Pulmonary & Critical Care

Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

Asthma affects people of all ages, but it most often starts in childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.

Synopsis

The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. This makes the airways swollen and very sensitive. They tend to react strongly to certain substances that are breathed in.

When the airways react, the muscles around them tighten. This causes the airways to narrow, and less air flows to your lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways may make more mucus than normal. Mucus is a sticky, thick liquid that can further narrow your airways.

This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are irritated.

Sometimes symptoms are mild and go away on their own or after minimal treatment with an asthma medicine. At other times, symptoms continue to get worse. When symptoms get more intense and/or additional symptoms appear, this is an asthma attack. Asthma attacks also are called flareups or exacerbations.

It’s important to treat symptoms when you first notice them. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can cause death.

Perspective

Asthma can’t be cured. Even when you feel fine, you still have the disease and it can flare up at any time.

But with today’s knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.

For successful, comprehensive, and ongoing treatment, take an active role in managing your disease. Build strong partnerships with your doctor and other clinicians on your health care team.

Causes

The exact causes of asthma are not known. Researchers believe it is a combination of factors such as family genes and certain environmental exposures interact to cause asthma to develop, most often early in life.

A number of things can bring about or worsen asthma symptoms. Your doctor will help you find out which things or “triggers” may cause your asthma to flare up if you come in contact with them.

Risk

Asthma affects people of all ages, but it most often starts in childhood. In the USA, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.

Young children who have frequent episodes of wheezing with respiratory infections, as well as certain other risk factors, are at the highest risk of developing asthma that continues beyond 6 years of age. These risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.

Among children, more boys have asthma than girls. But among adults, more women have the disease than men. It’s not clear whether or how sex and sex hormones play a role in causing asthma.

Symptoms

Common asthma symptoms include:

• Coughing. Coughing from asthma is often worse at night or early in the morning, making it hard to sleep.
• Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
• Chest tightness. This may feel like something is squeezing or sitting on your chest.
• Shortness of breath. Some people who have asthma say they can’t catch their breath or they feel out of breath. You may feel like you can’t get air out of your lungs.

Amongst others.

Diagnosis

Your primary care doctor will diagnose asthma based on your medical history, a physical exam, and results from tests. The Doctor also will figure out what your level of asthma severity is—that is, whether it’s intermittent, mild, moderate, or severe. Your severity level will determine what treatment you will start on.

Treatments

Asthma is a long-term disease that can’t be cured. The goal of asthma treatment is to control the disease. Good asthma control will:

• Prevent chronic and troublesome symptoms such as coughing and shortness of breath.
• Reduce your need of quick-relief medicines.

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• Help you maintain good lung function.
• Let you maintain your normal activity levels and sleep through the night.
• Prevent asthma attacks that could result in your going to the emergency room or being admitted to the hospital for treatment.

You can work with your doctor to create a personal written asthma action plan. The asthma action plan shows your daily treatment, such as what kind of medicines to take and when to take them. The plan explains when to call the doctor or go to the emergency room.

Your doctor will consider many things when deciding which asthma medicines are best for you. Doctors usually use a stepwise approach to prescribing medicines. Your doctor will check to see how well a medicine works for you; he or she will make changes in the dose or medicine, as needed.

Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler.

• Inhaled corticosteroids – The preferred and most effective long-term control medicine to relieve airway inflammation and swelling that makes the airways sensitive to certain substances that are breathed in.
• Inhaled long-acting beta2-agonists – open the airways and may be added to low-dose inhaled corticosteroids to improve asthma control. An inhaled long-acting beta2-agonist shouldn’t be used alone.
• Leukotriene modifiers – taken by mouth. They help block the chain reaction that increases inflammation in your airways.
• Cromolyn and nedocromil – inhaled medicines also help prevent inflammation and can be used to treat asthma of mild severity.
• Theophylline – taken by mouth and helps open the airways.

Prevention

There isn’t a way to prevent asthma from starting in the first place. However, you can take steps to control the disease and prevent its symptoms.