asthma overview

Asthma: “Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning. Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.” –NIH

In asthma, the  airways narrow, swell and produce extra mucus, which can make breathing difficult and trigger coughing, wheezing and shortness of breath. Asthma symptoms vary from person to person. For some, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

Classification of asthma:

  1. Mild intermittent: Mild symptoms up to two days a week and up to two nights a month.
  2. Mild persistent: Symptoms more than twice a week, but no more than once in a single day.
  3. Moderate persistent: Symptoms once a day and more than one night a week.
  4. Severe persistent: Symptoms throughout the day on most days and frequently at night

Asthma symptoms include:

  • Shortness of breath
  • Chest tightness or pain
  • Trouble sleeping caused by shortness of breath, coughing or wheezing
  • A whistling or wheezing sound when exhaling (this is especially common in children)
  • Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

For some people, asthma flares up in certain situations:

  • Exercise-induced asthma. It is triggered by strenuous physical activity and may be worse when the air is cold and dry.
  • Occupational asthma. It may be triggered by in the workplace, such as chemical fumes, gases, dust, etc.
  • Allergy-induced asthma. It may be triggered by airborne allergens like as pollen, mold spores, pet dander, etc.

Tests that may be performed during the exam:

The two most common tests are peak expiratory flow rate and spirometry. These are done to test lung function. Another screening test is the methacholine challenge. Methacholine can trigger asthma when inhaled. It causes a mild constriction of your airways. A very strong reaction to methacholine may indicate asthma. This test may be used even if the initial lung function test is normal.

If allergy is a suspected trigger, allergy testing may be ordered. Sputum eosinophil testing may also be performed. Eosinophils are a type of white blood cell that are indicate allergy. If exercise induced asthma is suspected, provocative testing may be performed to see if  symptoms are produced when the patient performs vigorous physical activity or takes several breaths of cold air.


The Medical Approach:

Long-term asthma control medications.

Inhaled corticosteroids. These are given to reduce inflammation. They inculde fluticasone (Flonase, Flovent HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta). At high doses side effects can include: sore mouth, thrush, cataract, thinning of bone, and slight growth reduction.

Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to 24 hours. These medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction. Other side effects can include: headache, nausea, stomach upset, pain, fever, muscle ache, fatigue, sore throat, laryngitis and liver enzyme elevation.

Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways. These medications are also known as rescue medicines. They are used for quick relief of asthma symptoms, such as wheezing, “feeling tight” when breathing, coughing and shortness of breath. Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. These drugs can mask asthma deterioration, so it is recommended that you not use them for an acute asthma attack. Discuss these issues with your doctor.

Combination inhalers. These medications — such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (Dulera) — contain a long-acting beta agonist along with a corticosteroid. Because these combination inhalers contain long-acting beta agonists, they may increase your risk of having a severe asthma attack.

Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex). Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer — a machine that converts asthma medications to a fine mist — so that they can be inhaled through a face mask or a mouthpiece. Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it.

Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it’s sometimes used to treat asthma attacks. Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it.

Oral and intravenous corticosteroids. These medications — which include prednisone and methylprednisolone — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they’re used only on a short-term basis to treat severe asthma symptoms.

Allergy medications may be recommended if the asthma is triggered or worsened by allergies. These include: Allergy shots (immunotherapy). The idea behind allergy shots is to gradually reduce the immune system reaction to specific allergens.

Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system.