Asthma

Overview

Asthma is a chronic lung condition. The airways become inflamed and swollen, causing them to narrow. Air can't move through the lungs as well as it should, making it difficult to breathe. For reasons we do not completely understand, asthma is becoming more common each year, especially in children.

Causes

The cause of asthma is poorly understood, but it may be partly inherited. Everyone's lungs are sensitive to different things such as pollen, air pollution, or strong chemicals. In simple terms, people with asthma have lungs that are more sensitive than average.

There are three processes in the lungs that produce asthma symptoms. First, the inner linings of the airways become inflamed. They swell up, leaving less room for air to pass through. Second, the muscles around the airways can tighten, closing them further. Finally, the airways produce mucus in response to the inflammation, clogging the shrunken tubes.

Asthma is in part an allergic response. It may be triggered by some external substance that particularly irritates your lungs. These triggers are often small protein particles called allergens. Some people are sensitive to more than one trigger. Common allergens include:

• grass, tree, and ragweed pollen
• moulds
• house dust mites
• cockroach particles
• animal dander

Other people can get an asthma attack from something they swallow rather than breathe. Examples of these triggers include:

• ASA* and other anti-inflammatory medications
• preservatives found in some drinks or foods
• nuts or shrimp

While most people develop asthma as children, adults can become asthmatic by being exposed to allergens for a long time. People who work with the following products may be at increased risk:

• foams and paints
• antibiotics
• cotton and flax
• detergents
• grains and cereals
• insulation and packaging materials

Asthma attacks can also be triggered by non-allergic irritants such as:

• viral infections such as the common cold or the flu
• laughing hard, crying, shouting
• smog and smoke
• strong smells (e.g., paint fumes, perfumes, cleaning products)
• suddenly breathing cold air
• vigorous exercise

Symptoms

Some children feel an itch on the back of the neck just prior to an asthma attack. Most people have some warning sign that they can learn to recognize. Some signs, like a sore throat, are obvious. Others, like dark circles under your eyes or a change in the colour of your face, may go unnoticed.

Asthma varies in its severity. Some people experience asthma symptoms continuously while others experience symptoms only if exposed to triggers. Regardless of the severity, typical asthma symptoms include:

• chest tightness
• coughing
• shortness of breath
• wheezing

With more severe asthma, these symptoms may occur at night.

Wheezing is the best-known asthma symptom, but not everyone with asthma wheezes. Some people only have a cough that doesn't seem to go away.

A really severe asthma attack is life threatening. Even if some air is coming in, deadly carbon dioxide builds up in the blood. If you or a family member can't breathe and the normal medication isn't working, call an ambulance.

Treatment

There's no cure for asthma. It's a chronic condition, and it can last a lifetime. Asthma treatment is aimed at keeping you feeling well, with as few symptoms as possible (or none at all in many cases). There are three main things you can do to treat asthma:

• avoid triggers
• use "preventer" medications such as corticosteroids (e.g., beclomethasone*, budesonide, or fluticasone) or leukotriene receptor antagonists (e.g., montelukast or zafirlukast)
• alleviate symptoms using "reliever" medications such as bronchodilators (e.g., salbutamol, formoterol, or terbutaline)

Asthma Triggers

Avoiding triggers is your first defence against an asthma attack. Below are some common asthma triggers and their remedies. Making these simple lifestyle changes to avoid your asthma triggers can go a long way toward preventing attacks.

Pollen (grasses, trees, weeds)

Keep doors and windows closed and use air conditioning to keep pollen out.
 

Dust mites (found in carpet, furniture, and pillows)

Use special coverings for mattresses and pillows. Remove carpets in bedrooms. Wash bedding in very hot water. Keep humidity between 30% and 40%.
 

Animal hair and dander

Pet removal is the best way to avoid pet allergen. If you have pets, keep them out of bedrooms and off furniture.
 

Mould

Get a dehumidifier to eliminate mould. Avoid freshly cut grass.
 

Environment (smoke, pollution, cold air)

Stop smoking and avoid all smokey areas. Stay indoors when the outside air quality is poor. Cover your nose and mouth in cold weather.
 

Exercise

Use reliever medication 10 to 15 minutes before exercising. Warm up and cool-down for 3 to 5 minutes.

Although avoiding triggers is an important part of asthma management, it is not always possible to avoid them completely. Therefore, medications are often needed to prevent and treat asthma symptoms. The most common asthma prevention medications are called corticosteroids (e.g., beclomethasone, budesonide, or fluticasone) and are inhaled through a "puffer" or inhaler. They are designed to decrease the swelling or inflammation in your airways. It usually takes a week or two for these medications to get the swelling and inflammation under control. They don't provide fast relief of asthma symptoms, but will prevent future symptoms. They control inflammation, which is the underlying cause of asthma.

People with asthma symptoms often need treatment that provides immediate relief. Bronchodilators (e.g., salbutamol, formoterol, or terbutaline) work quickly to relax the muscles around the airways and allow you to breathe more easily. These are reliever medications, which treat symptoms only and not the disease itself. If you are using relievers three times a week or more, talk to your doctor or health care professional. You may need some changes in your medication(s).

Asthma itself is difficult to prevent, but a lot can be done to reduce or eliminate your asthma symptoms.

If your doctor has given you a preventive medication to use every day, follow the instructions carefully. If you use it as suggested, it should control the swelling in your airways and reduce your asthma symptoms over the long term.

Since asthma medications are often inhaled through a "puffer," they require extra knowledge and care on your part. Asthma inhalers have to be used properly to get the right amount of medication into your lungs.

Learning how to use inhalers properly can take some practice. Ask your doctor or health care professional to check to see if you are using your inhaler properly. A spacer, a device that fits on your inhaler, makes it easier for you to ensure that more of your medication is reaching your lungs. Spacers also help to reduce some of the side effects of inhaled corticosteroids.

 

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*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.

Other tips:

Any one of the symptoms listed above is a good enough reason to see your doctor for a check-up. Some doctors will do lung tests, called pulmonary function tests, to help confirm a diagnosis of asthma. There are blood and sputum tests, and tests to eliminate other possible conditions such as throat infection or cystic fibrosis.

An allergist or other doctor can identify your triggers by scratching the skin with tiny amounts of various allergens to see which ones may be triggers in your asthma.

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