Asthma is a breathing condition characterized by intermittent wheezing, shortness of breath, and widespread narrowing of the airways. It may abate either spontaneously or as a result of treatment. One characteristic feature of asthma is inflammation of the airways, resulting in swelling of the lining of the bronchi in hyper-responsiveness (which is an exaggerated airway narrowing). The inflammatory changes may be triggered or caused by extrinsic factors such as dust, pollen, animal dander, molds, and other allergens. The airway hyper-responsiveness may be triggered by the above, and in addition exercise, stress, and cold dry air. There are a number of cases of asthma that are not brought on by any presently known external factors. This type of asthma is called intrinsic asthma, and it is also known as late-life asthma. Heredity, including allergies and certain occupational causes of asthma are also important.

Symptoms of Asthma

The severity of asthma may vary with the season, climate, temperature, and infection. There are usually symptom-free periods between attacks. The symptoms may eventually become more persistent.

Wheezing: A very common symptom of asthma which is often present throughout the breathing cycle, but most noticeably during expiration. This is often described as a high-pitched musical sound.

Breathlessness: The most troublesome symptom of asthma. Patients describe a sensation of “tightness” in the chest or an inability to catch their breath.

Cough: A symptom in some patients with asthma. This can occasionally be the only symptom of asthma.

Diagnostic Tests

Physical exam, chest x-rays, and breathing are usually normal during symptom free periods. Routine lung function tests may be normal between episodes of asthma. If asthma is suspected, your physician may order special testing. This testing, which is performed under careful supervision, requires inhaling a substance (methacholine or cold dry air) to help confirm the diagnosis of asthma. An important pulmonary test which you can administer to yourself is called the Peak Flow (see Pulmonary Function Testing, under COPD).

Treatment of Asthma

The aims of asthma therapy are more than just the alleviation of symptoms, but the elimination of the cause of the condition itself. There are effective therapies available now to control asthma.

The stepwise approach to asthma treatment is as follows: Step One - Avoidance

There are factors that are known to initiate (trigger) an attack of asthma.

(NOTE: These steps are for extrinsic asthma and may not play a role in the so-called intrinsic asthma for which there is no obvious cause).

Among these factors are:

• Dust and especially dust mite

• Mold and mold products

• Animal dander (e.g., hair)

• Pollen

• Cold, dry air

• Air pollution, cigarette smoke

• Respiratory infections

Rarely, exercise can trigger the symptoms of Asthma

Things you can do to avoid/minimize your exposure to these factors are:

• Thoroughly clean your home environment with special attention towards dust-attracting items such as carpets, drapes, and bedding.

• If possible, carpeting should be replaced with tile or linoleum.

• Walls should be as bare as possible.

• Drapery should be replaced with easier to clean items such as vertical blinds.

• Blankets and comforters should be washed frequently.

• If you are allergic to a particular type of pet and complete avoidance is impossible, then you should at least not allow the pet into the bedroom or other rooms where the majority of time is spent. Shampoo the pet frequently, especially cats.

• Avoid contact with people who have active respiratory infections.

• Frequent handwashing decreases the transmission of infection.

• You may ask your doctor about yearly vaccination to prevent influenza (flu) and other infections.

Step Two - Medication

Bronchodilators

• Short-acting: Albuterol, pirbuterol, metaproterenol

• Long-acting: Formoterol, salmeterol

This class of medications is the most commonly used in an inhaled form. This can be either as a small canister that sprays a fine mist or a powder dispenser. These inhalers are known as MDI’s (metered dose inhalers). There is also a liquid form that can be made into a mist to breathe via machine at home. There are also short and long-acting pill forms of some of these medications. NEVER USE A LONG-ACTDING FORM OF INHALER (I.E., SALMETEROL, FORMOTEROL) TO HELP ACUTE SYMPTOMS! They take much, much longer to work than short-acting versions, and your symptoms may get worse before the medication take effect. The advantage of the inhaled forms is that the medication is absorbed directly by the lungs. This leads to fewer side effects from the medication. Correct use of your inhaler is very important. If you have difficulty using your inhaler correctly, make sure to let your doctor know. Your doctor can prescribe either a different form of medication or type of inhaler or give more instructions on the proper use of your inhaler.

Anti-inflammatory steroids

Since asthma may have an inflammatory component, your doctor may prescribe a steroid-containing medication. The steroid contained in these medications is not the type that body-builders use. Your body normally makes its own anti-inflammatory steroids; however, extra doses may be of benefit in selected patients. Steroids may be given in several forms. The oral form of Prednisone or Methylprednisolone are usually given short-term with strict supervision, so as to reduce any long-term side effects. The inhaled steroids (including Fluonosilide, Triamcinolone, Acetonide, Fluticazone) are delivered straight to the lungs where you want it. Steroids may have side effects. The inhaled forms are the preferred forms since there is much less concern with potential for side effects.

It is advisable to rinse your mouth with water and then spit out the mixture, so as to avoid potential thrush (fungal overgrowth in the mouth and throat).

Theophylline
Theophylline is a type of medication that can have multiple effects on your body’s ability to breathe better. It can cause your airways to relax and open further, thereby making it easier to breathe. It can also improve the diaphragm’s ability to contract. Also theophylline can increase the clearance of mucus from your airways and help you clear excessive phlegm. However, theophylline can have side effects that can limit use. You may feel nervous after treatments or even feel nauseated. This is why your doctor may want to check your blood level from time to time to make sure that you are getting the correct dose.

The Next Step

There is impressive amount of research in asthma management, and in the near future we will undoubtedly see several novel and even more effective therapies available. One such new treatment has just been released in injectable form. The ultimate outcome of this treatment will become evident with the gaining of more experience.