Asthma is a lung condition that makes the primary airways—known as the bronchi—in the lungs swollen and inflamed all of the time. People who have asthma are more sensitive than other people to things inhaled from the environment, known as triggers.
These triggers make the muscles in an asthma sufferer’s lungs tighten, constricting the air passages and making breathing difficult. In addition, cells in the lungs produce more mucus in response to a trigger. The mucus can clog the bronchial tubes, which contributes to breathing problems. The airways also swell and become inflamed with white blood cells.
When the lungs react to a trigger, what’s known as an “asthma attack” can occur. Wheezing, coughing and/or tightness in the chest and shortness of breath are all hallmark symptoms of a classic asthma attack. Asthma can be controlled with the proper diagnosis and treatment.
The National Center for Health Statistics (a division of the U.S. Centers for Disease Control and Prevention, or CDC) reported that 18.9 million American adults and 7.1 million children suffered from asthma in 2011. The condition is becoming more common and more severe across all age, sex and racial groups.
Asthma typically develops during childhood. But many people develop the condition in adulthood, after age 20—known as adult onset asthma. Some individuals have their first asthma attack after age 50.
Who’s at Risk?
Obesity significantly increases a person’s risk of developing the condition. Heredity is also thought to play a role. Children of parents with asthma are at greater risk for developing the condition.
Pollution, poor air quality in urban environments, poverty and lack of patient education are also factors contributing to rising asthma and asthma-related complication rates. People who have allergies are at an increased risk of developing asthma, and those raised in environments where they were exposed to cigarette smoke also have a much higher incidence of the condition.
Women and Asthma
Women may first develop asthma during or after pregnancy, though the condition may also improve during pregnancy. There is some evidence that asthma may be affected by hormonal changes during a woman’s cycle and can be triggered prior to or during the menstrual period. Women are also more likely than men to die from asthma.
Researchers aren’t sure why some people’s airways are more sensitive to things in the environment. Asthma sufferers may have allergies to certain proteins, known as allergens, which are usually airborne and can trigger an attack. But not all asthma sufferers have defined allergies. An estimated 70 percent of people with asthma have airborne allergies.
Common Asthma Triggers
Common allergens include: dust mites, mold, pollen, cockroaches, animal dander and certain foods or chemicals commonly used in food processing. Contrary to popular belief, dog and cat fur don’t cause allergies. Rather, a protein found in the pet’s saliva, dander and urine causes allergies in some individuals. Other things can irritate the already-sensitive air passages of asthma or allergy sufferers. Common irritants include cigarette smoke, cold air and pollution. Exercise and stress also can trigger an asthma attack.
Controlling asthma includes short-term relief of symptoms and long-term strategies to prevent attacks from occurring. Medications and behavioral approaches, such as avoiding asthma triggers, for example, are both important to managing asthma successfully. Another critical part of asthma management is education and close consultation with your health care team. Newer medications are available, and older methods are being improved or have been withdrawn from the market.
Asthma symptoms that recur frequently, even when medication is taken regularly, can be a sign that a reassessment with a health care professional is necessary.
While primary care providers can diagnose and treat asthma, consultation with a specialist, such as an allergist or pulmonary or lung specialist, may be necessary. Asthma symptoms are sometimes mistaken for a bacterial infection. Antibiotics are not usually effective in controlling asthma. Pulmonary or lung function testing is essential to making the proper diagnosis.
Moderate and mild asthma attacks are common for asthma sufferers. During these attacks an asthma sufferer may feel restless, feel her chest tighten, wheeze and/or cough up mucus. Severe attacks interrupt breathing, causing breathlessness, difficulty talking and eventually loss of consciousness, if not treated immediately. Asthma symptoms and their severity can vary greatly, but they should always be taken seriously.
Common symptoms of asthma include:
- dry cough, especially at night or as a response to certain “triggers” or allergens, such as dust or pets
- a feeling of tightness or pressure in your chest
- difficulty breathing
- wheezing—which sounds like a whistling sound—when you exhale
- shortness of breath after exercise
- colds that migrate to your chest or don’t go away for 10 days or more
- waking up at night with shortness of breath
Common asthma triggers include the following:
- dust mites
- pet dander (protein in pet fur, saliva and urine)
- viral respiratory infections
- certain medications, such as aspirin and other nonsteroidal anti-inflammatories, and beta blockers
- menstrual cycles in some women
- irritants (tobacco smoke and some scented products and chemicals)
- food allergies
If you are experiencing one or more of the symptoms associated with asthma and have never received treatment or medication for it, it is very important that you make an appointment with a health care professional soon. To accurately diagnose your condition, your health care professional will ask you questions about your symptoms, perform a physical exam and conduct lung function tests.
Asthma symptoms are often associated with other illnesses in older adults, such as chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD) and sinusitis. COPD is a persistent blockage of the air passages caused by emphysema or chronic bronchitis. Emphysema occurs when the walls of the alveoli—or tiny air sacs—in the lungs are damaged. This damage makes the aveoli less elastic and, therefore, less effective at passing oxygen into the blood and removing carbon dioxide from the blood, leading to shortness of breath. It is most common among people who have smoked the equivalent of one pack of cigarettes per day or more for 10 years.
Chronic bronchitis, which produces a persistent cough not related to a cold or other medical condition, causes inflammation of the airways, which produces mucus and causes muscle spasms.
It is estimated that more than 75 percent of people with asthma also experience GERD, which causes the stomach’s digestive juices to back up or “reflux” into the esophagus—the passageway for food from the mouth to the stomach. Over time, the esophagus becomes inflamed or permanently damaged. Chronic heartburn, cough, snoring, wheezing and hoarseness are some symptoms of GERD.
Asthma and sinusitis frequently coexist, and many patients with asthma won’t improve unless their sinusitis is treated. Additionally, many only get asthma when their sinusitis worsens. Thus, a complete assessment of asthma always requires a review of the upper airway, including the sinuses.
Tests that measure your airflow are a primary tool in the diagnosis of asthma. Specialists and some primary health care professionals will use a spirometer, which is a machine that measures how much air you blow out each second. Another test employs a peak flow meter to measure how much air you can breathe out in a fast blast. These tests are simple and painless, but offer revealing information about your airflow. Your health care professional might also measure your airflow before and after treatment with a bronchodilator, a medicine that relaxes tight muscles in the airways, to judge reversibility or improvement with a bronchodilator, the hallmark of asthma.
Other tests may be administered to assess your sensitivity to specific allergens that may be triggering your asthma. Often skin tests are used to determine which allergens you are allergic to. Diluted extracts from allergens such as particular foods, pollens, dust mites and molds are injected under your skin or into a tiny scratch or puncture on your arm or back. If you have a positive reaction (meaning you are allergic), a small, raised, reddened area with a surrounding flush will appear at the test site, indicating antibodies to that specific allergen are present in the skin. These reactions can be modest or very large depending on how allergic you are.
Your health care professional might also conduct a blood test, which is not as sensitive as a skin test, to look for allergies. Using a sample of your blood, the test looks for levels of antibodies to particular allergens present in the home and outdoors in various parts of the United States.
Asthma requires continuous medical care and treatment. Asthma treatment focuses on opening airways by reducing inflammation and swelling of the bronchial tubes, both large and small—the lung structures affected by asthma. Once inflammation and swelling are reduced, the lungs may become less sensitive to triggers. Many medications are available to treat symptoms and prevent attacks from recurring. Nonmedical management strategies also are recommended: asthma sufferers are encouraged to identify triggers in their environment and avoid them, when possible, or at least be prepared for them by having and using medication, both control and reliever types.
Three groups of asthma medications are available: quick-relief medications, long-term controller medications and medications for allergy-induced asthma. They are available under many brand names and in a variety of forms: sprays, pills, powder, liquids and injections. Some are short acting and are administered directly to the lining of the lungs to immediately relieve symptoms. Controller medications are meant to have longer-term effects—preventing attacks from occurring. The longer-acting medications take a while to help symptoms subside. Some asthma medications are meant to be taken daily, while others are intended only for symptom relief, as symptoms develop.
Quick relief (or “rescue”) medications are used to provide short-term relief during an asthma attack or, for some people, before physical activity to prevent exercise-induced asthma or after exposure to a known allergen like cats or dust.
In a class of medications known as short-acting beta agonists, asthma medications called bronchodilators are typically designed to act quickly to stop an asthma attack once it has started by relaxing and opening—”dilating”—the bronchial tubes so more air is available. For this reason, they are in the quick-relief medications—or “rescue medications”—category. Coughing, wheezing and breathing difficulties are quickly relieved, and the effects of these medications last for several hours.
The most commonly used bronchodilator in the United States is albuterol (Ventolin, Proventil, ProAir), and the preferred method of taking bronchodilators is through inhalation with a metered dose inhaler. Other short-acting beta agonists used for asthma include levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). Both albuterol and levalbuterol are available in a solution form to be delivered by a nebulizer.
Another bronchodilator—ipratropium (Atrovent)—works to relax the airways and make breathing easier. Although it is primarily used for chronic bronchitis and emphysema, ipratropium is also sometimes used to treat acute asthma attacks.
Also in the rescue medications category, corticosteroids work to relieve airway inflammation caused by severe asthma. Corticosteroids are not the same type of steroids used by some athletes. These performance-enhancing drugs are called anabolic steroids. In inhaled form in standard doses, there are fewer side effects from corticosteroids used to treat asthma, though the risk of side effects may increase if you take this medication orally (in liquid or pill form) over a long time. Side effects may include hoarseness and thrush, a surface (throat) fungal infection, though rinsing the throat with water after inhaling reduces this risk.
Prednisone and methylprednisolone are two of the most commonly prescribed oral steroid drugs. They are available as liquids or pills for short-term use. Side effects include weight gain, menstrual irregularities, increased appetite and loss of energy, among others. Long-term effects of the drug include decreased bone density, bone fractures, ulcers, cataracts, high blood pressure, elevated blood sugar and many other potential problems.
In their inhaled form, corticosteroids are also frequently prescribed for long-term asthma control, discussed below.
Long-term controller medications:
Most long-term controller medications for asthma need to be taken every day for asthma prevention.
Inhaled corticosteroids, including fluticasone (Flovent Diskus, Flovent HFA), mometasone (Asmanex), beclomethasone (Qvar), budesonide (Pulmicort Flexhaler), ciclesonide (Alvesco) and others, are the most commonly prescribed long-term asthma remedy. Compared to oral corticosteroids, inhaled corticosteroids have a relatively low risk of side effects and are usually safe for long-term use in normal doses. It usually takes several days or weeks for these medications to start working.
Salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer) are two bronchodilators in a class of medications known as long-acting beta agonists (LABAs). When used with an inhaled corticosteroid, these drugs help control asthma symptoms. There are also devices available that contain both a LABA and an inhaled (anti-inflammatory) corticosteroid (Advair, Symbicort, Dulera).
Theophylline (Uniphyl), another type of slow-acting bronchodilator, is prepared in a slow-release form taken by mouth. Although not used as frequently as it used to be in the past, theophylline is sometimes used for persistent asthma symptoms, particularly nighttime asthma. Side effects of bronchodilators can include nervousness, shakiness and a rapid heart rate. There also may be interaction with other medications or reduced effectiveness caused by other factors.
If you are using rescue bronchodilators more than three times a day, you should consider notifying your health care professional because your asthma may not be under adequate control or could be getting worse. If your bronchodilator contains salmeterol, you shouldn’t use it more than two times a day or less than 12 hours apart. However, you may not be using your inhaler correctly for optimum relief. Although the majority of asthma patients use some type of inhaler, health care professionals say that some people who use them aren’t using them correctly. Some use them once a day or every other day, for example.
Salmeterol and formoterol may increase the risk of asthma-related death, so you should only use it as an additional therapy or if your asthma isn’t well controlled on other asthma-controller medications. This warning is particularly important for African Americans, who seem be most affected. Discuss this risk with your health care professional.
In addition, cromolyn solution, an anti-inflammatory medication, is available for use with a nebulizer to help prevent asthma attacks in children.
Leukotriene modifiers are a form of anti-inflammatory medication that helps prevent asthma symptoms for up to 24 hours. Leukotrienes are chemicals produced by the cells in the lung lining and are part of the chain reaction that causes inflammation and constriction of the airways. Leukotriene modifiers fight this allergic response by blocking the lung’s response to leukotrienes and thereby decreasing inflammation. These medications are taken orally in pill form, rather than inhaled. Montelukast (Singulair) and zafirlukast (Accolate) are two examples of leukotriene modifiers. Rarely, leukotriene modifiers have been linked to depression, hallucinations, suicidal thoughts, aggression and agitation. If you experience one of these psychological side effects while taking a leukotriene modifier for your asthma, call your health care professional right away.
An injectable medication, omalizumab (Xolair), is specifically for use in those age 12 and older with moderate to severe asthma symptoms, triggered by allergies whose symptoms are not adequately controlled with inhaled corticosteroids, long-acting bronchodilators or leukotriene receptor blockers. Omalizumab is a new class of allergic asthma therapy known as “anti-IgE” therapy, which targets an antibody called IgE that causes allergic reactions. The treatment binds to IgE and neutralizes it.
If your asthma is the result of or worsened by allergies, you may benefit from one of the following allergy-related treatments.
Immunotherapy is a treatment option for individuals who cannot easily avoid allergy-related asthma triggers or find available asthma medications ineffective or unusable for some reason. Immunotherapy, also called allergy desensitization shots, involves injecting small amounts of the allergen to which you are allergic into your body. Gradually, the amount injected is increased, allowing your body to build immunity to the allergen. Following treatment, when you are exposed to the allergen, you may have only minor symptoms or none at all. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), immunotherapy works best for allergic asthma, allergic rhinitis and conjunctivitis and stinging insect allergy. This is the only therapy that can induce long-term and perhaps permanent remission—when symptoms disappear and don’t return.
Antihistamines and decongestants are medications available both by prescription and over the counter to treat allergy symptoms that could trigger an asthma attack. Antihistamines work against histamine, a chemical produced by the body in response to an allergen. Antihistamines relieve symptoms such as watery and itchy eyes, sneezing and other allergy symptoms. Side effects of older antihistamines include drowsiness and dehydration, among others. Antihistamines are available in pill, liquid and injection forms, and decongestants are available in pill, liquid and nasal spray forms. Oral decongestants must be obtained from behind the counter because of concerns about illicit drug abuse and manufacturing.
Decongestants reestablish drainage of the nasal passages and relieve symptoms such as congestion, swelling, excess secretions and discomfort in the sinus areas. Decongestants may be pills, sprays or drops. Medications combining pain relievers and decongestants also are available. Side effects of decongestants include nervousness, sleeplessness and elevated blood pressure. Always check the labels on these and other medications for additional potential side effects.
Neither antihistamines nor decongestants are specifically indicated for use in asthma. However, leukotrienes, namely Singulair, are approved for both rhinitis and asthma.
Asthma and allergy sufferers should be cautious about herbal treatments for their conditions because of the potential for allergic responses. Any type of treatment should always be discussed with your health care professional before trying it.
Coping With Asthma While Pregnant
Although there is a slightly higher risk of complications in pregnant women with asthma compared to women without the condition, you can still have a safe and normal pregnancy, as long as asthma symptoms are kept under control. Uncontrolled asthma in the mother can, however, cause oxygen levels to decrease in the blood and can impact how much oxygen the baby receives.
It’s possible that the severity of your asthma may change during pregnancy. For about one-third of pregnant women, asthma symptoms generally seem to worsen, while one-third may be lucky and see an improvement. Another third seem to have no change in the severity of their asthma.
Most medications prescribed to control asthma are safe for pregnant women to take, and the risks of uncontrolled asthma in pregnant women appear to be greater than the risks of necessary asthma medications. Medications administered with inhalers generally are considered better for pregnant women than oral medications because inhaled medications go straight to the lungs and are less likely to get passed along to the baby. In more serious cases, oral medications may be necessary to control symptoms of asthma. Ask your health care professional treating your asthma to consult with your obstetrician before developing a treatment plan for you.
There is no way to prevent asthma from developing. You can learn to identify your asthma or allergy triggers and possibly avoid them. Developing an asthma management plan with your health care team can help you determine which medication works best for you and what other strategies you can use to improve your condition. Here are a few suggestions for avoiding triggers:
- Track your symptoms to identify what triggers your asthma attacks; once identified try to avoid them.
- Always be prepared to manage your attacks.
- Prevent symptoms before they occur, if possible.
- If you’re allergic to cat or dog dander, use your asthma medications before visiting someone with these pets, and be sure and have a reliever type medication with you, such as albuterol.
- If necessary, find a new home for your pet or keep it out of your sleeping area.
- If you smoke, quit, and turn your home into a smoke-free zone.
- When pollen counts or ozone levels are high in the summer, try to stay indoors and in air conditioning; use air filters on your furnace and air conditioner.
- If cold air is a trigger for you, wear a scarf to cover your mouth and nose when you are outside in the winter.
- Wash all your bedding, including pillow cases, clothes and stuffed animal toys, once a week or more often in hot water (greater than 130° F) and dry at high heat to kill dust mites.
- Use a dehumidifier in damp areas such as bathrooms and basements to reduce mold build-up.
- Avoid close contact with anyone who has a cold or the flu, and wash your hands regularly.
- Get a flu shot in the fall.
- Work with your health care professional to come up with a medication regimen that will still allow you to exercise.
- Use your asthma medications before exercising in cold air.
Facts to Know
- Asthma is a chronic lung condition caused by heightened sensitivity to various things in the environment, such as pollen, dust and smoke. Exposure to these “triggers” causes the air passages to become swollen and inflamed, causing the hallmark symptoms of an asthma “attack”: increased mucous production, wheezing, coughing, chest tightness and difficulty breathing.
- Asthma can’t be cured, but it can be controlled with a variety of medications. If not well controlled, asthma can be life threatening. Lifelong management is usually necessary.
- The rate of asthma is higher in children than in adults (8.2 percent of adults have asthma, compared to 9.5 percent of children).
- The National Center for Health Statistics (a division of the CDC) reported that 18.9 million American adults and 7.1 million children suffered from asthma in 2011. Asthma cases have been increasing in number and severity since the early 1980s, spanning people of all ages, sex and racial groups.
- According to the Asthma and Allergy Foundation of America, African Americans are three times as likely as Caucasians to be hospitalized from asthma and three times as likely to die from the disease. Racial differences in asthma prevalence and mortality are believed to be related to poverty, urban air quality, indoor allergens, lack of patient education and inadequate medical care. Women are more likely than men to die from asthma attacks.
- About half of all adults with asthma have allergies that may trigger asthma symptoms. Identifying, avoiding or controlling triggers is an important part of asthma management.
- Obesity is a major risk factor for developing asthma.
- Asthma is believed to have a genetic component. Children of a parent or parents with asthma are at greater risk of developing the condition.
- Three main groups of asthma medications are available: quick-relief medications, long-term controller medications and medications for allergy-induced asthma.
- Exercise can trigger an asthma attack; treatment with an inhaled bronchodilator before exercising can prevent exercise-induced asthma.
- What is asthma?Asthma is a lung condition that makes the primary airways—known as the bronchi—in the lungs swollen and inflamed. People who have asthma are more sensitive than other people to things in the environment, known as triggers. These triggers make the muscles in an asthma sufferer’s lungs tighten or constrict making the air passages narrow and breathing difficult. In addition, cells in the lungs produce more mucus in response to a trigger. The mucus clogs the bronchial tubes, which contributes to breathing problems. When the lungs react to a trigger, what’s known as an “asthma attack” occurs. Wheezing, coughing or tightness in the chest and shortness of breath are the hallmark symptoms of an asthma attack. This lifelong condition can’t be cured, but it can be controlled with the proper diagnosis and treatment.
- How prevalent is asthma among adults in the United States?The National Center for Health Statistics (a division of the U.S. CDC) reported that 18.9 million American adults and 7.1 million children suffered from asthma in 2011. Reported cases of asthma have been on the rise since the early 1980s among people of all ages, sex and racial groups. Many people develop asthma in childhood, but others develop the disease later in life—known as adult onset asthma. You can even first begin experiencing symptoms of the disease at age 50 or older.
- Is there a cure for asthma?No, asthma is a chronic disease that cannot be cured, but it can be controlled with medication and lifestyle changes. There are a variety of medications in a variety of forms to treat symptoms of asthma. Lifestyle modifications, such as identifying and avoiding or minimizing asthma triggers, are also important to managing the disease.
- Are women at greater risk for asthma compared with men?Women are more likely to die from asthma than are men. Studies have shown that asthma may be related to women’s hormonal changes and could be triggered before or during the menstrual period. Some women first develop asthma during or after a pregnancy, but asthma symptoms may also subside during pregnancy or not be affected at all.
- Are there certain groups of people who are at higher risk for asthma?The prevalence of asthma is definitely higher among children than adults and higher among African Americans and Hispanics than Caucasians. According to the Asthma and Allergy Foundation of America, African Americans are three times as likely as Caucasians to be hospitalized from asthma and three times as likely to die from the disease. Racial differences in asthma prevalence and mortality are believed to be highly related to poverty, urban air quality, indoor allergens, lack of patient education and inadequate medical care.
- What are some common symptoms of asthma?Some of the more common symptoms of adult onset asthma include the following:
- dry cough, especially at night or as a response to certain triggers or allergens
- a feeling of tightness or pressure in your chest
- difficulty breathing
- wheezing—which sounds like a whistling sound—when you exhale
- shortness of breath after exercise
- colds that migrate to your chest or don’t go away for 10 days or more
- waking up during the night
- What type of health care professional treats asthma?Primary care health professionals typically diagnose and treat asthma, but consultation with an allergist or possibly a pulmonary (lung) specialist may be recommended to help develop an asthma management program.
- Does it take a long time to diagnose asthma?Asthma can be hard to diagnose; therefore, its symptoms are sometimes misdiagnosed as respiratory infections or attributed to other conditions. Generally, with a thorough medical evaluation, which includes a physical, a medical history that includes evaluating your symptoms, different laboratory tests and respiratory-function tests, a diagnosis is quickly and accurately made. Once diagnosed, it can take some time for your health care team to determine which medications and dosages are right to best manage your symptoms.
- What are my treatment options?There are many medications to help manage and minimize the effects of the asthma. Some medicines are preventive and are used for long-term control, while others are used as quick relievers for immediate action when an asthma episode (or attack) occurs.
- I have asthma. Are my children at risk for developing this condition?Yes. Studies have shown that children of parents with asthma are at greater risk for developing the condition. It would be wise to discuss your children’s health with their pediatrician.