Asthma—Adult

by Rosalyn Carson-DeWitt, MD

Definition    TOP

Asthma is a chronic disease. It is a change in how the lining of the airways of the lungs work. Asthma makes the airways narrow and makes it hard to breathe.

Some people may have mild asthma with rare flare-ups. Others may have a severe, constant asthma.

Inflamed Bronchus in the Lungs

Copyright © Nucleus Medical Media, Inc.

Causes    TOP

The exact causes of asthma are unknown. Genetics do play a role.

The airways become very sensitive to triggers in people with asthma. The reaction causes a flare up of symptoms called an asthma attack. It includes swelling of airway and increase in mucus. At the same time, muscles around the airway tighten. These reactions all make it hard to breathe.

Risk Factors    TOP

Factors that may increase your chance of asthma include:

  • Regular exposure to cigarette smoke, including second-hand smoke
  • Regular exposure to industrial or agricultural chemicals
  • A family member who has asthma
  • History of bronchiolitis
  • Multiple respiratory infections during childhood, especially before the age of 1
  • Being overweight
  • History of wheezing or asthma as a child
  • Having allergies
  • Premature birth
  • Having a mother who smoked during pregnancy

Symptoms    TOP

An asthma attack can cause:

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

They can range from mild to very severe.

Diagnosis    TOP

You will be asked about your symptoms and past health. A physical exam will be done. The doctor may suspect asthma based on your symptoms.

Some tests may be done to see how well your lungs are working. Lung tests may include:

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 goal of treatment is to prevent asthma attacks when possible. A second goal is to manage attacks and ease breathing.

You and your doctor will create an asthma action plan. This is a plan you will follow to help control your asthma and handle asthma attacks. Tools can also be used at home to test your breathing. Keep in touch with your care team. Your plan made need to change over time.

Medicine

Medicine to Control Asthma

Some medicine is taken on a regular basis. It may help to stop asthma tacks from starting. They can not treat an existing attack. Medicine may include one or more of the following:

  • Inhaled corticosteroids—to prevent airway swelling and inflammation
  • Inhaled long-acting beta agonists—to keep airways relaxed
  • Oral leukotriene modifiers—to prevent airway inflammation and swelling, decrease mucus in the lungs, and open the airways
  • Inhaled cromolyn or nedocromil—to prevent airways from swelling after contact with a trigger
  • Biologic agents—if asthma is not controlled by other medicine

Medicine Used to Treat an Asthma Attack

Other medicine can be used to treat an asthma attack. It will help to open the airways and ease breathing. Options include:

  • Inhaled quick-acting beta agonists and anticholinergic agents—to open the airways
  • Corticosteroids pills—to reduce severe airway inflammation

Procedure

Bronchial thermoplasty may be done for severe asthma. A tool is used to clear out excess muscle around the airway. This will help keep airway more open during an attack.

Avoiding Attacks    TOP

Prevention can be an important part of asthma care. Finding triggers is the first step. 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

If possible triggers should be avoided. Others like medicine or exercise may only need some adjustments. Work with your care team to make your plan to avoid asthma attacks.

Prevention    TOP

Asthma cannot be prevented. However, you can help prevent some asthma attacks by avoiding triggers. 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 increase risk of asthma attacks.
  • Don't smoke.
  • Avoid secondhand smoke. Do not allow anyone to smoke in your home.
  • Don't use a wood-burning stove or fireplace. This includes unvented gas fireplaces.
  • Avoid strenuous activity in cold weather. If you must, use a scarf or mask. It will help to warm the air before it reaches your lungs.

Talk to your doctor about:

  • Right level of exercise
  • Ways to track your asthma
  • Work, hobbies, and home activities

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:

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Asthma overview. Asthma and Allergy Foundation of America website. Available at:
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Global Initiative for Asthma (GINA) global strategy for asthma management and prevention. (GINA 2018)
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Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 9/21/2018

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