Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Asthma—Adult

by Rosalyn Carson-DeWitt, MD

See also:

Definition

Asthma is inflammation and narrowing of the bronchial tubes. Air travels in and out of the lungs through these tubes.

Causes

The cause of asthma is not known. It does seem to run in some families. Current research suggests a combination of environment, genetics and biology may lead to asthma. Smoking during pregnancy is particularly harmful and places children at high risk of developing childhood asthma . Childhood viral infections are associated with later development of asthma. Possible triggers of an asthma attack in a person with asthma include:

  • Exposure to irritants or allergens, including:
    • Chemicals
    • Cigarette smoke
    • Dust
    • Mold and mildew
    • Perfumed products
    • Pet dander
    • Pollen
    • Smog or air pollution
    • Smoke from a wood-burning stove
  • Medications, such as aspirin , ibuprofen , and beta-blockers
  • Cold weather
  • Exercise
  • Gastroesophageal reflux disease (GERD)
  • Sinusitis
  • Sulfites used in dried fruits and wine
  • Viral illness
Risk Factors

These factors increase your chance of developing asthma. Tell your doctor if you have any of these risk factors:

  • Regularly breathing in cigarette smoke (including second-hand smoke)
  • Taking medicines such as acetaminophen
  • A parent who has asthma
  • Being overweight
  • Gastroesophageal reflux disease (GERD)
  • History of multiple respiratory infections during childhood
  • Living in a large urban area
  • Low birth weight
  • Regularly breathing in industrial or agricultural chemicals
Symptoms

Symptoms include:

  • Chest pain
  • Cough
  • Self-limited exercise, difficulty keeping up with peers
  • Shortness of breath
  • Tightness in the chest
  • Trouble breathing
  • Wheezing
Diagnosis

The doctor will ask about your symptoms and medical history and perform a physical exam:

Tests may include:

  • Allergy tests —usually skin or sometimes blood tests to find out if allergies may be contributing to the symptoms
  • Bronchoprovocation tests—lung function tests performed after exposure to methacholine, histamine, or cold or dry air to stimulate asthma; can help to confirm asthma in unclear cases
  • Exhaled nitric oxide (a marker of airway inflammation)—to suggest the diagnosis and manage medications
  • Peak flow examination—blowing quickly and forcefully into a special instrument that measures your output of air
  • Pulmonary function tests (PFTs)—breathing into a machine that records information about the function of your lungs
Treatment

The treatment strategy for asthma is four-fold:

  • Control of contributing factors (eg, gastroesophageal reflux and sinusitis ) and avoidance of allergens or irritants
  • Regular assessment and monitoring—Online programs aimed at helping you manage your own symptoms can improve asthma control and lung function (See American Lung Association or Asthma and Allergy Foundation of America ). Staying in contact with your doctor between visits can help you stay out of the hospital and have better control of your asthma. Whether you stay in contact over the phone, through email, or through your doctor's website, good communication and symptom management is important.
  • Medications
  • Patient education

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. In addition, it may be helpful to learn breathing techniques from a physical therapist.

Asthma Medications
Medications Used to Control Asthma

These medications are used to control the condition and avoid asthma attacks, not to treat an acute attack:

  • Long-acting beta agonists—(eg, inhaled salmeterol ) used daily to prevent asthma attacks; in most cases, prescribed with an inhaled corticosteroid
    • May increase the risk of asthma-related death, intubation (putting a tube in the windpipe to breath), and hospitalization—If you have any concerns, talk to your doctor.
  • Cromolyn sodium or nedocromil sodium inhaler—used daily to prevent asthma flare-ups or to prevent exercise-induced symptoms
  • Inhaled corticosteroid—used daily to reduce inflammation in your airways
  • Omalizumab (Xolair)—a monoclonal antibody against immunoglobulin E (IgE), given as an injection under the skin, used along with other medications
  • Theophylline —taken daily to help prevent asthma attacks, not as commonly used because of interactions with other drugs
  • Zafirlukast , zileuton , and montelukast —taken daily to help prevent asthma attacks
Medications Used to Treat an Asthma Attack

These medications are used to treat an asthma attack:

  • Anticholinergic agents—inhaled medications, such as ipratropium , that function as a bronchodilator, typically only used in an emergency setting
  • Corticosteroids—pills, injections, or intravenous (IV) medications given to treat acute flare-up of symptoms
    • Pills may be taken for a longer period of time if you have severe asthma that isn't responding to other treatments.
  • Quick-acting beta agonists—(eg, inhaled albuterol , xopenex ) relax your airways so that they become wider again, may also be used to avoid exercise-induced asthma attacks
  • Epinephrine —a shot given to stop an asthma attack
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 the attacks. Some general guidelines include:

  • Get a yearly seasonal flu shot .
  • Talk to your doctor about:
    • An appropriate level of exercise for you
    • Ways track your asthma—This will help you to identify and treat flare-ups right away.
  • Avoid breathing in chemicals or second-hand smoke. Spend time with your doctor reviewing your work, hobbies, and home activities to see if any of these may be causing or worsening your asthma.
  • Avoid strenuous outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
  • 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.
  • Don't use a wood-burning stove or fireplace, including unvented gas fireplaces. Researchers report that using closed system, non-polluting heating systems can help to reduce asthma symptoms in children.
  • Don't smoke. If you are pregnant, it is very important that you do not smoke.
  • If allergies trigger your asthma attacks, ask your doctor about allergy shots. If you commonly have nasal symptoms (stuffy, runny, or itchy nose), treatment of these may greatly improve your asthma.
  • Keep the humidity down in your house.
  • Keep windows closed.
  • Treat allergies and sinusitis.

Last reviewed: September 2011 by Tajender S. Vasu, MD.

RESOURCES:
CANADIAN RESOURCES:
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