Learn About Asthma
Understanding asthma, how it is diagnosed and treated, and how to live with the disease will increase your ability to best manage your symptoms and improve your quality of life.
- Asthma is a lung disease that affects more than 25 million men, women, and children in the United States.
- Asthmatics miss a combined 25 million days of school and/or work
- There is no cure for asthma
- Asthma is a common, manageable chronic lung condition with many treatment options enabling most patients to live a fully active and normal life.
What is Asthma?
Asthma is a chronic lung disease that causes inflammation and narrowing of the airways. These changes can cause episodes of wheezing, chest tightness, shortness of breath, and/or coughing.
How Asthma Affects Your Body?
The muscles around your airways (bronchial smooth muscle) tighten when asthma is active. This narrows the airways, causing less air to flow into the lungs which causes you to feel short of breath, and may also cause wheezing, coughing and tightness in the chest. The interior lining surface of the airways can be inflamed as a result of exposure to allergens or other irritants. This inflammation also contributes to airway narrowing and the symptoms of asthma. When your airways are swollen they may produce an increased amount of mucus leading to cough, wheeze and difficulty breathing.
How Serious is Asthma?
Asthma is a manageable, but serious condition; if untreated asthma can lead to chronic airway obstruction that cannot be fully reversed. Even when controlled there is risk of sudden worsening of symptoms called an asthma attack or “flare up” (exacerbation). Asthma exacerbations may become severe enough to lead to hospitalization and in very rare cases, death.
Asthma Symptoms, Causes and Risk Factors
Asthma is a disease that involves two components—chronic inflammation and bronchoconstriction or tightening of the airway. These two factors cause your airway passages to be hyper-reactive (or hypersensitive) to the environment. Asthma is a lifelong disease (there is no cure for asthma) although individuals can be symptom-free for years through adherence (continuous use) of their medication(s) and limiting their exposure to triggers.
What are the Symptoms of Asthma
The most common symptoms are asthma include:
- Chest discomfort
- Shortness of breath
- Cough, especially at night or early in the morning
- Inability to perform activities of daily living
What Causes Asthma?
There are a number of factors that worsen asthma but the “cause” of asthma is unknown; asthma may have a genetic cause and/or be caused by environmental exposures.
What are Risk Factors?
- Race is a risk factor for asthma—current data indicates that 1 in 6 African Americans have asthma and the greatest increase in the incidence of asthma is seen in this population. Asthma among Hispanics is four-times greater compared to Caucasians.
- Gender is also a risk factor for asthma with females out numbering males almost 2:1.
- Age—Asthma is more common in children than adults. Boys are more likely to have asthma than girls but women are more likely to have asthma compared to men.
- Family History—you are more likely to develop asthma if one of your biological parents has asthma
- Allergies—individuals with allergies to mold spores and dust mites are more likely to develop asthma.
- Exposure to smoke—children whose mothers smoked during pregnancy and exposure to second-hand smoke are more likely to develop asthma.
- Exposure to air pollution and toxic chemicals can also increase your risk of developing asthma.
- Obesity has recently been identified as a major risk factor for asthma and asthma is considered to more severe in this population.
- Viral infections—upper and lower respiratory tract infections
- Occupational Factors—exposure to compounds such as flour dust (bakery workers) and industrial chemicals.
- Stress and its alteration of the body’s immune system.
When to See Your Doctor
You should see your health-care provider if you any of the following symptoms:
1. Yellow zone or Red zone indicators on the Asthma Action Plan you develop with your healthcare provider.
2. Shortness of breath, coughing or wheezing that awaken you at night or restrict activities of daily living.
3. Daytime asthma symptoms greater than two days per week.
4. Shortness of breath that is unrelieved by your rescue inhaler.
5. Asthma symptoms that cause you to miss school or work.
6. Asthma symptoms that result in urgent care or emergency department visits.
7. Adverse (or unintended) effects of your controller or rescue agents.
8. Oral infections such as thrush.
Diagnosing and Treating Asthma
Asthma can be diagnosed by providers who work in primary care or by specialists including allergists or pulmonologists (lung specialists).
What to Expect
When you see your medical provider for evaluation of asthma you will likely be asked a series of questions regarding your symptoms to include what makes them worse. These are considered triggers. You may also be asked about your past medical history, work history, and family history. After taking a through history your provider will then perform a physical exam and may order tests to evaluate your lung function. These exams may include a peak flow measurement or a pulmonary function test. Other tests may be ordered depending on what triggers you may have reported to your provider. For example, allergy testing may be ordered if you have allergy symptoms that make your breathing worse and exercise breathing tests may be ordered if you report exercised induced symptoms.
How Asthma is Diagnosed
A pulmonary function test called spirometry is the gold standard test used to confirm the diagnosis of asthma. During a pulmonary function test, you are coached on various breathing maneuvers involving deep inhalations and full, rapid exhalations. You may also be given an inhaled medication called a bronchodilator during this test to. A significant improvement in your lung function after the inhaled medication can confirm the present of airway reactivity or asthma. Sometime the diagnosis of asthma is made clinically based on your symptoms and response to medication therapy.
How Asthma is Treated
Treatment for asthma can range from avoiding known triggers, allergy medications, inhaled medications, and medical procedures to reduce airway tightening. Inhaled medications are aimed at treating the inflammation within the airways and/or relaxing the smooth muscle surrounding and tightening the airways. If asthma symptoms are mild you may only need a bronchodilator or “reliever” inhaler to use only when you have asthma symptoms. If your asthma symptoms are more frequent or severe you will often be placed on maintenance (“controller”) medication therapy to be used every day routinely. Often times a combination of both are given.
Living with Asthma
If you are diagnosed with asthma it is important to work closely with your healthcare provider to help manage your disease. With proper avoidance of triggers and the right medications you will have more control over your symptoms.
What to Expect
Living with asthma may require daily medication to prevent symptoms and/or taking medications as needed for flare up of symptoms. It is important to avoid triggers that make your symptoms worse, as well as remain in contact with your healthcare provider, and keep up to date on your flu and pneumonia vaccines. Your healthcare provider may ask you to monitor your breathing at home to watch for any change that may suggest your asthma is not well controlled. An asthma action plan may be developed which will outline actions and medications to be taken based on your symptoms.
General health and fitness are important to asthmatics. In fact, may professional athletes have asthma. Following regularly with your healthcare provider also helps you become more successful in managing your disease and its symptoms. Staying well is also very important. Respiratory infections should be treated very quickly when you have asthma, as infections are a common trigger for asthma exacerbations. Preventing illness is a priority and frequent hand washing and keeping immunizations up to date are critical. Compliance with your medication regime will not only help control your symptoms but will also keep your asthma more manageable overall.
Resources to Help Manage Your Asthma
There are many places to get information and support regarding asthma. The American Lung Association web site is a great resource for information. The website has may also have information about local support groups in your area or ask your healthcare provider. Another resource may be your insurance provider who often employ asthma educators to provide education and resources to their clients.
Questions to Ask Your Doctor about Asthma
- What is an asthma action plan and how do I know that my asthma is controlled?
- How is a peak flow meter used and what are my green, yellow, and red zone measurements?
- When I catch a cold (upper respiratory infection) will it always worsen my asthma?
- If I have outdoor allergies (pollen, mold) or indoor allergies (animal dander, dust mites, cockroaches, or mold) what can I do to keep my asthma under control?
- What is the difference between a controller and a rescue inhaler?
- Do I have to take my controller inhaler every day if my asthma is under controller?
- What is the difference between a spacer and a holding chamber and how does it work with my inhalers?
- What oral hygiene (mouth care measures) is required when using my controller inhalers?
- What is the difference between HFA inhalers, metered dose inhalers, and dry powder inhalers?
- How many times can I use my rescue inhaler and/or nebulizer in a 24-hour period?
- Will the use of controller inhaler containing steroids impact my glaucoma?
- Will the use of controller inhaler containing steroids impact my blood pressure or heart rate?
- Can I exercise or play sports with asthma?
- Can I outgrow asthma?
- Can I pass asthma on to my children?
- How does smoking (and secondary exposure to tobacco smoke) affect my asthma?
- Do I have to prime or shake my inhaler with each use?
- When should I use my rescue inhaler?
- How often should I have my pneumonia and influenza vaccination?
Are you ready to take action? If so, here are a few resources on asthma.
The CHEST Foundation has also partnered with the Allergy and Asthma Network to bring you the best patient education on difficult to control asthma. For more information on difficult to control asthma, visit chestnet.org/asthma.
Corinne Preston, NP-C, FCCP
Date Last Reviewed