Asthma Email this page to a friend Share on facebook Share on twitter Bookmark & Share Printer-friendly version Asthma

is a disorder that causes the airways of the lungs to swell and narrow, l eading to wheezing, shortness of breath, chest tightness, and coughing. See also: Pediatric asthma Work-related asthma Causes Asthma is caused by inflammation in the airways. When an asthma attack occurs, t he muscles surrounding the airways become tight and the lining of the air passag es swells. This reduces the amount of air that can pass by. In sensitive people, asthma symptoms can be triggered by breathing in allergy-ca using substances (called allergens or triggers). Common asthma triggers include: Animals (pet hair or dander) Dust 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 Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) provoke asthma i n some patients. 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. Symptoms Most people with asthma have attacks separated by symptom-free periods. Some peo ple have long-term shortness of breath with episodes of increased shortness of b reath. Either wheezing or a cough may be the main symptom. Asthma attacks can last for minutes to days, and can become dangerous if the air flow is severely restricted. Symptoms include: Cough with or without sputum (phlegm) production Pulling in of the skin between the ribs when breathing (intercostal retracti ons) Shortness of breath that gets worse with exercise or activity Wheezing, which: Comes in episodes with symptom-free periods in between May be worse at night or in early morning May go away on its own Gets better when using drugs that open the airways (bronchodilators) Gets worse when breathing in cold air

Gets worse with exercise Gets worse with heartburn (reflux) Usually begins suddenly Emergency symptoms: Bluish color to the lips and face Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack Extreme difficulty breathing Rapid pulse Severe anxiety due to shortness of breath Sweating Other symptoms that may occur with this disease: 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 Allergy testing may be helpful to identify allergens in people with persistent a sthma. Common allergens include: Cockroach allergens Dust mites Molds Pet dander Pollens Common respiratory irritants include: Fumes from burning wood or gas Pollution Tobacco smoke The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard. However, lung sounds are usually normal between asthma episodes. Tests may include: Arterial blood gas Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin) Chest x-ray Lung function tests Peak flow measurements Treatment The goal of treatment is to avoid the substances that trigger your symptoms and control airway inflammation. You and your doctor should work together as a team to develop and carry out a plan for eliminating asthma triggers and monitoring s ymptoms. For information on treating asthma in children, see: Pediatric asthma.

There are two basic kinds of medication for treating asthma: Control drugs to prevent attacks Quick-relief drugs for use during attacks Control drugs for asthma control your symptoms if you don't have mild asthma. Yo u must take them every day for them to work. Take them even when you feel okay. The most common control drugs are: Inhaled corticosteroids (such as Asmanex, Alvesco, Qvar AeroBid, Flovent, Pu lmicort) prevent symptoms by helping to keep your airways from swelling up. Long-acting beta-agonist inhalers also help prevent asthma symptoms. Do not take long-acting beta-agonist inhaler drugs alone. These drugs are almost always used together with an inhaled steroid drug. It may be easier to use an inhaler that contains both drugs. Other control drugs that may be used are: Leukotriene inhibitors (such as Singulair and Accolate) Omalizumab (Xolair) Cromolyn sodium (Intal) or nedocromil sodium (Tilade) Aminophylline or theophylline (rarely used anymore) Quick-relief drugs work fast to control asthma symptoms: You take them when you are coughing, wheezing, having trouble breathing, or having an asthma attack. They are also called "rescue" drugs. They also can be used just before exercising to help prevent asthma symptoms that are caused by exercise. Tell your doctor if you are using quick-relief medicines twice a week or mor e to control your asthma symptoms. Your asthma may not be under control, and you r doctor may need to change your dose of daily control drugs. Quick-relief drugs include: Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, and Xo penex Your doctor might prescribe oral steroids (corticosteroids) when you have an asthma attack that is not going away. These are medicines that you take by mout h as pills, capsules, or liquid. Plan ahead. Make sure you do not run out of the se medications. A severe asthma attack requires a check-up by a doctor. You may also need a hosp ital stay, oxygen, breathing assistance, and medications given through a vein (I V). ASTHMA CARE AT HOME Self-care skills that are important in taking care of your asthma are Know the asthma symptoms to watch out for Know how to take your peak flow reading and what it means Keep the phone number of your child's doctor or nurse with you. Know which triggers make your asthma worse and what to do when this happens. Children with asthma need a lot of support at school. They may need help fro m school staff to keep their asthma under control and to be able to do school ac tivities. Asthma action plans are written documents for anyone with asthma. An asthma acti on plan should include:

A plan for taking asthma medications 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 do ctor 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 any sympto ms appear. Peak flow measurements can help show when medication is needed, or ot her action needs to be taken. Peak flow values of 50% - 80% of a specific person's best results are a sign of a moderate asthma attack, while values below 50% are a sign of a severe atta ck. Support Groups You can often ease the stress caused by illness by joining a support group, wher e members share common experiences and problems. See: Asthma and allergy - support group 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 lead normal lives. Possible Complications The complications of asthma can be severe. Some include: Death Decreased ability Lack of sleep due Permanent changes Persistent cough Trouble breathing to exercise and take part in other activities to nighttime symptoms in the function of the lungs that requires breathing assistance (ventilator)

When to Contact a Medical Professional Call for an appointment with your health care provider if asthma symptoms develo p. Call your health care provider or go to the emergency room if: An asthma attack requires more medication than recommended Symptoms get worse or do not improve with treatment You have shortness of breath while talking Your peak flow measurement is 50% - 80% of your personal best Go to the emergency room if the following symptoms occur: Drowsiness or confusion Severe shortness of breath at rest A peak flow measurement is 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 known triggers and substances that ir ritate 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 suc h as mold. Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks i n some people. If a person is allergic to an animal that cannot be removed from the home, t he animal should be kept out of the bedroom. Place filtering material over the h eating outlets to trap animal dander. Eliminate tobacco smoke from the home. This is the single most important thi ng a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue insid e on their clothes and hair -- this can trigger asthma symptoms. Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes as much as possible. Alternative Names Bronchial asthma; Exercise-induced asthma References Lugogo N, Que LG, Fertel D, Kraft M. Asthma. In: Mason RJ, Broaddus VC, Martin T R, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphi a, Pa: Saunders Elsevier; 2010:chap 38. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al . Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010 Sep;126(3):466-76. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelin es for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lu ng, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publica tion 08-4051. Wechsler ME. Managing asthma in primary care: putting new guideline recommendati ons into context. Mayo Clin Proc. 2009;84:707-717. Fanta CH. Asthma. N Engl J Med. 2009;360:1002-1014. Update Date: 5/1/2011 Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Denis Ha djiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy a nd Critical Care, University of Pennsylvania, Philadelphia, PA.