Asthma

Answer 1

Definition

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

See also: Pediatric asthma

Alternative Names

Bronchial asthma; Exercise-induced asthma

Causes, incidence, and risk factors

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

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

In sensitive individuals, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).

Common asthma triggers include:

• Animals (pet hair or dander)
• Dust
• Changes in weather (most often cold weather)
• Chemicals in the air or in food
• Exercise
• Mold
• Pollen
• Respiratory infections, such as the common cold
• Strong emotions (stress)
• Tobacco smoke

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) provoke asthma in some patients.

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

Symptoms

• Cough with or without sputum (phlegm) production
• Pulling in of the skin between the ribs when breathing (intercostal retractions)
• Shortness of breath that gets worse with exercise or activity
• Wheezing
  • Comes in episodes
  • May be worse at night or in early morning
  • May go away on its own
  • Gets better when using drugs that open the airways (bronchodilators)
  • Gets worse when breathing in cold air
  • Gets worse with exercise
  • Gets worse with heartburn (reflux)
  • Usually begins suddenly

Emergency symptoms:

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

Additional symptoms that may be associated with this disease:

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

Signs and tests

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

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

Tests may include:

• Arterial blood gas
• Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin)
• Chest x-ray
• Lung function tests
• Peak flow measurements

Treatment

The goal of treatment is to avoid the substances that trigger your symptoms and to control airway inflammation. You and your doctor should work together as a team to develop and carry out a plan for eliminating asthma triggers and monitoring symptoms.

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

• Long-acting medications to prevent attacks
• Quick-relief medications for use during attacks

Long-term control medications are used on a regular basis to prevent attacks, not to treat them. Such medicines include:

• Inhaled corticosteroids (such as Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation
• Leukotriene inhibitors (such as Singulair and Accolate)
• Long-acting bronchodilators (such as Serevent) help open airways
• Omilizumab (Xolair), which blocks a pathway that the immune system uses to trigger asthma symptoms
• Cromolyn sodium (Intal) or nedocromil sodium (Tilade)
• Aminophylline or theophylline (not used as frequently as in the past)
• Sometimes a single medication that combines steroids and bronchodilators are used (Advair, Symbicort)

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

• Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, Xopenex, and others
• Corticosteroids, such as methylprednisolone, may be given directly into a vein (intravenously), during a severe attack, along with other inhaled medications

People with mild asthma (infrequent attacks) may use quick relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent symptoms. A severe asthma attack requires a check up by a doctor and, possibly, a hospital stay, oxygen, and medications through a vein (IV).

A peak flow meter is a simple device to measure how quickly you can move air out of your lungs. It can help you see if an attack is coming, sometimes even before any symptoms appear. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of a specific person's best results are a sign of a moderate asthma attack, while values below 50% are a sign of a severe attack.

Support Groups

The stress caused by illness can often be helped by joining a support group, where members share common experiences and problems.

See: Asthma and allergy - support group

Expectations (prognosis)

There is no cure for asthma, although symptoms sometimes improve over time. With proper self management and medical treatment, most people with asthma can lead normal lives.

Complications

The complications of asthma can be severe. Some include:

• Death
• Decreased ability to exercise and take part in other activities
• Lack of sleep due to nighttime symptoms
• Permanent changes in the function of the lungs
• Persistent cough
• Trouble breathing that requires breathing assistance (ventilator)

Calling your health care provider

Call for an appointment with your health care provider if asthma symptoms develop.

Call your health care provider or go to the emergency room if:

• An asthma attack requires more medication than recommended
• Symptoms get worse or do not improve with treatment
• You have shortness of breath while talking
• Your peak flow measurement is 50-80% of your personal best

Go to the emergency room if:

• Drowsiness or confusion develops
• There is severe shortness of breath at rest
• The peak flow measurement is less than 50% of your personal best
• You have severe chest pain

Prevention

Asthma symptoms can be substantially reduced by avoiding known triggers and substances that irritate the airways.

Bedding can be covered with "allergy proof" casings to reduce exposure to dust mites. Removing carpets from bedrooms and vacuuming regularly is also helpful. Detergents and cleaning materials in the home should be unscented.

Keeping humidity levels low and fixing leaks can reduce growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people.

If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the patient's bedroom. Filtering material can be placed over the heating outlets to trap animal dander.

Eliminating tobacco smoke from the home is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma symptoms.

Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes, as much as possible.

References

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publication 08-4051.

Answer 2

Asthma is a complex reactive airway condition which demands serious attention.

The nature of this restrictive respiratory disease make it important to have a thorough assessment and an asthma plan in place in the event of an airway emergency.

The fact is that the brain begins to die after only one minute of oxygen deprivation, serious brain damage occurs after just 3 minutes, and in 15 minutes there is virtually no chance for recovery.

Answer 3

Definition

Asthma is a disorder that causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing.

See also:

• Pediatric asthma
• Work-related asthma

Alternative Names

Bronchial asthma; Exercise-induced asthma

Causes, incidence, and risk factors

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

In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).

Common asthma triggers include:

• Animals (pet hair or dander)
• Dust
• Changes in weather (most often cold weather)
• Chemicals in the air or in food
• Exercise
• Mold
• Pollen
• Respiratory infections, such as the common cold
• Strong emotions (stress)
• Tobacco smoke

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) provoke asthma in some patients.

Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.

Symptoms

Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom.

Asthma attacks can last for minutes to days, and can become dangerous if the airflow is severely restricted.

Symptoms include:

• Cough with or without sputum (phlegm) production
• Pulling in of the skin between the ribs when breathing (intercostal retractions)
• Shortness of breath that gets worse with exercise or activity
• Wheezing, which:
  • Comes in episodes with symptom-free periods in between
  • May be worse at night or in early morning
  • May go away on its own
  • Gets better when using drugs that open the airways (bronchodilators)
  • Gets worse when breathing in cold air
  • Gets worse with exercise
  • Gets worse with heartburn (reflux)
  • Usually begins suddenly

Emergency symptoms:

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

Other symptoms that may occur with this disease:

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

Signs and tests

Allergy testing may be helpful to identify allergens in people with persistent asthma. Common allergens include:

• Cockroach allergens
• Dust mites
• Molds
• Pet dander
• Pollens

Common respiratory irritants include:

• Fumes from burning wood or gas
• Pollution
• Tobacco smoke

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

Tests may include:

• Arterial blood gas
• Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin)
• Chest x-ray
• Lung function tests
• Peak flow measurements

Treatment

The goal of treatment is to avoid the substances that trigger your symptoms and control airway inflammation. You and your doctor should work together as a team to develop and carry out a plan for eliminating asthma triggers and monitoring symptoms.

For information on treating asthma in children, see: Pediatric asthma

There are two basic kinds of medication for treating asthma:

• Control drugs to prevent attacks
• Quick-relief drugs for use during attacks

Control drugs for asthma control your symptoms if you don't have mild asthma. You must take them every day for them to work. Take them even when you feel okay.

The most common control drugs are:

• Inhaledcorticosteroids (such as Asmanex, Alvesco, Qvar AeroBid, Flovent, Pulmicort) prevent symptoms by helping to keep your airways from swelling up.
• Long-acting beta-agonist inhalers also help prevent asthma symptoms. Do not take long-acting beta-agonist inhaler drugs alone. These drugs are almost always used together with an inhaled steroid drug. It may be easier to use an inhaler that contains both drugs.

Other control drugs that may be used are:

• Leukotriene inhibitors (such as Singulair and Accolate)
• Omalizumab (Xolair)
• Cromolyn sodium (Intal) or nedocromil sodium (Tilade)
• Aminophylline or theophylline (rarely used anymore)

Quick-relief drugs work fast to control asthma symptoms:

• You take them when you are coughing, wheezing, having trouble breathing, or having an asthma attack. They are also called "rescue" drugs.
• They also can be used just before exercising to help prevent asthma symptoms that are caused by exercise.
• Tell your doctor if you are using quick-relief medicines twice a week or more to control your asthma symptoms. Your asthma may not be under control, and your doctor may need to change your dose of daily control drugs.

Quick-relief drugs include:

• Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, and Xopenex
• Your doctor might prescribe oral steroids (corticosteroids) when you have an asthma attack that is not going away. These are medicines that you take by mouth as pills, capsules, or liquid. Plan ahead. Make sure you do not run out of these medications.

A severe asthma attack requires a check-up by a doctor. You may also need a hospital stay, oxygen, breathing assistance, and medications given through a vein (IV).

ASTHMA CARE AT HOME

• Self-care skills that are important in taking care of your asthma are
• Know the asthma symptoms to watch out for
• Know how to take your peak flow reading and what it means
• Keep the phone number of your child's doctor or nurse with you.
• Know which triggers make your asthma worse and what to do when this happens.
• Children with asthma need a lot of support at school. They may need help from school staff to keep their asthma under control and to be able to do school activities.

Asthma action plans are written documents for anyone with asthma. An asthma action plan should include:

• A plan for taking asthma medications when your condition is stable
• A list of asthma triggers and how to avoid them
• How to recognize when your asthma is getting worse, and when to call your doctor or nurse

A peak flow meter is a simple device to measure how quickly you can move air out of your lungs.

• It can help you see if an attack is coming, sometimes even before any symptoms appear. Peak flow measurements can help show when medication is needed, or other action needs to be taken.
• Peak flow values of 50% - 80% of a specific person's best results are a sign of a moderate asthma attack, while values below 50% are a sign of a severe attack.

Support Groups

You can often ease the stress caused by illness by joining a support group, where members share common experiences and problems.

See: Asthma and allergy - support group

Expectations (prognosis)

There is no cure for asthma, although symptoms sometimes improve over time. With proper self management and medical treatment, most people with asthma can lead normal lives.

Complications

The complications of asthma can be severe. Some include:

• Death
• Decreased ability to exercise and take part in other activities
• Lack of sleep due to nighttime symptoms
• Permanent changes in the function of the lungs
• Persistent cough
• Trouble breathing that requires breathing assistance (ventilator)

Calling your health care provider

Call for an appointment with your health care provider if asthma symptoms develop.

Call your health care provider or go to the emergency room if:

• An asthma attack requires more medication than recommended
• Symptoms get worse or do not improve with treatment
• You have shortness of breath while talking
• Your peak flow measurement is 50% - 80% of your personal best

Go to the emergency room if the following symptoms occur:

• Drowsiness or confusion
• Severe shortness of breath at rest
• A peak flow measurement is less than 50% of your personal best
• Severe chest pain
• Bluish color to the lips and face
• Extreme difficulty breathing
• Rapid pulse
• Severe anxiety due to shortness of breath

Prevention

You can reduce asthma symptoms by avoiding known triggers and substances that irritate the airways.

• Cover bedding with "allergy-proof" casings to reduce exposure to dust mites.
• Remove carpets from bedrooms and vacuum regularly.
• Use only unscented detergents and cleaning materials in the home.
• Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold.
• Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people.
• If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander.
• Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma symptoms.

Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes as much as possible.

References

Lugogo N, Que LG, Fertel D, Kraft M. Asthma. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 38.

Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010 Sep;126(3):466-76.

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publication 08-4051.

Wechsler ME. Managing asthma in primary care: putting new guideline recommendations into context. Mayo Clin Proc. 2009;84:707-717.

Fanta CH. Asthma. N Engl J Med. 2009;360:1002-1014.

Reviewed By

Review Date: 05/01/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA.

Answer 4

Breathing is something we do without even thinking about it. But some people have a hard time breathing easily. They wheeze, cough, and just can't get enough air into their lungs. Let's talk about asthma.

Normally when you breathe, oxygen-rich air enters your nose and mouth and travels to the airways in your lungs. But when you have an asthma attack, the muscles in your airways tighten. Your airways swell up and get narrower. It's like pressing on a straw when you're trying to drink through it. The more you press, the less of your drink can squeeze up through the straw. In the same way, less air can squeeze through tight airways into your lungs.

So, what causes asthma?

People with asthma have different triggers. Some people are sensitive to pet hair or dander. Others find that dust, pollen, smoke, or chemicals make them wheeze. You may have trouble breathing when you're under stress or working out at the gym.

Often people with asthma have allergies that trigger their attacks. Others have a parent or other relative who has allergies.

You may ask, ow can you know for sure that you have asthma?

During an asthma attack, you'll have trouble breathing. You may cough or wheeze as you try to draw air into your lungs. If you're having a severe attack, your lips and face may turn blue and you'll have a hard time getting any air. That's when it's time to call for emergency help.

Your doctor will listen to your lungs with a stethoscope, and may do other tests to check your blood and lung function. To find out what's triggering your asthma, you may need to be tested for allergies to mold, pollen, pet dander, or other substances.

To measure the strength of air flowing out of your lungs, you'll blow into a device called a peak flow meter. You can also use a peak flow meter to make sure you're keeping your asthma under control.

Different medicines are used to prevent and treat asthma. Control drugs help you avoid asthma attacks, but you need to take them every day for them to work. You breathe in control drugs like Flovent, Singulair, and Pulmicort through an inhaler.

If you're having an asthma attack, you can take a quick-relief drug to control your wheezing. Examples of quick-relief drugs include short-acting inhaled drugs and steroid medicines that you take by mouth.

When you have asthma, you need to be prepared. Know your asthma triggers and try to avoid them. Carry an inhaler with you in case you have an asthma attack. If you ever have an attack that's so severe you can't breathe, call 911 or get emergency medical help.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 5

asthama symptoms differ from one person to another, but there are a few symptoms which are common to all., you can read more about it at above links