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Asthma


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Definition

Asthma is a disease that causes the airways of the lungs to swell and narrow. It leads to wheezing, shortness of breath, chest tightness, and coughing.

Normal versus asthmatic bronchiole

Normal versus asthmatic bronchiole

Alternative Names

Bronchial asthma; Wheezing - asthma - adults

Causes

Asthma is caused by swelling (inflammation) in the airways. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight. This reduces the amount of air that can pass through the airway.

In people who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens or triggers.

Common asthma triggers

Common asthma triggers

Common asthma triggers include:

  • Animals (pet hair or dander)
  • Dust mites
  • Certain medicines (aspirin and other NSAIDS)
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Exercise
  • Mold
  • Pollen
  • Respiratory infections, such as the common cold
  • Strong emotions (stress)
  • Tobacco smoke

Substances in some workplaces can also trigger asthma symptoms, leading to occupational asthma. The most common triggers are wood dust, grain dust, animal dander, fungi, or chemicals.

Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.

Asthma Treatment Quiz

Which of the following is not a goal of asthma treatment?

The correct answer is to cure asthma. Unfortunately, there's no way to cure asthma. However, by working closely with your doctor, you can learn to manage it.

The main types of medicine for asthma are:

The correct answer is both A and B. The goals of asthma treatment are controlling airway swelling and avoiding what triggers your symptoms.

This device, used with an inhaler, helps get more medicine into the airways.

The correct answer is spacer. The spacer connects to the mouthpiece. The inhaled medicine goes into the spacer tube first. Then you take two deep breaths to get the medicine into your lungs. Using a spacer wastes less medicine than spraying the medicine into your mouth.

Sometimes younger children use a nebulizer to take their medicine. What does this machine do?

The correct answer is it turns asthma medicine into a mist children can breathe in. This device makes it easy and pleasant to breathe in the medicine. Small children may need to use a mask to help them inhale all the mist. Talk with your doctor if you have questions about your child's treatment.

You can stop taking your control medicine when you start to feel better.

The correct answer is false. Control drugs must be taken every day to be effective. Take your medicine even when you feel OK. You may need to take these medicines for at least a month before you start to feel better. Your doctor will work with you to find asthma medicines that are right for you.

Why should you use a peak flow meter to check how quickly you can move air out of your lungs?

The correct answer is all of the above. Peak flow measurements can help show when you need medicine or other action to treat your asthma. Peak flow values of 50 - 80% of your best results signal a moderate asthma attack, while values below 50% mean a severe attack.

If you use quick-relief drugs twice a week or more to control your asthma symptoms, you should:

The correct answer is tell your doctor. If you need to use quick-relief drugs more than twice a week your asthma may not be under control. Your doctor may need to change your dose of daily control drugs.

Getting rid of tobacco smoke at home is the most important thing a family can do to help a child with asthma.

The correct answer is true. Don't smoke inside or outside the home. Family members and visitors who smoke outside can carry the smoke inside on their clothes and hair. Helping children avoid asthma triggers is the first step toward helping them feel better.

Exercise can bring on asthma symptoms in some people, but you can still participate in the activities you love. Do this ahead of time:

The correct answer is use your quick-relief drugs just before exercising. Swimming is a good sport for people with exercise-induced asthma. The warm, moist air helps keep asthma symptoms away. Football, baseball, and other sports with breaks in the action are less likely to trigger asthma symptoms.

Asthma action plans should include:

The correct answer is all of the above. An asthma action plan is an important part of treatment for anyone with asthma. If you don't already have one, talk with your doctor about creating a personal asthma action plan.

Which of these asthma symptoms is an emergency?

The correct answer is all of the above. Asthma attacks can be dangerous if a person's airways become severely blocked. If you notice any of these symptoms, call 9-1-1. This might include oxygen, breathing assistance, and medicines given through a vein (IV).

People with asthma can lead normal, active lives.

The correct answer is true. Asthma can be scary, but it doesn't have to control you. By getting the right medical treatment, working closely with your doctor, and avoiding your asthma triggers, you can manage your condition and enjoy a full life.

Symptoms

Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom.

Asthma attacks can last for minutes to days. Attacks can become dangerous if airflow is severely blocked.

Symptoms of asthma include:

Emergency symptoms that need prompt medical help include:

Other symptoms that may occur:

  • Abnormal breathing pattern -- breathing out takes more than twice as long as breathing in
  • Breathing temporarily stops
  • Chest pain
  • Tightness in the chest

Exams and Tests

The health care provider will use a stethoscope to listen to your lungs. Wheezing or other asthma-related sounds may be heard.

Tests that may be ordered include:

Treatment

The goals of treatment are:

You and your doctor should work as a team to manage your asthma. Follow your doctor's instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms.

MEDICINES FOR ASTHMA 

There are two kinds of medicines for treating asthma:

  • Control medicines to help prevent attacks
  • Quick-relief (rescue) medicines for use during attacks

LONG-TERM MEDICINES

These are also called maintenance or control medicines. They are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel OK.

Some long-term medicines are breathed in (inhaled), such as steroids and long-acting beta-agonists. Others are taken by mouth (orally). Your doctor will prescribe the right medicine for you.

QUICK-RELIEF MEDICINES

These are also called rescue medicines. They are taken:

  • For coughing, wheezing, trouble breathing, or an asthma attack
  • Just before exercising to help prevent asthma symptoms caused by exercise

Tell your doctor if you are using quick-relief medicines twice a week or more. If so, your asthma may not be under control and your doctor may need to change your dose of daily control drugs.

Quick-relief medicines include:

  • Short-acting inhaled bronchodilators
  • Oral corticosteroids for when you have an asthma attack that is not going away

A severe asthma attack requires a checkup by a doctor. You may also need a hospital stay. There, you will likely be given oxygen, breathing assistance, and medicines given through a vein (IV).

ASTHMA CARE AT HOME

Asthma action plans are written documents for managing asthma. An asthma action plan should include:

  • Instructions for taking asthma medicines when your condition is stable
  • A list of asthma triggers and how to avoid them
  • How to recognize when your asthma is getting worse, and when to call your doctor or nurse

A peak flow meter is a simple device to measure how quickly you can move air out of your lungs.

  • It can help you see if an attack is coming, sometimes even before symptoms appear. Peak flow measurements help let you know when you need to take medicine or other action.
  • Peak flow values of 50 to 80% of your best results are a sign of a moderate asthma attack. Numbers below 50% are a sign of a severe attack.

Outlook (Prognosis)

There is no cure for asthma, although symptoms sometimes improve over time. With proper self-management and medical treatment, most people with asthma can a lead normal life.

Possible Complications

The complications of asthma can be severe, and may include:

  • Death
  • Decreased ability to exercise and take part in other activities
  • Lack of sleep due to nighttime symptoms
  • Permanent changes in the function of the lungs
  • Persistent cough
  • Trouble breathing that requires breathing assistance (ventilator)

When to Contact a Medical Professional

Call for an appointment with your provider if asthma symptoms develop.

Call your health care provider or go to the emergency room if:

  • An asthma attack requires more medicine than recommended
  • Symptoms get worse or do not improve with treatment
  • You have shortness of breath while talking
  • Your peak flow measurement is 50 to 80% of your personal best

Go to the emergency room if these symptoms occur:

  • Drowsiness or confusion
  • Severe shortness of breath at rest
  • A peak flow measurement of less than 50% of your personal best
  • Severe chest pain
  • Bluish color to the lips and face
  • Extreme difficulty breathing
  • Rapid pulse
  • Severe anxiety due to shortness of breath

Prevention

You can reduce asthma symptoms by avoiding triggers and substances that irritate the airways.

  • Cover bedding with allergy-proof casings to reduce exposure to dust mites.
  • Remove carpets from bedrooms and vacuum regularly.
  • Use only unscented detergents and cleaning materials in the home.
  • Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold.
  • Keep the house clean and keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches. Body parts and droppings from cockroaches can trigger asthma attacks in some people.
  • If someone is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Change the filter in furnaces and air conditioners often.
  • Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help someone with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair. This can trigger asthma symptoms. If you smoke, now is a good time to quit.
  • Avoid air pollution, industrial dust, and irritating fumes as much as possible.

Images

Lungs
Spirometry
Asthma
Peak flow meter
Asthmatic bronchiole and normal bronchiole
Common asthma triggers
Exercise-induced asthma
Respiratory system
Spacer use - Series
Metered dose inhaler use - Series
Nebulizer use - Series
Peak flow meter use - Series

References

Cydulka RK, Bates CG. Asthma. In: Adams JG, ed. Emergency Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 48.

Durrani SR, Busse WW. Management of asthma in adolescents and adults. In: Adkinson NF Jr., Bochner BS, Burks AW, et al, eds. In: Middleton's Allergy Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 55.

Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 41.

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publication 08-4051. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed April 29, 2015.

Review Date: 
4/21/2015
Reviewed By: 
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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