• Knowledgebase: Information on Specific Illnesses

    Here you will find discussions of specific illnesses and their management.

    66. Asthma - Top

    Definition
    Bronchial asthma is a lung disorder characterized by periodic attacks of wheezing alternating with periods of relatively normal breathing.

    Causes, Incidence and Risk Factors
    Bronchial asthma is usually intrinsic (no cause can be demonstrated), but is occasionally caused by a specific allergy (such as allergy to mold, dander, dust). Although most individuals with asthma will have some positive allergy tests, the allergy is not necessarily the cause of the asthma symptoms.
    Symptoms can occur spontaneously or can be triggered by respiratory infections, exercise, cold air, tobacco smoke or other pollutants, stress or anxiety, or by food allergies or drug allergies. The muscles of the bronchial tree become tight and the lining of the air passages become swollen, reducing airflow and producing the wheezing sound. Mucus production is increased.
    Typically, the individual usually breathes relatively normally, and will have periodic attacks of wheezing. Asthma attacks can last minutes to days, and can become dangerous if the airflow becomes severely restricted. Asthma affects 1 in 20 of the overall population, but the incidence is 1 in 10 in children. Asthma can develop at any age, but some children seem to outgrow the illness. Risk factors include self or family history of eczema, allergies or family history of asthma.


    Symptoms
    wheezing
    usually begins suddenly
    composed of a sequence of attacks (episodic)
    may be worse at night or in early morning
    aggravated by exposure to cold air
    aggravated by exercise
    resolves spontaneously
    good relief from bronchodilators (drugs that open the airways)
    rales
    cough with sputum (phlegm) production containing mucus (mucoid sputum)
    cough increasing recently
    shortness of breath aggravated by exercise
    shortness of breath occurs only when wheezing
    breathing requires increased work
    intercostal retractions
    Emergency symptoms:

    extreme difficulty breathing
    bluish color to the lips and face
    severe anxiety
    rapid pulse
    sweating
    Additional symptoms that may be associated with this disease:

    nasal flaring
    coughing up blood
    chest pain
    breathing, absent temporarily
    a feeling of chest tightness
    increased front-to-back diameter of the chest (barrel shaped chest)
    abnormal breathing pattern, exhalation takes more than twice as long as inspiration
    Signs And Tests
    Listening to the chest (auscultation) reveals wheezing during an episode. However, lung sounds are usually normal between episodes.
    Tests may include:

    pulmonary function tests
    chest X-ray
    CBC shows increase in eosinophils
    arterial blood gas
    This disease may also alter the results of the following tests:

    Immunoelectrophoresis - serum
    eosinophil count - absolute
    CPK



    Treatment
    Treatment is aimed at avoiding known allergens and controlling symptoms through medication.
    A variety of medications for treatment of asthma are available and include:

    anti-inflammatory medications
    inhaled corticosteroids (Azmacort, Vanceril, AeroBid)
    oral or intravenous corticosteroids (such as prednisone, methylprednisolone, and hydrocortisone)
    nedocromil sodium
    bronchodilators
    inhaled or oral (Proventil, Alupent, Bronkosol, and others)
    cromolyn sodium (Intal)--used to prevent attacks, not for treatment during an attack
    aminophylline or theophylline
    People with mild asthma (infrequent attacks) may use inhalers on an as-needed basis. Persons with significant asthma (symptoms occur at least every week) should be treated with anti-inflammatory medications, preferably inhaled corticosteroids, and then with bronchodilators such as inhaled Alupent or Vanceril. Acute severe asthma may require hospitalization, oxygen, and intravenous medications.
    A peak flow meter, a simple device to measure lung volume, can be used at home to check on lung functions on a daily basis. This often helps determine when medication is needed or can be tapered in the case of an exacerbation of symptoms.

    Expectations (Prognosis)
    Asthma is a disease that has no cure. With proper self management and medical treatment, most people with asthma can lead normal lives.

    Complications
    respiratory fatigue
    pneumothorax
    complications from overuse of medications (particularly inhalers)--see the specific medication
    Calling Your Health Care Provider
    Call for an appointment with your health care provider if you or your child experience mild asthma symptoms (to discuss treatment options).
    Call your health care provider or go to the emergency room if severe chest pain develops, an attack requires more intensive use of medication than usual or requires more medication than recommended in the prescription, or if shortness of breath occurs at rest.
    Call your health care provider if symptoms worsen or do not improve with treatment or if new symptoms develop.


    Prevention
    Decrease or control exposure to known allergens by staying away from cigarette smoke, removing animals from bedrooms or entire houses, and avoiding foods that cause symptoms. Allergy desensitization is rarely successful in reducing symptoms. - Updated: March 5, 2001

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    • James L Horwitz, MD

    David C. Thomas, MD

    Barbara Lindberg, PNP