Asthma

Asthma is a long-term (chronic) disease of the lungs that causes a person’s airways to become inflamed. This inflammation can make breathing difficult for three reasons:

• The inside lining of the airways swells and narrows the space inside your airways.
• The muscles around the airways tighten, which narrows the airways.
• Your airways produce more mucus, which clogs the airways.

When you breathe, you breathe in oxygen from the air. You also get rid of carbon dioxide when you breathe out, a gas that’s produced when your body’s cells use up oxygen. This exchange takes place in your lungs, two sponge-like organs in your chest. Here’s how it works:

1. When you take a breath in, air flows down your throat and windpipe. The windpipe is also called the trachea (tray-kee-uh).
2. From the trachea, air flows into large airways called bronchial tubes.
3. From the bronchial tubes, air goes deeper into the lungs through smaller and smaller branches. These smaller airways are called bronchioles.
4. At the end of this maze of little branches are tiny air sacs called alveoli (al-vee-uh-lahy). These air sacs take oxygen from the air you breathe and pass it into your bloodstream. They also collect carbon dioxide from the bloodstream for you to breathe out.

With your inflamed airways narrowed by swelling, tightening, and mucus, air doesn’t move as easily into and out of your lungs. It can be like trying to breathe through a narrow straw — you have to work extra hard to get air in and out. When you have other asthma symptoms, like coughing, wheezing, and chest tightness, and shortness of breath, you’re having an asthma flare-up or asthma “attack."

Since asthma interferes with your breathing, it’s a serious condition. Uncontrolled asthma causes people to miss work or school, go to the hospital, or even die. Fortunately, people can learn to control their asthma and avoid serious problems.

See a doctor if you notice any of the symptoms of asthma. It’s important to diagnose and treat asthma so you can control it before it becomes life threatening.

See your doctor if your asthma treatment isn’t working and you need to use your quick-relief medicine more than 2 times a week for an asthma flare.

Call 911 right away if you or your child has life-threatening symptoms of an asthma flare-up.

Researchers don’t know for sure what causes asthma. They think it is probably caused by a combination of genetics (what you inherit from your family) and your environment (the places you live, learn, work, or play).

However, doctors and researchers do have a good understanding of what causes asthma to flare up. If you have asthma, your inflamed airways are “twitchy”— they overreact to irritants in your environment. These irritants are called triggers, and they include anything that sets off an asthma flare-up. Different people have different triggers. Some common asthma triggers are allergies, chest colds, pollution, viral or bacterial infections, and exercise. To control your asthma, you have to find out what your triggers are and learn how to deal with them.

Although anyone can get asthma at any age, but certain risk factors can increase your changes of having it:

• Asthma often starts in childhood, and is more common in children than in adults.
• More boys than girls have asthma. But in adulthood, more women than men have it.
• People who have allergies or whose family members have allergies are more likely than other people to have asthma.
• Asthma tends to run in families. If your mother, father, or siblings have asthma, you’re at an increased risk.
• People who smoke or who are around a lot of secondhand smoke are more likely to get asthma.

Here’s what your doctor may do to gather information before an asthma diagnosis:

• During the medical history, your doctor will ask questions about your symptoms and what seems to trigger them. Your doctor will especially want to know about symptoms that repeat. Try to give as many details as possible, even if they seem unrelated.
• During your physical examination, your doctor may listen to your breathing and heartbeat, and check your body for signs of allergies.
• Pulmonary function testing (PFT) helps your doctor know how well your lungs are working. There are several different types of tests. One of the most common is spirometry, which measures the amount and speed of air you can breathe in and out. In addition to other readings, spirometry can determine how much air you can blow out in one second. This is your forced expiratory volume, or FEV1. For young children who often can't do the tests correctly, doctors rely on the medical history and physical exam to diagnose asthma.
• Your doctor may need to gather more information about your lungs, your breathing, and your asthma triggers by doing other tests. Blood tests or skin prick tests can check for allergies that might cause your asthma symptoms. A chest x-ray may be needed to check for lung problems other than asthma that could be causing your symptoms.

Treatment of asthma involves avoiding your triggers, taking medicine, and making sure you respond to your asthma symptoms when you notice them. Your doctor will create an Asthma Action Plan, a treatment plan that will help you prevent symptoms and respond when you have an asthma flare-up.

There are two basic types of asthma medicines:

• Quick-relief medicines. These medicines can relieve asthma symptoms or symptoms that come on fast (sudden onset symptoms). They work “quickly” — usually within 5 to 10 minutes — to help open airways during an asthma flare-up. They don’t prevent future asthma symptoms. If you use these medicines more than 2 times a week to stop asthma flare-ups, it may be that your symptoms are not being controlled well. Talk to your doctor.
• Controller medicines. These medicines can help prevent symptoms. They are usually for people with persistent asthma. For these medicines to work, you must take them every day, even when you’re symptom-free and feeling well. Taken regularly, controller medicines help prevent asthma flare-ups. Controller medicines CANNOT stop a sudden or severe asthma flare-up. For flare-ups, use your quick-relief or oral steroid medicine as instructed in your Asthma Action Plan.

Instead of being controlled by your asthma symptoms, you can begin to take charge of your health by controlling your asthma. Work with your asthma care team to:

• Know your symptoms so you can prevent or treat a flare-up.
• Avoid your triggers. A trigger is anything — a condition, a substance, an activity — that causes inflammation in your sensitive airways. A trigger makes your asthma worse or keeps it from getting better. Know what tends to trigger a flare-up and try to avoid those.
• Take your medicine correctly. Take your controller medicine every day, even when you’re feeling well. Make sure you know how to use your inhaler, spacer, or nebulizer properly.
• Follow your Asthma Action Plan every day. The things you do to control your asthma need to be daily habits. An Asthma Action Plan can help. The Plan lists symptoms to watch, triggers to avoid, and when and how to take your asthma medicines.
• Check your asthma control regularly. Over time, things can change: your environment, your response to medicines, and your sensitivity to certain triggers. All of these changes can affect your asthma control. Yet, studies show that many people think their asthma is controlled when it’s not. Your doctor needs to review your treatment at least every six months, even if you're feeling fine and doing well. Beyond these regular visits, your doctor also needs to see you any time your asthma symptoms are increasing. At least every two years, get pulmonary function testing.

While you may not be able to prevent having asthma, you can control your asthma and prevent flare-ups. Follow your Asthma Action Plan and avoid your triggers to prevent an asthma flare-up.

Intermountain Healthcare Patient Education, “Breathing Easier with Asthma”

Asthma symptoms vary from person to person and from time to time in each person. Below are some common asthma symptoms, described from least to most severe:

• Coughing, particularly at night or after exercise. The first thing you may notice is a persistent (ongoing) cough. Coughing at night and coughing after exercise are especially common in people with uncontrolled asthma.
• Wheezing. You may hear a high-pitched whistling sound as you breathe. This sound, called wheezing, means that the air is having trouble moving through your airways. Wheezing usually happens when you breathe out. But as your asthma worsens, you might also hear wheezing when you breathe in.
• Difficulty breathing and chest tightness. As your breathing becomes more difficult, you can feel pain or tightness in your chest. Children are more likely to say that their chest hurts.
• Shallow breathing. You may find it difficult to take a deep breath. Your breaths become shallow as your condition worsens.
• Fast breathing. As your breathing becomes shallow, it also becomes faster as your body tries to get more oxygen into your lungs. Fast breathing for young children is 50 or more breaths a minute while at rest. Fast breathing for other age groups is:
  • Toddler: More than 40 breaths a minute while at rest.
  • School age: More than 30 breaths a minute while at rest.
  • Adult: More than 20 breaths a minute while at rest.
• Retractions. As an asthma flare-up worsens, the skin and muscles between or under the ribs or at the base of the throat may retract, or pull in, with each breath in. This is most often seen in children and is a sign that they are really struggling to breathe.
• Life-threatening symptoms. If an asthma flare-up becomes very severe, you won’t be able to work hard enough to breathe in and out. At this point, your retractions and wheezing may actually begin to go away. Your breathing will become very shallow. And, because your body isn’t getting enough oxygen, your face and lips may turn slightly blue. Symptoms like these are very dangerous and require immediate emergency care.