Asthma

GENERAL INFORMATION:

What is asthma? Asthma is a long-term condition where your bronchial tubes swell and tighten. The bronchial tubes are airways that carry air in and out of your lungs. An asthma attack (episode of asthma) usually happens after you are exposed to triggers. Triggers are things that cause you to have an asthma attack. During an asthma attack your airways swell and make too much mucus. The small muscles in your airways also tighten. When this happens, less air flows to your lungs and you have trouble breathing. There is no cure for asthma, but the condition can be controlled.

What are the types of asthma? You can have mild (not serious) or severe (very bad) asthma. When you have mild asthma, you may have one of the following types:

• Mild intermittent: You have few and mild symptoms that come and go. You may have wheezing and shortness of breath once a week or less. You may have have asthma symptoms at night twice a month, or less than that. Your asthma attacks last a few minutes to a few hours. In between attacks, you may have no symptoms, and are able to breathe easily. Mild intermittent asthma does not slow you down when you are doing activities such as chores or exercise.
  
  
• Mild persistent: Your asthma attacks may come more than twice a week, but not for two days in a row. You may cough or have other symptoms at night twice a month or less often than that. Your asthma attacks may come often enough that it is hard for you to do the things that you enjoy doing.

What causes asthma? The exact cause of asthma is not known. The airways of people who have asthma may swell up and get narrow more easily than the airways of people who do not have it.

What may increase my risk of having asthma, or make it worse?

• Family history: Parents or other family members having asthma or atopy. Atopy is a condition where you easily get allergic reactions from different things.
  
  
• Medical problems: Having lung infections, sinusitis, and atopy. These conditions damage your airways and lungs, and make them react easily to things. Conditions such as gastroesophageal reflux disease (GERD) may also damage your airways and increase your risk for asthma. GERD is a condition where stomach acid goes the wrong way up your esophagus, sometimes reaching your airways. The esophagus is the tube that carries food from your mouth to your stomach.
  
  
• Obesity: This is weighing more than your caregiver suggests for you. Caregivers measure of your weight relative to your height (body mass index, or BMI) to learn if you are obese.
  
  
• Pregnancy and menstruation: Women who are pregnant or having their monthly period are at a higher risk of having an asthma attack.
  
  
• Closed and crowded places: These places often do not have good air flow. Dirt, dust, chemicals, smoke, and pet dander can build up inside these places, and you may breathe in more of these things.

What triggers may cause an asthma attack? Things that give you an asthma attack may not cause an attack in other people. Triggers include any of the following:

• Activities:
  
  
  • Coping with stress (pressure) at home, school, or work.
    
    
  • Drinking too much alcohol too often. Alcohol is found in adult drinks such as beer, whiskey and wine. Using street (illegal) drugs can also trigger an asthma attack.
    
    
  • Being active, such as doing household chores, playing sports or exercising.
    
    
  • Strong feelings, such as being very sad or happy, and crying or laughing hard.
  
  
• Allergens: These are things that usually cause allergies.
  
  
  • Certain foods.
    
    
  • Cockroach droppings, dust, or dust mites.
    
    
  • Dander from animals such as cats and dogs.
    
    
  • Mold, or plant pollen.
  
  
• Irritants: These are things that can hurt your airways and lungs.
  
  
  • Air pollution, chemical fumes, or cigarette smoke.
    
    
  • Strong smelling body care products.
    
    
  • Very cold or hot weather, with high or low humidity (amount of moisture in the air).
  
  
• Medical problems and medicines:
  
  
  • A cold or the flu.
    
    
  • Infections in your airways, lungs, or sinuses caused by bacteria or viruses.
    
    
  • Gastroesophageal reflux disease.
    
    
  • Medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, or heart medicine.

What are the signs and symptoms of asthma? Your asthma may come and go. You may have any of the following:

• Coughing: Having asthma can cause you to cough. This is usually worse at night or early in the morning.
  
  
• Hard time doing certain activities: Asthma can slow you down when you exercise or play sports. You may have trouble finishing what you are doing at work or at school during an asthma attack.
  
  
• Signs of allergies: A red, runny, and clogged nose, and itchy and teary eyes. You may also have dry, red, itchy, or flaking skin.
  
  
• Trouble breathing: Your chest may feel tight and your breathing may be hard and fast. You may feel like you cannot get enough air in or out of your lungs. You may be raising your shoulders to force air in and out of your lungs. Your lungs may not empty completely when you breathe out, and this may cause more trouble breathing.
  
  
• Trouble sleeping: Coughing and breathing problems may make it hard for you to fall asleep. Your symptoms can also wake you from your sleep at night or early in the morning. This can make you feel very tired during the day.
  
  
• Wheezing: A whistling or squeaky sound when you breathe.

What are the early warning signs of an asthma attack? You may have more asthma attacks during the spring or summer because there is more dust and pollen in the air. Being in closed or crowded places may make it more likely that you will have an asthma attack. Most people with asthma have warning signs before they have more serious symptoms. Warning signs are not the same for everyone with asthma. Your own warning signs may be different from time to time. By learning what your warning signs are, you can take your medicines, or get help right away. Doing this may help prevent serious asthma attacks. The following are some warning signs of an asthma attack:

• Breathing faster than usual.
  
  
• Coughing.
  
  
• Fast heartbeat.
  
  
• Feeling more tired than usual.
  
  
• Itchy or sore throat.
  
  
• Shortness of breath while exercising or doing an activity.
  
  
• Trouble sleeping, and feeling tired the next day.

What is an asthma exacerbation? An asthma exacerbation is a very bad asthma attack. These attacks can come with mild or severe asthma. With these attacks, your symptoms last longer and are more serious. Your symptoms may last for hours or days. You may have more wheezing, chest tightness, and trouble breathing than usual.

How is asthma diagnosed? Your caregiver will ask you what triggers your asthma attacks. He may ask how often you have asthma attacks and how bad your symptoms are. He may ask if you have been in the hospital for asthma treatment. He may ask about you and your family's medical conditions, such as allergies or lung infections. He will also check if you have vocal cord problems or other conditions that cause trouble breathing. Vocal cords are special tissues in your throat that give you your voice. Vocal cord problems block air going to your throat and give you breathing problems like those in asthma. You may need any of the following tests:

• Peak flow testing: A peak flow meter is a small tube-shaped device which measures air you blow out your mouth. This is called your peak expiratory flow (PEF). . Your PEF shows how fast air moves out of your lungs. During an asthma attack your airways tighten and your PEF usually decreases. Your PEF can help you know when to take your medicines. Your PEF can tell your caregiver if he needs to change your medicines. Use your peak flow meter correctly to get an accurate PEF. Ask caregivers how to use the peak flow meter correctly, and how to read your PEF values.
  
  
• Bronchoprovocation testing: This test lets caregivers find out how much air you can breathe out as fast as you can. Your caregiver will give you a chemical which can give you a mild asthma attack. After 10 minutes, he will measure the air you breathe out. If the amount of air you breathe out decreases, it is likely that you have asthma.
  
  
• Pulmonary function tests: Pulmonary function tests, also called PFTs, help caregivers learn how well your lungs work. During the test, you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers to see how well your lungs are moving and working.
  
  
• Allergy testing: These tests find out which things you are allergic to so you can avoid them. Your caregiver will put a drop of different liquids on your arm or back. These liquids usually cause allergies in people. These may include liquids from foods and some chemicals. He will prick the skin under these drops with a needle. He will wipe off the drops and watch closely for any redness or swelling on your skin. During the test he watches you to make sure you are OK. Ask your caregiver for more information about other types of allergy tests.
  
  
• Blood tests: You may need blood tests to check for infections or other medical conditions. These may tell your caregiver about other conditions causing asthma or making your asthma worse.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.

How is asthma treated? You and your caregiver will work together to decrease your symptoms, and prevent asthma attacks. You will work together to write an asthma action plan. An asthma action plan is a set of instructions for what to do when you have an asthma attack. It shows a list of your asthma medicines and their brand, dosage, and side effects. It tells which medicines and how much to take depending on how bad your symptoms are. It has instructions on how and when to seek help if your symptoms get worse. Write down when you have an asthma attack, and what may have caused it. Know what gives you an asthma attack, and stay away from it. Watch for early warning signs of asthma attacks. You may also need to use the following medicines:

• Bronchodilators: These medicines help you breathe easier by relaxing muscles that have tightened around your airways. This type of medicine may come in a device called an inhaler. An inhaler gives your medicine in mist form which you can breathe into your lungs. This may also be given using a machine, called a nebulizer, which turns liquid medicine into a mist. There are different types of inhalers and nebulizers that you can choose from. Using inhalers and nebulizers the right way takes practice. You may have to bring these medicines along with you all the time. Ask your caregiver about how to use them correctly.
  
  
• Steroids: These medicines decrease swelling in your airways to help you breathe easier. They are usually used in mild persistent asthma and the severe types of asthma. Steroids may come as inhalers or pills.

What are inhalers? Inhalers are devices which give your medicines as a mist or powder for you to breathe in. Your caregiver will help you choose the best type of inhaler for you. He will help you choose an inhaler that is easy for you to use and carry. The following are some types of inhalers. Ask your caregiver for more information about the inhaler that you need to use.

• Metered dose inhaler: This is a small tube shaped device which holds liquid asthma medicine. To use it, hold the open end inside your mouth. When you press a switch, the liquid medicine comes out as a mist. You breathe in this mist through your mouth, and it goes to your airways and lungs. Your caregiver may tell you to use a spacer with this inhaler. A spacer is a large tube which holds the mist before you breathe it in.
  
  
• Nebulizer: This inhaler type changes liquid asthma medicine into a mist. A long tube goes from the machine to a small round chamber (container) which holds liquid asthma medicine. After you turn on the machine, the liquid turns into a mist. You breathe in this mist through an opening on the chamber.
  
  
• Dry powder inhaler: This is a small tube or disc shaped device which contains powder asthma medicine. You hold the open end of it inside your mouth. When you press a switch, the powder is released inside. With this type of inhaler, you must breathe in hard to suck in the powder. The powder goes through your airways and reaches your lungs.

What is well-controlled asthma? When your asthma is well controlled, you will feel that you are breathing easier. Wheezing and tightness in your chest will be milder. Your symptoms will appear twice a week or less often. You will not wake up during the night or early in the morning because you are coughing or having trouble breathing. You will not need to use bronchodilator medicines more than twice a week. You will not be bothered by asthma symptoms when exercising, working, or doing things you enjoy. You will have an increase in your PEF, which means that you are breathing more easily.

How can I prevent asthma attacks? Things to avoid:

• Avoid triggers such as dust, smoke, chemicals, and very hard exercise. Do not eat foods that you know you are allergic to. Avoid foods that contain sulfites such as wine or processed foods. Stop smoking, and stay away from people who do. Keep windows closed during the seasons when pollen and molds are at the highest, such as spring.
  
  
• Keep pets, such as cats, out of your home. If you have cockroaches or other pests in your home, get rid of them quickly.

• Follow your asthma action plan. Remember the symptoms that you have before your asthma attacks. This helps you watch out for the next attack.
  
  
• Make sure air flows freely in all the rooms in your house. Use air conditioning to control the temperature and humidity in your house.
  
  
• Remove old carpets, fabric covered furniture, drapes, and furry toys in your house. Use special covers for your mattresses and pillows. These covers do not let dust mites pass through or live inside the pillow or mattress. Wash your beddings once a week in hot water.

What are the risks of having asthma? If you do not treat your asthma, you can have more and longer asthma attacks. Your symptoms can get worse, and you may die. Your airways may thicken, letting less air through them. Your air sacs may fill with mucus. Your lung tissue can get damaged and scarred. This can lead to other conditions such as emphysema and chronic obstructive pulmonary disease (COPD). Ask your caregiver if you have questions about your condition, medicines, or treatments.

When should I call my caregiver? Call your caregiver if:

• You are coughing more than usual, wheezing, and have trouble breathing.
  
  
• Your medicines do not relieve your symptoms as well as they used to.
  
  
• You find it hard to do the things you enjoy because of wheezing, coughing, or other symptoms.

When should I seek immediate help? Seek care immediately or call 911 if:

• You feel that very little air is reaching your lungs and you cannot breathe.
  
  
• You have trouble thinking, or you faint.
  
  
• You have very bad chest pain.
  
  
• Your lips or fingernails turn gray or blue.

Where can I find more information? Having asthma can be hard for you and your family. Learning more about asthma can help prevent asthma attacks. Contact the following for more information:

• American College of Allergy, Asthma, and Immunology
  85 West Algonquin Road, Suite 550
  Arlington Heights, IL 60005
  Phone: 1-847-4271200
  Phone: 1-800-8427777
  Web Address: www.acaai.org
  

• National Asthma Education and Prevention Program
  National Heart, Lung and Blood Institute
  National Asthma Education and Prevention Program
  P.O. Box 30105
  Bethesda, MD 20824-0105
  Phone: 1-301-592-8573
  Web Address: http://www.nhlbi.nih.gov/about/naepp/
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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