Asthma

    Definition

    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 during childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children. 3.5 million Blacks had asthma, and have the highest asthma prevalence of any racial/ethnic group (36 percent higher than that for Whites).

    • In 2009, about 2,380,000 African Americans reported that they currently have asthma.

    • African American women were 30% more likely to have asthma than non-Hispanic White women, from 2001-2003.

    • In 2007, African Americans were three times more likely to die from asthma related causes than the White population.

    • From 2003-2005, African American children had a death rate 7 times that of non-Hispanic White children.

    • African Americans had asthma-related emergency room visits 4.5 times more often than Whites in 2004.

    • Black children have a 260% higher emergency department visit rate, a 250% higher hospitalization rate, and a 500% higher death rate from asthma, as compared with White children.

    • Children in poor families are more likely to ever have been diagnosed with asthma.

    • While all of the causes of asthma remain unclear, children exposed to secondhand tobacco smoke exposure are at increased risk for acute lower respiratory tract infections, such as asthma, and children living below or near the poverty level are more likely to have high blood cotinine levels, a breakdown product of nicotine, than children living in higher income families.

    Causes

    The exact cause of asthma isn’t known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life.

    These factors include:

    • An inherited tendency to develop allergies, called atopy (AT-o-pee)
    • Parents who have asthma
    • Certain respiratory infections during childhood
    • Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing

    If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) may make your airways more reactive to substances in the air.

    Some factors may be more likely to cause asthma in some people than in others. Researchers continue to explore what causes asthma.

    The “Hygiene Hypothesis”

    One theory researchers have for what causes asthma is the “hygiene hypothesis.” They believe that our Western lifestyle—with its emphasis on hygiene and sanitation—has resulted in changes in our living conditions and an overall decline in infections in early childhood.

    Many young children no longer have the same types of environmental exposures and infections as children did in the past. This affects the way that young children’s immune systems develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions.

    Symptoms

    Common signs and symptoms of asthma include:

    • Coughing. Coughing from asthma often is worse at night or early in the morning, making it hard to sleep.
    • Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
    • Chest tightness. This may feel like something is squeezing or sitting on your chest.
    • Shortness of breath. Some people who have asthma say they can’t catch their breath or they feel out of breath. You may feel like you can’t get air out of your lungs.

    Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn’t always mean that you have asthma. The best way to diagnose asthma for certain is to use a lung function test, a medical history (including type and frequency of symptoms), and a physical exam.

    The types of asthma symptoms you have, how often they occur, and how severe they are may vary over time. Sometimes your symptoms may just annoy you. Other times, they may be troublesome enough to limit your daily routine.

    Severe symptoms can be fatal. It’s important to treat symptoms when you first notice them so they don’t become severe.
    With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.

    What Causes Asthma Symptoms To Occur?

    Many things can trigger or worsen asthma symptoms. Your doctor will help you find out which things (sometimes called triggers) may cause your asthma to flare up if you come in contact with them. Triggers may include:

    • Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers
    • Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home décor products, and sprays (such as hairspray)
    • Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and nonselective beta-blockers
    • Sulfites in foods and drinks
    • Viral upper respiratory infections, such as colds
    • Physical activity, including exercise

    Other health conditions can make asthma harder to manage. Examples of these conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions need treatment as part of an overall asthma care plan.

    Asthma is different for each person. Some of the triggers listed above may not affect you. Other triggers that do affect you may not be on the list. Talk with your doctor about the things that seem to make your asthma worse.

    Exams and Tests

    Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.
    Your doctor also will figure out the severity of your asthma—that is, whether it’s intermittent, mild, moderate, or severe. The level of severity will determine what treatment you’ll start on.

    You may need to see an asthma specialist if:

    • You need special tests to help diagnose 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 problems getting your asthma well controlled
    • You’re thinking about getting allergy treatments

    Medical and Family Histories

    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 whether 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 trigger your symptoms or worsen them.

    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 medicine 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 recommend 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 (brong-KO-prav-eh-KA-shun) 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 condition 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.

    Treatments

    Asthma is a long-term disease that can’t be cured. The goal of asthma treatment is to control the disease. Good asthma control will:

    • Prevent chronic and troublesome symptoms, such as coughing and shortness of breath
    • Reduce your need for quick-relief medicines (see below)
    • Help you maintain good lung function
    • Let you maintain your normal activity level and sleep through the night
    • Prevent asthma attacks that could result in an emergency room visit or hospital stay

    To control asthma, partner with your doctor to manage your asthma or your child’s asthma. Children aged 10 or older—and younger children who are able—also should take an active role in their asthma care.

    Taking an active role to control your asthma involves:

    • Working with your doctor to treat other conditions that can interfere with asthma management.
    • Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
    • Working with your doctor and other health care providers to create and follow an asthma action plan.

    An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening asthma, and seeking emergency care when needed.

    Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or “rescue,” medicines relieve asthma symptoms that may flare up.

    Your initial treatment will depend on the severity of your asthma. Followup asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.

    Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you’re exposed to the factors that can worsen your asthma.

    Your doctor may need to increase your medicine if your asthma doesn’t stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.

    Asthma treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will need to be adjusted to meet their special needs.

    Possible Complications

    Asthma may cause a number of complications, including:

    • Symptoms that interfere with sleep, work or recreational activities
    • Sick days from work or school during asthma flare-ups
    • Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
    • Emergency room visits and hospitalizations for severe asthma attacks
    • Side effects from long-term use of some medications used to stabilize severe asthma

    Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

     

    When to Contact a Medical Professional

    Call your doctor whenever you or your child has persistent:

    • Wheezing
    • Chest tightness
    • Difficulty breathing
    • Cough

    Some children with asthma may not complain specifically of shortness of breath. However, they may flare their nostrils or use their chest and neck muscles when breathing. These are signs that they are having trouble.

    If you already have been diagnosed with asthma, call your doctor if your symptoms:

    • Are getting worse
    • Are not being controlled by your regular medications

    For example, call your doctor if you must use your rescue bronchodilator more than four times a day. Also call if your peak-flow-meter readings are in the yellow or red zones.

    If you have an asthma attack and your symptoms persist despite your usual medications, seek emergency help immediately.

    Preventions

    Currently, asthma can’t be prevented. However, you can take steps to control the disease and prevent its symptoms.

    • Learn about your asthma and how to control it.
    • Follow your written asthma action plan. (For a sample plan, go to the National Heart, Lung, and Blood Institute’s Asthma Action Plan.)
    • Use medicines as your doctor prescribes.
    • Identify and try to avoid things that make your asthma worse (asthma triggers). However, one trigger you should not avoid is physical activity.

    Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

    • Keep track of your asthma symptoms and level of control.
    • Get regular checkups for your asthma.

    Natural Remedies

    Don’t let asthma knock the wind out of you. Asthma is a lung disorder characterized by sudden fits of wheezing, coughing, or shortness of breath. According to research or other evidence, the following self-care steps may be helpful:

    What You Need To Know:

    • Clean it up
      To avoid triggering asthma attacks, control household and workplace irritants such as dust, mold, smoke, chemicals, and animal dander, and dietary triggers like certain food additives
    • Keep a healthy body weight
      Shed extra pounds to improve breathing and decrease the need for medications
    • Check out certain antioxidants
      30 mg a day of lycopene or 64 mg a day of natural beta-carotene can help prevent exercise-related asthma attacks
    • Try proven herbal remedies
      Supplements containing boswellia extract (900 mg a day), ivy leaf extract (50 drops a day), or tylophora leaf (200 to 400 mg a day) may improve breathing symptoms; children should be given one-half of these amounts or less, depending on body weight
    • Watch the salt
      Avoid aggravating symptoms by limiting use of table salt and salty fast foods, and by reading labels to find low sodium groceries
    • See an allergist
      Find a specialist to help you build tolerance to allergens

    These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full asthma article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

     

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