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Asthma
Recommend
Asthma Overview
Asthma Causes
Asthma Symptoms
When to Seek Medical Care
Exams and Tests
Asthma Treatment
Self-Care at Home
Medical Treatment
Medications
Next Steps
Follow-up
Prevention
Outlook
Support Groups and Counseling
For More Information
Web Links
Multimedia
Synonyms and Keywords
Authors and Editors
Viewer Comments: Asthma - Effective Treatments
Asthma Overview
Asthma is a disease that affects the breathing passages of the lungs (bronchioles). Asthma is
caused by chronic (ongoing, long-term) inflammation of these passages. This makes the
breathing passages, or airways, of the person with asthma highly sensitive to various
"triggers."
This narrowing makes it difficult for air to be breathed out (exhaled) from the
lungs.
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With proper treatment, people with asthma can have fewer and less severe
attacks.
Without treatment, they will have more frequent and more severe asthma
attacks and can even die.
Asthma is on the rise in the United States and other developed countries. We are not sure
exactly why this is, but these factors may contribute.
We spend more and more time indoors, where we are exposed to indoor
allergens such as dust and mold.
The air we breathe is more polluted than the air most of our ancestors
breathed.
Our lifestyle has led to our getting less exercise and an epidemic of obesity.
There is some evidence to suggest an association between obesity and
asthma.
Asthma is a very common disease in the United States, where more than 17 million people
are affected. A third of these are children. Asthma affects all races and is slightly more
common in African Americans than in other races.
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Asthma is a major cause of work and school absence and lost productivity.
Asthma costs the U.S. economy nearly $13 billion each year.
Asthma Causes
The exact cause of asthma is not known.
What all people with asthma have in common is chronic airway inflammation
and excessive airway sensitivity to various triggers.
Research has focused on why some people develop asthma while others do
not.
Some people are born with the tendency to have asthma, while others are
not. Scientists are trying to find the genes that cause this tendency.
The environment you live in and the way you live partly determine whether
you have asthma attacks.
An asthma attack is a reaction to a trigger. It is similar in many ways to an allergic reaction.
When the cells of the immune system sense an invader, they set off a
series of reactions that help fight off the invader.
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In asthma, the "invaders" are the triggers listed below. Triggers vary among
individuals.
menstruation: In some, not all, women, asthma symptoms are closely tied to
the menstrual cycle.
Risk factors for developing asthma:
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hay fever (allergic rhinitis) and other allergies -- this is the single biggest risk
factor;
Asthma Symptoms
When the breathing passages become irritated or infected, an attack is triggered. The attack
may come on suddenly or develop slowly over several days or hours. The main symptoms
that signal an attack are as follows:
wheezing,
breathlessness,
chest tightness,
coughing, and
difficulty speaking.
Symptoms may occur during the day or at night. If they happen at night, they may disturb your
sleep.
Wheezing is the most common symptom of an asthma attack.
Wheezes are most often heard during exhalation, but they can occur during
breathing in (inhaling).
Not all asthmatics wheeze, and not all people who wheeze are asthmatics.
Current guidelines for the care of people with asthma include classifying the severity of
asthma symptoms, as follows:
Mild intermittent: This includes attacks no more than twice a week and
nighttime attacks no more than twice a month. Attacks last no more than a
few hours to days. Severity of attacks varies, but there are no symptoms
between attacks.
Mild persistent: This includes attacks more than twice a week, but not every
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day, and nighttime symptoms more than twice a month. Attacks are
sometimes severe enough to interrupt regular activities.
wheezing,
difficulty breathing,
Your provider also should be called if you have an asthma attack when you
are already taking oral or inhaled steroids or if your inhaler treatments are
not lasting four hours.
Although asthma is a reversible disease, and treatments are available, people can die from a
severe asthma attack.
If you are having an asthma attack and have severe shortness of breath or
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are unable to reach your health-care provider in a short period of time, you
must go to the nearest hospital emergency department.
Do not drive yourself to the hospital. Have a friend or family member drive. If
you are alone, call 911 immediately for emergency medical transport.
chest tightness,
wheezing.
Severe attacks are less common. They may involve the following symptoms:
breathlessness,
difficulty talking,
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.
If you are able to speak, the health-care provider will ask you questions about your
symptoms, your medical history, and your medications. Answer as completely as you can. He
or she will also examine you and observe you as you breathe.
If this is your first attack, or the first time you have sought medical attention for your
symptoms, the health-care provider will ask questions and perform tests to search for and
rule out other causes of the symptoms.
Measurements of how well you are breathing include the following:
Spirometer: This device measures how much air you can exhale and how
forcefully you can breathe out. The test may be done before and after you
take inhaled medication. Spirometry is a good way to see how much your
breathing is impaired during an attack.
Peak flow meter: This is another way of measuring how forcefully you can
breathe out during an attack.
Asthma Treatment
Since asthma is a chronic disease, treatment goes on for a very long time. Some people
have to stay on treatment for the rest of their lives. The best way to improve your condition
and live your life on your terms is to learn all you can about your asthma and what you can do
to make it better.
Become a partner with your health-care provider and his or her support
staff. Use the resources they can offer -- information, education, and
expertise -- to help yourself.
Become aware of your asthma triggers and do what you can to avoid them.
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Understand your treatment. Know what each drug does and how it is used.
Report any side effects you are having with your medications.
These are the goals of treatment:
Self-Care at Home
Current treatment regimens are designed to minimize discomfort, inconvenience, and the
extent to which you have to limit your activities. If you follow your treatment plan closely, you
should be able to avoid or reduce your visits to your health-care provider or the emergency
department.
Do not take cough medicine. These medicines do not help asthma and may
cause unwanted side effects.
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Take only the medications your health-care provider has prescribed for your
asthma. Take them as directed.
If the medication is not working, do not take more than you have been
directed to take. Overusing asthma medications can be dangerous.
Medical Treatment
If you are in the emergency room, treatment will be started while the evaluation is still going
on.
You may be given oxygen through a face mask or a tube that goes in your
nose.
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the blood level of this drug will be checked, and you may be given this
medication through an IV.
You will be observed for at least several hours while your test results are
obtained and evaluated. You will be monitored for signs of improvement or
worsening.
If you respond well to treatment, you will probably be released from the
hospital. Be on the lookout over the next several hours for a return of
symptoms. If symptoms should return or worsen, return to the emergency
department right away.
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He or she will ask you about frequency and severity of attacks, use of
rescue medications, and peak flow measurements.
Lung function tests may be done to see how your lungs are responding to
your treatment.
This is a good time to discuss medication side effects or any problems you
are having with your treatment.
The peak flow meter is a simple, inexpensive device that measures how forcefully you are
able to exhale.
Ask your health-care provider or an assistant to show you how to use the
peak flow meter. He or she should watch you use it until you can do it
correctly.
Keep one in your home and use it regularly. Your health-care provider will
make suggestions as to when you should measure your peak flow.
Checking your peak flow is a good way to help you and your health-care
provider assess what triggers your asthma and its severity.
Check your peak flow regularly and keep a record of the results. Over time,
your health-care provider may be able to use this record to determine
appropriate medications, reducing dose or side effects.
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Peak flow measures fall just before an asthma attack. If you use your peak
flow meter regularly, you may be able to predict when you are going to have
an attack.
Medications
Controller medicines help minimize the inflammation that causes an acute asthma attack.
Inhaled corticosteroids are the main class of medications in this group. The
inhaled steroids act locally by concentrating their effects directly within the
breathing passages, with very few side effects outside of the lungs.
Beclomethasone (Vancenase, Beclovent) and triamcinolone (Nasacort,
Atolone) are examples of inhaled corticosteroids.
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corticosteroids.
Omalizumab belongs to a newer class of agents that works with the body's
immune system. In people with asthma who have an elevated level of
Immunoglobulin E (Ig E), an allergy antibody, this drug given by injection
may be helpful with symptoms that are more difficult to control. This agent
inhibits IgE binding to cells that release chemicals that worsen asthma
symptoms. This binding prevents release of these mediators, thereby
helping in controlling the disease.
Rescue medications are taken after an asthma attack has already begun. These do not take
the place of controller drugs. Do not stop taking your controller drug(s) during an asthma
attack.
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Next Steps
Follow-up
If you have been treated in a hospital emergency department, you will be discharged once
you respond well to the treatment.
By following these steps, you can help minimize the frequency and severity
of your asthma attacks.
Asthma is now treated in a step-wise approach.
Intermittent asthma is treated with a rescue inhaler which is only used for
symptoms.
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Prevention
You need to know how to prevent or minimize future asthma attacks.
Keep taking your asthma medications after you are discharged. This is
extremely important. Although the symptoms of an acute asthma attack go
away after appropriate treatment, asthma itself never goes away.
Outlook
Most people with asthma are able to control their condition if they work together with a
health-care provider and follow their treatment regimen carefully.
People who do not seek medical care or do not follow an appropriate treatment plan are likely
to experience worsening of their asthma and deterioration in their ability to function normally.
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Multimedia
Media file 1: A child with asthma using a metered dose inhaler.
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Media file 5: A child with asthma uses a metered dose inhaler with a spacer.
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