Asthma

What is asthma?
Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems. The characteristics of asthma are three airway problems:

• obstruction
• inflammation
• hyper-responsiveness

Asthma is the most common, chronic health problem among children.

What are the symptoms of asthma?
Asthma may resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. It is under-diagnosed -- many people with the disease do not know they have it. Sometimes the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

What causes asthma?
The basic cause of the lung abnormality in asthma is not yet known, although healthcare professionals have established that it is a special type of inflammation of the airway that leads to:

• contraction of airway muscles
• mucus production
• swelling in the airways

It is important to know that asthma is not caused by emotional factors -- as commonly believed years ago. Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms or aggravate an attack. However, these reactions are considered to be more of an effect than a cause.

What are risk factors for asthma attacks?
Although anyone may have an asthma attack, it most commonly occurs in:

• children, by the age of 5
• adults in their 30s
• adults older than 65
• people living in urban communities

Other factors include:

• family history
• personal medical history of allergies

What happens during an asthma attack?
People with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs and airways.

• Lungs and airways overreact to certain triggers and become inflamed and clogged.

• Breathing becomes harder and may hurt.

• There may be coughing.

• There may be a wheezing or whistling sound, which are typical of asthma. Wheezing occurs because:

• muscles that surround the airways tighten, the inner lining of the airways swells and pushes inward.

• membranes that line the airways secrete extra mucus.

• the mucus can form plugs that further block the air passages.

• the rush of air through the narrowed airways produces the wheezing sounds.

What are triggers for asthma attacks?
Triggers that can cause an asthma attack:

• Allergens, such as:

• pollen

• mold

• animal dander

• house dust/dust mites

• cockroaches

• certain foods or sulfites used as food and beverage preservatives

• Respiratory infections often act as a major aggravating trigger, since they irritate the airways, nose, throat, lungs, and sinuses. Although it is well-known that irritation often precedes attacks of asthma, the exact biological mechanism for this is not yet known.

• Sinusitis, an inflammation of the nasal sinuses, often begins as an upper respiratory infection. Asthma may be aggravated by drainage of mucus into the nose, throat and bronchial tubes. Symptoms of sinusitis include wheezing, postnasal drip, nighttime cough and enlarged lymph nodes. Adolescents and adults may have headaches and sinus pressure or pain.

• Irritants, such as:

• strong odors and sprays, such as perfumes, household cleaners, cooking fumes (especially from frying), paints, and varnishes

• other chemicals such as coal, chalk dust, or talcum powder

• air pollutants

• changing weather conditions, including changes in temperature, barometric pressure, humidity and strong winds.

• Tobacco smoke, whether directly or passively inhaled, has harmful effects on the airways and is especially irritating for adults and children with asthma.

• Wood smoke from wood-burning heating stoves and fireplaces can be extremely irritating to asthmatics because of the release of chemicals such as sulfur dioxide.

• Exercise also can trigger an asthma attack. It is estimated that 85 percent of allergic asthmatics have symptoms of wheezing following exercise. Inhaled cool and dry air seems to be a strong asthma trigger. Long-term strenuous activities such as long distance running, are most likely to induce asthma, and swimming is the least likely.

• Sensitivity to medications, including:

• aspirin

• other non-steroidal anti-inflammatory medications in patients with aspirin sensitivity, such as ibuprofen, indomethacin, or naproxen

Before taking any medication, including over-the-counter medications, asthma sufferers should consult their physicians.

Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms or aggravate an attack. These reactions are considered to be more of an effect than a cause.

Your allergist can provide you with more information on the causes and treatment.

How is asthma diagnosed?
To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination, and laboratory tests, which may include:

• spirometry (using an instrument that measures the air taken into and out of the lungs)

• peak flow monitoring (another measure of lung function)

• chest x-rays

• blood tests

• allergy tests

How is asthma treated?
Specific treatments for asthma will be determined by the child's physician(s) based on the:

• patient's overall health and medical history
• extent of the disease
• patient's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• patient's or family's opinion or preference

As of yet, there is no cure for asthma, but it can be controlled with prescription medications that may help to prevent or relieve symptoms, and by learning how to manage episodes.

Four components of treatment:

1. The use of objective measures of lung function  -- spirometry, peak flow expiratory flow rate -- to assess the severity of asthma, and to monitor the course of treatment.

2. The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airway.

3. The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.

4. Patient education that includes a partnership among the patient, family members, and the child's physician.

Managing asthma:
People with asthma can learn to identify and avoid the things that trigger an episode, and educate themselves about medications and other asthma management strategies.

According to the Guidelines for the Diagnosis and Management of Asthma, published by the National Heart, Lung and Blood Institute:

• Asthma is a chronic disease. It has to be cared for all the time -- not just when symptoms are present. Guidelines to follow in the continuous management of asthma are summarized in the following 4 points:

• identify and minimize contact with asthma triggers.
• understand and take medications as prescribed.
• monitor asthma to recognize signs when it is getting worse.
• know what to do when asthma gets worse.

• Working with a healthcare professional is the best way to take care of asthma.

• The more informed a person is, the better one's asthma can be controlled.