Asthma is a chronic disease that affects your airways, i.e. the tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways are inflamed (swollen). The inflammation makes the airways very sensitive, and they tend to react strongly to things that you are allergic to or find irritating. When the airways react, they get narrower, even clogged, and less air flows through to your lung tissue. This causes symptoms like wheezing (a whistling sound when you breathe), coughing, chest tightness, and trouble breathing, especially at night and in the early morning.
Before having the actual diagnosis of asthma, some of the early warning signs for asthma include symptoms like: tiredness, itchy throat, headache, chest tightness, change is consisted of mucus (like color, amount, or thickness).
When full-blown asthma has developed in a person, asthma presents itself in asthma attacks, which may become problematic in daily life. With an asthma attack, you may notice e.g. wheezing, chronic coughing, shortness of breath or chest tightness.
Asthma cannot be cured, but most people with asthma can affect the situation so that they have few and infrequent symptoms, thus they can live active lives. Regular consultation at the doctor is recommended. It is beneficial to learn what things cause your asthma symptoms and how in practice to avoid them. Your doctor will also prescribe medicines to keep your asthma under control. Together with your doctor, you can identify your personal asthma action plan, that will help you to get asthma under control in daily life. Remember to use your asthma medication as prescribed.
Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.
What to do if you get an asthma attack?
- Stop the activity you were doing.
- Sit up and take your asthma medicine (inhaler).
- If your attack will not pass, then consult your physician.
Causes and Risk factors
It is not clear exactly what makes the airways of people with asthma inflamed in the first place. The actual cause may be due to a combination of things. Research suggests that if other people in your family have asthma, you are more likely to develop it, too. Newer research indicates that being exposed to things like tobacco smoke, infections, and some allergens early in your life may increase your chances of developing asthma.
Potential allergens include e.g. animal dander (from the skin, hair, or feathers of animals) dust mites (contained in house dust), cockroaches, pollen, indoor and outdoor mold, and irritants or allergens that you may be exposed to at your work, such as special chemicals or dust.
Other irritating factors can be listed such as cigarette smoke, air pollution, cold air or sudden changes in weather, strong odors from painting or cooking, strongly scented products.
Also, a strong emotional expression (including crying or laughing hard) and stress can cause an asthma attack.
Most people's asthma triggers are breathed in. But asthma symptoms may also be triggered by things you eat, drink or swallow, i.e. food or medication:
- Medicines such as aspirin and beta-blockers
- Sulfites, typically used as preservatives in food (dried fruit) or beverages (wine)
- A condition called gastroesophageal reflux disease that causes heartburn and can worsen asthma symptoms, especially at night
- Viral infections, such as cold, flu
Typically the diagnosis bases on the patient's symptoms, his medical history, a physical examination, and laboratory tests that measure pulmonary (lung) function. Doctors typically look for signs that the patient's airflow is obstructed and that the obstruction is at least partially reversible. Factors that trigger symptoms may be evident, such as exercise, cold air, and exposure to an allergen; however, the precipitating factors may not be clearly identified.
Evidence of reversible airway obstruction is often detected in the physical examination or by physiologic testing. Physiologic testing generally is recommended to confirm the diagnosis. During an asthma attack, wheezing can be heard by listening to the chest with a stethoscope. The airway obstruction is considered reversible if the wheezing disappears in response to treatment, or when the suspected triggering factor is removed or resolved.Typical methods for diagnosis are
- Spirometry A test that measures the amount of air entering and leaving the lungs. This simple test can be performed in the physician's office. In this test the patient exhales and inhales deeply, then seals his or her lips around the mouthpiece and blows as forcefully and for as long as possible until all the air is exhaled from the lungs.
- Peak Expiratory Flow Because asthma symptoms vary, it is not unusual for a patient with chronic asthma to have normal spirometry. In such cases, peak expiratory flow (PEF) rate monitoring may be used to demonstrate reversible airway obstruction. A peak flow meter is a portable device that can be carried by the patient. It consists of a small tube with a gauge that measures the maximum force with which one can blow air through the tube. The patient performs the peak flow meter test twice a day for about 2 weeks and records the results for review in a follow-up appointment.
- Bronchial Provocation Occasionally, a patient with a suspected asthma-related airway obstruction does not demonstrate obstruction in spirometry or peak flow monitoring. In this circumstance, the diagnosis of airway obstruction may be provided by bronchial provocation.Bronchial provocation, also known as bronchoprovocation and bronchial challenge, identifies and characterizes hyperresponsive airways by having the patient inhale an aerosolized chemical, called a bronchospastic agonist, that triggers a hyperresponsive reaction. The chemicals most often used are histamine and methacholine.
Tests may be performed to exclude other diseases and to evaluate conditions that worsen the asthmatic condition. These include the following:
- Chest x-rays are often obtained initially to rule out other health conditions.
- Allergy testing, either by skin testing or by measuring antibodies in the blood, sometimes is performed to determine if the asthma is allergy induced, and if so, what specific allergens are involved.
- X-rays of the sinuses is often done to exclude sinusitis as a factor.
- Evaluation for gastroesophageal reflux disease is often performed to evaluate its contribution to the control of asthma.
Asthma medicine and medication
Controller medications are used on a regular basis to control chronic symptoms and prevent attacks. They have typically inhaled corticosteroids (some brand names: AeroBid, Azmacort, Flovent, Pulmicort, Vanceril). They are the most effective long-term medications for asthma. They reduce inflammation in your airways, and decrease the frequency of your attacks and reduce the need for other medications used to control the symptoms. Side effect risk is low, because the inhaled corticosteroids go directly to the airways. Inhaled corticosteroids include fluticasone (brand name: Flovent), budesonide (brand name: Pulmicort), nedocromil (brand name: Tilade), triamcinolone (brand name: Azmacort), cromolyn (brand name:Intal), theophylline (some brand names: Slo-bid, Theo-Dur, Theo-24, Uni-Dur), anti-leukotrienes (some brand names: Accolate, Singulair, Zyflo), flunisolide (brand name: Aerobid) and beclomethasone (brand name: Qvar). Advair Diskus is a combination inhaler containing fluticasone and salmeterol. Metered dose inhaler requires the use of a spacer and gargle with water afterward.
Long-acting beta-2 agonists (LABA, brand name: Serevent) opens up constricted airways and belongs to the medications called bronchodilators. Medicine such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer) last at least 12 hours, and can be used to control moderate and severe asthma and also to prevent nighttime symptoms. Salmeterol or formoterol should always be combined on a regular schedule with inhaled corticosteroids and should not be used as the main treatment for asthma. LABA medication may increase the risk of severe asthma episodes and possibly death if a severe asthma episode occurs.
Leukotriene modifiers reduce the production or block the action of leukotrienes, which are released by cells in your lungs during an attack. Leukotrienes cause the airways linings to become inflamed, leading to wheezing, shortness of breath and mucus production. Leukotriene modifiers are montelukast (Singulair) and zafirlukast (Accolate). These used in conjunction with other medications e.g. inhaled corticosteroids, the leukotriene modifiers can help prevent more attacks.
Cromolyn and nedocromil are not effective for everyone, daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) can help prevent mild to moderate asthma attacks, including asthma caused by exercise if taken an hour before the activity.
Theophylline can be taken in pill form every day. It can help relieve the nighttime asthma symptoms. It can cause side effects, e.g. nausea and vomiting, severe abdominal pain, diarrhea, acid reflux, confusion, fast or irregular heartbeat, and nervousness.
Quick-relief medications are used for rapid and short-term relief during an asthma attack. These short-acting bronchodilators are taken as needed when you first feel the asthma signs and symptoms, e.g. coughing, wheezing, chest tightness or shortness of breath. They are also effective if taken before any signs or symptoms present themselves.
Short-acting beta-2 agonists (some brand names: Albuterol, Pirbuterol, Levalbuterol and Bitolterol) begin working within minutes and last four to six hours. They cannot prevent symptoms to reappearing. The most commonly used short-term bronchodilator for asthma is albuterol.
Ipratropium, anticholinergic (Atrovent) can be prescribed for the immediate relief of your asthma symptoms.
Oral and intravenous corticosteroids including prednisone, prednisolone, methylprednisolone, hydrocortisone and others can work against acute asthma attacks or very severe asthma. They might take a few hours or a few days to reach full effect. Long-term use can have serious side effects, including cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.
Allergy-induced asthma medication reduces the body sensitivity to an allergen and thus prevents the immune system to react.
Immunotherapy focuses on treating allergy triggers for asthma. Allergic asthma not easily controlled by avoiding allergy triggers and using medication can be alleviated by allergy desensitization shots (immunotherapy). It will begin with skin tests to determine the worst allergens, followed by a series of therapeutic injections, which contain small doses of the allergens. These injections are given once a week for a few months, then once a month for three to five years.
Omalizumab (Xolair) can reduce the number of asthma attacks by blocking the action of the Anti-IgE monoclonal antibodies, which are produced by your immune system to attack substances that generally cause no harm, such as pollen, dust mites, and pet dander.
Xolair could be used against moderate to severe asthma caused by an allergy, if all other treatments have failed and if you are over 12 years. It is delivered by injection every two to four weeks. Risks are a severe reaction within two hours of the shot, blood-clotting problems and a possible link to cancer, which is currently being studied.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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