Asthma
Bronchial asthma; Exercise-induced asthma
Last reviewed: July 14, 2010.
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Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.

See also: Pediatric asthma
Causes, incidence, and risk factors

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

In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing 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 in 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 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, and can become dangerous if the airflow is severely restricted.

Symptoms include:

*

Cough with or without sputum (phlegm) production *

Pulling in of the skin between the ribs when breathing (intercostal retractions) *

Shortness of breath that gets worse with exercise or activity *

Wheezing, which: o

Comes in episodes with symptom-free periods in between o

May be worse at night or in early morning o

May go away on its own o

Gets better when using drugs that open the airways (bronchodilators) o

Gets worse when breathing in cold air o

Gets worse with exercise o

Gets worse with heartburn (reflux) o

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 *

Nasal flaring *

Tightness in the chest

Signs and tests

Allergy testing may be helpful to identify allergens in people with persistent asthma. 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 symptoms.

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. You 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 Azmacort, Vanceril, AeroBid, Flovent) 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 generally 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), which blocks a pathway that the immune system uses to trigger asthma symptoms *

Cromolyn sodium (Intal) or nedocromil sodium (Tilade) *

Aminophylline or theophylline (rarely used anymore)

Asthma 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 more to control your asthma symptoms. Your asthma may not be under control, and your doctor may need to change your dose of daily control drugs.

Quick-relief drugs include:

*

Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, and Xopenex *

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 mouth as pills, capsules, or liquid. Plan ahead. Make sure you do not run out of these medications.

A severe asthma attack requires a check-up by a doctor. You may also need a hospital stay, oxygen, and medications given through a vein (IV).

Asthma action plans are written documents for anyone with asthma. An asthma action 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 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 any symptoms appear. Peak flow measurements can help show when medication is needed, or other 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 attack.

Support Groups

You can often ease the stress caused by illness by joining a support group, where members share common experiences and problems.

See: Asthma and allergy - support group
Expectations (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.
Complications

The complications of asthma can be severe. Some 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)

Calling your health care provider

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

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:

*

You develop drowsiness or confusion *

You have severe shortness of breath at rest *

Your peak flow measurement is less than 50% of your personal best *

You have severe chest pain

Prevention

You can reduce asthma symptoms by avoiding known 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, which can trigger asthma attacks in some people. *

If a person 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. *

Eliminate tobacco smoke from the home. This is the single most important thing 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 inside 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.
References
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.
Wechsler ME. Managing asthma in primary care: putting new guideline recommendations into context. Mayo Clin Proc. 2009;84:707-717. [PubMed]
Fanta CH. Asthma. N Engl J Med. 2009;360:1002-1014. [PubMed]

Review Date: 7/14/2010.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Lungs
Lungs

The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

Review Date: 2/2/2011.

Reviewed by: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Spirometry
Spirometry

Spirometry is a painless study of air volume and flow rate within the lungs. Spirometry is frequently used to evaluate lung function in people with obstructive or restrictive lung diseases such as asthma or cystic fibrosis.

Review Date: 10/9/2009.

Reviewed by: Andrew Schriber, MD, FCCP, Specialist in Pulmonary, Critical Care, and Sleep Medicine, Virtua Memorial Hospital, Mount Holly, New Jersey. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Asthma
Asthma

Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. The muscles of the bronchial tree become tight and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound. This is known as an asthma attack, which can occur as an allergic reaction to an allergen or other substance (acute asthma), or as a part of a complex disease cycle which may include reaction to stress or exercise (chronic asthma).

Review Date: 7/14/2010.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Normal versus asthmatic bronchiole
Normal versus asthmatic bronchiole

During an asthma attack smooth muscles located in the bronchioles of the lung constrict and decrease the flow of air in the airways. The amount of air flow can further be decreased by inflammation or excess mucus secretion.

Review Date: 7/14/2010.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Peak flow meter
Peak flow meter

A peak flow meter is commonly used by a person with asthma to measure the amount of air that can be expelled from the lungs. If the airways become narrow or blocked due to asthma, peak flow values will drop because the person cannot blow air out of the lungs as well. A peak flow meter can be a useful aid in monitoring a person's asthma over time and can also be used to help determine how well a patient's medications are working.

Review Date: 7/14/2010.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Asthmatic bronchiole and normal bronchiole
Asthmatic bronchiole and normal bronchiole

Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. When an asthma attack occurs, mucus production is increased, muscles of the bronchial tree become tight, and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound.

Review Date: 7/14/2010.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Common asthma triggers
Common asthma triggers

Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.

Review Date: 7/14/2010.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Exercise-induced asthma
Exercise-induced asthma

Exercise-induced asthma is distinct from allergic asthma in that it does not produce long-term increase in airway activity. People who only experience asthma when they exercise may be able to control their symptoms with preventive measures such as warm-up and cool-down exercises.

Review Date: 7/14/2010.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Respiratory system
Respiratory system

Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

Review Date: 11/1/2010.

Reviewed by: Shabir Bhimji MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
In this page

* Causes, incidence, and risk factors * Symptoms * Signs and tests * Treatment * Support Groups * Expectations (prognosis) * Complications * Calling your health care provider * Prevention * References

Presentations

*

Spacer use - series *

Metered dose inhaler use - series *

Nebulizer use - series *

Peak flow meter use - series

Read More

*

Wheezing *

Drug allergies *

Allergies *

Atopic eczema *

Collapsed lung *

Lung plethysmography

Figures
Lungs
Lungs
Spirometry
Spirometry
Asthma
Asthma
Normal versus asthmatic bronchiole
Normal versus asthmatic bronchiole
Peak flow meter
Peak flow meter
Asthmatic bronchiole and normal bronchiole
Asthmatic bronchiole and normal bronchiole
Common asthma triggers
Common asthma triggers
Exercise-induced asthma
Exercise-induced asthma
Respiratory system
Respiratory system
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