Asthma Management

Scientists reveal a new model to study childhood asthma

2009-02-06T23:59:00.000-08:00

Research into the development of childhood asthma can now be undertaken in more detail than ever before, thanks to the development of a new laboratory model by scientists at the MRC-Asthma UK Centre in Allergic Mechanisms of Asthma.

Researchers treated very young mice with house-dust mite extract to mimic what happens in young children. They found that, like in children, several things happened to the mice’s lungs. They saw inflammation, narrowing and increased sensitivity of the airways, higher levels of IgE in the blood (an indication of allergies), and high numbers of immune cells entering the lungs.

The new mouse model will provide researchers with unprecedented insight into how the lungs and immune system develop, and how exposure to dust, pollen and other allergens influence this process to cause asthma.

This research was funded by the British Lung Foundation and the Wellcome Trust. However, the same researchers, Professor Clare Lloyd and Dr Sejal Saglani, are also undertaking related Asthma UK-funded research projects into childhood wheeze and airway remodelling. Their ultimate aim is to reduce the impact that wheeze and asthma have on the lives of children and adults in the UK.

Dr Saglani said: ‘We hope to use this model to study asthma in far greater detail than has previously been possible.’

Dr Elaine Vickers, Research Relations Manager at Asthma UK, commented: ‘There are over a million children in the UK with asthma, and every 16 minutes a child is admitted to hospital because of their asthma symptoms. Professor Lloyd and Dr Saglani are highly experienced and talented researchers and we are confident in their ability to uncover new insight into asthma that could lead to significant benefits for both children and adults in the UK.’

This research was published online in the American Journal of Respiratory Cell and Molecular Biology.

Exercise & Sports

2009-02-06T23:52:00.000-08:00

If your asthma symptoms worsen during or after exercise it could be a sign that your asthma is poorly controlled. However, exercise is good for everyone including people with asthma, and if your asthma is well controlled you should be able to join in, have fun and keep fit.

Warming up thoroughly before and warming down after exercise may help to reduce your asthma symptoms
Take your usual dose of reliever inhaler immediately before you start warming up and keep it close at hand at all times during exercise
If you need to use your reliever inhaler, wait for it to take effect before exercising again
If you often get symptoms when exercising, review your asthma with your doctor or asthma nurse

Regular exercise is good for everyone, including people with asthma. The majority of people with asthma should be able to take part in any type of activity or exercise they enjoy, as long as their asthma is under control. Read on for information about exercise options, plus what you should do to ensure you exercise safely.

Children & exercise

Evidence shows that exercise is good for everyone, including children and young people with asthma.

Despite this, one in six parents say that their child’s asthma stops them from doing exercise or sport at school. Asthma UK's 'Out There & Active' campaign aims to promote understanding about exercise and asthma to parents, children and teachers, through a series of factfiles, posters and booklets.

Why is exercise good for people with asthma?

Exercising regularly keeps the heart, bones and digestive system healthy and helps to keep unwanted weight off. It makes us feel good and more able to cope with the stresses of everyday life.

Keeping fit and active becomes even more important as we grow older. We need to keep using our bodies in order to get the best out of them. Staying physically active keeps our joints working; it helps the speed of our reflexes and helps keep us strong. Evidence from a number of studies shows that those who continue to exercise through their middle years show less physical deterioration as they get older, compared with their less active counterparts.

There are all sorts of ways to exercise that can be both enjoyable and beneficial for everyone that does not have to include hours in the gym. As fitness guru Rosemary Conley, who has had asthma all her life, says: 'Go gently at first, but even a five minute walk three times a day will make a real difference. Walk to the shops, use the stairs more, mow the lawn – anything!'

Don't let asthma prevent you from exercising

While it is true that exercise can bring on asthma symptoms in some people, there are lots of steps you can take to prevent this happening.

The first thing to do is to check with your doctor or practice nurse that your asthma is as controlled as it could be. Your ultimate aim is to do 30 minutes of exercise three to five times a week at a level of exertion that makes you only mildly breathless. We are not talking exhaustion here. And remember, as you get older, even a small amount of gentle exercise will make all the difference.

Below are some tips for exercising if you have asthma.

Tips for exercising with asthma

Make sure the people you are exercising with know you have asthma.
Increase your fitness levels gradually.
Always have your reliever inhaler with you when you exercise.
If exercise triggers your asthma use your reliever inhaler immediately before you warm up.
Ensure that you always warm up and down thoroughly.
Try not to come into contact with things that trigger your asthma.
If you have symptoms when you exercise, stop, take your reliever inhaler and wait until you feel better before starting again.
If you use preventer medicine, take it as prescribed by your doctor or asthma nurse.

Exercise options

Aerobic exercise
Either specific fitness classes or activities such as cycling and dancing will increase heart-lung capacity and improve circulation, as well as improving muscle tone and stamina.

If you have painful and stiff joints avoid weight-bearing high-impact exercise such as aerobics and running. But don’t let stiffness be an excuse for not exercising. There are plenty of things you can do – for example, swimming and some forms of yoga – that put very little stress on weight-bearing joints such as knees and ankles. There are even exercises that you can do while sitting in a chair. Ask at your local leisure centre, ring your local council or get searching on the internet to find out more.

Yoga
Yoga is the hottest trend around with its constant stream of celebrity endorsement. It can provide a workout for both body and mind. Gentle postures are performed in harmony with breathing techniques to leave you feeling lighter, calmer and energised. Some people find that breathing techniques are beneficial for their asthma. However, it is important that you do not stop taking your normal asthma medicines unless your doctor or asthma nurse advises you to.

Swimming
Swimming is a particularly good exercise for people with asthma because the warm, humid environment in the pool is unlikely to trigger asthma symptoms (although for some people the chemicals used in the swimming pool may be a trigger). Swimming is also an excellent activity for people of all ages and fitness levels, burns off 300 or more calories an hour, and is unlikely to pull or strain muscles because the water acts as a support for your body.

Everyday activity
If time is an issue, build exercise into your routine slowly. A brisk 20 minute walk in your lunch hour, or small changes such as getting off the bus a stop earlier and taking the stairs rather than the lift will all count. Every little bit of activity really does help.

At the end of the day, you are much more likely to make exercise a regular part of your life if you find something you really enjoy doing. If you can achieve that goal, the resultant boost to health and well-being will soon become obvious even to the most dedicated couch potato! So get out there and active!

Smoking [triggers asthma]

2009-02-06T23:49:00.000-08:00

Smoking is dangerous for everyone, but particularly if you have asthma. Smoking can irritate the lungs and trigger your asthma symptoms.

If you smoke (or breathe in other people’s smoke) you increase the risk of having an asthma attack and may permanently damage your airways.
You put your children at risk of asthma if you smoke around them or during pregnancy
Many public places are now smoke free areas, but do not be afraid to ask other people to stop smoking around you

Asthma reviews

2009-02-06T23:41:00.000-08:00

Just like visiting the dentist or optician it is important to have regular review appointments with your doctor or asthma nurse to monitor your asthma symptoms and the medicines you are taking. Most doctors suggest that adults with asthma should have a review every 12 months, or more frequently if you have just been diagnosed, or following an asthma attack.

An asthma review is an appointment with your doctor or asthma nurse to talk about your asthma and discuss ways in which you can control your symptoms better.

When should you have an asthma review?

Every year if your symptoms are well controlled or more often if your symptoms are difficult to control.
A month or so after your asthma medicines are changed – to new medicine or if your normal medicine has been increased or decreased.
Within 48 hours of a serious asthma attack to make sure your symptoms are better controlled. You also need another review one to two weeks after a serious attack to make sure your symptoms are back under control.
If your personal asthma action plan is not helping you to get back in control of your symptoms.

During a review you should expect to be asked the following three questions:

Have you had difficulty sleeping because of your asthma symptoms (including cough)?
Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)?
Has your asthma interfered with your usual activities?

At your asthma review you should also discuss:

your written personal asthma action plan
your asthma medicines and if they are working for you
the inhalers you are using and if you are able to use your inhaler easily
how your asthma is affecting your life.

Be in control with your Asthma

2009-02-06T23:32:00.000-08:00

For most people asthma can be kept under control, and if your asthma is under control, you are more likely to have a better quality of life and be more able to do the things you want to.

Research shows that using a written personal asthma plan, which are free from Asthma UK or from your doctor or nurse, reduces the risk of asthma attacks and can help you to keep your asthma well controlled.

If your asthma is under control you are more likely to have a better quality of life and be more able to do the things you want to. In this section you will find information about how to spot when your asthma is not well controlled, practical help to get your symptoms back under control from our 'Be in Control' pack and advice on the questions you should be asking when you visit your doctor or asthma nurse.

Side effects of Asthma Medicines

2009-02-06T23:30:00.000-08:00

Side effects of reliever medicines

Relievers are a safe and effective medicine and have very few side effects. You cannot overdose on reliever medicine. Some relievers can temporarily increase your heartbeat or give you mild muscle shakes. These effects are more common when taking high doses. However they generally wear off within a few minutes or a few hours at most.

Side effects of preventer medicines

The possibility of side effects from taking your inhaled preventer medicine is very low. Because the inhaled medicine goes straight down to the airways where it is needed, very little is absorbed into the rest of the body.

If you use preventer medicine there is a small risk of having a sore tongue, sore throat, hoarseness of the voice and a mouth infection called thrush. To help prevent these side effects, rinse your mouth out and brush your teeth after using your preventer inhaler. Using a spacer will also help reduce the possibility of thrush.

Children should be monitored closely if they are taking preventer medicines - especially for growth.

It is possible that long-term and high-dose use of preventer medicines (inhaled steroids) may cause some other side effects (See 'Side effects of long-term use of steroid tablets', below). That is why your doctor and asthma nurse will try to keep you on the lowest dose to control your symptoms.

Several studies have suggested the possibility of a very slight increased risk of the development of cataracts in elderly people who have used inhaled steroids. As with use of all medicines, careful attention needs to be paid to the risk versus benefit argument and it's as likely that any risk can be reduced by always using the lowest possible dose of medication to control the condition.

Using your inhalers

2009-02-06T23:28:00.000-08:00

Using an inhaler is the most common way of taking asthma medicines. It is also a very effective way because inhaling the medicine takes it straight into your lungs.

It is important that you take the medicine properly. Your doctor or asthma nurse should explain how to use your inhaler so that every dose you take gives you the most benefit.

It is very common to experience problems using inhalers. Talk to your doctor or asthma nurse specialist and they will be able to check your inhaler technique or may give you a different inhaler.

They may also suggest that you try one of the following options:

Large volume spacers are available on prescription. These make aerosol inhalers easier to use and more effective. They trap the medicine inside the spacer, so you don't have to worry about pressing the inhaler and breathing in at exactly the same time. Ask your doctor, nurse or pharmacist for details.

If you have arthritis in your hand, or have difficulty holding the inhaler, a device like the Haleraid or Turboaid might be useful. The Haleraid fits onto some spray-type inhalers. It allows you to release medicines by applying pressure with the palm of your hand. This can be easier than pressing the canister down. Your doctor or asthma nurse will be able to advise you. The Haleraid is not available on prescription, but your pharmacist can order it direct from the manufacturers, Allen & Hanburys. Your pharmacist can also order the Turboaid from the manufacturers, Astra Zeneca.

Medicines of Asthma

2009-02-06T23:24:00.000-08:00

The most effective way of taking most asthma medicines is to inhale them so that they get straight into your lungs. There are two main inhaler medicines:

Reliever inhalers (usually blue). They quickly relax the muscles surrounding your narrowed airways’, allowing them to open wider making it easier to breathe stright away.
Preventer inhalers. Preventers control the swelling and inflammation in your airways, stopping them from being so sensitive and reducing the risk of severe attacks. The protective effect builds up over a period of time so if you have been prescribed one you should use it every day.

Although there is no cure for asthma, there are some excellent medicines available to help you to control your asthma so that is does not interfere with your daily life.

It is important that you take your asthma medicine properly and that your doctor or asthma nurse has explained how to use inhalers properly so that every dose you take gives you the most benefit.

Asthma & work

2009-02-06T23:19:00.000-08:00

If you have developed asthma as an adult, it may have been caused by something at work. Occupational asthma can sometimes take weeks, months or years to develop. Look out for the following signs:

Your symptoms worsening during your working week, at work or after work
Your sleep being disrupted because of increased symptoms in your working week
Your symptoms improving when you are not at work (for example when you are on holiday)

If you notice anything that makes your asthma worse, discuss it with your doctor and with your health and safety advisor at your workplace. Taking action to reduce these triggers, and making your employer aware that your asthma is affected is vital. It is also important that you are referred to an occupational asthma specialist to confirm the diagnosis.

Other Exercises and Techniques

2009-02-05T23:00:00.000-08:00

Recently, the Buteyko breathing technique has become popular with some asthmatics hoping to control their breathing. The method involves a system of breathing exercises and behavioral changes.

Developed by a Ukrainian physician, the technique is based on the theory that the symptoms of many respiratory disorders (including asthma) are caused by poor breathing patterns. Buteyko deemed this to be "hyperventilation," and his technique tries to slow patients’ rate of breathing to help them gain greater ability to control symptoms.

However, many experts are skeptical of the Buteyko technique, particularly the claim that asthmatics need to increase carbon dioxide levels in the body to best metabolize oxygen. Researchers point out that medical evidence indicates that asthmatics already have high levels of carbon dioxide in the blood and there is no solid evidence to support the Buteyko technique claims.

Studies of the Buteyko method to date have proved inconclusive. Many tests have found no improvement in any physiological asthma measures. Yet, there is evidence that some patients using the technique may require fewer medications to control their symptoms.

Other relaxation techniques, such as yoga and hypnosis, also have been suggested to asthma patients as ways to lessen symptoms. These techniques are based on the concept that a relaxed person will be able to control their breathing and breathe better than someone who is nervous and stressed. Stress may be an asthma trigger in some people and relaxation techniques may offer methods to alleviate stress.

Hypnosis, also known as hypnotic suggestion or hypnotherapy, involves placing the patient in an altered state of consciousness. Hypnosis can train a patient’s mind to relax when necessary, and the technique may be used anywhere. Children are especially good candidates for this technique because they tend to be hypnotized more easily than adults. Not all people are susceptible to hypnosis.

An ancient Hindu discipline, yoga promotes increased mental and physical control over the body through a variety of postures and breathing techniques. A main focus of yoga is to control the breath and promote relaxation.

Several yoga-related studies involving breathing exercises known as pranayama, stretches (postures) and meditation have suggested that lung function may improve with the regular use of yoga. Although yoga may be beneficial when it is added to standard treatments for asthma, it is not clear if yoga is more effective than any other form of exercise.

Just as with the Buteyko method, the evidence in support of yoga and hypnosis for asthma control appears to be inconclusive. Though some patients report better quality of life and improved mood after employing these techniques, supporting physiological evidence is lacking. Asthma is a physiological disease of the airways, and is not psychosomatic. No breathing technique or exercise program should be undertaken without consultation with a physician.

Pursed-lip breathing

2009-02-05T22:57:00.000-08:00

Pursed-lip breathing is the chief form of breathing control advocated for asthmatics. This technique is often taught to those with respiratory diseases such as chronic obstructive pulmonary disease (COPD). Pursed-lip breathing is designed to control shortness of breath by slowing the pace of breathing and increasing the effectiveness of each breath.

This technique is recommended during the difficult parts of any activity, such as bending, lifting or climbing stairs. Some also advocate using the technique to calm symptoms of an asthma attack. However, as with any recommendation, patients are urged to discuss the technique with their physician.

Pursed-lip breathing involves the following steps:

Relax neck and shoulder muscles.

Inhale slowly and normally (not deeply) through the nose for two counts, keeping the mouth closed.

Pucker or purse lips, as during whistling or when blowing out a candle.

Exhale slowly and gently (not forcefully) through pursed lips while counting to four. Exhalation should always take longer than inhalation.

Pursed-lip breathing acts as a "splint." It creates a back pressure that helps keep the airways open slightly longer to allow more stale air to escape so that more fresh air can replace it. The technique has the following benefits for those with breathing difficulties:

Increases the amount of air taken in and let out of the lungs (vital capacity)
Releases trapped air from the lungs

Extends time airways are open and makes breathing less work

Lengthens exhalation time, which slows breathing

Moves old air out of and new air into the lungs

Improves gas exchange as more oxygen enters the body and carbon dioxide exits

Relieves shortness of breath

Improves posture

Relaxes the body

Patients should practice the technique several times a day until it feels natural. It is important to create a rhythm of inhalation and exhalation, and not to hold the breath. Holding the breath locks up the diaphragm and tightens the muscles of the throat.

Many experts advocate pursed-lip breathing for asthmatics. During an asthma attack, less air reaches the lungs as the airways swell and produce excess mucus. This causes the person to work harder to breathe.

Pursed-lip breathing can make breathing more efficient, minimizing the effort necessary to breathe by emphasizing the use of the diaphragm and the muscles between the ribs instead of chest and neck muscles.

Advocates suggest asthmatics use the technique between two to four times a day. This can include once in the morning, during the late afternoon and at night just before sleep. Once an asthmatic has mastered pursed-lip breathing, it should be put into practice at the first hint of wheeze or when peak flow meter readings drop. Patients should continue to use pursed lip breathing until they no longer feel short of breath.

Patients who master the pursed-lip breathing technique may feel a greater sense of control over their respiratory disorder, according to advocates. This sense of confidence may help relax them during flare-ups, which in itself can lessen symptoms.

However, as with other breathing techniques, there is little hard data to support claims that pursed-lip breathing can improve a patient's asthma.

About asthma and breath management

2009-02-05T22:56:00.001-08:00

A number of breathing management techniques are promoted as non-drug approaches to managing asthma. The value of breath management in treating or preventing asthma symptoms has been debated within the medical community.

Some experts state flatly that there is no evidence that these techniques have any value for asthmatics. However, many others say techniques such as pursed-lip breathing, the Buteyko method, hypnosis and yoga relaxation can help patients to regulate their breathing, control asthma triggers and limit or reduce asthma attacks.

To date, studies of these techniques have largely failed to show their effectiveness. Although patients often report benefitting from the therapies, physiological evidence generally has not been found to support these claims. As with any recommendation, patients are urged to discuss the technique with their physician.

Known as complimentary medicine, breath management techniques are designed for use alongside prescribed medications. Therefore, patients using breath management techniques should not reduce or stop taking their prescribed asthma medications without instruction from a physician. Doing so could worsen the patient’s symptoms.

Types and Difference of Asthma

2009-02-05T22:55:00.001-08:00

Asthma affects people in different ways and to various degrees. There are four levels of severity used to classify different types of asthma:

Mild intermittent. Symptoms appear up to two days a week and two nights a month.
Mild persistent. Symptoms appear more than two nights a month and more than twice a week, but not more than once in a single day.
Moderate persistent. Symptoms occur every day and more than one night a week.
Severe persistent. Symptoms occur continuously throughout the day and frequently at night.

Asthma is most commonly triggered by allergens, such as dander, pollens, dust and molds. Known as allergic asthma, this form of asthma is found in approximately half of all asthma patients. But other stimuli also can trigger asthma symptoms or a full-blown asthma attack. Forms of asthma triggered by factors other than allergens include:

Exercise-induced asthma (EIA). Asthma that occurs during vigorous physical activity. The condition usually manifests itself a few minutes after a person begins exercise. EIA afflicts a large percentage of asthmatics, and also can occur in individuals who usually have no other asthma symptoms.
NSAID-sensitive asthma. Severe asthma attacks that occur as a result of taking nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen. People with this condition should consult a physician, who may recommend an alternative pain reliever, such as one that contains acetaminophen.
Nocturnal asthma. Asthma symptoms that manifest themselves primarily at night. It tends to occur between midnight and 8 a.m. and seems to be especially prevalent around 4 a.m.
Adult–onset asthma. Asthma that makes its first appearance in an adult after age 20. It is more common in women than in men.
Occupational asthma. Asthma that is triggered by conditions in the workplace. The main triggers for occupational asthma are airborne contaminants or allergens and extremes in temperature or humidity levels. It is most likely to occur among those who work with animals or animal–based products and in industries such as food service (especially bakery), chemicals, electronics, gardening, metalworking, painting, printing, plastics, rubber and textiles.

Prevention methods for Asthma

2009-02-05T22:53:00.000-08:00

Since it is not known why some people develop asthma and others do not, preventing the condition itself is not possible. However, there are several things that people can do to reduce the symptoms of asthma, including:

Reducing exposure to environmental triggers, such as pollens, molds, secondhand tobacco smoke and animal dander.
Leading a healthy lifestyle that includes proper rest, good nutrition and regular exercise.
Taking all asthma medications as directed.
Combating obesity. For reasons not fully understood, there appears to be a correlation between obesity and increased incidence of asthma. Obese individuals who lose weight often shed symptoms of asthma as well.

Gastroesophageal reflux disease (GERD) – a condition where stomach acid backs up into the esophagus – can trigger asthma symptoms, possibly as part of a nervous–system reflex. It is most likely to occur when an individual is lying down or sleeping after a big meal.

Steps to prevent GERD include:

Refrain from snacking for two hours before bedtime
Take antacids
Avoid foods that trigger heartburn
Raise the bed so the head is higher, forcing reflux downward

Viral respiratory infections, such as colds or the flu, also can trigger asthma. To minimize the likelihood of such symptoms:

Obtain an annual flu shot
Wash hands frequently
Do not share glasses, utensils and other items with those who are sick

Long-term-control medications also can help prevent asthma attacks. In addition, there are certain breathing techniques that people with asthma can learn to can minimize the impact of asthma on breathing.

Certain forms of asthma, such as exercise-induced asthma, require specialized forms of prevention. Patients should discuss specific steps for symptom prevention with their physician.

Click here to see the G.E.R.D.

Treatment methods for Asthma

2009-02-05T22:52:00.000-08:00

Once an individual has been diagnosed with asthma, a physician will develop an asthma action plan to help the patient monitor the condition. A typical plan will contain the following elements:

A list of specific symptoms that often precede an individual’s asthma attacks
Steps to take during an attack
How to recognize a serious attack, and what to do about it
How to recognize an emergency
Changes in environment and behavior that can reduce the chances of an asthma flare–up

Current asthma treatment focuses primarily on preventing or reducing the inflammation process, and relaxing the smooth muscle that tightens during bronchospasm. Healthcare professionals use asthma medications with two goals in mind:

To keep the airway clear so the patient can breathe normally.
To prevent airway remodeling, a thickening of the bronchial walls that can result from chronic inflammation and lead to permanent damage.

There are two categories of asthma medications:

Quick-relief medications. Also called “rescue” medications, these are designed to instantly relieve the symptoms of an asthma attack. They are usually not meant to be taken long–term.
Long-term-control medications. These are designed to minimize inflammation and prevent asthma flare-ups before they occur. Long-acting beta2 agonists are often used, as well as topical corticosteroids.

Patients with mild intermittent or mild persistent asthma may receive a quick-relief medication to aid them when their asthma flares-up. Those with moderate or severe asthma are more likely to need both quick-relief and long-term-control medications.

Asthma drugs can be delivered either in pill form or through an inhaler or nebulizer, which allows the drug to travel directly to the bronchial tubes while minimizing the effect on the rest of the body.

Bronchodilators are the primary class of medications used to treat asthma. These widen a person’s airways by relaxing the bronchial smooth muscle. Short-acting bronchodilators (such as beta2 agonists) provide immediate relief of asthma symptoms. Long-acting bronchodilators (which include long-acting beta2 agonists) relieve symptoms for longer periods of time and are used once in the morning, and once at night.

It is important not to overuse these medications. Such abuse can make an asthmatic condition worse and possibly even increase the risk of death from asthma.

Other asthma medications stop an asthma attack before it starts by preventing the bronchial inflammation that constricts airways and hampers breathing. These drugs include:

Corticosteroids. Medications similar to the body’s own hormones. They prevent the inflammation associated with asthma attacks.
Leukotriene modifiers. Medications that inhibit the role of leukotrienes, which are a type of chemical involved in an asthma attack. They may be taken daily or several times a day to prevent an asthma attack from occurring.
Mast cell stabilizers. Medications that prevent mast cells from triggering reactions that can lead to an asthma attack or allergic reaction. This class of drug is rarely prescribed.

Click here to see the Bronchodilators.

What are the triggers that can cause an asthma attack?

2009-02-05T22:51:00.001-08:00

According to the National Institute for Allergy and Infectious Diseases, the American Academy of Allergy, Asthma, and Immunology, and other organizations, triggers for asthma include the following:

Allergens pollen mold animal protein (dander, urine, oil from skin) house dust/dust mites cockroaches certain foods	Respiratory Infections and Sinusitis Infections can cause irritation of the airways, nose, throat, lungs, and sinuses, and worsens asthma.
Irritants strong odors and sprays, such as perfumes, household cleaners, cooking fumes, paints, and varnishes chemicals such as coal, chalk dust, or talcum powder air pollutants changing weather conditions, including changes in temperature, barometric pressure, humidity, and strong winds Chemical-exposure on the job, such as occupational vapors, dust, gases, or fumes.	Sensitivity to Medications Medications, such as aspirin and sulfites, cause up to 20 percent of adult asthmatic attacks as a result of sensitivities or allergies to them. These medications often include: aspirin other non-steroidal anti-inflammatory medications, such as ibuprofen, indomethacin, naproxen sulfites used as preservatives in food and beverage Before taking any medication, including over-the-counter medications, consult your physician.
Exercise Exercise can trigger an asthma attack, often because of the inhaled cool and dry air. Long-term strenuous activities such as long distance running, are most likely to induce asthma, and swimming is the least likely.	Gastroesophageal reflux GERD, a condition characterized by persistent reflux of stomach acids, is common in individuals with asthma. Symptoms may include heartburn, belching, or spitting up in infants.
Smoke Tobacco smoke, whether directly or passively inhaled, has been shown to worsen asthma. Wood smoke from wood-burning heating stoves and fireplaces can release irritating chemicals such as sulfur dioxide.	Emotional Anxiety and Nervous Stress Reactions from stress and anxiety are considered to be more of an effect than a cause. They can cause fatigue, which may affect the immune system and, in turn, increase either asthma symptoms or bring on an attack.

Other diagnosis method for Asthma

2009-02-05T22:49:00.002-08:00

A physician is likely to use several methods to determine whether or not a person has asthma. An individual’s medical history – including prior breathing problems, allergies or skin conditions – may offer important clues. A family history of asthma, eczema or allergies also may indicate an increased risk for asthma, as the condition appears to run in families with these conditions.

The physician may assess the severity of asthma using the following criteria:

Extent to which asthma attacks interfere with normal activities
Severity and duration of symptoms
Degree of airway obstruction

Mild to moderate asthma is often characterized by tightness in the chest, coughing up mucus, difficulty sleeping and wheezing. Severe attacks may be characterized by the following:

Difficulty speaking
Slight gray or bluish color to the lips and fingernail beds (cyanosis)
Sucked-in appearance to the rib cage
Breathlessness

Following the collection of a medical history, a physician will perform a physical examination to look for signs of asthma. The exam will focus on the respiratory tract, chest and skin. The physician will listen for wheezing and other sounds in the chest with a stethoscope (an instrument that uses rubber tubing that is placed in the ears and a cup-shaped device to detect sounds produced in the body). The physician will also use a nasal speculum (a handheld device with a telescope) to examine the inside of the nose for signs of allergies (e.g., swelling, polyps, increased secretions). The skin will be examined as well for signs of allergic conditions associated with asthma (e.g., eczema, hives).

Although, symptoms, a medical history and a physical exam can suggest the presence of asthma, diagnostic tests that measure an individual’s airflow are the primary means of uncovering asthma. These and other tests may include:

Pulmonary function test. A test that measures how much air the lungs can hold and how quickly it is exhaled.
Bronchoprovocation test. A test that involves inducing a minor asthma attack to diagnose asthma when symptoms are not present. Most bronchoprovocation tests use histamine or methacholine but may include specific agents, such as food additives or environmental allergens.
Spirometry. A test that measures how much air a person blows out in a specific period of time, and how forcefully it is blown. It can reveal the extent of airway obstruction present, and how much of the obstruction is reversible.
Pulse oximetry. A test in which a probe is placed on a fingertip to measure the amount of oxygen in a person’s bloodstream.
Chest x-ray. An image of the chest produced using low doses of radiation. This test can be useful in detecting air trapped in the lungs. It may also be used to rule out other conditions and diseases known to cause symptoms similar to asthma.
Allergy skin test. A test used to identify a specific allergen that might be triggering asthma attacks. While allergies are a separate condition from asthma, allergic reactions often trigger attacks in asthmatics. During this test, a small amount of one or more allergens is introduced to the patient’s skin (through a prick, scratch, injection or patch). The skin is then examined for a positive reaction. A hive will usually indicate that an allergy to the substance is present. The test is not 100 percent accurate, but it can be an effective tool in diagnosing allergy triggers.

Patients can play a vital role in the ongoing diagnosis of their own asthma by using a peak flow meter. This device measures the amount of air flowing into and out of a patient’s lungs. By using it every day, patients can detect changes in their breathing capacity before the condition manifests itself in asthma symptoms. Peak flow meters can also help an individual determine the severity of an asthma attack once it has begun.

Other conditions may have similar symptoms, such as chronic obstructive pulmonary disease, emphysema, early onset of heart failure (cardiac asthma) and vocal cord dysfunction. A physician may perform other tests to rule out these conditions, including imaging tests and blood tests.

How is asthma diagnosed?

2009-02-05T22:49:00.001-08:00

To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination, and laboratory tests, which may include the following:

spirometry - a spirometer is a device used by your physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:
- to determine how well the lungs receive, hold, and utilize air
- to monitor a lung disease
- to monitor the effectiveness of treatment
- to determine the severity of a lung disease
- to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
peak flow monitoring (PFM) - a device used to measure the fastest speed in which a person can blow air out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.
chest x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
blood tests - to analyze the amount of carbon dioxide and oxygen in the blood.
allergy tests

What happens during an asthma attack or asthma exacerbation?

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Persons with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.

The lungs and airways overreact to certain triggers causing:
- the lining of the airways to become inflamed and swollen.
- tightening of the muscles that surround the airways.
- an increased production of mucus.
Breathing becomes harder and may hurt.
There may be coughing.
There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways.

Asthma Attack

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Asthma attacks occur when an allergen (a substance the body perceives as a threat, triggering an allergic reaction) or irritant triggers an exaggerated response in a person with asthma (chronically sensitized or inflamed airways). Shortness of breath, chest tightness, coughing and wheezing (a whistling or high-pitched sound that results when breathing tubes are narrowed or obstructed) are among the symptoms that appear as the airways constrict and air becomes trapped in the lungs.

An asthma attack targets the body’s bronchial tubes, which bring oxygen to the lungs when a person inhales and remove carbon dioxide from the body when a person exhales. The diameter of these tubes narrows dramatically during an asthma attack due to a combination of factors, including:

Inflammation and swelling of the lining of the tube
Mucus buildup in the tube
Smooth-muscle tightening around the tube

As a result, the person is less able to move air into and out of the lungs. A person experiencing an asthma attack must immediately take prescribed medication such as an inhaled bronchodilator or an injection of epinephrine contained in an allergy kit. The longer an attack continues, the greater the risk of severe health consequences. People experiencing an asthma attack who do not have medication or have symptoms that are not relieved with medication should seek immediate emergency medical care. In rare cases, asthma attacks can be fatal.

What are the risk factors for an asthma attack?

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Although anyone may have an asthma attack, it most commonly occurs in the following persons:

children by the age of 5
adults in their 30s
adults older than 65
people living in urban communities

Other factors include the following:

family history of asthma
personal medical history of allergies

Children most susceptible to asthma attacks include the following:

children with a family history of asthma
children who have allergies
children who have exposure to secondhand tobacco smoke

What causes asthma?

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The exact cause of asthma is not completely known. It is believed to be partially inherited, but it also involves many other environmental, infectious, and chemical factors.

After a person is exposed to a certain trigger, the body releases histamine and other agents that can cause inflammation in the airways. The body also releases other factors that can cause the muscles of the airways to tighten, or become smaller. There is also an increase in mucus production that may clog the airways.

Some persons have exercise-induced asthma, which is caused by varying degrees of exercise. Symptoms can occur during, or shortly after, exercise. Each person has different triggers that cause the asthma to worsen. You should discuss this with your physician.

The changes that occur in asthma are believed to happen in two phases:

An immediate response to the trigger leads to swelling and narrowing of the airways. This makes it initially difficult to breathe.
A later response, which can happen four to eight hours after the initial exposure to the allergen, leads to further inflammation of the airways and obstruction of airflow.

Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

The source of asthma is not fully understood. Healthcare professionals believe a combination of genetic and environmental factors determine whether or not a person becomes asthmatic. The American Academy of Allergy, Asthma and Immunology estimates that 40 percent of children who have asthmatic parents will develop asthma.

One theory of asthma development involves immune system cells called T helper cells. It is known that T helper 2 cells (T_h2) release chemicals that activate other cells known to contribute to inflammation. In a normally functioning immune system, this process is balanced by T helper 1 cells (T_h1), which reduce inflammation. Evidence suggests that the T helper cells may be out of balance in asthmatics, preventing the body from controlling excess inflammation.

Immune system reactions are at the heart of another asthma theory, which states that the growing number of children with asthma stems from children having less exposure to certain types of bacteria, and infections than in the past. As a result, children have not developed the types of immune cells necessary to prevent asthma, according to this theory. Yet other research suggests that exposure to infections and allergens at an early age can increase the risk for developing asthma.

Physicians have noted that about 70 percent of people diagnosed as asthmatic also suffer from allergies. There also appears to be a strong association between a condition called sinusitis and asthma. Sinusitis, which is inflammation of the sinus cavities, occurs in 15 percent of people with asthma and 75 percent of those with severe asthma. By contrast, sinusitis occurs in about 5 percent of the general population.

This might occur because fluid from the sinuses may drain into the bronchial tubes, causing bronchitis. In turn, this might worsen asthma. It may also occur because the tissues in the sinuses and the airway linings are similar, so they may react to similar triggers.

In addition, all airway tissues are connected, and the inflammatory response may extend from the sinuses to the lower airways (bronchi).

Additional factors which may increase a person’s risk for asthma include:

Living in the inner city, or another large urban area
Exposure to secondhand smoke
Exposure to occupational irritants, such a chemicals used in farming and hairdressing, and in the manufacturing of paint, steel, plastic and electronics

A person with asthma is more likely to experience symptoms or full–blown asthma attacks when exposed to certain allergens and stimuli, which are classified as asthma triggers. These include:

Allergens, such as:
- Pollen
- Mold
- Dust
- Cockroaches
- Pet dander
Irritants, such as:
- Air pollution
- Tobacco smoke
- Cold air
- Perfume
- Spray-on deodorants
- Strong odors from household chemicals, sprays or paints and other irritants

Other potential asthma triggers include:

Certain foods
Exercise
Feathers in pillows
Aspirin or ibuprofen
Menstrual cycles (when hormonal changes may trigger asthma)
Pregnancy
Viral respiratory infections (including colds, bronchitis and flu)
Stress
Temperature changes
Sinus infections
Heartburn
Sulfites (a preservative used in salad bars, dehydrated soups, alcohol and other foods)
Gastroesophageal reflux disease (GERD)

Allergens are the most common trigger of asthma in those under the age of 30. Although allergens trigger the condition in many people over the age of 30, older adults tend to experience symptoms after exposure to irritants.

Physicians can help patients identify which factors trigger their asthma, and recommend steps the patients can take to avoid the triggers.

There also appears to be a link between obesity and asthma that is not yet understood. One study found that children who are obese at the time of puberty are three times more likely than their slimmer peers to continue to suffer from asthma into their teens. Other studies have found overweight school-age children are 50 percent more likely than those of normal weight to develop asthma, and those who had a high birthweight were 20 percent more likely to develop asthma later in childhood.

The association between asthma and obesity is also apparent in adults. Research has suggested that obese adults are three times more likely to develop asthma than thinner adults. There also appears to be a direct relationship between the amount of weight gained and the risk of developing asthma. Research suggests that an overweight person’s risk for asthma increases further as they gain more and more weight.

The mechanism behind the asthma-obesity link remains a mystery, though some research indicates that the two conditions share a gene that might link them together.

What are the symptoms of asthma?

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Asthma may resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. It is often under-diagnosed and many people with the disease do not know they have it. Sometimes, the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

Most experts now believe that asthma develops in an individual within the first few years of life. These symptoms sometimes can be observed during infancy, but there are other cases where asthma does not make its presence known until later in childhood or even into adulthood. Asthma symptoms are responsible for 1.8 million visits to the emergency room, making it one of the most common reasons for visits to emergency rooms and hospitalization.

The symptoms of asthma or an impending asthma attack are numerous. They include:

Rapid breathing
Chest pain or tightness
Chronic coughing
Breathing difficulty
Fever
Headache
Stuffy head
Sneezing
Scratchy or sore throat
Itchy, watery eyes
Runny nose
Restlessness
Listlessness

Some symptoms that appear to indicate asthma actually mask the presence of a separate condition, such as chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD) or sinusitis. Those who experience these symptoms should see a healthcare professional to obtain an accurate diagnosis.

It is important to note that the type and severity of symptoms experienced vary from person to person, as well as from episode to episode in the same person. The frequency of symptoms will also vary between patients. While some patients only experience symptoms every few months, others have symptoms every day. However, all patients can reduce the likelihood of asthma symptoms by consulting a physician and receiving proper treatment.

It is also important to note that signs and symptoms of asthma may vary in infants and children.

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What is asthma?

2009-02-05T22:35:00.000-08:00

Asthma is a chronic, inflammatory disease in which the airways become sensitive to allergens (any substance that triggers an allergic reaction). Several things happen to the airways when a person is exposed to certain triggers:

The lining of the airways become swollen and inflamed.
The muscles that surround the airways tighten.
The production of mucus in increased, leading to mucus plugs.

All of these factors will cause the airways to narrow, thus making it difficult for air to go in and out of your lungs, causing the symptoms of asthma.

Asthma is a chronic inflammation of the body’s bronchial (airway) tissues. People with asthma experience shortness of breath, chest tightness, coughing and wheezing. These symptoms intensify during an asthma attack, which occurs when exposure to allergens or other stimuli further inflame the airways, leading to an inability to expel trapped air from the lungs.

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Asthma is a chronic inflammation of the body’s bronchial (airway) tissues that afflicts millions of people in the United States. People with asthma experience shortness of breath, chest tightness, coughing and wheezing. These symptoms intensify during an asthma attack, which occurs when exposure to allergens or other stimuli further inflame the airways, leading to an inability to expel trapped air from the lungs. Most asthma attacks are mild, but even people with mild asthma can have a fatal attack, and more than 5,000 deaths a year are attributed to the condition.

The number of Americans with asthma has surged in recent years. According to the National Heart, Lung and Blood Institute, approximately 20 million people have been diagnosed with asthma. Greater numbers of children now have asthma than in the past (nearly 9 million), and poor children in urban environments have been hit particularly hard. On the other end of the spectrum, Americans over age 65 make up the nation’s largest group of asthmatics.

Asthma is diagnosed using a number of breathing–related tests and by ruling out other respiratory conditions, such as chronic obstructive pulmonary disease and emphysema. About 70 percent of people who have asthma also have allergies, according to the American Academy of Allergy, Asthma and Immunology (AAAAI). Like allergies, asthma may be passed down. A person is more likely to develop asthma if one or both parents have the condition.

There is no cure for asthma, but once diagnosed, it is a highly treatable condition. Various asthma medications can help prevent asthma attacks, or treat them once they have begun. Asthmatics can also modify their environment and day-to-day behavior in ways that reduce the likelihood of an asthma attack.

Some children with asthma may eventually see their symptoms subside as they grow older, but asthma is never actually “cured,” and symptoms can reoccur at a later date. Others see their symptoms worsen as they grow older.