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What Is Asthma?
Asthma is a chronic (long lasting) inflammatory lung disease that causes airways
to swell up, tighten, and narrow. A single episode of wheezing is not asthma.
Asthma occurs because the airways in the lungs overreact to various stimuli,
resulting in narrowing with obstruction to air flow. This recurrently results
in one or more of the following symptoms:
-
Tightness in the chest
-
Labored breathing
-
Coughing
-
Noises in the chest heard particularly during a prolonged forced expiration
(wheezing).
As a result of these symptoms, asthmatics may not tolerate exertion. They may be
awakened frequently at night. More severe symptoms may result in requirements
for urgent medical care and hospitalization. For a very few with particularly
severe asthma, there is a risk of fatality. Asthma affects the airways, which
begin just below the throat as a single tube called the trachea. The trachea is
situated immediately in front of the esophagus, the passageway that connects
the throat with the stomach. The trachea divides into two slightly narrower
tubes called the main bronchi (each one is called a bronchus). Each main
bronchus then divides into progressively smaller tubes - the smallest are
called bronchioles - to carry air to and from microscopic air spaces called
alveoli. It is in the alveoli that the important work of the lung occurs,
exchanging oxygen in the air for carbon dioxide in the blood. The airways
(trachea, bronchi, bronchioles) are surrounded by a type of involuntary muscle
known as smooth muscle. The airways are lined with a mucus membrane that
secretes a fine layer of mucus and fluid. This mucus washes the airways to
remove any bacteria, dirt, or other foreign material that might get into our
lungs. The overreaction or hyper-responsiveness of the airways results in
bronchospasm, which is excessive contraction or spasm of the bronchial smooth
muscle. The airways also become inflamed with swelling of the bronchial mucous
membrane (mucosa) and secretion of excessive thick mucus that is difficult to
expel. It is part of the evaluation process to identify the role of each of
these physiologic components in asthma. This is important because bronchospasm
(constriction of the muscle surrounding the airways) and inflammation respond
to different medications.
The airway hyper-responsiveness leading to obstruction of the airways occurs
from one or more of various stimuli that vary with the individual patient.
These include:
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Viral (but not bacterial) respiratory infections (common colds)
-
Inhaled irritants (cigarette smoke, wood burning stoves and fireplaces, strong
odors, chemical fumes)
-
Inhaled allergens (pollens, dusts, molds, animal danders)
-
Cold air
Occasional ingested substances (aspirin, sulfite preservatives, specific foods).
Sometimes these exposures just act as triggers of brief symptoms with rapid
relief once exposure ends. Sensitivity of the airway may be increased, however,
following even brief exposure to one of these. This causes a longer period of
asthmatic symptoms. More information should be provided to you for each of
these that are judged to be important for your asthma. The obstruction of the
airways decreases the rate at which air can flow. This is felt as tightness in
the chest and labored breathing (dyspnea).
The obstruction and inflammation causes coughing. Obstruction to air flow can be
measured with pulmonary function tests, which can detect even degrees of airway
obstruction not yet causing symptoms. Pulmonary function measurements can be an
extremely valuable tool for your physician to decide regarding treatment.
The increased mucus in the airways stimulates coughing as the body attempts to
clear the airways. The unusually thick (viscous) mucus is difficult to expel,
however, resulting in continued coughing that fails to adequately expel the
mucus. General irritability of the airways also causes coughing. The coughing
and mucus production may cause some physicians to diagnose bronchitis. However,
the term "bronchitis" simply means inflammation of the airways, and asthma
causes airway inflammation. Consequently, anti-asthmatic medication, and not
antibiotics, are the appropriate treatment.
Narrowing of the airway causes noises when air passes through them with
sufficient speed. This typical high-pitched noise is called wheezing. Mucus in
the airway causes a rattling sound. Complete obstruction of some airways can
cause absorption of air from the alveoli. This causes portions of the lung to
appear more dense and cast more of a shadow on a chest x-ray (this is called
atelectasis). The rattling sounds or increased shadows on the x-ray are often
misinterpreted as indicating pneumonia. The inappropriate diagnoses of
bronchitis and pneumonia cause much unnecessary use of antibiotics, which are
ineffective both for asthma in general and for most of the infections, such as
the common cold viruses, that trigger asthma. Asthma (pronounced: az-muh) is a
lung condition that causes a person to have difficulty breathing. Asthma is a
common condition: More than 6 million kids and teens have it. Asthma affects a
person's bronchial tubes, also known as airways. When a person breathes
normally, air is taken in through the nose or mouth and then goes into the
trachea (windpipe), passing through the bronchial tubes, into the lungs, and
finally back out again. But people with asthma have airways that are inflamed.
This means that they swell and produce lots of thick mucus. They are also
overly sensitive, or hyperreactive, to certain things, like exercise, dust, or
cigarette smoke. This hyperreactivity causes the smooth muscle that lines the
airways to tighten up. The combination of airway inflammation and muscle
tightening narrows the airways and makes it difficult for air to move through.
In most people with asthma, the difficulty breathing happens periodically. When
it does happen, it is known as an asthma flare - sometimes also referred to as
an asthma attack or episode. A person having an asthma flare may cough, wheeze
(make a whistling sound while breathing), be short of breath, and feel an
intense tightness in the chest. Many people with asthma compare a flare to the
sensation of trying to breathe through a straw - it feels extremely hard to get
air in and out of their lungs. An asthma flare can last for several hours or
longer if a person doesn't use asthma medication. When an asthma flare is over,
the person usually feels better. Between flares, a person's breathing can seem
completely normal, or a person may continue to have some symptoms, such as
coughing. Some people with asthma feel as if they are always short of breath.
Other people with the condition may only cough at night or while exercising and
they may never have a noticeable flare.
Causes of Asthma:
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Many children with asthma can breathe normally for a long time.
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Children with asthma have sensitive airways.
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When an asthma flare happens, airway muscles tighten up. The airway lining also
swells and can fill with mucus. Both of these cause the airway to narrow.
-
An asthma flare makes it hard for your child to breathe.
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Different things can cause a flare in different people. Sometimes, a flare is
triggered by exercise, smoke, allergies, viral infections, breathing in cold
air, and changes in the weather.
The basic abnormality causing asthma is the hyper responsive reaction of the
body to specific and non-specific stimuli. Some can develop asthma after a bout
of respiratory infection precipitating an underlying condition.
Others might experience worsening of symptoms on exercising, exposure to cold
air or due to occupational stimuli. Also in the list of causes are viral
infection and
emotional stress.
Non-specific hyperirritability of the respiratory airways is the most common
underlying cause in all asthmatics. Airway inflammation is believed to play a
fundamental role. Airborne allergens like dust, pollen, air pollution, sulfites
in food, aspirin, certain medication, and respiratory infections all play a
part in increasing airway reactivity and increasing the airway inflammation.
Anyone can get asthma, both children and adults.Children are more likely to get
asthma if a parent has asthma.
The Symptoms Of Asthma:
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A child with asthma has noisy breathing. Normal breathing is quiet.
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During an asthma flare, your child may cough, wheeze, sweat, feel tightness in
his chest, and feel short of breath. His heart will probably beat faster.
-
Your child may cough a lot at night but seem fine during the day.
-
A child with asthma may get chest colds a lot.
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A child with asthma may tire more easily than other children or avoid
activities and places that make it hard for him to breathe.
Is Asthma Contagious?
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No. Asthma is not contagious.
Treatments of Asthma:
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If you think your child has asthma, take him to the doctor.
-
Your doctor will probably want to know your family's history of asthma and
allergies.
Also be prepared to tell your doctor about your child's condition. How bad are
his symptoms? How long do they last? When do they begin? What seems to cause
them? What seems to make them better or worse? How do they go away?
The agent responsible for the abnormal response is removed.
Medication to improve the breathing and to remove the Mucus clots present
within the airway.
Underlying infection to be treated.
Know Your Respiratory System
What Have You to Do to Improve It?
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The doctor may use a machine to test your child's breathing.
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If the doctor thinks that your child has asthma, your child will need a plan to
control his symptoms and flares.
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Asthma is often treated with medication. Medication helps to both prevent
flares and treat symptoms.
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Make sure your child gets enough rest and eats healthy.
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Talk to your child's school. Discuss your child's asthma. What can trigger a
flare? What are his symptoms? What should be done? What medication is needed?
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A child with asthma can still be very active, if treated with the right
medication.
How Long Does Asthma Last?
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Each person has a different experience with his or her asthma.
-
For some, symptoms may improve as the child gets older. For others, symptoms
may get worse. For others, symptoms may seem to go away but show up again later
in life.
How Can Asthma Be prevented?
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Avoid things that trigger your child's asthma, such as allergies and breathing
in cold air.
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Look for signs that your child may be nearing a flare. Signs include change in
appearance or mood, change in breathing, or your child might say he "feels
funny."
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Follow the plan for managing your child's asthma. Make sure he takes medication
as prescribed.
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Avoid smoking around a child who has asthma. Smoke can trigger a flare.
When Should I Call The Doctor?
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Call the doctor if you think your child has asthma.
-
Call the doctor if your child is having difficulty breathing.
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Call the doctor if you have questions or concerns about your child's condition.
Quick Answers
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Asthma is a chronic (long lasting) lung disease that causes airways to swell
up, tighten, and narrow.
-
An asthma flare makes it hard for your child to breathe.
-
Anyone can get asthma, both children and adults.
-
A child with asthma has noisy breathing. Normal breathing is quiet.
-
Asthma is not contagious.
-
Asthma is often treated with medication. Medication helps to both prevent
flares and treat symptoms.
-
For some, symptoms may improve as the child gets older. For others, symptoms
may get worse.
-
Avoid things that trigger your child's asthma, such as allergies or certain
forms of exercise.
-
Call the doctor if you think your child has asthma.
Overview of Asthma Miles Weinberger, M.D. Professor of Pediatrics Director,
Pediatric Allergy and Pulmonary Division Peer Review Status: Internally Peer
Reviewed
Is All Asthma The Same?
Asthma is quite variable. Symptoms can range from trivial and infrequent in
some to severe, unrelenting, and dangerous in others. Even when severe,
however, the airway obstruction is usually fully reversible, either
spontaneously or as a result of treatment. This means that symptoms can be
relieved, airway obstruction can be reversed, and pulmonary function can be
made normal. There are different patterns of asthma. Some people have only an
intermittent pattern of disease. They have self-limited episodes of varying
severity followed by extended symptom-free periods. The individual episodes are
frequently triggered by viral respiratory infections (causes of the common
cold). This is particularly common in young children in whom viral respiratory
infections are frequent (as many as 8 to 12 per year during the toddler and
preschool age group). Others have these intermittent symptomatic periods
brought on by vigorous exertion, cold air, or specific environmental exposures.
This pattern is intermittent asthma. More prolonged periods of symptoms occur
in people who have asthma from seasonal outdoor inhalant allergens. This may be
from grass pollen on the West Coast or mold spores from molds that grow on
decaying vegetation in the Midwest. Through a knowledge of the aerobiology in
your area and allergy skin testing, your physician can attempt to identify
whether the symptoms fit into this pattern of disease. This pattern is seasonal
allergic asthma. Some patients have daily or very frequently recurring
symptoms. Although variable in severity, these patients do not have extended
periods free of chest tightness, labored breathing, exertional intolerance, or
cough. They may additionally have acute exacerbations triggered by the same
factors that cause symptoms with an intermittent or seasonal allergic pattern
of disease. Thus, viral respiratory infections (common colds) specific
environmental exposures may further increase the severity of symptoms in these
patients. This pattern is chronic asthma (sometimes called persistent asthma).
All patterns of disease are associated with varying degrees of severity ranging
from mild to severe. It is your doctor's job, with your help, to identify the
pattern and severity of disease and provide effective intervention measures to
rapidly relieve acute symptoms and determine appropriate maintenance measures
for those with extended symptomatic periods.
Why Does Someone get it?
Over 10% of people have some history of asthma. It often runs in
families. The heritable nature of asthma is not well understood, however, and
geneticists cannot define the precise manner in which it is passed from parents
to children. All we can say is that families with asthma are more likely to
have children with asthma. Although there appears to be an inherited
predisposition to develop asthma, severity varies considerably among
asthmatics, even among members in the same family. If asthma is present in both
parents, the likelihood of a child having asthma is even greater, but even then
not all of the children will have asthma. Even among identical twins, both do
not necessarily have asthma, although this is more likely than if they were
just siblings or nonidentical twins. This suggests that there is some
additional factor that we do not yet fully understand, other than inheritance,
that influences the development of asthma. Asthma commonly begins early in
childhood, even in infancy. But it can begin at any time, even among the
elderly. In many cases, asthma runs in families; sometimes it does not.
Sometimes it goes away with time; sometimes it does not. We do not know what
causes asthma to start nor can we predict who will lose it with time. We do
know that people with asthma can be provided with the means to control the
disease and prevent symptoms that interfere with daily living. Rather than ask
"Why do I have asthma?", it is better to ask "How can I control asthma so as to
go about my usual activities without having interference from asthma?".
What Can be Done About
it?
Asthma can be controlled. Moreover, it can be controlled by those who have
asthma. The role of the physician is to provide the means for the patient to
control asthma and to teach the patient to use provided measures (this is
called physician-directed self-management). Since asthma varies greatly in
pattern of symptoms and severity, the treatment plan needs to be
individualized. This should be done in a systematic manner. Goals of therapy
must be realistically attainable and explicitly defined for you. The plan for
attaining the treatment goals must be understood. Once the measures needed for
control of asthma are identified, they can be placed in the hands of the
patient with appropriate instructions for usage. Parental supervision is needed
for young children, but progressive responsibility for self-management is given
with advancing maturity. Treatment may consist of medication, environmental
changes, and life-style changes. The more the patient (or family for young
children) understands the disease and its treatment, the better the outcome is
likely to be. The patient (and family) should therefore be an active partner in
making decisions about treatment. Be wary, however, of superstitions and
misinformation regarding asthma. More than almost any other medical problem,
asthma is associated with a wide diversity of medical and nonmedical opinion.
Both the physician and the patient therefore need to exercise judgment. Four
common sense measures to remember are:
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Ineffective measures should not be continued
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Effective measures should be continued as long as they are needed unless risk
exceeds benefit
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Treatment should not be worse than the problem being treated
-
Treatment should be the simplest that is adequate. Remember that it is not
sufficient just to do what is prescribed. You must also understand why measures
are used so that you can be an active partner in learning what measures are
required and when they should be applied. Learn the names of your medications
(both the brand name and the generic name). Be critical in your observations.
Report observations and concerns regarding asthma to your physician. Ask
questions. Answering your questions is part of the physician's job in providing
you with the skills to manage your (or your child's) asthma. The final goal is
for you, not the physician, to be treating the asthma. After all, you are there
when it occurs. Your physician should try to determine the most appropriate
therapeutic measures. However, these measures are not optimally effective until
they are implemented by you.
Will it ever go away?
Asthma has a variable course. Many children with asthma see it improve or appear
to go away as they get older. This can happen any time in childhood or
adolescence. If asthma was only intermittent in nature and triggered by viral
respiratory infections (a particularly common form of asthma in young
children), there is an excellent likelihood that asthma will be much less of a
problem as the child gets older. Sometimes the nature of the asthma changes
with age. A young child may have asthma initially only from viral infections.
As the child ages, asthma may occur less from viral infections (because older
children get fewer viral respiratory infections than younger children), but
inhalant allergy may become an important contributor to the asthma. If asthma
persists into adult life, or returns later in adult life after a period of
remission, persisting asthmatic symptoms may not be readily explainable by any
environmental factors. Approximately half of children with chronic asthma have
little or no problem after adolescence. There appears to be no way to predict
who will "outgrow" their asthma and who will not. This does not relate to
severity, however. Very severe asthma often goes away, and mild asthma may
persist. Even when asthmatic symptoms cease to be a problem for a awhile, this
is not an assurance that asthma will not return later in life. We should
therefore not talk about "growing out of asthma" in children but should instead
refer to extended periods of remission when asthma becomes quiescent. Asthma
that persists into adult life, returns in an adult, or begins later in life, is
much less likely to go into remission, although some waxing and waning of
severity may occur. Whatever the course, however, asthma is virtually always
controllable with acceptably safe measures. While ongoing medical evaluation of
asthma should assess whether the disease is still active and continues to need
treatment, it is not wise to withhold treatment in the hope that asthma will go
away by itself. That may indeed occur, but it may not, and there can be
considerable avoidable suffering and disability in the interim.
Does asthma cause permanent damage?
The airway obstruction of asthma is generally completely reversible and usually
does not cause permanent damage to the lungs, heart, or other organs. However,
severe acute episodes of asthma can be associated with life threatening events
and even fatalities. Survival of severe life threatening events can be
associated with damage from lack of oxygen during the severe exacerbation, and
lack of oxygen to the brain can cause loss of consciousness and brain damage.
Chronic asthma with ongoing airway inflammation may also be associated with
what is called "remodeling" of the airways. This describes permanent changes
occurring in the tissues surrounding the airways that results in permanent
narrowing of airways. The potential for this emphasizes the importance of
monitoring pulmonary function in patients with asthma at regular intervals,
particularly those with a chronic pattern of asthma. Goal of Treament - Control
of the Disease
The primary goal of treatment is the control of asthma.
What does control of asthma mean?
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The ability to deal with acute exacerbations of asthma so that the need for
urgent medical care is prevented
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Prevention of hospitalization for asthma
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Tolerating all normal activities up to and including competitive athletics if
otherwise able
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The avoidance of symptoms that interfere with sleep.
-
Normal pulmonary physiology (as measured by pulmonary function equipment).
-
These goals should be reached safely and with the least interference with a
normal life-style. The risks and bother of the treatment must be carefully
weighed against the risk and bother of the asthma. The benefit obtained from
the treatment must be worth any inconvenience and potential medication risks
(and any medication has potential risks) imposed by the treatment.
In other words, it is the goal of treatment to determine the simplest, safest
therapeutic measures that minimize disability, normalize lung function, avoid
the need for acute medical care of asthma, and permit a normal life.
How the Treatment Goals are Attained Unfortunately, there is no magic bullet
for asthma. While treatment can control symptoms safely and effectively for
most patients most of the time, it is not a simple matter of the doctor writing
a prescription and the patient taking the medication. Successful treatment of
asthma is likely to require several steps on the part of physician. These
include:
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Confirmation of the diagnosis (make sure it's asthma and not some other
problem.)
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Characterization of the asthma with regard to:
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Chronicity (how frequent are the symptoms?)
-
Severity (how bad do the symptoms get?)
-
Identification of triggers (what makes the asthma worse?)
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Identification of the components of airway obstruction (bronchospasm,
inflammation, or both?)
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Development of a plan to identify the least treatment that is safe and
effective
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Teach implementation of that plan (what to do and when!) The diagnosis of
asthma is suspected when a patient has a history of recurrent or chronic
shortness of breath, labored breathing, or cough in the absence of any other
obvious reason. The diagnosis is confirmed by obtaining evidence that there is
airway obstruction that reverses either spontaneously or as a result of
treatment with anti-asthmatic measures. The procedures used to make the
diagnosis include a careful history, measurement of pulmonary function (unless
not practical, as in young children), and therapeutic trials of medication.
Chronicity refers to the relative persistence of symptoms and signs of asthma.
Some patients have only episodic or intermittent asthma; between relatively
infrequent episodes of acute symptoms, they are completely asymptomatic. Other
patients have extended periods of seasonally recurring symptoms due to seasonal
inhalant allergens. This pattern is classified as seasonal allergic asthma. Yet
others have chronic asthma. These patients may also have brief acute
exacerbations or recurring seasons of worsened symptoms but differ from
intermittent or seasonal allergic asthmatics in that they do not experience
extended periods free of symptoms and signs of asthma. Assessment of severity
is independent of chronicity. For any of the classifications, symptoms may
range from trivial to life-threatening. Severity of acute symptoms is judged by
the degree of medical care needed. Some patients never require an urgent visit
to a physician or an emergency room for their asthma while others have required
frequent emergency care and hospitalizations. Asthmatic symptoms that have
resulted in loss of consciousness or admission to an intensive care unit
identifies a particularly dangerous degree of severity. Severity of chronic
symptoms is judged by the degree of disability resulting from the daily or
frequently recurring symptoms that occur in the absence of effective
medication. Patients may have daily symptoms that cause only minimal
discomfort. These patients tolerate activities and sleep undisturbed by their
asthma. Others are literally pulmonary cripples with virtually no tolerance of
activity and frequent disturbance of sleep by shortness of breath or cough.
Triggers of asthma, those identifiable factors that commonly worsen symptoms
include:
-
Viral respiratory infections (common colds);
-
Airborne allergens (such as pollens, mold spores, animal danders, dusts);
-
Inhaled irritants (such as cigarette smoke, chemical fumes, strong odors, air
pollution);
-
Cold air
-
Exertion Other factors can also worsen asthma on occasion. Hyperventilation,
excessively rapid and deep breathing, can worsen asthma. This occurs from
anxiety in some patients, particularly when asthma symptoms have begun for some
other reason. A vicious cycle then occurs of asthma causing anxiety, which then
worsens asthma, thereby causing more anxiety, etc. Ingested substances, such as
aspirin, sulfite preservatives, and specific foods can cause acute attacks of
asthma in sensitive patients. The components of airway obstruction in asthma
include bronchospasm (constriction of the muscle surrounding the airways) and
inflammation. The distinction is important because the responses of each to
medical treatment are different. Bronchospasm (constriction of the muscle
surrounding the airways) responds to bronchodilators, medication that relaxes
the bronchial smooth muscle that causes narrowing of the airway from
bronchospasm. Bronchodilator medications, however, have little or no effect on
mucosal edema and mucous secretions caused by inflammation. Anti-inflammatory
corticosteroids (no relationship to "steroids" used by athletes to build
muscle) dramatically, though slowly, reduce the mucosal swelling and mucous
secretions but have no direct ability to relax the bronchial smooth muscle and
relieve the bronchospasm. An organized plan should determine specific treatment
needs to control the asthma. These include medication needs, environmental
alterations, and indications for allergy shots. Medication requirements can be
divided into two categories, intervention measures to relieve acute symptoms;
maintenance medication to prevent the rapid return of symptoms once the
intervention measures are stopped. Patients with an intermittent pattern of
asthma require only intervention measures.
Patients with sustained periods of asthmatic symptoms or asthma that returns
promptly after complete clearing with intervention measures require the use of
maintenance medication in addition to intervention measures. Virtually all
patients should be taught to deliver an inhaled bronchodilator to relieve or
prevent acute episodes of bronchospasm. This is all that is needed for many
patients. The need for corticosteroids as an additional intervention measure
should be assessed based on response to bronchodilator and prior history of
severity. For those with sustained periods of symptoms, maintenance medication
should be selected sequentially until symptoms and signs of asthma are
adequately suppressed. The goal is to permit normal sleep and activities
without excessively frequent addition of intervention measures (inhaled
bronchodilators and short courses of oral corticosteroids) for breakthrough
symptoms. The need for environmental alterations should be individualized as
carefully as medication selection. Non-allergic irritants such as cigarette
smoke or chemical fumes are usually assumed to be potentially detrimental to
asthma. The use of allergy skin testing helps identify potential allergic
sensitivity to specific environmental exposures. The use of allergy shots may
be indicated when environmental alteration is not practical for treatment of
clinically important airborne allergen sensitivity. The treatment plan can be
no more effective than its implementation. Most of the treatment, and certainly
the most important aspects of the treatment, are carried out by the patient (or
the family for young children). It is the physician's job (with help from other
health professionals) to teach, and it is your job to learn how to carry out
the treatment plan. This is an interactive and ongoing process. Use each
contact, whether in person or by phone, to learn more about managing your (or
your child's) asthma. Title Page
More About Asthma
There are many things that just seem to come naturally to some people. Maybe
you know a girl who's a natural at sports - put her in a uniform and she's off
and running. Some people are naturals at playing an instrument; it's like they
were born knowing how to count in 4/4 time. Others are naturals at math; give
them a test on theorems or equations and they're happy. But some people have a
problem with something that you'd think would come naturally to everyone:
breathing. When a person has asthma, it can make breathing very difficult. And
when it's hard to breathe, it can affect a person's game, that trumpet solo,
and even the all-important geometry test.
What Causes Asthma
No one knows exactly what causes asthma. It's thought to be a
combination of environmental and genetic (hereditary) factors. A teen with
asthma may have a parent or other close relative who has asthma or had it as a
child. Asthma isn't contagious, though, so you can't catch it from someone who
has it. Asthma symptoms can be brought on by dozens of different things, and
what causes asthma flares in one person might not bother another at all. The
things that set off asthma symptoms are called triggers. The following are some
of the common triggers:
-
Allergens.
Some people with asthma find that allergens - certain substances that cause an
allergic reaction in some people - can be a major trigger. Common allergens are
dust mites (microscopic bugs that live in dust), molds, pollen, animal dander,
and cockroaches.
-
Airborne i
rritants and pollutants. Certain substances in the air, such as chalk dust or
smoke, can trigger asthma because they irritate the airways. Cigarette smoke is
a major cause of asthma symptoms, and not just for smokers - secondhand smoke
can trigger asthma symptoms in people who are around smokers. Scented products
such as perfumes, cosmetics, and cleaning solutions can trigger symptoms, as
can strong odors from fresh paint or gasoline fumes. And some research studies
have found that high levels of air pollutants such as ozone may irritate the
sensitive tissues in the bronchial tubes and can possibly aggravate the
symptoms of asthma in some people with the condition.
-
Exercise. Some people have what's called exercise-induced asthma, which is
triggered by physical activity. Although it can be especially frustrating, most
cases of exercise-induced asthma can be treated so that people can still enjoy
the sports they love.
-
Weather. Cold or dry air can sometimes trigger asthma symptoms in certain
people, as can extreme heat or humidity.
-
Respiratory tract infections. Colds, flu, and other respiratory conditions can
trigger asthma in some people. There are lots of other things that can trigger
asthma symptoms in people with the condition. For example, a girl's asthma can
get worse just before her period. And even laughing, crying, and yelling can
sometimes cause the airways to tighten in sensitive lungs, triggering an asthma
flare.
How Do Doctors Diagnose Asthma?
Most people with asthma are diagnosed with the condition when they're kids, but
some don't find out that they have it until their teen years. In diagnosing
asthma, a doctor will ask about any concerns and symptoms you have, your past
health, your family's health, any medications you're taking, any allergies you
may have, and other issues. This is called the medical history. The doctor will
also perform a physical exam. He or she may recommend that you take some tests.
Tests that doctors use to diagnose asthma include spirometry (pronounced:
spye-rah-muh-tree) and peak flow meter tests, which involve blowing into
devices that can measure how well your lungs are performing. Your doctor may
also recommend allergy tests to see if allergies are causing your symptoms, or
special exercise tests to see whether your asthma symptoms may be brought on by
physical activity. Doctors occasionally use X-rays in diagnosing asthma, but
these are usually only to rule out other possible problems. Your family doctor
may refer you to a specialist for allergy diagnosis and treatment. Doctors who
specialize in the treatment of asthma include those who have been trained in
the fields of allergy, immunology (how the immune system works), and
pulmonology (conditions that affect the lungs).
How Is It Treated?
There's no cure for asthma, but the condition can usually be managed and flares
can be prevented. Asthma is treated in two ways: by avoiding potential triggers
and with medication. Teens who have asthma need to avoid the things that can
cause their symptoms. Of course, some things that can cause symptoms can't be
completely avoided (like catching a cold!), but people can control their
exposure to some triggers, such as pet dander, for example. In the case of
exercise-induced asthma, the trigger (physical activity) needs to be managed
rather than avoided. Exercise can help a person stay healthier overall, and
doctors can help athletes find treatments that allow them to them participate
in their sports. Doctors treat every asthma case individually because the
severity of each person's asthma and what triggers the symptoms are different.
For this reason, doctors have a variety of treatment medications at their
disposal. Most asthma medications are inhaled (which means that a person takes
the medication by breathing it into the lungs), but asthma medications can also
take the form of pills or liquids. They fall into two categories:
-
Medications that act quickly to halt asthma symptoms once they start.
Some medications can be used as needed to stop asthma symptoms (such as
wheezing, coughing, and shortness of breath) when a person first notices them.
These medications act fast to stop the symptoms, but they're not long lasting.
They are also known as "rescue," "quick-relief, " or "fast-acting" medications.
-
Long-term medications to manage asthma and prevent symptoms from occurring in
the first place.
Many people with asthma need to take medication every day to control the
condition overall. Long-term medications (also called "controller,"
"preventive," or "maintenance" medications) work differently from quick-relief
medications. They treat the problem of airway inflammation instead of the
symptoms (coughing, wheezing, etc.) that it causes. Long-term medications are
slow acting and can take days or even weeks to begin working. Although you may
not notice them working in the same way as quick-relief medications, regular
use of long-term medications should lessen your need for the quick-relief
medications. Doctors also prescribe long-term medications as a way to minimize
any permanent lung changes that may be associated with having asthma. Some
people with asthma rely only on quick-relief medications; others use
quick-relief medications together with long-term control medications to keep
their asthma in check overall. Each person needs to work closely with a doctor
to find the treatment that's right for them. In addition to avoiding triggers
and treating symptoms, people with asthma usually need to monitor their
condition to prevent flares and help their doctors adjust medications if
necessary. Two of the tools doctors give people to do this are:
-
Peak flow meter. This handheld device measures how well a person can blow out
air from the lungs. A peak flow meter reading that falls in the meter's green
(or good) zone means the airways are open. A reading in the yellow zone means
there's potential for an asthma flare. A reading in the red zone means the
flare is serious and could mean that a person needs medication or treatment
immediately - maybe even a trip to the doctor or emergency room. Teens who take
daily medicine to control their asthma symptoms should use a peak flow meter at
least one to two times a day and whenever they are having symptoms.
-
Asthma journal. Keeping a diary can also be an effective way to help prevent
problems. A daily log of peak flow meter readings, times when symptoms occur,
and when medications are taken can help a doctor develop the most appropriate
treatment methods. Dealing With Asthma
The best way to control asthma is prevention. Although medications can play an
essential role in preventing flares, environmental control is also very
important. Here are some things you can do to help prevent coming into contact
with the allergens or irritants that cause your asthma flares:
-
Keep your environment clear of potential allergens. For example, if dust is a
trigger for you, vacuum (or remove) rugs and drapes where dust mites can hide.
Placing pillows and mattresses in dust-proof covers can help. If pets trigger
your symptoms, keep a pet-free household. If you can't part with Fido or
Fluffy, keep certain rooms pet free and bathe your pet frequently to get rid of
dander.
-
Pay attention to the weather and take precautions when you know weather or air
pollution conditions may affect you. You may need to stay indoors or limit your
exercise to indoor activities.
-
Don't smoke (or, if you're a smoker, quit). Smoking is always a bad idea for
the lungs, but it's especially bad for someone who has asthma.
-
Be smart about exercise. It's a great way to keep the body and mind healthy, so
if you're prone to exercise-induced asthma flares, talk to your doctor about
how to manage your symptoms. If you get flares during a game or workout, stop
what you're doing until the flare has cleared or you've taken a fast-acting
medication. When the symptoms have gone, you can start exercising again.
Asthma doesn't have to prevent you from doing what you love! Sure, it takes a
bit of work (and remembering!) but if you take your medications properly,
recognize your symptoms and triggers, and check in with your doctor regularly,
you can do anything that other teens do. That includes any sports activity,
even cross-country skiing, swimming, or playing basketball. Take a long, deep
breath - right now. Inhale slowly, until your lungs can't hold anymore . . .
now let the air out gradually . . . ahhh. Breathing feels so natural that it's
easy to take for granted, isn't it? Normally, the air you breathe travels
effortlessly through your nose and mouth, down the trachea (also called the
"windpipe"), through the bronchial tubes into the lungs, and finally to tiny
clusters of air sacs, called alveoli. Here, oxygen is exchanged for carbon
dioxide in your blood.
Now try something different: run in place for 3 minutes. Then place a straw in
your mouth, close your lips around it, and try to breathe in and out - but only
through the straw. Not so easy anymore, is it? Now, narrow the straw by
pinching it in the middle. Even more difficult to breathe? That's what it feels
like when a child tries to breathe during an asthma flare-up (commonly called
an "attack"). During a flare, the airways narrow and become obstructed, making
it difficult for air to move through them. Asthma can be very scary (and when
not controlled, it can be life-threatening). Over 20 million people have asthma
in the United States. Did you know it's the number-one reason for kids
chronically missing school? And asthma flares are the most common reason for
pediatric emergency room visits due to a chronic illness. Some kids have only
mild, occasional symptoms or only show symptoms after exercising. Others have
severe asthma that, left untreated, can dramatically limit how active they are
and cause changes in lung function. But thanks to new medications and treatment
strategies, a child with asthma no longer needs to sit on the sidelines, and
parents no longer need to worry incessantly about their child's well being.
With patient education and the right asthma management plan, today's families
can learn to control symptoms and asthma flares more independently, allowing
kids and parents to do just about anything they want. Causes and Descriptions
of Asthma Flares
Asthma is a chronic inflammatory lung disease that causes airways to tighten
and narrow. Anyone can have asthma, including infants and adolescents. The
tendency to develop asthma is often inherited. Many children with asthma can
breathe normally for weeks or months between flares. When flares do occur, they
often seem to happen without warning. Actually, an asthma flare usually
develops over time, involving a complicated process of increasing airway
obstruction. All children with asthma have airways that are overly sensitive,
or hyperreactive, to certain asthma triggers. Things that trigger flares differ
from person to person. Some common triggers are exercise, allergies, viral
infections, and smoke. The sensitive airway linings react to trigger exposure
by becoming inflamed, swollen, and filled with mucus. The muscles lining the
swollen airways tighten and constrict, making them even more narrowed and
obstructed. So an asthma flare is caused by three important changes in the
airways:
-
swelling of the lining of the airways
-
excess mucus that results in congestion and mucus "plugs" that get caught in
the narrowed airways
-
bronchoconstriction: bands of smooth muscle lining the airways tighten up
Together, the swelling, excess mucus, and bronchoconstriction narrow the
airways and make it difficult to move air through (like breathing through a
straw). During an asthma flare, kids may experience coughing, wheezing (a
breezy whistling sound in the chest when breathing), chest tightness, increased
heart rate, sweating, and shortness of breath.
How Is Asthma Diagnosed?
Diagnosing asthma can be tricky and time-consuming because different children
with asthma can have very different patterns of symptoms. For example, some
kids cough constantly at night but seem fine during the day, while others seem
to get frequent chest colds that don't go away. It's not uncommon for kids to
have symptoms like these for months before being seen by a doctor. When
considering a diagnosis of asthma, a doctor rules out other possible causes of
a child's symptoms. He or she asks questions about the family's asthma and
allergy history, performs a physical exam, and possibly orders laboratory tests
such as chest X-rays, blood tests, and allergy skin tests. During this process,
parents must provide the doctor with detailed information, such as:
-
symptoms: how severe they are, when and where they occur, how frequently they
occur, how long they last, and how they go away
-
allergies: the child's and the family's allergy history
-
illnesses: how often the child gets colds, how severe they are, and how long
they last
-
triggers: exposures to irritants and allergens, recent life changes or
stressful events, or other things that seem to lead to a flare This information
helps the doctor understand a child's pattern of symptoms, which can then be
compared to the characteristics of different categories of asthma. To confirm
the diagnosis of asthma, a breathing test can be performed using a spirometer,
a machine that analyzes a child's airflow through both large and small airways.
A spirometer can also be used to see if the child's breathing problems can be
reversed with medication, a primary characteristic of asthma. The doctor may
take a spirometer reading, give the child an inhaled medication that opens the
airways, and then take another reading to see if breathing improves with
medication. If medication reverses airway narrowing significantly, as indicated
by improved airflow, then there's a strong possibility that the child has
asthma. Sometimes additional specialized tests are performed, such as allergy
skin testing, complete pulmonary function studies, or exercise challenge (where
changes in breathing when the child exercises are measured). These tests can
help verify that a child has asthma, and not a condition that just seems like
asthma. Once the child is diagnosed, the family can start learning how to
control asthma - so it no longer controls the family. At home, a peak flow
meter - a hand-held tool that measures breathing ability - can be used. When
peak flow readings drop, it's a sign of increasing airway inflammation.
More Information
Exercise-induced asthma
Kids who have exercise-induced asthma (EIA) develop asthma symptoms after
vigorous activity, such as running, swimming, or biking. Some kids with EIA
develop symptoms only after physical exertion, while others have additional
asthma triggers. With the proper medications, most kids with EIA can play
sports like any other child. In fact, over 10% of Olympic athletes have
exercise-induced asthma they've learned to control. Usually, a doctor can
diagnose EIA after taking a history alone. But sometimes further tests,
including an exercise challenge in a pulmonary function laboratory, are needed
to confirm the diagnosis. The doctor may want to target a child's tolerance for
a particular exercise, as not every type or intensity of exercise affects kids
with EIA the same way. If exercise is a child's only asthma trigger, the doctor
may prescribe a medication that the child takes before exercising to prevent
airways from tightening up. Of course, even after premedicating, asthma flares
can still occur. Parents (or older children) must carry the proper "rescue"
medication to all games and activities, and the child's school nurse, coaches,
scout leaders, and teachers must be informed of the child's asthma, especially
so the child will be able to take the medication at school as needed.
Allergy-triggered asthma
Not every child with asthma has allergy-triggered asthma, but an estimated 75%
to 85% of people with asthma have some type of allergy. Even if a child's
primary triggers are colds and flu (the most common triggers for children) or
exercise, allergies can sometimes play a minor role in aggravating the
condition. How do allergies cause flares in children with asthma? Children
inherit the tendency to have allergies from their parents, who pass along the
genetic material to make greater than normal amounts of the "allergic
antibody," immunoglobulin E (IgE). The IgE antibody recognizes small quantities
of allergens such as dust mites and molds and is responsible for generating
allergic reactions to these usually harmless particles. The IgE antibodies sit
on the surfaces of mast cells, which are found in different tissues throughout
the body. When allergens enter the body, they attach to the IgE antibody, which
triggers the mast cells to release histamine, a naturally occurring chemical,
to defend against the allergen "invader." The released histamine is what causes
the familiar sneezing, runny nose, and watery eyes associated with some
allergies - ways the body attempts to rid itself of the invading allergen. In a
child with asthma, histamine can also trigger asthma symptoms and flares. An
allergist can usually identify allergies a child may have. Once identified, the
best treatment is to avoid exposure to allergens whenever possible.
Environmental control measures for the home can help reduce a child's exposure
to allergens. When avoidance isn't possible, antihistamine medications may be
prescribed to block the release of histamine in the body. Nasal steroids may be
given to block allergic inflammation in the nose. In some cases, an allergist
can prescribe immunotherapy, a series of allergy shots that gradually make the
body unresponsive to specific allergens. Categories of asthma
A child's symptoms can be categorized into one of four main categories of
asthma, each with different characteristics and requiring different treatment
approaches.
-
Mild intermittent asthma
A child who has brief episodes of wheezing, coughing, or shortness of breath
occurring no more than twice a week is said to have mild intermittent asthma.
The child rarely has symptoms between episodes, with the exception of one or
two instances per month of mild symptoms at night. Mild asthma should never be
ignored; even between flares, airway inflammation exists. The doctor will
design an asthma management plan to treat mild symptoms.
-
Mild persistent asthma Children with episodes of wheezing, coughing, or
shortness of breath that occur more than twice a week but less than once a day
are said to have mild persistent asthma. Symptoms usually occur at least twice
a month at night and may affect normal physical activity.
-
Moderate persistent asthma Children with moderate persistent asthma have daily
symptoms and require daily medication. Nighttime symptoms occur more than once
a week. Episodes of wheezing, coughing, or shortness of breath occur more than
twice a week and may last for several days. These symptoms affect normal
physical activity.
-
Severe persistent asthma Children with severe persistent asthma have symptoms
continuously. They tend to have frequent episodes of wheezing, coughing, or
shortness of breath that may require emergency treatment and even
hospitalization. Many children with severe persistent asthma have frequent
symptoms at night and can handle only limited physical activity. Every child
needs to follow a custom asthma management plan to control his symptoms. The
severity of a child's asthma can both worsen and improve over time, placing him
in a new asthma category that requires different treatment.
What is asthma?
Asthma is a lung condition that causes wheezing, coughing, and shortness of
breath. It is caused by inflammation (swelling) of the lining of the airways in
your lungs. Asthma is a chronic condition, which means you may have it the rest
of your life. You may start coughing or wheezing when you breathe in irritants
or something you are allergic to. Cold air, viruses, and tobacco smoke are
possible irritants. Examples of things you might be allergic to are dust,
pollen, molds, and animal dander. Some people have coughing or wheezing only
during or after physical activity. This is called exercise-induced asthma.
Asthma may be mild, moderate, or severe. An asthma attack may last a few
minutes or for days. Attacks can happen anywhere and at any time. Severe asthma
attacks can be fatal. It is very important to get treatment for asthma so you
can live a healthy, active life. About 12 million Americans have asthma, and
the number of people who have asthma is increasing worldwide.
How does it occur?
If you have asthma, the airways in your lungs are always somewhat inflamed,
even when you do not have any symptoms. When your airways are exposed to
irritants or allergens, the airways become more swollen and begin to make
excess mucus. The tiny muscles in the walls of the airways begin to contract.
These reactions cause the airway openings to become smaller, making it harder
for air to move in and out. Wheezing is the sound of air moving through the
narrowed air passages. The extra mucus in the airways causes coughing.
What are the symptoms?
Symptoms you may have are:
-
wheezing
-
coughing
-
shortness of breath
-
chest tightness.
How is it diagnosed?
Your health care provider will ask about your history of breathing problems and
will do a physical exam. You may have one or more breathing tests. You may be
tested before and after taking medication to measure your response to
medication. A single attack of wheezing does not necessarily mean that you have
asthma. Certain infections and some chemicals can cause wheezing that lasts for
a short time and then does not occur again. Before deciding whether you have
asthma, your provider may want to see if you have another attack of wheezing.
How is it treated?
The goal of asthma therapy is to allow you to live a normal, active life. Your
treatment will probably include prescribed medicines and the removal of obvious
allergy-causing substances or irritants from your home. Two types of medicines
are used to control asthma: (1) quick-acting medicines called bronchodilators
and (2) preventive medicines. Quick-acting bronchodilators
Albuterol is the generic name of the most widely used quick-acting
bronchodilator. Bronchodilators relax the muscles in the airways. When the
muscles are relaxed, the airways become larger and allow more space for air to
move in and out. You take this medicine by inhaling it. You breathe it into
your lungs as you spray it into your mouth. If you have asthma attacks often,
you should always have a bronchodilator with you to use when you begin to
wheeze. If you have exercise-induced asthma, you should use the medicine before
exercise to prevent wheezing. Preventive medicines
Several types of medicines help prevent asthma. These medicines are now
considered the best and safest way to control asthma. They help reduce the
inflammation in your airways. They do not stop attacks of wheezing once the
wheezing starts. You must use a short-acting bronchodilator when you are
wheezing. The goals of preventive medicines are to:
-
prevent asthma attacks
-
prevent chronic asthma symptoms, such as shortness of breath
-
allow people with asthma to live fully active lives, including playing sports.
The medicines used most often for prevention are:
-
a long-acting, inhaled bronchodilator called salmeterol (Serevent) used 2 times
a day
-
inhaled steroids, such as Azmacort and Flovent, used 2 to 4 times a day. Your
health care provider may prescribe a medicine that is a combination of a
bronchodilator and steroid.
Other preventive medicines include:
-
theophylline, a pill often taken at bedtime to prevent nighttime wheezing
-
cromolyn or nedocromil, which are inhaled 3 to 4 times a day
-
zafirlukast (Accolate) or zileuton (Zyflo) pills taken daily. In addition to
using a quick-acting bronchodilator when you have asthma attacks, you may need
to combine different types of preventive medicines for the best control of your
wheezing. You need to work closely with your health care provider to find the
treatment right for you. Make sure you understand how to use each of your
medicines. Some are quick-acting and meant to be used when you have an asthma
attack. Others are slow acting and help prevent attacks but do not help when
you are having an attack. Inhalers
Make sure you know how to use your inhaler correctly. Read the directions that
come with your inhaler. Most inhalers work best if you hold them 1 to 2 inches
in front of your mouth when you spray. If you close your mouth around the
inhaler, less of the medicine will reach your lungs. If it is hard for you to
hold the inhaler in the right position, ask your health care provider for a
spacer tube. You can put one end of the spacer in your mouth and attach the
inhaler to the other end. This allows you to breathe in slowly and fully and to
inhale more of the asthma medicine. Ask your pharmacist how you can know when
your inhaler canister is empty. Peak flow meter
Your breathing ability can change from day to day. For example, illness or
seasonal allergies may make your airways more inflamed than usual. Your health
care provider may prescribe a peak flow meter. You can use the peak flow meter
to measure how well you are breathing. It can help you know when you might need
to increase your dosage of medicine to prevent severe attacks of wheezing.
Removal of irritants from your home
Ways to remove substances in your home that may cause wheezing are described
below.
How Can I Take Care of Myself?
Depending on your specific allergies, these guidelines may help keep allergens
and irritants out of your home:
-
Cover mattresses, box springs, and pillows with zippered plastic covers.
-
Wash bedding in hot water once a week.
-
Wash and thoroughly dry pillows once a month.
-
Avoid using a vaporizer or humidifier unless it is thoroughly cleaned regularly
to remove mold.
-
It is best not to have pets. If you do have a pet, have your pet bathed weekly.
You should also vacuum often and thoroughly and use a HEPA (high efficiency
particulate arresting) air filter.
-
Stay indoors when the humidity or pollen count is high.
-
Use air conditioning instead of open windows to cool your home.
-
Do not use attic fans.
-
Avoid cigarette smoke.
-
Avoid vapors from harsh chemicals, such as bleach. You should also:
-
Take your medicines exactly as prescribed.
-
Get a flu vaccine every October. Asthma can be a life-threatening condition. If
your medicines do not seem to be working to keep you breathing comfortably,
contact your health care provider. If you are having an asthma attack and using
your albuterol inhaler has not relieved your symptoms, you must get medical
care right away.
How Long will The Effects of Asthma Last?
Asthma is a chronic condition, even though you might not have any symptoms for
decades. Asthma is more common in children than adults. People who had asthma
as children often have no symptoms once they become adults, but the symptoms
may come back later in life. Asthma that develops for the first time in mid- or
late life usually continues to be a problem for the rest of your life.
General Info About Asthma:
Asthma is one of the diseases that affect a vast majority of the population and
causes a lot of problems not only to the patient but also to his family.
Valuable productive hours are lost and this is one of the leading causes of
industrial absenteeism especially in cases where the disease is an occupational
health hazard. In simple terms asthma refers to increased responsiveness of
lower airways to multiple stimuli. It can be acute when it lasts for a short
period or chronic when it lasts for days. It can be a mild attack or severe,
life threatening one. "Among the Diseases whereby the Region of the breath is
wont to be infested, if you regard their tyranny and cruelty, an Asthma (which
is sometimes by reason of a peculiar symptom denominated likewise an
Orthopnoea) doth not deserve the last place; for there is scarce any thing more
sharp and terrible than the fits thereof? Breathing, whereby we chiefly live,
is very much hindered by the assault of this disease, and is in danger, or runs
the risk of being quite taken away."
-Thomas Willis, 1674 Know Your Respiratory System
How Can we Diagnose
Asthma ?
Pulmonary function tests (lung function tests) are helpful in judging severity
of airway obstruction.
Arterial blood gas analysis shows decreased oxygen concentration in blood.
Blood analysis shows eosinophilia (abnormal increase in number of certain
specific type of blood cells called eosinophils).
The level of a certain antibody is elevated.
Sputum examination may show eosinophilia.
Chest X ray may show abnormality in the airway.
More Valuable
Information About Asthma...
Contrary to popular belief, asthma is not cured by fish or chicken. But
many fields of alternative medicine claim to have
remedies for the disease. Asthma can be treated by allopathic medication. Fears
that inhalers are addictive and are unsafe for use, are all fears of ignorant
people. In fact, with the use of inhalers and nebulisers the treatment of
asthma has been revolutionized and it is now much easier to treat an asthmatic.
Smoking Risk Calculator.
Glossary:
Eosinophilia - Increase in eosinophils.
Know Your Respiratory System.
Asthma in Pregnancy:
Asthma in Pregnancy Overview
Pregnancy is an exciting time in a woman's life. Changes in your body may be
matched by changes in your emotions. You don't know what to expect from day to
day. You may feel tired, uncomfortable, or cranky one day and energetic,
healthy, and happy the next. The last thing you need is an asthma attack.
Asthma is one of the most common medical conditions in the US and other
developed countries. If you have asthma, you know what it means to have an
exacerbation (attack). You may wheeze, cough, or have difficulty breathing.
Remember that the fetus (developing baby) in your uterus (womb) depends on the
air you breathe for its oxygen. When you have an asthma attack, the fetus may
not get enough oxygen. This can put the fetus in great danger. If you took
medication for your asthma before you became pregnant, especially if your
asthma was well controlled, you may be tempted to stop taking your medication
out of fear that it might harm the fetus. That would be a mistake without the
advice of your health care provider. The risk to the fetus from most asthma
medications is tiny compared to the risk from a severe asthma attack. Moreover,
women with asthma that is uncontrolled are more likely to have
complications during pregnancy. Their babies are more likely to be born preterm
(premature), to be small or underweight at birth, and to require longer
hospitalization after birth. The more severe the asthma, the greater the risk
to the fetus. In rare cases, the fetus can even die from oxygen deprivation.
How pregnancy may affect your asthma is unpredictable. About one third of women
with asthma experience improvement while they are pregnant, about one third get
worse, and the other third stay about the same. The milder your asthma was
before pregnancy, and the better it is controlled during pregnancy, the better
your chances of having few or no asthma symptoms during pregnancy. If asthma
control deteriorates during pregnancy, the symptoms tend to be at their worst
during weeks 24-36 (months 6-8). Most women experience the same level of
asthmatic symptoms in all their pregnancies. It is rare to have an asthma
attack during delivery (10%). In most cases, symptoms return to "normal" within
3 months after delivery. The important thing to remember is that your asthma
can be controlled during pregnancy. If your asthma is controlled, you have just
as much chance of a healthy, normal pregnancy and delivery as a woman who does
not have asthma.Asthma in Pregnancy
Asthma in Pregnancy Overview
Pregnancy is an exciting time in a woman's life. Changes in your body may be
matched by changes in your emotions. You don't know what to expect from day to
day. You may feel tired, uncomfortable, or cranky one day and energetic,
healthy, and happy the next. The last thing you need is an asthma attack.
Asthma is one of the most common medical conditions in the US and other
developed countries. If you have asthma, you know what it means to have an
exacerbation (attack). You may wheeze, cough, or have difficulty breathing.
Remember that the fetus (developing baby) in your uterus (womb) depends on the
air you breathe for its oxygen. When you have an asthma attack, the fetus may
not get enough oxygen. This can put the fetus in great danger. If you took
medication for your asthma before you became pregnant, especially if your
asthma was well controlled, you may be tempted to stop taking your medication
out of fear that it might harm the fetus. That would be a mistake without the
advice of your health care provider. The risk to the fetus from most asthma
medications is tiny compared to the risk from a severe asthma attack. Moreover,
women with asthma that is uncontrolled are more likely to have complications
during pregnancy. Their babies are more likely to be born preterm (premature),
to be small or underweight at birth, and to require longer hospitalization
after birth. The more severe the asthma, the greater the risk to the fetus. In
rare cases, the fetus can even die from oxygen deprivation. How pregnancy may
affect your asthma is unpredictable. About one third of women with asthma
experience improvement while they are pregnant, about one third get worse, and
the other third stay about the same. The milder your asthma was before
pregnancy, and the better it is controlled during pregnancy, the better your
chances of having few or no asthma symptoms during pregnancy. If asthma control
deteriorates during pregnancy, the symptoms tend to be at their worst during
weeks 24-36 (months 6-8). Most women experience the same level of asthmatic
symptoms in all their pregnancies. It is rare to have an asthma attack during
delivery (10%). In most cases, symptoms return to "normal" within 3 months
after delivery. The important thing to remember is that your asthma can be
controlled during pregnancy. If your asthma is controlled, you have just as
much chance of a healthy, normal pregnancy and delivery as a woman who does not
have asthma.
Asthma in Pregnancy
Treatment of Asthma In Pregnancy:
The best way to treat asthma is to avoid having an attack in the first place.
Avoid exposure to your asthma triggers. This might improve your symptoms and
reduce the amount of medication you have to take.
-
If you smoke, quit. Smoking can harm you and your fetus. Avoid being around
others who are smoking; secondhand smoke can trigger an asthma attack.
Secondhand smoke also can cause asthma and other health problems in your
children.
-
If you have symptoms of gastroesophageal reflux (for example, heartburn), avoid
eating large meals or lying down after eating.
-
Stay away from people who have a cold, the flu, or other infection.
-
Avoid things you are allergic to.
-
Remove contaminants and irritants from your home.
-
Avoid your known personal triggers (cat dander, exercise, whatever sets you
off). Asthma in Pregnancy
Use Of Asthma Medication During Pregnancy:
Asthma medications usually are taken in the same stepwise sequence you would
take them in before pregnancy.
When your health care provider considers your use of a drug during pregnancy,
he or she reflects on the following questions:
-
Is the drug necessary?
-
What information is available to assess the effect of the drug on the fetus?
-
What is the effect of the drug on the pregnancy, including labor, delivery, and
breastfeeding?
-
Does the dose or dosing interval of the drug need to be altered because of the
pregnancy?
-
Do the risks of the drug outweigh the benefits? We lack information on the
effects of many drugs on the fetus. The US Food and Drug Administration (FDA)
classifies drugs for use in pregnancy according to these categories:
-
A - Safe in pregnancy
-
B - Usually safe but benefits must outweigh the risks
-
C - Safety for use during pregnancy has not been established
-
D - Unsafe in pregnancy
-
X - Contraindicated in pregnancy A host of medications are listed in Category C
because there is not significant study data about the medication in pregnancy.
Several medications listed as Category C are generally regarded as safe, or
safe during certain stages of pregnancy. You may need to discuss your
medications and any concerns about them with your healthcare provide
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