Asthma is a chronic respiratory disease that causes inflammation and narrowing of the airways, making it difficult to breathe.
The two main categories of asthma include:
- Allergic: triggered by exposure to an allergen, such as pollen or pet dander
- Non-allergic: triggered by factors such as stress, illness, extreme weather, irritants in the air, and some medications
Types of asthma include:
- Adult-onset asthma in which symptoms don’t start until patients are adults
- Exercise-induced bronchoconstriction (EIB, also sometimes called exercise-induced asthma)
- Occupational asthma, usually occurs in people who work around chemical fumes, dust or other irritants in the air
- Chronic obstructive pulmonary disease (COPD) is a collection of lung diseases breathing problems and obstruct airflow and includes refractory (severe) asthma
The best medicine for asthma patients is one that controls symptoms, reduces asthma attacks, and has the minimum of side effects. This can vary for each patient based on their age, symptoms, lung function, risk factors for asthma attacks, patient preference, and certain practical issues, such as the ability to use the medication delivery device or the accessibility of medication.
Patients may be given a personalized “asthma action plan” by their doctor that provides instructions for the patient to follow at home to manage their asthma.
Asthma is usually treated with two kinds of medications: quick-relief and long-term control. Allergy shots (immunotherapy) can also be helpful.
Quick-relief medications are bronchodilators that expand the airways, and are taken at the first sign of asthma symptoms for immediate relief:
- Short-acting inhaled beta2-agonists (inhalers)
- Anticholinergics
Long-term asthma control medications are taken daily to prevent symptoms and asthma attacks and include:
- Inhaled corticosteroids
- Beclomethasone
- Budesonide
- Ciclesonide
- Fluticasone
- Mometasone
- Antileukotrienes or leukotriene modifiers
- Montelukast sodium
- Zafirlukast
- Zileuton
- Long-acting inhaled beta2-agonists (usually combined with an inhaled corticosteroid)
- Formoterol
- Salmeterol
- Vilanterol
For severe asthma, traditional treatments may be inadequate, and other therapies may be used, such as:
- Biologics
- Reslizumab
- Mepolizumab
- Omalizumab
- Benralizumab
- Dupilumab
- Oral corticosteroids
- Immunotherapy, useful when asthma is triggered by an allergy
- Allergy shots (subcutaneous immunotherapy [SCIT])
- Sublingual (under the tongue) tablets or drops (sublingual immunotherapy [SLIT])
- Only house dust mites and certain grass and ragweed pollens are treatable with tablets
- Not used for severe or uncontrolled asthma
What Are Symptoms of Asthma?
Symptoms of asthma include:
- Coughing, especially at night or early morning, during exercise, or when laughing
- Shortness of breath
- Difficulty breathing
- Chest tightness
- Wheezing
Asthma symptoms often:
- Come and go over time
- Start or worsen with viral infections, such as a cold
- Can be triggered by allergies, exercise, cold air, or hyperventilation from laughing or crying
- Worsen at night or in the morning
Asthma attacks are episodes when symptoms significantly worsen and require a change in usual treatment. Asthma attacks may have a gradual or sudden onset and can be life-threatening.
People with asthma may also experience stress, anxiety, and depression, because asthma can result in work and school absences and an inability to participate in their usual activities.
What Causes Asthma?
The cause of asthma is unknown, but it usually results from an immune system response to a substance in the lungs.
Common triggers for asthma symptoms include:
- Exposure to an allergen (such as pollen, ragweed, dust mites, mold, or animal dander)
- Illness, especially respiratory illness or the flu
- Irritants in the air (such as smoke, strong odors, chemical fumes)
- Certain medications
- Exercise
- Extreme weather conditions
- Panic
- Physical display of strong emotion that affects normal breathing patterns, such as laughing, crying, or shouting
- Some foods
- Stress
How Is Asthma Diagnosed?
Asthma is diagnosed with a patient history and a physical exam, which includes the doctor listening to a patient’s breathing and checking for allergic skin conditions.
Tests used to help diagnose asthma or rule out other causes include:
- Pulmonary function tests
- Spirometry
- Bronchoprovocation tests
- Peak expiratory flow (PEF)
- Fractional exhaled nitric oxide (FeNO) tests
- Provocation (Trigger) Tests
- Irritant challenge
- Exercise challenge
- Methacholine challenge
- Allergy skin or blood tests, in patients who have a history of allergies
Diagnosing asthma in children younger than 6 can be difficult, since they usually cannot perform a pulmonary function test such as spirometry. In this case, a doctor may try asthma medicines for a few months to see how the child responds.
What Are Complications of Asthma?
Complications of poorly-controlled asthma include:
- Fatigue
- Problems sleeping
- Exercise intolerance that can lead other health problems such as obesity or high blood pressure
- Repeated hospital visits
- Absences from work or school
- Poor performance at work or school
- Psychological problems such as stress, depression, and anxiety
- Learning difficulties in children
- Respiratory complications
- Partial or total collapse of the lung
- Pneumonia (infection of the lungs)
- Respiratory failure
- Status asthmaticus (severe asthma attacks that do not respond to treatment)
- Death
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https://www.nhlbi.nih.gov/health-topics/asthma
https://www.healthdirect.gov.au/complications-of-asthma
https://www.uptodate.com/contents/an-overview-of-asthma-management?search=An%20overview%20of%20asthma%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1