Asthma

Bronchial asthma; Exercise-induced asthma Last reviewed: July 14, 2010.

U.S. National Library of Medicine National Institutes of Health National Center for Biotechnology Information U.S. National Library of Medicine National Institutes of Health 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 longacting 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.

Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. Bronchial asthma is the more correct name for the common form of asthma. The term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a separate condition that is caused by heart failure. Although the two types of asthma have similar symptoms, including wheezing (a whistling sound in the chest) and shortness of breath, they have quite different causes. Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath. The cause is a sharply elevated resistance to airflow in the airways. Despite its most strenuous efforts, the respiratory musculature is unable to provide sufficient gas exchange. The result is a characteristic asthma attack, with spasms of the bronchial musculature, edematous swelling of the bronchial wall and increased mucus secretion. In the initial stage, the patient can be totally symptom-free for long periods of time in the intervals between the attacks. As the disease progresses, increased mucus is secreted between attacks as well, which in part builds up in the airways and can then lead to secondary bacterial infections. Bronchial asthma is usually intrinsic (no cause can be demonstrated), but is occasionally caused by a specific allergy (such as allergy to mold, dander, dust). Although most individuals with asthma will have some positive allergy tests, the allergy is not necessarily the cause of the asthma symptoms. Symptoms can occur spontaneously or can be triggered by respiratory infections, exercise, cold air, tobacco smoke or other pollutants, stress or anxiety, or by food allergies or drug allergies.

The muscles of the bronchial tree become tight and the lining of the air passages become swollen, reducing airflow and producing the wheezing sound. Mucus production is increased. Typically, the individual usually breathes relatively normally, and will have periodic attacks of wheezing. Asthma attacks can last minutes to days, and can become dangerous if the airflow becomes severely restricted. Asthma affects 1 in 20 of the overall population, but the incidence is 1 in 10 in children. Asthma can develop at any age, but some children seem to outgrow the illness. Risk factors include self or family history of eczema, allergies or family history of asthma. Bronchial asthma causes cough, shortness of breath, and wheezing. Bronchial asthma is an allergic condition, in which the airways (bronchi) are hyper-reactive and constrict abnormally when exposed to allergens, cold or exercise. Treatment is aimed at avoiding known allergens and controlling symptoms through medication. A variety of medications for treatment of asthma are available. People with mild asthma (infrequent attacks) may use inhalers on an as-needed basis. Persons with significant asthma (symptoms occur at least every week) should be treated with anti-inflammatory medications, preferably inhaled corticosteroids, and then with bronchodilators such as inhaled Alupent or Vanceril. Acute severe asthma may require hospitalization, oxygen, and intravenous medications. Decrease or control exposure to known allergens by staying away from cigarette smoke, removing animals from bedrooms or entire houses, and avoiding foods that cause symptoms. Allergy desensitization is rarely successful in reducing symptoms.

Bronchial Asthma
Ever hear the term "bronchial asthma" and wonder what it means? When people talk about bronchial asthma, they are really talking about asthma, a chronic inflammatory disease of the airways that causes periodic "attacks" of coughing, wheezing, shortness of breath, and chest tightness. According to the CDC, more than 22 million Americans, including 6.5 million children under 18, suffer with asthma today. Allergy clearly plays an important role in many asthma cases but not in all. As with allergy, you can blame your family history; there's certainly a strong genetic component for asthma. Asthma is associated with mast cells, eosinophils, and T lymphocytes. Mast cells are the allergycausing cells that release chemicals like histamine. Histamine is the substance that causes nasal stuffiness and dripping in a cold or hay fever, constriction of airways in asthma, and itchy areas in a skin allergy. Eosinophils are a type of white blood cell associated with allergic disease. T lymphocytes are also white blood cells associated with allergy and inflammation. These cells, along with other inflammatory cells, are involved in the development of airway inflammation in asthma that contributes to the airway hyperresponsiveness, airflow limitation, respiratory symptoms, and chronic disease. In certain individuals, the inflammation results in the feelings of chest tightness and breathlessness that's felt often at night (nocturnal asthma) or in the

early morning hours. Others only feel symptoms when they exercise (called exercise-induced asthma). Because of the inflammation, the airway hyperresponsiveness occurs as a result of specific triggers. Allergies are strongly linked to bronchial asthma and to other respiratory diseases such as chronic sinusitis, middle ear infections, and nasal polyps. Most interestingly, a recent analysis of people with asthma showed that those who had both allergies and asthma were much more likely to have nighttime awakening due to asthma, miss work because of asthma, and require more powerful medications to control their symptoms. Signs of a Pending Asthma Attack
Bronchial Asthma Triggers

Bronchial asthma triggers may include:

Tobacco smoke Infections such as colds, flu, or pneumonia Allergens such as food, pollen, mold, dust mites, and pet dander Exercise Air pollution and toxins Weather, especially extreme changes in temperature Drugs (such as aspirin, NSAID, and beta-blockers) Food additives (such as MSG) Emotional stress and anxiety Singing, laughing, or crying Smoking, perfumes, or sprays Acid reflux

Signs and Symptoms of Bronchial Asthma

With bronchial asthma, you may have one or more of the following signs and symptoms:

Shortness of breath Tightness of chest Wheezing Excessive coughing or a cough that keeps you awake at night

Diagnosing Bronchial Asthma

Because asthma does not always happen at the doctor's visit, it's important for you to describe your asthma signs and symptoms to your doctor. You might also notice when the symptoms occur such as during exercise, with a cold, or after smelling smoke. Asthma tests may include:

Spirometry: A lung function test to measure your breathing capacity and how well you breathe. You will breathe into a device called a spirometer.

Peak Expiratory Flow (PEF): Using a device called a peak flow meter, you forcefully exhale into the tube to measure the force of air you can expend out of your lungs. Peak flow monitoring can allow you to monitor your how well your asthma is doing at home. Chest X-Ray: Your doctor may do a chest X-ray to rule out any other diseases that may be causing similar symptoms.

Treating Bronchial Asthma

Once diagnosed, your asthma doctor will recommend asthma medication (which can include asthma inhalers and pills) and lifestyle changes to treat and prevent asthma attacks. For example, long-acting anti-inflammatory asthma inhalers are often necessary to treat the inflammation associated with asthma. These inhalers deliver low doses of steroids to the lungs with minimal side effects if used properly. The fast-acting or "rescue" bronchodilator inhaler works immediately on opening airways during an asthma attack. If you have bronchial asthma, make sure your doctor shows you how to use the inhalers. Be sure to keep your rescue inhaler with you in case of an asthma attack or asthma emergency. While there is no asthma cure yet, there are excellent asthma medications that can help with preventing asthma symptoms and asthma support that can help you live a normal, active life.