Asthma Insight & Management
Scientists don’t know precisely why some people get asthma and others don’t. What they do know is that it involves a combination of genetic factors, which individuals are born with, environmental factors, and an individual’s own immune system.
We don’t yet have the ability to link genetic factors to how asthma manifests itself in different patients. We have a better understanding of the environmental factors. Exposure to dust mites and respiratory infections from viruses are two known causes of the development of asthma. Dust mites are tiny insects that live in the home and feed off dead skin particles.
Environmental factors may play a role in the development of asthma. They include tobacco smoke, air pollution, and diet. Some scientists think exposure to excessive ozone in the air, or to particle pollution, may be involved. As for diet, there are some associations with being overweight or a low intake of antioxidants and omega-3 fatty acids, but these are not completely understood.
What are asthma symptoms? Learn more
Can you speak the asthma “lunguage?” See our asthma glossary
Asthma patients report a variety of bothersome symptoms such as coughing, wheezing, chest tightness and shortness of breath. Asthma symptoms are different for different people and they can vary from one time to another. They also can vary in frequency sometimes occurring once every few months and other times occurring every week or every day. Asthma symptoms can be mild, but sometimes they can be serious enough to make you stop what you are doing.
Asthma may persist throughout the year
, though many asthma patients surveyed in AIM who reported that they have asthma symptoms that have been more frequent or severe during a particular season or time of year in the past year say that
April is the worst month
for symptoms. Attacks can be set off by a variety of triggers
and environmental factors, including exercise, pollen, dust, animals, grass and tobacco or fumes or odors. Symptoms can worsen during periods of viral infection. Changes in the weather and stress can also aggravate asthma symptoms. Some people will experience tightening of the chest on cold wintry days, for example. In others, asthma may be triggered by an emotional instigation, such as crying or laughing.
When patients’ asthma symptoms get worse or they are in the middle of a flare-up, they may suddenly find they can’t breathe comfortably. What’s frightening about asthma is that exacerbations can occur without warning. They can cause discomfort, trips to the emergency room and overnight stays in the hospital.
Fortunately, doctors, researchers, and the asthma community have developed many effective ways to manage asthma. These approaches involve medicines, close partnerships between patients and doctors, and education for asthma patients, parents, and caregivers.
Your asthma action plan
Everybody who has asthma should have a written asthma action plan, worked out with your doctor and family members.You need to have a detailed physical examination and give the doctor your complete medical history. The doctor will use a spirometer, or flow meter, to measure the functional capability of your lungs, called a peak flow reading. A baseline measurement will help the doctor see how your lungs recover or worsen over the course of time.
The doctor will also ask about your environment (where you live, what you have inside your home, who you live with, whether you have pets) and what activities or situations aggravate your breathing problems.
Then, in collaboration with you and your family, the doctor will write up a plan that you can follow to lessen the impact of asthma on your life. Part of this plan may include making changes to the environment you live in, or changing your diet or exercise routine. The doctor will also talk to you about your willingness to take the action steps required to gain control of your asthma. You may be asked to take peak flow readings at home.
Treating asthma
Part of your action plan may include prescriptions for medicines that will help your lungs and airways work better. There are several categories of asthma medications, designed to accomplish different tasks in the body. Some are designed to be inhaled, and others to be taken by mouth and swallowed. Some are intended to give quick relief by relaxing the muscles in the airways, and others, known as “maintenance medicines,” help to prevent symptoms by reducing inflammation. And others are combinations of various types. It’s important to understand the difference between the medicines and to use them appropriately.
One thing jumps out from the survey: Many people with asthma may not be taking their medications properly.
They’re not grasping that taking their maintenance medicines
when prescribed regularly is the best way to avoid disruptive flare-ups.
Instead, they may be overusing their quick-relief medicines
.
The underlying problem seems to be that many people don’t want to take medicines when they feel fine. But to manage asthma effectively, patients who are given prescriptions for long-term maintenance medications by their doctors need to take the preventive medicines daily, but only if their doctor prescribes and where appropriate.
One common feature of asthma is the short periods when asthma symptoms become more frequent or more severe. These periods of symptom worsening are generally referred to as “asthma exacerbations” by health practitioners, but these periods are also referred to as “asthma flare-ups” or “asthma attacks” by patients. The majority of asthma patients surveyed in AIM report that they have experienced sudden severe episodes of coughing, wheezing, chest tightness or shortness of breath in the past year. They also report periods in the last year when their asthma symptoms are more frequent or severe than normal, and most commonly these patients reported that these episodes lasted one, two or three days. Asthma patients also report a 33 percent average decline in productivity
at times of the year when asthma is at its worst compared to a typical day.
The good news is that tools and techniques are available to help patients better manage their asthma. While asthma patients surveyed have low expectations for asthma control and tend to overestimate the level of asthma control that they are achieving, healthcare providers generally have higher expectations for asthma management than their patients. This means that education and continued communication between physicians and patients may be a key consideration in asthma control.
Do you want more sources of information about asthma? See our resource page
Allergist: A doctor that has specific training in the care of asthma and in some cases may be more familiar with current clinical guidelines than a pediatrician or general practitioner.
Asthma: A complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.
Asthma action plan: A written set of directions or a chart that tells you what to do if asthma symptoms occur, depending on their severity. Your action plan also should tell you what to do when you do NOT feel any symptoms (i.e., preventive care).
Asthma control: The extent to which the various manifestations of asthma have been reduced or removed by treatment. This includes the level of asthma control, which is gauged from symptoms and the extent to which the patient can carry out daily activities and achieve optimum quality of life, and the risk of loss of control, exacerbations, accelerated decline in lung function, and side effects of treatment.
Asthma flare-up: When symptoms of asthma, such as wheezing, coughing, or shortness of breath, become more severe, more frequent, or both. It is also known as an asthma flare, attack, episode, or exacerbation. The airways are overly sensitive to certain things (such as allergies, viral infections, cold air, exercise, and smoke) that can “trigger,” or bring on, an asthma flare-up.
Asthma inhaler: Hand-held portable devices that deliver medication to your lungs. A variety of asthma inhalers are available to help relieve or control asthma symptoms. Types of inhalers include metered dose inhaler and dry powder inhaler.
Bronchial tubes: Airways in the lungs. There is one major branch going into each lung, and these then divide into many smaller branches.
Exacerbations: Asthma exacerbations are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness, or some combination of these symptoms. Severe asthma exacerbations are defined as events that require urgent action on the part of the patient and physician to prevent hospitalization or death. Moderate asthma exacerbations are defined as events that are troublesome to a patient, and that prompt a need for a change in treatment, but that are not severe.
Inflammation: Occurs when the inner linings of airways become swollen or inflamed, leaving less room in the airways for the air to move through. In susceptible individuals, this inflammation causes recurrent episodes of coughing, wheezing, breathlessness, and chest tightness. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible with treatment.
Long-term control medications: Used daily to achieve and maintain control of persistent asthma. The most effective are those that attenuate the underlying inflammation characteristic of asthma.
Peak flow meter: Portable device that measures air flow, or peak expiratory flow rate (PEFR). It can be used to:
- Find out how severe your asthma is
- Check your response to treatment during an acute asthma episode
- Monitor progress in treatment of chronic asthma and provide information for any changes in your therapy
- Detect worsening lung function and avoid a possible serious asthma flare-up
Pulmonologist: A doctor with special training in diagnosing and treating respiratory (breathing) conditions.
Quick-relief medications: Medications that are used to treat acute symptoms and exacerbations of asthma.
Spirometry: A test for diagnosing asthma and one of the fundamental measures of asthma control. It provides an objective and highly reproducible measure of airflow limitation caused by smooth muscle contraction or structural changes. The instrument (spirometer) measures the maximum volume you can exhale after breathing in as much as you can. Small spirometers are available for home use, although peak flow meters are more appropriate for most people.
