Asthma

Illustration of  the anatomy of the respiratory system, adult

What is asthma?

Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems. The characteristics of asthma are three airway problems:

  • obstruction
  • inflammation
  • hyper-responsiveness

What are the symptoms of asthma?

The following are the most common symptoms for asthma. However, each individual may experience symptoms differently.

In some cases, the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

Asthma may resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. If it is not detected, many people with asthma do not know they have it. Consult your physician for a diagnosis.

What causes asthma?

The basic cause of the lung abnormality in asthma is not yet known, although healthcare professionals have established that it is a special type of inflammation of the airway that leads to the following:

  • contraction of airway muscles
  • mucus production
  • swelling in the airways

It is important to know that asthma is not caused by emotional factors - as commonly believed years ago. Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms, or aggravate an attack. However, these reactions are considered to be more of an effect than a cause.

What happens during an asthma attack?

Persons with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs and airways.

  • Lungs and airways overreact to certain triggers and become inflamed and clogged.
  • Breathing becomes harder and may hurt.
  • There may be coughing.
  • There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because:
    • muscles that surround the airways tighten, and the inner lining of the airways swells and pushes inward.
    • membranes that line the airways secrete extra mucus.
    • the mucus can form plugs that further block the air passages.
    • the rush of air through the narrowed airways produces the wheezing sounds.

What are the risk factors for an asthma attack?

Although anyone may have an asthma attack, it most commonly occurs in:

  • children and adolescents ages 5 to 17 years 
  • adults older than 65
  • people living in urban communities

Other factors include:

  • family history of asthma
  • personal medical history of allergies

How is asthma diagnosed?

To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination, and laboratory tests, which may include:

Illustration of  the anatomy of the respiratory system, adult
  • spirometry - a spirometer is a device used by your physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:
    • to determine how well the lungs receive, hold, and utilize air
    • to monitor a lung disease
    • to monitor the effectiveness of treatment
    • to determine the severity of a lung disease
    • to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
  • peak flow monitoring (PFM) - a device used to measure the fastest speed in which a person can blow air out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.
  • chest x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • blood tests - to analyze the amount of carbon dioxide and oxygen in the blood.
  • allergy tests

Treatment for asthma:

Specific treatment for asthma will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

As of yet, there is no cure for asthma. However, it can often be controlled with prescription medications that may help to prevent or relieve symptoms, and by learning ways to manage episodes.

Managing asthma:

People with asthma can learn to identify and avoid the things that trigger an episode, and educate themselves about medications and other asthma management strategies.

According to the Guidelines for the Diagnosis and Management of Asthma, published by the National Heart, Lung, and Blood Institute:

  • Asthma is a chronic disease. It has to be cared for all the time - not just when symptoms are present.
    • The four parts of continually managing asthma are:
      • Identify and minimize contact with asthma triggers.
      • Understand and take medications as prescribed.
      • Monitor asthma to recognize signs when it is getting worse.
      • Know what to do when asthma gets worse.
  • Working with a healthcare professional is the best way to take care of asthma.
  • The more information a person with asthma has, the better asthma can be controlled.

Four components of asthma treatment:

  1. The use of objective measures of lung function- spirometry, peak flow expiratory flow rate - to access the severity of asthma, and to monitor the course of treatment.
  2. The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airways.
  3. The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.
  4. Patient education that includes a partnership among the patient, family members, and the physician.

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