Asthma

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Asthma

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Alternative Names

bronchial asthma, reactive airway disease

Description

As you breathe in, air flows through your airways into the tiny air passageways in the lungs, known as the bronchioles, and then back out again. For people with asthma, it’s not that simple.
Asthma is a chronic condition in which inflammation in the airways causes tightness in the muscles surrounding the lungs and swelling in the lining of the air passages. When this happens, it becomes difficult for the person to efficiently move air in and out of the lungs.

For most people with asthma, symptom-free periods alternate with periods of inflammation. These inflammatory periods are known as asthma attacks. An attack can last for minutes or for days. When the airway becomes severely constricted, the condition can become dangerous or even fatal.

An asthma attack is characterized by shortness of breath accompanied by wheezing and coughing. In more severe cases, the nostrils may flair and the skin on the chest may retract between the ribs slightly. An asthma attack may resolve on it’s own, but it’s best to encourage the person to use a fast-acting bronchodilator to provide quick relief. If the person is in distress and a fast-acting medication is not available or if the fast-acting medication does not provide relief, seek emergency care immediately.

Causes

It’s unclear what causes asthma. Some people develop asthma as children while others develop adult-onset asthma. The disease does appear to run in families although it is possible to develop asthma with no family history.

Many individuals with asthma remain symptom-free until a trigger provokes an asthma attack. These triggers vary from person to person, but some of the most common triggers include:

  • Cigarette smoke
  • Pollen
  • Dust mites and cockroaches
  • Animal dander
  • Molds and other fungi
  • Chemical fumes
  • Heavy air pollution
  • Certain medications including aspirin and non-steroidal anti-inflammatories such as ibuprofen

Risk Factors

While asthma can strike anybody at any age, some factors do make a person more likely to develop the disease. Some of the known risk factors for developing asthma include:

  • Being overweight or obese
  • Genetic predisposition to asthma
  • Having an allergic hypersensitivity condition such as eczema, hay fever or allergic conjunctivitis

Studies have also shown that people who were born by caesarean section or who live with a higher-than-average stress level are also at an increased risk for developing asthma.

Symptoms

The defining characteristic of asthma is the asthma attack. The symptoms of a person suffering an asthma attack include:

  • A high-pitched whistling sound during breathing, known as wheezing
  • Coughing
  • Chest tightness
  • Nasal flaring
  • Difficulty breathing
  • Pulling in of the skin between the ribs, a condition known as intercostal retractions
  • Blueness of the lips
  • Fast pulse
  • Chest pain

Most of the time, these symptoms occur in the presence of an asthma attack, but a person with poorly controlled asthma may wheeze or cough even when they are not having an active attack.

An asthma attack can often come on quickly, and symptoms are often worse at night or in cold weather. While an attack may resolve itself, medication is typically needed to open the airways.

A person who is experiencing retractions, blue lips, chest pain or extreme difficulty breathing is in crisis and should receive emergency care immediately.

Tests and Exams

To diagnose asthma, a doctor will listen to the lungs using a stethoscope. The sounds produced by tight airways are distinctive and are a key diagnostic factor in asthma.

Lung function is tested using a spirometer, a device that measures the force of the air being moved in and out of the lungs. Some spirometers are manual while others are computerized. The person breaths in deeply and then exhales as hard as possible into the device, which then records both the maximum amount of air breathed in and out, called the forced vital capacity, and the most air that can be exhaled in one second, called the forced expiratory volume.

Diagnosis

The doctor will take into account the physical symptoms that are present, such as wheezing, coughing and signs of allergic reactions. A spirometry test will also be performed. If the value of the test is 80 percent or less of the expected range for the patient’s age, height, sex, and ethnicity, asthma is likely to be the diagnosis.

The doctor may perform other tests as well including x-rays and allergy tests to rule out other conditions that may cause asthma-like symptoms.

Treatment

Asthma treatment focuses on both environmental modifications to avoid triggers and medications to prevent and treat attacks.

Avoiding triggers can be challenging. It may have to mean giving up a beloved pet or avoiding areas where people smoke. It may be necessary to dust and vacuum the home more frequently or cover mattresses and pillows with allergen-free coverings. Allergy testing may be necessary to determine triggers, and it can be helpful to journal activities and symptoms to discover other triggers.

Medications to treat asthma fall into two categories:

  1. Long-acting preventive medications
  2. Short-acting medications

Long-acting medications are designed to prevent inflammation and must be used regularly to be effective. These medications are not appropriate for treating an acute asthma attack.

Some medications that are used to prevent asthma attacks from occurring are:

  • Inhaled corticosteroids (e.g. beclomethasone)
  • Long-acting bronchodilators (e.g. salmeterol)
  • Combination inhalers that combine long-acting bronchodilators with corticosteroids (e.g. fluticasone/salmeterol)
  • Leukotriene modifiers (e.g. montelukast)
  • Mast cell stabilizers (e.g. cromolyn)

Short-acting relief medications are intended for use in the case of an asthma attack. Taking the medication promptly can prevent an asthma attack from getting out of control and requiring emergency care.

Short-acting medications for the immediate relief of asthma include short-acting bronchodilators and corticosteroids. An albuterol inhaler is an example of a short-acting bronchodilator. Corticosteroids such as prednisone may be used during a period of exacerbation to control symptoms. They may also be given intravenously during a serious attack.

Prognosis

Asthma is a chronic condition that requires lifetime maintenance and monitoring. In some cases, a child who is diagnosed with asthma may eventually “outgrow” the condition. The condition may go into periods of remission especially when good effort is made to remove environmental triggers.

Mild asthma is more likely to allow long symptom-free periods although the patient should remain aware that symptoms could return. Medication compliance may allow even those with more severe asthma to experience symptom-free periods.

Complications

Poorly controlled or untreated asthma can cause severe disruption in the patient’s life and daily activities. Some common complications include:

  • Missed work and school
  • Lost sleep
  • Missed social activities
  • Financial difficulties caused by frequent doctor or emergency room visits
  • Medication side effects

In those with severe persistent asthma, permanent damage to the lungs is possible. This may occur in approximately 10 percent of those cases even with aggressive treatment.

Prevention

Because the exact cause of asthma is unknown, prevention of the disease itself may not be possible. Once the disease has been diagnosed, however, the patient can take these steps to prevent acute asthma attacks, allowing for more symptom-free periods:

  • Creating an asthma action plan with their doctor and following it
  • Vaccinating against the flu and pneumonia
  • Identifying triggers and taking steps to avoid them
  • Taking preventive medication exactly as prescribed
  • Learning signs that an attack may be imminent and taking short-acting relief medication promptly

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