ASTHMA BRONCHIAL There are some things that 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 teens are naturals at playing an instrument, and it's like they were born knowing how to count in 4/4 time. Still others are naturals at math, never fazed by theorems and equations. But some teens have a problem with something that you'd think would come naturally: 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, trumpet solo, and even his geometry test.

What Is Asthma?
Asthma is a common condition: there may be as many as 5 million kids and teens who have it. It affects nearly one in 10 kids and can start at any age, although it most often begins in the elementary school years. Some people, however, first notice symptoms of asthma while in their teen years. No one knows exactly what causes asthma, although 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 is never contagious, although it can sound that way because of the coughing and wheezing that often occur. Asthma affects a person's bronchial (pronounced: bron-kee-ul) tubes, also known as airways. When a person breathes normally, air is taken in through the nose or mouth and then goes into the windpipe, passing through the bronchial tubes, into the lungs, and finally back out again. But when a person has hypersensitive bronchial tubes, breathing becomes a challenge because the tubes become narrower. The airways of people with asthma "overreact" (are hyperreactive) to certain environmental factors. When the bronchial tubes narrow, it causes an asthma flare (sometimes also referred to as an asthma attack). During an asthma flare, the air has a difficult time flowing through the narrow passageways, making it hard to breathe. At the same time, the inner lining of the bronchial tubes swells, becomes inflamed, and makes more mucus than it normally would. All these changes prevent air from entering and exiting the lungs the way it should. A person having an asthma flare may wheeze (make a whistling sound while breathing), cough, and feel an intense tightness in his 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 his asthma medication. When an asthma flare is over, the airways eventually return to normal. Between flares, a person's breathing can be and sound completely normal, or a person may continue to have some symptoms, such as coughing.

Causes
Asthma symptoms can be caused by dozens of different things, and what causes symptoms in one teen might not bother another at all. Triggers are the things that set off asthma. Some people with asthma find that allergens - substances that cause an

allergic reaction in the bronchial tubes - can be a major trigger. Common allergens are dust mites (microscopic bugs that live in dust), molds, pollens, and cockroaches. Many teens who have asthma may have symptoms when they are around animals with fur, especially cats and dogs. These furry friends have dander (which is a bit like dandruff) in their fur, and it can cause a strong reaction in the bronchial tubes. Some other substances in the environment can be triggers because they irritate the airways just like allergens do. These include chalk dust, paint fumes, perfume, and cigarette smoke. Smoking is always a bad idea for the lungs (and for tons of other reasons), and especially for the lungs of someone who has asthma. In some people, an infection can trigger asthma - for example, if a teen with asthma gets a cold or flu infection, his or her airways will be much more sensitive than normal. Even cold air can sometimes be a trigger and cause certain people to have asthma symptoms. Some teens have what is known as exercise-induced asthma. With this type of asthma, a person will have a flare that is triggered by exercise or physical activity, including sports. The teen may not have any reaction to typical allergens like dander or mold, but if he exercises, he may have an exercise-induced asthma flare. This type of asthma can be especially frustrating for teens because it's during exercise when a person needs air the most. A serious concern is that the teen will ignore his asthma symptoms (such as tightness in the chest, coughing, shortness of breath, and wheezing) and continue to perform the physical activity. This can lead to a severe medical emergency or even death, in some rare cases. When a person begins to have symptoms of asthma, that person must stop the activity he or she is doing.

Treatments
Fortunately for people with asthma, the condition can usually be controlled and flares can be prevented. Teens who have asthma need to avoid things that can cause symptoms. But because many things that can cause symptoms can't be completely avoided (like colds and irritants, for example), there are different medications available for treating asthma. The same goes for exercise-induced asthma - many teens don't want to give up a sport because of asthma symptoms. And, with the right kind of treatment, they don't have to. When a doctor or asthma specialist (such as an allergist or immunologist) sees a patient with asthma, he or she treats each case individually because each person's triggers are different, and there are different types of medications that may work better in one person than another. Together, the patient and doctor typically will think about what causes the symptoms, when the symptoms occur, how fast the symptoms proceed, and how serious they are. After considering these things and asking the patient many questions, the doctor can decide on the right form of treatment. Some teens may need to take asthma medication only once in a while when they have symptoms. Others may need to take preventive medication every day, which works by keeping flares from occurring in the first place. Someone who knows ahead of time that he'll be exposed to certain triggers or allergens may take a special kind of medication that will keep his bronchial tubes relaxed. A teen with exercise-induced

asthma can also take a prescribed medication ahead of time and usually still be able to play an entire game or complete a workout without any problems. Often, a teen with asthma may need to take a bronchodilator (pronounced: bron-kody-lay-ter), a medication that dilates (opens up) the bronchial tubes. This medication is usually delivered through an inhaler, a small plastic tube that holds a container filled with the medicine. Most commonly used asthma medications are available in inhaler form. Other asthma medications are in pill or liquid form. In some cases, teens with asthma will also need to use a peak flow meter and keep an asthma journal - two tools that make controlling a teen's asthma much easier. A peak flow meter is a handheld device that measures how well a person can blow out air from the lungs and is easy to use. Each person's peak flow range indicating a good, fair, or poor reading will be different based on factors like the person's height and whether the person is a guy or girl. A good reading (green zone) means the teen's airways are open, and the need for medication depends on what the teen's doctor has set up with the teen ahead of time. A fair reading (yellow zone) on a peak flow meter means that an asthma flare is beginning, and indicates the need for medication and careful asthma monitoring. Poor readings (red zone) usually mean medication is needed immediately and if the teen is not does not start to improve, a trip to the doctor or emergency room is needed. 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. Keeping an asthma journal or diary can also be an effective way to help prevent problems. The teen's doctor may ask him to keep a daily log of peak flow meter readings or times when symptoms occurred. The doctor may want to see when medication was taken, or what kinds of activities or triggers led to an asthma flare. By keeping track of these types of things, the asthma journal can point to certain patterns - and together with medications and the use of a peak flow meter, the journal helps the doctor give the teen the best control of his asthma.

Dealing With Asthma

The absolute best way to control asthma is prevention. Although medications can play an essential role in preventing flares, environmental control is also very important. Environmental control means doing things such as clearing your environment of irritants, such as cigarette smoke and sprays, and vacuuming (or removing) rugs and drapes where dust mites can hide. Placing pillows and mattresses in dust-proof covers can help. In addition, having a pet-free household can eliminate irritating animal dander in your home. Whatever the type of treatment, the immediate goal is to bring the asthma flares under control. The long-term goal is to have asthma interfere with a teen's life as little as possible, so he is in control of the asthma, rather than the other way around. In the meantime, however, it's important to remember that asthma doesn't have to prevent a person from doing what he loves! Take a look at the list of famous people with asthma on the Web site of the American Academy of Allergy, Asthma, and Immunology. And remember, when a teen with asthma takes his medication properly,

follows the doctor's instructions, recognizes early warning signs and triggers, and takes the appropriate medical action, he can do anything that other teens can do, including any sports activity, even cross-country skiing, swimming, or playing basketball. Updated and reviewed by: Kim Rutherford, MD Date reviewed: May 2001 Originally reviewed by: Kathleen Trczinski, MSN, RN, and Neil Izenberg, MD

What is Asthma? Normal Airway

Airway with Inflammation

Airway with Inflammation, Bronchospasm and Mucus Production

Asthma is a chronic respiratory diseasesometimes worrisome and inconvenientbut a manageable condition. With proper understanding, good medical care, and monitoring, you can keep asthma under control. If you have asthma you are not alone. In the United States, asthma affects 14 to 15 million people. Today, 10 million adults have asthma. Asthma, also known as reactive airway disease, is defined as a chronic lung condition with:

Inflammation (swelling) of the airways Increased sensitivity of the airways to a variety of things that make asthma worse Obstruction of airflow

Typical Changes in the Airway Include: Inflammation Recent research has shown that inflammation of the lining of the airways is the most common feature of asthma. When they are stimulated, certain cells lining the airways release chemical substances (mediators) that lead to inflammation. This causes the airway lining to swell and narrow. The inflammation may last for weeks following an episode. Most people with asthma have some degree of inflammation all of the time. Some long-term control medications can help prevent and reduce inflammation. Read more about inflammation in asthma. Increased Sensitivity

Another characteristic of asthma is increased sensitivity of the airways. When inflammation occurs in the airways, the airways become more sensitive. When the airways are more sensitive, you are more likely to have asthma symptoms when exposed to things that make asthma worse. When there is less inflammation, the airways are less sensitive and you are less likely to have asthma symptoms when exposed to things that make asthma worse. Airway Obstruction In addition to inflammation, further airway obstruction sometimes occurs with asthma. Obstruction is caused by tightening of muscles that surround the airways. This is also called bronchospasm. Bronchospasm causes further narrowing of the inflamed airways. Inhaled quick-relief medications are generally very effective in reversing the bronchospasm. In some people with asthma, the mucus glands in the airways produce excessive

Recognizing Asthma Signs and Symptoms Recognizing the signs and symptoms of asthma is an important part of managing asthma. Knowing when early warning signs or mild symptoms are occurring is helpful so that treatment and other interventions can begin early. Early treatment is most effective. If severe symptoms are present, it is vital to begin the appropriate treatment immediately. Accurate and timely assessment of your symptoms or your child's symptoms can help you and your clinician decide if treatment should begin in the home, at your clinician's office or in the emergency room. Early Warning Signs of Asthma Early warning signs are experienced before the start of an asthma episode. By recognizing these clues that occur before actual asthma symptoms, early treatment can be started. These signs are unique to each person. Early warning signs may be the same, similar or entirely different with each episode. Some early warning signs may be noticed only by the individual, while other early warning signs are more likely to be noticed by other persons. In addition, a downward trend in peak flow numbers can be a reliable early warning sign. Some examples of early warning signs are:

Breathing changes Sneezing Moodiness Headache Runny/stuffy nose Coughing

Chin or throat itches Feeling tired Dark circles under eyes Trouble sleeping Poor tolerance for exercise Downward trend in peak flow number Get a complete checklist of early warning asthma

Asthma Symptoms Asthma symptoms indicate that an asthma episode is occurring. Examples of asthma symptoms include:

Wheezing Coughing Shortness of breath Tightness in the chest Peak flow numbers may be in the caution or danger range (usually 50% to 80% of personal best)

Changes have taken place in the airways and airflow is obstructed. Individuals with asthma experience some or all of these during an asthma episode. Action should be taken to treat these symptoms before they become worse. Talk with your health care provider about having a written asthma action plan. Severe Asthma Symptoms Severe asthma symptoms are a life-threatening emergency. These symptoms indicate respiratory distress. Examples of severe asthma symptoms include:

Severe coughing, wheezing, shortness of breath or tightness in the chest Difficulty talking or concentrating Walking causes shortness of breath Breathing may be shallow and fast or slower than usual Hunched shoulders (posturing) Nasal flaring (Nostril size increases with breathing) Neck area and between or below the ribs moves inward with breathing (retractions) Gray or bluish tint to skin, beginning around the mouth (cyanosis) Peak flow numbers may be in the danger zone (usually below 50% of personal best)

If any of these severe asthma symptoms occur, seek emergency medical treatment right away. Have your asthma action plan for getting emergency care quickly in the event of severe asthma symptoms. Inform family members and those who are close to you or your child of this emergency action plan.

Keeping a record of asthma symptoms in a symptom diary may be helpful in determining an action plan. There are many types of diaries available or you can use your own notebook. Some things to watch for and record are:

Asthma symptoms and their severity Peak flow numbers and/or peak flow zones School/Work days missed because of asthma Number of nighttime awakenings due to asthma symptoms A change in the use of quick-relief medicine Visits to the doctor Emergency room visits and hospital stays, if any

It is very important to work with your doctor or other health-care provider to determine the best action plan for early warning signs and for asthma symptoms. These are guidelines and the individual action plan should be determined by you and your health care provider. What Causes Asthma? Although the actual cause of asthma is not known, many studies have shown that several factors can lead to the development of asthma. These factors include a person's genetics, development and growth of the lungs and immune system, various infections and exposures in the environment. Is Asthma a Genetic Disease? It is widely accepted that asthma is a disease that can be inherited. However, the gene, or genes that are involved are not clearly identified. It is believed that the genes linked to asthma involve the lungs and the immune system. It is well known that the "Atopic Diseases," Atopic Dermatitis, Allergic Rhinitis and Asthma, are commonly found in one form or another within families. Does Asthma Develop During Childhood? The early months and years of a child's life are critical times during which a baby can develop or become susceptible to developing asthma. The abnormal development and growth of the lungs can increase a person's risk for developing asthma. Premature babies born with lungs not fully developed are more susceptible to colds and other respiratory infections. In some cases, an infection can cause inflammation and injure lung tissue. If the baby is exposed to secondhand smoke at this time, more damage to the lungs may occur and change how the lung functions. What is the Immune System's Role in Asthma? Many studies have shown that children and adults with asthma have an immune system that responds differently from those who do not have asthma. Many of these people with asthma are allergic and will react to things that do not cause problems in others. Their immune system overreacts when they come in contact with every day substances such as pollens, mold or cat

dander. In some cases, the immune system may overreact to other substances, such as a virus or bacteria, and increase the risk of asthma. Do Environmental Exposures Cause Asthma? There are many non-allergic or non-immunologic exposures in the environment that can increase the chance of developing asthma. Exposure to irritants on a long-term basis, such as secondhand smoke in the home, is a major risk factor for developing asthma. Other exposures like this are indoor chemicals and air pollution. More research is being done to better understand the role of genetics, infections, exposures and the immune system in the development of asthma and other allergic disorders. This information may help to prevent the development of these problems in the future. This information has been approved by David Tinkelman, MD (August How is Asthma Diagnosed? The first step in diagnosing asthma is a good evaluation. In many cases, a diagnosis of asthma is made based upon your history and symptoms at the time of evaluation. The family history should also be considered, as a positive family history increases a person's chances of developing asthma. Kinds of Tests Used to Diagnose Asthma Your doctor may have you perform a number of tests to evaluate breathing. These may include:

Detailed medical history and physical exam Spirometry breathing tests Chest and sinus X-rays

Specific tests that may be conducted in diagnosing asthma are explained in more detail:

Bronchial Provocation Test Exercise-Induced Bronchoconstriction Test Routine Pulmonary Function Test

Additional tests may be conducted in the management of asthma:

Allergy Intradermal Skin Test Allergy Prick Skin Test Barium Swallow Study Bone Density Test Bone Scan CT Scan of Sinuses Exercise Tolerance/Exercise for Desaturation Test

PH Probe Test Tailored Barium Swallow Study

When to Test for Asthma Many people see their family doctor or internal medicine doctor for asthma care. You and your doctor may choose to have you seen by a specialist, such as an allergist or pulmonologist (lung specialist). We recommend this if any one of the following occurs:

Severe asthma episode Several visits to the hospital or emergency room in the last year Conditions that complicate asthma such as chronic sinusitis, nasal polyps, or vocal cord dysfunction Frequent treatment with steroid tablets or syrup Confusion with the diagnosis Allergies are being considered Asthma seems to be getting worse

No matter what type of doctor you establish a partnership with to provide your asthma care, it is important to ask the following questions:

What is the doctor's overall philosophy about asthma treatment? Does the doctor or office staff take time to explain what is happening with you, provide education and answer your questions? What can you do to treat an asthma episode before you call the doctor? Who (specialist, non-specialist or an associate) will work with you to treat an asthma episode? Who is responsible for adjusting steroid doses?

In evaluating your progress, remember that asthma is a chronic condition that will change in course from time to time. If you feel that you are not making progress with your current treatment, talk with your doctor about your concerns. If things are not going well, ask your doctor about seeing a specialist. You should not feel embarrassed about asking for another opinion. This information has been approved by David Tinkelman, MD (July 2

What Makes Asthma Worse Airways of people with asthma are often chronically inflamed (swollen). Therefore, the airways are sensitive to things that make asthma worse. These, either singly or together, cause symptoms in people with asthma.

Identifying and controlling or treating things that make asthma worse is essential to good asthma management. Things that make asthma worse include: irritants, allergens, infections, weather, exercise, emotions, gastroesophageal reflux and hormonal changes. These vary from person to person. Irritants and Asthma Common airway irritants include smoke (e.g. tobacco smoke, smoke from wood-burning or kerosene stoves and fireplaces), aerosol sprays, strong odors (e.g. perfumes, cologne, gasoline fumes), dust and air pollution. These substances found in the environment can irritate sensitive airways. Cigarette smoke is a very serious asthma trigger - do not allow smoking in your home or car and always look for non-smoking sections in public areas. Allergens and Asthma A variety of allergens can make asthma symptoms worse. It is important to note that not all people with asthma have allergies. Reliable and valid allergy tests are available and a board-certified allergist can guide you through this process. Common allergens include animal dander, saliva and urine from feathered or furry animals, dust mites (a major component of house dust in humid climates), cockroaches, indoor and outdoor molds, pollens, foods and chemicals. If you are allergic to any of those substances, making changes in your environment to control or avoid contact with the allergen is very important. Ask your health care provider about environmental control. Read more about the relationship of allergies to asthma. Infections and Asthma Infections can also make asthma worse. Common cold viruses, respiratory infections, sinusitis and influenza frequently cause an increase of asthma symptoms. Your health care provider may recommend an annual flu vaccination. Exercise and Asthma Exercise or physical activity can make asthma worse; for some it may be the only cause of asthma symptoms. However, exercise is important for everyone and should not be avoided. For many people, using a pre-treatment medication 10-15 minutes before exercise allows them to exercise without experiencing asthma symptoms. Discuss pre-treatment before exercise with your health care provider. Read more about exercise-induced asthma. Weather and Asthma There is not one best weather climate for people with asthma. However, there are certain types of weather that may cause problems for some people with

asthma in any climate. Some weather situations that may make asthma symptoms worse include: extremely hot or cold temperatures, windy conditions, changes in the humidity or barometric pressure. Emotions and Asthma Emotions do not cause asthma, but can make asthma worse. Strong feelings can lead to changes in breathing patterns. Times of "good" stress and "bad" stress can cause problems for people with asthma. However, it is important to express your emotions and good asthma management can minimize the effect of stress. Changes In Breathing Patterns and Asthma Sneezing, laughing, holding your breath or sleep disorders may cause changes in breathing patterns which may make asthma worse. It is not always possible or desirable to avoid these situations; however, good asthma management may minimize these effects. Hormonal Changes and Asthma Some women with asthma have increased symptoms at a particular time during their menstrual cycle, such as pre-menstruation, or during pregnancy. This worsening results from a change in the balance of hormones that is occurring at that time. Your health care provider may adjust asthma medications during that time to reduce your symptoms. Gastroesophageal Reflux and Asthma Gastroesophageal reflux, or GER, occurs when the acidic contents of the stomach flow back up into the esophagus. This stimulates a reflex that may cause asthma to worsen. Symptoms of heartburn and breathing difficulty at night can indicate GER. Your health care provider can discuss preventive measures to reduce these symptoms. Read more about gastroesophageal reflux disease. Summary As you can see, there are a number of factors that can make asthma worse. It is helpful to think about your last asthma episode; did you experience any of the situations described in this information? Please discuss this information with your health care provider who can help you identify what makes your asthma worse and teach you ways to control or avoid exposure to them.

Are There Different Types of Asthma? Asthma is sometimes classified in various ways. Often, these "types of asthma" describe the triggers that may cause an asthma episode (or asthma attack) or the things that make asthma worse in certain individuals. Types of asthma include steroid-resistant, nocturnal, occupational and exerciseinduced. You can read more about each of these types of asthma by selecting the appropriate choice below: Exercise-Induced Asthma

Exercise can make asthma symptoms worse. With treatment and monitoring, people with exercise-induced asthma can participate in physical activities.

Nocturnal Asthma

Worsening of asthma at night is very common. Treatment of underlying causes is important in managing nocturnal asthma.

Occupational Asthma

Workplace exposure to certain chemicals or dusts can induce asthma. Quick recognition and control of workplace exposures is important.

Steroid-Resistant Asthma (Severe Asthma)

While the majority of patients respond to regular inhaled glucocorticoid (steroid) therapy, some are steroid resistant. Is Asthma Related to Other Conditions? Asthma is often associated with other conditions. These conditions are often considered triggers, or things that make asthma worse. They may lead to an asthma attack, or episode, or a worsening of asthma symptoms. Each of the following conditions is often associated with asthma; click below to read more about the relationship of each with asthma.

Allergies

Allergies can make asthma worse, although not all people with asthma have allergies, and not all people with allergies have asthma.

Gastroesophageal Reflux Disease (GERD)

In some people, the muscle between the esophagus and stomach may allow some back flow of stomach acid into the esophagus. This may cause heartburn, as well as a reflex response that can result in asthma symptoms.

RSV

There is a hypothesis that respiratory syncytial virus (RSV) can contribute to the development of asthma. Read about a study done to support this hypothesis. Sinusitis, an inflammation of the mucous membranes that line the sinus cavities, can be related to asthma.

Sinusitis

Sinusitis, an inflammation of the mucous membranes that line the sinus cavities, can be related to asthma. Vocal Cord Dysfunction (VCD)

Vocal Cord Dysfunction may be mistaken for Asthma: Learn what happens with Vocal Cord Dysfunction, how VCD is diagnosed, what triggers VCD symptoms, and how VCD is treated.