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Asthma—Adult

by Rosalyn Carson-DeWitt, MD

Definition TOP

Asthma is a chronic disease that affects the function and lining of the airways or tubes of the lungs. It narrows the airways and makes it difficult to breathe.

There are different degrees of asthma. Some people may have mild asthma with rare flare-ups. Others may have a severe, constant asthma.

Inflamed Bronchus in the Lungs

Causes TOP

The exact causes of asthma are unknown, but genetics play a role.

Asthma symptoms are caused by an increased sensitivity of the airways to certain triggers. The triggers cause the lining of the airways to swell and produce extra fluid called mucus. At the same time, the muscles around the outside of the airway tighten in response to the irritation. All of these reactions narrow the airways and make it difficult to breathe. This response is often referred to as an asthma attack.

Possible triggers of an asthma attack in a person with asthma include:

Viral illness
Exercise
Cold weather or changes in the weather
Sinusitis
Gastroesophageal reflux disease (GERD)
Sulfites, preservatives used in dried fruits and wine
Medications, such as aspirin, ibuprofen, and beta-blockers
Exposure to irritants or allergens, including:
- Cigarette smoke
- Smoke from a wood-burning stove
- Pet dander
- Dust
- Chemicals
- Mold and mildew
- Pollen
- Smog or air pollution
- Perfumed products

Risk Factors TOP

Factors that may increase your chance of asthma include:

Regularly breathing in cigarette smoke, including second-hand smoke
Regularly breathing in industrial or agricultural chemicals
A family member who has asthma
History of bronchiolitis
History of multiple respiratory infections during childhood, especially less than 1 year old
Being overweight
History of wheezing or asthma as a child
Having allergies
Premature birth
Having a mother who smoked during pregnancy

Symptoms TOP

Symptoms include:

Cough
Wheezing
Tightness in the chest
Trouble breathing
Shortness of breath
Chest pain
Limited exercise tolerance

Diagnosis TOP

You will be asked about your symptoms and medical history. A physical exam will be done.

Your doctor may also do some tests to measure lung function. They may include:

Peak flow assessment
Pulmonary function tests (PFTs)
Reversibility testing
Bronchoprovocation tests

Your doctor may also do some allergy tests. The test will help determine if allergies are causing symptoms. The test may include skin pricks or blood tests.

Treatment TOP

The treatment strategy for asthma includes:

Medications
Avoidance of allergens and irritants and control of contributing factors such as gastroesophageal reflux and sinusitis
Regular assessment and monitoring

You and your doctor should also create an asthma action plan. This is a plan you will follow to help control your asthma and handle asthma attacks.

Asthma Medications

Medications Used to Control Asthma

These medications are used to avoid asthma attacks, but will not treat an existing attack. Medication may include any of or combinations of:

Inhaled corticosteroids to prevent airway swelling and inflammation
Inhaled long-acting beta agonists to relax the airways and keep them from tightening
Oral leukotriene modifiers to prevent airway inflammation and swelling, decrease the amount of mucus in the lungs, and open the airways
Inhaled cromolyn or nedocromil to prevent airways from swelling from contact with an asthma trigger
Biologic agents, such as omalizumab, if asthma is not controlled by other medications

Medications Used to Treat an Asthma Attack

These medications are used to treat an asthma attack.

Medication may include:

Inhaled quick-acting beta agonists and anticholinergic agents to open the airways
Oral corticosteroids to reduce severe airway inflammation

Other Treatments

Bronchial thermoplasty to reduce excessive smooth muscle in the lungs and decrease the ability of the airways to constrict.

Prevention is an important step in asthma care. Allergy avoidance can be effective with asthma that is made worse by allergens. Some general tips for allergen avoidance include:

Avoid outside activities if there are high levels of air pollution, pollen, or mold spores.
Keep your windows closed during seasons with high pollen or mold spores. Air conditioning may help filter out allergens during warm seasons.
Consider getting a portable HEPA unit air cleaner to use in sleeping areas.
Consider getting HEPA filters for your heating/cooling system and your vacuum cleaner.
Have someone else vacuum for you. Avoid a room that has been freshly vacuumed. If you do vacuum, use a dust mask.
Keep the humidity down in your house. This may help prevent the growth of mold.
Treat allergies and sinusitis as advised by your doctor.
If allergies trigger your asthma attacks, ask your doctor about ways to manage your allergies.

It may be helpful to learn breathing techniques or doing breathing exercises. Improved fitness may also increase exercise tolerance and reduce attacks. Ask your doctor for advice.

Monitoring TOP

Your asthma plan may need to be adjusted to adapt to changes in your life or health. Staying in contact with your doctor between visits can help you have better control of your asthma.

Your doctor may want to monitor you at home with a peak flow meter.

Online programs aimed at helping you manage your own symptoms can improve asthma control and lung function. Some examples of programs include American Lung Association or Asthma and Allergy Foundation of America.

Prevention TOP

There are no guidelines for preventing asthma because the cause is unknown. However, you can help prevent asthma attacks by avoiding things that trigger your attacks. Triggers can vary from person to person but some general guidelines include:

Avoid strong chemicals or odors like perfume.
Avoid strenuous outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
Get a yearly flu shot. Colds and flus can worsen asthma.
Don't smoke. If you are pregnant, it is important that you do not smoke.
Avoid secondhand smoke. Do not allow anyone to smoke in your home.
Don't use a wood-burning stove or fireplace, including unvented gas fireplaces.
If cold weather triggers your asthma, avoid strenuous activities in cold weather. If you must, use a scarf or mask to warm the air before it reaches your lungs.

Talk to your doctor about:

The right level of exercise for you
Ways to track your asthma to help identify and treat flare-ups right away
Your work, hobbies, and home activities to see if any of these may be causing or worsening your asthma

RESOURCES:

American Academy of Allergy, Asthma, and Immunology
http://www.aaaai.org

Asthma and Allergy Foundation of America
http://www.aafa.org

CANADIAN RESOURCES:

Allergy Asthma Information Association
http://aaia.ca

The Lung Association
http://www.lung.ca

References:

Asthma in adults and adolescents. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated February 22, 2017. Accessed August 28, 2017.

Asthma exacerbation in adults and adolescents. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated January 13, 2017. Accessed August 28, 2017.

Asthma stepwise management in adults and adolescents. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated July 21, 2017. Accessed August 28, 2017.

Asthma overview. Asthma and Allergy Foundation of America website. Available at:
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Accessed August 28, 2017.

Breathing exercises and or retraining techniques in management of asthma. Agency for Healthcare Research and Quality website. Available at:
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Accessed August 28, 2017.

Sublett JL, Seltzer J, Burkhead R, et al. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. J Allergy Clin Immunol. 2010;125(1):32-38.

Flu and people with asthma. Center for Disease Control and Prevention website. Available at:
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Updated September 25, 2013. Accessed August 28, 2017.

1/6/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Levenson M. Long-acting beta-agonists and adverse asthma events meta-analysis. Joint Meeting of the Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee and Pediatric Advisory Committee. December 10-11, 2008.

2/17/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Bailey EJ, Cates CJ, Kruske S, et al. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2009;(1):CD006580.

7/6/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Thomas M, McKinley RK, Mellor S, et al. Breathing exercises for asthma: a randomised controlled trial. Thorax. 2009;64(1):55-61.

9/2/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Van der Meer V, Bakker MJ, van den Hout WB, et al. Internet based self-management plus education compared with usual care in asthma: a randomized trial. Ann Intern Med. 2009;151(2):110-120.

10/8/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Ducharme F, Chroinin M, Greenstone I, et al. Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev. 2010;(5):CD005535.

1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: McLean S, Chandler D, Nurmatov U, et al. Telehealthcare for asthma. Cochrane Database Syst Rev. 2010;(10):CD007717.

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11/2/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Normansell R, Kew KM, et al. Sublingual immunotherapy for asthma. Cochrane Database Syst Rev. 2015 Aug 28;8:CD011293.

Last reviewed September 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 8/28/2017

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