Asthma

Allergies and asthma go hand in hand the majority of the time. Determining how and when symptoms appear, whether they are seasonal or year-round, and whether they can be associated with any particular activity, place or exposure, is critical in the management of asthma.

Asthma occurs when the airways in your lungs (bronchial tubes) become inflamed and constricted. The muscles of the bronchial walls tighten, and your airways produce extra mucus that blocks your airways. Signs and symptoms of asthma range from minor wheezing to life-threatening asthma attacks.

Asthma can't be cured, but its symptoms can be controlled. Management includes avoiding asthma triggers and tracking your symptoms. You may need to regularly take long-term control medications to prevent flare-ups and short-term "rescue" medications to control symptoms once they start. Asthma that isn't under control can cause missed school and work or reduced productivity due to symptoms. As asthma changes over time, the need to work closely with your doctor to track your signs and symptoms and adjust your treatment as needed.

Asthma signs and symptoms range from minor to severe, and vary from person to person. You may have mild symptoms such as infrequent wheezing, with occasional asthma attacks. Between episodes, you may feel normal and have no trouble breathing. Alternatively, you may have signs and symptoms such as coughing and wheezing all the time or have symptoms primarily at night or only during exercise.

Asthma signs and symptoms include: shortness of breath, chest tightness or pain, trouble sleeping caused by shortness of breath, and coughing or wheezing (while exhaling). Asthma also may be present if you experience bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu.

Signs that your asthma is probably getting worse include:

• An increase in the severity and frequency of asthma signs and symptoms
• A fall in your lung function measured by Spirometry. This test measures the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath, and how fast you can breathe out.
  
• An increased need to use bronchodilators — medications that open up airways by relaxing the surrounding muscles

Work with your doctor to determine when you need to increase your medications or take other steps to treat symptoms of worsening asthma and get your asthma back under control. If your asthma keeps getting worse, you may need a trip to the emergency room. Your doctor can help you learn to recognize emergency signs and symptoms so you'll know when to get help.

Causes of Asthma

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

Asthma triggers are different from person to person. Exposure to various allergens and irritants can trigger signs and symptoms of asthma, including:

• Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
  
• Respiratory infections, such as the common cold
  
• Physical activity (exercise-induced asthma)
  
• Cold air
  
• Air pollutants and irritants such as smoke
  
• Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs
  
• Strong emotions and stress
  
• Sulfites, preservatives added to some perishable foods
  
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat
  
• Menstrual cycle in some women
  
• Allergic reactions to foods such as peanuts or shellfish
  
• Rapid worsening of shortness of breath or wheezing
  
• No improvement even after using short-acting bronchodilators
  
• Shortness of breath with minimal activity

Three key circumstances may lead you to talk to your doctor about asthma:

If you think you have asthma. If you have frequent coughs that last more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early, especially in children, may prevent long-term lung damage and prevent worsening of the condition over time.

To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good asthma control not only helps you feel better on a daily basis, but also can prevent a life-threatening asthma attack.

If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't work for you. Asthma changes over time, and you'll need periodic adjustments to your treatment to manage your symptoms. Don't try to solve the problem by taking more medication without consulting your doctor. Overusing asthma medication can cause side effects and may even make your asthma worse.

Severe asthma attacks Severe asthma attacks can be life-threatening and require emergency treatment. If your asthma isn't getting better with quick-relief medications (albuterol), seek emergency help right away. Work with your doctor ahead of time to determine what to do when your signs and symptoms worsen — and when you need emergency treatment. Signs of an asthma attack that needs emergency treatment include:

How asthma is classified

To classify your asthma severity, your doctor will evaluate your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests. Determining the severity level of your asthma will help your doctor choose the best treatment for you. Asthma severity often changes over time, requiring an adjustment to treatment.

Asthma is classified into four general categories:

Treatment for asthma generally involves avoiding the things that trigger your asthma attacks and taking one or more asthma medications. Treatment varies from person to person.

• Most people with persistent asthma use a combination of long-term control medications and quick-relief medications, taken with a hand-held inhaler.
  
  
• If your asthma symptoms are triggered by airborne allergens, such as pollen or pet dander, you may also need allergy treatment.
  
  
• You may need to try a few different medications before you find what works best.
  
  
• Because asthma changes over time, you will need to work with your doctor to monitor your symptoms and learn how to make needed adjustments.

Medications used to treat asthma include long-term control medications, quick-relief (rescue) medications and medications to treat allergies. The right medication for you depends on your age and symptoms, and what seems to work best to keep your asthma under control.

Long-term control medications

In most cases, these medications need to be taken every day. Types of long-term control medications include:

• Inhaled corticosteroids such as fluticasone (Flovent Diskus), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and others. These medications reduce airway inflammation and are the most commonly used long-term asthma medication. Unlike oral corticosteroids, these medications are considered relatively low risk for long-term corticosteroid side effects. You may need to use these medications for several days to weeks before they reach their maximum benefit.
  
  
• Long-acting beta-2 agonists (LABAs) such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). These inhaled medications, called long-acting bronchodilators, open the airways and reduce inflammation. They are often used to treat persistent asthma in combination with inhaled corticosteroids. Long-acting bronchodilators should not be used for quick relief of asthma symptoms.
  
• Leukotriene modifiers such as montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). These inhaled medications work by opening airways, reducing inflammation and decreasing mucus production. Cromolyn and nedocromil (Tilade). These inhaled medications reduce asthma signs and symptoms by decreasing allergic reactions. They're considered a second choice to inhaled corticosteroids, and need to be taken three or four times a day.
  
  
• Theophylline, a daily pill that opens your airways (bronchodilator). It relaxes the muscles around the airways.

Quick-relief medications (rescue medications)

You use quick-relief medications as needed for rapid, short-term relief of symptoms during an asthma attack, or before exercise, if your doctor recommends it. Only use these medications as often as your doctor tells you to. If you need to use these medications too often, you probably need to adjust your long-term control medication. Keep a record of how many puffs you use each day. Types of quick-relief medications include:

• Short-acting beta-2 agonists, such as albuterol. These inhaled medications, called bronchodilators, ease breathing by temporarily relaxing airway muscles. They act within minutes, and effects last four to six hours.
  
  
• Ipratropium (Atrovent). Your doctor might prescribe this inhaled anticholinergic for the immediate relief of your symptoms. Like other bronchodilators, ipratropium relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis.
  
  
• Oral and intravenous corticosteroids to treat acute asthma attacks or very severe asthma. Examples include prednisone and methylprednisolone. These medications relieve airway inflammation. They may cause serious side effects when used long term, so they're only used to treat severe asthma symptoms.

Medications for allergy-induced asthma. These decrease your body's sensitivity to a particular allergen or prevent your immune system from reacting to allergens. Allergy treatments for asthma include:

• Immunotherapy. Allergy desensitization shots or drops are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune system reaction to specific allergens.
  
• Anti-IgE monoclonal antibodies, such as omalizumab (Xolair). This medication reduces your immune system's reaction to allergens. Xolair is delivered by injection every two to four weeks.

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