Asthma

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

Causes

Asthma is caused by inflammation (swelling) in the airways. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight.

This reduces the amount of air that can pass through the airway.

Common asthma triggers include:

Animals (pet hair or dander)
Dust mites
Certain medicines (aspirin and other NSAIDS)
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

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.

In persons who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens or triggers.

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 blocked.

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

Emergency symptoms that need prompt medical help:

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

Other symptoms that may occur:

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

Exams and Tests:

Tests that may be ordered include:

Allergy testing – skin or a blood test to see if a person with asthma is allergic to certain substances
Arterial blood gas (usually only done with patients who are having a severe asthma attack)
Chest x-ray
Lung function tests, including peak flow measurements

Treatment:

The goals of treatment are:

Control airway swelling
Stay away from substances that trigger your symptoms
Help you to be able to do normal activities without asthma symptoms

You and your doctor should work as a team to manage your asthma. Follow your doctor’s instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms.

Common Asthma Medications Include:

There are two kinds of medicines for treating asthma:

Control medicines to help prevent attacks
Quick-relief (rescue) medicines for use during attacks

Long-term Medicines

These are also called maintenance or control medicines. They are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel OK.

Some long-term medicines are breathed in (inhaled), such as steroids and long-acting beta-agonists. Others are taken by mouth (orally). Your doctor will prescribe the right medicine for you.

Quick-relief Medicines

These are also called rescue medicines. They are taken:

For coughing, wheezing, trouble breathing, or an asthma attack
Just before exercising to help prevent asthma symptoms caused by exercise

Tell your doctor if you are using quick-relief medicines twice a week or more. Your asthma may not be under control and your doctor may need to change your dose of daily control drugs.

Quick-relief medicines include:

Short-acting inhaled bronchodilators
Oral corticosteroids for when you have an asthma attack that is not going away

A severe asthma attack requires a checkup by a doctor. You may also need a hospital stay. There, you will likely be given oxygen, breathing assistance, and medications given through a vein (IV).

Asthma At Home Care

Know the asthma symptoms to watch for.
Know how to take your peak flow reading and what it means.
Know which triggers make your asthma worse and what to do when this happens.

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

Instructions for taking asthma medicines 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 symptoms appear. Peak flow measurements help let you know when you need to take medicine or other action.
Peak flow values of 50% – 80% of your best results are a sign of a moderate asthma attack. Numbers below 50% are a sign of a severe attack.

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.

Possible Complications:

The complications of asthma can be severe, and may 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)

Contact a Medical Professional If:

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 medicine 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 these symptoms occur:

- Drowsiness or confusion
- Severe shortness of breath at rest
- A peak flow measurement of 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 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. Body parts and droppings from cockroaches 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. Change the filter in furnaces and air conditioners often.
Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help someone 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. If you smoke, now is a good time to quit.
Avoid air pollution, industrial dust, and irritating fumes as much as possible.

References

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;126:466-76.

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

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. Available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed May 14, 2014.

Nowak RM, Tokarski GF. Asthma. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 71.