Asthma

For Olympians and Weekend Warriors Alike, Winter Sports Can Trigger Asthma

Do you cough, wheeze, or get short of breath when you exercise in cold weather? You could have asthma, but you’ve got plenty of company. Exercise-induced asthma is surprisingly common among people who work out in cold climates, whether they’re jogging around the neighborhood or gunning for gold in Vancouver.

This week, for example, Norwegian cross-country skier Marit Bjørgen won the bronze medal in the women’s 10-kilometer race, even though she uses asthma medication. In fact, half of cross-country skiers and one-quarter of aspiring winter Olympians in general have exercise-induced asthma according to a 2000 study of 170 athletes conducted by the United States Olympic Committee.

“Any [exercise] outdoors on a mountaintop is a culprit, but just jogging in Central Park will do it as well,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital, in New York City. Exercise-induced asthma doesn’t have to slow you down, however. With the right medications and precautions, exercise-induced asthma won’t keep you from your daily workout, or even from competing at an elite level.

How cold and exercise cause asthma
Wheezing, chest tightness, and the other symptoms of exercise-induced asthma generally begin several minutes after you begin working out. For some people, the symptoms start soon after they finish exercising.

Although athletes who compete in warm-weather sports may suffer from exercise-induced asthma as well, mixing exercise and cold, dry air is especially problematic. For many people with regular asthma, in fact, just stepping outside in frigid temperatures is enough to cause symptoms.

“Both cold air and exercise in and of themselves can trigger asthma symptoms, but doing them together is more likely to trigger an exacerbation,” says Thomas M. Leath, MD, an assistant professor of pediatrics at Texas A&M Health Science Center College of Medicine.

When the air is dry—as it often is in cold climates during the winter—your lungs can become even more irritated, Dr. Horovitz adds. “The evaporative loss and cooling of the airways triggers the process of bronchial constriction,” he says. “One sport you don’t see exercise-induced asthma in so much is swimming. The humidity at water level is such that there isn’t as much evaporation as in running or winter sports.” (Chlorine, however, can trigger asthma symptoms, Dr. Horovitz notes.)

The bad news is that there is no asthma cure. The good news is that asthma can be treated with medication supplied by your doctor. There are two main types of asthma medication: anti-inflammatory, and bronchodilators. More details can be found in this website. If your asthma symptom is triggered by environment irritants, your best asthma cure would be to simply avoid those irritants. Although this is not a real asthma cure, it is a practical method of asthma relief.

Question: Can My Doctor Cure Asthma?
Answer: The short answer is unfortunately NO.

For a disease like asthma to be cured, doctors and scientist have to know the cause. In asthma, while we know a lot about the relationship between the immune system and asthma, for example, we do not know why this process occurs in particular individuals.

Asthma is an inflammatory process. While many of the medications used to treat asthma decrease inflammation, none actually cure the inflammation.
While there is no cure for asthma currently, asthma can be controlled with proper treatment. Medications can prevent or relieve asthma symptoms. Asthma care plans can help you learn what to do in an asthma attack, when you need to adjust your medication, and when you need to call your doctor. You can also also can learn to identify your asthma triggers and avoid them.

Asthma Cure

With education regarding triggers, medications and your specific asthma management strategy, most people can effectively control asthma and live a normal, active life.

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Free yourself of allergies and asthma once and for all with Dr. Pescatore’s breakthrough program

” Dr. Fred Pescatore’s The Allergy and Asthma Cure reveals a unique and revolutionary understanding of the underlying conditions of allergy and asthma-from food triggers to the environment to nutritional deficiencies. His integrative program of both alternative and traditional treatments can dramatically improve health and vitality, safely and soundly. This book will have a prominent place in my library and I highly recommend it! ”
-Ann Louise Gittleman, Ph.D., C.N.S., author of the bestselling The Fat Flush Plan

“Conventional medicine has largely shrugged its shoulders in confusion about the causes of allergies and asthma in millions of people. In this book Dr. Fred Pescatore deals with the roots of these modern epidemics, drawing on his clinical experience, and he provides clear recommendations for turning back the tide and restoring health.”
- Jack Challem, author of the bestselling Syndrome X and The Inflammation Syndrome

“The Allergy and Asthma Cure is the book we have all been waiting for. Dr. Pescatore manages, in a concise manner, to summarize all the facts and presents a comprehensive healing guide that incorporates both conventional and alternative approaches. A must-read for those dealing with these issues.”
-Artur Spokojny, M.D., F.A.C.C., Medical Director of Integrative Medicine of Manhattan, Associate Professor of Medicine, Weill Cornell Medical College

“I believe that The Allergy and Asthma Cure holds the key to understanding how nutritional medicine can really work for you. Allergies (from skin conditions to seasonal types) and asthma can be cured, not just held at bay. This book shows the way. Dr. Pescatore is truly a healer.”
-Roberta Flack, singer/songwriter

“I have seen firsthand how The Allergy and Asthma Cure has changed people’s lives for the better. I have started using his treatment protocols for my own patients with a remarkable success rate, and best of all with no side effects. Many of my patients are getting off their allergy and asthma medications completely. I strongly recommend this book to anyone with allergies or asthma.”
-Dana G. Cohen, M.D., board-certified, Internal Medicine

“This book is for anyone willing to give up his or her life as an asthmatic. I had tried every drug and treatment available and the asthma only got worse. Under Dr. Pescatore’s care, I began to see results within six weeks. It’s been over two years now living without an attack. His approach has changed the way I live.”
-Paul Goldman, patient

Deep Cure for “Asthma”

Superman had kryptonite. Samson got a haircut. Me? Dust mites. Those little scourges have made me asthmatic for the past 10 years — irritating my breathing, leading to countless sinus infections, and causing two episodes wherein I passed out from coughing. They limit the amount of exercise I can do at the gym and make me think twice about playing a game of pickup soccer. But worst of all, they curb the amount of time I can run around the house with my young daughter.

I’m not alone in my suffering. According to the Mayo Clinic, asthmatics are one of the fastest-growing medical demographics in the U.S., with roughly 20 million people afflicted in 2008.

Irritants are all around us. Everything from cold air to cat dander can send an asthmatic’s immune system into overdrive, producing histamines (natural chemicals your body uses to fight off outside intruders — instigating the itch in your lungs) and causing your bronchial tubes to swell and constrict.

Antihistamines, antibiotics, and two sinus surgeries provided me some relief, but nothing stuck. Finally, after I woke my wife up at three in the morning with a coughing fit one night — again — we had both had enough. The next day, after some Google searching, she told me that she had found my next vacation: two weeks 440 feet below the ground in an old salt mine in Wieliczka, Poland.

The Science
In 1958, Polish professor Mieczyslaw Skulimowski realized that our lungs and sinuses respond well to the cool, damp air in salt mines, also rich with sodium, magnesium, and selenium. He opened the first mine treatment center at Wieliczka in 1964, and it has been going strong ever since. Magnesium, it was discovered, prevents the spasms that provoke asthma attacks by keeping the smooth-muscle lining of the lung from contracting. Selenium is an antioxidant that studies have shown breaks down leukotrienes, compounds that irritate sinuses and lungs (similar to what the asthma drug Singulair does). And salt is a natural antibacterial agent, which can help prevent sinus and chest infections from spreading.

“After one treatment, patients report needing less medicine,” said Dr. Jolanta Czerwik, one of the physicians at the Wieliczka mine. “After two trips, research shows a 70 percent improvement, and after a third, asthma generally goes into remission.” When I asked her how it works she told me that “the body can only heal so much, so fast. It gives your immune system a chance to catch up. Afterward your body is trained to deal with your natural surroundings.”

My allergist back home, Dr. Robert Eitches, was also encouraging. “Being in a pollutant-free environment for a long period of time generally would be good for the lungs and sinuses,” he said.

I was desperate, so that was all the convincing I needed. The next thing I knew I was being herded into a cagelike elevator and shot into an 800-year-old mine.

The Treatment
My new subterranean digs felt a lot like a luxury spa, making my 14-day treatment downright pleasant. One room featured a relaxing pool with a waterfall fountain, and one of the dining rooms, the Jan-Haluszka Chamber, was adorned with three huge crystal chandeliers and had hosted several foreign dignitaries including former president George W. Bush.

But on my first day I quickly learned that getting well inside the mine is very similar to training for a marathon. “The air is the answer, so we must get as much of it through you as possible,” my instructor Marzena Boron insisted. For six and a half hours, the other eight patients and I were shuttled from yoga class, where we learned stretches that caused us to use our diaphragms rather than our chest muscles to breathe, increasing breathing efficiency; to treadmill-jogging; and then aerobics, which pumped gallons of the special air through our lungs in seconds.

The treatment seemed to be working. My postnasal drip disappeared, I never felt like coughing or sneezing, and while my lungs remained somewhat raspy, I never had problems with exercises that would have killed me aboveground. But I was most impressed with the results of my peak flow test, which measures how many liters of air I push through my lungs per minute. For my height and age, I was told that 545 is a good number (at home I typically score between 250 and 275). My average inside the mine, taken over the two weeks, was 355. Once I even broke 400.

For the first few weeks after returning to smoggy Los Angeles, I felt great, and my doctor noticed a 20 percent increase in my breathing capacity. If it lasts, I’m seriously considering going back next year for round two, if just to keep from waking my wife at 3 a.m.

•Beta2-agonists are the standard therapy. They may be administered with a nebulizer (a device that administers the drug in a fine spray) or given hourly with an inhaler. Studies are suggesting the use of inhaler is equally or possibly more effective than a nebulizer. Intravenous delivery is not recommended in most cases.
•A corticosteroid (commonly called a steroid) given within the first hour helps reduce the need for hospitalization. Steroids are typically administered intravenously or as an injection in adults. Lower doses work as well as higher ones in these situations.
•Intravenous magnesium opens airways and is an important emergency treatment for patients with very severe asthma.
•Oxygen is usually administered, and can be life saving in severe cases.
•In life-threatening situations, the patient may require mechanical ventilation.
•Antibiotics are not useful for asthma attacks if there is no strong evidence of the presence of a bacterial infection. (Viral infections, most often colds and flus, are more likely to trigger an asthma attack. In such cases, antibiotics do not

Asthma Treatment

appear to be beneficial and may have adverse effects.)

Discharge and Relapse After Hospitalization. It typically takes 3 to 4 hours to determine if a patient can be safely sent home or if they need to stay in the hospital. Patients are generally discharged under the following circumstances:

•When symptoms are gone or are minimal, and
•The peak expiratory flow rate is 70% or more of the predicted rate
Discharged patients generally take oral corticosteroids for 5 to 7 days. Despite reasonable precautions, about 20% of patients relapse within 2 weeks, although the risk is very low if they keep taking their medication after they leave

Asthma Treatments and drugs

Treatment for asthma generally involves avoiding the things that trigger your asthma attacks and taking one or more asthma medications. Treatment varies from person to person.

■Most people with persistent asthma use a combination of long-term control medications and quick-relief medications, taken with a hand-held inhaler.
■If your asthma symptoms are triggered by airborne allergens, such as pollen or pet dander, you may also need allergy treatment.
■You may need to try a few different medications before you find what works best.
■Because asthma changes over time, you will need to work with your doctor to monitor your symptoms and learn how to make needed adjustments.
Medications used to treat asthma include long-term control medications, quick-relief (rescue) medications and medications to treat allergies. The right medication for you depends on your age and symptoms, and what seems to work best to keep your asthma under control.

Long-term control medications
In most cases, these medications need to be taken every day. Types of long-term control medications include:

■Inhaled corticosteroids such as fluticasone (Flovent Diskus), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and others. These medications reduce airway inflammation and are the most commonly used long-term asthma medication. Unlike oral corticosteroids, these medications are considered relatively low risk for long-term corticosteroid side effects. You may need to use these medications for several days to weeks before they reach their maximum benefit.
■Long-acting beta-2 agonists (LABAs) such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). These inhaled medications, called long-acting bronchodilators, open the airways and reduce inflammation. They are often used to treat persistent asthma in combination with inhaled corticosteroids. Long-acting bronchodilators should not be used for quick relief of asthma symptoms.
■Leukotriene modifiers such as montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). These inhaled medications work by opening airways, reducing inflammation and decreasing mucus production.
■Cromolyn and nedocromil (Tilade). These inhaled medications reduce asthma signs and symptoms by decreasing allergic reactions. They’re considered a second choice to inhaled corticosteroids, and need to be taken three or four times a day.
■Theophylline, a daily pill that opens your airways (bronchodilator). It relaxes the muscles around the airways.
Quick-relief medications
Also called rescue medications, you use quick-relief medications as needed for rapid, short-term relief of symptoms during an asthma attack, or before exercise, if your doctor recommends it. Only use these medications as often as your doctor tells you to. If you need to use these medications too often, you probably need to adjust your long-term control medication. Keep a record of how many puffs you use each day. Types of quick-relief medications include:

■Short-acting beta-2 agonists, such as albuterol. These inhaled medications, called bronchodilators, ease breathing by temporarily relaxing airway muscles. They act within minutes, and effects last four to six hours.
■Ipratropium (Atrovent). Your doctor might prescribe this inhaled anticholinergic for the immediate relief of your symptoms. Like other bronchodilators, ipratropium relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis.
■Oral and intravenous corticosteroids to treat acute asthma attacks or very severe asthma. Examples include prednisone and methylprednisolone. These medications relieve airway inflammation. They may cause serious side effects when used long term, so they’re only used to treat severe asthma symptoms.
Medications for allergy-induced asthma. These decrease your body’s sensitivity to a particular allergen or prevent your immune system from reacting to allergens. Allergy treatments for asthma include:

■Immunotherapy. Allergy-desensitization shots (immunotherapy) are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune system reaction to specific allergens.
■Anti-IgE monoclonal antibodies, such as omalizumab (Xolair). This medication reduces your immune system’s reaction to allergens. Xolair is delivered by injection every two to four weeks.

Albuterol inhaler changes: Know what to expect
The Food and Drug Administration (FDA) has required that metered-dose albuterol inhalers that use chlorofluorocarbon (CFC) propellent be replaced with hydrofluoroalkane (HFA) inhalers by the end of 2008. HFA inhalers work as well as CFC inhalers and are as safe, but they don’t harm the ozone layer. If you’re used to using a CFC inhaler, talk to your doctor about making the switch to an HFA inhaler. There are a few differences you should know about:

■Your HFA inhaler may have a different taste and feel from your older CFC inhaler.
■HFA inhalers have a less forceful spray than the older CFC inhalers. Make sure you know how to use your inhaler correctly – otherwise, you may not get the full dose of medication with each spray.
■HFA inhalers are more costly than the older, generic albuterol CFC inhalers.
■HFA inhalers should be cleaned with water every week.
Treatment by severity for better control: A stepwise approach
Treatment based on asthma control can help you manage your asthma. Asthma treatment should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly.

For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma is not well controlled or getting worse, your doctor may increase your medication and recommend more frequent visits.

Guidelines for Treating Asthma at Home

Avoiding allergens, following appropriate drug treatments, and home monitoring are key elements in preventing dangerous asthma attacks and hospitalization. A combination of medications is important for both treating and preventing asthma attacks. In addition, good communication between the doctor and patient is a key factor in a successful management program. Written action plans, which instruct individual patients how to properly respond to changes in their unique symptoms, are a very important element in successful self-management of asthma.

Understanding the Difference Between Treating Symptoms and Controlling the Disease

Medications for asthma fall into two categories:

•Rescue Medication. Medications that open the airways (bronchodilators, or inhalers) are used to quickly relieve any moderate or severe asthma attack. These drugs are usually short-acting beta-adrenergic agonists (beta2-agonists). Other drugs used in special cases include corticosteroids taken by mouth and anticholinergic drugs. None of these drugs have any effect on the disease process itself. They are only useful for treating symptoms.
•Maintenance Medication. Simply coping with asthma symptoms without also controlling the damaging inflammatory response is a common and serious error. For adults and children over age 5 with moderate-to-severe persistent asthma, experts now recommend inhaled corticosteroids and long-acting beta2-agonists.
Patients can greatly reduce the frequency and severity of asthma attacks by understanding the difference between coping with asthma attacks and controlling the disease over time. Unfortunately, many patients do not understand the difference between medications that provide rapid short-term relief and those that are used for long-term symptom control. Many patients with moderate or severe asthma overuse their short-term medications and underuse their corticosteroid medications. The overuse of bronchodilators can have serious consequences; not using steroids can lead to permanent lung damage.

Patients need to understand that asthma symptoms can change quickly over time and that treatment strategies may need to change. In 2005, the two leading U.S. allergy associations published joint guidelines on controlling asthma. The guidelines emphasize that asthma treatment decisions need to be made on an individual basis. It is important that patients have a close relationship with their doctor. The doctor needs to evaluate a patient’s asthma symptoms at each and every visit to determine if there should be any changes in medication.

According to the guidelines, asthma management is classified as either “well-controlled” or “not well-controlled.” Your doctor may need to change some of your medications, or increase or decrease the dosage, depending on whether your asthma is well-controlled or not well-controlled.
These are the signs of well-controlled asthma:

•Asthma symptoms occur twice a week or less
•Rescue bronchodilator medication is used twice a week or less
•Symptoms do not cause nighttime or early morning awakening
•Symptoms do not limit work, school, or exercise activities
•Peak flow meter readings are normal or the patient’s personal best
•Both the doctor and the patient consider the asthma to be well controlled
Administering Inhaled Drugs
Most asthma drugs are inhaled using various forms of inhalers or nebulizers. Inhaled drugs must be used regularly as prescribed and the patient carefully trained in their use in order for them to be effective and safe. The basic devices are the metered-dose inhaler (MDI), breath-actuated inhalers, dry powder inhalers, and nebulizers.

MDIs have used chlorofluorocarbons (CFCs) as their propellants. CFCs are damaging to the environment. Over time CFCs are being replaced with other propellants (such as hydrofluoroalkane) that are equally effective to CFCs, are environmentally safe, and do not chill the device as CFCs do. Devices that don’t use propellants at all are also now available.

Metered-Dose Inhaler. The standard device for administering any asthma medication has been the metered-dose inhaler (MDI). This device, particularly when used with a holding chamber, allows precise doses to be delivered directly to the lungs.

MDI-delivered drugs must be used regularly as prescribed, and the patient carefully trained in their use, for the drugs to be effective and safe. Some patients hold the MDI too close to their mouths, or even inside them. Others may exhale too forcefully before inhalation. The holding chamber, or spacer, allows the patient additional time to inhale the medication, improving delivery. They vary, however, in their ability to deliver medication. Often MDIs continue to deliver propellant after the drug has been used up. Patients should track their medicine and throw the device away when the last dose has been administered.

Breath-Actuated Inhalers. Breath-actuated rotary inhalers (e.g., Easi-Breathe and Autohaler) deliver the drug directly to the back of the throat as the user inhales. Their primary advantage over the MDI is their ease of use. They also do not use CFCs as propellants. In comparison studies, patients have been very successful with the breath-actuated inhalers.

Dry Powder Inhalers. Dry powder inhalers (DPIs) deliver a powdered form of beta2 agonists or corticosteroids directly into the lungs. They also do not use CFCs. Such devices include Rotahaler, Spinhaler, Turbohaler, Clickhaler, Easyhaler, Diskhaler, Discus, Twisthaler, Spiros, and others. DPIs are as effective as the older devices, and generally have a better taste and are easier to manage. They may differ among themselves, however, in their ability to deliver drugs into the airways. In one study, for example, the Turbohaler was easier to use than the Diskhaler, achieving better delivery. The Discus is another effective DPI; it has a dose counter and protects against exhalation effects.

Humidity or extreme temperatures can affect these inhalers’ performance, so they should not be stored in humid places (bathroom cabinets) or locations subject to high temperatures (glove compartments during summer months).

Dry-powder may cause tooth erosion, and children are advised to rinse their mouths out right after taking the drug and to brush twice a day with a fluoride toothpaste.

Other Hand-Held Inhalers. Respimat delivers a fine-mist spray that is created by forcing the liquid medication through nozzles. It does not use any propellant.

Nebulizers. A nebulizer is a device that administers the drug in a fine spray that the patient breathes in. They are mostly used in hospital settings or when the patient cannot use an inhaler. Nebulizers may be important for delivering newer drugs used in asthma treatment.

Asthma Treatment

Definition of Asthma Treatment
Treatment of asthma can be divided into long-term control and quick-relief medications.

Description of Asthma Treatment
Long-term control medications are taken daily to maintain control of persistent asthma. They primarily serve to control airway inflammation.

The quick-relief medications are taken to achieve prompt reversal of an acute asthma “attack” by relaxing bronchial smooth muscle.

Many asthma medications can be administered orally or by inhalation. Metered-dose inhalers (MDI’s) are the most widely used method, but dry powder inhalers are becoming popular. Metered-dose inhalers are changing from the type propelled by liquified chlorofluorocarbons (CFCs) to a new, CFC-free delivery system (see the National Heart Lung and Blood Institute review on the new MDIs at http://www.nhlbi.nih. gov/health/public/lung/asthma/mdi.htm). Nebulizer therapy is reserved for patients who are unable to use MDI’s because of difficulties with coordination.

Treatment of Asthma Treatment
Asthma cannot be cured, but it can be controlled with proper asthma management.

The first step in asthma management is environmental control. Asthmatics cannot escape the environment, but through some changes, they can control its impact on their health.

Listed below are some ways to change the environment in order to lessen the chance of an asthma attack:

Clean the house at least once a week and wear a mask while doing it

Avoid pets with fur or feathers

Wash the bedding (sheets, pillow cases, mattress pads) weekly in hot water

Encase the mattress, pillows and box springs in dust-proof covers

Replace bedding made of down, kapok or foam rubber with synthetic materials

Consider replacing upholstered furniture with leather or vinyl

Consider replacing carpeting with hardwood floors or tile

Use the air conditioner

Keep the humidity in the house low

The second step is to monitor lung function. Asthmatics use a peak flow meter to gauge their lung function. Lung function decreases before symptoms of an asthma attack – usually about two to three days prior. If the meter indicates the peak flow is down by 20 percent or more from your usual best effort, an asthma attack is on its way.

The third step in managing asthma involves the use of medications. There are two major groups of medications used in controlling asthma – anti-inflammatories (corticosteroids) and bronchodilators.

Anti-inflammatories reduce the number of inflammatory cells in the airways and prevent blood vessels from leaking fluid into the airway tissues. By reducing inflammation, they reduce the spontaneous spasm of the airway muscle. Anti-inflammatories are used as a preventive measure to lessen the risk of acute asthma attacks. The corticosteroids are given in two ways – inhaled via a metered dose inhaler (MDI) or orally via pill/tablet or liquid form. The inhaled corticosteroids are flunisolide (AeroBid), triamcinolone (Azmacort) and beclomethasone (Beclovent and Vaceril). The oral corticosteroids (pill/tablet form) are prednisone (Deltasone, Meticorten or Paracort), methylprednisolone (Medrol) and prednisolone (Delta Cortef and Sterane). The oral corticosteroids (liquid form) are Pedipred and Prelone. These liquid forms are used for asthmatic children.

Three drugs, zafirlukast (Accolate), montelukast (Singulair) and zileuton (Zyflo), are part of a newer class of anti-inflammatories called leukotriene modifiers. Taken orally, these drugs work by inhibiting leukotrienes (fatty acids that mediate inflammation) from binding to smooth muscle cells lining the airways. They also reduce the recruitment of inflammatory cells to the airways. These drugs both prevent and reduce symptoms, and are intended for long-term use.

Other inhaled anti-inflammatory drugs include cromolyn sodium (Intal) and nedrocromil (Tilade).

Bronchodilators work by increasing the diameter of the air passages and easing the flow of gases to and from the lungs. They come in two basic forms – short-acting and long-acting. The short-acting bronchodilators are metaproterenol (Alupent, Metaprel), ephedrine, terbutaline (Brethaire) and albuterol (Proventil, Ventolin). These drugs are inhaled and are used to relieve symptoms during acute asthma attacks. The long-acting bronchodilators are salmeterol (Serevent), metaproterenol (Alupent), and theophylline (Aerolate, Bronkodyl, Slo-phyllin, and Theo-Dur to name a few). Serevent and Alupent are inhaled and theophylline is taken orally. These drugs are sometimes used to control symptoms in special circumstances, such as during sleep or when intensive exposure to a particular irritant can be predicted (i.e. pollen season). Atrophine sulfate (Atrovent) is another highly effective bronchodilator. This drug opens the airways by blocking reflexes through nerves that control the bronchial muscles.

Some people cannot control the symptoms by avoiding the triggers or using medication. For these people, immunotherapy (allergy shots) may help. Immunotherapy involves the injection of allergen extracts to “desensitize” the person. The treatment begins with injections of a solution of allergen given one to five times a week, with the strength gradually increasing.

Note: Asthmatics vary considerably in their responses to different types, combinations and amounts of medicines so therapy must be carefully tailored to the individual. Even medication that may work well with some asthmatics may not be effective for others. Please discuss your individual situation with your doctor and both of you will determine a course of management that is best for you.

Prevention of Asthma Treatment
Periodic assessments and ongoing monitoring of asthma are essential to determine if therapy is adequate. Patients need to understand how to use a peak flow meter and understand the symptoms and signs of an asthma exacerbation.

Regular follow-up visits (at least every six months) are important to maintain asthma control and to reassess medication requirements.

Patients with persistent asthma should be given an annual influenza vaccine.

Questions To Ask Your Doctor About Asthma Treatment
Is there any further testing that can be done?

What further treatment do you recommend?

Will you be prescribing something new?

What are the side effects?

What is an MDI (inhaler)?

What is a spacer?

Am I using my MDI (inhaler) correctly?

What is a peak flow meter?

How do I use it?

How often?

I have heard that some medications are ‘second-line’ treatments. What does that mean?

Severe wheezing when breathing both in and out
Coughing with asthma that won’t stop
Very rapid breathing
Chest pain or pressure
Tightened neck and chest muscles, called retractions
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Blue lips or fingernails
Or worsening symptoms despite use of your medications
Some people with asthma may go for extended periods without having an asthma attack or other symptoms, interrupted by periodic worsening of their symptoms, due to exposure to asthma triggers or perhaps from overdoing it during exercise-induced asthma.

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

What Happens If an Asthma Attack Goes Untreated?
Without immediate asthma medicine and asthma treatment, your breathing will become more labored, and wheezing may get louder. If you use a peak flow meter during an asthma attack, your personal best reading will probably be reduced.

As your lungs continue to tighten during the asthma attack, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so much during the asthma attack that there is not enough air movement to produce wheezing. This is sometimes called the “silent chest,” and it is a dangerous sign. You may need to be taken to a hospital immediately with a severe asthma attack. Unfortunately, some people interpret the disappearance of wheezing during the asthma attack as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate treatment for an asthma attack, you will eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as “cyanosis,” means you have less and less oxygen in your blood. Without immediate aggressive treatment in an intensive care unit, you will lose consciousness and eventually die.

How Do I Recognize the Early Signs of An Asthma Attack?
Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These changes start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

How Do I Recognize the Early Signs of An Asthma Attack? continued…
In general, these asthma attack symptoms 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 of an asthma attack include:

Frequent cough, especially at night
Reduced peak flow meter readings
Losing your breath easily or shortness of breath
Feeling very tired or weak when exercising
Wheezing or coughing after exercise or exercise-induced asthma
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 with nighttime asthma
The severity of an asthma attack can escalate rapidly, so it’s important to treat these symptoms immediately once you recognize them.

What Do I Do If I Have An Asthma Attack?
If you or a loved one is experiencing an asthma attack and the symptoms do not improve after following the asthma action plan, contact your asthma doctor and follow the “Red Zone” or emergency instructions. Immediate medical attention is necessary.

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What Is an Asthma Attack or Flare Up
An asthma attack is a sudden worsening of your asthma symptoms caused by narrowing of your airways or bronchoconstriction as a result of inflammation, swelling, and mucus. Both you and your child need to:

•Understand The Asthma Care Plan
•Know Your Symptoms
•Know Your Peak Flow
•Know Your Medications
•Recognize Early Warning Signs
•Identify Indications For Emergency Care

Understand Your Asthma Care Plan To Prevent An Asthma Attack:
For anyone who has asthma, an asthma care plan is essential to prevent worsening of your symptoms and an asthma attack. The asthma care plan is your guide to determining how well your asthma is controlled and what actions need to be taken when asthma worsens or when you develop symptoms of an asthma attack. With your input, your doctor will develop your asthma care plan. Most plans have 3 components:

1.Stage of severity- identified by the peak expiratory flow rate
2.A list of symptoms to watch for
3.Specific actions to take based on peak flow or symptoms
Make sure you understand the plan and do not be afraid to ask questions. Make sure any other caregivers and his/ her school understand the asthma care plan as well.

Know Your Asthma and Asthma Attack Symptoms:
Everyone with asthma is different. Some people will have frequent attacks while others may go a long period between attacks. You need to monitor your asthma symptoms like chest tightness, wheezing, shortness of breath, and chronic cough. The action plan that you and your child’s healthcare provider have developed will list how to treat asthma symptoms.

Know Your Peak Flow:
A peak flow meter is the key to determining how your asthma is doing and preventing an asthma attack. It tells you how well you are breathing and its use is a key part of the asthma care plan.

If peak flow numbers are declining, your asthma is getting worse and you need to act quickly to prevent an asthma attack. You need to give medications based on the instructions in the asthma care plan to stop the symptoms from getting more severe and a full blown asthma attack.

Know Your Medications:
Understanding the purpose of each medication in the treatment of asthma is very important because some medications are designed for the acute relief of asthma symptoms and an asthma attack and some for the long term control of asthma. Taking a long-term beta agonist control medication during an acute asthma attack can actually lead to worsening of asthma.

The asthma care plan will outline which specific medications to take depending on peak flow and other symptoms.

Recognize Early Warning Signs Of Worsening Asthma & an Asthma Attack:
As the parent of a child with asthma or someone with asthma, it is very important that you recognize and treat the early warning signs of an asthma attack. Appropriate management early on in an asthma attack may prevent a trip to the ER, an admission to the hospital or worse. Generally, early warning signs of worsening asthma and an asthma attack include:

•A drop in peak expiratory flow rate
•Increased cough
•Wheezing
•Chest tightness
•Some difficulty performing normal daily activities
•Individual factors you notice over time that indicate worsening asthma or an asthma attack
You will likely be in the ‘yellow zone’ of the asthma care plan when developing these symptoms. Based on your asthma care plan, follow the instructions about taking extra doses of quick-relief medications and initiating other treatments like a course of oral corticosteroids. The asthma care plan will have instructions regarding how to proceed and when to call your doctor.

Most of the time when symptoms are identified and treated early, you will notice a prompt improvement in both peak flow and symptoms. However, you need to be prepared if your symptoms don’t improve.

Make sure you discuss your asthma care plan with your health care provider. If you or your child is frequently needing to step up asthma treatment because of symptoms or worsening peak flows, or frequent asthma attacks, this is a sign of poor control and adjustments to the plan may be needed.

Identify Indications For Emergency Care:
One of the most important skills as a patient or parent of a child with asthma is to know when you need no longer treat asthma at home, call your doctor, or just head to the emergency department. All of the following symptoms are indications that you or your child needs to seek a healthcare provider for emergency care immediately:

•Wheezing that occurs while breathing both in and out
•Coughing that has become continuous
•Difficulty breathing
•Tachypnea or breathing very fast
•Retractions where your skin is pulled in as you breath
•Shortness of breath
•Difficulty talking in complete sentences
•Becoming pale
•Becoming anxious
•Blue lips or fingernails called cyanosis
If you or your child has any of these symptoms, they are in the ‘red zone’ of the asthma care plan and you should begin following those instructions immediately, which should also include seeing a healthcare provider. Make sure that you keep your emergency numbers and details of who to contact in an emergency situation in an easily identifiable place like the refrigerator or a bulletin board near your phone. It is also a good idea to carry this information with you.

Adult recommendations do not significantly differ for handling an acute asthma flare.

When you or your child’s asthma is under control, you should be free of asthma symptoms and able to do most of normal activities. Prompt identification and action of an asthma attack and worsening asthma symptoms will prevent complications and frequent visits to the emergency department.

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What are the risk factors for an asthma attack?
Although anyone may have an asthma attack, it most commonly occurs in the following persons:

•children by the age of 5
•adults in their 30s
•adults older than 65
•people living in urban communities

Other factors include the following:

•family history of asthma
•personal medical history of allergies
Children most susceptible to asthma attacks include the following:

•children with a family history of asthma
•children who have allergies
•children who have exposure to secondhand tobacco smoke
What happens during an asthma attack or asthma exacerbation?
Persons with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.

•The lungs and airways overreact to certain triggers causing:
◦the lining of the airways to become inflamed and swollen.
◦tightening of the muscles that surround the airways.
◦an increased production of mucus.
•Breathing becomes harder and may hurt.
•There may be coughing.
•There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways.

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1.1 What is an asthma attack?
An asthma attack, also known as an asthma episode or flare, is any shortness of breath which interrupts the asthmatic’s well-being and requires either medication or some other form of intervention for the asthmatic to breathe normally again.

1.1.1 What is wheezing?
Wheezing is the whistling or rattling sound that occurs when air flows through obstructed airways. At the start of an asthma attack, wheezing usually only occurs while exhaling, or breathing out, but as the attack progresses, wheezing may then be heard both while inhaling and exhaling. If after the attack progresses further, the asthmatic then stops wheezing, this may indicate that many bronchioles (small airways) have become completely blocked, which is a very serious condition.
1.1.2 Do all asthmatics wheeze?
No, not all asthmatics wheeze. Although wheezing is extremely common in asthmatics, in All About Asthma, Dr. Paul says, “It is important to note that not all asthmatic symptoms need be present for one to experience an asthma attack. For instance, not all asthmatics wheeze. And sometimes wheezing is so slight, it can only be heard with a stethoscope. With some asthmatics, coughing is the only symptom present.” Similarly, in Children with Asthma, Dr. Plaut states that children with chronic coughs “may have asthma even though no wheezing is present.” He diagnoses such children with asthma if their peak flow improves when given an inhaled bronchodilator.
1.1.3 What is “coughing asthma”?
In Children with Asthma, Dr. Plaut defines “coughing asthma” as “a form of asthma in which coughing is the only symptom and there is no abnormality in any lung function test.” This condition is also known as “cough variant asthma.” Coughing asthma often improves when standard asthma medications are taken.
1.1.4 Is asthma hereditary?
No, asthma itself is not hereditary, but there does seem to be a hereditary component to the tendency to develop asthma. In All About Asthma, Dr. Paul states that if neither parent has asthma, the chances of each of their children having asthma are less than 10%. When one parent has asthma, the chances rise to 25%, and when both parents have asthma, the chances climb to 50%. (Actually, there is considerable disagreement among my sources as to the exact numbers, but all agree that the chances climb dramatically if one or both parents have asthma.)
Similarly, if one or both parents have allergies, the chances of each of their children having allergies are 35% and 65%, respectively, compared to a less than 10% chance if neither parent has allergies.

However, Dr. Paul cautions that “children don’t inherit asthma itself, but the tendency to develop it.” Whether or not an individual develops asthma is also influenced by their exposure to various other factors such as infections, irritants, and allergens.

If you have wheezing, coughing and shortness of breath, your doctor may suspect you have asthma. But these signs and symptoms alone aren’t enough to diagnose asthma because they can also be caused by other conditions. Your doctor will base your diagnosis on a number of things, including a physical exam and answers to questions about your symptoms and health (medical history). In addition, you may need further evaluation, which can include lung function tests or other tests.

Medical history
Your doctor will ask you about several things, which may include:

■What your symptoms are
■If you have hay fever or other allergies — which can be linked to asthma
■Whether you have any biological (blood) relatives with hay fever or other allergies
■What health problems you have now or have had in the past
■What medications or herbal supplements you take

Physical exam
A physical exam for possible asthma generally includes:

■An examination of your nose, throat and upper airways (upper respiratory tract).
■Listening to the sounds your lungs make with a stethoscope as you breathe. Wheezing — high-pitched whistling sounds when you breathe out — is one of the main signs of asthma.
■Examining your skin for signs of allergic conditions such as eczema and hives, which are often associated with asthma.

Lung function tests
Spirometer
Although your symptoms, medical history and physical examination may suggest that you have asthma, lung function tests (also called pulmonary function tests) may be needed to confirm an asthma diagnosis. Lung function tests may include one or more of the following tests.

Spirometry
This noninvasive test measures how well you breathe. During spirometry, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. Spirometry testing reveals two measurements that are important in diagnosing asthma:

■Forced vital capacity (FVC), which is the maximum amount of air you can inhale and exhale
■Forced expiratory volume (FEV-1), which is the maximum amount of air you can exhale in one second
Your doctor will compare these two measurements. If certain key measurements are below normal for a person your age, it may be a sign that your airways are obstructed. Your doctor may ask you to inhale a bronchodilator drug used in asthma treatment to open obstructed air passages and then try the test again. If your measurements improve significantly, it’s likely that you have asthma. Your doctor may still suspect that you have asthma even if your initial spirometry measurements are normal. If so, you may need additional tests.

Exhaled nitric oxide test
A relatively new tool for measuring asthma, the nitric oxide test is available in only some hospitals and doctors’ offices. High levels of nitric oxide gas in the air you breathe out can be a sign of asthma. Nitric oxide gas is produced by the body normally, but high levels in your breath can mean your airways are inflamed — a sign of asthma.

Challenge test
During this test, your doctor deliberately tries to trigger airway obstruction and asthma symptoms by having you inhale an airway-constricting substance such as methacholine. If you appear to have asthma triggered by exercise (exercise-induced asthma), you may be asked to do vigorous physical activity to trigger symptoms.

After triggering your symptoms, you retake the spirometry test. If your spirometry measurements are still normal, it’s likely that you don’t have asthma. But if your measurements have fallen significantly, it may mean you have asthma.

When checking children under age 5, doctors seldom conduct lung function tests because young children usually have trouble following the instructions. Instead, when a child’s signs and symptoms, medical history, and physical examination suggest asthma, the doctor may prescribe a bronchodilator — a drug that opens the airways. If your child’s signs and symptoms improve after using the bronchodilator, an asthma diagnosis is likely.

Additional tests: Ruling out conditions other than asthma
Depending on your age, your medical history and initial testing, your doctor may suspect that you have a condition other than asthma. Conditions that can cause asthma-like symptoms include:

■Other lung disease such as chronic obstructive pulmonary disease (COPD)
■Airway tumors
■Airway obstruction
■Bronchitis
■Lung infection (pneumonia)
■Blood clot in the lung (pulmonary embolism)
■Congestive heart failure
■Vocal cord dysfunction
■Viral lower respiratory tract infection
If your doctor suspects that you have another condition, you may have other tests, such as:

■Chest and sinus X-rays
■Complete blood count
■Computerized tomography (CT) scans of the lungs
■Gastroesophageal reflux assessment
■Sputum induction and examination
Your doctor may also want to see whether you have any other conditions that can accompany asthma. These include:

■Heartburn, or gastroesophageal reflux disease (GERD)
■Hay fever
■Sinusitis
Your doctor may also perform allergy tests. Although allergy tests aren’t used to diagnose asthma, they can help identify substances that may be causing or worsening your asthma.

“Asthma Diagnosis”

When asthma is suspected, the patient should describe for the doctor any pattern related to the symptoms and possible precipitating factors, including:

•Whether symptoms are more frequent during the spring or fall (allergy seasons).
•Whether exercise, a respiratory infection, or exposure to cold air has ever triggered an attack.
•Any family history of asthma or allergic disorders, such as eczema, hives, or hay fever.
•Any occupational or long-term exposure to chemicals. Early detection of occupational asthma is very important. If symptoms improve on weekends and vacation and are worse at work, the job is likely to be the source of the asthma, although this is not always the case. Asthma is common, and exacerbation at work may be coincidental.

Ruling Out Other Diseases
A number of disorders may cause some or all of the symptoms of asthma:

•Asthma and chronic obstructive lung diseases (chronic bronchitis and emphysema) affect the lungs in similar ways and, in fact, may all be present in the same person. Unlike other chronic lung conditions, asthma usually first appears in patients less than 30 years old and with chest x-rays that are normal. Still, it may be difficult to distinguish these disorders in some adults with late onset asthma.
•Panic disorder can coincide with asthma or be confused with it.
•Gastroesophageal reflux disorder (GERD) is a common companion in asthma and may affect treatment.
•Other diseases that must be considered during diagnosis are pneumonia, bronchitis, severe allergic reactions, pulmonary embolism, cancer, heart failure, tumors, psychosomatic illnesses, and certain rare disorders (such as tapeworm and trichomoniasis).

Pulmonary Function Tests
If symptoms and a patient’s history suggest asthma, the doctor will usually perform tests known as pulmonary function tests to confirm the diagnosis and determine the severity of the disease.

Using a spirometer, an instrument that measures the air taken into and exhaled from the lungs, the doctor will determine several values:

1. Vital capacity (VC), which is the maximum volume of air that can be inhaled or exhaled.

2. Peak expiratory flow rate (PEFR), commonly called the peak flow rate, which is the maximum flow rate that can be generated during a forced exhalation.

3. Forced expiratory volume (FEV1), which is the maximum volume of air expired in one second.

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How Is Asthma Diagnosed?
Your primary care doctor will diagnose asthma based on your medical history, a physical exam, and results from tests. He or she 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.

You may need to see an asthma specialist if:

You need special tests to be sure you have asthma
You’ve had a life-threatening asthma attack
You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall difficulty getting your asthma well controlled
You’re thinking about getting allergy treatments

Medical History
Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms, and when and how often they occur. Let your doctor know if your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night.

Your doctor also may want to know what factors seem to set off your symptoms or worsen them.

Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea.

Physical Exam
Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions such as eczema.

Keep in mind that you can still have asthma even if you don’t have these signs on the day that your doctor examines you.

Diagnostic Tests
Lung Function Test
Your doctor will use a test called spirometry (spi-ROM-eh-tre) to check how your lungs are working. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out. Your doctor also may give you medicines and then test you again to see whether the results have improved.

If the starting results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your diagnosis will likely be asthma.

Other Tests
Your doctor may order other tests if he or she needs more information to make a diagnosis. Other tests may include:

Allergy testing to find out which allergens affect you, if any.
A test to measure how sensitive your airways are. This is called a bronchoprovocation test. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in.
A test to show whether you have another disease with the same symptoms as asthma, such as reflux disease, vocal cord dysfunction, or sleep apnea.
A chest x ray or an EKG (electrocardiogram). These tests will help find out whether a foreign object or other disease may be causing your symptoms.
Diagnosing Asthma in Young Children
Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (aged 0 to 5 years) can be hard to diagnose. Sometimes it can be difficult to tell whether a child has asthma or another childhood condition because the symptoms of both conditions can be similar.

Also, many young children who have wheezing episodes when they get colds or respiratory infections don’t go on to have asthma after they’re 6 years old. These symptoms may be due to the fact that infants have smaller airways that can narrow even further when they get a cold or respiratory infection. The airways grow as a child grows older, so wheezing no longer occurs when the child gets a cold.

A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:

One or both parents have asthma
The child has signs of allergies, including the allergic skin condition eczema
The child has allergic reactions to pollens or other airborne allergens
The child wheezes even when he or she doesn’t have a cold or other infection
A lung function test along with a medical history and physical exam is the most certain way to diagnose asthma. However, this test is hard to do in children younger than 5 years. Thus, doctors must rely on children’s medical histories, signs and symptoms, and physical exams to make a diagnosis. Doctors also may use a 4 to 6 week trial of asthma medicines to see how well a child responds.

Let’s look at some asthma risk factors and see how they increase the chance that a person will have the asthma symptoms of cough, wheezing, and shortness of breath associated with the disease. After determining your personal risk factors for asthma, decide on the ones you can control and try to make some lifestyle changes. Avoidance of the risk factors you can control is crucial in preventing asthma symptoms. While you cannot change your gender or family history, you can avoid smoking with asthma, breathing polluted air, and obesity. Take control of your asthma — by controlling your asthma risk factors. By understanding all the risk factors, you may be able to prevent or control your asthma.

Gender and Asthma
Childhood asthma occurs more frequently in boys than in girls. It’s unknown why this occurs although some experts find a young male’s airway size is smaller when compared to the female’s airway, which may contribute to increased risk of wheezing after a cold or other viral infection. Around age 20, the ratio of asthma between men and women is the same. At age 40, more females than males have adult asthma.

Family History of Asthma
Blame Mom or Dad or both for your asthma. Your inherited genetic makeup predisposes you to having asthma. In fact, it’s thought that three-fifths of all asthma cases are hereditary. According to a CDC report, if a person has a parent with asthma, he or she is three to six times more likely to develop asthma than someone who does not have a parent with asthma.

Airway Hyperreactivity and Asthma
It appears that having airway hyperreactivity is another risk factor for asthma, although researchers are not sure why this is true. In asthma, the airways are hyperreactive and become inflamed when they meet such asthma triggers as allergens or cold air. Not all people with airway hyperreactivity develop asthma, but in those who do have it, the airway hyperreactivity appears to increase the risk of asthma.

Atopy and Asthma
Atopy means allergic hypersensitivity that affects different parts of the body that do not come in contact with allergens, substances that trigger the body’s allergic reaction. Atopy can include eczema (atopic dermatitis), allergic rhinitis, allergic conjunctivitis, and asthma.

Studies indicate that 40% to 50% of children with eczema or atopic dermatitis develop asthma. Some findings indicate that children with atopic dermatitis may have more severe and persistent asthma as adults.

Allergies Linked to Asthma
Allergies and asthma often coexist. Indoor allergies are a predictor of who might be at risk for an asthma diagnosis. One nationwide study showed levels of bacterial toxins called endotoxins in house dust were directly related to asthma symptoms and use of asthma inhalers, bronchodilators, and other asthma drugs.

Sources of other indoor allergens include animal proteins (particularly cat and dog allergens), dust mites, cockroaches, and fungi. Changes that have made houses more “energy-efficient” over the years are thought to increase exposure to these causes of asthma.

Environmental Factors and Asthma
Indoor air pollution such as cigarette smoke, mold, and noxious fumes from household cleaners and paints can cause allergic reactions and asthma. Environmental factors such as pollution, sulfur dioxide, nitrogen oxide, ozone, cold temperatures, and high humidity are all known to trigger asthma in susceptible individuals. In fact, asthma symptoms and hospital admissions are greatly increased during periods of heavy air pollution. Ozone is the major destructive ingredient in smog. It causes coughing, shortness of breath, and even chest pain — and can boost the susceptibility to infection. Sulfur dioxide, another component of smog, also irritates the airways and constricts the air passages, resulting in asthma attacks.

Gas stoves are the primary source of indoor nitrogen dioxide. Studies show that people who cook with gas are more likely to have wheezing, breathlessness, asthma attacks, and hay fever than those who cook with other methods. It is estimated that more than half of the households in the U.S. use gas stoves.

Weather changes can also result in asthma attacks in some people. For instance, cold air causes airway congestion and an increase in mucus production. Increases in humidity may also cause breathing difficulty in a certain population.

Cigarette Smoke Is an Asthma Risk Factor
Several studies confirm that cigarette smoking is linked with an increased risk for developing asthma. There’s also evidence that cigarette smoking among adolescents increases the risk of asthma. Even more findings link secondhand smoke exposure with the development of asthma in early life.

The Link Between Obesity and Asthma
A review of seven studies revealed that asthma was 38% more common in overweight adults (those with a BMI greater than 25 but less than 30) and nearly twice as common among obese adults (those with a BMI of 30 or greater). Researchers thought that this risk might be greater for nonallergic asthma than allergic asthma.

Pregnancy and Asthma
Maternal smoking during pregnancy appears to result in lower lung function in infants compared to those whose mothers did not smoke. Premature birth is also a risk factor for developing asthma.

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Top 6 Asthma Risk Factors

14 million adults and 6 million children in the US alone suffer from asthma. Wondering if asthma might be in your future or your child’s future?

Risk factors are certain personal traits or events that increase the likelihood that you will experience a specific disease or a condition associated with a disease. Look at this list of top asthma risk factors to decide if you or your child may develop asthma at some point in the future. If your risk is high, take steps to avoid the factors you can.

1. Family History of Asthma
Having a parent or sibling with asthma means you have a high risk of developing asthma yourself..
2. Living in Urban Areas
People who live in urban areas are exposed to air pollution on a daily basis and are more likely to develop asthma. There are also more cockroaches in urban areas. Cockroach sensitivity is a common trigger for asthma..
3. Exposure to Secondhand Smoke
People who live with someone who smokes or have frequent, prolonged exposure to secondhand smoke (such as in a work setting) are at a much higher risk for developing asthma. So, parents should never smoke around their children or even in the same house. Even better, they should quit!.
4. Low Birth Weight
Children who were smaller than the norm at birth, such as those born early, are also at higher risk for asthma..
5. Other Health Problems
Adults who also have gastroesophageal reflux disease (GERD), are obese, and / or have chronic sinusitis carry a higher than usual risk for being diagnosed with asthma..
6. Exposure to Irritants on the Job
If you are exposed to certain chemicals or other irritating substances on a regular basis at work, you could be at risk for developing occupational asthma. Risky occupations may include farming, hairdressing, and paint, steel, plastics, and electronics manufacturing.

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Adult Asthma Risk Factors

According to a major national 2001 survey, American adults have a 10% lifetime risk for developing asthma. As of 2002, an estimated 20 million adults had the disorder. Between 1980 and 1996 the prevalence of asthma increased by nearly 74%, but it may be stabilizing. Other respiratory diseases, sinusitis, and ear infections are also on the rise, suggesting that airborne or environmental factors may be at work that affects all of these conditions, including asthma.

Gender
Before puberty, asthma occurs more often in males, but after adolescence, it appears to be more common in females. In adults with similar cases of actual airway obstruction, women are likely to report more severe symptoms than men are. In addition, women may be at much greater risk of death from asthma than men.

Obesity
In both adults and children, the incidence of obesity and asthma has been increasing in parallel over recent years. Studies report a strong association between the two conditions. Some experts suggest that excess weight pressing on the lungs may trigger the hyperreactive response in the airways typical of asthma. Others believe that asthma leads to obesity by inhibiting physical activity, although several studies have found no difference in activity levels between people with or without asthma. Some studies suggest that many obese people may be misdiagnosed as having asthma when in fact they are simply short of breath, possibly because of the increased effort required for breathing.

In any case, there is evidence that losing weight can relieve asthma symptoms. Some evidence also suggests that people who are overweight, (body mass index greater than 25), have more difficulty getting their asthma under control. Weight loss in anyone who is obese and has asthma or shortness of breath reduces airway obstruction and improves lung function. [See In-Depth Report #53: Weight control and diet.]

Smoking
In one study of elderly people with severe adult-onset asthma, smoking was the most significant risk factor for developing this condition. Smoking, in any case, contributes to decline in lung function in everyone.

Population Differences
Urban Life and Poverty. African Americans have higher rates of asthma than Caucasian Americans or other ethnic groups. They are also more likely to die of the disease. Ethnicity and genetics, however, are less likely to play a role in these differences than socioeconomic differences, such as having less access to optimal health care. Poverty is a consistent risk factor in most studies. Both the elderly and the urban poor have the highest risk for severe asthma and death. Urban life, in fact, has been associated with a higher risk for asthma in all income groups and among both children and adults. Twin studies also suggest that people who have lower educational levels (as well as those who exercise less) are at higher risk for adult-onset asthma, further suggesting a link to lower economic status.

Geographical Differences. Asthma rates vary widely among different populations regardless of socioeconomic or other factors. For example, asthma and hospitalization rates are dramatically higher in New York Puerto Ricans than in Hispanic Americans who live in Los Angeles or the Southwest. Among the U.S. states, rates are lowest in Louisiana and highest in Maine.

There are significant differences among nations. In a major study of 22 nations published in 2001, the countries with the highest asthma rates were Britain, Ireland, Australia, New Zealand, and the U.S. (According to another study, asthma rates are also significantly higher in Canadian adults than they are in comparable European groups.) Low rates were reported in Iceland, Norway, Spain, Germany, Italy, Algeria, India, and Eastern European nations. The reasons for these variations are still unknown.

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.

Asthma

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.

Know the Symptoms of an Asthma Attack
An asthma attack is the episode in which bands of muscle surrounding the airways are triggered to tighten. This tightening is called bronchospasm. During the attack, the lining of the airways becomes swollen or inflamed and the cells lining the airways produce more and thicker mucus than normal.

All of these factors — bronchospasm, inflammation, and mucus production — cause symptoms such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack include:

Severe wheezing when breathing both in and out
Coughing that won’t stop
Very rapid breathing
Chest pain or pressure
Tightened neck and chest muscles, called retractions
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Blue lips or fingernails
The severity of an asthma attack can escalate rapidly, so it’s important to treat these asthma symptoms immediately once you recognize them.

Without immediate treatment, such as with your asthma inhaler or bronchodilator, your breathing will become more labored. If you use a peak flow meter at this time, the reading will probably be less than 50%.

As your lungs continue to tighten, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so there is not enough air movement to produce wheezing. This is sometimes called the “silent chest,” and it is an ominous sign. You need to be transported to a hospital immediately. Unfortunately, some people interpret the disappearance of wheezing as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate asthma treatment, you will eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as cyanosis, means you have less and less oxygen in your blood. Without aggressive treatment for this asthma emergency, you will lose consciousness and eventually die.

If you are experiencing an asthma attack, follow the “Red Zone” or emergency instructions in your asthma action plan immediately. These symptoms occur in life-threatening asthma attacks. You may need medical attention right away.

Know About Unusual Asthma Symptoms
Not everyone with asthma has the usual symptoms of cough, wheezing, and shortness of breath. Sometimes individuals have unusual asthma symptoms that may not appear to be related to asthma. Some “unusual” asthma symptoms may include the following:

rapid breathing
sighing
fatigue
inability to exercise properly (called exercise-induced asthma)
difficulty sleeping or nighttime asthma
anxiety
difficulty concentrating
chronic cough without wheezing
Also, asthma symptoms can be mimicked by other conditions such as bronchitis, vocal cord dysfunction, and even heart failure.

It’s important to understand your body. Talk with your asthma doctor and others with asthma. Be aware that asthma may not always have the same symptoms in every person.

Know Why Infections Trigger Asthma Symptoms
Sometimes a virus or bacterial infection is an asthma trigger. For instance, you might have a cold virus that triggers your asthma symptoms. Or your asthma can be triggered by a bacterial sinus infection. Sinusitis with asthma is common.

It’s important to know the signs and symptoms of respiratory tract infections and to call your doctor immediately for diagnosis and treatment. For instance, you might have symptoms of increased shortness of breath, difficulty breathing, or wheezing with a bronchial infection. In people who don’t have asthma, the bronchial infection may not trigger the same debilitating symptoms. Know your body and understand warning signs that an infection might be starting. Then take the proper medications as prescribed to rid the infection and regain control of your asthma and good health

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Adult Asthma Symptoms

Asthma symptoms vary in severity from occasional mild bouts of breathlessness to daily wheezing that persists despite taking large doses of medication. After exposure to asthma triggers, symptoms rarely develop abruptly but progress over a period of hours or days. Occasionally, the airways have become seriously obstructed by the time the patient calls the doctor.

The classic symptoms of an asthma attack include:

•Wheezing when breathing out is nearly always present during an attack. Usually the attack begins with wheezing and rapid breathing, and, as it becomes more severe, all breathing muscles become visibly active.
•Shortness of breath (dyspnea). Shortness of breath is a major source of distress in patients with asthma. However, the severity of this symptom does not always reflect the degree to which lung function is impaired. Some patients are not even aware that they are experiencing shortness of breath. Such patients are at particular risk for very serious and even life-threatening asthma attacks, since they are less conscious of symptoms. Those at highest risk for this effect tend to be older, female, and to have had the disease for a longer period of time.
•Coughing. In some people, the first symptom of asthma is a nonproductive cough. Some patients find this cough even more distressing than wheezing or sleep disturbances.
•Chest tightness or pain. Initial chest tightness without any other symptoms may be an early indicator of a serious attack.
•Neck muscles may tighten, and talking may become difficult or impossible.
•Rapid heart rate.
•Sweating.
•Chest pain occurs in about three-quarters of patients. It can be very severe, although the pain’s intensity is not necessarily related to the severity of the asthma attack itself.

The end of an attack is often marked by a cough that produces a thick, stringy mucus. After an initial acute attack, inflammation persists for days to weeks, often without symptoms. (The inflammation itself must still be treated, however, because it usually causes relapse.)

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“Asthma Symptoms”

Asthma signs and symptoms range from minor to severe, and vary from person to person. You may have mild symptoms such as infrequent wheezing, with occasional asthma attacks. Between episodes you may feel normal and have no trouble breathing. Or, you may have signs and symptoms such as coughing and wheezing all the time or have symptoms primarily at night or only during exercise.

Asthma signs and symptoms include:

■Shortness of breath
■Chest tightness or pain
■Trouble sleeping caused by shortness of breath, coughing or wheezing
■An audible whistling or wheezing sound when exhaling
■Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu
Signs that your asthma is probably getting worse include:

■An increase in the severity and frequency of asthma signs and symptoms
■A fall in peak flow rates as measured by a peak flow meter, a simple device used to check how well your lungs are working
■An increased need to use bronchodilators — medications that open up airways by relaxing the surrounding muscles
Work with your doctor to determine when you need to increase your medications or take other steps to treat symptoms of worsening asthma and get your asthma back under control. If your asthma keeps getting worse, you may need a trip to the emergency room. Your doctor can help you learn to recognize emergency signs and symptoms so you’ll know when to get help.

This report provides facts about adult asthma and advice about how best to manage it. For starters, asthma is not just a childhood condition. Many adults have lived with asthma for years; others have been diagnosed only recently. This report is geared specifically to the often neglected adult asthma community. If you have had asthma since childhood, the advances in medical understanding and treatment of this disorder may surprise you and inspire you to make adjustments in your care. And if you have been only recently diagnosed or are trying to manage asthma in addition to other medical conditions, such as heart disease, this report provides practical advice and suggestions.

There is a lot of good news to share. Many treatments have become available since the 1990s, including selective and long-acting bronchodilators, leukotriene modifiers, and biological therapies such as monoclonal antibodies. Because of the tremendous progress in understanding and treating asthma, most people with asthma can now expect to achieve good control of this disorder and live fully functional lives. While millions of Americans live with asthma, the death rate from asthma is declining in the United States, an indication that more Americans are managing their disease well.

In this report, you will learn what asthma is, read about developments in treatment, and discover simple steps you can take to reduce exposure to asthma triggers. You will learn how to plan in advance for an asthma attack so that you remain safe and healthy. You’ll also have an opportunity to consider how to control your asthma in different real-life scenarios, so that you feel prepared for almost any situation. Armed with the knowledge and skills outlined in this report, you will become asthma smart — and as healthy as possible.

Adult “Asthma” Symptoms

Asthma symptoms vary in severity from occasional mild bouts of breathlessness to daily wheezing that persists despite taking large doses of medication. After exposure to asthma triggers, symptoms rarely develop abruptly but progress over a period of hours or days. Occasionally, the airways have become seriously obstructed by the time the patient calls the doctor.

The classic symptoms of an asthma attack include:

•Wheezing when breathing out is nearly always present during an attack. Usually the attack begins with wheezing and rapid breathing, and, as it becomes more severe, all breathing muscles become visibly active.
•Shortness of breath (dyspnea). Shortness of breath is a major source of distress in patients with asthma. However, the severity of this symptom does not always reflect the degree to which lung function is impaired. Some patients are not even aware that they are experiencing shortness of breath. Such patients are at particular risk for very serious and even life-threatening asthma attacks, since they are less conscious of symptoms. Those at highest risk for this effect tend to be older, female, and to have had the disease for a longer period of time.
•Coughing. In some people, the first symptom of asthma is a nonproductive cough. Some patients find this cough even more distressing than wheezing or sleep disturbances.
•Chest tightness or pain. Initial chest tightness without any other symptoms may be an early indicator of a serious attack.
•Neck muscles may tighten, and talking may become difficult or impossible.
•Rapid heart rate.
•Sweating.
•Chest pain occurs in about three-quarters of patients. It can be very severe, although the pain’s intensity is not necessarily related to the severity of the asthma attack itself.

Causes of Adult Asthma

Asthma has dramatically risen worldwide over the past decades, particularly in developed countries, and experts are puzzled over the cause of this increase. The mechanisms that cause asthma are complex and vary among population groups and even from individual to individual. Many asthma sufferers have allergies, and some researchers are targeting common factors in both these conditions. Not all people with allergies have asthma, however, and not all cases of asthma can be explained by allergic response.

Asthma is most likely to be caused by a convergence of factors that can include genes (probably several) and various environmental and biologic triggers (e.g., infections, dietary patterns, hormonal changes in women, and allergens).

The Allergic Response
Nearly half of adults with asthma have an allergy-related condition, which, in most cases developed first in childhood. (In patients who first develop asthma during adulthood, the allergic response usually does not play a strong causal role.) Important irritants or allergens include:

•Dust mites, specifically mite feces, which are coated with enzymes that contain a powerful allergen. These are the primary allergens in the home.
•Animal dander.
•Pollen. An asthma attack from an allergic response to pollen is more likely to occur during extreme air changes, such as thunderstorms. Major weather changes, such as El Nino, can affect the timing of allergy seasons. For example, in 1998, when the effects of El Nino were very strong, allergy and asthma attacks were markedly increased, and maximum tree pollen counts occurred 2 to 4 weeks earlier and mold counts 2 to 3 months earlier than in the previous year.
•Molds. A 2002 study suggested that molds might produce a worse asthma attack in adults than other allergens.
•Fungi.
•Cockroaches. Cockroaches are major asthma triggers and may reduce lung function even in people without a history of asthma.
•Fossil Fuels. Certain chemicals may trigger allergic rhinitis. Some experts believe that refined fossil fuels, such as diesel fuel and particularly kerosene, may be important triggers for allergic rhinitis. And, in people who already have allergies or asthma, exposure to such fossil fuels may worsen symptoms.

The Allergic Process. The allergic process, called atopy, and its connection to asthma is not completely understood. It involves various airborne allergens or other triggers that set off a cascade of events in the immune system leading to inflammation and hyperreactivity in the airways. One description is as follows:

•The conductor in an orchestra of immune factors that contribute to allergies and asthma appears to be a category of white blood cells known as helper T cells, in particular a subgroup called Th2 cells.
•Th2 cells overproduce interleukins (ILs), immune factors that are molecular members of a family called cytokines, which are involved in the inflammatory process.
•Interleukins 4, 9, and 13 may be responsible for a first-phase asthma attack. These interleukins stimulate the production and release of antibody groups known as immunoglobulin E (IgE). (People with both asthma and allergies appear to have a genetic predisposition for overproducing IgE.)
•During an allergic attack, these IgE antibodies can bind to special cells in the immune system called mast cells, which are generally concentrated in the lungs, skin, and mucous membranes. This bond triggers the release of several active chemicals, importantly potent molecules known as leukotrienes. These chemicals cause airway spasms, overproduce mucus, and activate nerve endings in the airway lining.
•Another cytokine, interleukin 5, appears to contribute to a late-phase inflammatory response. This interleukin attracts white blood cells known as eosinophils. These cells accumulate and remain in the airways after the first attack. They persist for weeks and mediate the release of other damaging particles that remain in the airways.
The Immune Response. Researchers are investigating the role that T cells play in asthma. T cells are white blood cells that are involved in the immune response. Researchers had focused on the T cell called type 2 helper (Th2) cells. However, a 2006 breakthrough study in the New England Journal of Medicine suggested that a different type of T cell may play a stronger role in asthma than previously thought.

Researchers discovered that these cells, called natural killer T cells, are far more common in the lungs of people with asthma than in the lungs of healthy people. Natural killer T cells are very rare, but researchers found them in 60% of people with moderate-to-severe persistent asthma. While this research is preliminary, it may explain why corticosteroid drugs do not work well for some patients with asthma: Steroid drugs target Th2 and other inflammatory cells, not natural killer T cells. Researchers think that further investigation of natural killer T cells may lead the way to new types of asthma drugs. If these cells prove to be involved in asthma, then drugs that eliminate them might become an important new treatment.

Remodeling and Causes of Persistent Asthma
Over the course of years the repetition of the inflammatory events involved in asthma can cause irreversible structural and functional changes in the airways, a process called remodeling. The remodeled airways are persistently narrow and can cause chronic asthma. Researchers are trying to determine how this process occurs:

Interleukins. Some researchers are looking at potent immune factors, including interleukins 11 and 13. They have been linked to a number of processes possibly involved in remodeling, including scarring in the airways and overgrowth of cells in the smooth muscles that line the airways.

Growth Factors. Compounds known as vascular endothelial growth factor (VEGF) have been observed in the airways of patients with asthma. VEGF is a powerful promoter of cell growth in blood vessel linings, and some researchers believe it may be major factor in remodeling.

Genetic Factors
About one-third of all persons with asthma share this condition with another member of their immediate family. Asthma may be more likely to pass to children from their mother than from their father. Both allergies and asthma are strongly associated with hereditary factors, sharing certain genetic markers, but they are not always inherited together.

Research on the genetics of these conditions is confusing. Of some significant promise, researchers have identified a gene (ADAM33), which has been linked to asthma. The gene regulates one of the enzymes called metalloproteases, which are involved with the smooth muscle in the airway. A mutation of this gene could play a role in airway changes that occur after inflammation.

Female Hormones
Hormones or changes in hormone levels appear to play a role in the severity of asthma in women.

Menstrual-Related Asthma. Between 30 – 40% of women with asthma experience fluctuations in severity that are associated with their menstrual cycle. One study indicated that women with menstrually associated asthma tend to have the following characteristics:

•Older age
•Had asthma for a long time
•Had severe asthma attacks that were likely to occur 3 days before and 4 days into the menstrual period
Oral contraceptives (OCs) theoretically should help asthma sufferers by leveling out hormonal changes, but they do not appear to have much effect. (There have been a few reports of asthma exacerbation with OCs, but these are uncommon events.)

Asthma during Pregnancy. During pregnancy, one-third of women with asthma suffer more from the condition, one-third suffer less, and one-third experience no difference in severity. Some studies suggest that expectant mothers carrying a female baby tend to have more severe asthma symptoms than do those who are bearing a male.

Menopause and Asthma. Around the time of menopause (called perimenopause) when estrogen declines, the risk for hospitalization in women with asthma increases fourfold compared to previous years. Studies have not demonstrated that that hormone replacement therapy (HRT), which contains estrogen, has much benefit.

NSAIDs and Acetaminophen
About 10% of adults and some fewer children have aspirin-induced asthma (AIA). With this condition, asthma gets worse when patients take aspirin. Aspirin is one of the drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs). Although aspirin is used to reduce inflammation in other disorders, it appears to have the opposite effect in many asthma cases. It is not wholly known why this occurs. AIA often develops after a viral infection. It is a particularly severe asthmatic condition, associated with up to 25% of asthma-related hospitalizations. In about 5% of cases, aspirin is responsible for a syndrome that involves multiple attacks of asthma, sinusitis, and nasal congestion. Such patients also often have polyps (small benign growths) in the nasal passages.

Patients with aspirin-induced asthma (AIA) should avoid aspirin and most likely other NSAIDs, including ibuprofen (Advil) and naproxen (Aleve).

Exercise-induced asthma (EIA) is a limited form of asthma in which exercise triggers coughing, wheezing, or shortness of breath.

Nocturnal Asthma
Asthma occurs primarily at night (nocturnal asthma) in as many as 75% of patients with asthma. Attacks often occur between 2 and 4 A.M. Factors that might play role in nocturnal asthma may include one or more of the following:

•Chemical and temperature changes in the body during the night that increase inflammation and narrowing of the airways
•Delayed allergic responses from exposure to allergens during the day
•The wearing off of inhaled medications toward the early morning
•An increase in acid reflux (back up of stomach acid) that causes airways to narrow
•Postnasal drip that occurs during sleep
•Conditions relating to sleep, such as sleep apnea or sleeping on one’s back, which may worsen any asthma attack that occurs at night
Some experts believe that nocturnal asthma may actually be a unique form, with its own specific biologic mechanisms that occur only at night and which reduce natural steroid hormones (which block inflammation).

Contributing Medical Conditions
Infections. The role of infections in asthma is complicated. Respiratory infections may play a role in some cases of adult-onset asthma, but may be protective against asthma in small children. (In both children and adults with existing allergic asthma, however, an upper respiratory tract infection often worsens an attack.)

Researchers are particularly interested in the organisms Chlamydiapneumoniae and Mycoplasmapneumoniae adenovirus. They are major causes of both mild and serious respiratory infections and are becoming important suspects in many cases of severe adult asthma. (If such respiratory infections occur in young children, they are unlikely to affect adult-onset asthma.)

In one study, patients whose asthma occurred after infections had more severe conditions than those whose asthma was due to other causes. The infection-initiated asthma, however, lasted only 5.6 years compared to 13.3 years in the non-infection group.

In any age group, respiratory infections worsen existing asthma in people who have it already. Rhinovirus (the common cold virus) has been reported to be the most common infection associated with asthma attacks. In one study, it was associated with 61% of asthma exacerbations in children and 44% in adults. Some research suggests that colds promote allergic inflammation and increase the intensity of airway responsiveness for weeks.

GERD. At least half of patients with asthma have gastroesophageal reflux disease (GERD), the cause of heartburn. It is not entirely clear which condition causes the other or whether they are both due to common factors.

Causes Asthma

Heartburn is a condition where the acidic stomach contents back up into the esophagus causing pain in the chest area. This reflux usually occurs because the sphincter muscle between the esophagus and stomach is weakened. Standing or sitting after a meal can help reduce the reflux that causes heartburn. Continuous irritation of the esophagus lining as in gastroesophageal reflux disease is a risk factor for the development of adenocarcinoma.
Some theories for the causal connection between GERD and asthma are:

•Acid leaking from the lower esophagus in GERD stimulates the vagus nerve, which runs through the gastrointestinal tract. This stimulated nerve triggers the nearby airways in the lung to constrict, causing asthma symptoms.
•Acid backup that reaches the mouth may be inhaled into the airways (aspirated). Here, the acid triggers a reaction in the airways that cause asthma symptoms.
GERD is sometimes hard to detect and might be a contributor in the following patients:

•Those who do not respond to asthma treatments
•Those whose asthma attacks follow episodes of heartburn
•Those whose attacks worsen after eating or exercise
•Those whose coughs follow episodes of acid reflux. (One study found that GERD was associated with about half of the episodes of coughs and wheezes in patients with asthma.)
Treating GERD symptoms with anti-acid drugs may resolve asthma in some (but not all) patients who share both conditions. A small 2005 observational study found that while GERD was common in patients with asthma, treatment of GERD had no effect on asthma symptoms. [See In-Depth Report #85: Heartburn and gastroesophageal reflux disease.]

Sinusitis. Almost half of children and adults with allergic asthma have sinus abnormalities, and in various studies, between 17 – 30% of patients with asthma develop true sinusitis. The presence of sinusitis, however, does not appear to increase the severity of asthma.

What is adult-onset asthma?
When a doctor makes a diagnosis of asthma in people older than 20, it is known as adult-onset asthma.

Among those who may be more likely to get adult-onset asthma are:

Women who are having hormonal changes, such as those who are pregnant or who are experiencing menopause
Women who take estrogen following menopause for 10 years or longer
People who have just had certain viruses or illnesses, such as a cold or flu
People with allergies, especially to cats
People who are exposed to environmental irritants, such as tobacco smoke, mold, dust, feather beds, or perfume. Irritants that bring on asthma symptoms are called “asthma triggers.” Asthma brought on by workplace triggers is called “occupational asthma.”

What is the difference between childhood asthma and adult-onset asthma?
Adults tend to have lower lung capacity (the volume of air you are able to take in and forcibly exhale in one second) after middle age because of changes in muscles and stiffening of chest walls. This decreased capacity may cause doctors to miss the diagnosis of adult-onset asthma.

How is adult-onset asthma diagnosed?
Your asthma doctor may diagnose adult-onset asthma by:

Taking a medical history, asking about symptoms, and listening to you breathe
Performing a lung function test, using a device called a spirometer to measure how much air you can exhale after first taking a deep breath. The device also measures how fast you can empty your lungs. You may be asked at some time before or after the test to inhale a short-acting bronchodilator (medicine that opens the airways by relaxing tight muscles and that also help clear mucus from the lungs).
Performing a methacholine challenge test. This asthma test may be performed if your symptoms and spirometry test do not clearly show asthma. When inhaled, methacholine causes the airways to spasm and narrow if asthma is present. During this test, you inhale increasing amounts of methacholine aerosol mist before and after spirometry. The methacholine test is considered positive, meaning asthma is present, if the lung function drops by at least 20%. A bronchodilator is always given at the end of the test to reverse the effects of the methacholine.
Performing a chest X-ray. An X-ray is an image of the body that is created by using low doses of radiation reflected on special film or a fluorescent screen. X-rays can be used to diagnose a wide range of conditions, from bronchitis to a broken bone. Your doctor might perform an X-ray exam on you in order to see the structures inside your chest, including the heart, lungs, and bones. By viewing your lungs, your doctor can see if you have a condition other than asthma that may account for your symptoms. Although there may be signs on an X-ray that suggest asthma, a person with asthma will often have a normal chest X-ray.

Who gets asthma?
Anyone can get asthma at any age. Among those at higher risk for asthma are people who:

Have a family history of asthma
Have a history of allergies (allergic asthma)
Have smokers living in the household
Live in urban areas

How is asthma classified?
Asthma is classified into four categories based upon frequency of symptoms and objective measures, such as peak flow measurements and/or spirometry results. These categories are: mild intermittent; mild persistent; moderate persistent; and severe persistent. Your physician will determine the severity and control of your asthma based on how frequently you have symptoms and on lung function tests. It is important to note that a person’s asthma symptoms can change from one category to another.

Mild intermittent asthma
Symptoms occur less than three times a week, and nighttime symptoms occur less than two times per month.
Lung function tests are greater than 80% of predicted values. Predictions are often made on the basis of age, sex, and height. For a person with asthma, the “predicted” figure could be replaced by the person’s own personal best test value as the figure for comparison.
No medications are needed for long-term control.

Mild persistent asthma
Symptoms occur more three to six times per week .
Lung function tests are greater than 80% of predicted.
Nighttime symptoms three to four times a month.
Moderate persistent asthma
Symptoms occur daily.
Nocturnal symptoms greater than five times per month
Asthma symptoms affect activity, occur more than two times per week, and may last for days.
There is a reduction in lung function, with a lung function test range of 60% to 80% of predicted.

Severe persistent asthma
Symptoms occur continuously, with asthma at night frequently.
Activities are limited.
Lung function is decreased to less than 60% of predicted.
How is asthma treated?
Asthma can be controlled, but there’s no asthma cure. There are certain goals in asthma treatment. If you are unable to achieve all of these goals, it means asthma is not in good control. You should contact your asthma care provider for help with asthma.

The treatment goals include the following:

Live an active, normal life.
Prevent chronic and troublesome symptoms.
Attend work or school every day.
Perform daily activities without difficulty.
Stop urgent visits to the doctor, emergency room, or hospital.
Use and adjust medications to control asthma with little or no side effects.
Properly using asthma medication, as prescribed by your doctor, is the basis of good asthma control, in addition to avoiding triggers and monitoring daily asthma symptoms. There are two main types of asthma medications:

Anti-inflammatories: This is the most important type of medication for most people with asthma. Anti-inflammatory medications, such as inhaled steroids, reduce swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to triggers. These medications need to be taken daily, and may need to be taken for several weeks before they begin to control asthma. Anti-inflammatories lead to a reduction in symptoms, better airflow, less sensitive airways, less airway damage, and fewer asthma episodes. If taken every day, they are helpful in controlling or preventing asthma. Oral steroids are taken for acute flares and help increase the efficacy of other medications and help reduce inflammation.
Bronchodilators: These medications relax the muscle bands that tighten around the airways. This action rapidly opens the airways, letting more air in and out of the lungs and improving breathing. As the airways open, the mucus moves more freely and can be coughed out more easily. In short-acting forms, bronchodilators known as beta-agonist relieve or stop asthma symptoms and are very helpful during an asthma episode. In long-acting forms, a beta-agonist may be helpful in preventing exercise-induced asthma.
Asthma medications can be taken by inhaling the medications (using a metered dose inhaler, dry powder inhaler, or asthma nebulizer) or by swallowing oral medications (pills or liquids). If you are also taking drugs for other conditions, you should work with your providers to check drug interactions and simplify medications when possible.
Monitoring symptoms
An important part of treatment is keeping track of how well the lungs are functioning. Asthma symptoms are monitored using a peak flow meter. The meter can alert you to changes in the airways that may be a sign of worsening asthma. By taking daily peak flow readings, you can learn when to adjust medications to keep asthma under good control. Your doctor can also use this information to adjust your treatment plan.

“Asthma” action plan
Based on your history and the severity of asthma, your doctor will develop a care plan called an asthma action plan. The asthma action plan describes when and how to use asthma medications, actions to take when asthma worsens, and when to seek care for an asthma emergency. Make sure you understand this plan; if not, ask your asthma care provider any questions you may have.

For a variety of reasons, what happens during an asthma episode is that the bronchial tubes become narrow, or even blocked. As a result, air can’t get in or out of the lungs easily, and the child begins to breathe heavily, wheeze or cough.

There are two reasons the bronchi narrow: Either because they are squeezed by muscles from the outside or because they are blocked by mucus and swelling inside the bronchial tubes.

Bronchoconstriction

The condition when bronchi are narrowed by squeezing, is called “Bronchoconstriction.” This occurs when muscles, wrapped around the bronchi like a series of elastic bands, tighten and restrict the passage of air. It’s normal for these muscles to occasionally close the airway. But in asthmatics these muscles sometimes overreact, become twitchy and constrict or block the bronchi.

Inflammation

For many years, bronchoconstriction was thought to be the main cause of asthma. More recently, we’ve become aware of another problem: Bronchial Inflammation. This occurs when the walls of the bronchi swell up and produce mucus, in reaction to some sort of irritation.

It’s normal for the bronchi to produce mucus in order to trap breathed-in irritants, and protect the lungs. But some asthmatics can produce an overabundance of mucus, and the bronchi can become chronically inflamed,

asthma

resulting in blocked airways and asthmatic symptoms.

So there are two possible conditions associated with an asthmatic’s airways, bronchoconstriction and bronchial inflammation. In fact it is widely believed that the more an airway is inflamed, the more likely it is that the bronchial muscles will constrict.

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All of us have heard of asthma and know that it is something to do with difficulty breathing, but unless you have experienced it first hand in yourself or with your child, you have no idea of the terror this condition can bestow. Asthma attacks can be very frightening and there is often panic. Although there are varying degrees of the disease, it can be life threatening. If you or a family member has asthma, prepare an emergency plan ahead of time. If the attacks are usually mild, you may have a routine of medications, such as an inhaler that is kept on the person at all times. For a more serious attack, however, have a plan of action. Talk to your doctor about keeping an injectable bronchodilator in the house. Have emergency call numbers posted by and/or on the phone itself. Talk to all members, even younger members of the family and explain to them about calling 911 for emergencies, like when “Johnny” is having trouble breathing.

Now let’s talk about this terrential disease, asthma, in more detail. Asthma is a disease that effects the bronchial tubes. It is a direct result of allergies. Asthma is a very scary thing for any person, especially a young child. The bronchial tubes of people with asthma are very sensitive to substances that they are allergic to. These irritants cause the bronchial tubes to swell. Asthma has exacerbations or “attacks”, as most people call them. An asthma attack can occur when someone is exposed to the irritants they are highly allergic to. As of yet, there is no cure for asthma, but doctors are learning more about it. Most persons develop asthma in childhood, but some people develop asthma as adults. It usually gets progressively worse in adults, leading to emphysema. About one in four persons who develop the disease in childhood will have a spontaneous recovery.

The symptoms include: wheezing, coughing, shortness of breath, and tightness of the chest, the person may turn bluish in color and after have weakness, rapid pulse and even nausea and chest pain. Things that can cause an asthma attack, depending on the person, as different people are allergic to different things, include, but are not limited to:
-certain foods

-certain medicines

-air pollution

-smoke

-molds

-perfumes

-dust

-fumes

-additives and preservatives in certain foods such as wine, salad dressings, beer, dehydrated soups.

-hair spray, spray deoderants

-pollen

other things such as:

-emotional stress

-exercise

-temperature changes

-medications

-sinus and other infections

Asthma causes

Treatment and care of asthma is directed toward immediate relief of the attack. Parents of asthmatic children may anticipate an approaching attack and medication that provides sedation and bronchodilation. The control of asthma depends on finding the cause and eliminating it. No smoking for adults who have asthma. There are two kinds of asthma medicines: those that relieve airway constriction and those that reduce swelling and inflammation like steroids. They are usually given via inhalers but pills are used as well. In some cases, studies have shown that coffee, can help relieve an acute asthma attack, supposedly because of the caffiene and heat.

A peak flow meter is an instrument needed by asthmatics. Your doctor can give you one. It is a simple hand held device that is an important part of controlling asthma. It measures the rate of air exhaled from the lungs. You take a deep breath, then blow into it. It records a number. Do it three times. Whatever your best score was, is YOUR peak flow personal best number. Do it everyday for a couple of weeks to make sure you have YOUR personal best right. After you know your best number, let your doctor know. This will help him treat YOUR asthma best.

An asthma attack is very scary, especially for a child. Try to keep them calm and stay with them. If an asthma attack is severe, 911 should be activated and hospitalization is sometimes required. Reducing exposure to allergens and keeping the person calm and limit exposure to drastic temperature changes and avoid foods that the person is allergic to.

Ways to reduce exposure to allergens that can precipitate asthma attacks are:

-Clean carpets

-wash pillowcases and sheets in hot water weekly

-wash your hands regularly to avoid exposure to illness

-remove rugs, carpets and drapes which collect dust

-keep your windows closed

-keep air conditioning on, but make sure your ducts and filters are kept clean

-keep animals outside

What Causes Asthma

Since asthma has a genetic origin and is a disease you are born with, passed down from generation to generation, the question isn’t really “what causes asthma,” but rather “what causes asthma symptoms to appear?” People with asthma have inflamed airways which are super-sensitive to things which do not bother other people. These things are called “triggers.”

Although asthma triggers vary from person to person based on if you have allergic asthma or non-allergic asthma, some of the most common include:

Substances that cause allergies (allergens) such as dust mites, pollens, molds, pet dander, and even cockroach droppings. In many people with asthma, the same substances that cause allergy symptoms can also trigger an asthma episode. These allergens may be things that you inhale, such as pollen or dust, or things that you eat, such as shellfish. It is best to avoid or limit your exposure to known allergens in order to prevent asthma symptoms.

Irritants in the air, including smoke from cigarettes, wood fires, or charcoal grills. Also, strong fumes or odors like household sprays, paint, gasoline, perfumes, and scented soaps. Although people are not actually allergic to these particles, they can aggravate inflamed, sensitive airways. Today most people are aware that smoking can lead to cancer and heart disease. What you may not be aware of, though, is that smoking is also a risk factor for asthma in children, and a common trigger of asthma symptoms for all ages. It may seem obvious that people with asthma should not smoke, but they should also avoid the smoke from others’ cigarettes. This “secondhand” smoke, or “passive smoking,” can trigger asthma symptoms in people with the disease. Studies have shown a clear link between secondhand smoke and asthma, especially in young people. Passive smoking worsens asthma in children and teens and may cause up to 26,000 new cases of asthma each year.

Respiratory infections such as colds, flu, sore throats, and sinus infections. These are the number one asthma trigger in children.

Exercise and other activities that make you breathe harder. Exercise—especially in cold air—is a frequent asthma trigger. A form of asthma called exercise-induced asthma is triggered by physical activity. Symptoms of this kind of asthma may not appear until after several minutes of sustained exercise. (When symptoms appear sooner than this, it usually means that the person needs to adjust his or her treatment.) The kind of physical activities that can bring on asthma symptoms include not only exercise, but also laughing, crying, holding one’s breath, and hyperventilating (rapid, shallow breathing). The symptoms of exercise-induced asthma usually go away within a few hours. With proper treatment, a child with exercise-induced asthma does not need to limit his or her overall physical activity. (See the page on Exercise-Induced Asthma .)

Weather such as dry wind, cold air, or sudden changes in weather can sometimes bring on an asthma episode.

Expressing strong emotions like anger, fear or excitement. When you experience strong emotions, your breathing changes — even if you don’t have asthma. When a person with asthma laughs, yells, or cries hard, natural airway changes may cause wheezing or other asthma symptoms.

Some medications like aspirin can also be related to episodes in adults who are sensitive to aspirin. Irritants in the environment can also bring on an asthma episode. These irritants may include paint fumes, smog, aerosol sprays and even perfume.
People with asthma react in various ways to these factors. Some react to only a few, others to many. Some people get asthma symptoms only when they are exposed to more than one factor or trigger at the same time. Others have more severe episodes in response to multiple factors or triggers. In addition, asthma episodes do not always occur right after a person is exposed to a trigger. Depending on the type of trigger and how sensitive a person is to it, asthma episodes may be delayed.

Each case of asthma is unique. If you have asthma, it is important to keep track of the factors or triggers that you know provoke asthma episodes. Because the symptoms do not always occur right after exposure, this may take a bit of detective work.

What Happens During an Asthma Episode?

During normal breathing, the airways to the lungs are fully open, allowing air to move in and out freely. But people with asthma have inflamed, super-sensitive airways. Their triggers cause the following airway changes, which in turn cause asthma symptoms:

The lining of the airways swell and become more inflamed
Mucous clogs the airways
Muscles tighten around the airways (bronchospasm)
These changes narrow the airways until breathing becomes difficult and stressful, like trying to breathe through a straw stuffed with cotton.

Why Does My Asthma Act Up at Night?

For reasons we don’t fully understand, uncontrolled asthma — with its underlying inflammation — often acts up at night. It probably has to do with natural body rhythms and changes in your body’s hormones, as well as the fact that some symptoms appear hours after you come in contact with a trigger. The important thing to know about nighttime asthma is that, working with your doctor, you should be able to sleep through the night.

The Role of Heredity in Asthma.

Like baldness, height and eye color, the capacity to have asthma is an inherited characteristic. Yet, although you may be born with the genetic capability to have asthma, asthma symptoms do not automatically appear. We do not know for certain why some people get asthma and others do not. However, doctors doing research have found that certain traits make it more likely that a person will develop asthma.

Heredity. To some extent, asthma seems to run in families. People whose brothers, sisters or parents have asthma are more likely to develop the illness themselves.

Atopy. A person is said to have atopy (or to be atopic) when he or she is prone to have allergies. For reasons that are not fully known, some people seem to inherit a tendency to develop allergies. This is not to say that a parent can pass on a specific type of allergy to a child. In other words, it doesn’t mean that if your mother is allergic to bananas, you will be too. But you may develop allergies to something else, like pollen or mold.
In addition, several factors must be present for asthma symptoms to develop:

Specific genes must be acquired from parents.
Exposure to allergens or triggers to which you have a genetically programmed response.
Environmental factors such as quality of air, exposure to irritants, behavioral factors such as smoking, etc.

What’s causes asthma?

No one knows exactly what causes asthma. It is not even clear whether asthma is one disorder or a group of disorders with similar manifestations. Still, much has been learned about who is most likely to develop asthma and how an asthma attack occurs. To put it simply, a person becomes susceptible to developing asthma because of genes, but develops the disorder only after exposure to things in the environment that stimulate the immune system in such a way that the airways become inflamed and prone to attacks.

A simple example may help explain how genetic and environmental factors can interact to produce asthma. Suppose you inherit a tendency to be allergic to cockroaches. After many years of living in a single-family house, you move to an apartment complex. The good news is that you don’t have to mow the lawn anymore — but you may also find yourself living with cockroaches for the first time in your life. This can lead over time to an allergic irritation of your bronchial tubes. Once irritated or inflamed in this way, your bronchial tubes react not only to cockroaches but also to many other types of stimuli that typically make asthma worse, such as smoke, exercise, and respiratory infections. After many months or years of exposure, even if you move out of the apartment into one that doesn’t have a cockroach problem, this hypersensitivity of your airways — in other words, your asthma — may persist.

It has long been known that people inherit a tendency to develop asthma. The condition tends to run in families; if your brothers, sisters, or parents have asthma, you are more likely to develop it yourself.

The genetic contribution to asthma is far from simple, however. It’s almost certain that a number of genes are responsible for the predisposition to asthma, and that these genes somehow interact to produce the disorder. Yet even if you are born with the genes predisposing you to asthma, you may never go on to develop the disease. This has been shown by studies of identical twins, who share the same genes. When one identical twin develops asthma, there is only a one in three chance that the other twin will develop it as well. Clearly, something in the environment must also be responsible for asthma.

Scores of asthma-related genes have been discovered, and this knowledge is helping to expand avenues of asthma research. Still other asthma genes are thought to exist, and it is unclear yet which ones are most significant. The research in this area continues, with the hope that better understanding of the genetic basis of asthma will lead to better treatments and potentially even a cure.

Asthma – Environmental factors

It is likely that inhaled substances are the most important environmental factors contributing to the development of asthma in people with a genetic predisposition to the disorder. The leading suspects are allergens (substances that cause an allergic reaction; see “The allergy connection”). Other potential culprits include tobacco smoke, air pollution, and infectious agents such as viruses and mycoplasma. Asthma most often develops during childhood following exposure to one or more of these environmental factors, but it can also develop in adulthood.

Adults who smoke, who are exposed to irritating chemicals in the workplace, or who suffer a particularly nasty respiratory infection may develop asthma. A number of specific occupations can expose workers to agents that can trigger asthma (see “Selected causes of occupational asthma”). Hormone replacement therapy in menopausal women is another risk factor: The Nurses’ Health Study, a large epidemiological study that has collected information about women’s health issues since 1976, found that menopausal women who were currently using or who had used estrogen replacement therapy had a 50% greater risk of developing asthma than those who did not take hormones. In addition, a study of more than 2,000 women found that hormone replacement therapy may increase women’s risk of asthma and wheezing, particularly if they are lean. Often, however, there is no identifiable cause of adult-onset asthma. In some cases, the problem may have been present in childhood but was undiagnosed, or it may have been present in childhood, become dormant around adolescence, then resurfaced in adulthood.

The allergy connection

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When most people think of allergies, they’re likely to think of sneezing and a runny or stuffy nose; red, itchy, watery eyes; or perhaps dry, red, itchy skin. But one theory about asthma is that it is also an allergic reaction — in this case, affecting the bronchial tubes.

In fact, allergic rhinitis (allergies of the nose), allergic conjunctivitis (allergies of the lining of the eyes), and allergic dermatitis (allergies of the skin, also called eczema) frequently occur together in various combinations both in individuals and in families, and they often occur together with asthma.

All these conditions share a common mechanism: They result from a specific type of allergic reaction. The tendency to have this specific type of allergic reaction is called atopy, and people who have this tendency are said to be atopic. Asthma accompanied by allergies is often referred to as atopic asthma or extrinsic asthma. The vast majority of children with asthma, and probably at least half of the adults with the disorder, have the atopic variety.

The allergic basis of asthma has provided insight into which proteins and cells are involved in the inflammation of the bronchial tubes. People who have allergies make a special kind of protein, called an antibody, that is precisely shaped to recognize and attach itself firmly to a particular allergen. This antibody belongs to the family of immune defenders called immunoglobulins. The defenders that are specifically designed to recognize allergens are referred to as immunoglobulin E (IgE). Let’s say you are allergic to dust mites; you make IgE antibodies that recognize the dust mite allergen.

Allergic asthma

The IgE antibodies do not roam freely in your breathing tubes but are firmly attached to immune system cells called mast cells. These cells are located mainly in parts of the body that regularly encounter substances from the outside world: the skin, intestinal tract, lining of the eye (conjunctiva), nose, and breathing tubes.

In people with allergic asthma, the surface of each mast cell is coated with firmly attached IgE antibodies. All remains quiet until the IgE antibodies recognize and attach themselves to an allergen. Then, within seconds, an explosive reaction takes place (see Figure 3). The mast cell makes and releases a barrage of chemicals that carry out the inflammatory reaction. These chemicals include histamine (which you may be aware of if you are familiar with antihistamines for treating allergies), leukotrienes, and many others.

Together these inflammatory chemicals cause blood vessels to leak fluid, producing swelling in the breathing tubes. They stimulate the walls of the breathing tubes to secrete mucus. They also make the muscles surrounding the breathing tubes contract, narrowing these passageways. As if that weren’t enough, mast cells also call in reinforcements, other cells involved in allergic inflammation that travel from the blood to the site of the allergic reaction and make things worse. The most important of these reinforcements are blood cells called eosinophils. Like mast cells, they release chemicals that cause the airways to narrow.

Chronic inflammation
In asthma, the allergic inflammatory process never really stops. An important medical discovery was that some inflammation is present in the bronchial tubes of people with asthma even when they feel well and when their breathing is normal. Medical researchers performed experiments in people with asthma to sample (biopsy) small pieces of the walls of the bronchial tubes. The samples were taken at times when the research participants were free of asthma symptoms. Yet in the biopsied tissues, scientists found evidence of persistent inflammation of the bronchial tubes.

This suggests that airway inflammation in asthma is always present, at least to some degree. The inflammation may be so mild that it does not cause narrowing of the bronchial tubes. But the persistent presence of this inflammation is probably a major reason that the bronchial tubes are twitchy, or capable of narrowing abnormally.

Why is asthma so common?

“Asthma” used to be on the increase in the United States (see “Asthma in America”), but its prevalence has stabilized. Despite this good news, official estimates of asthma prevalence may not truly reflect how many people really have the disease, because studies have shown that there are many people with undiagnosed asthma.

According to the Global Initiative on Asthma, more than 10% of the people in North America, Australia, and much of South America have asthma, compared with fewer than 2.5% in the former Soviet Union and much of Asia. The higher prevalence of asthma in urban versus rural environments, and in westernized versus developing countries, has made researchers wonder if some lifestyle factor has contributed to the dramatic increase of allergies and asthma in the industrialized world. Several hypotheses have been developed, although there remains no consensus about what may have caused the increase.

Air pollution. This would seem an obvious culprit for the increase in asthma in industrialized nations, since air pollution can trigger an asthma attack, but this popular explanation for the increase in asthma does not hold up under close examination. When Germany became a unified country again in 1990, researchers compared asthma prevalence in the former East Germany and West Germany. The expectation was that asthma would be more common among people living in the highly polluted East German cities. In fact, just the opposite was true: Asthma turned out to be more common in West Germany, indicating that something other than air pollution must be responsible.

Increased exposure to allergens. Another theory holds that modern urban life is exposing young children more to common household allergens and making them more susceptible to allergy-related asthma. As a rule, people are much more likely than their parents and grandparents to live in the city and spend much of the time indoors, in close quarters with dust mites, cockroaches, and animal hair (from either pets or pests). Television, computers, and video games have seduced people into staying inside even more. To further complicate matters, home insulation was upgraded in response to the energy crisis of the 1970s, so that houses and apartments today tend to be more tightly sealed. The result is far less circulation of fresh air and greater exposure to higher concentrations of allergens.

The hygiene theory. According to this hypothesis, the immune systems of children who are exposed to lots of important infections and toxins early in life tend to ignore less serious challenges, such as those from allergens like pollen and dog dander. But when children grow up in a germ-free environment, they are exposed to relatively fewer serious infections, and the immune system has more “free time” to direct its attention against harmless allergens. So the good news is that serious infections such as tuberculosis and whooping cough are much less common than they used to be. The bad news, according to the hygiene theory, is that children’s immune systems are more likely to react in a way that causes allergic diseases, including asthma.

Several major medical studies have supported the hygiene hypothesis. For instance, infants who go to day care or have older siblings are less likely to develop asthma later in childhood than those who don’t attend day care or have siblings. Because they are more frequently exposed to other children, the infants who go to day care and have older siblings are naturally exposed to more germs. Similarly, children living in farming communities with close contact with farm animals are less likely than others to develop asthma (and their risk decreases the more they are exposed to toxins from animal droppings). It may be that their developing immune systems learn to focus on germs and toxins and to ignore allergens, thereby decreasing the likelihood of allergies and asthma later in childhood.

Obesity. Yet another theory about the increase in asthma is that it is linked to being overweight. Obesity is common in the United States and has increased since the 1970s. Being overweight raises the risk for heart disease, diabetes, and other diseases. Findings from several studies suggest that asthma can also be added to the list of obesity-related illnesses. In one study, researchers looked at more than 7,000 children, ages 4 to 17, and found that those who were overweight were almost twice as likely to develop asthma as normal-weight children. Another study found that women who are overweight have an increased risk of asthma, wheezing, and allergy. The exact connection between asthma and weight is unknown, but one simple explanation is that excess weight places pressure on the chest, which contributes to constriction of the airways.

asthma

“Asthma” is a lung condition that afflicts 23 million people in the United States, including more than 6 million children. In asthma, the bronchial tubes, the passages that bring air into the lungs, become swollen and inflamed. The swelling can cause coughing, wheezing (a type of breathing characterized by a whistling noise during inhale or exhale), shortness of breath, and difficulty breathing.

What causes asthma? Experts aren’t exactly sure, but they do know that a combination of genetics and a sensitivity to certain triggers such as allergens, infections, secondhand smoke, and even exercise can lead to asthma. And they know for certain that you can’t catch asthma from someone else—it’s not a communicable disease.

What is “asthma”?

Asthma makes it hard for your child to breathe. It causes swelling and inflammation Click here to see an illustration. in the airways that lead to the lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for your child to breathe. These flare ups are also called asthma attacks or exacerbations.

Asthma affects children in different ways. Some children only have asthma attacks during allergy season, when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.

Even if your child has few asthma attacks, you still need to treat the asthma. If the swelling and irritation in your child’s airways isn’t controlled, asthma could lower your child’s quality of life, prevent your child from exercising, and increase your child’s risk of going to the hospital.

Even though asthma is a lifelong disease, treatment can control it and keep your child healthy. Many children with asthma play sports and live healthy, active lives.
What causes asthma?

Experts do not know exactly what causes asthma. But there are some things we do know:

* Asthma runs in families.
* Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies.
* Pollution may cause asthma or make it worse.

What are the symptoms?

Symptoms of asthma can be mild or severe. When your child has asthma, he or she may:

* Wheeze, making a loud or soft whistling noise that occurs when the airways narrow.
* Cough a lot.
* Feel tightness in the chest.
* Feel short of breath.
* Have trouble sleeping because of coughing and wheezing.
* Quickly get tired during exercise.

Many children with asthma have symptoms that are worse at night.
How is asthma diagnosed?

Along with doing a physical exam and asking about your child’s symptoms, your doctor may order tests such as:

* Spirometry. Doctors use this test to diagnose and keep track of asthma in children age 5 and older. It measures how quickly your child can move air in and out of the lungs and how much air is moved. Spirometry is not used with babies and small children. In those cases, the doctor usually will listen for wheezing and will ask how often the child wheezes or coughs.
* Peak expiratory flow (PEF). This shows how fast your child can breathe out when trying his or her hardest.
* A chest X-ray to see if another disease is causing your child’s symptoms.
* Allergy tests, if your doctor thinks your child’s symptoms may be caused by allergies.

Your child needs routine checkups so your doctor can keep track of the asthma and decide on treatment.
How is it treated?

There are two parts to treating asthma. The goals are to:

* Control asthma over the long term. To do this, use a daily asthma treatment plan. This is a written plan that tells you which medicine your child needs to take. It also helps you track your child’s symptoms and know how well the treatment is working. Many children take controller medicine—usually an inhaled corticosteroid—every day. Taking controller medicine every day helps reduce the swelling of the airways and prevent attacks.
* Treat asthma attacks when they occur. Use an asthma action plan, which tells you what to do when your child has an asthma attack. It helps you identify triggers that can cause your child’s attacks. Your child will use quick-relief medicine, such as albuterol, during an attack.

Using an inhaler with a spacer Click here to see an illustration. is the best way to get the most medicine to your child’s lungs. But your child has to use the inhaler correctly for it to work well. If you are not sure how to use the inhaler the right way, ask your doctor to show you how.

If your child needs to use the quick-relief inhaler more often than usual, talk to your doctor. This is a sign that your child’s asthma is not controlled and can cause problems.

Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your child’s asthma treatment and action plans.
What else can you do to help your child’s asthma?

You can prevent some asthma attacks by helping your child avoid those things that cause them. These are called triggers. A trigger can be:

* Irritants in the air, such as cigarette smoke or other air pollution. Try not to expose your child to tobacco smoke.
* Things your child is allergic to, such as pet dander, dust mites, cockroaches, or pollen. Taking certain types of allergy medicines may help your child.
* Exercise. Ask your doctor about using an inhaler before exercise if this is a trigger for your child’s asthma.
* Other things like dry, cold air; an infection; or some medicines, such as aspirin. Try not to have your child exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections, and ask about what medicines your child should avoid.

It can be scary when your child has an asthma attack. You may feel helpless, but having a daily treatment plan and an asthma action plan will help you know what to do during an attack. An asthma attack may be severe enough to need urgent medical care, but in most cases you can take care of symptoms at home if you have a good asthma action plan.
Asthma can be managed with a variety of medications, and by avoiding triggers such as pollen, pets, or other allergens.

Asthma

What Is Asthma?
Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. 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 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.

Overview
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.

Outlook
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.

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When a person with asthma comes into contact with something that irritates their airways (an asthma trigger), the muscles around the walls of the airways tighten so that the airways become narrower and the lining of the airways becomes inflamed and starts to swell. Sometimes sticky mucus or phlegm builds up which can further narrow the airways. The illustration on the right shows a cross section of the airways, with and without inflammation.

All these reactions cause the airways to become narrower and irritated – making it difficult to breath and leading to symptoms of asthma.

5.4m people in the UK are currently receiving treatment for asthma.
1.1m children in the UK are currently receiving treatment for asthma.
There is a person with asthma in one in five households in the UK.

What is Asthma – Video

Asthma is a disease affecting the airways that carry air to and from your lungs. People who suffer from this chronic condition (long-lasting or recurrent) are said to be asthmatic.

The inside walls of an asthmatic’s airways are swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to irritations and increases your susceptibility to an allergic reaction.

As inflammation causes the airways to become narrower, less air can pass through them, both to and from the lungs. Symptoms of the narrowing include wheezing (a hissing sound while breathing), chest tightness, breathing problems, and coughing. Asthmatics usually experience these symptoms most frequently during the night and the early morning.

Asthma Statistics
More than 22 million people — and some 6 million children — have asthma. Everyday in the United States:

•40,000 people will miss school or work because of asthma
•30,000 people will have an asthma attack
•5,000 people will visit the emergency room because of their asthma
•1,000 people will be admitted to the hospital because of asthma
•11 people will die due to asthma

Asthma Definition
Asthma is a chronic lung disease that causes episodes of difficult breathing. This is primarily due to constriction, tightening of the muscles surrounding the airways, and inflammation, soreness, swelling and irritation of the airways in the lungs.

Asthma?
Have you, or someone you know, been diagnosed with asthma? If so, you probably have lots of questions.

You may wonder, for example, just what asthma is. The medical definition of asthma is simple, but the condition itself is quite complex.

Doctors define asthma as a “chronic inflammatory disease of the airway” that causes the following symptoms:

Shortness of breath
Tightness in the chest
Coughing
Wheezing
Asthma has no set pattern. Its symptoms:

Can be mild, moderate or severe
Can vary from person to person
Can flare up from time to time and then not appear for long periods
Can vary from one episode to the next
The cause of asthma is not known, and currently there is no cure. However, there are many things you can do so you can live symptom-free.

Breathing: Normal Airway Versus Asthma Airway
In someone with normal lung function, air is inhaled through the nose and mouth. It passes through the trachea (also called the windpipe) before moving into the bronchi (large airways), which are branching tubes leading away from the trachea. The bronchi branch into smaller and smaller tubes, ending in many small sacs called alveoli. It’s in the alveoli that oxygen, which the body needs, is passed to the blood, while carbon dioxide, which the body doesn’t, is removed from it.

People with asthma often have trouble breathing when they’re in the presence of what are called “triggers.” When someone with asthma has asthma symptoms, it means that the flow of air is obstructed as it passes in and out of the lungs. This happens because of one or both of the following:

The lining of the airways becomes inflamed (irritated, reddened and swollen), and may produce more mucous. The more inflammation the more sensitive the airway becomes, and the more symptoms.
The muscles that surround the airways become sensitive and start to twitch and tighten, causing the airways to narrow. This usually occurs if the inflammation is not treated.
Both of these factors cause the airways to narrow, making it difficult for air to pass in and out of them.

The airways of someone with asthma are inflamed, to some degree, all the time. The more inflamed the airway the more sensitive the airway becomes. This leads to an increase in breathing difficulty.

Asthma Can Affect Anyone
Asthma is a chronic condition, meaning it needs to be monitored and controlled over a lifetime.

Anyone can get asthma, although it’s usually first diagnosed in young people. Currently, about three million Canadians have asthma.