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Asthma

Asthma

Asthma is a disease that affects the breathing passages of the lungs (bronchioles). Asthma is caused by chronic (ongoing, long-term) inflammation of these passages. This makes the breathing passages, or airways, of the person with asthma highly sensitive to various "triggers".

 

 

  • When the inflammation is "triggered" by any number of external and internal factors, the passages swell and fill with mucus.
  • Muscles within the breathing passages contract (bronchospasm), causing even further narrowing of the airways.
  • This narrowing makes it difficult for air to be breathed out (exhaled) from the lungs.
  • This resistance to exhaling leads to the typical symptoms of an asthma attack.

 

Because asthma causes resistance, or obstruction, to exhaled air, it is called an obstructive lung disease. The medical term for such lung conditions is chronic obstructive pulmonary disease or COPD. COPD is actually a group of diseases that includes not only asthma but also chronic bronchitis and emphysema.

 

Like any other chronic disease, asthma is a condition you live with every day of your life. You can have an attack any time you are exposed to one of your triggers. Unlike other chronic obstructive lung diseases, asthma is reversible.

 

  • Asthma cannot be cured, but it can be controlled.
  • You have a better chance of controlling your asthma if it is diagnosed early and treatment is begun right away.
  • With proper treatment, people with asthma can have fewer and less severe attacks.
  • Without treatment, they will have more frequent and more severe asthma attacks and can even die. Asthma is on the rise in the United States and other developed countries. We are not sure exactly why this is, but these factors may contribute.
  • We grow up as children with less exposure to infection than did our ancestors, which has made our immune systems more sensitive.
  • We spend more and more time indoors, where we are exposed to indoor allergens such as dust and mold.
  • The air we breathe is more polluted than the air most of our ancestors breathed.
  • Our lifestyle has led to our getting less exercise and an epidemic of obesity. There is some evidence to suggest an association between obesity and asthma. Asthma is a very common disease in the United States, where more than 17 million people are affected. A third of these are children. Asthma affects all races and is slightly more common in African Americans than in other races.
  • Asthma affects all ages, although it is more common in younger people. The frequency and severity of asthma attacks tend to decrease as a person ages.
  • Asthma is the most common chronic disease of children.
  • Asthma has many costs to society as well as to the individual affected.
  • Many people are forced to make compromises in their lifestyle to accommodate their disease.
  • Asthma is a major cause of work and school absence and lost productivity.
  • Asthma is one of the most common reasons for emergency department visits and hospitalization.
  • Asthma costs the U.S. economy nearly $13 billion each year.
  • Approximately 5,000 people die of asthma each year in this country.

 

The good news for people with asthma is that you can live your life to the fullest. Current treatments for asthma, if followed closely, allow most people with asthma to limit the number of attacks they have. With the help of your health-care provider, you can take control of your care and your life.

Symptoms

People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus.

 

Common asthma symptoms include:

 

  • Coughing, especially at night.
  • Wheezing.
  • Shortness of breath.
  • Chest tightness, pain, or pressure.

 

Still, not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms of asthma at different times. Your symptoms may also vary from one asthma attack to the next, being mild during one and severe during another.

 

Some people with asthma may go for extended periods without having any symptoms, interrupted by periodic worsening of their symptoms called asthma attacks. Others might have asthma symptoms every day. In addition, some people may only have asthma during exercise or asthma with viral infections like colds.

 

Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours. Severe attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms to help you prevent severe episodes and keep asthma under better control. 

 

Know the Early Symptoms of Asthma

 

Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These signs may start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

 

In general, these signs are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse.

 

Early warning signs include:

 

  • Frequent cough, especially at night.
  • Losing your breath easily or shortness of breath.
  • Feeling very tired or weak when exercising.
  • Wheezing or coughing after exercise.
  • Feeling tired, easily upset, grouchy, or moody.
  • Decreases or changes in lung function as measured on a peak flow meter.
  • Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache).
  • Trouble sleeping.

 

If you have early warning signs or symptoms, you should take more asthma medication as described in your asthma action plan.

 

Know the Asthma Symptoms in Children

 

Asthma affects as many as 10% to 12% of children in the United States and is the leading cause of chronic illness in children. For unknown reasons, the incidence of asthma in children is steadily increasing. While asthma symptoms can begin at any age, most children have their first asthma symptoms by age 5.

 

Asthma is characterized by inflammation of the bronchial tubes with increased production of sticky secretions inside the tubes. Not all children with asthma wheeze. Chronic coughing with asthma may be the only obvious sign, and a child’s asthma may go unrecognized if the cough is attributed to recurrent bronchitis.

Causes

The exact cause of asthma is not known.

 

  • What all people with asthma have in common is chronic airway inflammation and excessive airway sensitivity to various triggers.
  • Research has focused on why some people develop asthma while others do not.
  • Some people are born with the tendency to have asthma, while others are not. Scientists are trying to find the genes that cause this tendency.
  • The environment you live in and the way you live partly determine whether you have asthma attacks.
  • An asthma attack is a reaction to a trigger. It is similar in many ways to an allergic reaction.
  • An allergic reaction is a response by the body's immune system to an "invader".
  • When the cells of the immune system sense an invader, they set off a series of reactions that help fight off the invader.
  • It is this series of reactions that causes the production of mucus and bronchospasms. These responses cause the symptoms of an asthma attack.
  • In asthma, the "invaders" are the triggers listed below. Triggers vary among individuals.
  • Because asthma is a type of allergic reaction, it is sometimes called reactive airway disease.

 

Each person with asthma has his or her own unique set of triggers. Most triggers cause attacks in some people with asthma and not in others.

 

Common triggers of asthma attacks are the following:

 

  • exposure to tobacco or wood smoke,
  • breathing polluted air,
  • inhaling other respiratory irritants such as perfumes or cleaning products,
  • exposure to airway irritants at the workplace,
  • breathing in allergy-causing substances (allergens) such as molds, dust, or animal dander,
  • an upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis,
  • exposure to cold, dry weather,
  • emotional excitement or stress,
  • physical exertion or exercise,
  • reflux of stomach acid known as gastroesophageal reflux disease, or GERD,
  • sulfites, an additive to some foods and wine,
  • menstruation: In some, not all, women, asthma symptoms are closely tied to the menstrual cycle.

 

Risk factors for developing asthma:

 

  • hay fever (allergic rhinitis) and other allergies - this is the single biggest risk factor;
  • eczema: another type of allergy affecting the skin;
  • genetic predisposition: a parent, brother, or sister also has asthma.

Treatment

As of yet, there's no cure for asthma. However, it often can be controlled by taking prescription medications that may help prevent or relieve symptoms. Learning ways to manage episodes can also make a difference. People with asthma can learn to identify and avoid the things that trigger an episode, and educate themselves about medications and other asthma management strategies.

 

If you are in the emergency room, treatment will be started while the evaluation is still going on.

 

  • You may be given oxygen through a face mask or a tube that goes in your nose.
  • You may be given aerosolized beta-agonist medications through a face mask or anebulizer, with or without an anticholinergicagent.
  • Another method of providing inhaled beta-agonists is by using a metered dose inhaleror MDI. An MDI delivers a standard dose of medication per puff. MDIs are often used along with a "spacer" or holding chamber. A dose of six to eight puffs is sprayed into the spacer, which is then inhaled. The advantage of an MDI with a spacer is that it requires little or no assistance from therespiratory therapist.
  • If you are already on steroid medications, or have recently stopped taking steroid medications, or if this appears to be a very severe attack, you may be given a dose of IV steroids.
  • If you are taking a methylxanthine, such as theophylline or aminophylline, the blood level of this drug will be checked, and you may be given this medication through an IV.
  • People who respond poorly to inhaled beta-agonists may be given an injection or IV dose of a beta-agonist such as terbutaline or epinephrine.
  • You will be observed for at least several hours while your test results are obtained and evaluated. You will be monitored for signs of improvement or worsening.
  • If you respond well to treatment, you will probably be released from the hospital. Be on the lookout over the next several hours for a return of symptoms. If symptoms should return or worsen, return to the emergency department right away.
  • Your response will likely be monitored by a peak flow meter.

 

In certain circumstances, you may need to be admitted to the hospital. There you can be watched carefully and treated should your condition worsen.

 

Conditions for hospitalization include the following:

 

  • an attack that is very severe or does not respond well to treatment;
  • poor lung function observed on spirometry;
  • elevated carbon dioxide or low oxygen levels in your blood;
  • a history of being admitted to the hospital or placed on a ventilator for your asthma attacks;
  • other serious disease that may jeopardize your recovery;
  • other serious lung illnesses or injuries, such as pneumonia or pneumothorax (a "collapsed" lung).

 

If your asthma has just been diagnosed, you may be started on a regimen of medications and monitoring.

 

You will be given two types of medications:

 

  • Controller medications: These are for long-term control of persistent asthma. They help to reduce the inflammation in the lungs that underlies asthma attacks. You take these every day regardless of whether you are having symptoms or not.
  • Rescue medications: These are for short-term control of asthma attacks. You take these only when you are having symptoms or are more likely to have anattack -- for example, when you have an infection in your respiratory tract.

 

Your treatment plan will also include other parts:

 

  • awareness of your triggers and avoiding the triggers as much as possible;
  • recommendations for coping with asthma in your daily life;
  • regular follow-up visits to your health care provider;
  • use of a peak flow meter.

 

At your follow-up visits, your health-care provider will review how you have been doing.

 

  • He or she will ask you about frequency and severity of attacks, use of rescue medications, and peak flow measurements.
  • Lung function tests may be done to see how your lungs are responding to your treatment.
  • This is a good time to discuss medication side effects or any problems you are having with your treatment. The peak flow meter is a simple, inexpensive device that measures how forcefully you are able to exhale.
  • Ask your health-care provider or an assistant to show you how to use the peak flow meter. He or she should watch you use it until you can do it correctly.
  • Keep one in your home and use it regularly. Your health-care provider will make suggestions as to when you should measure your peak flow.
  • Checking your peak flow is a good way to help you and your health-care provider assess what triggers your asthma and its severity.
  • Check your peak flow regularly and keep a record of the results. Over time, your health-care provider may be able to use this record to determine appropriate medications, reducing dose or side effects.
  • Peak flow measures fall just before an asthma attack. If you use your peak flow meter regularly, you may be able to predict when you are going to have an attack.
  • It can also be used to check your response to rescue medications.

 

Together, you and your health-care provider will develop an action plan for you in case of asthma attack.

 

The action plan will include the following:

 

  • how to use the controller medication;
  • how to use rescue medication in case of an attack;
  • what to do if the rescue medication does not work right away;
  • when to call the health-care provider;
  • when to go directly to the hospital emergency department.
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