Asthma - Adult

Definition

Asthma is a chronic disease that affects the function and lining of the airways or tubes of the lungs. It narrows the airways and makes it difficult to breathe.

There are different degrees of asthma. Some people may have mild asthma with rare flare-ups. Others may have a severe, constant asthma.

Inflamed Bronchus in the Lungs

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Causes

The exact causes of asthma are unknown, but genetics play a role.

Asthma symptoms are caused by an increased sensitivity of the airways to certain triggers. The triggers cause the lining of the airways to swell and produce extra fluid called mucus. At the same time, the muscles around the outside of the airway tighten in response to the irritation. All of these reactions narrow the airways and make it difficult to breathe. This response is often referred to as an asthma attack.

Possible triggers of an asthma attack in a person with asthma include:

• Viral illness
• Exercise
• Cold weather or changes in the weather
• Sinusitis
• Gastroesophageal reflux disease (GERD)
• Sulfites, preservatives used in dried fruits and wine
• Medications, such as aspirin, ibuprofen, and beta-blockers
• Exposure to irritants or allergens, including:
  • Cigarette smoke
  • Smoke from a wood-burning stove
  • Pet dander
  • Dust
  • Chemicals
  • Mold and mildew
  • Pollen
  • Smog or air pollution
  • Perfumed products

Risk Factors

Factors that may increase your chance of asthma include:

• Regularly breathing in cigarette smoke, including second-hand smoke
• Regularly breathing in industrial or agricultural chemicals
• A family member who has asthma
• History of bronchiolitis
• History of multiple respiratory infections during childhood, especially less than 1 year old
• Being overweight
• History of wheezing or asthma as a child
• Having allergies
• Premature birth
• Having a mother who smoked during pregnancy

Symptoms

Symptoms include:

• Cough
• Wheezing
• Tightness in the chest
• Trouble breathing
• Shortness of breath
• Chest pain
• Limited exercise tolerance

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your doctor may also do some tests to measure lung function. They may include:

• Peak flow assessment
• Pulmonary function tests (PFTs)
• Reversibility testing
• Bronchoprovocation tests

Your doctor may also do some allergy tests. The test will help determine if allergies are causing symptoms. The test may include skin pricks or blood tests.

Treatment

The treatment strategy for asthma includes:

• Medications
• Avoidance of allergens and irritants and control of contributing factors such as gastroesophageal reflux and sinusitis
• Regular assessment and monitoring

You and your doctor should also create an asthma action plan. This is a plan you will follow to help control your asthma and handle asthma attacks.

Asthma Medications

Medications Used to Control Asthma

These medications are used to avoid asthma attacks, but will not treat an existing attack. Medication may include any of or combinations of:

• Inhaled corticosteroids to prevent airway swelling and inflammation
• Inhaled long-acting beta agonists to relax the airways and keep them from tightening
• Oral leukotriene modifiers to prevent airway inflammation and swelling, decrease the amount of mucus in the lungs, and open the airways
• Inhaled cromolyn or nedocromil to prevent airways from swelling from contact with an asthma trigger
• Biologic agents, such as omalizumab, if asthma is not controlled by other medications

Medications Used to Treat an Asthma Attack

These medications are used to treat an asthma attack.

Medication may include:

• Inhaled quick-acting beta agonists and anticholinergic agents to open the airways
• Oral corticosteroids to reduce severe airway inflammation

Other Treatments

Bronchial thermoplasty to reduce excessive smooth muscle in the lungs and decrease the ability of the airways to constrict.

Prevention is an important step in asthma care. Allergy avoidance can be effective with asthma that is made worse by allergens. Some general tips for allergen avoidance include:

• Avoid outside activities if there are high levels of air pollution, pollen, or mold spores.
• Keep your windows closed during seasons with high pollen or mold spores. Air conditioning may help filter out allergens during warm seasons.
• Consider getting a portable HEPA unit air cleaner to use in sleeping areas.
• Consider getting HEPA filters for your heating/cooling system and your vacuum cleaner.
• Have someone else vacuum for you. Avoid a room that has been freshly vacuumed. If you do vacuum, use a dust mask.
• Keep the humidity down in your house. This may help prevent the growth of mold.
• Treat allergies and sinusitis as advised by your doctor.
• If allergies trigger your asthma attacks, ask your doctor about ways to manage your allergies.

It may be helpful to learn breathing techniques or doing breathing exercises. Improved fitness may also increase exercise tolerance and reduce attacks. Ask your doctor for advice.

Monitoring

Your asthma plan may need to be adjusted to adapt to changes in your life or health. Staying in contact with your doctor between visits can help you have better control of your asthma.

Your doctor may want to monitor you at home with a peak flow meter.

Online programs aimed at helping you manage your own symptoms can improve asthma control and lung function. Some examples of programs include American Lung Association or Asthma and Allergy Foundation of America.

Prevention

There are no guidelines for preventing asthma because the cause is unknown. However, you can help prevent asthma attacks by avoiding things that trigger your attacks. Triggers can vary from person to person but some general guidelines include:

• Avoid strong chemicals or odors like perfume.
• Avoid strenuous outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
• Get a yearly flu shot. Colds and flus can worsen asthma.
• Don't smoke. If you are pregnant, it is important that you do not smoke.
• Avoid secondhand smoke. Do not allow anyone to smoke in your home.
• Don't use a wood-burning stove or fireplace, including unvented gas fireplaces.
• If cold weather triggers your asthma, avoid strenuous activities in cold weather. If you must, use a scarf or mask to warm the air before it reaches your lungs.

Talk to your doctor about:

• The right level of exercise for you
• Ways to track your asthma to help identify and treat flare-ups right away
• Your work, hobbies, and home activities to see if any of these may be causing or worsening your asthma