Asthma
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Asthma (AZ-muh) is a chronic disease that affects your airways, which are 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 to which you
are allergic or find irritating. When the airways react, they get narrower and
less air flows through to your lung tissues. This causes symptoms like wheezing
(a whistling sound when you breathe), coughing, chest tightness, and trouble
breathing.
Asthma cannot be cured, but for most patients it can be controlled
so that you have only minimal and infrequent symptoms and you
can live an active life. So, if you have asthma, taking care
of it is an important part of your life. Controlling your asthma
means staying away from things that bother your airways and
taking medicines as directed by your doctor. By controlling
your asthma every day, you can prevent serious symptoms and
take part in all activities. If your asthma is not well controlled,
you are likely to have symptoms that can make you miss school
or work and keep you from doing things you enjoy. Asthma is
one of the leading causes of children missing school.
When you experience a worsening of your asthma symptoms, it
is called an asthma episode or attack. In an asthma attack,
muscles around the airways tighten up, making the airway openings
narrower so less air can flow through. Inflammation increases
and the airways become more swollen and narrow. Cells in the
airways also make more mucus than usual. This extra mucus also
narrows the airways. These changes cause the symptoms of asthma
and make it harder to breathe. Asthma attacks are not all the
same-some are worse than others. In a severe asthma attack,
the airways can close so much that not enough oxygen gets to
vital organs. This condition is a medical emergency. People
can die from severe asthma attacks.
If you have asthma, you should see your doctor regularly. You
will need to learn what things cause your asthma symptoms to
worsen and how to avoid them. Your doctor will also prescribe
medicines to keep your asthma under control.
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It is not clear exactly what makes the airways of people with
asthma inflamed in the first place. Your inflamed airways may
be due to a combination of things. We know that if other people
in your family have asthma, you are more likely to develop
it. New research suggests exposures early in your life (like
tobacco smoke, infections, and some allergens) may be important.
There are things that can make asthma symptoms worse and lead
to asthma attacks. Some of the more common things that can
worsen your asthma symptoms are exercise, allergens, irritants,
and viral infections. Some people only have asthma with exercise
or a viral infection. The lists below give some examples of
things that can worsen asthma symptoms.
Allergens
- Animal dander (from the skin, hair, or feathers of animals)
- Dust mites (contained in house dust)
- Cockroaches
- Pollen from trees and grass
- Mold (indoor and outdoor)
Irritants
- Cigarette smoke
- Air pollution
- Cold air or changes in weather
- Strong odors from painting or cooking
- Scented products
- Strong emotional expression (including crying or laughing
hard), and stress
Others
- Medications such as aspirin and beta-blockers
- Sulfites in food (dried fruit) or beverages (wine)
- A condition called gastroesophageal (GAS-tro-e-sof-o-JEE-al)
reflux disease (GERD) that causes heartburn and can worsen
asthma symptoms, especially at night.
- Irritants or allergens that you may be exposed to at
your work such as special chemicals or dusts
- Infections.
This is not a complete list of all the things that can worsen
asthma. People can have trouble with one or more of these.
It is important for you to learn which ones are problems for
you. Your doctor can help you identify which things effect
your asthma and ways to avoid them.
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In the United States, about 15 million people have asthma.
Nearly 5 million of them are children. Asthma is closely linked
to allergies. Most, but not all, people with asthma have allergies.
Children with a family history of allergy and asthma are more
likely to have asthma.
Although asthma affects people of all ages, it often starts
in childhood and is more common in children than adults. More
boys have asthma than girls, but in adulthood, more women have
asthma than men.
Although asthma is a problem among all races, blacks have more
asthma attacks and are more likely than whites to be hospitalized
for asthma attacks and to die from asthma.
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Common asthma symptoms include:
- Coughing.Coughing from asthma is often worse at night or early
in the morning, making it hard to sleep.
- Wheezing.Wheezing is a whistling or squeaky sound when you breathe.
- Chest tightness.This can feel like something is squeezing or sitting
on your chest.
- Shortness of breath.Some people say they can't catch their breath,
or they feel breathless or out of breath. You may feel like you can't get
enough air in or out of your lungs.
- Faster breathing or noisy breathing.
People with asthma may have:
- Wheezing when they have a cold or other illness
- Frequent coughing, especially at night (sometimes this is the only sign
of asthma in a child)
- Asthma symptoms brought on by exercises such as running, biking, or other
brisk activity, especially during cold weather
- Coughing or wheezing brought on by prolonged crying or laughing
- Coughing or wheezing when they are near an allergen or irritant
If you notice that you or your child has these symptoms, talk to your doctor
or your child's doctor.
Not all people have these symptoms, and symptoms may vary from
one asthma attack to another. Symptoms can differ in how severe
they are: sometimes symptoms can be mildly annoying; other
times they can be serious enough to make you stop what you
are doing, and sometimes symptoms can be so serious that they
are life threatening. Symptoms also differ in how often they
occur. Some people with asthma only have symptoms once every
few months, others have symptoms every week, and still other
people have symptoms every day. With proper treatment, however,
most people with asthma can expect to have minimal or no symptoms.
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Some things your doctor will ask about include:
- Periods of coughing, wheezing, shortness of breath, or chest tightness
that come on suddenly or occur often or seem to happen during certain times
of year or season
- Colds that seem to "go to the chest" or take more than 10 days to get
over
- Medicines you may have used to help your breathing
- Your family history of asthma and allergies
- What things seem to cause asthma symptoms or make them worse.
Your doctor will listen to your breathing and look for signs of asthma or allergies.
Your doctor will probably use a device called a spirometer
to check your
airways. This test is called spirometry. The test measures how much air and how
fast you can blow air out of your lungs after taking a deep breath. The results
will be lower than normal if your airways are inflamed and narrowed, as in asthma,
or if the muscles around your airways have tightened up. As part of the test,
your doctor may give you a medication that helps open up narrowed airways to
see if it changes or improves your test results. Spirometry is also used to check
your asthma over time to see how you are doing.
If your spirometry results are normal but you have asthma symptoms,
your doctor will probably want you to have other tests to see
what else could be causing your symptoms. One test commonly
used is a bronchial challenge test. A substance such as methacholine,
which causes narrowing of the airways in asthma, is inhaled.
The effect is measured by spirometry. Children under age 5
usually cannot use a spirometer successfully. If spirometry
cannot be used, the doctor may decide to try medication for
a while to see if the child's symptoms get better.
Besides spirometry, your doctor may also recommend that you have:
- Allergy testing to find out if and what allergens affect you
- A test that uses a hand-held peak flow meter every day for 1-2 weeks to
check your breathing (a peak flow meter is a device that shows how well
you are breathing)
- A test to see how your airways react to exercise
- Tests to see if you have gastroesophageal reflux disease (GERD)
- Test to see if you have sinus disease.
Other tests, such as a chest x-ray or an electrocardiogram, may be needed to
find out if a foreign object, or other lung diseases or heart disease could
be causing asthma symptoms. A correct diagnosis is important because asthma
is treated differently from other diseases with similar symptoms.
Depending on the results of your physical exam, medical history, and lung function
tests, your doctor can determine how severe your asthma is. This is important
because your asthma severity will determine how your asthma should be treated.
A general way to classify severity is to consider how often a person has symptoms
when that person is not taking any medicine or when his or her asthma is not
well controlled. Based on symptoms, the four levels of asthma severity classification
are:
- Mild Intermittent (comes and goes)--when your asthma is not well
controlled, you have asthma symptoms twice a week or less, and you are bothered
by symptoms at night twice a month or less.
- Mild persistent asthma--when your asthma is not well controlled,
you have asthma symptoms more than twice a week, but no more than once in
a single day. You are bothered by symptoms at night more than twice a month.
You may have asthma attacks that affect your activity.
- Moderate persistent asthma--when your asthma is not well controlled,
you have asthma symptoms every day, and you are bothered by nighttime symptoms
more than once a week. Asthma attacks may affect your activity.
- Severe persistent asthma--when your asthma is not well controlled,
you have symptoms throughout the day on most days, and you are bothered
by nighttime symptoms often. In severe asthma, your physical activity is
likely to be limited.
Anyone with asthma can have a severe attack-even those who have intermittent
or mild persistent asthma.
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You and your doctor together can decide about your treatment
goals and what you need to do to control your asthma. Asthma
treatment includes:
- Avoiding things that bring on your asthma symptoms or make symptoms worse.
Doing so can reduce the amount of medicine you need to control your asthma.
Allergy medicine and allergy shots in some cases may help your asthma.
- Using asthma medicines.
With proper treatment, you should ideally have these results:
- Your asthma should be controlled.
- You should be free of asthma symptoms.
- You should have fewer attacks.
- You should need to use short-acting bronchodilators less
often.
- You should be able to do normal activities without having
symptoms.
Your doctor will fill out an action plan for your asthma. Your
action plan will tell you what medications you should take
and other things you should do to keep your asthma under control.
1. Quick Relief medicines give rapid, short-term treatment
and are taken when you have worsening asthma symptoms that
can lead to asthma episodes or attacks. You will feel the effects
of these medicines within minutes.
2. Long-term Control medicines are taken every day, usually
over long periods of time, to control chronic symptoms and
to prevent asthma episodes or attacks. You will feel the full
effects of these medicines after taking them for a few weeks.
People with persistent asthma need long-term control medicines.
Quick relief medicines are used only when needed. A type of
quick relief medicine is a short-acting inhaled bronchodilator.
Bronchodilators work by relaxing tightened muscles around the
airways. They help open up airways quickly and ease breathing.
They are sometimes called "rescue" or "relief" medicines because
they can stop an asthma attack. These medicines act quickly
but their effects only last for a short period of time. You
should take quick relief medicines when you first begin to
feel asthma symptoms like coughing, wheezing, chest tightness,
or shortness of breath. Anyone who has asthma should always
have one of these inhalers in case of an attack. For severe
attacks, your doctor may use steroids to treat the inflammation.
Long-term control medicines. The most effective, long-term control medication
for asthma is an inhaled corticosteroid (kor-ti-ko-STE-roid) because this medicine
reduces the swelling of airways that makes asthma attacks more likely.
- Inhaled corticosteroids (or steroids for short) are the preferred treatment
for controlling mild, moderate, and severe persistent asthma. They are safe
when taken as directed by your doctor. Inhaled medicines go directly into
your lungs where they are needed. There are many kinds of inhalers that
require different techniques, and it is important to know how to use your
inhaler correctly. In some cases, steroid tablets or liquid are used for
short times to bring asthma under control. The tablet or liquid form may
also be used to control severe asthma.
- Long-acting beta-agonists are another kind of long-term control medication.
They are bronchodilators, not anti-inflammatory drugs. These medicines are
used to help control moderate and severe asthma and to prevent nighttime
symptoms. Long-acting beta-agonists are taken together with inhaled corticosteroid
medicine.
- Leukotriene modifiers (montelukast, zafirlukast, and zileuton) are long-term
control medicines used either alone to treat mild persistent asthma or together
with inhaled corticosteroids to treat moderate persistent asthma or severe
persistent asthma.
- Cromolyn and nedocromil are also long-term control medicines used to treat
mild persistent asthma.
- Theophylline is a long-term control medication used either alone to treat
mild persistent asthma or together with inhaled corticosteroids to treat
moderate persistent asthma. People who take theophylline should have their
blood levels checked to be sure the dose is appropriate.
If you stop taking long-term control medicines, your asthma will likely worsen
again.
Many people with asthma need both a short-acting bronchodilator
to use when symptoms worsen and long-term daily asthma control
medication to treat the ongoing inflammation. Over time, your
doctor may need to make changes in your asthma medication.
You may need to increase your dose, lower your dose, or try
a combination of medications. Be sure to work with your doctor
to find the best treatment for your asthma. The goal is to
use the least amount of medicine necessary to control your
asthma.
Use a peak flow meter. As part of your asthma action plan,
you may use a hand-held device called a peak flow meter at
home to measure lung function. To use it, you take a deep breath
and blow hard into a tube to find out how fast you can blow
out. This gives you a peak flow number. You will need to find
out your "personal best" peak flow number by recording the
peak flow number daily for a few weeks until your asthma is
under control. The highest number you get during that time
is your personal best peak flow. Then you can compare future
peak flow measurements to your personal best peak flow, and
that will show if your asthma is staying under control or not.
Your doctor will tell you how and when to use your peak flow
meter and how to use your medication based on the results.
You may be asked to use your peak flow meter each morning to
keep track of how well you are breathing. The peak flow meter
can help warn of a possible asthma attack even before you notice
symptoms. If your peak flow meter shows that your breathing
is getting worse, you should follow your action plan. Take
your quick relief or other medication as your doctor directed.
Then you can use the peak flow meter to see how your airways
are responding to the medication.
Ask your doctor about how you can help take care of your own asthma. You should
know:
- How to take your long-term daily medication correctly
- What things tend to make your asthma worse and ways to avoid them
- Early signs to watch for that mean your asthma is starting to get worse
(like a drop in your peak flow number or an increase in symptoms)
- How and when to use your peak flow meter
- What medication and how much to take to stop an asthma attack and how
to use it correctly
- When to call or see your doctor
- When you should get emergency treatment
Treating asthma in children. Children with asthma, like adults with asthma,
should see a doctor for treatment. Treatment may include allergy testing, finding
ways to limit contact with things that cause asthma attacks, and taking medication.
Young children will need help from their parents and other
caregivers to keep their asthma under control. Older children
can learn to care for themselves and follow their asthma action
plan with less supervision.
Medications for asthma in children are like those adults use,
but doses are smaller. Children with asthma may need both a
quick-relief (or "rescue") inhaler for attacks and daily medication
to control their asthma. Children with moderate or severe asthma
should learn to use a peak flow meter to help keep their asthma
under control. Using a peak flow meter can be very helpful
because children often have a hard time describing their symptoms.
Parents should be alert for possible signs of asthma in children,
such as coughing at night, frequent colds, wheezing, or other
signs of breathing problems. If you suspect asthma or that
your child's asthma is not in good control, take your child
to a doctor for an exam and testing.
Your doctor will choose medication for your child based on
the child's symptoms and test results. If your child has asthma,
you will need to go to the doctor for regular followup visits
and make sure that your child uses the medication properly.
Treating asthma in older adults. Older adults may need to have
adjustments in their asthma treatment because of other diseases
or conditions they have. Some medicines (like beta blockers
used for treating high blood pressure and glaucoma, aspirin,
and nonsteroidal anti-inflammatory drugs) can interfere with
asthma medications or even cause asthma attacks. Be sure to
tell your doctor about all medications that you take, including
over-the-counter ones. Using steroids may affect bone density
in adults, so ask your doctor about taking calcium and vitamin
D supplements and other ways to help keep your bones strong.
Treating asthma in pregnancy. If you are pregnant, it is very
important to both you and your baby to control your asthma.
Uncontrolled asthma can lower the oxygen level in your blood,
which means that your baby gets less oxygen too. Most asthma
medications are safe to take during pregnancy. If you are pregnant
or thinking about becoming pregnant, talk to your doctor about
your asthma and how to have a healthy pregnancy.
Treating exercise-induced asthma. Regular physical exercise
is important for good health. If exercise brings on asthma
symptoms, work with your doctor to find the best way to avoid
having symptoms when you exercise. Some people with asthma
use inhaled quick relief medication before exercising to keep
symptoms under control. If you use your asthma medication as
directed and learn how to pace yourself, you should be able
to take part in any physical activity or sport you choose.
Many Olympic athletes have asthma.
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If you have asthma, it is important to learn how to take care
of yourself. Work with your doctor to make an action plan that you are both
happy with.
- Tell your doctor about all other medications you are taking, in case one
of them affects your asthma.
- Follow your asthma action plan and have regular checkups.
- Learn to use your medication correctly. Ask your doctor to teach you how
to use your inhaler. This is very important. If inhalers are not used correctly,
less medication gets into the airways.
- If you are having problems taking your asthma medicine, let your doctor
know right away.
You need to know what things worsen your asthma symptoms. Then do what you can
to avoid or limit contact with these things.
- If animal dander is a problem for you, keep your pet out of the house
and/or at least out of your bedroom and wash your pet often, or find it
a new home.
- Do not smoke or allow smoking in your home.
- If pollen is a problem for you, stay indoors with the air conditioner
on when the pollen count is high.
- To control dust mites, wash your sheets, blankets, pillows, and stuffed
toys once a week in hot water. You can get special dust proof covers for
your mattress and pillows.
- To prevent colds and flu, wash your hands often and get a flu shot every
year. Children with asthma should get flu shots, too.
- If cold air bothers you, wear a scarf over your mouth and nose in the
winter.
- If you get asthma when you exercise or do routine physical activities
like climbing stairs, work with your doctor to find ways to be active without
having asthma symptoms. Physical activity is important.
- If you are allergic to sulfites, avoid foods (like dried fruit) or beverages
(like wine) that contain them.
Be alert for warning signs of an asthma attack.
- Watch for symptoms (coughing, wheezing, chest tightness, and difficulty
breathing) and use your medication as directed by your doctor.
- Use your peak flow meter as directed to monitor your asthma.
Adopt a healthy lifestyle. While a healthy lifestyle may not keep you from having
problems with allergies and asthma, being healthier in general can't hurt! Eat
a healthy diet rich in fruits and vegetables and low in fats and sugars, get
enough rest, exercise regularly, try to find ways to manage stress in your life,
and don't smoke.
If your asthma is not under control, there will be signs that you should not
ignore. The following are some signs that your asthma is getting worse:
- Your asthma symptoms happen more often.
- Your asthma symptoms are worse than they used to be.
- Your asthma symptoms are bothering you a lot at night and making you lose
sleep.
- You are missing school or work because of your asthma.
- Your peak flow number is low or varies a lot from morning to evening.
- Your asthma medications do not seem to be working very well anymore.
- You have to use your short-acting "quick relief" or "rescue" inhaler more
often. (Using quick relief medicine every day, or using more than one inhaler
a month is too much)
- You have to go to the emergency room or doctor because of an asthma attack.
- You end up in the hospital because of your asthma.
If your asthma seems to be getting worse, see your doctor. You may need to change
your medication or do other things to get your asthma under control.
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Children with asthma need the help of parents, other caregivers,
teachers, and health care professionals to keep their asthma
under control.
You can help your child with asthma keep it under control. For example, you
can:
- Take your child to the doctor for regular checkups and treatment.
- Schedule your child for a flu shot.
- Make sure your child has an asthma action plan and that you know how to
follow it.
- Help your child learn about asthma and how to control it.
- Help your child learn what things cause his or her asthma symptoms and
how to avoid them, if possible.
- Protect your child from tobacco smoke by not smoking and not allowing
people to smoke in your home.
- Find ways to reduce your child's exposure to allergens that bring on asthma
attacks, like pollen, dust mites, cockroaches, or animal dander.
- Make sure your child knows how to take asthma medication correctly (if
your child is old enough to use an inhaler without your help).
- Make sure that your child uses a peak flow meter to help monitor and control
asthma.
- Encourage your child to take part in physical activity. Work together
to keep his or her asthma under control. Your child can be active.
- Talk to your child's other caregivers, teachers, or coaches about his
or her asthma; give them copies of your child's asthma action plan.
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We don't yet know how to prevent asthma, but there are some
things that can lower the chances of an asthma attack.
To prevent asthma symptoms:
- Learn about your asthma and how to control it.
- Use medications as directed by your doctor to prevent
or stop attacks.
- Avoid things that make your asthma worse, as much as
possible.
- Get regular checkups from your doctor.
- Follow your asthma action plan.
Scientists do not yet know how to prevent the inflammation
of the airways that leads to asthma. Scientists are exploring
some theories:
- Babies exposed to tobacco smoke are more likely to get asthma. If a mother
smokes during pregnancy, her baby may also be more likely to get asthma.
- Personal smoking may also cause asthma.
- Obesity may be linked to asthma as well as other health
problems.
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