Asthma

What is Asthma?

Asthma is a condition in which your airways narrow and swell and produce extra mucus. 

Facts about Asthma

• In the United States, about 25.7 million people have asthma, including seven million children.
• Approximately 1.8 million people have an asthma-related emergency department visit each year, and 439,000 people are hospitalized.
• About 3,400 people die from asthma each year in the United States. The number of asthma deaths has been declining steadily since 2001.
• Worldwide, there are about 334 million people with asthma.

Symptoms

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
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

For some people, asthma signs and symptoms flare up in certain situations:

• Exercise: triggered when the air is cold and dry
• Occupational (at a worksite): triggered by workplace irritants such as chemical fumes, gases, or dust
• Allergy-induced: triggered by airborne substances, such as pollen, mold spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet dander)

Causes, Triggers and Risk Factors:

Causes:

It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic (inherited) factors.

Triggers:

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

• Respiratory infections, such as the common cold
• Physical activity (exercise-induced asthma)
• Cold air
• Air pollutants and irritants, such as smoke
• Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)
• Strong emotions and stress
• Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer, and wine
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

Risk Factors:

A number of factors are thought to increase your chances of developing asthma:

• Having a blood relative (such as a parent or sibling) with asthma
• Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
• Being overweight
• Being a smoker
• Exposure to secondhand smoke
• Strong emotions and stress
• Exposure to exhaust fumes or other types of pollution
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing, and manufacturing

Treatment:

Prevention and long-term control are key in stopping asthma attacks before they start. Medications are both for long-term control as well as short term control (in case of an attack).

Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. Preventive, long-term control medications reduce the inflammation in your airways that lead to symptoms.

Types of long-term control medications include:

• Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flonase, Flovent HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta).
• TLeukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to 24 hours.
• Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways.
• Combination inhalers. These medications — such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (Dulera) — contain a long-acting beta agonist along with a corticosteroid.
• Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways.
• Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma   attack — or before exercise if your doctor recommends it.
• 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).
• Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe.
• Oral and intravenous corticosteroids. These medications — which include prednisone and methylprednisolone — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they're used only on a short-term basis to treat severe asthma symptoms.
• Allergy medications may help if your asthma is triggered or worsened by allergies. These 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).
• Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for a period of three to five years.
• Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system.
• Bronchial thermoplasty: This treatment — which isn't widely available nor right for everyone — is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications.

Lifestyle Modifications:

Taking steps to reduce your exposure asthma triggers is a key part of asthma control, including:

• Use your air conditioner
• Decontaminate your decor
• Maintain optimal humidity
• Prevent mold spores
• Reduce pet dander
• Clean regularly
• Cover your nose and mouth if it's cold out 

Other measures:

• Get regular exercise
• Decontaminate your decor
• Maintain a healthy weight
• Control heartburn and gastroesophageal reflux disease (GERD) 

References:

• Mayo Clinic - Asthma