Asthma Health Article

Definition

Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.

Alternative Names

Bronchial asthma; Exercise-induced asthma

Causes, incidence, and risk factors

Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swell. This reduces the amount of air that can pass by, and can lead to wheezing sounds.

Most people with asthma have wheezing attacks separated by symptom-free periods. Some patients have long-term shortness of breath with episodes of increased shortness of breath. Still, in others, a cough may be the main symptom. Asthma attacks can last minutes to days and can become dangerous if the airflow becomes severely restricted.

In sensitive individuals, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers). Triggers include pet dander, dust mites, cockroach allergens, molds, or pollens. Asthma symptoms can also be triggered by respiratory infections, exercise, cold air, tobacco smoke and other pollutants, stress, food, or drug allergies. Aspirin and other non-steroidal anti-inflammatory medications (NSAIDS) provoke asthma in some patients.

Approximately 20.5 million Americans currently have asthma. Many people with asthma have an individual or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.

Symptoms

• Wheezing
  • Usually begins suddenly
  • Comes in episodes
  • May be worse at night or in early morning
  • Gets worse with cold aira, exercise, and heartburn (reflux)
  • May go away on its own
  • Is relieved by bronchodilators (drugs that open the airways)
• Cough with or without sputum (phlegm) production
• Shortness of breath that gets worse with exercise or activity
• Intercostal retractions (pulling of the skin between the ribs when breathing)

Emergency symptoms:

• Extreme difficulty breathing
• Bluish color to the lips and face
• Severe anxiety due to shortness of breath
• Rapid pulse
• Sweating
• Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack

Additional symptoms that may be associated with this disease:

• Nasal flaring
• Chest pain
• Tightness in the chest
• Abnormal breathing pattern --breathing out takes more than twice as long as breathing in
• Breathing temporarily stops

Signs and tests

Allergy testing may be helpful in identifying allergens in patients with persistent asthma. Common allergens include pet dander, dust mites, cockroach allergens, molds, and pollens. Common respiratory irritants include tobacco smoke, pollution, and fumes from burning wood or gas.

The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard. However, lung sounds are usually normal between asthma episodes.

Tests may include:

• Lung function tests
• Peak flow measurements
• Chest x-ray
• Blood tests, including eosinophil count (a type of white blood cell)
• Arterial blood gas

Treatment

Treatment is aimed at avoiding known allergens and respiratory irritants and controlling symptoms and airway inflammation through medication.

There are two basic kinds of medication for the treatment of asthma:

Long-term control medications are used on a regular basis to prevent attacks, not for treatment during an attack. Types include:

• Inhaled steroids (such as Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation
• Leukotriene inhibitors (such as Singulair and Accolate)
• Anti-IgE therapy (Xolair), a medicine given by injection to patients with more severe asthma
• Long-acting bronchodilators (such as Serevent) help open airways
• Cromolyn sodium (Intal) or nedocromil sodium
• Aminophylline or theophylline (not used as frequently as in the past)

Sometimes a combination of steroids and bronchodilators are used, using either separate inhalers or a single inhaler (such as Advair Diskus).

Quick relief, or rescue, medications are used to relieve symptoms during an attack. These include:

• Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, Xopenex, and others.
• Corticosteroids, such as prednisone or methylprednisolone) given by mouth or into a vein

Persons with mild asthma (infrequent attacks) may use quick relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms. A severe asthma attack requires a medical evaluation and may require a hospital stay, oxygen, and intravenous medications.

A peak flow meter, a simple device to measure lung volume, can be used at home to help you "see an attack coming" and take the appropriate action, sometimes even before any symptoms appear. If you are not monitoring asthma on a regular basis, an attack can take you by surprise.

Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of an individual’s personal best results indicate a moderate asthma attack, while values below 50% indicate a severe attack.