Asthma

ASTHMA

What Is Asthma?

Asthma

Asthma is a chronic, inflammatory lung disorder of the airways with 2 main components: constriction (the tightening of the muscles around the airways) and inflammation (the swelling of the airways). Asthma is characterized by recurrent breathing problems and acute episodic attacks of shortness of breath, wheezing, chest tightness and coughing.

Asthma Attacks

Asthma attacks are episodes of shortness of breath and/or wheezing that may last minutes to hours. During an asthma attack, the air passages in the lungs become narrower, which makes breathing more difficult. The problem is an oversensitivity of the lungs and airways, which overreact to certain triggers and become inflamed and clogged. Generally, people who have asthma have these acute episodic attacks separated by symptom free periods.

Some have described an asthma episode to feel a bit like taking very deep breaths of very cold air on a freezing winter day, or possibly in high altitudes. Breathing becomes harder and may hurt, there may be coughing, and inhaling air may make a wheezing or whistling sound. These problems occur because the airways of the lungs are getting narrower; muscles that surround the airways tighten, the inner lining of the airways swell and push inward, and the membranes that line the airways secrete extra mucus, which can form plugs that further block the air passages. The rush of air through the narrowed airways produces the wheezing sounds that are typical of asthma.

Asthma Facts and Figures

There is no cure for asthma, but asthma symptoms can be controlled.
Currents estimates believe that at least 1 in every 20 individuals has asthma.
The prevalence of asthma has increased by 61% in the last 20 years.
Asthma is the leading chronic illness among children.

Types of Asthma

Allergy induced asthma

When your body responds to an allergen with an allergic reaction, it produces histamines, which cause inflammation and irritation as it works to rid the body of the allergen. In allergy induced asthma, the histamine release additionally causes the lungs and bronchial airways to become constricted and inflamed, making it difficult to breathe and thereby causing asthmatic symptoms.

Bronchial Asthma

Bronchial Asthma is simply another medical term that means asthma. Asthma and bronchial asthma are synonymous.

Exercise induced asthma (EIA)

In exercise induced asthma, you may experience breathing difficulty within 5-20 minutes after exercise or general physical activity. Symptoms may include wheezing, chest tightness, coughing and chest pain. Other symptoms may include prolonged shortness of breath, often beginning 5-10 minutes after brief exercise.

Patients with EIA generally have airways that are sensitive to sudden changes in temperature or humidity. During physical activity, people have a tendency to breathe through their mouths, oftentimes allowing cold, dry air to reach the lower airways without passing through the warming, humidifying effects of the nose. Since mouth breathing only moistens air to 60-70% relative humidity (nose-breathing warms and saturates air to about 80 to 90% relative humidity before it reaches the lungs), it may be a factor in causing EIA.

Nocturnal Asthma

Asthma that is experienced during and throughout the night or in the very early hours of the morning is sometimes referred to as nocturnal asthma. The symptoms include chest tightness, dry cough during the night or when you are trying to fall asleep, and wheezing.

Asthma Causes

What Causes Asthma?

The true cause of asthma, and why your lungs overreact to certain triggers, essentially a lung abnormality, is not yet known. Through research, scientists have established that the disease is a special type of inflammation of the airway that leads to the contraction of airway muscle, mucus production and swelling in the airways. Thus, the airways become overly responsive to environmental changes and the result is wheezing and coughing.

If your lungs and airways are oversensitive to certain triggers, asthma symptoms can be caused by breathing in allergy causing substances (called allergens or triggers – please click here to read our Key to Understanding Allergies page for more information).

Asthma triggers vary from person to person. Various factors can trigger symptoms of asthma by increasing airway hyper-responsiveness. These include:

Airborne allergens including animal dander, dust mites, mold, pollen
Air pollutants and irritants including tobacco smoke
Allergic reactions to foods
Allergic reactions to certain medications including aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS)
Cold air
Exercise or physical activity (exercise-induced asthma)
Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into the throat
Infections such as the common cold, flu, or pneumonia
Respiratory infections including the common cold
Stress,anxiety and emotional behavior such as laughing or crying
Sulfites, preservatives added to some perishable foods
Weather, particularly extreme changes in temperature

Asthma Risk Factors

What are the risk factors associated with asthma?

While the true cause of asthma is unknown and it is not clear why some people get asthma and others don’t; it is clear that both genetics and environmental factors play a role. Evidence shows that the following factors may increase your chances of developing asthma:

Family history of asthma
Being overweight
Frequent viral infections in childhood, particularly respiratory infections
Exposure to secondhand smoke
Living in a polluted, urban area
Born with low birth weight
Childhood exposure and sensitization to a variety of allergens may contribute to developing asthma, although the exact correlation is unclear.

Asthma Symptoms

How Is Asthma Diagnosed?

Generally, Symptoms of Asthma may include:

Chest tightness, pain or pressure
Coughing, especially excessive coughing at night
Shortness of breath
Trouble sleeping due to shortness of breath, coughing or wheezing
Wheezing while exhaling

Possible signs that your asthma is getting worse:

If there is an increase in the severity and/or frequency of your asthma signs symptoms, and/or attacks
If there is an increase in your need to use your asthma medications, especially your bronchodilators (the medicine that opens up airways by relaxing surrounding muscles)
If you regularly use a peak flow meter and you notice a general, overall decrease in your peak flow measurements (which check how well your lungs are working

Severity of Asthma Symptoms

Asthma signs and symptoms range from mild intermittent asthma to severe persistent asthma. This varies from person to person. Asthma is classified into the following categories of severity*:

Mild Intermittent Asthma – includes having mild symptoms, 2 or fewer times per week, and nocturnal awakening fewer than 2 times per month.

Usually treated with a short acting quick relief medication used on an as needed basis is recommended for this degree of severity.

Mild Persistent Asthma - includes having asthma symptoms more than 2 times per week, nocturnal awakening more than 2 times a month (but less than 1 time per week).

Usually treated with a short acting quick relief medication used on an as needed basis and a long term controller – low dose of inhaled corticosteroid is recommended long term medication for this degree of severity.

Moderate Persistent Asthma – includes having asthma symptoms daily and nocturnal awakening more than 1 time per week.

Usually treated with a low to medium dose of inhaled corticosteroid together with a long acting bronchodilator are the preferred therapies

Severe Persistent Asthma – these patients have symptoms that include asthma symptoms continuously and frequent nocturnal awakenings, and are potentially limited in their physical activity

Usually treated with a high dose of inhaled corticosteroid together with a long acting bronchodilator are the preferred therapies

Patients with severe persistent asthma who difficulty managing their symptoms despite the use of high dose corticosteroids typically have chronic limitations on their physical ability and require frequent bronchodilator use. These patients must seek out an asthma specialist to try and minimize their symptoms and their need for oral corticosteroids.

Severe asthma attacks may be life threatening! If your asthma is not relieved by quick relief medications, seek emergency help immediately; call your physician, health care provider or 911 right away. Signs of a severe asthma attack that may need emergency treatments include:

Respiratory distress at rest
Difficulty in speaking in sentences
Diaphoresis (excessive sweating)
No improvement even after using short-acting bronchodilators
Agitation – rapid worsening of shortness of breath or wheezing
The presence or intensity or wheezing is an unreliable indicator of the severity of an attack.

*Please see your doctor for your diagnosis since each classification is measured by the symptoms experienced as well as by tests performed only by your physician or health care professional.

Asthma Testing

Asthma is sometimes hard to diagnose because it can resemble other respiratory problems like emphysema, bronchitis and lower respiratory infections. For that reason, asthma is under diagnosed; that is, many people with the disease do not know they have it and therefore are never treated. Sometimes the only symptom is a chronic cough, especially at night. Or, coughing or wheezing may occur only with exercise. Some people mistakenly think they are having recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

To properly diagnosis asthma and to distinguish it from other lung disorders, a thorough health history review, a physical examination and certain laboratory tests with your physician or healthcare professional is a great first step. The tests that may help your doctor determine if you have asthma include the following:

Pulmonary Function Tests

Pulmonary function tests, such as spirometry and peak flow monitoring, measure lung function.

Spirometry

Spirometry measures the narrowing of your bronchial tubes by using an instrument to check how much air you can exhale after a deep breath, and how fast you can breathe out.

Peak flow monitoring

A peak flow meter is a simple, portable device that can even be used at home to help detect subtle changes in your breathing before you notice symptoms. The meter measures your ability to push air out of your lungs. If the readings are lower than usual, it is a sign your asthma may be about to flare up. Your doctor will give you instructions on how to track and deal with low readings.

Chest X-Rays

Although a chest x-ray is not routinely required to test for asthma, it may be required if your doctor suspects a complicating pulmonary process, such as pneumonia, or to rule out the possibility of cough, dyspnea (shortness of breath), or wheezing.

Blood and Allergy Testing

While blood tests give a picture of your overall health, allergy testing may be recommended to identify any allergies that trigger asthma symptoms. Specific tests can measure levels of immunoglobulin E (IgE), a key antibody that’s released during an allergic reaction. While everyone’s body produces IgE, people who have allergies make larger quantities of this protective protein.

Evaluation for Heartburn and GERD

Gastroesophageal reflux disease (GERD) may worsen asthma symptoms. Thus, your physician may call for specific testing to diagnose GERD.

Asthma Treatment Options<

How Do I Treat Asthma?

Asthma Medications

The main way to prevent asthma is by avoiding your asthma triggers – and medications.

Once a proper asthma diagnosis is made, specific asthma medications can be prescribed to help manage your asthma and prevent asthma attacks.

Generally, asthma medications are either short term quick relief medications (also called rescue inhalers) or long term control medications.

If your asthma is caused by allergies which are triggered by allergens such as animal dander or pollen, you may also need allergy treatment in addition to your asthma medications. Click here to read up on allergies for more information.

Please check each individual specific medication for complete detailed information on side effects, dosage, directions, etc. Please see your physician or health care provider if you experience side effects from any medications you are taking.

By understanding how asthma medications work, you can be informed when you work with your doctor to develop your treatment plan that will work for you. If you think you might have asthma or are experiencing any symptoms of asthma, please see your doctor and discuss asthma medication options suitable for you.

Long Term Control Asthma Medications

These medications generally need to be taken daily.

The following are all long term control medications grouped together by medication type:

Inhaled corticosteroids – these reduce airway inflammation and are the most commonly used long-term asthma medication. They are considered relatively low risk for long term corticosteroid side effects. You may need to use these medications for several days to weeks before they reach their maximum benefits.

Inhaled Corticosteroid Medications Include:

Generic Name: Beclomethasone Diaproprionate

Brand Names: QVAR 40mg, QVAR 80mg

Generic Name: Budesonide

Brand Names: Pulmicort Respules, Pulmicort Turbuhaler

Generic Name: Flunisolide

Brand Names: AeroBid, Aerospan HFA

Generic Name: Fluticasone Proprionate

Brand Names: Flovent, Flovent Diskus (50 mg; 100 mg; 250mg), Flovent HFA

Generic Name: Mometasone Furoate

Brand Name: Asthmanex

Generic Name: Triamcinolone

Brand Name: Azmacort

Possible side effects include, but are not limited to: dry mouth, cough, hoarseness, headache, nosebleeds (nasal steroids only), throat irritation

Long Acting Bronchodilators – long acting beta-2 agonists (LABAs) – are inhaled medications that open your airways and reduce inflammation. Long acting bronchodilators should not be used for quick relief of asthma symptoms.

Examples of Long Acting Bronchodilators Include:

Generic Name: Formoterol Fumarate

Brand Name: Foradil Aerolizer

Generic Name: Salmeterol Xinofate

Brand Name: Serevent Diskus

Possible side effects include, but are not limited to: increased heart rate, palpitations, nervousness, sleeplessness, headache, nausea, vomiting, tremor, shaking feeling

Combination Medications – Long Acting Bronchodilators with Corticosteroid - these are inhaled medications that treat airway constriction and inflammation. Examples include:

Generic Name: Flucticasone Propionate & Salmeterol Xinofate

Brand Name: Advair

Generic Name: Budesonide & Formeterol Fumerate

Brand Name: Symbicort

Possible side effects include, but are not limited to: cough, dry mouth, hoarseness, headache, increased heart rate, palpitations, nervousness, sleeplessness, headache, nausea, throat irritation, vomiting, tremor, shaking feeling

Leukotriene Modifiers – Another medication option for allergy sufferers, particularly effective for those who also have asthma (although it is used to treat symptoms of hay fever as well) is leukotriene inhibitors. Leukotrienes are inflammatory chemicals released by your immune system (similar to the release of histamine) during an allergic reaction. The following medications are prescription leukotriene inhibitors approved for those with asthma and indoor and outdoor allergies

Generic Name: Montelukast

Brand Name: Singulair (10 mg tablet)

Generic Name: Zafirlukast

Brand Name: Accolate

Generic Name: Zileuton

Brand Name: Zyflo

Possible side effects include, but are not limited to: cough, dizziness, headache, stomach upset or pain, stuffy nose, tiredness, or muscle weakness.

Cromolyn and Nedocromil – these medications are mast cell stabilizers, which inhibit the mast cells (the main purpose of a mast cell is to destroy microorganisms invading your body) from releasing the chemical histamine. These types of medications may be used before exposure to the known trigger and are used to prevent wheezing, shortness of breath, and other breathing problems caused by asthma. They are administered via an inhaler.

Generic Name: Cromolyn Sodium

Brand Name: Intal

Generic Name: Nedocromil Sodium

Brand Name: Tilade

Possible side effects include, but are not limited to: abdominal pain, coughing, headache, nausea, skin rash/itching, sore throat.

Theophylline – a daily medication in pill form that serves as a bronchodilator by opening your airways by relaxing the muscles around the airways.

Generic Name: Theophylline

Brand Names: Aerolate III, Aerolate JR, Aerolate SR, Choledyl SA, Elixophyllin, Quibron-T, Quibron-T/SR, Slo-bid, Slo-Phyllin, Theo-24, Theochron, Theo-Dur, Theolair, Theolair SR, T-Phyl, Uni-Dur, Uniphyl

Possible side effects include, but are not limited to: stomach upset, nausea and vomiting, restlessness, rapid heart rate, wakefulness, irritability, dizziness, palpitations

Quick Relief Medications

These medications are generally used as needed for rapid, short term relief of symptoms during an asthma attack. If you need to use these medications too often, you probably need to adjust your long-term control medication.

The following are all quick relief medications grouped together by medication type.

Bronchodilators – short acting beta-2 agonists – these are inhaled medications that temporarily ease breathing by relaxing airway muscles. Such medications act within minutes and their effects last 4-6 hours.

Inhaled or Oral Bronchodilator Medications Include:

Generic Names: Albuterol or Albuterol Sulfate

Brand Names: Accuneb, Proventil HFA, Ventolin HFA, ProAir HFA, Proventil Repetabs (tablet), VoSpire ER

Generic Name: Pirbuterol Acetate

Brand Name: Maxair

Generic Name: Terbutaline Sulfate

Brand Name: Brethine (tabs only)

Generic Name: Levalbuterol Hydrochloride

Brand Name: Xopenex

Generic Name: Levalbuterol tartrate

Brand Name: Xopenex HFA

Possible side effects include, but are not limited to: increased heart rate, palpitations, nausea, vomiting, nervousness, headache, sleeplessness, tremor, shaking feeling

Ipratropium Bromide – a medication mostly used for emphysema and chronic bronchitis, it is an inhaled anticholinergic for the immediate relief of your symptoms and works like other bronchodilators.

Generic Name: Ipratropium Bromide

Brand Name: Atrovent

Possible side effects include, but are not limited to: dry mouth and rapid heart beat.

Oral and Intravenous Corticosteroids – these are the most potent asthma medications. They treat acute asthma attacks or very severe asthma by relieving airway inflammation. They may cause serious side effects when used long term, so they are only used to treat severe asthma symptoms.

Oral Corticosteroids Include:

Generic Name: Dexamethasone

Brand Names: Decadron, Deltasone

Generic Name: Prednisone

Brand Name: Orasone

Possible side effects include, but are not limited to: decreased or blurred vision, frequent urination, insomnia, increased thirst or appetite, mood changes, nervousness, restlessness, skin rash, poorly controlled hypertension and diabetes. If used long-term, you may be predisposed to fractures, cataracts, and GI ulcers.

Monoclonal antibodies (anti IgE antibodies) – these injections reduce your immune system’s reaction to allergens by blocking IgE. Xolair is delivered by injection every two to four weeks. Intravenous Corticosteriods Include:

Generic Name: Omalizumab

Brand Name: Xolair

Possible side effects include, but are not limited to: injection-site reaction, headache, sinusitis, sore throat viral infections, and upper respiratory tract infection.

Managing Your Asthma

How Do I Manage Asthma?

Management includes avoiding asthma triggers and tracking your symptoms. You may need to regularly take long-term control medications to prevent flare-ups and short-term “rescue” medications to control symptoms once they start. In most people asthma changes over time, so you may need to work closely with your doctor or health care specialist to track your signs and symptoms and to adjust your treatment as needed.

Work with your doctor to determine when you need to increase your medications or take other steps to treat symptoms of worsening asthma and get your asthma back under control. If your asthma keeps getting worse, you may need a trip to the emergency room. Your doctor can help you learn to recognize emergency signs and symptoms so you’ll know when to get help.

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