Asthma is a chronic condition that causes episodic interference with normal breathing by narrowing the airways that allow air to pass in and out of the lungs. This happens when an allergen or an irritant triggers a hyper-reactive response that causes the muscles around the airways to tighten, followed by an inflammatory response that cases mucus production and swelling of the airway’s lining.
For most people who have asthma, an attack is triggered by one or more factors. What causes an asthma attack in one person, however, may not bother another person who has asthma. These are common asthma triggers:
- Allergens. Some people’s immune systems overreact to specific allergens that normally are not harmful to the body, such as dust mites, molds, pollen or animal dander. For some people, the allergic reaction to a specific allergen can cause an asthma episode.
- Infections. Bacterial and viral infections are common asthma triggers. Viral infections, such as a cold or the flu, tend to trigger asthma episodes more often than bacterial infections, such as strep throat or sinus infections.
- Irritants. Asthma symptoms are also aggravated by irritants such as smoke from tobacco or wood, air pollution and various fumes and fragrances. Some of these irritants may trigger your asthma, although others may not.
- Exercise. Aerobic exercise, such as jogging or cross-country skiing, sometimes causes asthma episodes, especially exercises that involves continuous movement over a long period in cold, dry air.
- Aspirin and other NSAIDs. Aspirin and other nonsteroidal anti-inflammatory drugs act as triggers in a small percentage of people with asthma. Because aspirin-induced asthma can be severe and come on very quickly, you should avoid taking aspirin and other NSAIDs if you have aspirin-sensitive asthma.
- Emotions. Excitement, stress, fear and other emotions may trigger asthma episodes in some people. The emotions themselves are not the direct triggers. The asthma episodes occur as a result of rapid or heavy breathing brought on by crying, laughing or feeling anxious.
Asthma severity varies from person to person. Most people who have asthma develop their first symptoms while still young. About half show symptoms before age 10, and an additional third before age 40. But anyone can develop asthma at any time.
Symptoms of an asthma attack can be: wheezing, rapid breathing, shortness of breath, coughing, a feeling of tightness in the chest, rapid heart rate and sweating. The severity of these symptoms may range from a mild shortness of breath with some coughing and wheezing to severe shortness of breath with chest tightness, difficulty speaking and gasping for air. After an asthma attack, the cough, mucus production and inflammation can continue for days or weeks.
Asthma severity is classified according to how frequently a person has attacks and the severity of the symptoms during an attack. The classifications are mild intermittent, mild, moderate and severe persistent. The treatment plan is based on the asthma severity. A treatment plan usually includes avoiding triggers, monitoring of breathing with a peak flow meter when necessary and medications. A good asthma management plan should be able to reduce the severity and frequency of asthma symptoms and prevent unscheduled visits to the clinic or emergency room.
A peak-flow meter is a good tool for assessing and monitoring asthma. It measures the maximum speed at which air can be exhaled from the lungs. During an asthma episode, the peak flow slows down because the airways are constricted and partly blocked. Your breathing capacity may begin to drop up to 24 hours before asthma symptoms appear. The peak-flow meter can detect this drop so you can start taking medications before you begin to wheeze or cough.
There are many different kinds of asthma medications. In general, medications provide rapid short-term relief and long-term control of symptoms. The type of medication your doctor prescribes will depend on how severe your asthma is. Many people with mild, intermittent asthma do well with quick-relief medications alone. Most people who have frequent asthma episodes or persistent asthma take at least two kinds of medications. One medication provides quick relief during an asthma episode, and one long-term control medication prevents or reduces asthma episodes.
Long-Term Control Medications
The best way to control an asthma episode is to prevent it from beginning. Several types of medications are used for long-term control of asthma. Anti-inflammatory medications, such as inhaled corticosteroids, cromolyn sodium and nedocromil, prevent mucus production and airway swelling. Other types of long-term control medications include long-acting beta-agonists, theophylline and leukotriene modifiers.
The common types of quick-relief medications you can use at home include beta-agonists, anticholinergics and oral corticosteroids. Beta-agonists and anticholinergics relax the smooth muscle of the airways, making it easier to breathe. Oral corticosteroids help control the symptoms of asthma by reducing swelling, inflammation and mucus production in the airways.
Asthma Action Plan
One way many people manage their asthma is by using an asthma action plan. An asthma action plan is something you and your doctor develop together. It can help you recognize the early warning signs of an asthma episode and outline the steps to follow for relief.
Your asthma action plan will outline a medication program based on both symptoms and peak-flow readings. Usually the first step in an action plan is to avoid asthma triggers and to take long-term control medications to prevent episodes. The second step involves the use of fast-acting medications to relieve asthma symptoms when an episode does occur.
Keep a copy of your asthma action plan in your purse or wallet and at home or at the office. Parents should provide a copy of their child’s plan to the child’s day care provider or teacher and to the school nurse. Although the asthma action plan can help you avoid unnecessary visits to your doctor or the emergency room, never hesitate to get care if you need it.
Self-Care Steps for Asthma
The following self-care steps assume you have seen a doctor and have the right medications for managing your asthma. If you have coughing, wheezing or chest tightness that has not been diagnosed as asthma, see your doctor.
- Become an asthma expert. Read about asthma and attend patient information sessions and asthma support groups.
- Follow your asthma action plan. Know the warning signs of an asthma episode. Make sure you have written instructions for what to do in an asthma emergency. Keep a record of your episodes, medications, peak-flow readings and responses to medications.
- Manage your medications. Know the kinds of medications you should take, how much and how often. Know the possible side effects and what you can do to minimize them. Make sure you know which medications should be taken first, and follow the instructions carefully. Learn the correct use of an inhaler with a spacer. Don’t run out of your medicines. Ask your doctor or pharmacist to check all new medications for possible interactions with the asthma medications you are taking.
- Use your peak flow meter. Keep daily records of your symptoms and peak-flow readings, so you will be able to reduce the number and severity of asthma episodes.
- Identify and avoid triggers. Your record keeping will help you determine what triggers your asthma episodes. If inhalants such as dust and animal dander are high on your list, take steps to keep your living areas free of these triggers. Steer clear of irritants, cigarette smoke and car exhaust fumes.
- When an episode occurs, follow your asthma action plan; stay calm, stop your activity, take a few relaxed breaths, drink extra fluids and use your inhaler. Treat symptoms within minutes of their onset. It takes less medicine to stop an episode in its early phase.
- Stay physically fit. You should be able to control your asthma so you can exercise.
- Keep good records of your medications and dosages, and make sure someone else in your family knows where to find this information in an emergency.
- See your doctor regularly for exams.
Special Concerns for Children
Asthma causes more hospital and emergency room visits than any other chronic childhood disease. Children with well-controlled asthma, however, should be able to participate in any activity or sport they choose.
Children too young to use an inhaler are often treated with a machine called a nebulizer. This device uses compressed air to turn a solution of liquid medication into a fine mist, which the child breathes in through a mask or mouthpiece.
Many children seem to outgrow asthma symptoms, although the underlying condition — extra-sensitive bronchial tube lining — remains throughout life. About half of children with asthma will not have symptoms by age 15. Smoking may trigger the return of the problem.