Asthma

condition-asthma

Approximately 1 in 12 people, or about 26 million Americans, suffer from asthma. Of the millions of Americans who suffer from asthma, about 7 million are children. Asthma can affect patients of any age, and most often begins during childhood. The severity of asthma varies with each patient. For some, it is an infrequent and mild condition, while for others it is a major interference with daily responsibilities and activities. If uncontrolled, a major asthma attack can be life threatening.

Asthma can also be called bronchial asthma or reactive airway disease.

What is Asthma?

Asthma is a chronic, obstructive lung condition that involves the narrowing, swelling, and inflammation of the bronchial tubes that allow air to flow into and leave the lungs. These airways also produce extra mucus, making it difficult to breathe, and trigger symptoms such as coughing, wheezing, and shortness of breath.

Exercise-induced asthma, or exercise-induced bronchoconstriction, is asthma that is experienced in otherwise healthy patients during physical activity or exertion. This type of asthma can be managed with an appropriate treatment plan so normal activity can be resumed and you can maintain a healthy lifestyle.

Occupational asthma develops in patients who work closely with, or around, chemical fumes, dust, air irritants, gases, or other harmful substances.

Allergic asthma describes the condition that many asthma patients have, in which their asthma is also accompanied by allergies. Those with a family history of allergies and asthma are more likely to develop asthma at some point in their lives. Not all asthma patients have allergies, and not all allergy patients have asthma.

What Causes Asthma?

The cause of asthma is not yet fully understood. Many believe it is due to both environmental and genetic factors.
Individuals with a family history of asthma are more likely to also suffer from asthma. Certain people with allergies are more prone to asthma.

Patients with a history of respiratory infections, particularly those who contracted such infections during early childhood, are more prone to asthmatic attacks, due to early inflammation and lung tissue damage.

Children who have been exposed to certain environmental pollutants or allergens in early childhood, before the immune system fully develops, have also been shown to suffer from asthma. People who work in environments where exposure to chemicals or pollutants is common, as well as those who live or grew up in urban environments containing smog and air pollution, are also at risk of developing asthma.

Because cigarette smoke can irritate the lungs and airways, patients who smoke have an increased chance of developing asthma.

Overweight and obese patients also have a higher risk of asthma. While the exact causes are not fully understood, many experts believe it may be due to additional inflammation caused by the excess weight.
A common misconception is that asthma comes and goes with each attack. In fact, patients always live with the disease, but particular triggers can provoke the asthmatic attacks that make this condition symptomatic. Triggers vary from patient to patient. Common triggers of asthma include:

  • Exercise or physical activity
  • Stress
  • Cold air
  • Extremely dry weather
  • Extremely wet weather
  • Windy weather
  • Irritants, allergens, or small particles in the air – such as pollen, pet dander, dust mites, mold, smoke, chemical fumes, strong smells, cockroaches
  • Medications – such as aspirin, beta blockers, ibuprofen (Advil, Motrin IB), naproxen (Aleve)
  • Allergies
  • Food additives – such as sulfite
  • Illness – such as colds, flus, viral respiratory infections, heartburn, GERD
  • Menstruation in women
  • Experiencing strong emotions- such as shouting, crying, or laughing

Signs and Symptoms of Asthma

Asthma symptoms often vary from patient to patient, as well as with each attack in the same patient. Some attacks may be mild, while others may be more severe and debilitating. The frequency of asthma attacks also varies – some patients experience symptoms almost daily, while other can go for longer periods of time between attacks. Symptoms are experienced when the airways swell, and become inflamed and filled with mucus. Some common asthma symptoms include:

  • Wheezing
  • Shortness of breath
  • Fatigue, especially during exercise
  • Coughing
  • Throat irritation
  • Fast heart rate
  • Chest tightness
  • Chest pain
  • Chest pressure
  • Feeling easily upset, moody, or grouchy
  • Difficulty sleeping (often due to constant coughing or wheezing)
  • Difficulty speaking
  • Anxiety, panic
  • Pallor
  • Sweating

Prevention of Asthma

Removing the triggers that induce or worsen asthma symptoms can help lessen the severity, frequency, and duration of an asthma attack.

If you have consulted with a medical provider previously and developed an asthma attack plan, close adherence to such a plan can help lessen the severity, frequency, and duration of an attack. Taking prescribed medication, monitoring breathing, and identifying triggers and subsequent attacks can help prevent worsening of asthmatic attacks.

Receiving current flu and pneumonia vaccines can help prevent an asthma attack triggered by symptoms associated with these conditions.

Patients who are smokers often find asthma relief after quitting smoking.

Some patients have also found relief through oxygen therapy.

Treatment of Asthma

While there is no cure for asthma, management of symptoms can help many patients live normal and active lives.

Your medical provider may prescribe medications to help prevent and control symptoms of an asthma attack. The medication, dosage, and frequency of use varies with each patient, and it is important to work with your medical provider to develop an asthma treatment plan that is best for your health.

There are two general categories of asthma medications – fast-acting (rescue) medications, and longer-term asthma control medications.

Quick-relief rescue medications are typically used during an asthma attack, taken at the first signs of breathing difficulties, and provide immediate relief. Some patients with exercise-induced asthma are encouraged to take these medications prior to physical activities. Common asthma rescue medications include:

  • Short acting inhaled beta-2 agonists – bronchodilators such as albuterol (ProAir HFA, Ventolin HFA), levalbuterol (Xopenex), pirbuterol (Maxair)
  • Ipratropium (Atrovent) – bronchodilator
  • Corticosteroids (oral and intravenous) – such as prednisone, methylprednisolone
  • Anticholinergics
  • Antibiotic or antiviral medications – for patients with flare-ups caused by certain infections

If you find that you need to use your rescue medications more frequently than recommended by your doctor (often this is more than twice a week,) you may be a good candidate for long-term asthma control medications. Short-term rescue medications can help stop the symptoms associated with an asthma attack by quickly opening the affected and swollen airways, but they do not clear up the airway inflammation seen in many chronic asthma patients. Long-term asthma control medications are taken daily, even if you are not experiencing symptoms. These medications help control inflammation, and work to prevent symptoms of an asthma attack. Common long-term asthma control medications include:

  • Corticosteroids (inhaled) – fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), flunisolide (Aerobid), ciclesonide (Alvesco), beclomethasone (Qvar), mometasone (Asmanex)
  • Antileukotrienes or Leukotriene modifiers – montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo)
  • Long-acting beta-2 agonists – salmeterol (Serevent), formoterol (Foradil, Perforomist); often taken in combination with an inhaled corticosteroid
  • Combination inhalers – typically a combination of a long-acting beta agonist and corticosteroid, including fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicord), mometasone-formoterol (Dulera)
  • Theophylline (Theo-24, Elixophyllin) – bronchodilator
  • Cromolyn sodium and nedocromil
  • Methylxanthines
  • Immunomodulators

If asthma is triggered by allergies, allergy medication may help control asthma symptoms:

  • Oral and nasal spray antihistamines
  • Oral and nasal spray decongestants
  • Corticosteroid nasal sprays
  • Cromolyn nasal sprays
  • Omalizumab (Xolair)
  • Allergy shots

In a small population of patients, bronchial thermoplasty may be an effective approach to asthma treatment. This procedure is a technique that heats up the inside of the lungs and airways using an electrode, decreasing the amount of smooth muscle and lessening the ability of the airways to constrict.

Patients who take oral and intravenous corticosteroids (rescue medications) for long periods of time can develop serious side effects including:

  • Cataracts, or clouding of the lens in the eyes
  • High blood sugar, which may lead to the onset or worsening of diabetes
  • Osteoporosis or increased risk for bone fractures and bone thinning
  • Decreased production of adrenal gland hormone
  • Impaired wound healing
  • Increased risk of bruising
  • Oral thrush, fungal infections

As with all medications, side effects are possible. It is important to consult with a medical provider if experiencing any unusual or unexpected side effects. It is important to follow the treatment regime agreed upon by both you and your medical provider.

When Should I Call a Doctor?

If you have not been diagnosed with asthma by a medical provider and are experiencing shortness of breath, you should be evaluated as soon as possible. Patients who are experiencing asthma symptoms for the first time should set up time to speak with a medical provider to develop a safe and effective asthma treatment plan.

The course of a patient’s asthma condition may change over time. Consider speaking with a medical provider if you notice changes in the severity, signs, or symptoms of your asthma. Patients who have been diagnosed with asthma, are experiencing shortness of breath, and symptoms that are worse than their typical asthma attacks should seek medical care as soon as possible.

Severe asthma attacks lasting longer than a few hours warrant immediate medical attention.

Asthma attacks with symptoms that do not improve after six months of treatment should be re-evaluated by a medical provider.

Children under 5 years of age should be seen by a medical provider if they are experiencing symptoms daily, and up to 4 nights each month.

You should seek medical help if your asthma symptoms are limiting you from daily activities and responsibilities, such as work or school.

Patients experiencing side effects from asthma control or preventive medications should seek medical counsel for reevaluation of their asthma care plan.

Medical providers trained to assist with asthma-related care, treatment and prevention include:

  • Primary care providers
  • Pulmonologists
  • Pediatricians
  • Respiratory therapists
  • Allergists