Asthma

Asthma is a chronic lung disease that that affects your airways, which are tubes that carry air in and out of your lungs. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), 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 usually starts during childhood.

If you have asthma, the inside walls of your airways become sore and swollen. This inflammation makes them sensitive, and then they react to minor irritations or allergens. This reaction causes the airways to get narrower and your lungs get less air. The muscles around the airways can also tighten when something triggers your symptoms.

Sometimes, asthma symptoms are triggered by physical activity. Some otherwise healthy people can develop asthma symptoms only when exercising. This is called exercise-induced bronchoconstriction (EIB) or exercise-induced asthma (EIA). However, staying active is an important way to stay healthy, so asthma should not prevent you from exercising or participating in sports. Your physician can develop a management plan to help you control your symptoms before, during, and after physical activity.

People with a family history of allergies or asthma are more prone to developing asthma. Many people with asthma also have allergies. This is called allergic asthma. Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job.

Asthma is treated with 2 kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms. There is no cure for asthma, but once it is properly diagnosed and a treatment plan is in place you will be able to manage your condition, and your quality of life will improve.

Symptoms of asthma include:

• Wheezing
• Coughing, especially early in the morning or at night
• Chest tightness
• Shortness of breath

Not all people who have asthma have these symptoms, and having these symptoms does not always mean that you have asthma. Your doctor will diagnose asthma based on lung function tests, your medical history, and a physical exam. You may also have allergy tests.

When your asthma symptoms become worse than usual, it is called an asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.

Asthma attacks are often caused by allergies and exposure to allergens such as pet dander, dust mites, pollen or mold. Non-allergic triggers include smoke, pollution or cold air or changes in weather.

Asthma symptoms may be worse during exercise, when you have a cold, or during times of high stress.

Children with asthma may show the same symptoms as adults with asthma: coughing, wheezing and shortness of breath. But, in some children, chronic cough may be the only symptom.

The exact cause of asthma is not known. Genetic and environmental factors likely interact to cause asthma, most often early in life. These factors include:

• An inherited tendency to develop allergies, called atopy
• Parents who have asthma
• Certain respiratory infections during childhood
• Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing

If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) may make your airways more reactive to substances in the air.

An allergist will diagnose asthma by taking a thorough medical history and performing breathing tests to measure how well your lungs work. Your doctor will listen to your breathing and look for signs of asthma or allergies, including wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema).

One test of lung function is called spirometry. You will take a deep breath and blow into a sensor to measure the amount of air your lungs can hold and the speed of the air you inhale or exhale. This test diagnoses asthma severity and measures how well treatment is working.

Many people with asthma also have allergies, so your doctor may perform allergy testing. Treating the underlying allergic triggers for your asthma will help you avoid asthma symptoms.

If you have asthma, you will need long-term care and management for the condition. Successful asthma treatment requires that you take an active role in your care and follow your asthma action plan.

Work with your doctor to develop an asthma action plan. This plan will help you know when and how to take your medicines and will help you identify your asthma triggers and manage your disease if asthma symptoms worsen.

Record your asthma symptoms as a way to track how well your asthma is controlled. You may use a peak flow meter to measure and record how well your lungs are working.

Have regular asthma checkups so your doctor can assess your level of asthma control and adjust your treatment as needed. Get treatment for any other conditions that can interfere with your asthma management.

Your asthma might be getting worse if:

• Your symptoms start to occur more often, are more severe, or bother you at night and cause you to lose sleep
• You limit your normal activities or miss school or work because of your asthma
• Your peak flow number is low compared to your personal best or varies a lot from day to day
• Your asthma medicines do not seem to work well anymore
• You have to use your quick-relief inhaler more often or more than 2 days a week
• You have to go to the emergency room or doctor because of an asthma attack

If you have any of these signs, see your doctor. He or she might need to change your medicines or take other steps to control your asthma.

The main goal of asthma treatment is to achieve the best control of your asthma using the least amount of medicine.

First, avoid things that worsen your asthma. For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom.

If your asthma symptoms are clearly related to allergens, and you cannot avoid exposure to those allergens, allergy shots may be recommended as a treatment.

Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions need to be managed as well as your asthma.

Medications are available to help control your asthma. Some asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs. Not all inhalers are used the same way. Your doctor or another health care provider should show you the right way to use your inhaler.

Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. These medicines reduce airway inflammation, which helps prevent symptoms from starting. These medicines do not provide quick relief from symptoms or attacks. Take the long-term control medicine at the same time every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine.

Long-term control medicines include:

• Inhaled corticosteroids, such as (fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide (Alvesco), flunisolide (Aerobid), beclomethasone (Qvar) and others), to relieve the inflammation and swelling that makes your airways sensitive to certain inhaled substances.
• Cromolyn, which is taken using a device called a nebulizer, prevents airway inflammation
• Omalizumab (anti-IgE), which is given as a shot (injection) 1 or 2 times a month, prevents your body from reacting to asthma triggers, such as pollen and dust mites.
• Inhaled long-acting beta2-agonists, such as salmeterol (in Advair Diskus, Advair HFA) and formoterol (in Symbicort, Dulera), help to open the airways. Inhaled long-acting beta2-agonists should never be used on their own for long-term asthma control; they must be used with inhaled corticosteroids. Combination inhalers are available that contain an inhaled corticosteroid plus a long-acting beta2-agonist.
• Leukotriene modifiers, such as montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR), are taken by mouth. They help block stop the inflammation in your airways.
• Theophylline, which is taken by mouth, helps open the airways.

People who have asthma also need quick-relief medicines, or rescue medicines, to help relieve asthma symptoms that may flare up. These medicines act quickly to relax tight muscles around your airways when you are having a flare-up. This allows the airways to open up so air can flow through them. Quick-relief medications do not decrease inflammation. Carry your quick-relief inhaler with you at all times in case you need it. Quick-relief medicines should be taken when you first notice asthma symptoms. If you use the rescue medicine more than 2 days a week, you may need to make changes to your asthma action plan.

Inhaled short-acting beta2-agonists are the first choice for quick-relief asthma medications. These include:

• albuterol (ProAir HFA, Ventolin HFA, others)
• levalbuterol (Xopenex HFA)
• pirbuterol (Maxair Autohaler)

Rarely, oral and intravenous corticosteroids, such as prednisone (Delatsone, Orasone, Sterapred, others) and methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol), may be required for acute asthma flare-ups or for severe symptoms. These should not be used on a long-term basis.