Asthma

What Is Asthma?

Asthma is a chronic disease of the airways that makes breathing difficult. With asthma, there is inflammation of the air passages that results in a temporary narrowing of the airways that carry oxygen to the lungs. This results in asthma symptoms, including coughing, wheezing, shortness of breath, and chest tightness. Some people refer to asthma as "bronchial asthma."

Even though there are seemingly miraculous treatments for asthma symptoms, asthma is still a serious -- even dangerous -- disease that affects more than 22 million Americans and causes nearly 2 million emergency room visits ever year. With proper asthma treatment, you can live well with this condition. Yet inadequate asthma treatment limits the ability to exercise and be active. Poorly controlled asthma can lead to multiple visits to the emergency room and even hospital admission, which can affect your performance at home and work.

In each of the following sections, there are in-depth articles that link to the topics. Be sure to read each health topic so you have a greater understanding of asthma and how it is diagnosed and treated.

There are three major features of asthma:

1. Airway obstruction. During normal breathing, the bands of muscle that surround the airways are relaxed, and air moves freely. But in people with asthma, allergy-causing substances and environmental triggers make the bands of muscle surrounding the airways tighten, and air cannot move freely. Less air causes a person to feel short of breath, and the air moving through the tightened airways causes a whistling sound known as wheezing.

(Fortunately, this airway narrowing is reversible, a feature that distinguishes asthma from other lung diseases such as bronchitis or emphysema.)

2. Inflammation. People with asthma have red and swollen bronchial tubes. This inflammation is thought to contribute greatly to the long-term damage that asthma can cause to the lungs. And, therefore, treating this inflammation is key to managing asthma in the long run.

3. Airway irritability. The airways of people with asthma are extremely sensitive. The airways tend to overreact and narrow due to even the slightest triggers such as pollen, animal dander, dust, or fumes.

Asthma Causes and Triggers

People with asthma have very sensitive airways that react to many different things in the environment called "asthma triggers." Contact with these triggers cause asthma symptoms to start or worsen. The following are common triggers for asthma:

• Infections such as sinusitis, colds, and flu
• Allergens such as pollens, mold spores, pet dander, and dust mites
• Irritants such as strong odors from perfumes or cleaning solutions, and air pollution
• Tobacco smoke
• Exercise, called exercise-induced asthma
• Weather; changes in temperature and/or humidity, cold air
• Strong emotions such as anxiety, laughter or crying, stress
• Medications, such as aspirin-sensitive asthma

No one really knows the causes of asthma. What we do know is that asthma is a chronic inflammatory disease of the airways. The causes of asthma symptoms can vary for different people. Still, one thing is consistent with asthma: when airways come into contact with an asthma trigger, the airways become inflamed, narrow, and fill with mucus.

When you have an asthma attack, spasms of the muscles around the airways, inflammation and swelling of the mucosal membrane lining the airways, and excessive amounts of mucus contribute to airway narrowing. This makes airway resistance increase and the work of breathing more difficult, causing shortness of breath, cough, and wheezing. You may have coughing with asthma because of the irritation inside the airway and the body's attempt to clean out the accumulations of thick mucus.

So why do you have asthma and your friend doesn't? No one really knows for sure. We do know that allergies play a role in many people with asthma but not in all. As with allergy, you can blame your family history, as there is a strong genetic component for asthma.
If you or a loved one has asthma, it's important to understand the many asthma triggers. Once you identify and reduce exposure to the specific triggers or causes of asthma, you can take an active role in controlling your asthma and reducing the frequency of asthma attacks. For example, if you find that allergies are the cause of your asthma, you may have allergic asthma. Being aware of allergies and avoiding them can significantly help in asthma prevention by reducing the frequency or severity of asthma attacks. Or if environmental pollution seems to cause your asthma, it's important to stay indoors during periods of heavy air pollution. Try to find the specific triggers or causes of your asthma, and then plan to avoid these triggers and have better asthma control.

Allergies Can Cause Asthma

Allergies with asthma is a common problem. Eighty percent of people with asthma have allergies to airborne substances such as tree, grass, and weed pollens, mold, animal dander, dust mites, and cockroach particles. In one study, children who had high levels of cockroach droppings in their homes were four times more likely to have childhood asthma than children whose homes had low levels. Asthma exacerbation after dust exposure is usually due to dust mite allergy.

Food and Food Additives Trigger Asthma

While it's not common for food allergies to cause asthma, food allergies can cause a severe life-threatening reaction. The most common foods associated with allergic symptoms are:

• Eggs
• Cow's milk
• Peanuts
• Soy
• Wheat
• Fish
• Shrimp and other shellfish
• Salads & fresh fruits

Food preservatives can also trigger asthma. Sulfite additives, such as sodium bisulfite, potassium bisulfite, sodium metabisulfite, potassium metabisulfite, and sodium sulfite, are commonly used in food processing or preparation and may trigger asthma in those people who are sensitive.

Exercise-Induced Asthma

Strenuous exercise can cause a narrowing of the airways in about 80% of people with asthma. In some people, exercise is the main trigger for their asthma symptoms. If you have exercise-induced asthma, you will feel chest tightness, coughing, and difficulty breathing within the first five to eight minutes of an aerobic workout. These symptoms usually subside in the next 20 to 30 minutes of exercise, but up to 50% of those with exercise-induced asthma may have another asthma attack six to 10 hours later.

Heartburn and Asthma

Severe heartburn and asthma often go hand-in-hand. Recent studies show that up to 89% of those with asthma also suffer from severe heartburn, known as gastroesophageal reflux disease (GERD). GERD generally occurs at night when the sufferer is lying down. Normally a valve between the esophagus and stomach prevents stomach acids from backing up into the esophagus. In GERD, the valve does not function properly. The stomach acids reflux, or back up, into the esophagus; if the acid reaches into the throat or airways the irritation and inflammation can trigger an asthma attack.
Certain clues that suggest reflux as the cause of asthma include the onset of asthma in adulthood, no family history of asthma, no history of allergies or bronchitis, difficult-to-control asthma, or coughing while lying down.
If your doctor suspects this problem, he or she may recommend specific tests to look for it.

Smoking and Asthma

People who smoke cigarettes are more likely to get asthma. If you smoke with asthma, it may make your symptoms such as coughing and wheezing worse. Women who smoke during pregnancy increase the risk of wheezing in their babies. Babies whose mothers smoked during pregnancy also have worse lung function than those whose mothers did not smoke. If you have asthma and you're a smoker, quitting is the most important step you can take to protect your lungs.

Sinusitis and Other Upper Respiratory Infections

Much like asthma causes inflammation in the lining of the airways, sinusitis causes inflammation in the mucous membranes that line the sinuses. This inflammation causes the mucous membranes in the sinuses to secrete more mucus -- also similar to asthma. When the sinuses get inflamed, the airways respond similarly in many people with asthma, leading to sinusitis with asthma. Prompt treatment of a sinus infection is often necessary to help relieve asthma symptoms.

Infections and Asthma

Cold, flu, bronchitis, and sinus infections can cause an asthma attack. These respiratory infections that trigger asthma can be viral or bacterial and are a common cause of asthma especially in children under age 10. This airway sensitivity that causes the airways to more easily narrow can last as long as two months after an upper respiratory infection. It's thought that anywhere from 20% to 70% of asthmatic adults have coexisting sinus disease. Conversely, 15% to 56% of those with allergic rhinitis (hay fever) or sinusitis have evidence of asthma.

Medications and Asthma

Many people with asthma have aspirin-sensitive asthma and it's possible they're sensitive to other medications such as anti-inflammatory drugs like ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), ketoprofen (Orudis) and beta-blockers (used to treat heart disease, high blood pressure, and glaucoma). If you know you're sensitive to these drugs, make sure your doctor has the problem documented on your chart, and always talk to your pharmacist about this reaction before taking a new medication.

Other Causes of Asthma

Irritants. Many irritants, including tobacco smoke, smoke from wood-burning appliances or fireplaces, strong odors from perfumes, cleaning agents, etc., are all irritants that can trigger asthma. In addition, air pollution, occupational dust or vapors can also trigger an attack.
Weather. Cold air, changes in temperature, and humidity can cause asthma.
Strong emotions. Stress and asthma are often seen together. Anxiety, crying, yelling, stress, anger, or laughing hard can trigger an asthma attack.

How Do Triggers Make Asthma Worse?

In people with asthma, the airways are always inflamed and very sensitive, so they react to a variety of external factors, or "triggers." Coming into contact with these triggers is what causes the symptoms of asthma -- the airways tighten and become inflamed, mucus blocks the airways and results in a worsening of asthma symptoms. An asthma attack can begin immediately after exposure to a trigger or several days or even weeks later.
There are many causes of asthma. Reactions to the causes of asthma are different for each person and vary from time to time. Certain causes of asthma may be harmless to some people but contribute to inflammation in others. Some people have many causes of their asthma while others have no identifiable ones. Recognizing and avoiding the specific causes of asthma, when possible, is an important way to control asthma. Keep in mind, however, that the best way to control is with asthma treatment and asthma drugs.

How Can I Tell What Causes and Triggers My Asthma?

Determining what factors were present when your asthma symptoms started is the first step to identifying the causes of your asthma. Although there are many different asthma triggers, you may not react to all of them. Some people have only one cause or trigger, while others have many causes.
Many causes of asthma can be identified through a history of reaction and skin or blood testing. Your doctor may also recommend using a device called a peak flow meter. The peak flow meter measures how much and how quickly air is exhaled from the lungs. It can alert you to changes in your breathing and the onset of asthma symptoms.
Ask your asthma doctor if using a peak flow meter would be helpful to you as you narrow down the causes of your asthma.

Asthma Attack

An asthma attack is a sudden worsening of symptoms. With an asthma attack, your airways tighten, swell up, or fill with mucus. Common symptoms include:

• Coughing, especially at night
• Wheezing (a high-pitched whistling sound when breathing out)
• Shortness of breath
• Chest tightness, pain, or pressure

What Is an Asthma Attack?

An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways (bronchospasm). During the asthma attack, the lining of the airways also becomes swollen or inflamed and thicker mucus -- more than normal -- is produced. All of these factors -- bronchospasm, inflammation, and mucus production -- cause symptoms of an asthma attack 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 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.
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.

Not every person with asthma has the same symptoms of an asthma attack. You may not have all of these symptoms, or you may have different symptoms at different times. Your symptoms may also vary from one asthma attack to the next, being mild during one attack and severe during another.

 

Adult-Onset Asthma

Asthma affects 22 million Americans. Asthma may occur at any age, although it's more common in younger individuals (under age 40).

People who have a family history of asthma have an increased risk of developing the disease. Allergies and asthma often occur together. Smoking with asthma, a dangerous combination, is still seen commonly.

However, anyone can develop asthma at any time, and adult-onset asthma happens frequently. If you have symptoms of asthma, talk to your doctor. If you have adult-onset asthma, your doctor will instruct you in using the asthma inhalers and other asthma medications to prevent further breathing problems.

Asthma in Children

Asthma is increasingly prevalent among children. Nearly one in 10 American children now has asthma, a sharp rise that still has scientists searching for a cause. An estimated 6.5 million children under age 18 (8.9%) are now diagnosed with the disease. The rate of childhood asthma has more than doubled since 1980, according to the CDC.

Asthma symptoms can vary from episode to episode in the same child. Signs and symptoms of asthma to look for include:

• Frequent coughing spells, which may occur during play, at nighttime, or while laughing. It's important to know that coughing with asthma may be the only symptom present.
• Less energy during play
• Rapid breathing
• Complaint of chest tightness or chest "hurting"
• Whistling sound when breathing in or out. This whistling sound is called wheezing.
• Seesaw motions in the chest from labored breathing. These motions are called retractions.
• Shortness of breath, loss of breath
• Tightened neck and chest muscles
• Feelings of weakness or tiredness