Asthma

What is asthma?

Asthma is a disease of the lungs. The airways of people who have asthma are extra sensitive to the things they’re allergic to (called allergens) and to other irritating things in the air (called irritants).

Asthma symptoms start when allergens or other irritants cause the lining of the airways to become inflamed (swollen) and narrow. The muscles around the airways can then spasm (contract rapidly), causing the airways to narrow even more.

When the lining of the airways is inflamed, it produces more mucus. The mucus clogs the airways and further blocks the flow of air. This is called an “asthma attack.”

Symptoms

What is an asthma attack?

An asthma attack occurs when excess mucus causes your air tubes to swell and tighten. Asthma attacks can be mild, moderate or severe. Symptoms of an asthma attack include the following:

• Coughing
• Feeling breathless
• Tightness in the chest
• Wheezing (breathing that makes a hoarse, squeaky, musical or whistling sound)
• Cough with mucus
• Wheezing or whistling sound when breathing
• Difficulty breathing and talking
• Trouble sleeping

Signs of an emergency

Call your doctor or seek emergency care right away if you experience any of the following symptoms:

• Your rescue medicine doesn’t relieve your symptoms.
• Your peak flow keeps dropping after treatment or falls below 50% of your best.
• Your fingernails or lips turn gray or blue.
• You have trouble walking or talking.
• You have extreme difficulty breathing.
• Your neck, chest or ribs are pulled in with each breath.
• Your nostrils flare when you breathe.
• Your heartbeat or pulse is very fast

How can I tell if an asthma attack is serious?

You should use (or have your child use) a peak flow meter every day. A peak flow meter measures how much air flows out of your lungs. People who have asthma have lower air flow in and out of their lungs than other people. Measuring peak flow levels can help you see problems with your air flow before you have any symptoms of asthma.

A meter can also help tell you and your doctor how serious your asthma attacks are. You’ll be able to see when you should take medicine or when you need emergency care. Peak flow readings may also help you find the triggers that make your asthma symptoms worse.

How can I tell if my asthma is getting worse?

Signs that your asthma is getting worse include having symptoms at night, a drop in your peak flow and the need to use your rescue medicine more often. Talk to your doctor if you think that your asthma is getting worse.

Causes & Risk Factors

What causes asthma symptoms?

Your asthma can flare up for many different reasons. Allergies can make your asthma symptoms get worse. Viral infections (such as a cold), tobacco, pollutants (such as wood smoke), cold air, exercise, fumes from chemicals or perfume, sinus infections and heartburn can all cause a flare-up. For some people, strong emotions or stress can trigger an asthma attack. Pay attention to the way these things affect your asthma. If you and your doctor figure out which things bother your asthma, you can start trying to address them.

Diagnosis & Tests

What is a peak flow meter?

A peak flow meter is a hand-held device that measures your peak expiratory flow rate (PEFR), or how fast you can blow air out of your lungs. Measuring your peak flow regularly can help you tell whether your asthma is getting worse.

To use a peak flow meter, you will first need to find out your “personal best” peak flow. Take a deep breath and blow as hard as you can into the mouthpiece. Your personal best is the highest reading you get on the meter over a 2-week period when your asthma is under good control.

How do I use a peak flow meter?

To use a peak flow meter, follow these steps:

• Move the indicator to the bottom of the numbered scale.
• Stand up.
• Take a deep breath.
• Close your lips (or have your child close his or her lips) around the mouthpiece of the flow meter. Your tongue should not go inside the tube.
• Blow out as hard and fast as possible.

The indicator on the meter will move up. Write down the number where it stops. Repeat steps 1 through 5 two more times. Write down the highest of the three numbers on the peak flow meter record chart.

Sample peak flow chart

Below is a sample of a peak flow meter record chart. You may mark your child’s daily scores on a similar graph to see whether your asthma is in the green zone, yellow zone or red zone.

Adapted from “Teach your patients about asthma. A clinician’s guide.” Bethesda, Md.: National Heart, Lung, and Blood Institute, 1992; DHHS publication no. 92-2737.

What is the peak flow zone system?

Once you know your (or your child’s) personal best peak flow score, your doctor can tell you how to do the next step. Peak flow scores are put in “zones” like the colors in traffic lights.

• Green Zone:This is a score that is 80% to 100% of the personal best score. It signals that your/your child’s asthma is under control. No symptoms are present, but you/your child should take preventive asthma medicines as usual.
• Yellow Zone:This is a score that is 50% to 80% of the personal best score. It signals that your/your child’s asthma is getting worse. You may be coughing or wheezing frequently. You may need extra asthma medicine. Follow your doctor’s written instructions or call your doctor for advice.
• Red Zone:This is a score that is below 50% of the personal best score. It signals a medical emergency. You/your child may have severe coughing, wheezing and shortness of breath, and your lips and fingernails may be turning a grayish or bluish color. Use an inhaler or other medicine to open your airways right away. Call your doctor immediately for more advice.

Treatment

How do I control my asthma symptoms?

Treatment of your symptoms involves avoiding things that causeasthma attacks  , keeping track of your symptoms and taking medicine.

What medicines are used to treat asthma?

Asthma medicines can generally be divided into two groups: medicines to prevent attacks (controller medicines) and medicines to treat attacks (sometimes called rescue medicines). Your doctor will talk to you about these medicines and what to do if you have an asthma attack. Ask your doctor for written instructions about how to take your medicines. Your doctor may have a form to give you, or you canprint out this one  .

Controller and Quick-Relief Medicines

The following are some of the prescription medicines most commonly used by people who have asthma:

Controller Medicines

• Inhaled corticosteroids
• Cromolyn
• Nedocromil
• Anti-leukotrienes
• Theophylline
• Salmeterol (inhaled long-acting beta2 agonist)

Quick-Relief Medicines

• Albuterol, pirbuterol, levalbuterol or bitolterol (inhaled short-acting beta2 agonist)
• Ipratropium (anticholinergic)
• Prednisone, prednisolone (oral steroids)

How do controller medicines work?

Controller medicines help reduce the swelling in your airways to prevent asthma attacks. Controller medicines must be taken on a regular basis–whether or not you’re having symptoms. They take hours or days to start to help and don’t work well unless you take them regularly.

How do rescue medicines work?

Rescue medicines (also called quick-acting or quick-relief medicines) provide quick relief during an asthma attack by helping the muscles around your airways relax, which allows your airways to open. If you feel like you’re having an asthma attack, follow your doctor’s instructions for taking this medicine right away.

Primatene Mist Inhaler was discontinued

Primatene Mist Inhaler, an over-the-counter asthma inhaler, is longer available after December 31, 2011. If you currently use Primatene Mist Inhaler, it’s safe to continue using it as long as it hasn’t expired. Talk to your doctor about switching to a different medicine to treat your asthma. For more information, visit theU.S. Food and Drug Administration website  .

Warning signs of an asthma attack

• Peak flow 50% to 80% of your personal best
• Coughing or wheezing
• Shortness of breath
• Tightness in chest

If your symptoms don’t respond to medicine or if your peak flow drops below 50% of your personal best, call your doctor or go directly to the nearest emergency room (by ambulance, if necessary).

Prevention

Is there anything I can do to help avoid asthma attacks?

You can help avoid asthma attacks by avoiding the triggers (also called allergens) and irritants that can start an asthma attack. Triggers and irritants vary for each individual, but the following are some examples of common triggers and irritants:

• Air pollution
• Dust
• Mold
• Pollen
• Tobacco smoke
• Pet dander
• Exercise
• Changes in temperature
• Certain foods
• Sulfite (food preservative in red wine, beer, salad bars, dehydrated soups, and other foods)
• Aspirin, or ibuprofen (brand names: Advil, Motrin, Nuprin)
• Heartburn
• Sinus infections
• Strong emotions (such as crying or laughing)
• Perfume
• Spray-on deodorants
• Viruses

How do I avoid common asthma triggers?

If pollen and mold cause your symptoms, use your air conditioner and try to keep the windows of your home and car closed. Change the filter on your heating and cooling system frequently.

To keep mold down, clean and air out bathrooms, kitchens and basements often. Use an air conditioner or dehumidifier to keep the level of humidity less than 50%.

People who are allergic to dust are actually allergic to the droppings of dust mites. To reduce dust mites in your home, wash bed sheets weekly in hot water (above 130°F). Cover mattresses and pillows in airtight covers, and remove carpets and drapes. If you must have carpet, you can treat it with chemicals to help reduce dust mites. Try to avoid stuffed animals, dried flowers and other things that trap dust.

Pets can cause problems if you are allergic to them. If you have a pet, keep it out of your bedroom.

Don’t allow smoking in your house or car. Tobacco smoke can make asthma worse.

Other Organizations

Questions to Ask Your Doctor

• My child has asthma. Will he or she grow out of it?
• Will you provide written instructions for my/my child’s treatment plan?
• What information do I need to give my child’s school about his/her treatment?
• Would allergy testing help determine what’s causing asthma symptoms?
• What changes can I make at home to relieve my/my child’s asthma symptoms?
• Is it safe to exercise and/or play sports with asthma?
• What are the signs of an emergency? What should I do in an emergency?

Asthma, Adult

Asthma is a long-term (chronic) condition in which the airways get tight and narrow. The airways are the breathing passages that lead from the nose and mouth down into the lungs. A person with asthma will have times when symptoms get worse. These are called asthma attacks. They can cause coughing, whistling sounds when you breathe (wheezing), shortness of breath, and chest pain. They can make it hard to breathe. There is no cure for asthma, but medicines and lifestyle changes can help control it.

There are many things that can bring on an asthma attack or make asthma symptoms worse (triggers). Common triggers include:

• Mold.
• Dust.
• Cigarette smoke.
• Cockroaches.
• Things that can cause allergy symptoms (allergens). These include animal skin flakes (dander) and pollen from trees or grass.
• Things that pollute the air. These may include household cleaners, wood smoke, smog, or chemical odors.
• Cold air, weather changes, and wind.
• Crying or laughing hard.
• Stress.
• Certain medicines or drugs.
• Certain foods such as dried fruit, potato chips, and grape juice.
• Infections, such as a cold or the flu.
• Certain medical conditions or diseases.
• Exercise or tiring activities.

Asthma may be treated with medicines and by staying away from the things that cause asthma attacks. Types of medicines may include:

• Controller medicines. These help prevent asthma symptoms. They are usually taken every day.
• Fast-acting reliever or rescue medicines. These quickly relieve asthma symptoms. They are used as needed and provide short-term relief.
• Allergy medicines if your attacks are brought on by allergens.
• Medicines to help control the body’s defense (immune) system.

Follow these instructions at home:

Avoiding triggers in your home

• Change your heating and air conditioning filter often.
• Limit your use of fireplaces and wood stoves.
• Get rid of pests (such as roaches and mice) and their droppings.
• Throw away plants if you see mold on them.
• Clean your floors. Dust regularly. Use cleaning products that do not smell.
• Have someone vacuum when you are not home. Use a vacuum cleaner with a HEPA filter if possible.
• Replace carpet with wood, tile, or vinyl flooring. Carpet can trap animal skin flakes and dust.
• Use allergy-proof pillows, mattress covers, and box spring covers.
• Wash bed sheets and blankets every week in hot water. Dry them in a dryer.
• Keep your bedroom free of any triggers. 
• Avoid pets and keep windows closed when things that cause allergy symptoms are in the air.
• Use blankets that are made of polyester or cotton.
• Clean bathrooms and kitchens with bleach. If possible, have someone repaint the walls in these rooms with mold-resistant paint. Keep out of the rooms that are being cleaned and painted.
• Wash your hands often with soap and water. If soap and water are not available, use hand sanitizer.
• Do notallow anyone to smoke in your home.

General instructions

• Take over-the-counter and prescription medicines only as told by your doctor.
  • Talk with your doctor if you have questions about how or when to take your medicines.
  • Make note if you need to use your medicines more often than usual.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your doctor.
• Stay away from secondhand smoke.
• Avoid doing things outdoors when allergen counts are high and when air quality is low.
• Wear a ski mask when doing outdoor activities in the winter. The mask should cover your nose and mouth. Exercise indoors on cold days if you can.
• Warm up before you exercise. Take time to cool down after exercise.
• Use a peak flow meter as told by your doctor. A peak flow meter is a tool that measures how well the lungs are working.
• Keep track of the peak flow meter’s readings. Write them down.
• Follow your asthma action plan. This is a written plan for taking care of your asthma and treating your attacks.
• Make sure you get all the shots (vaccines) that your doctor recommends. Ask your doctor about a flu shot and a pneumonia shot.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• You have wheezing, shortness of breath, or a cough even while taking medicine to prevent attacks.
• The mucus you cough up (sputum) is thicker than usual.
• The mucus you cough up changes from clear or white to yellow, green, gray, or bloody.
• You have problems from the medicine you are taking, such as:
  • A rash.
  • Itching.
  • Swelling.
  • Trouble breathing.
• You need reliever medicines more than 2–3 times a week.
• Your peak flow reading is still at 50–79% of your personal best after following the action plan for 1 hour.
• You have a fever.

Get help right away if:

• You seem to be worse and are not responding to medicine during an asthma attack.
• You are short of breath even at rest.
• You get short of breath when doing very little activity.
• You have trouble eating, drinking, or talking.
• You have chest pain or tightness.
• You have a fast heartbeat.
• Your lips or fingernails start to turn blue.
• You are light-headed or dizzy, or you faint.
• Your peak flow is less than 50% of your personal best.
• You feel too tired to breathe normally.

Summary

• Asthma is a long-term (chronic) condition in which the airways get tight and narrow. An asthma attack can make it hard to breathe.
• Asthma cannot be cured, but medicines and lifestyle changes can help control it.
• Make sure you understand how to avoid triggers and how and when to use your medicines.

Asthma, Pediatric 

Asthma is a long-term (chronic) condition that causes swelling and narrowing of the airways. The airways are the breathing passages that lead from the nose and mouth down into the lungs. When asthma symptoms get worse, it is called an asthma flare. When this happens, it can be difficult for your child to breathe. Asthma flares can range from minor to life-threatening. There is no cure for asthma, but medicines and lifestyle changes can help to control it. With asthma, your child may have:

• Trouble breathing (shortness of breath).
• Coughing.
• Noisy breathing (wheezing).

It is not known exactly what causes asthma, but certain things can bring on an asthma flare or cause asthma symptoms to get worse (triggers). Common triggers include:

• Mold.
• Dust.
• Smoke.
• Things that pollute the air outdoors, like car exhaust.
• Things that pollute the air indoors, like hair sprays and fumes from household cleaners.
• Things that have a strong smell.
• Very cold, dry, or humid air.
• Things that can cause allergy symptoms (allergens). These include pollen from grasses or trees and animal dander.
• Pests, such as dust mites and cockroaches.
• Stress or strong emotions.
• Infections of the airways, such as common cold or flu.

Asthma may be treated with medicines and by staying away from the things that cause asthma flares. Types of asthma medicines include:

• Controller medicines. These help prevent asthma symptoms. They are usually taken every day.
• Fast-acting reliever or rescue medicines. These quickly relieve asthma symptoms. They are used as needed and provide short-term relief.

Follow these instructions at home:

General instructions

• Give over-the-counter and prescription medicines only as told by your child’s doctor.
• Use the tool that helps you measure how well your child’s lungs are working (peak flow meter) as told by your child’s doctor. Record and keep track of peak flow readings.
• Understand and use the written plan that manages and treats your child’s asthma flares (asthma action plan) to help an asthma flare. Make sure that all of the people who take care of your child:
  • Have a copy of your child’s asthma action plan.
  • Understand what to do during an asthma flare.
  • Have any needed medicines ready to give to your child, if this applies.

Trigger Avoidance

Once you know what your child’s asthma triggers are, take actions to avoid them. This may include avoiding a lot of exposure to:

• Dust and mold.
  • Dust and vacuum your home 1–2 times per week when your child is not home. Use a high-efficiency particulate arrestance (HEPA) vacuum, if possible.
  • Replace carpet with wood, tile, or vinyl flooring, if possible.
  • Change your heating and air conditioning filter at least once a month. Use a HEPA filter, if possible.
  • Throw away plants if you see mold on them.
  • Clean bathrooms and kitchens with bleach. Repaint the walls in these rooms with mold-resistant paint. Keep your child out of the rooms you are cleaning and painting.
  • Limit your child’s plush toys to 1–2. Wash them monthly with hot water and dry them in a dryer.
  • Use allergy-proof pillows, mattress covers, and box spring covers.
  • Wash bedding every week in hot water and dry it in a dryer.
  • Use blankets that are made of polyester or cotton.
• Pet dander. Have your child avoid contact with any animals that he or she is allergic to.
• Allergens and pollens from any grasses, trees, or other plants that your child is allergic to. Have your child avoid spending a lot of time outdoors when pollen counts are high, and on very windy days.
• Foods that have high amounts of sulfites.
• Strong smells, chemicals, and fumes.
• Smoke.
  • Do notallow your child to smoke. Talk to your child about the risks of smoking.
  • Have your child avoid being around smoke. This includes campfire smoke, forest fire smoke, and secondhand smoke from tobacco products. Do notsmoke or allow others to smoke in your home or around your child.
• Pests and pest droppings. These include dust mites and cockroaches.
• Certain medicines. These include NSAIDs. Always talk to your child’s doctor before stopping or starting any new medicines.

Making sure that you, your child, and all household members wash their hands often will also help to control some triggers. If soap and water are not available, use hand sanitizer.

Contact a doctor if:

• Your child has wheezing, shortness of breath, or a cough that is not getting better with medicine.
• The mucus your child coughs up (sputum) is yellow, green, gray, bloody, or thicker than usual.
• Your child’s medicines cause side effects, such as:
  • A rash.
  • Itching.
  • Swelling.
  • Trouble breathing.
• Your child needs reliever medicines more often than 2–3 times per week.
• Your child’s peak flow measurement is still at 50–79% of his or her personal best (yellow zone) after following the action plan for 1 hour.
• Your child has a fever.

Get help right away if:

• Your child’s peak flow is less than 50% of his or her personal best (red zone).
• Your child is getting worse and does not respond to treatment during an asthma flare.
• Your child is short of breath at rest or when doing very little physical activity.
• Your child has trouble eating, drinking, or talking.
• Your child has chest pain.
• Your child’s lips or fingernails look blue or gray.
• Your child is light-headed or dizzy, or your child faints.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.