Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.
Normally, with every breath you take, air goes through your nose or mouth and down into your throat and into your airways, eventually making it to your lungs. There are lots of small air passages in your lungs that help deliver oxygen from the air into your bloodstream.
Asthma symptoms occur when the lining of your airways swell and the muscles around them tighten. Mucus then fills the airways, further reducing the amount of air that can pass through.
These conditions can then bring on an asthma “attack,” the coughing and tightness in your chest that’s typical of asthma.Asthma can’t be cured, but its symptoms can be controlled.
Causes Of Asthma
No single cause has been identified for asthma. Instead, researchers believe that the breathing condition is caused by a variety of factors.
These factors include:
- Genetics. If a parent or sibling has asthma, you’re more likely to develop it.
- History of viral infections. People with a history of severe viral infections during childhood (e.g. RSV) may be more likely to develop the condition.
- Hygiene hypothesis. This theory explains that when babies aren’t exposed to enough bacteria in their early months and years, their immune systems don’t become strong enough to fight off asthma and other allergic conditions.
Signs And Symptoms Of Asthma
Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times — such as when exercising — or have symptoms all the time.
Asthma signs and symptoms include:
- Shortness of breath
- Chest tightness or pain
- Wheezing when exhaling, which is a common sign of asthma in children
- Trouble sleeping caused by shortness of breath, coughing or wheezing
- Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
Signs that your asthma is probably worsening include:
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- Asthma signs and symptoms that are more frequent and bothersomeIncreasing difficulty breathing, as measured with a device used to check how well your lungs are working (peak flow meter)
- The need to use a quick-relief inhaler more oftenFor some people, asthma signs and symptoms flare up in certain situations:
- Exercise-induced asthma, which may be worse when the air is cold and dry
- Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
- Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet dander).
Treatment Of Asthma
Prevention and long-term control are key to stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid triggers and tracking your breathing to make sure your medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler.
The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma under control.
Preventive, long-term control medications reduce the swelling (inflammation) in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary.
Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you’ll have an asthma attack.
Types of long-term control medications include:Inhaled corticosteroids. These medications include fluticasone propionate (Flovent HFA, Flovent Diskus, Xhance), budesonide (Pulmicort Flexhaler, Pulmicort Respules, Rhinocort), ciclesonide (Alvesco), beclomethasone (Qvar Redihaler), mometasone (Asmanex HFA, Asmanex Twisthaler) and fluticasone furoate (Arnuity Ellipta).
You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, inhaled corticosteroids have a relatively low risk of serious side effects.
Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms.
Montelukast has been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away if you experience any of these reactions.
Combination inhalers. These medications — such as fluticasone-salmeterol (Advair HFA, Airduo Digihaler, others), budesonide-formoterol (Symbicort), formoterol-mometasone (Dulera) and fluticasone furoate-vilanterol (Breo Ellipta) — contain a long-acting beta agonist along with a corticosteroid.
Theophylline. Theophylline (Theo-24, Elixophyllin, Theochron) is a daily pill that helps keep the airways open by relaxing the muscles around the airways. It’s not used as often as other asthma medications and requires regular blood tests.
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack. They may also be used before exercise if your doctor recommends it.
Types of quick-relief medications include:
- Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex, Xopenex HFA).
- Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer, a machine that converts asthma medications to a fine mist. They’re inhaled through a face mask or mouthpiece.
- Anticholinergic agents. Like other bronchodilators, ipratropium (Atrovent HFA) and tiotropium (Spiriva, Spiriva Respimat) act quickly to immediately relax your airways, making it easier to breathe. They’re mostly used for emphysema and chronic bronchitis, but can be used to treat asthma.
- Oral and intravenous corticosteroids. These medications — which include prednisone (Prednisone Intensol, Rayos) and methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol) — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so these drugs are used only on a short-term basis to treat severe asthma symptoms.
Complications Of Asthma
Asthma complications include:
- Signs and symptoms that interfere with sleep, work and other activities
- Sick days from work or school during asthma flare-ups
- A permanent narrowing of the tubes that carry air to and from your lungs (bronchial tubes), which affects how well you can breathe
- Emergency room visits and hospitalizations for severe asthma attacks
- Side effects from long-term use of some medications used to stabilize severe asthma
- Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.
While there’s no way to prevent asthma, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.
- Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack. Then be sure to follow your plan.
- Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life.
- Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.
- Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
- Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter. A peak flow meter measures how hard you can breathe out. Your doctor can show you how to monitor your peak flow at home.Identify and treat attacks early. If you act quickly, you’re less likely to have a severe attack. You also won’t need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed. Also, immediately stop any activity that may have triggered the attack. If your symptoms don’t improve, get medical help as directed in your action plan.
- Take your medication as prescribed. Don’t change your medications without first talking to your doctor, even if your asthma seems to be improving. It’s a good idea to bring your medications with you to each doctor visit. Your doctor can make sure you’re using your medications correctly and taking the right dose.
- Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn’t under control. See your doctor about adjusting your treatment.
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