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This federal government site is sponsored by the National Institutes of Health and includes a comprehensive section with information about asthma, allergies, and other respiratory conditions.
AAFA is a not-for-profit organization, founded in 1953. Their web site offers extensive information on asthma and allergies. Of particular note is their "Ask the Allergist" section.
This on-line exhibition examines the history of asthma, the experiences of people with the disease, and contemporary efforts to understand it. It was created by the National Library of Medicine in collaboration with the National Heart, Lung, and Blood Institute, the National Institute of Allergy and Infectious Diseases, and the National Institute of Environmental Health Sciences.
This site, primarily designed for doctors who treat asthma and allergies, has a large patient information section.
This site has on-line fact sheets about asthma in children, teens, adults, and older adults, as well as information about asthma medicines, peak flow meters, and home control of allergies and asthma.
This site offers an excellent, well-organized overview of the symptoms, diagnosis and treatment of asthma.
Episode number: 
213

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Asthma (transcript)

Asthma is a chronic disease that makes breathing difficult.  If you have asthma, your airways – the tubes through which air flows to and from your lungs – are very sensitive to things you are allergic to (allergens) or find irritating (irritants).  The airways react strongly to these things; the reaction causes the airways to narrow, so less air can move through them.

There are three kinds of reactions that cause this narrowing of the airways:

  • Inflammation, which means the airways become red and swollen (inflamed)
  • "Bronchoconstriction," which means the muscles surrounding the airways contract and tighten, squeezing the airways
  • Over production of mucous, which means the cells in the walls of the airways produce more mucous than normal, clogging the airways

The narrowing leads to the symptoms of asthma, which include:

  • Wheezing (a raspy, squeaking, or whistling sound when you breathe)
  • Coughing
  • A feeling of tightness in the chest
  • Shortness of breath

There are two kinds of asthma, allergic and non-allergic. In allergic asthma, allergens cause the airways to become inflamed. The inflammation can lead the body to release histamines, chemicals that cause the swelling, mucous secretion, and muscle contractions.  (For more information about allergies and allergens, go to Key Point 2). 

In non-allergic asthma, irritants cause inflammation or bronchoconstriction.  Irritants can include, among others, smoke, viruses, hyperventilation, exercise, cold air, dry air, and even strong emotions such as anxiety and stress.

Allergens and irritants are usually called asthma "triggers" because they provoke asthma symptoms.  (However, some medical professionals distinguish between "triggers" which cause bronchoconstriction, and asthma "inducers" which cause inflammation.)  For more information about asthma triggers, go to Key Point 1.

When airways are already inflamed, they're more sensitive to allergens and irritants.  So a person with inflamed airways is more likely to suffer asthma symptoms.  We don't know why people first get inflamed airways, but there does seem to be a genetic factor to it.  That means you can be born with the tendency or predisposition to have asthma, but it does not mean you definitely will get it. 

Asthma varies from person to person, that is, not everyone reacts to the same triggers, suffers the same symptoms, nor suffers them at the same intervals (i.e., daily, weekly, etc.).  Further, each individual's symptoms can vary from one time to another, and their frequency can also vary. Asthma often begins in childhood, though there is also "adult onset asthma." 

When the symptoms of asthma become very strong, we say the person is having an "asthma attack."  In a severe asthma attack, a person may have so much trouble breathing that emergency treatment is needed.  This can cause serious damage to the body.  In fact, according to the American Academy of Allergy Asthma & Immunology about 5000 people per year die from very severe asthma attacks.

The National Institutes of Health (NIH) says about fifteen million Americans have asthma, including close to five million children.  The Asthma and Allergy Foundation of America puts the total figure nearer twenty million.  In children, more boys than girls have asthma; in adults, the situation is reversed.  Although asthma is a problem among all races in America, the NIH says African-Americans have more asthma attacks, are more likely to be hospitalized for it, and are more likely to die from it.

There are many things we don't know about asthma – including how to cure it.  But we do know how to treat it so we can alleviate its effects and allow people to live with few or no asthma symptoms.  For more information about treating asthma, go to Key Point 3. 


Quick Facts

  • Asthma is a chronic lung condition that can develop at any age.  Though it often starts in childhood, and is the most common chronic respiratory disease of children, there is also "adult onset asthma.
  • Between fifteen and twenty million Americans, including about five million children, have asthma. 
  • The effects of asthma on the individual vary from very mild to very severe. During a very severe asthma attack, a person may have so much trouble breathing that emergency treatment is needed. 
  • According to the Canadian Lung Association there is a general trend of increased deaths and hospitalizations from asthma recorded in all the industrialized countries of the world.
  • About five thousand people die from asthma annually, but virtually all these deaths are preventable. Asthma can be successfully controlled and symptoms prevented with medicines and other measures.
  • There are two kinds of asthma, allergic and non-allergic. In allergic asthma, allergens (substances that people are allergic to) provoke the symptoms of asthma.  People with allergies are more likely to have asthma, and vice-versa.  In fact, hay fever (technically known as allergic rhinitis) is considered a risk factor for developing asthma.
  • Although we do not yet have a cure for asthma, modern treatment methods, including drugs and other kinds of care, enable us to minimize and even prevent asthma symptoms and asthma attacks. 
  • There are two types of asthma medication. Long-term control medicines are taken regularly over long periods of time to prevent or reduce asthma symptoms.  Quick relief or "rescue" offer immediate, short-term relief from asthma symptoms.

*Quick Facts have been reviewed by medical experts working with Second Opinion and are current as of September, 2005.

Ask Your Doctor

This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.

  • I've noticed these symptoms: . . . What medical tests should I take to get an accurate diagnosis?
  • Are my respiratory (breathing) problems caused by asthma or something else?
  • What type of asthma do I have?
  • How severe is my asthma?
  • What medications should I take for long-term control my asthma?
  • What medications should I take when I need immediate relief from asthma symptoms?
  • How dangerous is my asthma?
  • What should I do in case of emergency, that is, a severe asthma attack that seriously threatens my breathing?
  • What life-style changes (such as diet, exercise, etc.) should I make to treat my asthma?
  • What changes in my environment should I make to treat my asthma

Key Point 1

Asthma means that the inside of your airways are very reactive to things you are allergic to (allergens) or find irritating (irritants), causing the airways to narrow and allow less air to flow to your lungs.  

Common allergens include:

  • Dust mites (found in ordinary house dust)
  • Pollen from flowers, trees, plants, etc.
  • Mold (indoor and outdoor)
  • Animal dander (from the skin, hair, or feathers of animals)
  • Cockroaches and cockroach droppings
  • Certain foods (such as fish, shellfish, peanuts, milk, eggs, soy, wheat, tree nuts)
  • Certain food additives, such as sulfites in dried fruit or beverages (wine)
  • Certain medicines, such as penicillin, aspirin or other non-steroidal anti-inflammatory drugs such as ibuprofen, and beta-blockers (used to treat heart disease, high blood pressure, and migraine headaches)

(For more information about allergies and allergens, go to Key Point 2.) 

Common irritants include:

  • Cigarette smoke
  • Air pollution
  • Cold air or changes in weather
  • Strong odors from painting or cooking
  • Scented products

Other things that can provoke asthma symptoms include:

  • Exercise
  • Viral infection
  • Strong emotional expression (such as crying or laughing hard)
  • Anxiety and stress
  • Gastroesophageal reflux disease, a condition that causes heartburn

All of these things – allergens, irritants, and the others – are often called asthma triggers because they can provoke asthma symptoms.  These symptoms include wheezing, coughing, a feeling of tightness in the chest, and shortness of breath.  If you have these symptoms, you should see your doctor for a thorough examination and diagnosis. 

Normally, this will include:

  • A medical history -- you'll be asked questions about
    • The asthma symptoms you suffer, such as how often, how severe, and what things seem to provoke or worsen them 
    • Allergies or allergy symptoms you have
    • Family members with allergies or asthma
    • Asthma triggers you may encounter at home or work, such as animals, pollen, tobacco smoke, etc.
  • A physical examination, with special attention to the respiratory system (lungs and airways)
  • A series of diagnostic tests, which may include:
    • Lung function tests to measure various aspects of your breathing, such as:
      • Spirometry, a major test for diagnosing asthma, which uses a device called a spirometer to measure the amount of air you can breathe and the rate at which it flows through your airways.  The test may include using a medicine that widens narrowed airways, to see if this improves results.   The medicine is inhaled using a device called a bronchodilator (for more information about bronchodilators, go to Key Point 3.) 
      • Peak airflow test, which uses a hand-held device called a peak flow meter to measure how fast and how much you can exhale.  People with asthma often use peak flow meters at home to monitor their condition.
    • Allergy tests (for more information about allergy tests, go to Key Point 2.) 
    • Trigger tests to see how you react to known asthma triggers.  One trigger test involves inhaling a substance called methacholine that constricts the airways of people with asthma; test results that worsen after inhaling methacholine suggest a diagnosis of asthma.
    • Exercise challenge tests to see how your respiratory system responds to physical activity.
    • Asthma medication trials, to see if your symptoms improve when you take samples of asthma medicines; improvement suggests a diagnosis of asthma.
    • Additional tests to rule out other conditions that can cause asthma-like symptoms, such as heart disease, other lung conditions, and gastroesophageal reflux (which causes heartburn).
    • Chest x-ray.
    • Blood and saliva tests.

Because a person's symptoms can vary from one time to another, an immediate diagnosis may not be possible.  But the eventual diagnosis will indicate if you have asthma and how severe it is.  Generally, asthma cases are classified as being in one of four levels of severity, depending on how often symptoms occur when the condition is not treated:

  • Mild intermittent asthma: symptoms happen in general twice a week or less, and at night twice a month or less.
  • Mild persistent asthma: symptoms happen in general more than twice a week, but no more than once a day, and at night more than twice a month;  asthma attacks may affect activity.
  • Moderate persistent asthma: symptoms happen in general every day, and at night more than once a week; asthma attacks may affect activity
  • Severe persistent asthma: symptoms happen in general throughout the day on most days, and often at night; asthma attacks most likely affect and limit activity.

The treatment prescribed will depend on the severity level.  For information about treating asthma, go to Key Point 3.

    

Key Point 2

Allergies create inflammation in the airways.  The inflammation causes the release of histamines, chemicals that cause swelling, an excess of mucous secretion, and muscle contractions in the airway.  This is an asthma attack.  (For more information about asthma attacks, go to the Asthma home page.) 

An allergy means your body reacts abnormally to certain substances, called "allergens," that you're sensitive to.  Allergies are specific to an individual, that is, each person "with allergies" reacts only to certain specific allergens, and the symptoms that result, known as the "allergic reaction," are also specific to that person.   The tendency to develop allergies is inherited, but specific allergies are not. 

Many people with allergies also have or develop asthma.  In fact, allergens are one class of asthma triggers – substances that provoke asthma symptoms and asthma attacks. (For more information about asthma triggers, go to Key Point 1.)

There are several types of allergens, including:

  • Certain foods, such as fish, shellfish, peanuts, milk, eggs, soy, wheat, and tree nuts
  • Certain medicines, such as penicillin, aspirin or other non-steroidal anti-inflammatory drugs such as ibuprofen, and beta-blockers (used to treat heart disease, high blood pressure, and migraine headaches)
  • The venom from stinging insects
  • Natural rubber latex

But the most common type of allergens that act as asthma triggers are inhaled (breathed in) allergens, including:

  • Dust mites (found in ordinary house dust)
  • Pollen from flowers, plants, grass, trees, etc.
  • Mold (indoor and outdoor)
  • Animal dander (from the skin, hair, or feathers of animals)
  • Cockroach droppings

If you inhale something you're allergic to, your body produces chemicals called histamines that cause you to have an allergic reaction.  The type of reaction depends on the individual, the specific allergen, and the severity of the allergy. Typical allergic reactions to inhaled allergens include:

  • Itchy eyes, nose, or throat
  • Watery eyes
  • Chest congestion
  • Nasal congestion
  • Runny nose
  • Sneezing
  • Wheezing
  • Swelling
  • Redness

These symptoms can be produced by several allergies, including one of the most common, popularly known as "hay fever," technically known as allergic rhinitis. According to the American Academy of Allergy Asthma & Immunology, up to 78% of people with asthma also have allergic rhinitis; therefore it is considered a risk factor in developing asthma. (A risk factor is something that increases your chances of getting a particular disease.) 

Because allergens are one class of asthma triggers and so many people with allergies also have asthma, allergy tests are given when you're being examined for asthma.  Allergy tests determine if you have allergies, and what your allergens are.

There are several forms of allergy tests, but the most common pricks your skin with a tiny needle to expose your blood or skin to a tiny amount of a common allergen.  Usually you're pricked in several places at once, each place with a different allergen.  If you're allergic to an allergen, the skin that was exposed to it will show a reaction (such as redness or swelling).  The reactions happen fairly quickly, so you normally have the results within fifteen minutes of the test.

Knowing if you have allergies and what they are is important information for diagnosing and treating asthma.  The treatment you receive will depend, in part, on the nature of your allergies.  For information about treating asthma, go to Key Point 3.

    

Key Point 3

Control of inflammation in the airways is the key to the treatment of persistent asthma.  There are drugs that work and make a real difference in quality of life.

There are two types of asthma medication: long-term control medicines and quick relief or "rescue" medicines.

  • Long-term control medicines prevent or reduce asthma symptoms by reducing their causes: the inflammation in the airways and the muscle tightening that squeezes the airways.  They're taken regularly, usually daily, over long periods of time.  Their effects are first felt after several weeks.
  • "Rescue" medicines offer quick, short-term relief from asthma symptoms or an asthma attack.  They work within minutes.

There are two main types of long-term control medicines: anti-inflammatories and bronchodilators. 

  • Anti-inflammatories prevent or reduce the inflammation of the airways that makes them swollen and narrow; they also help prevent the production of mucous that clogs the airways.
  • Bronchodilators open up the airways by relaxing the muscles that have tightened around them.

Long-term control anti-inflammatories include:

  • Inhaled corticosteroids;  a variety of inhalers are available; each works differently and you need to learn how to use yours correctly; among the available inhalers are:
    • Metered dose inhalers (or MDIs), popularly known as "puffers"
    • Dry powder inhalers, available under several brand names
    • Nebulizers  
  • Oral corticosteroids (taken in pill, tablet or liquid form) may be used to control severe asthma, and are sometimes used short-term to treat severe asthma attacks.  Corticosteroids are different from the anabolic steroids athletes sometimes use illegally.
  • Non-steroid anti-inflammatory drugs, such as:
    • Cromolyn sodium (inhaled)
    • Nedocromil sodium (inhaled)
  • Leukotriene modifiers (tablets), a new type of medicine that controls leukotrienes, chemicals in the body involved in creating inflammation.  Montelukast, zafirlukast, and zileuton are the leading leukotriene modifiers.

Long-term control bronchodilators include:

  • Long-acting beta agonists (inhaled), used to control moderate and severe asthma and  prevent symptoms at night and often taken with inhaled anti-inflammatories
  • Theophylline, an oral bronchodilator

Short-term, quick-relief  "rescue" medicines are usually bronchodilators.  You use them to combat asthma symptoms when you first feel them; they act quickly but last only a short period of time. The most common are short-term beta agonists and anticholinergics. They're usually inhaled, and most people with asthma carry an inhaler with them.  But they can also be taken orally (in tablet or liquid form) or be injected.   In severe cases, an anti-inflammatory corticosteroid may be taken orally or injected.

All of the above medicines can have side effects, may interact with other medicines you are taking, and must be taken only in the prescribed doses and under a doctor's supervision.

Because allergens are one class of asthma triggers and so many people with allergies also have asthma, allergen immunotherapy, popularly known as "allergy shots," is often given to people with allergic asthma.  (For more information about allergies and asthma, go to Key Point 2.) 

Allergy shots work like a vaccine to reduce your sensitivity to allergens. They are given over a period of time and gradually increase your immunity to the allergens that bother you.  As you develop this immunity, the allergic reactions you suffer will disappear or be greatly reduced.  This can also prevent or greatly reduce asthma symptoms. 

Aside from taking medicines, asthma treatment involves working with your doctor to develop an action plan for asthma management to control your condition.  According to guidelines set up by the National Institutes of Health, a plan asks you to do four basic actions:

  • Know what your asthma triggers are and take steps to avoid them.  This may mean making changes in your environment and lifestyle.
  • Take your medicines as prescribed.
  • Monitor the severity your asthma and your response to the medicines.  Use tools such as peak flow meters and spirometers to measure various aspects of your breathing.
  • Stay educated and informed and know what to do if your condition worsens.  Develop a plan with your doctor, who is your partner in managing your asthma care.

The guidelines also suggest that an asthma management plan should enable you to:

  • Prevent asthma symptoms and asthma attacks
  • Maintain normal breathing and normal activities, including work, school and exercise
  • Sleep all night with no asthma symptoms
  • Have few or no side-effects from asthma medications
  • Avoid hospital stays and emergency visits
  • Meet your own expectations of satisfactory care

The bottom line is this: although we do not yet have a cure for asthma, modern treatment methods enable us to minimize and even prevent asthma symptoms and asthma attacks.

Medline Plus

Medline Description: 

Conduct an off-site search for Asthma information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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