Asthma is a long-term disease of the airways of the lung. The airways become sensitive to triggers (allergens and irritants). With exposure to triggers, the following changes occur:
- The lining of the airways becomes swollen and inflamed.
- The muscles that surround the airways tighten.
- More mucus is produced, leading to mucus plugs.
All of these factors cause the airways to narrow. This makes it hard for air to go in and out of the lungs.
The exact cause of asthma is unknown. It is believed to be partly inherited. The environment, infections, and chemicals released by the body are also involved.
Exercise causes symptoms in many people with asthma. Symptoms can occur during, or shortly after, exercise. In some people, stress or strong emotions can cause asthma symptoms.
All of the following may be asthma triggers:
It is most common in the following people:
- Children and teens ages 5 to17
- Those living in cities
Other factors include the following:
- Personal or family history of asthma or allergies
- Exposure to secondhand tobacco smoke
- Children with a family history of asthma
- Children who have allergies or atopic dermatitis
- Children who have exposure to secondhand and tobacco smoke
The symptoms of asthma include:
- Trouble breathing or shortness of breath
- Tightness in the chest
- Wheezing or a whistling sound when breathing
- Breathing becomes harder and may hurt
- Talking and sleeping may be difficult with severe symptoms
To diagnose asthma and rule out other lung disorders, health care providers rely on your medical history, physical exam, and other tests. An important test for the diagnosis and monitoring of asthma is spirometry.
A spirometer is a device that is used to determine how well the lungs are working. It measures the amount and speed of air exhaled.
Other tests may also be done to check for conditions such as allergies.
Your healthcare provider will figure out the best treatment based on:
- How old you are
- Your overall health and medical history
- How sick you are
- How well you can handle specific medicines, treatments, or therapies
- How long the condition is expected to last
- Your opinion or preference
There is no cure for asthma. It can usually be controlled by avoiding triggers and taking medicines as prescribed by your healthcare provider.
Monitoring symptoms, and knowing what to do if symptoms get worse, is also a vital part of asthma care. Experts recommend making an Asthma Action Plan with your provider.
Medicines for asthma
The two types of asthma medicines are long-term control and short-term or quick-relief medicines. Long-term control medicines are usually taken every day to control asthma symptoms. Quick-relief medicines calm asthma symptoms fast, but only last for a short time. People with asthma may take either long-term or quick-relief medicines alone. Some people with asthma take short-term medicines along with long-term control medicines.
Your healthcare provider should regularly assess and adjust your medicines as needed.
Long-term control medicines
When you first start taking long-term control medicines, it may take a few weeks for the medicines to work. It is very important to take these medicines every day. Long-term asthma control medicines include:
- Anti-inflammatory medicines. These include inhaled corticosteroids and nebulizer cromolyn and nedocromil. These medicines reduce or prevent swelling in the airways.
- Bronchodilators. These medicines include inhaled long-acting beta2-agonists, inhaled long-acting muscarinic antagonists (tiotropium), sustained-release theophylline and sustained-release beta2-agonist tablets. These medicines relax muscles around the airways. (Inhaled long-acting beta2-agonists should never be used for long-term asthma control unless they're used with inhaled corticosteroids).
- Leukotriene modifiers. These medicines block the action of chemicals called leukotrienes, which cause inflammation and narrowing of the airways.
- Anti-IgE (omalizumab). This medicine reduces allergic reactions. It is given once or twice monthly by injection, usually for people with asthma that is harder to control.
Quick-relief medicines quickly relax the muscles around the airways. The relief only last about 2 to 3 hours. Only control medicines give long-term control and help prevent the recurrence of symptoms.
Quick-relief medicines may include:
- Inhaled short-acting-beta2-agonists. Short-acting beta2-agonists help relax muscles around the airways.
- Inhaled anticholinergics. These are medicines that block a chemical called acetylcholine. Acetylcholine contracts the muscles and increases production of mucus in the airways.
Inhalation devices for asthma
Inhaled medicines go directly to the lungs. There are fewer side effects than medicines taken by mouth. Inhaled medicines may be anti-inflammatory or bronchodilating, or both. The devices are:
- Metered-dose inhalers (MDI). This is the most common type of inhaler. It uses a chemical to push the medicine out of the inhaler. MDIs are held in front of or inserted into the mouth as the medicine is released in puffs or used with a space device. Follow the instructions on the use and cleaning of the inhaler. Healthcare providers, nurses, respiratory therapists, and pharmacists can answer any questions.
- Nebulizers. A nebulizer is a device that sprays a fine mist of medicine. This is done through a mask, using air under pressure, or an ultrasonic machine. A mouthpiece or mask is connected to a machine via plastic tubing to deliver medicine. There are different kinds of nebulizers. Some are smaller and can easily travel. Knowing how to use and clean a nebulizer is important. Healthcare professionals can help.
- Dry powder or rotary inhalers. These inhalers deliver powered medicine as a person breathes. As with any medical device, follow all instructions.
Avoiding triggers is key in managing asthma. Triggers may be allergens, irritants, other health problems, exercise, medicines, and strong emotions. The following can help you limit your exposure:
- Dust. Dust is the most common year-round allergen. The allergy is actually caused by tiny dust mites. Dust mites are found in mattresses, carpets, and upholstered furniture, like sofas and chairs. They live best in warm, humid conditions. The best way to prevent allergy symptoms caused by dust mites is to limit your exposure. Pay special attention to the bedroom where you spend a lot of your time. Install dust mite covers on your mattress, box spring, and pillows.
- Pollens. If you are allergic to pollen, during pollen season keep all car and house windows closed and use the air conditioning. If you are outdoors, shower, wash your hair, and change your clothes when you go inside.
- Pets. Pets that have fur or feathers cause allergies for many people. Some people with pets are not able to keep them because of their allergies. If you do have pets, try to avoid touching them. If you do pet or handle them, wash your hands afterward. Be sure to keep pets off your bed and out of your bedroom. And have someone brush and bathe your pet regularly.
- Mold and mildew. These can trigger asthma. Outside, avoid damp, shady areas. Use exhaust fans when cooking or bathing. Keep indoor humidity below 45% and drain and clean your dehumidifier regularly.
Even though exercise is a common asthma trigger, you should not limit your participation in sports or exercise, unless directed by a healthcare provider. Exercise is good for your health and lungs. Activities such as swimming, golf, and karate are good choices for persons with asthma. Always warm-up before exercise and cool down at the end of exercise. Ask your provider about using your quick-relief medicine before starting exercise.
If you smoke, quit.
Avoid smoke and don’t use wood stoves or kerosene heaters. Also avoid strong perfumes, cleaning products, fresh paint, and other things with strong odors.
Some medicines can worsen asthma symptoms. These medicines include aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs), and beta-blockers used to treat heart disease and high blood pressure. Talk with your healthcare provider about your asthma history and use of these medicines.
Other health problems
Respiratory infections, such as colds and the flu, gastroesophageal reflux (GERD or heartburn), being overweight, sleep apnea, depression, and other problems can make it more difficult to control asthma. Work with your provider to treat any of these problems.
Emotions that go with laughing and crying can trigger asthma symptoms. There are ways to learn how to better manage your emotions.
- Asthma is a long-term disease of the airways.
- Triggers irritate sensitive airways, making it hard to breathe.
- Avoiding triggers is an important part of treatment.
- Long-term medicines control symptoms and are taken every day, even when you feel well and don't have asthma symptoms.
- Rescue medicines provide relief from symptoms quickly, but the relief is only short-term.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
January 16, 2018
Asthma treatment in adolescents and adults. UpToDate., An Official American Thoracic Society clinical Practice Guideline: Exercise-induced Bronchoconstriction. American Thoracic Society., Asthma Action Plan. National Heart, Lung and Blood Institute., Indoor Environment Exposure and Exacerbation of Asthma. Environmental Health Sciences. , Mold Allergy. Asthma Allergy Foundation of America.
Brown, Kim, APRN , Pierce-Smith, Daphne, RN, MSN, CCRC