“Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.”
“For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.”
“Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed.”
In the United States, asthma affects an estimated 26 million people — many of whom may not be aware that they have it, especially if their symptoms aren’t severe.
The most common signs of asthma are:
- Coughing, especially at night, during exercise or when laughing
- Difficulty breathing
- Chest tightness
- Shortness of breath
- Wheezing (a whistling or squeaky sound in your chest when breathing, especially when exhaling)
“Any asthma symptom is serious and can become deadly if left untreated. If you’re experiencing one or more of these symptoms, visit an allergist for a diagnosis — and then develop an asthma action plan.”
“Most children with asthma have symptoms before they turn 5. In very young children, it may be hard for parents, and even doctors, to recognize that the symptoms are due to asthma. The bronchial tubes in infants, toddlers and preschoolers are already small and narrow, and head colds, chest colds and other illnesses can inﬂame these airways, making them even smaller and more irritated.”
Common symptoms include:
- Coughing, especially at night
- A wheezing or whistling sound when breathing, especially when exhaling
- Trouble breathing or fast breathing that causes the skin around the ribs or neck to pull in tightly
- Frequent colds that settle in the chest
“Your child might have only one of these symptoms or several of them. You may think it’s just a cold or bronchitis. If the symptoms recur, that’s a clue that your child might have asthma. In addition, symptoms may worsen when your child is around asthma triggers, such as irritants in the air (smoke or strong odors, for example) or allergens like pollen, pet dander and dust mites.”
CAUSES OF ASTHMA
“Asthma symptoms may be triggered by exposure to an allergen (such as ragweed, pollen, animal dander or dust mites), irritants in the air (such as smoke, chemical fumes or strong odors) or extreme weather conditions. Exercise or an illness — particularly a respiratory illness or the flu — can also make you more susceptible.”
“A physical display of strong emotion that affects normal breathing patterns — such as shouting, crying or laughing — can also act as an asthma trigger. Panic can prevent a person with asthma from relaxing and following instructions, which is essential during an asthma attack. Scientists have found that rapid breathing associated with strong emotions can cause bronchial tubes to constrict, possibly provoking or worsening an attack.”
“Asthma symptoms can appear at any time. Mild episodes may last only a few minutes and may be resolved spontaneously or with medication; more severe episodes can last from hours to days.
People with asthma, like those with any chronic condition, may experience significant stress. Because it is a leading cause of work and school absences, asthma can affect a person’s livelihood, education and emotional well-being. Depression may set in when people diagnosed with asthma believe that they are unable to participate in normal activities.”
“If you’re experiencing breathing difficulties that interfere with your daily activities and decrease the quality of your life, visit an asthma screening event in your area and see an allergist for diagnosis and treatment. An allergist can also help you recognize the early warning signs of an attack and coach you in ways to cope during an emergency.”
Since asthma is a chronic disease, treatment goes on for a very long time. Some people have to stay on treatment for the rest of their lives. The best way to improve your condition and live your life on your terms is to learn all you can about your asthma and what you can do to make it better.
- Become a partner with your health-care provider and his or her support staff. Use the resources they can offer — information, education, and expertise — to help yourself.
- Become aware of your asthma triggers and do what you can to avoid them.
- Follow the treatment recommendations of your health-care provider. Understand your treatment. Know what each drug does and how it is used.
- See your health-care provider as scheduled.
- Report any changes or worsening of your symptoms promptly.
- Report any side effects you are having with your medications.
These are the goals of treatment:
- prevent ongoing and bothersome symptoms;
- prevent asthma attacks;
- prevent attacks severe enough to require a visit to your provider or an emergency department or hospitalization;
- carry on with normal activities;
- maintain normal or near-normal lung function; and
- have as few side effects of medication as possible.
“Current treatment regimens are designed to minimize discomfort, inconvenience, and the extent to which you have to limit your activities. If you follow your treatment plan closely, you should be able to avoid or reduce your visits to your health-care provider or the emergency department.”
Know your triggers and do what you can to avoid them.
- If you smoke, quit.
- Do not take cough medicine. These medicines do not help asthma and may cause unwanted side effects.
- Aspirin and nonsteroidal anti-inflammatory drugs, such as ibuprofen, can cause asthma to worsen in certain individuals. These medications should not be taken without the advice of your health-care provider.
- Do not use non-prescription inhalers. These contain very short-acting drugs that may not last long enough to relieve an asthma attack and may cause unwanted side effects.
- Take only the medications your health-care provider has prescribed for your asthma. Take them as directed.
- Do not take any non-prescription preparations, herbs, or dietary supplements, even if they are completely “natural,” without talking to your health-care provider first. Some of these may have unwanted side effects or interfere with your medications.
- If the medication is not working, do not take more than you have been directed to take. Overusing asthma medications can be dangerous.
- Be prepared to go on to the next step of your action plan if necessary.
EMERGENCY TREATMENT FOR ASTHMA
“If you are in the emergency room, treatment will be started while the evaluation is still going on.
You may be given oxygen through a face mask or a tube that goes in your nose.
You may be given aerosolized beta-agonist medications through a face mask or a nebulizer, with or without an anticholinergic agent.
Another method of providing inhaled beta-agonists is by using a metered dose inhaler or MDI. An MDI delivers a standard dose of medication per puff. MDIs are often used along with a “spacer” or holding chamber. A dose of six to eight puffs is sprayed into the spacer, which is then inhaled. The advantage of an MDI with a spacer is that it requires little or no assistance from the respiratory therapist.”
“If you are already on steroid medications, or have recently stopped taking steroid medications, or if this appears to be a very severe attack, you may be given a dose of IV steroids.
If you are taking a methylxanthine, such as theophylline or aminophylline, the blood level of this drug will be checked, and you may be given this medication through an IV.
People who respond poorly to inhaled beta-agonists may be given an injection or IV dose of a beta-agonist such as terbutaline or epinephrine.”
“You will be observed for at least several hours while your test results are obtained and evaluated. You will be monitored for signs of improvement or worsening.
If you respond well to treatment, you will probably be released from the hospital. Be on the lookout over the next several hours for a return of symptoms. If symptoms should return or worsen, return to the emergency department right away.
Your response will likely be monitored by a peak flow meter.”
In certain circumstances, you may need to be admitted to the hospital. There you can be watched carefully and treated should your condition worsen. Conditions for hospitalization include the following:
- an attack that is very severe or does not respond well to treatment;
- poor lung function observed on spirometry;
- elevated carbon dioxide or low oxygen levels in your blood;
- a history of being admitted to the hospital or placed on a ventilator for your asthma attacks;
- other serious disease that may jeopardize your recovery; and
- other serious lung illnesses or injuries, such as pneumonia or pneumothorax (a “collapsed” lung).
Controller medicines help minimize the inflammation that causes an acute asthma attack.
Long-acting beta-agonists (LABA): “”This class of drugs is chemically related to adrenaline, a hormone produced by the adrenal glands. Inhaled long-acting beta-agonists work to keep breathing passages open for 12 hours or longer. They relax the muscles of the breathing passages, dilating the passages and decreasing the resistance to exhaled airflow, making it easier to breathe. They may also help to reduce inflammation, but they have no effect on the underlying cause of the asthma attack. Side effects include rapid heartbeat and shakiness. Salmeterol (Serevent), formoterol (Foradil), indacaterol (Arcapta), and vilanterol (used in Breo and Anoro) are long-acting beta-agonists. These drugs should not be used alone in patients with asthma. There is a box warning based on the SMART trial with salmeterol in which there was an increased risk of cardiac death in asthmatics. This issue appears to be mitigated when these drugs are used in combination with inhaled steroids.
Inhaled corticosteroids are the main class of medications in this group. The inhaled steroids act locally by concentrating their effects directly within the breathing passages, with very few side effects outside of the lungs. Beclomethasone (Beclovent), fluticasone (Flovent, Arnuity), budesonide (Pulmicort), and triamcinolone (Azmacort) are examples of inhaled corticosteroids.”
Combination therapy with both a LABA and an inhaled corticosteroid: “These include Advair (salmeterol, fluticasone), Symbicort (formoterol, budesonide), and Dulera (formoterol, mometasone), and are all taken twice daily. Newer agents like Breo are combination therapies that only need to be taken once daily.
Leukotriene inhibitors are another group of controller medications. Leukotrienes are powerful chemical substances that promote the inflammatory response seen during an acute asthma attack. By blocking these chemicals, leukotriene inhibitors reduce inflammation. The leukotriene inhibitors are considered a second line of defense against asthma and usually are used for asthma that is not severe enough to require oral corticosteroids.”
Short-acting beta-agonists (SABA) “are the most commonly used rescue medications. Inhaled short-acting beta-agonists work rapidly, within minutes, to open the breathing passages, and the effects usually last four hours. Albuterol (Proventil, Ventolin) is the most frequently used SABA medication.”
Anticholinergics “are another class of drugs useful as rescue medications during asthma attacks. Inhaled anticholinergic drugs open the breathing passages, similar to the action of the beta-agonists. Inhaled anticholinergics take slightly longer than beta-agonists to achieve their effect, but they last longer than the beta-agonists. An anticholinergic drug is often used together with a beta-agonist drug to produce a greater effect than either drug can achieve by itself. Ipratropium bromide (Atrovent) is the inhaled anticholinergic drug currently used as a rescue asthma medication.”