Asthma

Asthma Overview

Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness and coughing. Uncontrolled, asthma can be extremely dangerous—leading to death, decreased ability to exercise, fatigue, and a persistent cough. Almost 10% of children have asthma in the United States, according to the Centers for Disease Control and Prevention, and it accounts for more than 2 million emergency department visits each year.

Symptoms

Asthma symptoms can vary greatly among individuals and range from minor to severe. Patients might find they have symptoms primarily at night, during exercise or when they are exposed to specific asthma triggers. Symptoms include:

Shortness of breath
Trouble sleeping because of coughing, wheezing or shortness of breath.
Chest tightness.
A whistling or wheezing sound—common among children with asthma.

For some people, asthma symptoms flare up only with certain triggers:

Exercise-induced asthma occurs during exercise. For many people, exercise-induced asthma is worse when the air is cold and dry.
Occupational asthma is asthma that's caused or worsened by breathing in a workplace irritant such as chemical fumes, gases or dust.
Allergy-induced asthma: Some people have asthma symptoms that are triggered by particular allergens, such as pet dander, cockroaches or pollen.

Risk Factors

Many factors can lead to the development of asthma, including:

A family history of asthma
Allergies
Low levels of Vitamin D
Smoking or second-hand smoke
Low birth weight
Workplace exposures to chemicals
Sinusitis or the inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection
Antibiotic use in the first year of life

In addition, several other factors can play a role in the development of asthma, such as:

Gender - Before puberty, asthma is more common in boys, but after adolescence, it becomes more common in girls. And in adults, women report more severe symptoms than men. In addition, women might be at a greater risk of death from asthma than men.
Obesity - Increasingly, studies are showing a strong association between obesity and asthma - with some health experts suggesting that the excess weight pressing on the lungs might trigger an asthma attack. Others speculate that asthma leads to obesity because it inhibits physical activity. Finally, some wonder whether obese patients might be misdiagnosed with asthma, when they are really just simply short of breath. However, losing weight appears to relieve many asthma symptoms.
Urban living and poverty - The urban poor are among those for the greatest risk for severe asthma and death. Reasons range from a lack of asthma management plans to poor living conditions.

Asthma Prevention

There is no cure for asthma, and no way to prevent it from starting. It can be controlled with the help of consistent medical planning with your Wellstar physician. Steps include:

Create a written asthma action plan (the National Heart, Lung, and Blood Institute offers an Asthma Action Plan for a sample).
Use the medicines that your Wellstar physician prescribes).
Identify the things that make your asthma worse).
Have regular checkups for your asthma).

Allergies and Asthma

Allergy testing may be helpful in identifying allergens in people with persistent asthma. Common allergens include pet dander, dust mites, cockroach allergens, molds, and pollens. Common respiratory irritants include tobacco smoke, pollution, and fumes from burning wood or gas.

Tests and Screenings for Asthma

When asthma is suspected, your Wellstar physician may order a variety of tests:

Blood tests to measure eosinophil count (a type of white blood cell), IgE (a type of immune system protein called an immunoglobulin) and RAST (a radioimmunoassay test to detect certain types of allergens).
Spirometry, the most common of the Pulmonary Function Tests (PFTs), that measures the amount and flow of the air that can be inhaled and exhaled.
A peak flow meter, an inexpensive, portable, handheld device that measures how well the air is moving out of your lungs.
A chest x-ray, to rule out other diseases.

Asthma Diagnosis

Your Wellstar doctor will diagnose asthma based on your medical history, a physical exam, and results from tests. Your severity level will determine what treatment you will start on and whether you need to see an asthma specialist.

To diagnose asthma, your doctor might ask about your family history of asthma and allergies and how often you are experiencing asthma symptoms. They will also try to determine with you what factors seem to make your symptoms worse. Your doctor will also ask about other conditions that are related to asthma such as sinus infections, reflux disease, sleep apnea and stress.
Next, your Wellstar physician will conduct a physical exam to look for signs of asthma or allergies, including wheezing, a runny nose or allergic skin conditions.
Then, your Wellstar physician could conduct a number of diagnostic tests, including lung function tests, allergy tests and tests to determine if you might have another disease similar to asthma, such as reflux disease, vocal cord dysfunction or sleep apnea. They might also order an EKG or electrocardiogram to make sure there isn’t a foreign object or some other disease causing your symptoms.

Diagnosing Asthma in Children

Asthma in young children (aged 0 to 5 years) can be hard to diagnose. A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:

One or both parents have asthma.
The child has signs of allergies, including the allergic skin condition eczema.
The child has allergic reactions to pollens or other airborne allergens.
The child wheezes even when he or she doesn't have a cold or other infection.

Your Wellstar physician might also use a four- to six-week trial of asthma medication to see how well a young child responds.

Time to See An Asthma Specialist

You might need to see a Wellstar asthma specialist if:

You've had a life-threatening asthma attack.
You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall difficulty getting your asthma well controlled.
You're thinking about getting allergy treatments.

Diagnostic Procedures

Physical exam
Lung function tests
Allergy tests
Electrocardiogram (EKG)

Asthma Treatment

Because asthma is a chronic disease that cannot be cured, the goal of asthma is to control the symptoms. A good asthma plan will:

Prevent chronic and troublesome symptoms such as coughing and shortness of breath.
Maintain good lung function.
Allow you to keep up normal activity levels and sleep through the night.
Prevent asthma attacks that could result in an emergency room or hospital visit.

To reach this goal, you should actively partner with your Wellstar doctors to manage your asthma or your child's asthma. Children aged 10 or older—and younger children who are able—also should take an active role in their asthma care.

Together, you should develop a plan that outlines how and when to take your medicines properly, avoid factors that worsen your asthma, track your level of asthma control, respond to worsening asthma, and seek emergency care when needed.

Your initial asthma treatment will depend on how severe your disease is. Follow-up asthma treatment will depend on how well your plan is working to control your symptoms and prevent you from having asthma attacks.

Your level of asthma control can vary over time and with changes in your home, school, or work environments that alter how often you are exposed to the factors that can make your asthma worse. Your doctor may need to increase your medicine if your asthma doesn't stay under control.

On the other hand, if your asthma is well controlled for several months, your Wellstar physician may be able to decrease your medicine. These adjustments to either up or down your medicine will help you maintain the best control possible with the least amount of medicine necessary.

Asthma treatment for certain groups of people, such as children, pregnant women, or those for whom exercise brings on asthma symptoms, will need to be adjusted to meet their special needs.

You can check out the National Heart, Lung, and Blood Institute's (NHLBI's) Asthma Action Plan for a sample plan.

Taking Care of Asthma with Medication

Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up. People with mild asthma (infrequent attacks) may use quick relief medication as needed.

These include:

Short-acting bronchodilators (inhalers), such as Proventil^®, Ventolin^®, Xopenex^®, and or ProAir^®
Corticosteroids, such as methylprednisolone, may be given directly into a vein (intravenously), during a severe attack, along with other inhaled medications.

Long-term control medications are used on a regular basis to prevent attacks, not to treat them. Such medicines include:

Inhaled corticosteroids (such as Azmacort^®, Flovent^®, Plumicort^®) prevent inflammation
Leukotriene inhibitors (such as Singulair^® and Accolate^®)
Long-acting bronchodilators (such as Serevent^® and Floradil^®) help keep airways open
Omilizumab (Xolair^®), which blocks a pathway that the immune system uses to trigger asthma symptoms
Cromolyn sodium (Intal^®) or nedocromil sodium (Tilade^®)
Aminophylline or theophylline (not used as frequently as in the past)
Sometimes, a single medication that combines steroids and bronchodilators is used (Advair^®, Symbicort^®)

Those with persistent asthma should take control medications on a regular basis to prevent symptoms. A severe asthma attack requires a check up by a doctor and, possibly, a hospital stay, oxygen, and medications through a vein (IV).

Tools for Treatment

A peak flow meter is a simple device to measure how quickly you can move air out of your lungs. It can help you see if an attack is coming, sometimes even before any symptoms appear. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50-80% of a specific person's best results are a sign of a moderate asthma attack, while values below 50% are a sign of a severe attack.

Pulmonary Medicine at Wellstar

Wellstar Pulmonary Network provides top-flight pulmonary care throughout the Wellstar Health System. Each of Wellstar’s physicians, certified in their field, have the knowledge and skill needed to diagnose and treat all pulmonary conditions and diseases, ranging from asthma, bronchitis, emphysema, pneumonia, respiratory failure, pulmonary hypertension, lung cancer and sleep apnea. In addition, many of our providers have special training in internal medicine, pulmonary diseases and critical care medicine. As a result, you can feel confident—at every level—about your pulmonary care at Wellstar.

Ongoing Care for Asthma

Wellstar’s world-class, community-based physicians utilize state-of-the-art medical centers and hospitals with the latest technologies and medical resources. Our clinicians are dedicated to:

Helping you create and maintain healthy lifestyles.
Offering advice to prevent illness and injuries.
Providing early and appropriate care of acute illness to prevent its progression.