Asthma

Asthma is a chronic respiratory disease that affects the airways in the lungs. It occurs in people of all ages and often starts during childhood. In asthma the muscles around your airways become tight, causing the bronchial tubes to narrow. You can also have increased mucus production which clogs the airways even more. This can lead to shortness of breath, wheezing, coughing, and chest tightness. If not treated, asthma can be life-threatening. Asthma, particularly severe asthma, can also lead to the development of chronic obstructive pulmonary disease (COPD).

More than 27 million Americans have asthma. This equals about 1 in 12 people. It is a leading chronic disease in children. Currently, there are about 4.5 million children under the age of 18 with asthma.

Asthma symptoms can vary in severity from person to person and be triggered by factors such as allergens (e.g., pollen, dust mites, pet dander), respiratory infections, exercise, cold air, air pollution, smoke, and certain medications.

While there is no cure for this lung disease, it can be managed with asthma medicines and lifestyle changes. Treatment typically involves daily medications to prevent symptoms as well as inhalers or nebulizers which deliver medication directly to your lungs during asthma flare-ups or severe asthma attacks. Avoiding asthma triggers can also help to reduce asthma symptoms.

The exact cause of asthma is not known, but it is believed to result from a combination of genetic and environmental factors that put you at a greater risk of developing asthma. Some risk factors include:

• Genetic Factors: Asthma tends to run in families, so if you have a family history of asthma or other allergic conditions (such as hay fever or eczema), you are at a higher risk of developing asthma.

• Environmental Allergens: Exposure to certain allergens in the environment can trigger asthma symptoms or worsen existing asthma. Common allergens that can trigger asthma include pollen, dust mites, mold, pet dander, and cockroach droppings.

• Respiratory Infections: Viral respiratory infections, especially during early childhood, have been linked to the development of asthma. Respiratory infections can cause inflammation in the airways, making them more reactive and prone to asthma symptoms.
• Occupational and Environmental Factors: Exposure to pollutants and irritants, such as secondhand smoke, poor air quality, chemical fumes, and strong odors, can irritate your airways and trigger asthma symptoms.
• Early Childhood Exposures: Children exposed to tobacco smoke, indoor and outdoor pollutants, and certain allergens may increase their risk of developing asthma later in life.
• Obesity: Obesity has been linked to an increased risk of asthma. It is thought that inflammation and changes in lung function that are related to being obese may contribute to the development or worsening of asthma symptoms.
• Stress: While not a direct cause, stress and emotional factors can trigger asthma symptoms or worsen existing asthma in some people.

While these factors increase the risk of developing type 2 diabetes, it's important to note that not everyone with these risk factors will develop the condition. Making healthy lifestyle choices, such as maintaining a healthy weight, eating a balanced diet, staying physically active, and managing stress, can significantly reduce the risk of developing type 2 diabetes.

The symptoms of asthma can vary in severity and may differ from person to person. Common symptoms of asthma include:

• Shortness of Breath: Feeling breathless or having difficulty breathing is one of the main symptoms of asthma. This can range from mild to severe and can occur during physical activity or at rest.
• Wheezing: Wheezing is a high-pitched whistling sound that occurs when air flows through narrowed airways. It is often heard while you are exhaling but may also occur while inhaling.
• Coughing: A persistent cough, particularly at night or early in the morning, is another common symptom of asthma. The cough may be dry or produce mucus, and it can worsen when exposed to triggers such as allergens or irritants.
• Chest Tightness: Many people with asthma describe a feeling of tightness or pressure in the chest. This symptom can vary in intensity and may accompany other asthma symptoms.
• Difficulty Sleeping: Asthma symptoms, particularly coughing and wheezing, can disrupt sleep and lead to difficulty falling asleep or staying asleep throughout the night.
• Fatigue: Chronic asthma symptoms, especially if poorly controlled, can lead to fatigue or low energy levels due to the increased effort required to breathe.

For 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, which is triggered by workplace irritants such as chemical gases, fumes, or dust.
• Allergy-induced asthma, which is triggered by airborne allergens, such as pollen, mold spores, cockroach waste, or pet dander.

It's important to note that asthma symptoms can vary based on the type of asthma and factors such as exposure to allergens or irritants, respiratory infections, physical activity, stress, or changes in weather conditions.

Asthma diagnosis typically involves a combination of the following:

1. Medical History: Your healthcare provider will start by asking about your symptoms, including any coughing, wheezing, shortness of breath, or chest tightness you may be experiencing. They will also inquire about your personal and family medical history, including any history of allergies, asthma, or other respiratory conditions.
2. Physical Exam: A physical exam will be performed to listen to your lungs and check for signs of asthma, such as wheezing. Your healthcare provider may also look for any other conditions that could be causing your symptoms.
3. Lung Function Tests: Lung function tests, also known as pulmonary function tests (PFTs), are important for diagnosing and assessing the severity of your asthma. The most common lung function test for asthma is spirometry, which measures how much air you can inhale and exhale and how quickly you can exhale.
4. Peak Flow: This involves using a peak flow meter, which is a handheld device that measures how fast you can exhale air from your lungs. Regular peak flow measurements can help track changes in your lung function over time and see how well your medications are working.
5. Allergy Testing: Allergy testing may be recommended to identify specific allergens that could be triggering asthma symptoms. This may involve skin prick tests or blood tests to detect allergic antibodies (IgE) to common allergens such as pollen, dust mites, mold, pet dander, or certain foods.
6. Other Tests: In some cases, additional tests may be performed to rule out other conditions that have some of the same symptoms as asthma symptoms. These may include chest X-rays, CT scans, or tests for conditions such as gastroesophageal reflux disease (GERD) or vocal cord dysfunction.

Based on the results of these tests, your healthcare provider will determine whether you have asthma and develop a treatment plan to help manage your symptoms. Effective asthma management typically involves a combination of medications, avoiding triggers, lifestyle modifications, and regular monitoring to control symptoms and maintain good lung health.

Asthma treatment tries to control symptoms, prevent asthma attacks, and maintain good lung function. Treatment plans can include:

• Medications:

  • Quick Relief Medications (Short-acting Beta Agonists): These medications provide quick relief of asthma symptoms by relaxing the muscles around your airways, making it easier to breathe during an asthma attack. They are typically taken as asthma inhalers or through a nebulizer. The most common asthma medication used is albuterol.

  • Controller Medications (Long-term Control): Controller medications are taken regularly to prevent asthma symptoms and reduce airway inflammation. They include inhaled corticosteroids such as Flovent HFA (fluticasone propionate), Pulmicort Flexhaler (budesonide), Alvesco (ciclesonide), and Qvar Redihaler (beclomethasone), long-acting beta-agonists such as Serevent (salmeterol), and leukotriene modifiers such as Singulair (montelukast), Accolate (zafirlukast), and Zyflo (zileuton). These medications help to control asthma on a day-to-day basis and reduce the frequency and severity of asthma attacks.
  • Biologic Therapies: Your healthcare provider may prescribe a biologic medication if you have severe asthma that is not well-controlled with other treatments. These medications are typically given by injection or infusion and include Nucala (mepolizumab), Xolair (omalizumab), and Cinqair (reslizumab).
  • Oral Corticosteroids: Oral corticosteroids may be prescribed for short-term use during severe asthma flare-ups to quickly reduce inflammation in the airways and improve symptoms. They are typically used for short periods due to the risk of side effects with long-term use.
  • Allergy Shots (Immunotherapy): Over time, allergy shots gradually reduce your immune system's reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for three to five years.

• Allergen Avoidance: Identifying and avoiding triggers that trigger or worsen asthma symptoms is an essential part of asthma management. This may involve minimizing your exposure to allergens such as pollen, dust mites, mold, pet dander, and other environmental triggers.

• Lifestyle Modifications: Making lifestyle changes can help improve asthma control and reduce the number of asthma attacks. This can include maintaining a healthy weight, quitting smoking, managing stress, and getting regular exercise.

• Asthma Action Plan: A written asthma action plan developed with your healthcare provider will show you how to manage asthma symptoms and respond to asthma attacks. It includes instructions on using medications, recognizing worsening symptoms, and seeking emergency care when necessary.
• Regular Monitoring: Regular monitoring of asthma symptoms, lung function, and medication use is important for seeing how well your treatment plan is working and adjusting it if needed. This may involve keeping track of peak flow measurements, symptom diaries, and scheduled follow-up appointments with your healthcare provider.
• Emergency Treatment: In the event of a severe asthma exacerbation or asthma attack, prompt medical attention is essential. Emergency treatment may involve the use of rescue medications, such as short-acting beta-agonists and oral corticosteroids, oxygen therapy, and, in severe cases, hospitalization for further evaluation and management.

You need to work closely with your healthcare provider to develop a treatment plan that addresses your specific needs and goals. With proper management, you can lead an active, symptom-free life and avoid asthma attacks.

Sources:

• What is Asthma? National Blood, Lung, and Heart Institute. https://www.nhlbi.nih.gov/health/asthma. Accessed Apr. 5, 2024.
• Asthma. Centers for Disease Control and Prevention. https://www.cdc.gov/asthma/default.htm. Accessed Apr. 5, 2024.
• What is Asthma? Allergy and Asthma Network. https://allergyasthmanetwork.org/what-is-asthma/. Accessed Apr. 5, 2024.
• What is Asthma? American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/what-is-asthma. Accessed Apr. 5, 2024.
• Asthma 101. American College of Asthma, Allergy and Immunology. https://acaai.org/asthma/asthma-101. Accessed Apr. 5, 2024.