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Asthma
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Asthma



Related terms
Background
Author information
Bibliography
Symptoms
Treatment
Related definitions
Classifications of asthma
Types of asthma
Severity of asthma
Predisposition to asthma
Types of inhalers

Related Terms
  • Adult onset asthma, allergic asthma, allergist, asthmatics, boswellia, breathing problems, bronchodilator, bronchospasm, choline, coleus, corticosteroids, cough-variant asthma, dry-powder inhaler, ephedra, exercise-induced asthma, extrinsic asthma, immunologist, inhaler, intrinsic asthma, leukotriene modifiers, long-acting beta agonists, MDI, metered-dose inhaler, nebulizer, non-allergic asthma, occupational asthma, oral beta agonists, peak flow meter, psychotherapy, short-acting bronchodilators, short-acting beta agonists, spirometer, spirometry, theophylline, trigger avoidance, wheezing, yoga.

Background
  • Asthma is a chronic, inflammatory lung disease. The air passages within the lungs are constantly swollen, restricting the amount of air allowed to pass through the trachea. Asthmatics have recurrent breathing problems and a tendency to cough and wheeze.
  • According to the American Lung Association, about 20 million Americans have asthma, which causes about 5,000 deaths each year.
  • Asthma is incurable, but many medications and changes in behavior may help manage the condition.
  • Allergic asthma occurs when allergens cause the airway to become inflamed.
  • When the airway becomes constricted during vigorous physical activity, the condition is known as exercise-induced asthma.
  • Cough-variant asthma is a chronic, persistent cough without shortness of breath.
  • Occupational asthma occurs as a result of a particular environment. Once the patient is out of the environment, symptoms gradually disappear.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Allergy Asthma and Immunology. .
  2. American Academy of Family Physicians. Chronic Obstructive Pulmonary Disease. .
  3. American Lung Association. Epidemiology & statistics Unit, Research and Program Services. . May 2005. .
  4. Asthma and Allergy Foundation of America. Asthma. .
  5. Centers for Disease Control. Surveillance for Asthma - United States, 1960-1995, MMWR. 1998; 47 (SS-1). .
  6. MayoClinic.com. Asthma. .
  7. National Heart Lung and Blood Institute. .
  8. National Institute of Environmental Health Sciences. Asthma and its Environmental Triggers. .
  9. Natural Standard: The Authority on Integrative Medicine. .
  10. Dey AN, Schiller JS, Tai DA. Summary health statistics for U.S. children: National Health Interview Survey, 2002. Vital Health Stat 10. 2004 Mar;(221):1-78.

Symptoms
  • Bronchospasm (abnormal contraction of the bronchi, resulting in airway obstruction).
  • Coughing (constantly or intermittently).
  • Wheezing or whistling sounds when exhaling.
  • Shortness of breath or rapid breathing.
  • Chest tightness or chest pain.
  • Fatigue.
  • Infants may have trouble feeding and may grunt during suckling.

Treatment
  • Long-term:
  • Combined therapy medicine: Combined therapy involves both a controller (long-acting bronchodilator) and reliever (corticosteroid) medicine. This therapy is used to manage asthma symptoms for long-term.
  • Cromolyn sodium and nedocromil sodium: Cromolyn sodium (like Intal® and nedocromil sodium (like Tilade®) are used to help prevent the airways from swelling when they are exposed to asthma triggers. These inhaled non-steroids may also help prevent exercise-induced asthma attacks.
  • Immunotherapy: During immunotherapy (also known as allergy shots), the patient receives periodic injections, as determined by the allergist/immunologist, over the course of three to five years. The solutions in the injections contain the substances the individual is allergic to. The treatment helps the immune system tolerate the allergens and lessens the need for medications.
  • Peak flow meter: A peak flow meter is a portable device that measures airflow, or peak expiratory flow (PEF). When asthmatics blow into the device quickly and forcefully, the peak flow reading indicates how open the airways are. Patients should compare their daily peak flow recordings with their "personal best" recording. The device helps patients determine the severity of the asthma. It is enables patients to check their responses to treatment and monitor their treatment progress.
  • Inhaled corticosteroids: Inhaled corticosteroids (Aerobid®, Azmacort®, Beclovent®, Flovent®, Pulmicort® or Vanceril®) are used to prevent and reduce airway swelling, as well as decrease the amount of mucus in the lungs. These medications are generally considered safe when taken as directed.
  • Leukotriene modifiers: Leukotriene modifiers (like Accolate® or Singulair®) are a new type of long-term control medication. They help prevent airway inflammation and swelling, as well as decrease the amount of mucus in the lungs.
  • Long-acting beta agonists: Long-acting beta agonists, such as Serevent® (which is inhaled) may be taken with or without anti-inflammatories to help control persistent symptoms. Long-acting, inhaled beta agonists should not be used as a substitute for anti-inflammatories. This type of medicine may also prevent exercise-induced asthma. However, these medications cannot relieve symptoms quickly, and they should not be used to treat an acute attack. A short-acting, inhaled beta agonist should be used to treat acute symptoms.
  • Oral corticosteroids: Oral corticosteroids like (Aristocort®, Celestone®, Decadron®, Medrol®, Prednisone® or Sterapred®) are available in pill/tablet format for adults. Liquid corticosteroids (like Pediapred® or Prelone®) are available for children. These medications can be used short-term for severe asthma episodes or as long-term therapy for individuals who have severe asthma.
  • Trigger avoidance: Since asthma can be triggered by allergens, symptoms can be caused or aggravated by the environment. An allergist or immunologist can help patients recognize the allergens and irritants that trigger asthma attacks. Exposure to common irritants, including pollen, animal dander, mold spores and dust mites, may trigger asthma.
  • Eliminate potential food allergens, including dairy (milk, cheese and sour cream), eggs, nuts, shellfish, wheat (gluten), corn, preservatives and food additives (like dyes and fillers). Food allergies can be a contributing factor in immune imbalance triggering symptoms of asthma.
  • Short-term:
  • Oral beta agonists: Oral beta agonists (like Alupent®, Brethine®, Bricanyl®, Proventil®, Repetabs®, Ventolin® or Volmax®) may be used to decrease acute symptoms that arise quickly. Oral beta agonists are available in pill, syrup and inhaled form.
  • Short-acting bronchodilators: Short-acting bronchodilators are also used for quick relief of asthma symptoms. They open airways by relaxing the muscles that tighten around airways during an asthma attack.
  • Short-acting beta agonists: Short-acting beta agonists (like Albuterol®, Brethaire®, Bronkosol®, Isoetharine®, Maxair®, Medihaler-Iso®, Metaprel®, Proventil®, Tornalate® or Ventolin®) may help relieve asthma symptoms quickly. These medications may also help prevent exercise-induced asthma. If these medications are taken daily, or if they are taken more than three times in a single day, the asthma may be worsening, or the inhaler may not be used correctly.
  • Theophylline: Theophylline (like Aerolate®, Elixophyllin®, Quibron-T®, Resbid®, Slo-bid®, T-Phyl®, Theolair®, Theo-24®, Theo-Dur®, Theo-X®, Uni-Dur® or Uniphyl®) may be used to treat persistent asthma symptoms and to prevent nighttime asthma. In order to be effective, theophylline must remain at a constant level in the bloodstream. If the level is too high, it can be potentially dangerous. A qualified healthcare provider will perform regular blood tests to ensure safety. Sustained release theophylline is not the preferred primary long-term control treatment, but it has been shown to be effective when taken with anti-inflammatories to control nighttime asthma attacks.
  • Pregnancy:
  • General: Many asthma medications are considered safe for pregnant patients because the risk of adverse effects appears to be less than the risk of uncontrolled asthma. Medications that have been used in pregnant women include inhaled bronchodilators, cromolyn sodium and beclomethasone, all of which have a local effect. Theophylline has also been used during pregnancy if the asthma is not adequately controlled by the other medications. Oral steroid medications, such as prednisone, should only be used when necessary for severe asthma during pregnancy. Consult a qualified healthcare professional before beginning any treatment.

Related definitions
  • Chronic obstructive pulmonary disease (COPD) or chronic obstructive lung disease: Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease, is a general term for diseases that damage the lungs. It is estimated that more than 16 million Americans have some form of COPD. The two main COPDs include chronic bronchitis and emphysema. Asthma is also considered a COPD.
  • COPD develops over many years, and smoking tobacco is almost always the cause of the disease.
  • The most common symptoms of COPD are chronic coughing and shortness of breath. Individuals who have COPD may be more susceptible to colds and the flu. The heart may become enlarged because it is strained. In addition, many COPD patients may experience high blood pressure.
  • There is no cure for COPD. Treatment varies, depending on the specific condition. It can range from medication and oxygen supplementation to transplant surgery. Bronchodilators are commonly used to relax the bronchi muscles that can cause bronchospasms and restrict the airways. Bronchodilators are either short-acting or long-acting.
  • Emphysema: Nearly three million Americans have been diagnosed with emphysema, and it is estimated that millions more are in the early, asymptomatic stages of the disease.
  • The most common cause of emphysema is smoking tobacco. Tobacco smoke temporarily paralyzes the cilia (small hairs) the line the bronchial tubes. The cilia are designed to filter irritants out of the airways. However, when the cilia are paralyzed, irritants remain in the bronchial tubes and infiltrate the alveoli, inflaming the tissue and breaking down the elastic fibers.
  • A minority of patients develop emphysema as a result of low levels of alpha-1-antitrypsin (AAt). This protein protects the elastic fibers in the lungs from being destroyed by certain enzymes. Therefore, this hereditary condition causes progressive lung damage, which can result in emphysema.
  • Emphysema causes the air sacs in the walls of the lungs lose elasticity. Eventually, the walls stretch and break, which creates larger, less efficient air sacs. It becomes difficult for the patient to breathe. Common symptoms include chronic, mild cough, loss of appetite, weight loss and fatigue.
  • There is currently no cure for emphysema. Treatment focuses on managing symptoms and preventing complications. Smokers are advised to abstain from smoking in order to prevent the symptoms from worsening. Medications often include bronchodilators, inhaled steroids, supplemental oxygen, protein therapy, antibiotics (for respiratory infections), lung volume reduction surgery and lung transplant. Pulmonary rehabilitation therapy is also available for patients.
  • Since smoking causes most cases of emphysema, the best prevention method is to abstain from smoking tobacco.
  • Dyspnea: Dyspnea is a term that describes difficulty breathing or shortness of breath. This is a common symptom of many medical disorders, especially COPD.
  • Airway obstruction: Airway obstruction describes partial or complete blockage of the airway passages to the lungs. The cause of this condition varies greatly. Possible causes include allergic reactions, infections, anatomical abnormalities, trauma and foreign substances (e.g. choking). An early sign of airway obstruction is agitation, which may cause individuals to cough suddenly. Signs of respiratory distress include labored, ineffective breathing and loss of consciousness if the obstruction is not removed or relieved.
  • Treatment for airway constriction depends on the underlying cause. If it is an allergic reaction, medication may be prescribed and the patient should avoid exposure to the allergen. Anatomical abnormalities may require surgery to open the airways. Infections may require antibiotics. If an adult is choking, the Heimlich maneuver should be performed.

Classifications of asthma
  • Asthma is classified as either allergic or non-allergic. Both conditions cause airway obstruction and inflammation that is partly reversible by medication. They also produce the same symptoms. The main difference, however, is their cause.
  • Allergic (extrinsic) asthma: An allergic reaction triggers what is known as allergic asthma. Inhaled allergens like dust mites, mold spores, pollen and pet dander may trigger allergic asthma. It is the most common form of asthma, affecting more than 50% of asthma sufferers.
  • Non-allergic (intrinsic) asthma: Non-allergic asthma is not related to allergies and does not involve the immune system. Instead, factors like anxiety, stress, exercise, cold air, dry air, smoke, hyperventilation, viruses and other irritants trigger the disease.

Types of asthma
  • Childhood asthma:
  • Nine million U.S. children, from newborns to 18-year-olds, have been diagnosed with asthma, according to a 2002 National Health Interview Survey.
  • Asthma rates in children younger than five years old have increased more than 160% from 1980 to 1994. One study found a strong correlation between obesity and asthma, but no similar relationship between obesity and allergies. Researchers believe that asthma was the result of the increased physical exertion of the lungs in obese individuals.
  • Many children with asthma have what is known as allergic asthma. In such cases, exposure to allergens like dust mites, pollen, mold and animal dander may irritate the airways, causing even more constriction, as well as causing the production of excess mucus and inflammation of the airway passages.
  • Adult onset asthma:
  • Asthma symptoms may appear at any time in life. Individuals who develop asthma as adults have what is known as adult onset asthma. It is possible to develop asthma at the age of 50 or later.
  • Unlike children who usually experience intermittent symptoms, individuals with adult onset asthma are more likely to experience persistent symptoms.
  • The cause of adult onset asthma is unknown. However, some evidence suggests that allergy and asthma may be genetically inherited.
  • In addition, obesity appears to significantly increase the risk of developing asthma as an adult.
  • Pregnancy and asthma:
  • Asthma is one of the most common, potentially serious medical problems that occur during pregnancy. According to some studies, asthma may complicate up to seven percent of all pregnancies.
  • Researchers estimate that about one-third of pregnant women with asthma will experience increased symptoms during the pregnancy; another third will experience the same symptoms, while the last third will experience a lessening of symptoms.
  • Pregnant women with asthma have an increased risk of delivering prematurely or giving birth to an infant with low birth weight. In addition, pregnant women with asthma are more likely to experience hypertension (high blood pressure) or a related condition called pre-eclampsia (swelling, high blood pressure and kidney malfunction).
  • If asthma is not controlled, the mother has lower levels of oxygen in her blood. This may result in decreased oxygen in the fetal blood, which may also cause growth deficiencies or death in the fetus.
  • However, proper treatment and management of asthma symptoms helps reduce the risk of complications, according to research.
  • Aspirin-induced asthma:
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil® or Motrin®), may cause asthma symptoms, nasal congestion, watery eyes and, occassionally, facial flushing and swelling in about 10% of asthmatics. Since sensitization and IgE production are not involved in aspirin-sensitive asthma, it is not considered an allergic reaction.
  • In the body, these drugs inhibit the cyclooxygenase-1 (COX-1) enzyme, which produces inflammation and fever. Their ability to inhibit the enzyme allows NSAIDs to reduce pain, inflammation and fever.
  • Inhibiting the enzyme also allows NSAIDs to clear the way for different enzymes that have adverse effects in some people. One of these enzymes triggers the release of chemicals that can cause the airways to swell and increase mucus production, leading to an asthma attack. The process is an unwanted side effect NSAIDs, not an immune-system reaction to NSAIDs.
  • Asthmatics and especially asthmatics who also have nasal polyps, are vulnerable to asthma as a side effect of aspirin and aspirin-like drugs.

Severity of asthma
  • Mild intermittent: Symptoms occur twice a week or less. Exacerbations are short and the intensity varies. Nighttime symptoms occur twice a month or less.
  • Mild persistent: Symptoms occur more than twice a week but less than once a day. Exacerbations may affect daily activities. Nighttime symptoms occur more than twice a month.
  • Moderate persistent: Symptoms occur daily. Exacerbations occur twice a week or more. Nighttime symptoms occur more than once a week.
  • Severe persistent: Symptoms are constant and limit the individual's physical activities. Frequent exacerbations disrupt daily activities, and nighttime symptoms occur more than twice a week.

Predisposition to asthma
  • Infants or young children who wheeze and suffer from viral upper respiratory infections.
  • Individuals with strong allergies.
  • Individuals with a family history of asthma and/or allergy.
  • Perinatal exposure to tobacco smoke and allergens.

Types of inhalers
  • Dry powder-inhaler: Dry-powder inhalers are the most common inhalers used today. This type of inhaler does not need a propellant. Instead, the individual inhales the medicine so it can reach the lung. Children, people with severe asthma and people suffering from acute attacks may be unable to produce enough airflow to use these inhalers successfully.
  • Metered-dose inhaler: The most efficient way to get asthma medication into the airways is with a metered-dose inhaler (MDI). When used properly, about 12-14% of the medication is inhaled deep into the lungs with each puff of the MDI. They are especially important for delivering quick relief medication - short-acting beta agonists - that relieve an acute asthma attack. MDIs are also used to deliver some long-term control medications, including anti-inflammatories and long-acting bronchodilators, which are taken routinely to manage asthma symptoms. An MDI is especially recommended for use with inhaled steroids because it reduces the amount of drug dispersed into the mouth, which reduces the risk of side effects.
  • Metered-dose inhalers are designed to release a pre-measured amount of medication into the lungs. There are several different types, but in general, they all have a chamber that holds the medication and a propellant that turns the medication into a fine mist. A button is pushed to force the medication out through the mouthpiece.
  • Medication that is inhaled acts more quickly than medication taken by mouth. It also causes few adverse effects because the medication goes directly to the lungs and not to other parts of the body.
  • If an MDI is not used correctly, symptoms may persist or worsen. Individuals who have trouble using the device correctly may use a spacer to help them get the medication they need. Spacers are attached to the mouthpiece, and they hold the discharged, pre-measured medication in a chamber until the patient breathes in. Spacers are recommended for young children and older adults who have trouble coordinating breathing and activating the MDI.
  • Nebulizer: A nebulizer is an electrical device that sends medicine directly into the mouth by a tube (or mask in children). This method does not require hand-breath coordination. The patient puts the prescribed amount of medication into the tube, and then places the tube in the mouth (or places the mask over the child's nose and mouth). Then the patient breathes normally until all of the medication is gone.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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