Asthma—Adult

by Rosalyn Carson-DeWitt, MD

Related Media: Handling Emotional and Stress Triggers

See also:

• Asthma—Child

Definition

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

Inflamed Bronchus in the Lungs

2009 Nucleus Medical Media, Inc.

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. Possible triggers of an asthma attack in a person with asthma include:

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

Risk Factors

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

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

Symptoms

Symptoms include:

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

Diagnosis

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

Tests may include:

• 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
• 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
• Allergy tests —usually skin or sometimes blood tests to find out if allergies may be contributing to the symptoms

Treatment

The treatment strategy for asthma is four-fold:

• Regular assessment and monitoring—Online programs aimed at helping patients to manage their own symptoms can improve asthma control and lung function. (See American Lung Association or Asthma and Allergy Foundation of America.)
• Control of contributing factors (eg, gastroesophageal reflux and sinusitis) and avoidance of allergens or irritants
• Patient education
• Medications

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.

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:

• Keep windows closed.
• Consider getting HEPA filters for your heating/cooling system and your vacuum cleaner.
• Keep the humidity down in your house.
• Avoid strenuous outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
• Get a yearly seasonal flu shot. Also get the pandemic H1N1 flu vaccine once it is available.
• Treat allergies and sinusitis.
• Don't smoke.
• Avoid breathing in chemicals or second-hand smoke.
• Don't regularly use a wood-burning stove. Researchers reported that heating systems that are more efficient and non-polluting can help to reduce asthma symptoms in children.
• If allergies trigger your asthma attacks, ask your doctor about allergy shots.
• 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.

American Academy of Allergy, Asthma, and Immunology
http://www.aaaai.org/

American Lung Association
http://www.lungusa.org/

Asthma and Allergy Foundation of America
http://www.aafa.org/

Allergy Asthma Information Association
http://aaia.ca/

The Canadian Lung Association
http://www.lung.ca/

REFERENCES:

Bone R, et al. Pulmonary and Critical Care Medicine . St. Louis, MO: Mosby-Year Book, Inc; 1998.

Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

Conn HF, Rakel RE. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

High ozone levels harmful to respiratory system, especially for asthmatics. American Academy of Allergy, Asthma & Immunology website. Available at http://www.aaaai.o... . Accessed June 23, 2008.

Kleigman RM, Jensen HB, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007.

US Centers for Disease Control and Prevention. Asthma information for patients and parents. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/H1N1flu/asthma.htm . Updated September 15, 2009. Accessed September 18, 2009.

10/29/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Howden-Chapman P, Pierse N, Nicholls S, et al. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial. BMJ. 2008 Sep 23.

1/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Levenson M. Long-acting beta-agonists and adverse asthma events meta-analysis. Joint Meeting of the Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee and Pediatric Advisory Committee. December 10-11, 2008.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bailey EJ, Cates CJ, Kruske S, Morris A, Chang A, Brown N. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2009;(1):CD006580.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Thomas M, McKinley RK, Mellor S, et al. Breathing exercises for asthma: a randomised controlled trial. Thorax. 2009;64:55-61. Epub 2008 Dec 3.

9/2/2009 DynaMed Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Van der Meer V, Bakker MJ, van den Hout WB, et al. Internet based self-management plus education compared with usual care in asthma: a randomized trial. Ann Intern Med. 2009;151:110-120.

Last reviewed September 2009 by Christine Colpitts, CRT, MA
Last Updated: 11/18/2009