The stages of an asthma attack.
Illustration by Frank Forney. © 2016 Cengage Learning®.
Asthma is a condition that causes episodic breathing difficulties. These episodes are caused by narrowed and inflamed airways of the lungs. Asthma flare-ups or attacks can be triggered by dust, pollutants, smoke, allergies, cold air, or infections.
When Stacy was young, her parents noticed that she seemed to get tired more quickly than her friends while playing. She also had repeated coughing spells, and her breathing was sometimes noisy. After examining Stacy, asking lots of questions, and having her use a little machine to measure her breathing, the doctor diagnosed her problem as asthma. As part of the way Stacy took care of herself, she sometimes had to take asthma medicine at school. This medication made her teachers and friends interested in learning more about asthma. When Stacy was 12, she began a school-wide project with the help of her teacher and the school nurse. The goal was to make her school more comfortable for those who have asthma. No smoking was allowed, even during after-school events. Extra measures were taken to keep the school as free as possible of substances that could trigger asthma flare-ups, such as dust; mold; cockroach saliva, feces, or shedding body parts; and strong fumes from paint and chemicals. A plan was set up that allowed students with asthma to take their own medicines at school. Special lessons were offered to all students and teachers about what asthma is and how to help a classmate who has it. The result was a school that was a healthier place not just for Stacy but for everyone.
Several changes happen inside the airways in the lungs of people who have asthma. First, there is inflammation, or swelling, of the lining of the airways. Second, the swollen tissues make a thick, slippery substance called mucus * . Third, the muscles around the airways may squeeze tight, causing the airways to narrow. These three processes—inflammation, mucus production, and muscle constriction—combine to reduce the size (the diameter) of the airways. That makes it harder to breathe, like trying to blow air through a narrow straw.
During an asthma attack, these changes get worse. The airways swell on the inside while they are being squeezed on the outside. At the same time, thick mucus plugs the smaller airways. The person may start to make whistling or hissing sounds with each breath. The person's chest may also feel tight. In addition, the person may cough to try to clear the lungs.
Cases of asthma vary in severity. Some people may have only mild symptoms a few times per month, whereas others may have severe symptoms every day. Asthma has four levels, depending on how severe each case is.
A person with this type of asthma has daytime symptoms less than twice per week and nighttime symptoms less than twice per month. Attacks are brief and usually do not affect activities. Intermittent means that the symptoms come and go.
A person with this type of asthma has mild symptoms more than twice per week, never more than once per day. Nighttime symptoms occur more than two times a month.
A person with this type of asthma has symptoms every day and flare-ups more than twice per week. Nighttime symptoms occur more than once per week. When symptoms do occur, they can last for days and can make it hard for the sufferer to participate in certain activities.
A person with this type of severe asthma has symptoms throughout the day and night. The asthma makes it hard or impossible for a person to participate in many physical activities.
People with asthma have what are sometimes called “sensitized” airways. Everyday factors that cause little or no trouble for most people can sometimes cause people with asthma to have a flare-up or attack. These factors are known as asthma triggers. There are two main kinds of triggers: allergic and nonallergic. An allergic trigger results from substances called allergens * , which trigger an allergy. Examples of allergens that may trigger asthma are pollens, molds, animal dander (small scales from fur or feathers), dust mites * , cockroach saliva, feces, or shedding body parts, and certain foods and medicines. Most of these allergy-causing substances enter the body through the air that people breathe, but some are swallowed.
Asthma is one of the most common health problems in the United States. It can affect both children and adults, and is the most common chronic * health problem seen among children and teenagers. Childhood asthma is slightly more common in boys than girls. The condition is also more common among African American children than Caucasian children, although the reason for this difference is not clear. It may have to do with environmental conditions.
The following are the most common symptoms of asthma. A person may have all, some, or just one of these symptoms:
The degree to which asthma interferes with a person's daily life varies significantly. Some people have ongoing problems. The frequency of their attacks may range from several times per week to almost constantly. Their ability to take part in physical activities may be limited until they are able to get their asthma under control with treatment. Those with milder problems are usually able to do whatever they want to do, so long as they reduce their environmental triggers, take their medicine as directed, and follow any other advice from their doctors.
Asthma tends to get worse at night. Nocturnal (or nighttime) asthma occurs while a person is sleeping. For some people, nocturnal asthma is one of many symptoms; other people seem to have coughing or wheezing only at night. The greatest amount of constriction of the airways experienced by people with nighttime asthma occurs between the hours of 4:00 λ.μ. and 6:00 λ.μ. This is also the time frame during which most symptoms are experienced and deaths from asthma are more likely to occur.
Many people with asthma have trouble with noisy breathing during or after exercise, a condition known as exercise-induced asthma. Other symptoms include coughing, a rapid heartbeat, and a feeling of tightness in the chest 5 to 10 minutes after exercise. For some people, exercise is the only asthma trigger. That means they have asthma symptoms only after exercise-like activities and do not have symptoms at any other time. Cold or dry air, high pollen counts, air pollution, a stuffed-up nose, and an infection of the airways are all factors that tend to make the problem worse. Types of exercise that may lead to wheezing include swimming, running, using a treadmill, and playing basketball—exercises that are aerobic (designed to increase oxygen consumption).
Occupational asthma is caused by breathing fumes, gases, or dust while on the job. Asthma can start for the first time in a worker who was previously healthy, or it can get worse in a worker who already had the condition. Symptoms include wheezing, chest tightness, and coughing. Other symptoms that may go along with the asthma include a runny or stuffed-up nose and red, sore, itchy eyes. The asthma may last for a long time, even after the worker is no longer around the substance that caused it.
Other factors linked to the development of asthma include obesity, family history of asthma, sensitivity to aspirin especially in adults with nasal polyps * , and gastroesophageal reflux disease (GERD). *
Status asthmaticus (STA-tus az-MAT-i-kus) is a severe asthma attack that does not get better when individuals take their medicine as usual. This kind of attack is an emergency that must be treated right away in a hospital, where other medicines may be used.
The doctor performs a physical checkup and asks questions about symptoms and when they occur. In addition, the doctor may do various tests to help identify asthma and its causes.
Allergy tests help identify those substances to which a person is allergic. Skin tests are most common. Tiny amounts of possible allergens are put on the skin, and the skin is checked to see which substances, if any, cause a reaction. In another type of allergy test, a blood sample is checked for certain antibodies, which are substances made in the blood that fight foreign or harmful substances. People with allergies may have high levels of immunoglobulin E (IgE) antibodies. The blood test is generally not considered as precise as the skin test, and it cannot check for as many allergens.
An x-ray is an invisible wave that goes through most solid matter depending on its density and produces an image on film. After the film is developed, a special picture can be viewed that shows how the lungs and other structures look. An x-ray can help rule out other causes of wheezing.
These tests show how well the lungs are working. In one test, the person blows into a device called a spirometer (spi-ROM-i-ter), which measures the amount of air going in and out of the lungs. Another test uses a peak flow meter to measure how fast the person can breathe air out of the lungs. A peak flow meter is a simple handheld device that can be used at home. Many people with asthma use peak flow meters regularly to check for early warning signs of an upcoming asthma attack. Doing so gives them time to take certain medicines that can often stop the attack.
Asthma that is not under control can cause many problems. People miss school or work, must go to the hospital, and can even die (rarely) because of asthma. With treatment, most people can control their asthma. People with well-controlled asthma have few if any symptoms during the day and can sleep well at night. They can also take part in their usual activities, including sports and exercise. Asthma does not go away just because its symptoms do. Individuals need to continue taking care of their condition: avoiding triggers, not smoking, and living in a healthful, clean environment. Ongoing attention is required even in mild asthma cases.
Besides avoiding exposure to asthma triggers, asthma is mostly treated with medicines. There are two characteristics of asthma: inflammation and spasms (or constriction) of the muscles in the airways. Asthma treatment focuses on both. Asthma medicines fall into two groups: those used to prevent symptoms and control the disease for a long time, and those that give short-term relief during an asthma attack. Taking the right medicine at the right time is important.
Long-term control medicines are taken every day to help prevent symptoms from starting. It may take several weeks for these medicines to produce their best results. The most effective ones work by reducing swelling in the airways. Many are inhaled (breathed into the lungs). Not everyone needs such medicines. They may be very helpful for people who have daytime asthma symptoms three or more times per week, or nighttime symptoms three or more times per month. Medicines for long-term control of asthma include the following:
Short-term relief medicines are taken only when needed to relax and open the airways quickly. They can be used to relieve symptoms or to prevent them if a person's peak flow meter * readings begin to drop, signaling an upcoming asthma attack. But the effects last for only a few hours. These drugs cannot keep the symptoms from coming back the way long-term control medicines can. These drugs are inhaled and are taken at the first sign of trouble or before contact with a trigger.
Medicines that provide short-term relief of asthma are called short-acting bronchodilators. These drugs relax the muscles around the airways, making breathing easier. They begin to work within five minutes, and their effects last for four to six hours. Such drugs are taken right after symptoms start or just before exercise.
Many asthma medicines are made to be breathed into the lungs. Such inhaled drugs go straight to the place where they are needed. The most popular device for taking inhaled medicines is a metered-dose inhaler, which gets the drug to the lungs in exact amounts. The inhaler is a small handheld canister with a button that the person pushes to make the medicine spray into the mouth. Often a tube called a spacer is attached to the canister to make it easier to use.
Another type of device that is sometimes used to take inhaled medicines is a nebulizer (NEB-you-lyz-er), which turns liquid medicine into a very fine mist. These devices are helpful for babies, young children, and elderly or very sick adults who would have trouble handling a metered-dose inhaler.
People with asthma should try to figure out what makes their symptoms worse and take steps to avoid or control those substances or situations. Here are a few ways that many people control some common asthma triggers. Not all of them will work for everyone.
To control pollens and outdoor molds, people with asthma often do the following:
To control indoor molds, people with asthma often do the following:
Dander is small scales from the hair of animals, such as cats, and from bird feathers. Some people are allergic to it, and people with asthma often take the following steps:
People with asthma often find that they are allergic to dust because of the tiny insects called mites that live in the dust. Many people with asthma find that it helps to keep their homes free of dust. For example, they take the following steps:
Many people with asthma are sensitive to cockroach droppings and make a special effort to get rid of these stubborn creatures by taking the following steps:
It is important to do the following:
Smoking is not good for anyone, not the person smoking or people who are in the same room with tobacco smoke. People with asthma are especially endangered by tobacco smoke and find it is best not to smoke; to ask other family members to quit smoking; and to ask visitors not to smoke.
People with asthma also do the following:
It is healthful for just about everyone to exercise, and people with asthma are no exception. To make their exercise and sports activities more enjoyable, people with asthma usually do the following:
See also Allergies • Chronic Obstructive Pulmonary Disease (COPD) • Tobacco-Related Diseases: Overview
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Malo, Jean-Luc, Moira Chan-Yeung, and David I. Bernstein. Asthma in the Workplace. 4th ed. Boca Raton, FL: CRC Press, 2013.
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Allergy and Asthma Network. 8229 Boone Blvd., Suite 260, Vienna, VA 22182. Telephone: 800-878-4403. Website: http://www.allergyasthmanetwork.org (accessed March 10, 2016).
American Academy of Allergy, Asthma, and Immunology. 555 E. Wells St., Suite 1100, Milwaukee, WI 53202-3823. Telephone: 414-272-6071. Website: http://www.aaaai.org (March 10, 2016).
American College of Allergy, Asthma, and Immunology. 85 W. Algonquin Rd., Suite 550, Arlington Heights, IL 60005. Telephone: 847-427-1200. Website: http://www.acaai.org (accessed March 10, 2016).
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* mucus (MYOO-kus) is a thick, slippery substance that lines the insides of many body parts.
* allergens are substances that provoke a response by the body's immune system or cause a hypersensitivity reaction.
* dust mites are tiny insects that live in dust and in materials such as carpets, pillows, mattresses, and furniture.
* chronic (KRAH-nik) lasting a long time or recurring frequently.
* stethoscope (STETH-o-skope) is a medical instrument used for listening to sounds produced in the chest, abdomen, and other areas of the body.
* nasal polyps (POL-ips) are growths that occur inside the air passages of the nose. They are usually soft and painless.
* gastroesophageal reflux disease (GERD) is a disorder of the digestive tract. GERD causes symptoms such as heartburn, nausea, and chest pain.
* corticosteroids (kor-ti-ko-STERoids) are a group of adrenalcortex steroids, such as cortisone, that are distinguished by their main biological activity.
* bronchodilators (brong-ko-DYlay- tors) are drugs used in the treatment of asthma to widen the bronchi, which are the major airways in the lungs.
* peak flow meter is a hand-held device that allows an individual to determine volume of air flow through the lungs.