Asthma (Az-muh) is a chronic disease that affects your airways. The airways are the tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways are inflamed (swollen). The inflammation makes the airways very sensitive, and they tend to react strongly to things that you are allergic to or find irritating. When the airways react, they get narrower, and less air flows through to your lung tissue. This causes symptoms like wheezing (a whistling sound when you breathe), coughing, chest tightness, and trouble breathing, especially at night and in the early morning.
Asthma cannot be cured, but most people with asthma can control it so that they have few and infrequent symptoms and can live active lives.
When asthma symptoms become worse than usual, it is called an asthma episode or attack. During an asthma attack, muscles around the airways tighten up, making the airways narrower so less air flows through. Inflammation increases, and the airways become more swollen and even narrower. Cells in the airways may also make more mucus than usual. This extra mucus also narrows the airways. These changes make it harder to breathe.
Asthma attacks are not all the same—some are worse than others. In a severe asthma attack, the airways can close so much that not enough oxygen gets to vital organs. This condition is a medical emergency. People can die from severe asthma attacks.
So, if you have asthma, you should see your doctor regularly. You will need to learn what things cause your asthma symptoms and how to avoid them. Your health care provider will also prescribe medicines to keep your asthma under control.
It is not clear exactly what makes the airways of people with asthma inflamed in the first place. Your inflamed airways may be due to a combination of things. We know that if other people in your family have asthma, you are more likely to develop it. New research suggests that being exposed to things like tobacco smoke, infections, and some allergens early in your life may increase your chances of developing asthma.
There are things in the environment that bring on your asthma symptoms and lead to asthma attacks. Some of the more common things include exercise, allergens, irritants, and viral infections. Some people have asthma only when they exercise or have a viral infection.
The list below gives some examples of things that can bring on asthma symptoms.
This is not a complete list of all the things that can bring on asthma symptoms. People can have trouble with one or more of these. It is important for you to learn which ones are problems for you. Your medical provider can help you identify which things affect your asthma and ways to avoid them.
Not all people have these symptoms, and symptoms may vary from one asthma attack to another. Symptoms can differ in how severe and how often they are: Sometimes symptoms can be mildly annoying, other times they can be serious and persistent enough to make you stop what you are doing, and sometimes symptoms can be so serious and frequent that they are life threatening.
Some things your provider will ask about include:
Your health care provider will listen to your breathing and look for signs of asthma or allergies.
Your medical provider will probably use a device called a spirometer to check how your lungs are working. This test is called spirometry. The test measures how much air you can blow out of your lungs after taking a deep breath, and how fast you can do it . The results will be lower than normal if your airways are inflamed and narrowed, or if the muscles around your airways have tightened up.
As part of the test, your health care provider may give you a medicine that helps open narrowed airways to see if the medicine changes or improves your test results.
Other tests, such as a chest x ray or an electrocardiogram, may be needed to find out if a foreign object or other lung diseases or heart disease could be causing your symptoms. A correct diagnosis is important because asthma is treated differently from other diseases with similar symptoms.
Depending on the results of your physical exam, medical history, and lung function tests, your provider can determine how severe your asthma is. This is important because the severity of your asthma will determine how your asthma should be treated. One way for medical practitioners to classify asthma severity is by considering how often you have symptoms when you are not taking any medicine or when your asthma is not well controlled.
Anyone with asthma can have a severe attack—even people who have intermittent or mild persistent asthma.
Your health care provider can work with you to decide about your treatment goals and what you need to do to control your asthma to achieve these goals. Asthma treatment includes:
Your medical provider will work with you to develop an asthma self-management plan for controlling your asthma on a daily basis and an emergency action plan for stopping asthma attacks. These plans will tell you what medicines you should take and other things you should do to keep your asthma under control.
There are two main types of medicines for asthma:
Everyone with asthma needs a quick-relief or "rescue" medicine to stop asthma symptoms before they get worse. Short-acting inhaled beta-agonists are the preferred quick-relief medicine. These medicines are bronchodilators. They act quickly to relax tightened muscles around your airways so that the airways can open up and allow more air to flow through.
You should take your quick-relief medicine when you first begin to feel asthma symptoms, such as coughing, wheezing, chest tightness, or shortness of breath. You should carry your quick-relief inhaler with you at all times in case of an asthma attack.
Your medical provider may recommend that you take your quick-relief medicines at other times as well—for example, before exercise.
The most effective, long-term control medicine for asthma is an inhaled corticosteroid (kor-ti-ko-STE-roid) because this medicine reduces the airway swelling that makes asthma attacks more likely.
Inhaled corticosteroids (or steroids for short) are the preferred medicine for controlling mild, moderate, and severe persistent asthma. They are generally safe when taken as directed by your health care provider.
In some cases, steroid tablets or liquid are used for short periods of time to bring asthma under control. The tablet or liquid form may also be used to control severe asthma.
If you stop taking long-term control medicines, your asthma will likely worsen again.
Many people with asthma need both a short-acting bronchodilator to use when symptoms worsen and long-term daily asthma control medicines to treat the ongoing inflammation.
Over time, your medical provider may need to make changes in your asthma medicine. You may need to increase your dose, lower your dose, or try a combination of medicines. Be sure to work with your provider to find the best treatment for your asthma. The goal is to use the least amount of medicine necessary to control your asthma.
Most asthma medicines are inhaled. They go directly into your lungs where they are needed. There are many kinds of inhalers, and many require different techniques. It is important to know how to use your inhaler correctly.
As part of your daily asthma self-management plan, your health care practitioner may recommend that you use a hand-held device called a peak flow meter at home to monitor how well your lungs are working.
You use the peak flow meter by taking a deep breath in and then blowing the air out hard into the peak flow meter. The peak flow meter then gives you a peak flow number that tells you how fast you moved the air out.
You will need to find out your "personal best" peak flow number. You do this by recording your peak flow number every day for a few weeks until your asthma is under control. The highest number you get during that time is your personal best peak flow. Then you can compare future peak flow measurements to your personal best peak flow, and that will show if your asthma is staying under control.
Your provider will tell you how and when to use your peak flow meter and how to use your medicines based on the results. You may be advised to use your peak flow meter each morning to keep track of how well you are breathing.
Your peak flow meter can help warn you of a possible asthma attack even before you notice symptoms. If your peak flow meter shows that your breathing is getting worse, you should follow your emergency asthma action plan. Take your quick-relief or other medicines as your doctor directed. Then you can use the peak flow meter to see how your airways are responding to the medicine.
Ask your provider about how you can take care of your asthma. You should know:
Major portions of this article were reprinted from the National Heart, Lung, and Blood Institute's asthma resources.
Authored by: Hall Health Center Primary Care Clinic staff, reprinted from the National Heart, Lung and Blood Institute
Reviewed by: Hall Health Center Primary Care Clinic staff (KC), February 2014