Introduction

Asthma occurs when the main air passages of your lungs, the bronchial tubes,
become inflamed. The muscles of the bronchial walls tighten, and cells in the
lungs produce extra mucus further narrowing your airways. This can cause minor
wheezing to severe difficulty in breathing. In some cases, your breathing may be
so labored that an asthma attack becomes life-threatening.

Asthma is a chronic but treatable condition. You can manage your condition
much like someone manages diabetes or heart disease. You and your doctor can
work together to control asthma, reduce the severity and frequency of attacks
and help maintain a normal, active life.

Signs and symptoms

Asthma signs and symptoms can range from mild to severe. You may have only
occasional asthma episodes with mild, short-lived symptoms such as wheezing.
In between episodes you may feel normal and have no difficulty breathing. Some
people with asthma have chronic coughing and wheezing punctuated by severe
asthma attacks.

Most asthma attacks are preceded by warning signs. Recognizing these warning
signs and treating symptoms early can help prevent attacks or keep them from
becoming worse.

Warning signs and symptoms of asthma in adults may include:

 Increased shortness of breath or wheezing

 Disturbed sleep caused by shortness of breath, coughing or wheezing

 Chest tightness or pain

 Increased need to use bronchodilators — medications that open up

airways by relaxing the surrounding muscles

 A fall in peak flow rates as measured by a peak flow meter, a simple and
inexpensive device that allows you to monitor your own lung function

Children often have an audible whistling or wheezing sound when exhaling and
frequent coughing spasms.

Causes
Asthma is probably due to a combination of environmental and genetic factors.
You're more likely to develop asthma if it runs in your family and if you're
sensitive to environmental allergens or irritants. Early, frequent infections and
chronic exposure to secondhand smoke or certain allergens may increase your
chances of developing asthma.

Exposure to various allergens and irritants may trigger your asthma symptoms.
The following are common things that trigger asthma symptoms:

 Allergens, such as pollen, animal dander or mold

 Cockroaches and dust mites
 Air pollutants and irritants
 Smoke
 Strong odors or scented products or chemicals
 Respiratory infections, including the common cold
 Physical exertion, including exercise
 Strong emotions and stress
 Cold air
 Certain medications, including beta blockers, aspirin and other
nonsteroidal anti-inflammatory drugs
 Sulfites, preservatives added to some perishable foods
 Gastroesophageal reflux disease (GERD), a condition in which stomach
acids back up into your esophagus. GERD may trigger an asthma attack
or make an attack worse.
 Sinusitis

Risk factors
Approximately 14 million adults and 6 million children in the U.S. have asthma. In
fact, asthma is the most common chronic illness of childhood and a common
reason for missed school days. Asthma is more common in boys than in girls.
But after puberty asthma is more common in females.

A number of factors may increase your chances of developing asthma. These

include:

 Livingin a large urban area, especially the inner city, which may
increase exposure to environmental pollutants
 Exposure to secondhand smoke
 Exposure to occupational triggers, such as chemicals used in farming
and hairdressing, and in paint, steel, plastics, and electronics
manufacturing
 Having one or both parents with asthma
 Respiratory infections in childhood
 Low birth weight
 Obesity
 Gastroesophageal reflux disease (GERD)

When to seek medical advice

Three key circumstances may lead you to talk to your doctor about asthma:
  Ifyou think you have asthma. Wheezing, difficulty breathing, pain or
tightening in your chest, or coughing are common signs and symptoms of
asthma. Wheezing, especially, is a frequent sign of asthma in children.
However, some people with asthma never wheeze. Instead, they have
recurrent, spasmodic coughs that are often worse at night. If you or your
children have frequent coughs that last more than a few days or any other
signs or symptoms of asthma, see your doctor.

 If
you know you have asthma. If you know you have asthma, talk to
your doctor about ways to manage your condition. Working as a team,
you and your doctor can develop a plan to help you control your signs and
symptoms, prevent an attack or stop an attack in progress. Don't try to
treat asthma yourself. Many asthma deaths result from a lack of proper
treatment.

 Ifyour medication isn't working. Sometimes your medications may not

offer the relief you need. Be sure to contact your doctor right away if a
prescribed dosage of medication doesn't work for you. In some cases you
may not be using your inhalers correctly. Don't try to solve the problem by
taking more medication without consulting your doctor — overusing
inhalers or taking too much medication can be dangerous.

Screening and diagnosis

Diagnosing asthma can be difficult. Signs and symptoms can range from mild to
very severe and are often similar to those of other conditions, including
emphysema, early congestive heart failure or vocal cord problems.

In order to rule out these and other possible conditions, your doctor will likely use
several tests to arrive at a diagnosis. In most cases you'll be asked to give a
complete medical history and have a physical exam. You may also be given lung
(pulmonary) function tests to determine how much air moves in and out as you
breathe.

The two most common tools to measure lung function are:

 Spirometer. A spirometer is used by a medical professional to measure

narrowing of your bronchial tubes. This device measures the volume of air
you can exhale after you've taken a deep breath. A spirometer also shows
how quickly you can get air out of your lungs.

 Peak flow meter. A peak flow meter can be used at home to help detect
subtle increases in airway obstruction before you notice symptoms. If the
readings are lower than usual, it's a sign your asthma may be about to
flare up. Your doctor can give you instructions on how to deal with low
readings.

Lung function tests often are done before and after taking a medication known as
a bronchodilator to open your airways. If your lung function improves with use of
a bronchodilator, it's likely you have asthma.
If there is uncertainty about a diagnosis of asthma, your doctor may also
recommend a methacholine bronchial challenge. If you have asthma, inhaling a
known asthma trigger called methacholine will cause mild constriction of your
airways, which can be measured with a lung function test. A positive
methacholine test supports a diagnosis of asthma.

How asthma is classified

The results of your physical exam and diagnostic tests can help your doctor
classify how severe your asthma is, which helps guide how it should be treated.
The four main classifications of asthma are:

 Mildintermittent. This is the mildest form of asthma. Generally, people

with mild intermittent asthma have mild symptoms up to two days a week
and up to two nights a month.

 Mild
persistent. You have mild persistent asthma if you have asthma
symptoms more than twice a week, but no more than once in a single
day.

 Moderate persistent. If you have asthma symptoms once a day and

more than one night a week, you may have moderate persistent asthma.

 Severe
persistent. This is the most severe form of asthma, causing
symptoms throughout the day on most days and frequently at night.

Complications
Asthma accounts for millions of missed school days and workdays each year. It's
also a common reason for emergency room visits and hospitalizations. You can
reduce your risk of severe attacks by making sure your asthma is well controlled
and by knowing how to recognize and treat attacks before they occur.

Controlling your asthma can also help you avoid serious side effects from long-
term use of some medications used to stabilize severe asthma. Using inhaled
corticosteroids, which have fewer side effects than oral corticosteroids, can help
you reduce the need for emergency treatment of asthma.

Treatment
There are several types of medications available for treating asthma. Most
people use a combination of long-term control medications and quick relief
medications. Your doctor can help you decide which option is best for you based
on your age and the severity of your symptoms. In general, the main types of
asthma medications are:

 Long-term-controlmedications. These are used regularly to control

chronic symptoms and prevent asthma attacks.
  Quick-relief medications. You use these as needed for rapid, short-
term relief of symptoms during an asthma attack.

 Medications for allergy-induced asthma. These decrease your body's

sensitivity to a particular allergen and prevent your immune system from
reacting to allergens.

Long-term control medications

These medications are usually taken every day on a long-term basis, to control
persistent asthma.

 Inhaled corticosteroids. These anti-inflammatory drugs are the most

effective medications for asthma. They reduce inflammation in your
airways and prevent blood vessels from leaking fluid into your airway
tissues.

Corticosteroids help decrease the frequency of your attacks and reduce

the need for other medications you may use to control your symptoms.
Because inhaled corticosteroids control most forms of asthma by
delivering medication directly to your airways, they have a lower risk of
side effects than are associated with oral corticosteroids. Inhaled
corticosteroids include fluticasone (Flovent), budesonide (Pulmicort),
triamcinolone (Azmacort), flunisolide (Aerobid) and beclomethasone
(Qvar). Advair Diskus is a combination inhaler containing fluticasone and
salmeterol.

Side effects associated with inhaled corticosteroids can include

hoarseness or loss of voice, oral yeast infections (thrush), and cough.
Long-term use of inhaled corticosteroids may slightly increase the risk of
skin thinning, bruising, osteoporosis, eye pressure and cataracts. In
children, inhaled corticosteroids may slow growth.

If you're using a metered-dose-inhaler form of corticosteroid, be sure to

use a spacer and rinse your mouth with water after each use. This
reduces the amount of drug that can is swallowed and absorbed into your
body. It also reduces side effects, such as mouth and throat irritation and
oral yeast infections (thrush).

 Long-acting beta-2 agonists (LABAs). These medications are part of a

group of medications called bronchodilators, which open up constricted
airways. Long-acting beta-2 agonists, such as salmeterol (Serevent
Diskus) and formoterol (Foradil), last at least 12 hours. They're used to
control moderate and severe asthma and to prevent nighttime symptoms.
Salmeterol or formoterol are used on a regular schedule along with
inhaled corticosteroids and should not be used as the main treatment for
asthma.

On Nov. 18, 2005, the Food and Drug Administration (FDA) issued a
public health advisory for three LABA medications, stating the
medications may increase the risk of severe asthma episodes and
possibly death if a severe asthma episode occurs. The three asthma
medications included in the advisory are: Advair Diskus, Foradil Aerolizer
 and Serevent Diskus. If you experience asthma attacks and you're taking
one of these medications, you'll need to talk with your doctor to determine
the best course of action.

 Leukotriene modifiers. These drugs reduce the production or block the

action of leukotrienes — substances released by cells in your lungs during
an asthma attack. Leukotrienes cause the lining of your airways to
become inflamed, which in turn leads to wheezing, shortness of breath
and mucus production. Leukotriene modifiers include montelukast
(Singulair) and zafirlukast (Accolate).

Leukotriene modifiers are used with other medications — such as inhaled

corticosteroids — to help prevent asthma attacks. Although generally not
as effective as inhaled corticosteroids, leukotriene modifiers are an option
if you have mild asthma and want to avoid corticosteroids.

 Cromolyn and nedocromil. Although they're not effective for everyone,

daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) may help
prevent attacks of mild to moderate asthma. They may also be used to
help prevent asthma triggered by exercise.

 Theophylline. You take this bronchodilator in pill form every day. It may
be helpful for relieving your nighttime symptoms of asthma. But
theophylline may cause side effects, such as nausea and vomiting,
severe abdominal pain, diarrhea, acid reflux, confusion, fast or irregular
heartbeat, and nervousness. If you're taking theophylline, get regular
blood tests to make sure you're getting the correct dosage.

Quick-relief medications
Short-acting bronchodilators — often called "rescue" or "quick-relief" medications
—stop the symptoms of an asthma attack in progress. You take these
medications when you begin to have symptoms, such as coughing, wheezing,
chest tightness or shortness of breath. You may also use short-acting
bronchodilators to prevent an asthma attack when your peak flow meter shows
that your readings are lower than normal.

 Short-acting beta-2 agonists. These bronchodilators begin working

within minutes and last four to six hours. But they can't keep symptoms
from coming back. The most commonly used short-acting bronchodilator
for asthma is albuterol.

 Ipratropium (Atrovent). Your doctor might prescribe this anticholinergic

for the immediate relief of your asthma symptoms.

 Oral and intravenous corticosteroids for asthma attacks. These

corticosteroids — including prednisone, methylprednisolone,
hydrocortisone and others — may be taken to treat acute asthma attacks
or very severe asthma. They may take a few hours or a few days to be
fully effective. Long-term use of these medications can cause serious side
effects, including cataracts, loss of bone mineral (osteoporosis), muscle
weakness, decreased resistance to infection, high blood pressure and
 thinning of the skin. Asthma attacks can be life-threatening and should be
managed by a doctor.

Medications for asthma triggered by allergies

Other medications focus on treating allergy triggers for asthma and include:

 Immunotherapy. Allergy-desensitization shots (immunotherapy) may

help if you have allergic asthma that can't be easily controlled by avoiding
triggers. You'll begin with skin tests to determine which allergens trigger
your asthma symptoms, followed by a series of therapeutic injections
containing small doses of those allergens. You generally receive
injections once a week for a few months, then once a month for a period
of three to five years. Over time, you should lose your sensitivity to the
allergens. Immunotherapy isn't for everyone, though. You're most likely to
benefit if it's clear you have allergic asthma. In addition, immunotherapy
carries the risk of an allergic reaction to the shot. Life-threatening
reactions are rare but possible.

 Anti-IgE monoclonal antibodies. If you have allergies, your immune

system produces allergy-causing IgE antibodies to attack substances that
generally cause no harm, such as pollen, dust mites and pet dander. If
you have allergic asthma that's difficult to control, omalizumab (Xolair)
may reduce the number of asthma attacks you experience by blocking the
action of these antibodies. That way your immune system isn't prompted
to react and cause the inflammation that makes breathing difficult.

Xolair is used in children over 12 years old and adults with moderate to
severe asthma caused by an allergy, if all other treatments have failed.

Xolair is delivered by injection every two to four weeks. Risks include the
possibility of a severe reaction within two hours of receiving the shot,
blood-clotting problems, and a possible link to cancer. That link is
currently being studied. Also, if you're pregnant or breast-feeding, tell your
doctor beforehand.

Treatment by severity for better control

Treatment based on asthma severity can help you control your asthma.
According to guidelines from the American Academy of Allergy, Asthma &
Immunology and the American College of Allergy, Asthma & Immunology,
asthma therapy should be flexible and based on changes in symptoms,
which should be assessed thoroughly each time you see your doctor.
Then, treatment can be adjusted accordingly.

For example, if your asthma is well controlled, your doctor may prescribe
less medicine. If your asthma is not well controlled or getting worse, your
doctor may increase your medication and recommend more frequent
visits.

Prevention
The best way to prevent asthma attacks is to identify and avoid indoor and
outdoor allergens and irritants. That's easier said than done because thousands
of outdoor allergens and irritants — ranging from pollen and mold to cold air and
air pollution — can trigger your attacks. A number of indoor allergens, including
dust mites, cockroaches, pet dander and mold, can do the same. A common
asthma irritant is tobacco smoke.

Even if you reduce indoor and outdoor allergens and irritants, managing asthma
can be challenging. It often takes ongoing communication and teamwork with
your doctor. But by working together, you and your doctor can design a step-by-
step plan for living with your condition. In addition to knowing and avoiding your
triggers, develop an action plan, monitor your breathing and treat attacks early.

 Develop an action plan. With your doctor and health care team, write a
detailed plan for taking maintenance medications and managing an acute
attack. Then be sure to follow your plan. Asthma is an ongoing condition
that needs regular monitoring and treatment. Taking control of your
treatment can make you feel more in control of your life in general.

 Monitor your breathing. You may learn to recognize warning signs of

an impending attack, such as slight coughing, wheezing or shortness of
breath. But because your lung function may decrease before you notice
any signs or symptoms, regularly measure your peak airflow with a home
peak flow meter.

 Treat attacks early. If you act quickly, you're less likely to have a severe
attack. You also won't need as much medication to control your
symptoms. When your peak flow measurements decrease and alert you
to an impending attack, take your medication as instructed and
immediately stop any activity that may have triggered the attack. If your
symptoms don't improve, get medical help as directed in your action plan.

Self-care
Although many people with asthma rely on medications to relieve symptoms and
control inflammation, you can do several things on your own to maintain overall
health and lessen the possibility of attacks:

 Exercise. You don't have to be sedentary if you have asthma. Regular

exercise can strengthen your heart and lungs so that they don't have to
work so hard. Aim for 30 minutes of exercise on most days. If you've been
inactive, start slowly and try to gradually increase your activity over time.
Keep in mind that exercising in cold temperatures may trigger symptoms.
If you do exercise in cold temperatures, wear a face mask to warm the air
you breathe. And don't exercise in temperatures below zero. Activities
such as golf, walking and swimming are less likely to trigger attacks, but
be sure to discuss any exercise program with your doctor.

 Use your air conditioner. Air conditioning helps reduce the amount of
airborne pollen from trees, grasses and weeds that finds its way indoors.
 Air conditioning also lowers indoor humidity and can reduce your
exposure to dust mites. If you don't have air conditioning, try to keep your
windows closed during pollen season.

 Decontaminate your decor. Minimize dust that may aggravate

nighttime symptoms by replacing certain items in your bedroom. For
example, encase pillows, mattresses and box springs in dust-proof
covers. Remove carpeting and install hardwood or linoleum flooring. Use
washable curtains and blinds.

 Maintain optimal humidity. Keep humidity low in your home and office.
If you live in a damp climate, talk to your doctor about using a
dehumidifier.

 Keep indoor air clean. Have a utility company check your air
conditioner and furnace once a year. Change the filters in your furnace
and air conditioner according to the manufacturer's instructions. Also
consider installing a small-particle filter in your ventilation system. If you
use a humidifier, change the water daily.

 Reduce pet dander. If you're allergic to dander, avoid pets with fur or
feathers. Having pets regularly bathed or groomed also may reduce the
amount of dander in your surroundings.

 Clean regularly. Clean your home at least once a week. Because

cleaning stirs up dust, however, wear a mask or, if you can, have
someone else clean.

 Limituse of contact lenses. Try substituting eyeglasses for your

contact lenses when the pollen count is high. Pollen grains can become
trapped under the lenses.

 Control heartburn and gastroesophageal reflux disease (GERD). It's

possible that the acid reflux that causes heartburn may damage lung
airways and worsen asthma symptoms. If you have frequent or constant
heartburn, talk to your doctor about treatment options.

Coping skills
Asthma can be challenging and stressful. You may sometimes become
frustrated, angry or depressed because you need to cut back on your usual
activities, to avoid environmental triggers. You may also feel hampered or
embarrassed by the symptoms of the disease and by complicated management
routines. Children in particular may be reluctant to use a metered dose inhaler in
front of their peers.

But asthma doesn't have to be a limiting condition. The best way to overcome
anxiety and a feeling of helplessness is to understand your condition and take
control of your treatment. Here are some suggestions that may help:

 Identifythe things that trigger your symptoms. This can be one of

the most important ways to take control of your life. Also take peak flow
 measurements regularly and follow your action plan for using medications
and managing attacks.

 Paceyourself. Take breaks between tasks and avoid activities that

make your symptoms worse.

 Makea daily to-do list. This may help you avoid feeling overwhelmed.
Reward yourself for accomplishing simple goals.

 Talkto others with your condition. Chat rooms and message boards
on the Internet or support groups in your area can connect you with
people facing similar challenges and let you know you're not alone.

If you have a child with asthma, be encouraging and supportive. Focus attention
on the things your child can do, not on the things he or she can't do. Involve
teachers, school nurses, coaches, friends and relatives in helping your child
manage an asthma condition.