Asthma is a chronic lung disease that affects more than 17 million
Americans. Asthma is characterized by inflammation of the airways. The
inflammation makes the airways smaller and therefore making it more
difficult for air to move in and out of the lung. This creates the symptoms
of asthma:
- Cough
- Chest tightness
- Shortness of breath
- Wheezing
Triggers of asthma
Asthma symptoms can be triggered by several factors, including:
- Allergens
- Irritants such as tobacco smoke, strong odors
- Weather changes
- Viral or sinus infections
- Exercise
- Reflux disease (Stomach acid flowing back up the esophagus, or food
pipe)
- Medications or foods
- Emotional anxiety
Every person has their own triggers. If you have asthma you can minimize
your symptoms by avoiding the factors that trigger your symptoms, and by
working with your physician to develop an effective management and treatment
plan.
Allergens
Allergic rhinitis, or "hay fever," is a risk factor in developing asthma.
Symptoms of both can be triggered by allergens - any substance that triggers
allergies. These include:
- Pollens
- Molds
- Animal dander
- House dust mite
- Cockroach droppings
If your asthma is triggered by allergens, it is important to avoid
exposure to them. See your allergist/immunologist for recommendations on
control measures to help avoid allergens.
Irritants
Inflamed asthmatic airways are sensitive to environmental irritants.
Irritants that can trigger and aggravate asthma include:
- Air pollutants such as tobacco smoke, wood smoke, chemicals in the air
and ozone
- Occupational exposure to vapors, dust, gases or fumes
- Strong odors or sprays such as perfumes, household cleaners, cooking
fumes (especially from frying), paints or varnishes
- Other airborne particles such as coal dust, chalk dust or talcum
powder
- Changing weather conditions, such as changes in temperature and
humidity, barometric pressure or strong winds
All of these irritants can aggravate asthma, particularly tobacco smoke.
Several studies have reported an increased incidence of asthma in children
whose mothers smoke. No one should smoke in the home of an asthmatic.
Infections
Viral infections such as colds or viral pneumonia can trigger or aggravate
asthma, especially in young children. These infections can irritate the
airways, nose, throat, lungs, and sinuses, and this added irritation often
triggers asthma flare-ups. Additionally, sinusitis - an inflammation
of the hollow cavities found around the eyes and behind the nose - can
trigger asthma.
Exercise
Strenuous physical exercise can also trigger attacks. Mouth breathing,
exercising in cold, dry air, or prolonged, strenuous activities such as
medium- to long-distance running can increase the likelihood of
exercise-induced asthma (EIA). For more information, please see the Tips
brochure in this series or speak to your allergist/immunologist.
Reflux disease
Gastroesophageal reflux disease (GERD), a condition in which stomach
acid flows back up the esophagus, can affect patients with asthma. Symptoms
include severe or repeated heartburn, belching, night asthma, increased
asthma symptoms after meals or exercise, or frequent coughing and
hoarseness. GERD reflux treatment is often beneficial for asthma symptoms as
well.
Medications
Some adults with asthma may experience an asthma attack as a result of
taking certain medications. These can include aspirin or other non-steroidal
anti-inflammatory drugs (NSAIDS) such as ibuprofen; and beta-blockers (used
to treat heart disease, high blood pressure or migraine headaches). Before
taking any over-the-counter medications, those with asthma should consult
their physicians.
Food
For some, eating certain foods or various food additives can trigger asthma
symptoms. Culprits include milk, eggs, peanuts, tree nuts, soy, wheat, fish
and shellfish. If any of these foods triggers asthma attacks, the best
remedy is to avoid eating them.
Emotional Anxiety
Emotional factors alone cannot provoke asthma. However, anxiety and nervous
stress can cause fatigue, which may also increase asthma symptoms and
aggravate an attack. As with any other chronic health condition, proper
rest, nutrition and exercise are important to overall well-being and can
help in managing asthma.
Asthma management
Since asthma is a chronic disease, it requires continuous management and
appropriate treatment. According to the national Guidelines for the
Diagnosis and Management of Asthma (National Asthma Education and
Prevention Program, National Institutes of Health, 1997), asthma treatment
has four main components:
- The use of objective measure of lung function (such as peak flow
meters and spirometers) to assess the severity of asthma and to monitor
the course of treatment
- Environmental control measures to avoid or eliminate factors that
trigger asthma symptoms or flare-ups
- Medication therapy for long-term management to reverse and prevent
airway inflammation as well as therapy to manage asthma flare-ups
- Patient education to foster a partnership between the patients, his or
her family, and the physician and other health care providers
According to the Guidelines, there are six goals for the effective
management of asthma:
- Prevent chronic and troublesome symptoms
- Maintain (near) "normal" breathing
- Maintain normal activity levels, including exercise
- Prevent recurrent asthma flare-ups, and minimize the need for
emergency room visits or hospitalizations
- Provide optimal medication therapy with no or minimal adverse effects
- Meet patients' and families' expectations of satisfactory asthma care
You and your physician can work together on these goals to ensure that
your asthma is well-managed. Having asthma should not stop you from
participating in normal activities.
Medication treatment
Asthma management includes using proper medications to prevent and
control asthma symptoms and to reduce airway inflammation. Asthma
medications are thus categorized into two general classes, quick-relief and
long-term control medications. Quick-relief medications that are used to
provide temporary relief of symptoms include:
- Bronchodilators, generally used as "rescue medications," open
up the bronchial tubes so that more air can flow through. Bronchodilators
include beta-agonists and anticholinergics, and come in inhaled, tablet,
liquid or injectable forms.
- Corticosteroids are administered for short-term use orally or
by injection to speed up the resolution of airway inflammation.
Long-term control medications are taken daily to control the airway
inflammation in persistent asthma. This class includes:
- Inhaled corticosteroids are the most effective long-term
therapy available for persistent asthma. They are generally well tolerated
and safe at recommended dosages.
- Cromolyn or Nedocromil stop the development of inflammation in
the lungs, as well as help to prevent it. Response to these two are less
predictable then the response to inhaled corticosteroids. These
medications are very safe.
- Leukotrienes modifiers fight potent chemicals called
leukotrienes (lu-ko-try-eens) responsible for airway inflammation within
the body. They are generally safe.
- Inhaled beta 2-agonists are long-acting and beneficial when
added to inhaled corticosteroids.
- Methylxanthines provide mild to moderate dilation of the
airways and may have a mild anti-inflammatory effect. Theophylline is the
most frequently used methylxanthine.
- Omalizumab was approved in 2003 as a new class of therapy,
known as anti-IgE, for patients with moderate to severe persistent
allergic asthma. IgE is an antibody that we all have and it is responsible
for causing allergic problems in some people. It may reduce allergic
reactions by causing free IgE to disappear from the body so that the IgE
cannot attach to pollen (and other substances that are present).
Combination therapy, with the addition of a long-acting beta2-agonist to
low-to-medium doses of inhaled corticosteroids, results in improvement in
asthma control. Adding a leukotriene modifier or theophylline to inhaled
corticosteroids also improves asthma control but the evidence is not as
substantial.
Make sure you follow your physician's instruction on the appropriate use
and dosage of your prescribed medications.
The better informed you are about your asthma triggers and management,
the less asthma symptoms will interfere with your activities. It is
important to avoid your triggers, work with your physician on a management
plan and take appropriate medications as prescribed. Together, you and your
allergist/immunologist can work to ensure that asthma does not interfere
with your optimal quality of life.
For more information on any of the topics mentioned in this brochure,
please see the appropriate Tips brochures in this series or speak
with an allergist/immunologist.
Your allergist/immunologist can provide you with more information on
asthma triggers and management.
Tips to Remember are created by the Public Education Committee
of the American Academy of Allergy, Asthma and Immunology. This brochure was
updated in 2003.
The content of this brochure is for informational purposes only. It is
not intended to replace evaluation by a physician. If you have questions or
medical concerns, please contact your allergist/immunologist.
Shailen R. Shah, MD
