Asthma

What is asthma?

Asthma is a chronic condition that affects the airways. It causes wheezing and can make it hard to breathe. Some triggers include exposure to an allergen or irritant, viruses, exercise, emotional stress, and other factors.

Types of asthma

Allergic asthma: is inflammation of the inside lining of the nose and is the single most common chronic allergic disease. In those with allergic rhinitis, increased sensitivity (allergy) to a substance causes your body’s immune cells to release histamines in response to contact with the allergens. Histamines, along with other chemicals, lead to allergy symptoms.

Exercise-induced bronchoconstriction (EIB): it usually affects people within a few minutes of starting exercise and up to 10–15 minutes after physical activity. This condition was previously known as exercise-induced asthma (EIA). Up to 90 percent of people with asthma also experience EIB.

Cough-variant asthma (CVA): In the type of asthma called cough-variant asthma, severe coughing is the predominant symptom. There can be other causes of cough such as postnasal drip, chronic rhinitis, sinusitis, or gastroesophageal reflux disease (GERD or heartburn). Coughing because of sinusitis with asthma is common.

Occupational asthma: is a type of asthma that results from workplace triggers. With this type of asthma, you might have difficulty breathing and asthma symptoms just on the days you're on the job. Many people with this type of asthma suffer with runny nose and congestion or eye irritation or have a cough instead of the typical asthma wheezing.

Nighttime (Nocturnal) asthma: also called nocturnal asthma, is a common type of the disease. If you have asthma, the chances of having symptoms are much higher during sleep because asthma is powerfully influenced by the sleep-wake cycle (circadian rhythms). Your asthma symptoms of wheezing, cough, and trouble breathing are common and dangerous, particularly at nighttime.

Cause of asthma

Instead, researchers believe that the breathing condition is caused by a variety of factors. These factors include:

Genetics: If a parent has asthma, you’re more likely to develop it.

History of viral infections: People with a history of viral infections during childhood are more likely to develop the condition.

Hygiene hypothesis: This hypothesis proposes that babies aren’t exposed to enough bacteria in their early months and years. Therefore, their immune systems don’t become strong enough to fight off asthma and other conditions.

Early allergen exposure: Frequent contact with possible allergens and irritants may increase your risk for developing asthma.

Asthma triggers

Certain conditions and environments may also trigger symptoms of asthma. These triggers include:

Illness: Respiratory illnesses such as the flu and pneumonia can trigger asthma attacks.

Exercise: Increased movement may make breathing more difficult.

Irritants in the air: People with asthma may be sensitive to irritants such as chemical fumes, strong odors, and smoke.

Allergens: Animal dander, dust mites, and pollen are just a few examples of allergens that can trigger symptoms.

Extreme weather conditions: Conditions such as very high humidity or low temperatures may trigger asthma.

Emotions: Shouting, laughing, and crying may trigger an attack.

Asthma symptoms

Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times such as when exercising, or have symptoms all the time.

Asthma signs and 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 (wheezing is a common sign of asthma in children)

Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

• Asthma signs and symptoms that are more frequent and bothersome
• Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
• The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:

• Exercise-induced asthma,which may be worse when the air is cold and dry
• Occupational asthma,triggered by workplace irritants such as chemical fumes, gases or dust
• Allergy-induced asthma,triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)

When to see a doctor

See our doctors' to determine what to do when your signs and symptoms worsen and when you need emergency treatment.

Risk factors

A number of factors are thought to increase your chances of developing asthma. These include:

• Having a blood relative (such as a parent or sibling) with asthma
• Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
• Being overweight
• Being a smoker
• Exposure to secondhand smoke
• Exposure to exhaust fumes or other types of pollution
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

Complications

Asthma complications include:

• Signs and symptoms that interfere with sleep, work or recreational activities
• Sick days from work or school during asthma flare-ups
• Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
• Emergency room visits and hospitalizations for severe asthma attacks
• Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Asthma diagnosis

Physical exam

To rule out other possible conditions such as a respiratory infection or chronic obstructive pulmonary disease (COPD)  our doctors' will do a physical exam and ask you questions about your signs and symptoms and about any other health problems.

Tests to measure lung function

You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:

• This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
• Peak flow.A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Our doctors' will give you instructions on how to track and deal with low peak flow readings.

Lung function tests often are done before and after taking a medication called a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma.

Additional tests

Other tests to diagnose asthma include:

• Methacholine challenge.Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.
• Nitric oxide test.This test, though not widely available, measures the amount of the gas, nitric oxide, that you have in your breath. When your airways are inflamed a sign of asthma you may have higher than normal nitric oxide levels.
• Imaging tests.A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.
• Allergy testing.This can be performed by a skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy.
• Sputum eosinophils.This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).
• Provocative testing for exercise and cold-induced asthma.In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.

Asthma Treatment

• Inhaled corticosteroids.These anti-inflammatory drugs include 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).

You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.

• Leukotriene modifiers.These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to 24 hours.

In rare cases, 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.

• Long-acting beta agonists.These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways.

Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration, don't use them for an acute asthma attack.

• 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.
• Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways. It's not used as often now as in past years.

• 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.
• 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.

Lifestyle and home remedies

Although many people with asthma rely on medications to prevent and relieve symptoms, you can do several things on your own to maintain your health and lessen the possibility of asthma attacks.

Avoid your triggers

Taking steps to reduce your exposure asthma triggers is a key part of asthma control, including:

• Use your air conditioner.Air conditioning reduces the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your exposure to dust mites. If you don't have air conditioning, try to keep your windows closed during pollen season.
• Decontaminate your decor.Minimize dust that may worsen nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dustproof covers. Remove carpeting and install hardwood or linoleum flooring. Use washable curtains and blinds.
• Maintain optimal humidity.If you live in a damp climate, talk to your doctor about using a dehumidifier.
• Prevent mold spores.Clean damp areas in the bath, kitchen and around the house to keep mold spores from developing. Get rid of moldy leaves or damp firewood in the yard.
• Reduce pet dander.If you're allergic to dander, avoid pets with fur or feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.
• Clean regularly.Clean your home at least once a week. If you're likely to stir up dust, wear a mask or have someone else do the cleaning.
• Cover your nose and mouth if it's cold out.If your asthma is worsened by cold or dry air, wearing a face mask can help.

Alternative medicine

Certain alternative treatments may help with asthma symptoms.

• Breathing exercises.These exercises may reduce the amount of medication you need to keep your asthma symptoms under control.
• Herbal and natural remedies.Our Herbal Medicine Yash-cough syrup, Milax Tea, Cleanves and Yuwy Capsules, Moringa Plus decoction and Hepatocare syrup all will help to manage  and prevent Asthma. 

Asthma prevention

Avoiding triggers: Steer clear of chemicals, smells, or products that have caused breathing problems in the past.

Reducing exposure to allergens: If you’ve identified allergens, such as dust or mold, that trigger an asthma attack, avoid them as best you can.

Getting allergy shots: Allergen immunotherapy is a type of treatment that may help alter your immune system. With routine shots, your body may become less sensitive to any triggers you encounter.

Taking preventive medication: Your doctor may prescribe medicine for you to take on a daily basis. This medicine may be used in addition to the one you use in case of an emergency.

Our doctors' can help you put an asthma action plan in place so that you know which treatments to use and when.