Asthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs.
If you have asthma your airways are always inflamed. They become even more swollen and the muscles around the airways can tighten when something triggers your symptoms. This makes it difficult for air to move in and out of the lungs, causing symptoms such as coughing, wheezing, shortness of breath and/or chest tightness.
For many asthma sufferers, timing of these symptoms is closely related to physical activity. And, some otherwise healthy people can develop asthma symptoms only when exercising. This is called exercise-induced bronchoconstriction (EIB), or exercise-induced asthma (EIA). Staying active is an important way to stay healthy, so asthma shouldn't keep you on the sidelines. Your physician can develop a management plan to keep your symptoms under control before, during and after physical activity.
People with a family history of allergies or asthma are more prone to developing asthma. Many people with asthma also have allergies. This is called allergic asthma.
Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job.
Childhood asthma impacts millions of children and their families. In fact, the majority of children who develop asthma do so before the age of five.
There is no cure for asthma, but once it is properly diagnosed and a treatment plan is in place you will be able to manage your condition, and your quality of life will improve.
An allergist / immunologist is the best qualified physician in diagnosing and treating asthma. With the help of your allergist, you can take control of your condition and participate in normal activities.
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Asthma Symptoms & Diagnosis
According to the leading experts in asthma, the symptoms of asthma and best treatment for you or your child may be quite different than for someone else with asthma.
The most common symptom is wheezing. This is a scratchy or whistling sound when you breathe. Other symptoms include:
• Shortness of breath
• Chest tightness or pain
• Chronic coughing
• Trouble sleeping due to coughing or wheezing
Asthma symptoms, also called asthma flare-ups or asthma attacks, are often caused by allergies and exposure to allergens such as pet dander, dust mites, pollen or mold. Non-allergic triggers include smoke, pollution or cold air or changes in weather.
Asthma symptoms may be worse during exercise, when you have a cold or during times of high stress.
Children with asthma may show the same symptoms as adults with asthma: coughing, wheezing and shortness of breath. In some children chronic cough may be the only symptom.
If your child has one or more of these common symptoms, make an appointment with an allergist / immunologist:
• Coughing that is constant or that is made worse by viral infections, happens while your child is asleep, or is triggered by exercise and cold air
• Wheezing or whistling sound when your child exhales
• Shortness of breath or rapid breathing, which may be associated with exercise
• Chest tightness (a young child may say that his chest “hurts” or “feels funny”)
• Fatigue (your child may slow down or stop playing)
• Problems feeding or grunting during feeding (infants)
• Avoiding sports or social activities
• Problems sleeping due to coughing or difficulty breathing
Patterns in asthma symptoms are important and can help your doctor make a diagnosis. Pay attention to when symptoms occur:
• At night or early morning
• During or after exercise
• During certain seasons
• After laughing or crying
• When exposed to common asthma triggers
An allergist diagnoses asthma by taking a thorough medical history and performing breathing tests to measure how well your lungs work.
One of these tests is called spirometry. You will take a deep breath and blow into a sensor to measure the amount of air your lungs can hold and the speed of the air you inhale or exhale. This test diagnoses asthma severity and measures how well treatment is working.
A FeNO test or exhaled nitric oxide test, in patients with allergic or eosinophilic asthma, is a way to determine how much lung inflammation is present and how well inhaled steroids are suppressing this inflammation. With allergic or eosinophilic asthma, sometimes you may feel your breathing is fine, but when you measure your exhaled nitric oxide, it may still be significantly elevated, and you might do better in the long-term using slightly more of your inhaled steroid to suppress this inflammation.
Many people with asthma also have allergies, so your doctor may perform allergy testing. Treating the underlying allergic triggers for your asthma will help you avoid asthma symptoms.
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Asthma Treatment & Management
There is no cure for asthma, but symptoms can be controlled with effective asthma treatment and management. This involves taking your medications as directed and learning to avoid triggers that cause your asthma symptoms. Your allergist will prescribe the best medications for your condition and provide you with specific instructions for using them.
Controller medications are taken daily and include inhaled corticosteroids (fluticasone (Flovent Diskus, Flovent HFA, Arnuity Ellipta), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide (Alvesco), flunisolide (Aerobid), beclomethasone (Qvar) and others).
Combination inhalers contain an inhaled corticosteroid plus a long-acting beta-agonist (LABA). LABAs are symptom-controllers that are helpful in opening your airways. However, in certain people they may carry some risks.
LABAs should never be prescribed as the sole therapy for asthma. Current recommendations are for them to be used only along with inhaled corticosteroids. Combination medications include fluticasone and salmeterol (Advair Diskus, Advair HFA), fluticasone and vilanterol (Breo Ellipta), budesonide and formoterol (Symbicort), and mometasone and formoterol (Dulera).
Anticholinergics are inhaled medications that also help in opening the airways. The medication tiotropium (Spiriva Respimat) is used as maintenance therapy in asthma.
Leukotriene modifiers are oral medications that include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR).
Quick-relief or rescue medications are used to quickly relax and open the airways and relieve symptoms during an asthma flare-up, or are taken before exercising if prescribed. These include: short-acting beta-agonists. These inhaled bronchodilator (brong-koh-DIE-lay-tur) medications include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). Quick-relief medications do not take the place of controller medications. If you rely on rescue relief more than twice a week, it is time to see your allergist.
Oral and intravenous corticosteroids may be required for acute asthma flare-ups or for severe symptoms. Examples include prednisone and methylprednisolone. They can cause serious side effects if used on a long term basis.
Several newer medications are also used to treat severe or difficult-to-treat asthma on a regular basis. These are injections or infusions, are called biologics, and sometimes blood tests are necessary to determine if these treatments are suitable for your particular kind of asthma. These include omalizumab (Xolair) for allergic asthma, and the medications benralizumab (Fasenra), mepolizumab (Nucala), and reslizumab (Cinqair) if your asthma occurs in association with the presence of cells called eosinophils on a blood test. Dupilumab (Dupixent) has been approved to treat eosinophilic asthma as well as asthma that is dependent on regular oral corticosteroids for treatment.
Visit the AAAAI Drug Guide for a complete list of medications commonly used to treat asthma.
If you are pregnant, you may be hesitant about taking medications, including those for asthma. This can be a mistake for your health and that of your baby-to-be. Continue taking your prescribed asthma medications and make an appointment with your allergist to discuss treatments that will help you have a healthy pregnancy. Additionally, you may want to enroll in a study designed to monitor medications and pregnancy.
People with asthma are at risk of developing complications from respiratory infections such as influenza and pneumonia. That is why it is important for asthma sufferers, especially adults, to get vaccinated annually.
With proper treatment and an asthma management plan, you can minimize your symptoms and enjoy a better quality of life.