. Between episodes you may feel normal and have no trouble breathing
. Or, you may have signs and symptoms such as coughing and wheezing all the time
or have symptoms primarily at night or only during exercise. Asthma signs and s
ymptoms 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 exh
aling Bouts of coughing or wheezing that are worsened by a respiratory virus suc
h as a cold or the flu
Signs that your asthma is probably getting worse include:
An increase in the severity and frequency of asthma signs and symptoms A fall in
peak flow rates as measured by a peak flow meter, a simple device used to check
how well your lungs are working An increased need to use bronchodilators — medica
tions that open up airways by relaxing the surrounding muscles
Work with your doctor to determine when you need to increase your medications or
take other steps to treat symptoms of worsening asthma and get your asthma back
under control. If your asthma keeps getting worse, you may need a trip to the e
mergency room. Your doctor can help you learn to recognize emergency signs and s
ymptoms so you'll know when to get help.
Causes
It isn't clear why some people get asthma and others don't, but it's probably du
e to a combination of environmental and genetic (inherited) factors. Asthma trig
gers are different from person to person. Exposure to various allergens and irri
tants can trigger signs and symptoms of asthma, including:

Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mi
tes Respiratory infections, such as the common cold Physical activity (exercise-
induced asthma) Cold air Air pollutants and irritants such as smoke Certain medi
cations, including beta blockers, aspirin and other nonsteroidal anti-inflammato
ry drugs Strong emotions and stress Sulfites, preservatives added to some perish
able foods Gastroesophageal reflux disease (GERD), a condition in which stomach
acids back up into your throat Menstrual cycle in some women Allergic reactions
to foods such as peanuts or shellfish
Risk factors
Asthma is common, affecting millions of adults and children. A growing number of
people are diagnosed with the condition each year, but it isn't clear why. A nu
mber of factors are thought to increase the chances of developing asthma. These
include:

A family history of asthma Frequent respiratory infections as a child Exposure t

o secondhand smoke Living in an urban area, especially if there's a lot of air p
ollution Exposure to occupational triggers, such as chemicals used in farming, h
airdressing and manufacturing Low birth weight
Being overweight
When to seek medical advice
Three key circumstances may lead you to talk to your doctor about asthma:

If you think you have asthma. If you have frequent coughs that last more than a
few days or any other signs or symptoms of asthma, see your doctor. Treating ast
hma early, especially in children, may prevent long-term lung damage and prevent
worsening of the condition over time. To monitor your asthma after diagnosis. I
f you know you have asthma, work with your doctor to keep it under control. Good
asthma control not only helps you feel better on a daily basis, but also can pr
event a life-threatening asthma attack. If your asthma symptoms get worse. Conta
ct your doctor right away if your medication doesn't work for you. Asthma change
s over time, and you'll need periodic adjustments to your treatment to manage yo
ur symptoms. Don't try to solve the problem by taking more medication without co
nsulting your doctor. Overusing asthma medication can cause side effects and may
even make your asthma worse.
Severe asthma attacks Severe asthma attacks can be life-threatening and require
emergency treatment. If your asthma isn't getting better with quick-relief medic
ations, seek emergency help right away. Work with your doctor ahead of time to d
etermine what to do when your signs and symptoms worsen — and when you need emerge
ncy treatment. Signs of an asthma attack that needs emergency treatment include:

Rapid worsening of shortness of breath or wheezing No improvement even after usi

ng short-acting bronchodilators Shortness of breath with minimal activity
Tests and diagnosis
Diagnosing asthma can be difficult. Signs and symptoms can range from mild to se
vere and are often similar to those of other conditions, including emphysema, ea
rly congestive heart failure or vocal cord problems. In children, it can be hard
to differentiate asthma from wheezy bronchitis, pneumonia or reactive airway di
sease. In order to rule out other possible conditions, your doctor will do a phy
sical exam and ask you questions about your signs and symptoms and about any oth
er health problems. You may also be given lung (pulmonary) function tests to det
ermine how much air moves in and out as you breathe. Tests to measure lung funct
ion include:

Spirometry. This test measures the narrowing of your bronchial tubes by checking
how much air you can exhale after a deep breath, and how fast you can breathe o
ut.
Peak flow. A peak flow meter is a simple device that can be used at home to help
detect subtle changes before you notice symptoms. If the readings are lower tha
n usual, it's a sign your asthma may be about to flare up. Your doctor will give
you instructions on how to track and deal with low readings.
Lung function tests often are done before and after taking a bronchodilator to o
pen your airways. If your lung function improves with use of a bronchodilator, i
t's likely you have asthma. Other diagnostic tests to diagnose asthma include:

Methacholine bronchial challenge. If you have asthma, inhaling a known asthma tr

igger called methacholine will cause mild constriction of your airways. A positi
ve methacholine test supports a diagnosis of asthma. This test may be used if yo
ur initial lung function test is normal. Nitric oxide test. This test is sometim
es used to diagnose and monitor asthma. It measures the amount of a gas called n
itric oxide you have in your breath. If your airways are inflamed — a sign of asth
ma — you may have higher than normal levels of nitric oxide. This test isn't widel
y available.
How asthma is classified To classify your asthma severity, your doctor will eval
uate your answers to questions about symptoms (such as how often you have asthma
attacks and how bad they are), along with the results of your physical exam and
diagnostic tests. Determining the severity level of your asthma will help your
doctor choose the best treatment for you. Asthma severity often changes over tim
e, requiring an adjustment to treatment. Asthma is classified into four general
categories: Asthma classification Mild intermittent Mild persistent Moderate per
sistent Severe persistent Signs and symptoms Mild symptoms up to two days a week
and up to two nights a month Symptoms more than twice a week, but no more than
once in a single day Symptoms once a day and more than one night a week Symptoms
throughout the day on most days and frequently at night
Complications
Asthma may cause a number of complications, including:

Emergency room visits and hospitalizations for severe asthma attacks Permanent n
arrowing of the bronchial tubes (airway remodeling)
Side effects from long-term use of some medications used to stabilize severe ast
hma
Treatments and drugs
Treatment for asthma generally involves avoiding the things that trigger your as
thma attacks and taking one or more asthma medications. Treatment varies from pe
rson to person.

Most people with persistent asthma use a combination of long-term control medica
tions and quick-relief medications, taken with a hand-held inhaler. If your asth
ma symptoms are triggered by airborne allergens, such as pollen or pet dander, y
ou may also need allergy treatment. You may need to try a few different medicati
ons before you find what works best. Because asthma changes over time, you will
need to work with your doctor to monitor your symptoms and learn how to make nee
ded adjustments.
Medications used to treat asthma include long-term control medications, quick-re
lief (rescue) medications and medications to treat allergies. The right medicati
on for you depends on your age and symptoms, and what seems to work best to keep
your asthma under control. Long-term control medications In most cases, these m
edications need to be taken every day. Types of long-term control medications in
clude:

Inhaled corticosteroids such as fluticasone (Flovent Diskus), budesonide (Pulmic

ort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and
others. These medications reduce airway inflammation and are the most commonly
used long-term asthma medication. Unlike oral corticosteroids, these medications
are considered relatively low risk for longterm corticosteroid side effects. Yo
u may need to use these medications for several days to weeks before they reach
their maximum benefit. Long-acting beta-2 agonists (LABAs) such as salmeterol (S
erevent Diskus) and formoterol (Foradil Aerolizer). These inhaled medications, c
alled longacting bronchodilators, open the airways and reduce inflammation. They
are often used to treat persistent asthma in combination with inhaled corticost
eroids. Long-acting bronchodilators should not be used for quick relief of asthm
a symptoms. Leukotriene modifiers such as montelukast (Singulair), zafirlukast (
Accolate) and zileuton (Zyflo CR). These inhaled medications work by opening air
ways, reducing inflammation and decreasing mucus production. Cromolyn and nedocr
omil (Tilade). These inhaled medications reduce asthma signs and symptoms by dec
reasing allergic reactions. They're considered a second choice to inhaled cortic
osteroids, and need to be taken three or four times a day. Theophylline, a daily
pill that opens your airways (bronchodilator). It relaxes the muscles around th
e airways.
Quick-relief medications Also called rescue medications, you use quick-relief me
dications as needed for rapid, short-term relief of symptoms during an asthma at
tack, or before exercise, if your doctor recommends it. Only use these medicatio
ns as often as your doctor tells you to. If you need to use these medications to
o often, you probably need to adjust your longterm control medication. Keep a re
cord of how many puffs you use each day. Types of quick-relief medications inclu
de:

Short-acting beta-2 agonists, such as albuterol. These inhaled medications, call

ed bronchodilators, ease breathing by temporarily relaxing airway muscles. They
act within minutes, and effects last four to six hours. Ipratropium (Atrovent).
Your doctor might prescribe this inhaled anticholinergic for the immediate relie
f of your symptoms. Like other bronchodilators, ipratropium relaxes the airways,
making it easier to breathe. Ipratropium is mostly used for emphysema and chron
ic bronchitis. Oral and intravenous corticosteroids to treat acute asthma attack
s or very severe asthma. Examples include prednisone and methylprednisolone. The
se medications relieve airway inflammation. They may cause serious side effects
when used long term, so they're only used to treat severe asthma symptoms.
Medications for allergy-induced asthma. These decrease your body's sensitivity t
o a particular allergen or prevent your immune system from reacting to allergens
. Allergy treatments for asthma include:

Immunotherapy. Allergy-desensitization shots (immunotherapy) are generally given

once a week for a few months, then once a month for a period of three to five y
ears. Over time, they gradually reduce your immune system reaction to specific a
llergens. Anti-IgE monoclonal antibodies, such as omalizumab (Xolair). This medi
cation reduces your immune system's reaction to allergens. Xolair is delivered b
y injection every two to four weeks.
Albuterol inhaler changes: Know what to expect The Food and Drug Administration
(FDA) has required that metered-dose albuterol inhalers that use chlorofluorocar
bon (CFC) propellent be replaced with hydrofluoroalkane (HFA) inhalers by the en
d of 2008. HFA inhalers work as well as CFC inhalers and are as safe, but they d
on't harm the ozone layer. If you're used to using a CFC inhaler, talk to your d
octor about making the switch to an HFA inhaler. There are a few differences you
should know about:

Your HFA inhaler may have a different taste and feel from your older CFC inhaler
. HFA inhalers have a less forceful spray than the older CFC inhalers. Make sure
you know how to use your inhaler correctly - otherwise, you may not get the ful
l dose of medication with each spray. HFA inhalers are more costly than the olde
r, generic albuterol CFC inhalers. HFA inhalers should be cleaned with water eve
ry week.
Treatment by severity for better control: A stepwise approach Treatment based on
asthma control can help you manage your asthma. Asthma
treatment should be flexible and based on changes in symptoms, which should be a
ssessed thoroughly each time you see your doctor. Then, treatment can be adjuste
d accordingly. For example, if your asthma is well controlled, your doctor may p
rescribe less medicine. If your asthma is not well controlled or getting worse,
your doctor may increase your medication and recommend more frequent visits.
Prevention
Working together, you and your doctor can design a step-by-step plan for living
with your condition and preventing asthma attacks.

Develop a written asthma plan. With your doctor and health care team, write a de
tailed plan for taking maintenance medications and managing an acute attack. The
n 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 mo
re in control of your life in general. Identify and avoid asthma triggers. A num
ber of outdoor allergens and irritants — ranging from pollen and mold to cold air
and air pollution — can trigger asthma attacks. Find out what causes or worsens yo
ur asthma, and take steps to avoid those triggers. Monitor your breathing. You m
ay learn to recognize warning signs of an impending attack, such as slight cough
ing, wheezing or shortness of breath. But because your lung function may decreas
e before you notice any signs or symptoms, regularly measure your peak airflow w
ith a home peak flow meter. Identify and treat attacks early. If you act quickly
, you're less likely to have a severe attack. You also won't need as much medica
tion to control your symptoms. When your peak flow measurements decrease and ale
rt you to an impending attack, take your medication as instructed and immediatel
y stop any activity that may have triggered the attack. If your symptoms don't i
mprove, get medical help as directed in your action plan. Don't let up on your m
edication program. Just because your asthma seems to be improving, don't change
anything without first talking to your doctor. It's a good idea to bring your me
dications with you to each doctor visit, so your doctor can double-check that yo
u're using your medications correctly and taking the right dose.
Lifestyle and home remedies
Although many people with asthma rely on medications to relieve symptoms and con
trol inflammation, you can do several things on your own to maintain overall hea
lth and lessen the possibility of attacks. Avoid your triggers Taking steps to r
educe your exposure to things that trigger asthma symptoms is a key part of asth
ma control. Here are some things that may help:
Use your air conditioner. Air conditioning helps reduce the amount of airborne p
ollen 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 seaso
n. Decontaminate your decor. Minimize dust that may aggravate nighttime symptoms
by replacing certain items in your bedroom. For example, encase pillows, mattre
sses and box springs in dust-proof covers. Remove carpeting and install hardwood
or linoleum flooring. Use washable curtains and blinds. Maintain optimal humidi
ty. Keep humidity low in your home and office. If you live in a damp climate, ta
lk to your doctor about using a dehumidifier. Keep indoor air clean. Have a util
ity company check your air conditioner and furnace once a year. Change the filte
rs in your furnace and air conditioner according to the manufacturer's instructi
ons. Also consider installing a smallparticle filter in your ventilation system.
If you use a humidifier, change the water daily. Reduce pet dander. If you're a
llergic 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 reg
ularly. Clean your home at least once a week. If you're likely to stir up dust,
wear a mask or have someone else do the cleaning. If it's cold out, cover your f
ace. If your asthma is worsened by cold, dry air, wearing a face mask can help.
Stay healthy Taking care of yourself and treating other conditions linked to ast
hma will help keep your asthma under control. A few things you can do include:

Exercise. Having asthma doesn't mean you have to be less active. Treatment can p
revent asthma attacks and control symptoms during activity. Regular exercise can
strengthen your heart and lungs, which helps relieve asthma symptoms. Aim for 3
0 minutes of exercise on most days. If you've been inactive, start slowly and tr
y to gradually increase your activity over time. Maintain a healthy weight. Bein
g overweight can worsen asthma symptoms, and it puts you at higher risk of other
health problems. 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. You may need treatment for GERD before you
r asthma symptoms improve.
Coping and support
Asthma can be challenging and stressful. You may sometimes become frustrated, an
gry 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 symptom
s of the disease and by complicated management routines. Children in particular
may be reluctant to use an inhaler in front of their peers.
But asthma doesn't have to be a limiting condition. The best way to overcome anx
iety and a feeling of helplessness is to understand your condition and take cont
rol of your treatment. Here are some suggestions that may help:

Identify the things that trigger your symptoms. This can be one of the most impo
rtant ways to take control of your life. Also take peak flow measurements regula
rly and follow your action plan for using medications and managing attacks. Pace
yourself. Take breaks between tasks and avoid activities that make your symptom
s worse. Make a daily to-do list. This may help you avoid feeling overwhelmed. R
eward yourself for accomplishing simple goals. Talk to others with your conditio
n. 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 no
t alone. If your child has asthma, be encouraging. Focus attention on the things
your child can do, not on the things he or she can't. Involve teachers, school
nurses, coaches, friends and relatives in helping your child manage asthma.