Discuss all medical advice, diagnosis, and treatment with your healthcare provider.

The Basics

What is asthma?

Asthma is a chronic disease in which the airways for breathing become blocked or constricted. This results in breathing difficulties that can, but don’t have to, impede your lifestyle. Asthma has become a great threat to women’s health. As women are more likely to develop adult-onset asthma, the population of women living with asthma is growing.

The airways in an asthmatic patient are swollen and irritated as a result of inflammation. Also, in asthma the muscles around the airways become tight or constricted. This means that less air flows in and out of the lungs. This causes symptoms like shortness of breath, chest tightness, and wheezing, which is a whistling sound when you breathe. Asthma can also cause coughing and breathing problems during exercise.

Asthma is a chronic disease for which there is no cure. However, by adhering to your prescribed treatment and having regular check-ups, you can keep the symptoms under control so that you can maintain an active lifestyle, and prevent any serious complications such as hospitalization.

During an asthmatic episode, or asthma attack, symptoms become worse than usual. The muscles around the airways tighten, causing less air to flow through. Cells in the airways also make more mucus than usual, which further narrows the airways. All of these symptoms make it very difficult to breathe. Asthma attacks may be mild or serious. In a serious attack, you may have so little oxygen getting to vital organs that you may need to be hospitalized and given supplemental oxygen therapy; people can die from serious asthma attacks.

During normal breathing, the airways to the lungs are wide open. When an asthmatic person is exposed to asthma triggers, three things happen:

• The lining of the airways swell and become more inflamed
• Mucus clogs the airways
• Muscles around the airways tighten

All of these occurrences cause breathing to become constricted and strained.

Signs and Symptoms

The symptoms of asthma can often be mistaken for cold or flu symptoms. However, if you have consistently recurring symptoms that worsen at certain times of year, if you have a history of asthma in your family, or if you are getting severe shortness of breath or chest tightness, you should check with your doctor about your symptoms. Some symptoms of asthma include

• Shortness of breath
• Coughing (especially at night and early in the morning)
• Wheezing
• Chest pain or tightness
• A combination of these symptoms

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What causes asthma?

Doctors do not know exactly what causes asthma, but they do know that if someone else in your family has asthma, you are more likely to develop it. Asthma can be a hereditary illness, passed down from generation to generation. If you are born with asthma, it could remain latent. It is when you are exposed to certain triggers that your asthma symptoms will appear. Triggers such as irritants in the air or environment can cause your symptoms to emerge.

Common Asthma Triggers

Cigarette smoke and air pollutants:

• Cigarette smoke—Secondhand smoke is a major trigger of asthma, especially in children. Passive smoking worsens asthma symptoms and studies have shown that passive smoking may result in up to 26,000 new cases of asthma a year in children and teenagers.
• Wood fires, charcoal grills
• Strong fumes from paint, gasoline, and perfume

Substances that cause allergies:

There is a connection between substances that cause allergies (allergens) and asthma triggers. Whether it's dust or shellfish that gives you an allergic reaction, this could also lead to asthma symptoms. Other common allergens include

• Dust mites
• Cockroach droppings
• Pet dander
• Molds

Respiratory (lung or airway) infections:

This is the number one cause of asthma symptoms’ appearance in children. They include

• Head colds
• Bronchitis
• Sore throats
• Sinus infections (throat infections)

Exercise:

Exercising, particularly in the cold air, can trigger asthma. With proper preventative treatment, people with asthma should not need to change their exercise habits. Any kind of exercise that makes you breathe harder like laughing or crying hard, shouting, or hyperventilating can be a trigger.

Weather:

• Dry wind
• Cold air
• Sudden changes in weather and/or tempeature

Some medications:

There are certain medications that may cause or worsen asthma. Examples include aspirin and other anti-inflammatory medications and beta-adrenergic blocking agents which can be used to treat certain heart conditions.

Foods:

Foods are not common triggers of asthma; usually food allergies manifest in a combination of asthma symptoms and skin and gut symptoms.

In some people allergies to foods such as nuts and shellfish can trigger sudden episodes of wheeze and shortness of breath. Some people with asthma are sensitive to certain food additives, although this is not common.

Because the triggers of asthma vary, individuals need to be cognizant of their own triggers. In addition, some people may experience an episode only when they are exposed to more than one trigger, and some may experience an episode if they are exposed to just one. Also, some people may find that an asthma attack will occur immediately after being exposed to a trigger, whereas others may find it takes some time after exposure before they experience symptoms. This makes it even more difficult to identify the trigger.

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Types of asthma

Asthma is divided into two categories: allergic and nonallergic. Allergic asthma is the most common form. More than 50% of the 30 million asthmatic Americans suffer from allergic asthma. It is brought on by the inhalation of certain allergic (called allergens) triggers, like pet dander or mold.

Nonallergic asthma is triggered by other factors like stress, exercise, smoke, airway infections (eg, bronchitis) or other disruptions in the normal breathing process. In nonallergic asthma, the immune system is not enlisted.

The four levels of asthma severity

• Mild Intermittent (comes and goes)—asthma symptoms appear twice a week or less. You occasionally experience nighttime symptoms, but no more than twice a month. Between episodes, you experience no symptoms and your lung function is normal (lung function testing can be performed by your healthcare professional).
• Mild Persistent—asthma symptoms appear more than twice a week, but you never experience symptoms more than once in one day. You experience nighttime symptoms more than twice a month. You may have asthma attacks that affect your activities.
• Moderate Persistent—asthma symptoms appear every day, and you experience nighttime symptoms more than once a week. Asthma attacks may affect your activities.
• Severe Persistent—asthma symptoms are felt throughout the day on most days, and you are often afflicted by nighttime symptoms. If you have severe persistent asthma, your activities are probably greatly affected and you may have reduced lung functioning on testing.

Note: Anyone with asthma can have a severe attack, even people with mild or intermittent conditions.

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Asthma and women: the statistics

Even though more boys than girls are diagnosed with asthma, there is a markedly higher rate of asthma in women than in men after the teenage years. Women are more likely to develop asthma after age 20.

Asthma is more severe in women than in men, especially during the reproductive years from ages 20 to 50. Women often develop asthma as a result of hormonal fluctuations. Some women develop asthma symptoms for the first time after a pregnancy, or during menopause. An ongoing Harvard Nurses Health Study found that women who take hormone therapy for 10 years or more after menopause are 50% more likely to develop asthma than women who never used estrogen.

The asthma death rate for women aged 35 to 64 years is 22.3 per million, compared with 13.0 for men. The difference becomes more dramatic for women aged 65 years and older: 99.1 per million compared with 68.1 per million for men.

Of adults whose cases of acute asthma presented to the emergency department, women were almost twice as common as men. Men received less outpatient care and had worse lung function, but women were more likely to be admitted to the hospital and to report worsening symptoms in follow-up visits. There is still much research to be done to fully understand the complex relationship between gender and acute asthma.

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How does asthma affect women differently?

Puberty and menstruation

Some girls find that when they first go through puberty their asthma symptoms worsen. Your symptoms will usually return to normal once your menstrual periods stabilize.

• Keep a peak flow diary to track how your menstrual period is affecting your asthma.
• If your asthma gets consistently worse, see your healthcare professional. You may be in need of an extra preventative medicine, which you would take on the week before your period to minimize symptoms.
• Some medicines such as anti-inflammatory medicines used to treat menstrual pain may actually induce asthma attacks. If you take such medicines regularly, talk to your doctor.

Sleep

Asthma in young women significantly increases the risk of developing obstructive sleep apnea, a disorder where the tissues at the back of the throat temporarily collapse during sleep, causing the pathway to the lungs to be obstructed until the brain wakes up. This results in poor sleep quality and drowsiness. Symptoms of obstructive sleep apnea include loud snoring, cessation of breathing at night, excessive daytime sleepiness, and needing to pass urine frequently at night. Long-term consequences of untreated sleep apnea include high blood pressure and a higher risk for developing heart attacks andstrokes.

Pregnancy

If you are pregnant, it is vital for both you and your baby that you control your asthma. Uncontrolled asthma can lower the oxygen level in your blood, which means that your baby gets less oxygen, too, and therefore your baby’s growth and development will be affected.

Most, although not all, asthma medicines are safe to take during pregnancy. Doctors recommend that it is much less risky to take some asthma medicines during pregnancy than to take the chance that you will have an asthma attack.

If you are pregnant or thinking about becoming pregnant, talk to your healthcare professional about your asthma and how to have a healthy pregnancy.

Motherhood

Asthma is a major issue for children. It is the third-leading cause of hospitalization among children under 15 years of age. Treatment costs are estimated at $3.2 billion annually for children under 18.

Menopause

Because menopause is another point in time when your hormones are in flux, your asthma symptoms may worsen. Be conscious of any changes in your symptoms, and discuss them with your healthcare professional.

Osteoporosis

This condition, through which your bones become brittle, is a major health problem for aging women. This disease affects one in three women after menopause. Studies have found that women who suffer from asthma may be slightly more likely to get osteoporosis. Taking steroid tablets (eg, prednisone) or high doses of preventative inhalers over an extended period of time may increase the risk of developing osteoporosis. You should talk to your clinician about this.

Women with asthma should be exceptionally careful to reduce their risk of osteoporosis. Here are some ways in which you can reduce the risk:

• Ensure that your diet has sufficient calcium by consuming foods like yogurt, cheese, and milk. Tinned fish with bones, tofu, and leafy greens also contain a high dose of calcium.
• Do regular weight-bearing exercise. Walking, dancing, weight-training, and running are all examples of weight-bearing exercise.
• Do not smoke. Smoking is an independant risk factor for developing osteoporosis.
• Drink only moderate amounts of alcohol.

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Diagnosis and Treatment

Diagnosis

If you answer yes to any of the following questions, you may have asthma, and you should see your clinician to establish a diagnosis and treatment plan.

• Do you experience periods of coughing, wheezing, shortness of breath, or chest tightness that comes on suddenly, occurs often, or seems to happen consistently during a certain time of year?
• Do you get colds or infections that you feel in your chest, or that take more than 10 days to get over?
• Do you use any medicine to help your breathing?
• Do you have a family history of asthma or allergies?
• Do you have problems with breathing, coughing, or wheezing during exercise?

Once you make an appointment to see your healthcare professional, you can expect several things from the visit. Your doctor will listen to your breathing and check for signs of asthma in your lungs. Then they will probably use a device called a spirometer (speh-ROM-et-er) to check how well your lungs are functioning. This test, called spirometry, measures how much air you can blow out of your lungs after taking a deep inhalation, and how fast you can do it. If you have inflamed airways or tightened muscles around the airways, your results will be lower than normal. This may be a sign that you have asthma.

As another part of the test, your healthcare professional may give you medicine that helps open narrowed airways. By administering the test after you’ve been given this medicine, he/she will see if your results improve. People with asthma will often experience improvement in their lung function after taking medicines that dilate the airways.

If your spriometry results come out normal, but you are experiencing asthma-like symptoms, your clinician will want to conduct other tests, such as:

• Allergy testing (eg, skin tests)
• Peak flow meter test
• A test to see how your airways react to exercise
• Tests to see if you have gastroesophageal reflux disease
• Sinus tests (eg, CAT scan of your sinuses)
• Chest X-ray

These various tests are important because there are similar symptoms for a variety of illnesses, and you want to be sure you are diagnosed and treated for the right one.

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Prevention

1.  Preventing the development of asthma
There are several possible risk factors for developing asthma and not all can be completely proven or avoided. However, some of the possible risk factors that can be avoided include:

• Smoking
• Secondhand tobacco smoke exposure
• Exposure to maternal smoking before birth may increase a newborn’s risk of developing asthma after birth  
• Other factors during pregnancy and after childbirth include:
  • Certain dietary factors during pregnancy, such as aedquate vitamin D intake, may be important in preventing asthma in newborns
  • Although breast-feeding is not proven to reduce the risk of developing asthma in children, women are encouraged to breast-feed for at least 4 to 6 months after childbirth.
• Obesity

2. Preventing asthma symptoms

Avoiding asthma triggers is one of the best ways to prevent asthma symptoms. Long-term preventative medication is also available and will be discussed below in the section ‘Accepted Treatments.’
A healthcare professional can help identify specific asthma triggers, since the triggers will be different for everyone. Sometimes he/she will recommend skin or blood tests to determine if symptoms are triggered by allergic reactions to specific substances. Not everyone needs this testing.

Common triggers include:

• Indoor triggers: dust mites, mold, animal dander, cockroaches
• Outdoor allergens: irritants, chemicals
• Other triggers: respiratory infections, physical activity, allergies to food and medicines

People with asthma should speak to their healthcare professional about vaccinations to prevent certain infections that can make asthma worse. Most people with asthma, for example, should get an annual influenza vaccine and pneumoccocal vaccination to prevent a type of bacterial pneumonia.

A severe asthma attack can be prevented by becoming familiar with the warning signs and then following the treatment instructions in an asthma management plan developed by a healthcare professional.

One of the ways to know about an impending asthma attack is to monitor your asthma at home with the use of a peak flow meter. This device is often recommended to monitor how well the lungs are working on a day-to-day basis. The readings do not replace the more detailed reading that a spirometry machine can give but nevertheless a peak flow meter can be used at home and a spirometry machine cannot. Use a peak flow meter to take in a deep breath and then blow out the air into this device as hard and fast as you can.  You will see a number on the peak flow meter, which is an indication of your personal peak flow.  Record this number in your chart and try to get the ‘best’ or highest number you can reach.  If your number is unusually low, a peak flow meter can warn of a possible asthma attack before it happens. Then you may want to follow an asthma management plan outlined by a healthcare professional.

Here is a summary of how to prevent asthma symptoms:

• Learn as much as possible about asthma and how to control it
• Use medicines as directed by a healthcare professional to prevent or stop attacks
• Monitor peak flow readings
• Avoid asthma triggers as much as possible
• Get regular checkups from a healthcare professional
• Follow an asthma management plan

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Accepted treatments

Treatments for asthma include quick-relief and long-term preventative medicines. These two varieties of treatment are often used together in an optimal treatment plan. Asthma sufferers will need medication on hand for quick relief, but only people who have frequent asthma symptoms or asthma attacks will need long-term preventive medicines.

Quick-relief medications, often called “relievers,” are taken at the first sign of asthma symptoms for fast-acting relief and become effective in minutes.
They include:

• Short-acting beta-agonists
• Anticholinergics

Long-term preventative medications are taken every day by people with persistent asthma over a long period of time to prevent symptoms. They need to be taken consistently for a few weeks to become effective. These medicines are often known as "preventers."
They include:

• Inhaled steroids
• Long-acting beta-agonists
• Leukotriene modifiers
• Cromolyn and nedocromil
• Theophylline
• Anti-IgE therapy
• Oral corticosteroids

Inhaled delivery systems

These asthma medicines are taken into the body via inhalation and are available in different forms. These medicines need to be inhaled correctly to ensure that the medicine reaches the lungs. The different forms of asthma medication include:

• Metered-dose inhaler (MDI)
• Dry powder inhaler
• Nebulizer

Inhalers must be used correctly to be effective.  Many people do not properly use metered-dose inhalers (MDIs) because it is quite difficult to inhale effectively while pushing the inhaler’s release at the same time. Attaching a spacer to the inhaler and then inhaling through a spacer makes the process much easier. A spacer is a plastic handheld device with a chamber and a mouthpiece. Many healthcare professionals will recommend that using a spacer with an inhaler is actually the best way to manage your asthma symptoms.

Here are the steps that you need to follow to use a metered dose inhaler with a spacer:

1. Attach the metered dose inhaler to one end of the spacer. Put the other end with the mouthpiece into your mouth and press your lips tightly around it to ensure a good seal.
2. Spray the medicine into the spacer by pressing the release button on the inhaler.
3. Take at least six deep inhalations, one after the other without releasing your mouth from the mouthpiece.

A healthcare professional will be able to check whether you are using the correct technique when using a spacer and metered dose inhaler.

Dry powder inhalers are a good alternative to metered dose inhalers since they can be used more easily and do not need to be used with a spacer to be effective.

Another way to receive asthma medication is through a nebulizer, which is a machine that holds the medication in a liquid form and transforms it into a gas, which then can be inhaled through a mask attached to the nebulizer. Nebulizers are also helpful in controlling the amount of medication being delivered and are an alternative to using a spacer.  The important point is to know how to use the different devices available and to use them properly each time.

Asthma affects every person differently. This means that every person has different levels of symptoms, different triggers, different tolerances or intolerances to medication, different levels of lung function on testing, and different treatment goals.

Recommendations for asthma treatment will mostly depend on its severity, which a healthcare professional can determine. Asthma severity generally depends on the number of symptoms, including daytime symptoms like shortness of breath, waking at night with asthma, and the measurements of peak flow through the day.

A healthcare professional can help in assessing asthma needs and develop an approach to the condition that will meet an individual's goals. One of the clinician’s most important tasks is to create an asthma management plan, a detailed written plan of what medication to take and what to do if asthma symptoms are getting worse. However, a healthcare professional should be regularly seen so he/she can monitor symptoms, medications, and lung function measurements. Over time symptoms may improve, and so one of the advantages of regular checkups is that a healthcare professional can recommend whether medications can be alterted or reduced according to an individual's symptoms.

Here is a summary of the healthcare professional’s role and the patient's role in ensuring that asthma is controlled adequately.

Role of the Healthcare Professional	Patient's Role
Assess asthma severity	See a healthcare professional. Know the symptoms of asthma. Carry a list of medications.
Recommend best treatment and asthma management plan	If the treatment plan is unclear, ask for an explanation. Keep an asthma management plan handy for easy reference.
Explain how to use metered-dose inhalers	Practice using your metered-dose inhalers with a spacer. Keep a supply of inhalers at home, and get a new prescription before they run out.
Monitor lung function and response to treatments	Go for regular checkups and also learn to monitor the severity of symptoms with a home peak flow meter.
Assess for any side effects of treatment	See a healthcare provider about any side effects. Don’t stop taking any medications without his/her approval.
Educate the patient about asthma and its triggers	Keep track of what triggers asthma symptoms by writing a symptom diary.

A more detailed explanation of the different treatments for asthma follows.

Quick-relief medications:

1. Short-acting beta-agonists

Beta-agonists relax the muscles around the airways, so that breathing is easier. The metered-dose inhaler needs to be carried at all times to use at the first sign of asthma symptoms. It does not treat the airway inflammation underlying asthma but is useful in the treatment of symptoms. Side effects include shakiness and increased heart rate.

• Alupent^® (metaproterenol)
• Maxair^® and Maxair Autohaler^® (pirbuterol)
• Proventil^®, Proventil^® HFA^®, and Ventolin^® (albuterol)
• Xopenex^® (levalbuterol)

2. Anticholinergics

These medicines also open the airways also by affecting the muscle around them. They are slower acting than the short-acting beta-agonists, so generally the short-acting beta-agonists are preferable for quick relief.

• Atrovent^® (ipratropium)

Long-term preventative medications:

1. Inhaled corticosteroids (steroids)

These medicines reduce the inflammation in the airways, which is the underlying cause of breathing problems in asthma. Therefore, they are prescribed for daily use in people with frequent symptoms. Daily use over time reduces both inflammation and symptoms.

• Flovent^® (fluticasone)
• Pulmicort^® (budesonide)
• Aerobid^® (flunisolide)
• Azmacort^® (triamcinolone)
• Qvar^® (beclomethasone HFA)

2. Inhaled long-acting beta-agonists:

These medicines, like short-acting beta-agonists, relax muscles around the airways; however, they take longer to start working and usually have a 12-hour effect. They are prescribed in addition to inhaled corticosteroids (and should not be used alone) for people who still have frequent symptoms despite the use of regular inhaled steroids.

• Foradil^® (formoterol)
• Serevent^® (salmeterol)

3. Combination inhaled steroids and long-acting beta-agonists

• Advair^® (a combination of Flovent^® and Serevent^®) 

4. Leukotriene modifiers

Modifiers are used either alone or together with inhaled corticosteroids to treat people with moderate or severe persistent asthma.

• Singulair^® (montelukast)
• Accolate^® (zafirlukast)
• Zyflo^® (zileutin)

  5. Cromolyn and nedocromil

• Tilade^® (nedocromil)
• Intal^® (cromolyn)

These medicines are used to treat persistent asthma symptoms alone or in combination with an inhaled corticosteroid.

6. Theophylline

Theophylline relaxes muscles around the airways and is available as a tablet, capsule, or syrup. Theophylline does have troublesome side effects so it is not commonly prescribed for long-term preventative treatment. But it is useful for people who cannot tolerate long-acting beta-agonists or who need the benefit of an oral medicine (syrup).

• Theo-Dur^®
• Slo-Bid^®
• Uniphyl^®
• UniDur^®

 

7. Oral corticosteroids (steroids)

In the event of an asthma attack or sudden, severe symptoms, oral forms of steroids (tablets or liquid) can reduce airway inflammation quickly. They are prescribed for a few days at a time to treat asthma attacks. Side effects may include increased appetite, moodiness, and insomnia.

• Deltasone^® (prednisone)
• Medrol^® (methylprednisolone)
• Orapred^® (prednisolone)
• Prelone^®, Pediapred^® (prednisolone)

8. Anti-IgE therapy

Anti-IgE therapy is a form of asthma therapy that helps reduce the allergy in the immune system, which can be the cause of asthma in many people.  It is called anti-IgE because the medication blocks IgE, an immune system chemical that is involved in producing allergies.

• Xolair^® (omalizumab)
  
  The FDA has approved omalizumab to treat asthma in people older than 12 years. It is only available in the form of an injection given under the skin (called a subcutaneous injection) one to two times each month from a healthcare provider. It is useful for people with asthma symptoms that cannot be controlled by other preventative medications. Common side effects of omalizumab include injection site reactions (redness, pain, and/or swelling) and viral infections. Severe allergic reactions such as anaphylaxis to omalizumab may occur, but rarely.

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Emerging treatments

Apart from anti-IgE therapy, other medications that act by altering the immune system are being developed for the treatment of asthma and allergies. These include

• Monoclonal antibodies to CD23
• Cytokine modulators

 

Treatment of asthma attacks

Sudden ashtma attacks are usually rare if symptoms are well controlled with long-term preventative medication. However, if a sudden asthma attack occurs and is not treated early enough, hospitalization may be required since sudden attacks are actually life threatening. A healthcare professional can provide a written plan of what to do in the event of a sudden asthma attack. Usually he/she will recommend using quick reliever medication more frequently, about every 3 hours, along with an oral steroid. You should know what the warnings signs of a sudden asthma attack are:  worsening asthma symptoms, the need to use a reliever more often, and waking up at night with asthma symptoms. If you have any of these warning signs, you should make an appointment to see a healthcare provider as soon as possible.

Asthma and pregnancy

Generally, pregnant women are concerned about taking any medication during pregnancy for fear of harming the unborn baby. However, some women with severe asthma need medication since severe asthma can be life threatening for both the pregnant woman and her unborn child. If you are pregnant, a healthcare provider can assess how much and what medication is safe to take according to the severity of the symptoms. You should aim to take the minimum amount or dose of medications to control your symptoms in order to minimize the risk of side effects from treatment. All medications are classified by the FDA according to their risk of being taken in pregnancy, and your healthcare provider can tell you which medications are advisable.

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Empower Yourself

Dealing with asthma

• Stay up to date in breakthroughs in asthma research. Web sites like the AAFA (Asthma and Allergy Foundation of America) and the US Department of Health and Human Services are constantly updated with new findings.
• Talk to your healthcare professional and be sure to take prescribed medications. There are lots of over the counter asthma treatments, but make sure you talk to your doctor before self-treating.
• Check your lungs daily with a peak flow meter. This is a handheld device that measures your breathing to monitor how well your lungs are working.
• Visit your doctor for in-office tests. These lung tests are painless and easy, and they give your doctor valuable information that will allow him/her to adjust your medication according to your lungs functioning.
• Create an Asthma Management Plan with your healthcare professional. This plan will help guide you if your symptoms worsen, and will give you tips to prevent them from worsening.
• Stay away from asthma triggers: Allergy-proof your house for dust, mold, cockroaches, and other indoor allergens. Be conscious of when pollen counts are high outside, and reduce outdoor activities at these times. Alter your diet so you are not exposed to any allergens. Reduce allergens in the workplace, or any other place where you spend a lot of time.

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Frequently asked questions

What is asthma?

Asthma is a chronic, inflammatory disease of the airways caused by oversensitivity of the lungs and airways, which overreact to certain “triggers” by becoming inflamed and clogged, causing recurrent breathing problems, wheezing, and coughing.

Can asthma be cured?

There is no cure for asthma, but it can be controlled with proper treatment. Patients with asthma can take prescribed medications to prevent or relieve their symptoms, and they can learn ways to manage their asthma attacks. They also can learn to identify and avoid the things that trigger their asthma.

Will I always have asthma?

Not necessarily. Some people stop having asthma attacks as they get older. Others become adept at avoiding the things that trigger their asthma. In most cases, however, asthma is a chronic disease that requires long-term care and treatment. The better one can adjust to it, the better one can become at preventing or minimizing his or her breathing problems.

How is asthma diagnosed?

Asthma symptoms can resemble those of other respiratory (lung) problems (such as emphysema, bronchitis, and respiratory infections) asthma often goes undiagnosed. Many people live with the disease for years without knowing they have it. They only know they have a chronic cough, often at night, or that they have difficulty breathing in cold air, especially while working or exercising. Some think they have chronic bronchitis.

To diagnose asthma, doctors use a combination of medical history, physical examination, and laboratory tests such as spirometry (a method of measuring the air taken into and expelled from the lungs), peak flow monitoring (a method of measuring how much air a person can expel from his or her lungs), chest X-rays, and blood or allergy tests.

What does an asthma attack feel like?

The disease has various symptoms that can be described differently by asthma patients. In asthma, the effort required to breathe becomes progressively greater, and the act of breathing may become painful. The patient may cough and wheeze, producing a gasping or whistling sound.

Some asthma sufferers describe a feeling of suffocation and overpowering tightness in the chest and throat. Others say the sensation of an acute asthma episode is similar to taking a deep breath, holding it, and then, without exhaling, trying to inhale a second deep breath on top of the first.

What causes these symptoms?

The symptoms of asthma result from a narrowing of the airways in the lungs. In an asthma episode, the muscles surrounding these airways constrict, and the airways become swollen and inflamed. This narrows the passages. The membranes lining the airways begin to secrete extra mucus, which further block the air passages. As the person tries to breathe, air forced through the narrowed air passages produces a characteristic wheezing sound.

Should people with asthma exercise?

Yes, if they are feeling well. Everyone who is physically able to do so can benefit from exercise. It is generally advisable to consult a doctor before beginning any exercise program. People with asthma may also need to take special precautions in cold weather or during seasons when pollen is in the air. They may be able to prevent exercise-induced asthma symptoms by using an inhaled bronchodilator before exercise.

Should I limit my activity because of asthma?

With proper treatment and care to avoid asthma triggers, most asthma patients can live a full and active life. A healthcare professional can help determine when to take medication that can prevent an asthma attack, such as before exercising, in cold weather, or when air pollution or airborne pollen levels are high.

What signs warn a person their asthma is worsening?

There are several telltale signs: the development of asthma symptoms at night, when none existed previously; a drop in peak flow meter readings of 20% or more; the need to use a inhaled bronchodilator more often. Patients who feel their asthma is getting worse should see their clinicians as soon as possible. They may recommend a change in therapy, an adjustment to their medication dosage, or a different type of medicine altogether.

What support groups exist for people with asthma?

There are several. Parents of children with asthma can contact the Allergy and Asthma Network/Mothers of Asthmatics, Inc, for information on a variety of advocacy activities for children with asthma. The AAN/MA has chapters across the country.

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Glossary of asthma terms

Action plan: A written set of directions or a chart that tells you what to do if asthma symptoms occur, depending on their severity. Your action plan also should tell you what to do when you do NOT feel any symptoms (ie, preventive care).

Albuterol: An asthma medication (see short-acting beta-agonist).

Allergic asthma: A chronic, inflammatory disorder of the airways characterized by wheezing, breathing difficulties, coughing, chest tightness, wherein these sypmtoms are caused by an allergic reaction to an inhaled allergen, rather than an irritant or other nonallergy factor. (See “nonallergic asthma” for more information.)

Allergen: A substance that triggers an allergic reaction. Many allergens are responsible for triggering asthma, including dust mites, animal dander, mold, and cockroaches.

Allergist: A physican that has specific training in the care of asthma and in some cases may be more familiar with current clinical guidelines than a pediatrician or general practitioner.

Alveoli: Tiny air sacs where oxygen is transferred into your lungs and carbon dioxide waste enters the airways in order to be exhaled.

Asthma: A chronic, inflammatory disorder of the airways characterized by wheezing, breathing difficulties, coughing, chest tightness, and other possible symptoms. People with asthma have very sensitive airways that are constantly on the verge of overreacting to asthma triggers.

Asthma management plan: A personal plan for an individual patient describing what medication to use for what asthma symptoms and how often.

Beta-agonists: Asthma drugs that relax the muscles around the bronchial tubes (“bronchodilators”), thus opening the airways or helping keep them open. There are two main types. The long-acting type is taken every day to prevent symptoms, often in combination with a steroid. The short-acting type is used for quick relief of symptoms during an asthma episode/attack. Albuterol is the most commonly used short-acting beta-agonist.

Bronchial tubes: Airway passages in the lungs. There is one major branch going into each lung, and these then divide into many smaller branches.

Bronchioles: The smallest airway passages in the lungs.

Bronchirtis: Infection of the main bronchial tube.

Bronchoconstriction: This is when the muscles that surround the airways becomes constricted and narrowed.

Bronchodilators: Drugs that relax the muscles around the airways, thus opening up the airways. Some bronchodilators are used for quick relief of symptoms during an asthma attack. Others are taken every day to prevent symptoms.

CAT scan: Otherwise known as as CT scan. A medical test that produces images of the body via a special type of X-ray machine. The images produce a cross sectional view of different parts of the body, involving organs, bone, blood vessels and other tissues of the body.

Chest X-ray: A radiographic X-ray of the lungs and heart.

Control drug: A drug that some people take on a daily basis to prevent asthma symptoms and asthma attacks.

Corticosteroids: The most common and effective type of drug used for long-term daily control of asthma (prevention of symptoms). They are most frequently inhaled using either a metered dose inhaler, dry powder inhaler, or nebulizer. Corticosteroids primarily decrease or prevent inflammation.

Cromolyn: An anti-inflammatory drug that may be used on a daily basis to prevent symptoms of asthma.

Dry powder inhaler: A small device similar to a metered dose inhaler, but where the drug is in powder form. The patient exhales a full breath, places the lips around the mouthpiece, then quickly breathes in the powder.

Emphysema: Emphysema is a type of chronic lung disease involving damage to the air sacs (alveloi) in the lungs, usually as a result of cigarette smoking. It causes symptoms including shortness of breath, chronic cough, and reduced tolerance to exercise. People with emphysema are also more susceptible to chest infections.

Holding chamber: See Spacer.

Immunotherapy: A series of injections that help build up the immune system’s tolerance to an asthma trigger (or allergen).

Ipratropium bromide: A bronchodilator sometimes used for quick relief of asthma symptoms, often for people who do not tolerate beta-agonists. It is also used for people whose asthma is worsened by beta-blocker medication for the heart.

Leukotriene modifiers: Control drugs in the form of tablets for patients with mild-to-moderate persistent asthma. For mild asthma, they are sometimes considered as an alternative to inhaled steroids. For moderate asthma, they may be considered as a supplement to inhaled steroids in place of long-acting beta agonists.

Lung function tests: Lung function tests are performed to evaluate how well your lungs are working. The tests can measure how much air your lungs are taking in with each breath, how quickly air is moving in and out of the airways and lungs, and many other aspects of breathing. Lung function testing is performed in order to help make the diagnosis of lung diseases as well as the monitor response to lung disease treatments.

Metered dose inhaler (MDI): The most common device people use to take asthma medication. An MDI allows you to inhale a specific amount of medicine (a “metered dose”). It consists of a metal canister, which keeps the medication under pressure, and a plastic sleeve, which helps to release the medication. When you press the canister, medicine particles that you can inhale are propelled toward your throat.

Nebulizer: A device that creates a mist from asthma medicines, which makes it easy and pleasant to inhale the drug into the lungs. The drug is placed into a small cup. Air from a small compressor converts the medicine into an aerosol mist, which travels through a hose with a mouthpiece attached. By taking slow, deep breaths, the medicine is delivered into your lungs.

Nedocromil sodium: An inhaled medication that may be used on a daily basis to treat inflammation in the airways and prevent asthma attacks.

Nonallergic asthma: A chronic, inflammatory disorder of the airways characterized by wheezing, breathing difficulties, coughing, chest tightness, wherein these sypmtoms are caused by an inhaled irritant or other nonallergy factor; when these symptoms are not caused by allergic reactions. (See “allergic asthma” for more information.)

Obesity: A condition of being overweight according to a person's height, age, sex, and build.

Peak flow: A measurement of how well you can blow out air of your lungs. If your airways become narrow and blocked due to asthma, you can't blow air out as well, and your peak flow values drop.

Peak flow meter: A handheld plastic device that measures peak flow.

Pneumococcal vaccination: A vaccination against a form of pneumonia.

Relief drug: A drug used as needed to relieve asthma symptoms during asthma attacks. Also called a quick-relief or rescue drug.

Rescue drug: Relief or quick-relief drug.

Sinusitis: An inflammation or infection of one or more sinuses. The sinuses are hollow air spaces located around the nose and eyes.

Spacer: A plastic chamber that works with your MDI to deliver medication more easily and effectively, and can reduce side effects. When you use an MDI by itself, more of the medicine is left in your mouth and throat, wasting your dose and causing an unpleasant aftertaste. Spacers hold the medicine between you and the MDI, so that you can inhale it slowly and more completely. Spacers are also called holding chambers.

Spirometry: Test for diagnosing asthma. A spirometer is an instrument that measures the maximum volume you can exhale after breathing in as much as you can. Small spirometers are available for home use, although peak flow meters are more appropriate for most people. Spirometry readings are a more accurate way of determining lung function that readings from a peak flow meter.

Steroids: See Corticosteroids

Vitamin D: A vitamin found in food and also produced in the skin from sunlight exposure. It is an important vitamin for bone strength and for regulating calcium levels in the blood.

Wheeze: A whistling sound produced by trying to breathe through a narrowed airway. A symptom of asthma can also be a symptom of emphysema and bronchitis, for example.

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Asthma resources

• Government Agencies
• Private Organizations
• Newsletters, Magazines, and Reports

Government Agencies

*Accepts Spanish calls

* National Center for Complementary and Alternative Medicine, NIH, HHS
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
Fax: (866) 464-3616
http://nccam.nih.gov/news/newsletter/2007_winter/roundup.htm

* National Heart, Lung, and Blood Institute, NIH, HHS
PO Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
Fax: (301) 496-1072
http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html


Private Organizations

Asthma and Allergy Foundation of America
1233 20th Street, NW
Suite 402
Washington, DC 20036
Phone: (800) 727.8462
http://www.aafa.org

Asthma UK
Summit House
70 Wilson Street
London EC2A 2DB
Phone: 020 7786 5000
Fax: 020 7256 6075
http://www.asthma.org.uk/

American College of Allergy, Asthma, and Immunology
555 East Wells Street
Suite 1100
Milwaukee, WI 53202-3823
Phone: (414) 272-6071
www.aaaai.org


Newsletters, Magazines, Reports

Healthy Women Today
The National Women's Health Information Center
www.womenshealth.gov/newsletter

MSNBC
Report on Women and Sleep Apnea as a result of asthma
http://www.msnbc.msn.com/id/14624754/

Bella Online
An asthma newsletter for women
http://www.bellaonline.com

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References

1. National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051). Full text available online: www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

2. Pratter, MR, Curley, FJ, Dubois, J, Irwin, RS. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 1989; 149:2277.

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