Asthma and Asthma-Related Services
ASTHMA AS AN ALLERGIC CONDITION
WHAT IS ASTHMA?
Asthma is a breathing disorder that continues over time and is caused by narrowing or obstruction of the airways or breathing tubes.
The following three processes can cause airway obstruction:
- Inflammation of the airways that leads to swelling.
- Clogging of the airways caused by mucus or phlegm.
- Tightening of the airways caused by constriction or narrowing of the muscles in the breathing tubes.
WHAT ARE ASTHMA SYMPTOMS?
Asthma is recurrent and reversible episodes of airway obstruction. Symptoms include:
- Wheezing, described as a whistling sound heard when exhaling
- Chest tightness
- Breathlessness or shortness of breath
- Feeling tired or lacking energy
- Feeling short of breath when active or exercising
WHAT CAUSES ASTHMA?
Increased sensitivity or reactivity of the airways causes asthma. This increased airway sensitivity causes inflammation or swelling, mucous production and bronchial tube narrowing. Certain substances or events that cause an asthma episode are called triggers.
Common triggers include:
- Allergies such as cat or dog dander, dust or dust mites, molds, cockroaches, and pollens from trees, grass or weeds.
- Upper respiratory infections that are usually viral
- Inhaled cigarette smoke including firsthand, secondhand and perhaps even third hand smoke
- Strong colognes or perfumes
- Chemical smells from things like cleaning products
- Environmental effects like cold air or high humidity
- Exercise or strenuous activity
- Emotional stresses (including laughter)
Exposures to these triggers may increase asthma symptoms and can lead to an asthma episode.
HOW IS ASTHMA DIAGNOSED?
Asthma is diagnosed from a complete history of previous or present symptoms and by physical exam and lung function studies. The usual guidance is that three separate and distinct episodes of asthma with consistent symptoms are needed to make the diagnosis. Often, medical records of documented symptoms or physical findings are helpful.
Lung function tests that measure airway obstruction or flows can be helpful at the time of diagnosis and used as a way to follow the progress of asthma treatment. Newer lung function tests can evaluate byproducts of allergic inflammation called nitric oxide (eNO or exhaled nitric oxide).
Once diagnosed, a severity category of intermittent, mild, moderate or severe is assigned. Control of asthma symptoms is categorized as well controlled, not well controlled or poorly controlled.
HOW IS ASTHMA IN CHILDREN TREATED?
After the diagnosis of asthma is made, children are categorized into groups by the frequency of their symptoms. Asthma education helps families and patients understand symptoms and treatment plans. Issues of environmental control are discussed that relate to the family environment. The allergy evaluation looks into possible environmental triggers. If a child is sensitive to a particular allergen, a large part of asthma education includes the best and most effective way to avoid that allergen.
In addition to environmental control, medications may be prescribed for long-term control or for quick relief. Long-term control medicines are used daily and help to control inflammation. This group includes:
- Inhaled steroids
- Long acting beta agonists
- Oral medications called leukotriene modifiers
- Oral theophylline
Quick relief medications are given to relieve acute or new symptoms. These include:
- Inhaled albuterol or variations of albuterol
- Oral steroids, but these take time to work
- Inhaled ipratroprium
Immune modulation (a way to adjust immune response) of asthma may include:
- Allergen immunotherapy (desensitization)
- Anti-IgE treatment (a form of treatment that blocks the response of IgE, which are cells that tell the body to have an allergic reaction)
Goals of asthma treatment include:
- Monitoring asthma symptoms and maintaining a scheduled plan of asthma care.
- Treating other physical problems that may cause asthma, like chronic nasal symptoms, sinusitis (inflamed sinuses) or gastroesophageal reflux.
- Identifying potential triggers and reducing or eliminating exposure.
- Developing a written treatment plan for chronic or daily care and a specific plan for increased asthma episodes tailored to the child and the family.
- Allowing participation in activities to the fullest of the child's ability.