This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

ASTHMA

Asthma is a condition in which a person has periods of wheezing and trouble breathing which occur over and over because of inflammation of the small air passages in the lungs. During periods of asthma, these passages become narrowed due to muscle spasms in the walls of the passages. The tissues in the walls also begin to swell. Mucus is produced and clogs the smaller air passages. This results in shortness of breath, wheezing, and trouble breathing.

The amount of difficulty breathing varies from person to person. Most of the time, it is mild, but some people may need to be hospitalized if their symptoms become severe. The goal of asthma treatment is to keep these symptoms from happening or if they do, to keep them under control.

If asthma is not effectively treated, irreversible damage to the airways can occur over time, causing permanent restrictions in breathing.

WHAT CAUSES ASTHMA?

No one knows exactly what causes asthma, but it is believed to be related to a hypersensitivity of the lungs. Some people's lungs seem to overreact to certain substances or conditions which then triggers an episode of asthma. It is also believed that this hypersensitivity may be hereditary since asthma tends to run in families.

The condition and substances that can trigger an episode vary from person to person. Common irritants that may affect some people include:

a) viral or bacterial infections of the respiratory tract

b) plants -- such as pollen from flowers, trees, grasses, or hay

c) animals- such as "dander" from dogs, cats or hamsters, or the feathers in pillows

d) dust or molds

e) chemicals, such as in a medication or preservatives

f) foods -- usually milk, nuts, chocolate, eggs, orange juice or fish

Anything that irritates the lungs can be a factor in triggering an asthma attack. This includes cigarette smoke, air pollution, chemical fumes or vapors, and certain household products like paint, cleaners, deodorants or perfumes. Infections from colds, viruses or bronchitis may sensitize the lungs to react to other triggers. For some people, the weather may have an effect--especially cold air or extreme humidity.

Although emotions are not the cause of asthma as was once believed, excitement or overexertion can make the symptoms worse. For some people, laughing too hard, crying, or coughing can bring on an asthma response.

WHO GETS ASTHMA?

Anyone can get asthma at any time. It is very common during childhood, although many children outgrow the wheezing. It can also begin when you are an adult, especially when the triggering substances are things that you have developed an allergy to. If you have a family history of asthma or allergies, you may also be more likely to have asthma.

WHAT ARE THE SYMPTOMS?

Symptoms of asthma include coughing, wheezing, noisy breathing, or breathing which is fast and appears to be gasping or difficult. Asthma attacks can begin abruptly or develop over several hours. How often you are bothered by your condition and how bad your symptoms are will vary. Some people are bothered by asthma symptoms at certain times of the day, such as in the morning or at bedtime. Some people are bothered all of the time.

DIAGNOSING ASTHMA

During a physical exam, you will probably be asked questions about when and where your episodes occur, how long they last, what medications you take, and other medical problems. Your doctor may also ask about your allergies, infections, and whether anyone in your family has respiratory problems. The doctor will listen to your lungs with a stethoscope to check for wheezing or other abnormal breath sounds.

Your doctor may order a chest x-ray to look at your lungs. Breathing tests called pulmonary function tests (PFT's) or peak flow tests may be done to measure how much air you inhale and exhale, the speed that you exhale, and how much resistance is in the air passages. The results of the breathing tests will assist in the diagnosis and treatment plan for your condition.

You may be asked to give a sample of your sputum to see if you have an infection in your lungs. If you are having a severe attack, special tests such as an arterial blood gas (ABG) or oximetry will be done to check how much oxygen is in your blood. You may be tested for allergies which can help determine which substances might be triggering your asthma episodes. How severe your symptoms and how often you have them will help the doctor determine the best treatment for you.

TREATMENT

Although there is no cure for asthma, it can be controlled. By avoiding known irritants, and with medication, many people can prevent or reduce the frequency and/or severity of their symptoms. Medications used for asthma are often dissolved in a fine mist spray and inhaled, putting the medication directly into the lungs. This has been proven to be the most efficient and effective way to get the medication into the lungs with the least side effects. Some of the medications also come in pill form. The common types of medication used for asthma are:

a) Corticosteroids which reduce swelling and inflammation in the airways.

b) Bronchodilators which open the airways by relaxing the muscles in the airways.

c) Anti-inflammatory drugs which reduce inflammation and allergic response.

The best combination of medications will depend on how old you are, how often you are bothered, how bad your symptoms are, how you respond to different medications, and your lifestyle. Most people with asthma do best when they take their medications regularly even when they have no symptoms, and add or increase the medications when they feel an episode coming on. It is important to take your medications correctly and regularly for the best control of your asthma.

If your symptoms get worse and your body does not respond to your regular medications, you may need to be hospitalized for closer monitoring and different medications. You may receive medications intravenously and/or inhaled frequently until your breathing is comfortable.

Oxygen can help if you are having difficulty breathing. Your doctor or nurse may ask you to drink plenty of fluids to loosen the mucus secretions or you may be

given fluids intravenously. Tests to measure how your lungs are doing and how your body is responding to the treatments will be done regularly.

WHAT YOU CAN DO

If you can, try to identify what triggers your asthma and then try to avoid exposure to them. Keep a record of when and where your attacks occur and at what time of year. If your asthma is caused by cigarette smoke, you will feel much better if you stop smoking and avoid exposure to the smoke of others. If dust is the culprit, keep your room or house as dust-free as possible and consider wearing a mask while cleaning. Avoid carpets, blankets, and upholstered furniture that hold dust. Replace feather pillows with ones that are filled with non-allergenic materials. Avoid house pets if animals trigger your episodes. If overexertion brings on your asthma, pace yourself when working or exercising especially if the air is cold or dry. During an asthma episode, learn how to relax and control your breathing if you can.

For many people, taking the prescribed asthma medications can prevent or lessen the severity of episodes. Your medications work best if they are taken exactly the way they have been prescribed. Because many people with asthma are on several different medications with different amounts at different times, it is important to be sure you understand how your medications are supposed to be taken. Follow your schedule closely, taking the right amount at the right time.

Regular contact with your doctor is important to discuss if changes or adjustments are needed. If your medications are not working the way they should or you are having more frequent or severe symptoms, let your doctor know. Successful management of your asthma depends on good communication with your doctor or health care professional in charge of your care. If you don't understand how to take your medications or are unable to follow the schedule you have been given, you must communicate this. If your asthma is troublesome to you and interferes with your daily life even when you are following your treatment plan, ask for more help. Medical and education specialists are available in most health care organizations that can teach you what you need to know and work with you until you find a program that works for you.

COPING

For some people having asthma can be frightening, especially if the symptoms come on quickly. Family members may also feel helpless and guilty. These feelings can sometimes interfere with family life as much as the asthma episodes themselves. Many people may be helped by talking to a friend, family member, or counselor. By learning about asthma and how to prevent and manage asthma symptoms, most people can lead active lives. There are also community organizations, support groups and local resources that can assist you with learning about your asthma, medications, supplies and equipment. You can learn a lot from others about how they cope. It can also help to seek professional counseling and to talk openly about your thoughts and feelings to friends and family.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

Planetree Health Fact Sheets are developed by Planetree, Inc., a non-profit consumer health organization, founded in 1978. The Planetree Alliance includes hospitals and libraries which, among many other patient-centered concepts, promote the importance of access to health information for patients, families, and community. For more information regarding affiliation with the international Planetree Alliance, call (203) 732-1365 or visit Planetree, Inc. at www.planetree.org.