Asthma

Asthma is a disease where the airways in the lungs become blocked, swollen or grow more sensitive to particles in the air. A growing number of people are affected by asthma. It is the leading reason why children are put in the hospital. It is also the number one chronic condition that causes children to be absent from school.

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Symptoms

How often and how severe symptoms are varies from person to person. Even with the same person, the symptoms may vary from time to time. Some people only rarely have mild, short attacks. Others will have mild coughing and wheezing a lot of the time. These symptoms may get worse when the person is exposed to things they are allergic to; when viral infections occur or as a result of exercising. Sometimes crying, screaming or laughing hard may set off the symptoms.

The first signs of an attack are acute bouts of wheezing, coughing or being short of breath or symptoms that slowly get worse until the person has a hard time breathing.

Sometimes with children, an itch on the front of the neck or upper chest maybe a warning sign that an attack is about to happen. Other times, a child's only symptom may be a dry cough, especially at night or when exercising.

The person having an attack may notice a cough, shortness of breath, a feeling of tightness or pressure in the chest and may hear wheezes. The cough during an acute attack usually does not produce mucus.

During an acute attack, a person will have a rapid heartbeat and breathing rate. He or she will prefer to sit upright or lean forward. The person may feel anxious and appear to be fighting for air. A doctor listening to the person's chest will hear wheezes. Coarse whistles or snoring sounds may be heard along with the wheezes. The chest may appear too full with trapped air.

If the bout is severe enough, the person may not be able to speak more than a few words at a time. Over time, the person may get tired and be breathing shallowly and not very effectively. His or her skin may start turning bluish.

As the breathing process fails and carbon dioxide builds up in the blood, the person may become confused or lethargic. A doctor may hear less wheezing because the patient's lungs are filling up with mucus. As he or she gets tired, less oxygen and carbon dioxide are being exchanged, so the lungs sound quieter. This is a sign of a serious breathing problem that can quickly become life threatening.

Causes and Risk Factors

Several factors lead to the blocking of the airways, including:

  • Increased secretions
  • Infiltration of cells in the walls of the airways
  • Injury
  • Peeling of the cells that line the airways
  • Spasms of the muscles that line the airways
  • Swelling of the mucous linings of the airways

Muscle spasms in the airways used to be considered the leading cause of obstruction to the airways. Now it is believe that inflammatory disease plays a key role, particularly in chronic asthma.

Most people with asthma have airways that close up quickly in response to stimuli. Why this happens it not yet known. It may be due to changes in the lungs. For example, when the cells in the airways peel away, the person loses factors that help relax contractions in the airways. Thickening inside the airways may be another factor.

Factors that affect inflammation may also have an effect on contractions of the air passages, the production of mucus and swelling inside the air passages. Sometimes these factors are released or formed because of allergic reactions. These include histamine and other substances that make the lungs more sensitive.

More blacks die from asthma than whites. It can affect both adults and children.

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Diagnosis

Some of the tests that may be done to determine if a person is having an asthma attack include:

  • Measuring the amounts of various gases in the blood
  • Checking how much acid is in the blood
  • Lung functioning tests to see how blocked the passages are, how they respond to allergens and irritants and to monitor a patient's condition over time. These are most useful when done before and after a patient is given a spray to open up his or her airways. This will help show how reversible the blockage is.
  • Exercise testing on a treadmill or a bicycle. This is particularly useful with children. More than 90% of children with asthma have lungs that work less effectively after seven minutes of exercise testing.
  • Testing to see whether the lungs are filling and emptying equally together. In people with asthma, the distribution of air through the lungs is often not normal.
  • Measuring whether the lungs are showing a reaction to an allergen
  • Examining the sputum. In a person with asthma and no other complications, the sputum is likely to be sticky, rubbery and whitish. If there is an infection, the sputum may be yellowish.
  • Chest X-ray. This will show whether there is air trapped inside the chest. In children with asthma, the middle part of their right lung may be collapsed
  • Allergy tests to see how sensitive the person is to irritants such as cigarette smoke or allergens from the environment. As part of this, the doctor may ask whether other members of the family have any allergies.

With children it is important to rule out other possible causes of the breathing difficulties, including:

  • A foreign object in the lung that is causing a blockage
  • Abnormalities in the blood vessels, lungs or digestive system that may be putting pressure on the lungs or airways
  • Viruses such as respiratory syncytial virus (RSV) that can cause symptoms like those of asthma
  • Diseases like cystic fibrosis or ones that cause deficiencies in the immune system

In adults, it is important to rule out lung disease and heart failure.

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Treatments

Asthma cannot be cured. The goal of treatment is to prevent symptoms, keep the lungs working as well as possible, maintain normal activities, avoid getting worse, reducing the need for going to the hospital or the emergency department and to avoid bad side effects of treatment.

Managing asthma well usually depends on:

  • Evaluating how severe the asthma is
  • Monitoring the patient well during therapy
  • Controlling environmental factors to prevent attacks. This may mean getting rid of things that may kick off an attack such as animal danders, dust, airborne molds, pollens and cockroaches. Other approaches may include placing the person's mattress and box springs in a zippered casing, removing carpets, controlling temperature and humidity or avoiding foods that contain sulfites (such as red wine, beer or shrimp) if they tend to trigger an attack.
  • Using drugs to control attacks, minimize the symptoms that set off an attack and keeping the airways from getting swollen and red. These can include drugs that relieve the symptoms and those that work to provide long-term control of the condition. Different drugs use different approaches -- such as relaxing muscles, reducing swelling, blocking allergic reactions -- to help a person continue breathing freely.
  • Education. The more a person and his or her family know about asthma - what causes attacks, what drugs to take when and how early to step in to prevent and attack from getting worse - the better off he or she is.

A patient's doctor will provide day-to-day instructions and plans for managing asthma depending on the symptoms and severity of the person's condition.

An acute attack is usually described as:

  • Mild (stage I)
  • Moderate (stage II)
  • Severe (stage III)
  • Respiratory failure (stage IV)

Treatment of an attack can range from inhaling a spray designed to open up airways to being hospitalized and given intravenous drugs. At many stages of asthma, a person may be given oxygen to help them breath and to help them relax.

If there is a lung infection along with asthma, a person may be put on antibiotics. Fluids and the balance of electrolytes in the blood will need to be monitored, especially if an attack lasts more than 12 hours.

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