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Asthma -- Adult

Definition

Asthma is a chronic disease that affects the function and lining of the airways or tubes of the lungs. It narrows the airways and makes it difficult to breathe.
Inflamed Bronchus in the Lungs
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Causes

Asthma symptoms are caused by an increased sensitivity of the airways to certain triggers. The triggers cause the lining of the airways to swell and produce extra fluid called mucus. At the same time, the muscles around the outside of the airway tighten in response to the irritation. All of these reactions narrow the airways and make it difficult to breathe. This response is often referred to as an asthma attack.
Possible triggers of an asthma attack in a person with asthma include:
  • Viral illness
  • Exercise
  • Cold weather
  • Sinusitis
  • Gastroesophageal reflux disease (GERD)
  • Sulfites used in dried fruits and wine
  • Medications, such as aspirin, ibuprofen, and beta-blockers
  • Exposure to irritants or allergens, including:
    • Cigarette smoke
    • Smoke from a wood-burning stove
    • Pet dander
    • Dust
    • Chemicals
    • Mold and mildew
    • Pollen
    • Smog or air pollution
    • Perfumed products

Risk Factors

Factors that may increase you risk for asthma include:
  • Regularly breathing in cigarette smoke, including second-hand smoke
  • Regularly breathing in industrial or agricultural chemicals
  • A family member who has asthma
  • History of multiple respiratory infections during childhood
  • Being overweight
  • History of wheezing or asthma as a child
  • Having allergies
  • Having a mother who smoked during pregnancy

Symptoms

Symptoms include:
  • Wheezing
  • Tightness in the chest
  • Trouble breathing
  • Shortness of breath
  • Cough
  • Chest pain
  • Limited exercise tolerance

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Your doctor may also do some tests to measure lung function. They may include:
Your doctor may also do some allergy tests . The test will help determine if allergies are causing symptoms. The test may include skin pricks or blood tests.

Treatment

The treatment strategy for asthma includes:
  • Medications
  • Avoidance of allergens and irritants and control of contributing factors such as gastroesophageal reflux and sinusitis
  • Regular assessment and monitoring
You and your doctor should also create an asthma action plan. This is a plan you will follow to help control your asthma and handle asthma attacks.

Asthma Medications

Medications Used to Control Asthma
These medications are used to relax the airways and keep them from tightening. Examples include inhaled corticosteroids and long-acting beta agonists. The medications will help to avoid asthma attacks, but will not treat an existing attack.
Medications Used to Treat an Asthma Attack
These medications are used to treat an asthma attack. Examples include quick-acting beta agonists, anticholinergic agents, and corticosteroids.

Other Treatments

Prevention is an important step in asthma care. Allergy avoidance can be effective with asthma that is made worse by allergens. Some general tips for allergen avoidance include:
  • Avoid outside activities if there are high levels of air pollution, pollen, or mold spores.
  • Keep your windows closed during seasons with high pollen or mold spores. Air conditioning may help filter out allergens during warm seasons.
  • Consider getting a portable HEPA unit air cleaner to use in sleeping areas.
  • Consider getting HEPA filters for your heating/cooling system and your vacuum cleaner.
  • Have someone else vacuum for you. Avoid a room that has been freshly vacuumed. If you do vacuum, use a dust mask.
  • Keep the humidity down in your house. This may help prevent the growth of mold.
  • Treat allergies and sinusitis as advised by your doctor.
If allergies trigger your asthma attacks, ask your doctor about allergy shots. If you commonly have a stuffy, runny, or itchy nose, these shots may improve your asthma.
In addition, it may be helpful to learn breathing techniques or doing breathing exercises. Ask your doctor for advice.

Monitoring

Your asthma plan may need to be adjusted to adapt to changes in your life or health. Staying in contact with your doctor between visits can help you have better control of your asthma.
Online programs aimed at helping you manage your own symptoms can improve asthma control and lung function. Some examples of programs include American Lung Association or Asthma and Allergy Foundation of America .

Prevention

There are no guidelines for preventing asthma because the cause is unknown. However, you can help prevent asthma attacks by avoiding things that trigger your attacks. Triggers can vary from person to person but some general guidelines include:
  • Avoid strong chemicals or odors like perfume.
  • Avoid strenuous outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
  • Get a yearly flu shot . Colds and flus can worsen asthma.
  • Don't smoke. If you are pregnant, it is important that you do not smoke.
  • Avoid secondhand smoke. Do not allow anyone to smoke in your home.
  • Don't use a wood-burning stove or fireplace, including unvented gas fireplaces.
  • If cold weather triggers your asthma, avoid strenuous activities in cold weather. If you must, use a scarf or mask to warm the air before it reaches your lungs.
Talk to your doctor about:
  • The right level of exercise for you
  • Ways to track your asthma to help identify and treat flare-ups right away
  • Your work, hobbies, and home activities to see if any of these may be causing or worsening your asthma

RESOURCES

American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org

Asthma and Allergy Foundation of America http://www.aafa.org

CANADIAN RESOURCES

Allergy Asthma Information Association http://aaia.ca

The Canadian Lung Association http://www.lung.ca

References

Asthma in adults and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 1, 2014. Accessed August 21, 2014.

Asthma exacerbation in adults and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 15, 2014. Accessed August 21, 2014.

Asthma overview. Asthma and Allergy Foundation of America website. Available at: http://www.aafa.org/display.cfm?id=8. Accessed August 21, 2014.

Breathing exercises and or retraining techniques in management of asthma. Agency for Healthcare Research and Quality website. Available at: http://www.effectivehealthcare.ahrq.gov/ehc/products/222/1251/CER71%5FBreathingExercises%5FFinalReport%5F20120905.pdf. Accessed August 21, 2014.

Medical effects of mold exposure. American Academy of Allergy, Asthma & Immunology website. Available at http://www.aaaai.org/media/resources/academy%5Fstatements/position%5Fstatements/mold.pdf. Published February 2006. Accessed August 21, 2014.

Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ. 2009 October 27; 181(9): E181-E190.

Sublett JL, Seltzer J, Burkhead R, et al.; American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. J Allergy Clin Immunol. 2010 Jan;125(1):32-8.

Flu and people with asthma. United States Centers for Disease Control and Prevention. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/flu/asthma/. Updated September 25, 2013. Accessed August 21, 2014.

10/29/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Howden-Chapman P, Pierse N, Nicholls S, et al. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial. BMJ. 2008 Sep 23.

1/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Levenson M. Long-acting beta-agonists and adverse asthma events meta-analysis. Joint Meeting of the Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee and Pediatric Advisory Committee. December 10-11, 2008.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Bailey EJ, Cates CJ, Kruske S, et al. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2009;(1):CD006580.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Thomas M, McKinley RK, Mellor S, et al. Breathing exercises for asthma: a randomised controlled trial. Thorax. 2009;64:55-61. Epub 2008 Dec 3.

9/2/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Van der Meer V, Bakker MJ, van den Hout WB, et al. Internet based self-management plus education compared with usual care in asthma: a randomized trial. Ann Intern Med. 2009;151:110-120.

10/8/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Ducharme F, Chroinin M, Greenstone I, et al. Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev. 2010;(5):CD005535.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: McLean S, Chandler D, Nurmatov U, et al. Telehealthcare for asthma. Cochrane Database Syst Rev. 2010;(10):CD007717. 11/12/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Freitas DA, Holloway EA, et al. Breathing exercises for adults with asthma.Cochrane Database Syst Rev. 2013 Oct 1;10:CD001277.

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