Bronchial AsthmaEver hear the term “bronchial asthma” and wonder what it means? When people talk about bronchial asthma, they are really talking about asthma, a chronic inflammatory disease of the airways that causes periodic “attacks” of coughing, wheezing, shortness of breath, and chest tightness.

According to the CDC, more than 22 million Americans, including 6.5 million children under 18, suffer with asthma today. Allergy clearly plays an important role in many asthma cases but not in all. As with allergy, you can blame your family history; there’s certainly a strong genetic component for asthma.

Because of asthma symptoms, asthma is associated with mast cells, eosinophils, and T lymphocytes. Mast cells are the allergy-causing cells that release chemicals like histamine. Histamine is the substance that causes nasal stuffiness and dripping in a cold or hay fever, constriction of airways in asthma, and itchy areas in a skin allergy. Eosinophils are a type of white blood cell associated with allergic disease.  T lymphocytes are also white blood cells associated with allergy and inflammation.

These cells, along with other inflammatory cells, are involved in the development of airway inflammation in asthma that contributes to the airway hyperresponsiveness, airflow limitation, respiratory symptoms, and chronic disease. In certain individuals, the inflammation results in the feelings of chest tightness and breathlessness that’s felt often at night (nocturnal asthma) or in the early morning hours. Others only feel symptoms when they exercise (called exercise-induced asthma).  Because of the inflammation, the airway hyperresponsiveness occurs as a result of specific triggers.

Allergies are strongly linked to bronchial asthma and to other respiratory diseases such as chronic sinusitis, middle ear infections, and nasal polyps. Most interestingly, a recent analysis of people with asthma showed that those who had both allergies and asthma were much more likely to have nighttime awakening due to asthma, miss work because of asthma, and require more powerful medications to control their symptoms.

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Bronchial Asthma TriggersAsthma triggers may include:

Tobacco smoke Infections such as colds, flu, or pneumonia Allergens such as food, pollen, mold, dust mites, and

pet dander Exercise Air pollution and toxins Weather, especially extreme changes in temperature Drugs (such as aspirin, NSAID, and beta-blockers) Food additives (such as MSG) Emotional stress and anxiety Singing, laughing, or crying Smoking, perfumes, or sprays Acid reflux

Signs and Symptoms of Bronchial AsthmaWith bronchial asthma, you may have one or more of the following signs and symptoms:

Shortness of breath Tightness of chest Wheezing

Excessive coughing or a cough that keeps you awake atAsthma SymptomsPeople with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. Common symptoms of asthma include :

Wheezing

Coughing, especially at night

Shortness of breath Chest tightness, pain, or pressure

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Still, not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your asthma symptoms may also vary from one asthma attack to the next, being mild during one asthma attack and severe during another.

Some people with asthma may go for extended periods without having any symptoms, interrupted by periodic worsening of their symptoms called asthma attacks. Others might have asthma symptoms every day. In addition, some people with asthma may only have asthma during exercise or asthma with viral infections like colds.

Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours. Severe attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms to help you prevent severe episodes and keep asthma under better control. 

1. Know the Early Asthma SymptomsEarly warning signs are changes that happen just before or at the very beginning of an asthma attack. These asthma attack symptoms may start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

In general, these signs are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse. Early warning signs include:

Frequent cough, especially at night losing your breath easily or shortness of breath Feeling very tired or weak when exercising Wheezing or coughing after exercise Feeling tired, easily upset, grouchy, or moody Decreases or changes in lung function as measured on a peak

flow meter Signs of a cold, or allergies (sneezing, runny nose, cough, nasal

congestion, sore throat, and headache) Trouble sleeping

If you have early warning signs or symptoms, you should take more asthma medication as described in your asthma action plan

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3. Know the Symptoms of an Asthma Attack

An asthma attack is the episode in which bands of muscle surrounding the airways are

triggered to tighten. This tightening is called bronchospasm. During the attack, the lining of

the airways becomes swollen or inflamed and the cells lining the airways produce more and

thicker mucus than normal.

Asthma Tests

There are some key asthma tests your doctor will use in diagnosing asthma. Some asthma

tests, such as pulmonary function tests, measure lung function. Other asthma tests determine

if you are allergic to specific foods, pollen, or other particles. Blood tests give a picture of your

overall health; specific tests also measure levels of immunoglobulin E (IgE), a key antibody

that’s released during an allergic reaction.  While everyone makes IgE, people who have

allergies make larger quantities of this protective protein.

All of these asthma tests help your doctor determine if asthma is indeed present and if there

are other coexisting conditions, such as allergies and asthma, GERD and asthma, or sinusitis

and asthma. Once a proper asthma diagnosis is made, specific asthma medications can be

prescribed to help manage your asthma and prevent asthma attacks.

Pulmonary Function Tests

Pulmonary function tests (or lung function tests) are asthma tests that assess lung function.

The two most common pulmonary function tests used to diagnose asthma are spirometry and

methacholine challenge tests.

Spirometry is a simple breathing test that measures how much and how fast you can blow air

out of your lungs. It is often used to determine the amount of airway obstruction you have.

The methacholine challenge test may be performed if your symptoms and screening

spirometry do not clearly or convincingly establish a diagnosis of asthma. Your doctor will

know which test is best for your situation.

Chest X-Ray

While a chest x-ray is not an asthma test, it may be used to make sure nothing else is causing

your asthma symptoms. An X-ray is an image of the body that is created by using low doses

of radiation reflected on special film or a fluorescent screen. X-rays can be used to diagnose

a wide range of conditions, from bronchitis to a broken bone. Your doctor may perform an X-

ray exam on you in order to see the structures inside your chest, including the heart, lungs,

and bones. By viewing your lungs, your doctor can see if asthma is causing your symptoms.

Evaluation for Heartburn and GERD

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Gastroesophageal reflux disease, commonly called GERD is another condition that may

worsen asthma. If your doctor suspects this problem, he or she may recommend specific

tests to look for it.

For more detail, see WebMD's article on Heartburn and Asthma.

Allergy Tests

Allergy testing may be recommended to identify any allergies that trigger asthma symptoms.

For more detail, see WebMD's article on Allergies and Asthma.

Asthma Attack Symptoms

Can you recognize asthma attack symptoms? Being acutely aware of asthma attack

symptoms is crucial to preventing an asthma emergency.

Some asthma attack symptoms such as wheezing are easy to identify. Yet other asthma

attack symptoms such as feelings of anxiety or panic are not as well known. Some people

have coughing with asthma no wheezing with an asthma attack. Others may have an itchy

chin before they start to feel short of breath and cough. Still others may only have symptoms

at nighttime (called nocturnal asthma). Understanding asthma attack symptoms early on will

help in prevention of asthma symptoms as you seek quick treatment with asthma medication

when it’s most effective.

Understanding Asthma Attack Symptoms

An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of

muscles of your airways (bronchospasm). During the attack, the lining of the airways

becomes swollen or inflamed and more and thicker mucus than normal is produced. All of

these factors -- bronchospasm, inflammation, and mucus production -- cause asthma attack

symptoms such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty

performing normal daily activities. Other symptoms of an asthma attack include:

Severe wheezing when breathing both in and out

Coughing that won't stop

Very rapid breathing

Chest pain or pressure

Tightened neck and chest muscles, called retractions

Difficulty talking

Feelings of anxiety or panic

Pale, sweaty face

Blue lips or fingernails

Or worsening symptoms despite use of your medications

q If you have asthma, you may go for weeks to months without having any asthma attack

symptoms. Then suddenly, when you least expect it, you might have asthma symptoms such

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as shortness of breath, coughing, and wheezing. Sometimes allergies to seasonal pollen or

weather changes can trigger asthma attack symptoms. Other times, a viral infection such as

cold or flu can trigger asthma attack symptoms. Even exercise or sudden stress can cause

asthma attack symptoms. As an example, sinusitis with asthma is common. Even exercise

can cause asthma symptoms (called exercise-induced asthma). Stress triggers asthma, too.

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What Is Asthma?

What Is Asthma?

Asthma is a chronic disease of the airways that makes breathing difficult. With asthma, there

is inflammation of the air passages that result in a temporary narrowing of the airways that

carry oxygen to the lungs. This results in asthma symptoms, including coughing, wheezing,

shortness of breath, and chest tightness. Some people refer to asthma as “bronchial asthma.”

Even though there are seemingly miraculous treatments for asthma symptoms, asthma is still

a serious -- even dangerous -- disease that affects more than 22 million Americans and

causes nearly 2 million emergency room visits ever year. With proper asthma treatment, you

can live well with this health condition. Yet inadequate asthma treatment limits the ability to

exercise and be active. Poorly controlled asthma can lead to multiple visits to the emergency

room and even hospital admission, which can affect your performance at home or at work.

In each of the following sections, there are in-depth articles that link to the topics. Be sure to

read each health topic so you have a greater understanding of asthma and how it is

diagnosed and treated.

There are three major features of asthma:

1. Airway obstruction. During normal breathing, the bands of muscle that surround the

airways are relaxed, and air moves freely. But in people with asthma, allergy-causing

substances and environmental triggers make the bands of muscle surrounding the airways

tighten, and air cannot move freely. Less air causes a person to feel short of breath, and the

air moving through the tightened airways causes a whistling sound known as wheezing.

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(Fortunately, this airway narrowing is reversible, a feature that distinguishes asthma from

other lung diseases such as bronchitis or emphysema.)

2. Inflammation. People with asthma have red and swollen bronchial tubes. This

inflammation is thought to contribute greatly to the long-term damage that asthma can cause

to the lungs. And, therefore, treating this inflammation is key to managing asthma in the long

run.

3. Airway irritability. The airways of people with asthma are extremely sensitive. The

airways tend to overreact and narrow due to even the slightest triggers such as pollen, animal

dander, dust or fumes.

Adult-Onset Asthma: Are You at Risk?

Asthma affects 22 million Americans. Asthma in children occurs in approximately 10%-12% of

kids. Asthma may occur at any age, although it's more common in younger individuals (under

age 40).

People who have a family history of asthma have an increased risk of developing the disease.

Allergies and asthma often occur together. Smoking with asthma, a dangerous combination,

is still seen commonly.

However, anyone can develop asthma at any time, and adult-onset asthma happens

frequently. If you have symptoms of asthma, talk to your doctor. If you have adult-onset

asthma, your doctor will instruct you in using the asthma inhalers and other asthma

medications to prevent further breathing problems

Asthma Doctor: 10 Questions You Must Ask

Going to an asthma doctor can be frightening. Many patients tell of feeling rushed and

nervous, and they forget to ask important questions about asthma.

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It’s a good idea to have questions ready to ask before your doctor’s appointment. You might

jot down asthma questions and concerns on a notepad and take these to your doctor’s visit.

If you’re unsure about what to ask the asthma doctor, consider the following 10 questions

about asthma. You can print out this page and take it with you to your next appointment with

your asthma doctor.

1. What is asthma?

2. What are the causes of asthma?

3. Are there lifestyle habits I can change to get some asthma relief and reduce my risk of an

asthma attack?

4. What kinds of asthma tests will I need?

5. How do I use an asthma inhaler?

6. Are there some natural asthma therapies I can use along with asthma medications?

7. Is it safe to exercise with asthma?

8. How can an asthma action plan guide me in treating daily symptoms?

9. Does stress trigger asthma?

10. Are you aware of any asthma support groups?

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Asthma treatment can vary from anti-inflammatory and bronchodilator asthma inhalers to oral

medications to asthma drugs delivered in an asthma nebulizer or breathing machine. Get a

better understanding of how asthma medications work so you'll know which medications can

prevent asthma symptoms. Also, learn about natural asthma remedies and ways to monitor

your breathing at home

Asthma Medications

Asthma medications can save your life -- and let you live an active life in spite of your asthma.

There are two basic types of medications used in asthma treatment:

Steroids and Other Anti-Inflammatory Drugs

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Anti-inflammatory medications, particularly inhaled steroids, are the most important treatment

for most people with asthma. These lifesaving medications prevent asthma attacks and work

by reducing swelling and mucus production in the airways. As a result, the airways are less

sensitive and less likely to react to asthma triggers and cause asthma symptoms.

Asthma, Steroids, and Other Anti-Inflammatory Drugs

The key treatments for most people with asthma are steroids and other anti-inflammatory

drugs. Not only do steroids and anti-inflammatory drugs help people gain better asthma

control, but these asthma drugs help to prevent asthma attacks.

Steroids and other anti-inflammatory drugs work by reducing swelling and mucus production

in the airways of a person with asthma. As a result, the airways are less sensitive and less

likely to react to asthma triggers, allowing people with symptoms of asthma to have better

control over their condition.

What Are the Main Types of Steroids and Anti-Inflammatory Drugs That Control

Asthma?

The main types of anti-inflammatory drugs for better asthma control are steroids or

corticosteroids (inhaled and oral), mast cell stabilizers, the leukotriene modifier drugs, and IgE

blockers.

What Are Inhaled Steroids?

Inhaled steroids are the most effective asthma medications to reduce airway inflammation

and mucus pr oduction. The use of inhaled steroids leads to:

B Better asthma control

Fewer symptoms and flare-ups

Reduced need for hospitalization

e Note that while inhaled steroids prevent asthma symptoms, they do not relieve asthma

symptoms you already have. Dosages of inhaled steroids in asthma inhalers vary.

Inhaled steroids need to be taken daily for best results. Some improvement in asthma

symptoms can be seen in one to three weeks after starting inhaled steroids, with the best

results seen after three months of daily use. 

Inhaled steroids (asthma inhalers) for better asthma control include:

A Advair (a combination medication that includes a steroid plus a long-acting

bronchodilator drug)

Aerobid

Asmanex

Azmacort

Flovent

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Pulmicort

Symbicort (a combination medication that includes a steroid plus a long acting

bronchodilator drug)

Inhaled steroids come in three forms: the metered dose inhaler (MDI), dry powder inhaler

(DPI), and nebulizer solutions.

What Are the Side Effects of Inhaled Steroids?

Inhaled steroids have few side effects, especially at lower doses. If you are taking higher

doses, thrush (yeast infection in the mouth) and hoarseness may occur, although this is rare.

Rinsing the mouth, gargling after using the asthma inhaler and using a spacer device with

metered dose inhalers will help prevent these side effects. Thrush is easily treated with an

antifungal mouthwash.

Inhaled steroids (asthma inhalers) are safe for adults and children. Side effects with these

anti-inflammatory asthma inhalers are minimal. Your doctor will prescribe the lowest dose that

effectively controls your or your child's asthma.

On a side note, many parents are concerned about giving their children "steroids." The

inhaled steroids are not the same as anabolic steroids that some athletes take to build

muscle. These steroids are anti-inflammatory drugs, the cornerstone of asthma therapy.

There are many benefits of using anti-inflammatory asthma inhalers to self-manage asthma.

To learn more about using inhaled steroids in children, see WebMD's article on Childhood

Asthma.

d To learn more about using inhaled steroids in children, see WebMD's article on Childhood

Asthma.

What Are the Benefits of Using Inhaled Steroids?

The benefits of inhaled steroids for better asthma control far exceed their risks, and include:

Re Bronchodilators

Bronchodilators relieve the symptoms of asthma by relaxing the muscle bands that tighten

around the airways.  

Short-acting bronchodilator inhalers are used to quickly relieve the cough, wheeze, chest

tightness, and shortness of breath caused by asthma (they dilate or widen the bronchial

tubes). The most commonly prescribed short-acting bronchodilator is albuterol. However,

albuterol only lasts for a few hours. If you need to use an asthma reliever more than twice a

week, then your asthma is not optimally controlled.  Ask your doctor about improving your

asthma controller medication.

Long-acting bronchodilators are often combined with inhaled steroids when someone has

asthma symptoms more than once a week despite treatment with an inhaled steroid alone.

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For in-depth information, see WebMD's article on Bronchodilators: Airway Openers.

Asthma Inhalers

Asthma inhalers are the most common and effective way to deliver asthma medication to the

lungs. There are some combination asthma inhalers, which contain two different medications:

an inhaled steroid and a long-acting bronchodilator. These combination asthma inhalers are

popular due to their convenience, and the medications last for at least 12 hours.

For in-depth information, see WebMD's article on Asthma Inhalers.

Asthma Nebulizer

If you’re having difficulty using small inhalers, your doctor may prescribe an asthma nebulizer,

also known as a breathing machine. The asthma nebulizer with a mask is typically used for

infants, small children, elderly adults or anyone who has difficulty using inhalers with spacers.

The nebulizer changes asthma medications from a liquid to a mist, so that they can be more

easily inhaled into the lungs.  This takes a few more minutes of time when compared to

inhalers.

For in-depth information, see WebMD's article on Asthma Nebulizer (Breathing Machine).

duced frequency of asthma attacks

Decreased use of beta-agonist bronchodila

Improved lung function

Reduced emergency room visits and hospitalizations for life-threatening asthma

 

How do Prednisone and Systemic Steroids Work to Increase Asthma Control?

Using systemic steroids (steroids that get into the bloodstream and not just the lungs) such as

prednisone with asthma helps to treat severe asthma episodes, allowing people to gain better

asthma control. Prednisone and other steroid drugs are used with asthma medications to

either control sudden and severe asthma attacks or to treat long-term, hard-to-control asthma.

Qvarvair (a combination medication that includes a steroid plus a long-acting

bronchodilator drug)

Aerobid

Asmanex

Azmacort

Flovent

Pulmicort

Symbicort (a combination medication that includes a steroid plus a long acting

bronchodilator drug)

Reduced frequency of asthma attacks

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Decreased use of beta-agonist bronchodila

Improved lung function

Reduced emergency room visits and hospitalizations for life-threatening asthma

 

How do Prednisone and Systemic Steroids Work to Increase Asthma Control?

Using systemic steroids (steroids that get into the bloodstream and not just the lungs) such as

prednisone with asthma helps to treat severe asthma episodes, allowing people to gain better

asthma control. Prednisone and other steroid drugs are used with asthma medications to

either control sudden and severe asthma attacks or to treat long-term, hard-to-control asthma.

tter Better asthma control

Fewer symptoms and flare-ups

Advair (a combination medication that includes a steroid plus a long-acting bronchodilator

drug)

Aerobid

Asmanex

Azmacort

Flovent

Pulmicort

Symbicort (a combination medication that includes a steroid plus a long acting

bronchodilator drug)

Qvar

Inhaled steroids come in three forms: the metered dose inhaler (MDI), dry powder inhaler

(DPI), and nebulizer solutions

asthma control

Fewer symptoms and flare-ups

Reduced need for hospitalization

Better asthma control

Fewer symptoms and flare-ups

Reduced need for hospitalNote that while inhaled steroids prevent asthma symptoms, they

do not relieve asthma symptoms you already have. Dosages of inhaled steroids in asthma

inhalers vary.

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ugh, especially at

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