Asthma

What is Asthma?

Asthma is a chronic disease of the airways of the lungs. The airways of people who have asthma intermittently become inflamed.  This inflammation swells the lining of the airway and causes thickening of the muscles surrounding the airways, which can make breathing difficult and cause symptoms of coughing, wheezing, and shortness of breath.  Exposure to cold air, fumes or irritating substances, exercise or allergies can trigger or worsen asthma symptoms. Seasonal or environmental allergies may also cause asthma symptoms to flare up. Asthma can affect people of any age.

The Facts

• Asthma is a worldwide problem: 300 million people are affected
• Children: 6 million children in the United States have asthma
• Pregnant women: 4 to 8 percent are affected in the United States
• Senior citizens: 5% of seniors have asthma
• The impact: asthma limits a person's ability to perform normal activities, sports, and may cause that person to miss work or school
• Untreated asthma may cause disruption to family life and friendships, increase levels of stress, and lead to frequent visits to the emergency room

Who Gets Asthma?

It's hard to explain why some people get asthma and others don't, it is likely due to the combination of the person's genes and the environment they live in.

The Person (Host Factors)

• Genes play a role in the development of asthma
  • A person is more likely to get asthma if their parents, brothers, or sisters have asthma
  • Certain people will be more at risk to develop symptoms following exposure to environmental allergen and irritants based on their genetics.
• Differences between men and women
  • Boys under the age of 14 are twice as likely to have asthma.
  • In adults, asthma is found greater in women than in men

Environmental Factors

• Outdoor allergies: airborne pollens (tree, grass, weed), molds
• Indoor allergies: dust mites, house dust, dogs, cats, mice, molds, yeast, and cockroach
• Tobacco smoke: cigarette use, secondhand smoke exposure, or having a mother who smoked while pregnant
• Work environment: exposure to certain metals, chemicals, fumes, dust, molds
• Air pollution
• Infections to certain types of viruses, parasites, and bacteria

Diet

• Infants fed formulas with cow's milk or soy protein
• Eating more processed food and less fruits and vegetables
• Eating more vegetable oil and margarine and less fish (oily fish)
• Allergies to some foods, such as eggs, peanuts, or shellfish

When Does Asthma Begin?

Asthma symptoms start when allergens or other irritants cause the lining of the airways to become swollen and narrow. Symptoms get worse when this swelling increases and the muscles around the airways begin to spasm or constrict.  The swollen and constricted airways produce extra mucus, thereby clogging the airways further and blocking the flow of air. This is called an "asthma attack."

What Are the Symptoms?

• Cough (which may be worse at night)
• Chest tightness or pain
• Wheezing (whistling sound when you breath)
• Difficulty breathing with normal day-to-day activities or with exercise
• Cough or wheezing after exercise
• Trouble sleeping because of coughing, wheezing, and shortness of breath

What Can Trigger an Asthma Attack?

• Seasonal pollens or hay fever, dust, molds
• Pets
• Weather changes, cold air
• Infections - viruses, sinus infection
• Tobacco smoke
• Strong emotions - laughing or crying
• Heartburn
• Exercise
• Air pollution
• Perfumes, spray-on deodorants
• Food allergies
• Aspirin, or ibuprofen (Advil, Motrin, Nuprin)
• Sulfite (food preservative in red wine, beer, salad bars, dehydrated soups and other foods)
• Pregnancy and the menstrual cycle in some women

How is Asthma Diagnosed?

To establish a diagnosis of asthma the health care professionals at the Respiratory Specialist will perform the following:

A Complete Medical History

• Review what symptoms the person is having, and establish if the symptoms agree with the diagnosis of asthma or another medical condition
• Review past medical problems and family history 
• Review environmental factors (allergies, smoking, irritant exposure)
• Review what triggers make asthma symptoms worse

A Complete Physical Exam

• Check for signs of breathing difficulties
• Check and listen for abnormal breathing sounds
• Check for signs of seasonal allergies and nasal polyps
• Check for skin rashes or hives

Testing

1. Lung function testing: determines how easily air can move in and out of the lungs.
   • Spirometry/Pulmonary Function Testing checks for airway obstruction or "blocked airways". This is a screening test. During testing, a medication will be given to open your airway, this is called a bronchodilator. If the airways "open up" or lung function improves, then you likely have asthma.
2. Breathing challenge test: uses exercise or irritant exposure to check for airway obstruction. The best test for asthma.
   • Methacholine challenge - Methacholine causes airways to mildly tighten. If you react to Methacholine, this increases the chance you have asthma. If you do not react, that makes asthma less likely because this medication is similar to known asthma triggers.
   • Exercise testing - physical activity can trigger asthma symptoms. Also this will allow the health care provider to check for other problems other than asthma (i.e. heart problems, physical deconditioning).
3. Allergy skin testing should be considered to evaluate asthma triggers.
4. Additional testing.
   • Blood work is sometimes needed to evaluate for inflammation, allergies, cystic fibrosis, and alpha 1 - antitrypsin.
   • Chest X-rays and CT scan of lungs may also be needed in some cases to evaluate the design or structure of the lungs, other lung conditions, or the possibility of infections.

How Severe is My Asthma?

Once asthma has been officially diagnosed it is placed into categories based on how severe the asthma symptoms have become (severity), and of the degree asthma symptoms are minimized by therapy (control).

Classifying Asthma Severity

• Intermittent - daytime symptoms occur 2 times per week or less, and nighttime symptoms occur 2 nights per month or less
• Mild Persistent - symptoms occur three times per week, but not daily. Nighttime symptoms occur 3-4 nights per month
• Moderate Persistent - symptoms occur once a day, and nighttime symptoms occur 2 nights per week
• Severe Persistent - symptoms occur throughout the day and night

Levels of Control

• Well controlled
• Not well controlled
• Very Poorly controlled