An understanding why you have asthma and what is happening in your lungs that causes coughing, wheezing and shortness of breath will help you control this chronic problem and minimize its adverse effects on your life.
What is Asthma?
Asthma is a chronic disease involving the airways in the lungs. The airways, also known as bronchial tubes or breathing tubes, permit air containing oxygen to pass in and out of the lungs. When you have asthma, even in the absence of symptoms, your airways are inflamed. This chronic inflammation (called bronchial hyperreactivity) makes your airway sensitive to things that would not otherwise irritate them. Such things include viral respiratory infections, exercise, smoke and other forms of air pollution, allergens, sleep, cold air, and even laughter. If you are sensitive to one or more of these, they may trigger an asthma “attack” by causing muscles in your airways to contract, mucous-producing cells to secrete lots of thick phlegm, and the walls that form your airway to swell with fluid. These three things – bronchial muscle spasm, mucous secretion, and airway swelling - cause narrowing of your airway making it harder to breathe in and much harder to breathe out and resulting in these symptoms:
- Shortness of Breath
- Chest Tightness
Types of Asthma
Asthma can be caused by many different triggers. Forms of asthma include:
- Exercise-induced Bronchoconstriction - This is also known as exercise-induced asthma. Symptoms of chest tightness, coughing and wheezing begin after a few minutes of aerobic exercise like running or swimming.
- Allergic Asthma – Symptoms of asthma occur with exposure to the allergens to which a person is sensitive. Common allergic triggers include house dust mites, animal dander or hair, mold spores and tree, weed and grass pollen.
- Occupational Asthma - This is caused by inhaling fumes, gases, dust, or other harmful substances while on the job.
- Childhood Asthma - A majority of children who develop asthma usually do so after the age of three.
What is an Asthma Attack?
Asthma attacks occur when an asthma trigger causes airway wall swelling, airway muscle contraction (called bronchospasm), and increases mucous production. The symptoms of an asthma attack include coughing, wheezing, labored breathing, and chest tightness or a sensation of a weight on the chest. Coughing occurs to assist the airway in cleansing itself of the burden of increased, thick phlegm. Wheezing is the sound air makes as it moves past globs of mucous in the narrowed airway. Because airways are narrowed during an asthma attack greater physical effort is required to inflate and empty the lungs. This additional effort causes fatigue resulting in labored breathing and chest tightness. Asthma attacks are generally brought on by exposure to a trigger such as:
- Allergens such as dust mites, pet dander, cockroaches, molds, and pollens
- Tobacco Smoke
- Air Pollution
- Respiratory infections, especially viral respiratory infections
- Cold air
- Polluted air
Knowing the triggers that adversely affect your breathing is an important step to controlling your asthma.
Although up to half of infants and young children will outgrow episodes of wheezing triggered by viral upper respiratory infections, asthma beginning in later childhood, adolescence and adult life is a condition likely to be permanent. That doesn’t mean that asthma will control your life or prevent you from full participation in work, school, play or family or social life. Some combination of lifestyle adaptation, avoidance of asthma triggers, daily and when needed rescue medications, and immunotherapy will help you live a full and active life in spite of underlying asthma. Your asthma specialist can help you select the medications and treatments best suited for you now and in the future.
Medications for Asthma
There are a several different medications that your doctor may prescribe depending on the type and severity of your asthma. Most of these medications are inhaled allowing them to go directly to the breathing tubes. This allows these medications to act rapidly while limiting the amount of drug reaching the rest of your body and minimizing side effects.
- Bronchodilators – These inhaled medications rapidly relax airway muscle spasm (bronchospasm) relieving labored breathing, wheezing and coughing. Short-acting bronchodilators like albuterol that work for up to four hours are used to prevent exercise-triggered asthma and to provide immediate relief during exacerbations of asthma (asthma attacks). Long-acting agents that work for 12-24 hours are used in combination with inhaled corticosteroids to help control chronic asthma.
- Long-acting muscarinic agents (LAMAs or anticholinergics)- These are another group of inhaled medications that relieve bronchospasm. Their uses are similar to bronchodilators. They are especially effective in relieving chronic coughing.
- Leukotriene Modifiers- These medications, taken by mouth, are used to help control chronic asthma. Persistent asthma is the term physicians call chronic asthma.
- Inhaled corticosteroids-Taken daily, these commonly prescribed medications are effective agents for controlling persistent asthma.
- Systemic corticosteroids- Usually taken by mouth but can be administered by injection, these potent hormones are used to decrease the severe inflammation that accompanies asthma episodes that fail to respond to other medications.
- Biologics- Also known as monoclonal antibodies, these injections administered periodically ranging from every to two weeks to once every two months are used for individuals with multiple episodes of asthma requiring many visits to the emergency department or urgent care facility, hospitalization for intensive treatment, or frequent use of systemic corticosteroids.
Chronic exposure to some asthma triggers like allergens, cigarette smoke, and pollution contribute to perennial asthma, All triggers can bring on a sudden increase in asthma symptoms called an asthma attack when exposure is intermittent. Controlling chronic exposure and anticipating sudden exposure to triggers helps control persistent asthma and decreases asthma attacks. Some common triggers of asthma include:
- Allergies to dust mites, pets, pollen, mold spores
- Viral respiratory infections like the common cold and influenza (the flu)
- Cold air
- Weather changes
Unlike a blood pressure cuff for high blood pressure there is no simple device for measuring asthma control. There is also no easily performed blood test for asthma like a blood glucose test used for monitoring diabetes mellitus. There are, however, simple, useful tools that you can use to follow control of your asthma. These tools will help you detect early declines in asthma control enabling you to adjust your medication regimen or promptly seek medical care.
One simple such tools is the “Rule of Twos”:
- Use of a short-acting bronchodilator to relieve symptoms no more than 2x a week
- Waking at night because of asthma symptoms no more than twice a month
- Previous asthma attack requiring emergency medical care no more than once in past year.
- Seek medical care or advice whenever one of these rules is broken.
We can also create printed, personalized asthma treatment plans to assist you in controlling asthma.
If allergies are a trigger of your asthma teaching the immune system to tolerate rather than react to allergen exposure may significantly reduce asthma attacks and asthma symptoms and help to control persistent asthma.
Cigarette smoking or passive exposure to cigarette smoke, obesity, stress, living near a street, freeway, or railroad with exposure to diesel exhaust, and even certain occupations are risk factors and triggers for asthma. Quitting smoking, weight loss, moving to a new home and changing jobs can have beneficial effects in controlling asthma.
Managing Your Asthma
Many people who have asthma have other medical conditions that make asthma control more difficult. Allergic rhinitis, nasal polyps, gastroesophageal reflux, and obesity are a few of these conditions. Medications used to treat some diseases, like high blood pressure, may adversely affect control of asthma. Working with your asthma specialist you will identify the many factors that contribute to poor asthma control and find solutions to these problems.