Asthma

Jai Ganesh · Today 18:08:51

Asthma

Gist

Asthma is a chronic respiratory disease involving inflammation, mucus production, and muscle tightening that narrows airways, causing wheezing, coughing, chest tightness, and shortness of breath. It is caused by genetic and environmental factors. While often a lifelong condition, it is manageable with medication. Common triggers include allergies, smoke, infections, exercise, and, in severe cases, untreated, it can lead to permanent airway structural changes.

Asthma is caused by a combination of genetic predisposition and environmental factors, leading to chronic airway inflammation and hyperresponsiveness, where airways tighten, swell, and produce excess mucus when exposed to triggers like allergens (pollen, dust mites), irritants (smoke, pollution), exercise, cold air, respiratory infections, and strong emotions. While genetics increases susceptibility, environmental exposures often trigger symptoms in those predisposed to the condition, creating a complex interplay.

Summary

Asthma is a common long-term inflammatory disease of the airways. It is characterized by variable and recurring symptoms and reduced lung function. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. A sudden worsening of asthma symptoms sometimes called an 'asthma attack' or an 'asthma exacerbation' can occur when allergens, pollen, dust, or other particles, are inhaled into the lungs, causing the bronchioles to constrict and produce mucus, which then restricts oxygen flow to the alveoli. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.

Asthma is thought to be caused by a combination of genetic and environmental factors. Environmental factors include exposure to air pollution and allergens. Other potential triggers include medications such as aspirin and beta blockers. Diagnosis is usually based on the pattern of symptoms, response to therapy over time, and spirometry lung function testing. Asthma is classified according to the amount of medication required to control symptoms or mechanisms underlying the condition.

There is no known cure for asthma, but it can be controlled. Symptoms can be prevented by avoiding triggers, such as allergens and respiratory irritants, and suppressed with the use of inhaled corticosteroids. Long-acting beta agonists (LABA) or antileukotriene agents may be used in addition to inhaled corticosteroids if asthma symptoms remain uncontrolled. Treatment of rapidly worsening symptoms is usually with an inhaled short-acting beta2 agonist such as salbutamol and corticosteroids taken by mouth. In very severe cases, intravenous corticosteroids, magnesium sulfate, and hospitalization may be required.

In 2019, asthma affected approximately 262 million people and caused approximately 461,000 deaths. Most of the deaths occurred in the developing world. Asthma often begins in childhood, and the rates have increased significantly since the 1960s. Asthma was recognized as early as Ancient Egypt. The word asthma is from the Greek ἆσθμα (âsthma), which means 'panting'.

Details

Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out 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 your treatment as needed.

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
* Wheezing when exhaling, which is a common sign of asthma in children
* Trouble sleeping caused by shortness of breath, coughing or wheezing
* Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

* Asthma signs and symptoms that are more frequent and bothersome
* Increasing difficulty breathing, as measured with a device used to check how well your lungs are working (peak flow meter)
* The need to use a quick-relief inhaler more often

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, triggered by workplace irritants such as chemical fumes, gases or dust
* Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, math waste, or particles of skin and dried saliva shed by pets (pet dander)

When to see a doctor:

Seek emergency treatment

Severe asthma attacks can be life-threatening. Work with your doctor to determine what to do when your signs and symptoms worsen — and when you need emergency treatment. Signs of an asthma emergency include:

* Rapid worsening of shortness of breath or wheezing
* No improvement even after using a quick-relief inhaler
* Shortness of breath when you are doing minimal physical activity

Contact your doctor

See your doctor:

* If you think you have asthma. If you have frequent coughing or wheezing that lasts more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early may prevent long-term lung damage and help keep the condition from getting worse over time.
* To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good long-term control helps you feel better from day to day and can prevent a life-threatening asthma attack.
* If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't seem to ease your symptoms or if you need to use your quick-relief inhaler more often.
Don't take more medication than prescribed without consulting your doctor first. Overusing asthma medication can cause side effects and may make your asthma worse.
* To review your treatment. Asthma often changes over time. Meet with your doctor regularly to discuss your symptoms and make any needed treatment adjustments.

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 inherited (genetic) factors.

Asthma 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:

* Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of math waste
* Respiratory infections, such as the common cold
* Physical activity
* Cold air
* Air pollutants and irritants, such as smoke
* Certain medications, including beta blockers, aspirin, and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (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. They include:

* Having a blood relative with asthma, such as a parent or sibling
* Having another allergic condition, such as atopic dermatitis — which causes red, itchy skin — or hay fever — which causes a runny nose, congestion and itchy eyes
* Being overweight
* Being a smoker
* Exposure to secondhand smoke
* Exposure to exhaust fumes or other types of pollution
* Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

Complications

Asthma complications include:

* Signs and symptoms that interfere with sleep, work and other activities
* Sick days from work or school during asthma flare-ups
* A permanent narrowing of the tubes that carry air to and from your lungs (bronchial tubes), which affects how well you can breathe
* Emergency room visits and hospitalizations for severe asthma attacks
* Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Prevention

While there's no way to prevent asthma, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.

* Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack. Then be sure to follow your plan.
Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life.
* Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.
* Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
* Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath.
But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter. A peak flow meter measures how hard you can breathe out. Your doctor can show you how to monitor your peak flow at home.
* Identify and treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms.
When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed. Also, immediately stop any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.
* Take your medication as prescribed. Don't change your medications without first talking to your doctor, even if your asthma seems to be improving. It's a good idea to bring your medications with you to each doctor visit. Your doctor can make sure you're using your medications correctly and taking the right dose.

Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn't under control. See your doctor about adjusting your treatment.

Additional Information

Asthma is a condition that causes your airways to swell, narrow and fill with mucus. This can make it hard to breathe or cause other symptoms, like chest tightness, cough and wheezing. Common asthma triggers include allergies (like pets or pollen), smoke, cold weather, exercise, strong smells and stress. Asthma attacks can be fatal if not treated.

What Is Asthma?

Asthma is a condition that causes long-term (chronic) inflammation in your airways. The inflammation makes them react to certain triggers, like pollen, exercise or cold air. During these attacks, your airways narrow (bronchospasm), swell up and fill with mucus. This makes it hard to breathe or causes you to cough or wheeze. Without treatment, these flare-ups can be fatal.

Millions of people in the U.S. and around the world have asthma. It can start in childhood or develop when you’re an adult. It’s sometimes called bronchial asthma.

Types of asthma

Types of asthma include:

* Allergic asthma: when allergies trigger asthma symptoms
* Cough-variant asthma: when your only asthma symptom is a cough
* Exercise-induced asthma: when exercise triggers asthma symptoms
* Occupational asthma: when substances you breathe in at work cause you to develop asthma or trigger asthma attacks
* Asthma-COPD overlap syndrome (ACOS): when you have both asthma and COPD (chronic obstructive pulmonary disease)

Symptoms and Causes:

Symptoms of asthma

Symptoms of asthma include:

* Shortness of breath
* Wheezing
* Chest tightness, pain or pressure
* Cough

You might have asthma most of the time (persistent asthma). Or you might feel fine in between asthma attacks (intermittent asthma).

Asthma causes

Experts aren’t sure what causes asthma. But you might be at a higher risk if you:

* Live with allergies or eczema (atopy)
* Were exposed to toxins, fumes or secondhand or thirdhand smoke (residue left behind after smoking), especially early in life
* Have a biological parent with allergies or asthma
* Experienced repeated respiratory infections (like RSV) as a child

Asthma triggers

Asthma triggers are anything that causes asthma symptoms or makes them worse. You might have one specific trigger or many. Common triggers include:

* Allergies: pollen, dust mites, pet dander, other airborne allergens
* Cold air: especially in winter
* Exercise: especially intense physical activity and cold-weather sports
* Mold: even if you’re not allergic
* Occupational exposures: sawdust, flour, glues, latex, building materials
* Respiratory infections: colds, flu and other respiratory illnesses
* Smoke: smoking, secondhand smoke, thirdhand smoke
* Stress: physical or emotional
* Strong chemicals or smells: perfumes, nail polish, household cleaners, air fresheners
* Toxins in the air: factory emissions, car exhaust, wildfire smoke

Asthma triggers can bring on an attack right away. Or it might take hours or days for an attack to start after you’re exposure to a trigger.

Complications of asthma

Asthma can cause severe flare-ups that don’t get better with treatment (status asthmaticus). This can be fatal if you can’t get enough oxygen to your organs and tissues.

Diagnosis and Tests:

How doctors diagnose asthma

An allergist or pulmonologist diagnoses asthma by asking about your symptoms and performing lung function tests. They’ll ask about your personal and family medical history. It can be helpful to let them know what makes asthma symptoms worse and if anything helps you feel better.

Tests

Your provider might determine how well your lungs are working and rule out other conditions with:

* Allergy blood tests or skin tests: These can determine if an allergy is triggering your asthma symptoms.
* Blood count: Providers can look at eosinophil and immunoglobulin E (IgE) levels and target them for treatment if they’re elevated. Eosinophils and IgE can be elevated in certain types of asthma.
* Spirometry: This is a common lung function test that measures how well air flows through your lungs.
* Chest X-rays or CT scans: These can help your provider look for causes of your symptoms.

Management and Treatment:

What is the best way to manage asthma?

The best way to manage asthma is to avoid any known triggers and use medications to keep your airways open. Your provider might prescribe:

* Maintenance inhalers: These usually contain inhaled steroids that reduce inflammation. Sometimes, they’re combined with different types of bronchodilators (medicines that open your airways).
* A rescue inhaler: Fast-acting “rescue” inhalers can help during an asthma attack. They contain a bronchodilator that quickly opens your airways, like albuterol.
* A nebulizer: Nebulizers spray a fine mist of medication through a mask on your face. You might use a nebulizer instead of an inhaler for some medications.
* Leukotriene modifiers: Your provider might prescribe a daily pill to help reduce asthma symptoms and your risk of an asthma attack.
* Oral steroids: Your provider might prescribe a short course of oral steroids for a flare-up.
* Antihistamines: Your provider might recommend cetirizine (Zyrtec®), loratadine (Claritin®), fexofenadine (Allegra®) or other allergy medications if you have allergic asthma.
* Biologic therapy: Treatments like monoclonal antibodies might help severe asthma.
* Bronchial thermoplasty: If other treatments don’t work, your provider may suggest bronchial thermoplasty. In this procedure, a pulmonologist uses heat to thin the muscles around your airways.

Asthma action plan

Your healthcare provider will work with you to develop an asthma action plan. This plan tells you how and when to use your medicines. It also tells you what to do when you have certain symptoms and when to seek emergency care. Ask your healthcare provider to walk you through it.

When should I see my healthcare provider?

Talk to your healthcare provider if you’re having frequent asthma attacks or feel like your symptoms aren’t manageable. Make sure you understand your asthma action plan and when to go to the emergency room.

Use your rescue inhaler, then call your local emergency number if you’re having a severe asthma attack or are experiencing these symptoms:

* Anxiety or panic
* Bluish, whitish or grayish fingernails, lips or gums
* Chest pain or pressure
* Coughing that won’t stop
* Severe wheezing when you breathe
* Difficulty talking or swallowing
* Pale, sweaty face
* Rapid breathing

Outlook / Prognosis:

What can I expect if I have asthma?

Most people with asthma can manage their symptoms. Asthma management means you:

* Can do the things you want to do at work and home
* Have no (or minimal) asthma symptoms
* Rarely need to use your rescue inhaler
* Can sleep without asthma symptoms waking you up
* Don’t need oral steroids for flare-ups more than twice a year

Some people are able to avoid triggers and have no symptoms most of the time. Others need to use a maintenance inhaler or other medications in addition to avoiding triggers. Kids may have fewer or no symptoms as they get older and their airways get bigger.

What can I do to feel better?

You might be able to reduce or avoid asthma symptoms with a few everyday habits. These include:

* Avoid triggers whenever possible. It might be helpful to keep a symptoms journal to figure out what makes your symptoms worse.
* Be physically active to a level that’s right for you. Ask your provider what they recommend. A pulmonary rehabilitation program might help.
* Don’t smoke or vape.
* Let your provider know if you’re unable to use inhalers or take medication as prescribed.
* A peak flow meter: This can measure how much your airways are restricted during certain activities.

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Asthma

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