Asthma

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by Rosalyn Carson-DeWitt, MD

En Español (Spanish Version)More InDepth Information on This Condition


* Definition  

Asthma is inflammation and narrowing of the bronchial tubes. Air travels in and out of the lungs through these tubes.

Inflamed Bronchus in the Lungs  

2009 Nucleus Medical Art, Inc.

* Causes  

The cause of asthma is not known. It does seem to run in some families. Current research suggests a combination of environment, genetics and biology may lead to asthma. Possible triggers of an asthma attack in a person with asthma include:

  • Exercise
  • Cold weather
  • Viral illness
  • Sinusitis
  • Gastroesophageal reflux disease (GERD)
  • Sulfites 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  

A risk factor is something that increases your chance of getting a disease or condition.

  • Living in a large urban area
  • Regularly breathing in cigarette smoke (including second-hand smoke)
  • Regularly breathing in industrial or agricultural chemicals
  • A parent who has asthma
  • History of multiple respiratory infections during childhood
  • Low birth weight
  • Being overweight
  • Gastroesophageal reflux disease (GERD)
* Symptoms  

Symptoms include:

  • Wheezing
  • Tightness in the chest
  • Trouble breathing
  • Shortness of breath
  • Cough
  • Chest pain
  • Self-limited exercise, difficulty keeping up with peers
* Diagnosis  

The doctor will ask about your symptoms and medical history and perform a physical exam:

Tests may include:

  • Peak flow examination—blowing quickly and forcefully into a special instrument that measures your output of air
  • Pulmonary function tests (PFTs)—breathing into a machine that records information about the function of your lungs
  • Bronchoprovocation tests—lung function tests performed after exposure to methacholine, histamine, or cold or dry air, to stimulate asthma
    • Can help to confirm asthma in unclear cases, but not often used in a general practice setting
  • Exhaled nitric oxide (a marker of airway inflammation)—to confirm the diagnosis and manage medications
  • Allergy tests —usually skin or sometimes blood tests to find out if allergies are causing your symptoms
* Treatment  

The treatment approach to asthma is four-fold:

Often, you'll need to take more than one type of medication.

Asthma Medications  
  • Quick-acting beta agonists—(eg, inhaled albuterol or xopenex ) relax your airways so that they become wider again
    • Also called rescue inhalers, are used to stop an acute episode of asthma, or "asthma attack"
  • Long-acting beta agonists—(eg, inhaled salmeterol) used daily to prevent asthma attacks
    • Should not be used to try to stop an asthma attack in progress
    • May increase the risk of asthma-related death, intubation (putting a tube in the windpipe to breath), and hospitalization—If you have any concerns, talk to your doctor.
  • Inhaled steroid—used daily to reduce inflammation in your airways, should not be used to try to stop an asthma attack in progress
  • Cromolyn sodium or nedocromil sodium inhaler—used daily to prevent asthma flare-ups
    • May also be used just before exercise for exercise induced asthma
    • Should not be used to try to stop an asthma attack in progress
  • Zafirlukast , Zileuton , and Montelukast —taken daily to help prevent asthma attacks
  • Omalizumab (Xolair)—a monoclonal antibody against immunoglobulin E (IgE), used in conjunction with other medications
    • Given as a subcutaneous injection to treat allergic asthma
  • Anticholinergic agents— inhaled medications, such as ipratropium , that function as a bronchodilator
  • Corticosteroids—pills, injections, or intravenous (IV) medications given to treat acute flare-up of symptoms
    • Corticosteroid pills may be taken for a longer period of time if you have severe asthma that isn't responding to other treatments
  • Theophylline —taken daily to help prevent asthma attacks
* Prevention  

There are no guidelines for preventing asthma because the cause is not known. However, you can help prevent asthma attacks by avoiding things that trigger the attacks. Some general guidelines include:

  • Keep windows closed.
  • Consider getting HEPA filters for your heating/cooling system and your vacuum cleaner.
  • Keep the humidity down in your house.
  • Avoid strenuous outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
  • Get a yearly flu shot .
  • Treat allergies and sinusitis.
  • Don't smoke.
  • Avoid breathing in chemicals or second-hand smoke.
  • Don't use a wood-burning stove regularly. Researchers reported that heating systems that are more efficient and non-polluting can help to reduce asthma symptoms in children.
  • Consider getting allergy shots, if allergies trigger your asthma attacks.
  • Talk to your doctor about an appropriate level of exercise for you.
  • Talk to your doctor about how to track your asthma, so you can identify and treat flare-ups immediately.

Last reviewed November 2007 by Kari Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Copyright © 2009 EBSCO Publishing. All rights reserved.

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