Asthma
Bronchial asthma; Wheezing - asthma - adults
Asthma is a disease that causes the airways of the lungs to swell and narrow. It leads to wheezing, shortness of breath, chest tightness, and coughing.
Causes
Asthma is caused by swelling (inflammation) in the airways. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight. This reduces the amount of air that can pass through the airway.
In people who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens or triggers.
Allergens
An allergen is a substance that can cause an allergic reaction. In some people, the immune system recognizes allergens as foreign or dangerous. As ...
Common asthma triggers include:
- Animals (pet hair or dander)
- Dust mites
- Certain medicines (aspirin and other NSAIDS)
- Changes in weather (most often cold weather)
- Chemicals in the air or in food
- Exercise
- Mold
- Pollen
- Respiratory infections, such as the common cold
- Strong emotions (stress)
- Tobacco smoke
Substances in some workplaces can also trigger asthma symptoms, leading to occupational asthma . The most common triggers are wood dust, grain dust, animal dander, fungi, or chemicals.
Occupational asthma
Occupational asthma is a lung disorder in which substances found in the workplace cause the airways of the lungs to swell and narrow. This leads to ...
Many people with asthma have a personal or family history of allergies , such as hay fever ( allergic rhinitis ) or eczema . Others have no history of allergies.
Allergies
An allergy is an immune response or reaction to substances that are usually not harmful.
Allergic rhinitis
Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are ...
Eczema
Atopic dermatitis is a long-term (chronic) skin disorder that involves scaly and itchy rashes. It is a type of eczema. Other forms of eczema include...
Symptoms
Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom.
Asthma attacks can last for minutes to days. Attacks can become dangerous if airflow is severely blocked.
Symptoms of asthma include:
-
Cough
with or without sputum (phlegm) production
Cough
Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...
-
Pulling in of the skin between the ribs when breathing (
intercostal retractions
)
Intercostal retractions
Intercostal retractions occur when the muscles between the ribs pull inward. The movement is most often a sign that the person has a breathing probl...
-
Shortness of breath
that gets worse with exercise or activity
Shortness of breath
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
- Wheezing
Emergency symptoms that need prompt medical help include:
-
Bluish color
to the lips and face
Bluish color
Cyanosis is a bluish color to the skin or mucous membrane that is usually due to a lack of oxygen in the blood.
- Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack
-
Extreme
difficulty breathing
Difficulty breathing
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
-
Rapid pulse
Rapid pulse
A bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat.
-
Severe
anxiety
due to shortness of breath
Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
- Sweating
Other symptoms that may occur:
- Abnormal breathing pattern -- breathing out takes more than twice as long as breathing in
- Breathing temporarily stops
-
Chest pain
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
- Tightness in the chest
Exams and Tests
The health care provider will use a stethoscope to listen to your lungs. Wheezing or other asthma-related sounds may be heard.
Tests that may be ordered include:
-
Allergy testing --
skin
or a
blood test
to see if a person with asthma is allergic to certain substances
Skin
Allergy skin tests are used to find out which substances cause a person to have an allergic reaction.
Blood test
An absolute eosinophil count is a blood test that measures the number of white blood cells called eosinophils. Eosinophils become active when you ha...
-
Arterial blood gas
(usually only done with people who are having a severe asthma attack)
Arterial blood gas
Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.
-
Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
-
Lung function tests
, including peak flow measurements
Lung function tests
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning.
Treatment
The goals of treatment are:
- Control airway swelling
-
Stay away from substances that trigger your symptoms
Stay away from substances that trigger ...
Asthma triggers - stay away from; Asthma triggers - avoiding; Reactive airway disease - triggers; Bronchial asthma - triggers
- Help you to be able to do normal activities without asthma symptoms
You and your doctor should work as a team to manage your asthma. Follow your doctor's instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms.
MEDICINES FOR ASTHMA
There are two kinds of medicines for treating asthma:
- Control medicines to help prevent attacks
- Quick-relief (rescue) medicines for use during attacks
LONG-TERM MEDICINES
Asthma - inhaled corticosteroids; Asthma - long-acting beta-agonists; Asthma - leukotriene modifiers; Asthma - cromolyn; Bronchial asthma-control dru...
These are also called maintenance or control medicines. They are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel OK.
Some long-term medicines are breathed in (inhaled), such as steroids and long-acting beta-agonists. Others are taken by mouth (orally). Your doctor will prescribe the right medicine for you.
QUICK-RELIEF MEDICINES
Asthma - quick-relief drugs - short-acting beta-agonists; Asthma - quick-relief drugs - bronchodilators; Asthma - quick-relief drugs - oral steroids;...
These are also called rescue medicines. They are taken:
- For coughing, wheezing, trouble breathing, or an asthma attack
- Just before exercising to help prevent asthma symptoms caused by exercise
Tell your doctor if you are using quick-relief medicines twice a week or more. If so, your asthma may not be under control and your doctor may need to change your dose of daily control drugs.
Quick-relief medicines include:
- Short-acting inhaled bronchodilators
- Oral corticosteroids for when you have an asthma attack that is not going away
A severe asthma attack requires a checkup by a doctor. You may also need a hospital stay. There, you will likely be given oxygen, breathing assistance, and medicines given through a vein (IV).
ASTHMA CARE AT HOME
-
Know the
asthma symptoms to watch for
.
Asthma symptoms to watch for
Asthma attack - signs of; Reactive airway disease - asthma attack; Bronchial asthma - attack
- Know how to take your peak flow reading and what it means.
-
Know which triggers
make your asthma worse and what to do when this happens.
Know which triggers
Asthma triggers - stay away from; Asthma triggers - avoiding; Reactive airway disease - triggers; Bronchial asthma - triggers
-
Know how to care for your
asthma when you exercise
.
Asthma when you exercise
Wheezing - exercise-induced; Reactive airway disease - exercise
Asthma action plans are written documents for managing asthma. An asthma action plan should include:
- Instructions for taking asthma medicines when your condition is stable
- A list of asthma triggers and how to avoid them
- How to recognize when your asthma is getting worse, and when to call your provider
A peak flow meter is a simple device to measure how quickly you can move air out of your lungs.
Peak flow meter
Asthma - make peak flow a habit; Reactive airway disease - peak flow; Bronchial asthma - peak flow
- It can help you see if an attack is coming, sometimes even before symptoms appear. Peak flow measurements help let you know when you need to take medicine or other action.
- Peak flow values of 50% to 80% of your best results are a sign of a moderate asthma attack. Numbers below 50% are a sign of a severe attack.
Outlook (Prognosis)
There is no cure for asthma, although symptoms sometimes improve over time. With proper self-management and medical treatment, most people with asthma can lead a normal life.
Possible Complications
The complications of asthma can be severe, and may include:
- Death
- Decreased ability to exercise and take part in other activities
- Lack of sleep due to nighttime symptoms
- Permanent changes in the function of the lungs
- Persistent cough
- Trouble breathing that requires breathing assistance (ventilator)
When to Contact a Medical Professional
Call for an appointment with your provider if asthma symptoms develop.
Call your provider or go to the emergency room if:
- An asthma attack requires more medicine than recommended
- Symptoms get worse or do not improve with treatment
- You have shortness of breath while talking
- Your peak flow measurement is 50% to 80% of your personal best
Go to the emergency room if these symptoms occur:
- Drowsiness or confusion
- Severe shortness of breath at rest
- A peak flow measurement of less than 50% of your personal best
- Severe chest pain
- Bluish color to the lips and face
- Extreme difficulty breathing
- Rapid pulse
- Severe anxiety due to shortness of breath
Prevention
You can reduce asthma symptoms by avoiding triggers and substances that irritate the airways.
- Cover bedding with allergy-proof casings to reduce exposure to dust mites.
- Remove carpets from bedrooms and vacuum regularly.
- Use only unscented detergents and cleaning materials in the home.
- Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold.
- Keep the house clean and keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches. Body parts and droppings from cockroaches can trigger asthma attacks in some people.
- If someone is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Change the filter in furnaces and air conditioners often.
- Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help someone with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair. This can trigger asthma symptoms. If you smoke, now is a good time to quit.
- Avoid air pollution, industrial dust, and irritating fumes as much as possible.
References
Cydulka RK, Bates CG. Asthma. In: Adams JG, ed. Emergency Medicine . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 48.
Durrani SR, Busse WW. Management of asthma in adolescents and adults. In: Adkinson NF, Bochner BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55.
Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 42.
National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publication 08-4051. Updated 2012. www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf . Accessed April 29, 2015.
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Lungs - illustration
The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
Lungs
illustration
-
Spirometry - illustration
Spirometry is a painless study of air volume and flow rate within the lungs. Spirometry is frequently used to evaluate lung function in people with obstructive or restrictive lung diseases such as asthma or cystic fibrosis.
Spirometry
illustration
-
Asthma - illustration
Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. The muscles of the bronchial tree become tight and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound. This is known as an asthma attack, which can occur as an allergic reaction to an allergen or other substance (acute asthma), or as a part of a complex disease cycle which may include reaction to stress or exercise (chronic asthma).
Asthma
illustration
-
Peak flow meter - illustration
A peak flow meter is commonly used by a person with asthma to measure the amount of air that can be expelled from the lungs. If the airways become narrow or blocked due to asthma, peak flow values will drop because the person cannot blow air out of the lungs as well. A peak flow meter can be a useful aid in monitoring a person's asthma over time and can also be used to help determine how well a patient's medications are working.
Peak flow meter
illustration
-
Asthmatic bronchiole and normal bronchiole - illustration
Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. When an asthma attack occurs, mucus production is increased, muscles of the bronchial tree become tight, and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound.
Asthmatic bronchiole and normal bronchiole
illustration
-
Common asthma triggers - illustration
Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.
Common asthma triggers
illustration
-
Exercise-induced asthma - illustration
Exercise-induced asthma is distinct from allergic asthma in that it does not produce long-term increase in airway activity. People who only experience asthma when they exercise may be able to control their symptoms with preventive measures such as warm-up and cool-down exercises.
Exercise-induced asthma
illustration
-
Respiratory system - illustration
Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.
Respiratory system
illustration
-
Spacer use - Series
Presentation
-
Metered dose inhaler use - Series
Presentation
-
Nebulizer use - Series
Presentation
-
Peak flow meter use - Series
Presentation
-
Lungs - illustration
The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
Lungs
illustration
-
Spirometry - illustration
Spirometry is a painless study of air volume and flow rate within the lungs. Spirometry is frequently used to evaluate lung function in people with obstructive or restrictive lung diseases such as asthma or cystic fibrosis.
Spirometry
illustration
-
Asthma - illustration
Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. The muscles of the bronchial tree become tight and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound. This is known as an asthma attack, which can occur as an allergic reaction to an allergen or other substance (acute asthma), or as a part of a complex disease cycle which may include reaction to stress or exercise (chronic asthma).
Asthma
illustration
-
Peak flow meter - illustration
A peak flow meter is commonly used by a person with asthma to measure the amount of air that can be expelled from the lungs. If the airways become narrow or blocked due to asthma, peak flow values will drop because the person cannot blow air out of the lungs as well. A peak flow meter can be a useful aid in monitoring a person's asthma over time and can also be used to help determine how well a patient's medications are working.
Peak flow meter
illustration
-
Asthmatic bronchiole and normal bronchiole - illustration
Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. When an asthma attack occurs, mucus production is increased, muscles of the bronchial tree become tight, and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound.
Asthmatic bronchiole and normal bronchiole
illustration
-
Common asthma triggers - illustration
Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.
Common asthma triggers
illustration
-
Exercise-induced asthma - illustration
Exercise-induced asthma is distinct from allergic asthma in that it does not produce long-term increase in airway activity. People who only experience asthma when they exercise may be able to control their symptoms with preventive measures such as warm-up and cool-down exercises.
Exercise-induced asthma
illustration
-
Respiratory system - illustration
Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.
Respiratory system
illustration
-
Spacer use - Series
Presentation
-
Metered dose inhaler use - Series
Presentation
-
Nebulizer use - Series
Presentation
-
Peak flow meter use - Series
Presentation
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Asthma
(Alt. Medicine)
-
Asthma in adults
(In-Depth)
-
Asthma in children and adolescents
(In-Depth)
-
Asthma medications - theophylline derivatives
(Alt. Medicine)
Review Date: 4/21/2015
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.