Asthma: An overview

If you’re just starting to suffer symptoms of asthma, or if you’re newly diagnosed, here’s what you need to know about this chronic condition.

Asthma is a chronic lung disease in which your airways react to certain triggers, making it hard to breathe. With exposure to triggers, your airways might become swollen, inflamed and filled with mucus. The muscles around the airways might tighten. More mucus might be made.

“All of these changes make the airways narrower,” explained Basil Kahwash, M.D., of the Vanderbilt Allergy, Sinus and Asthma Program. “This makes it hard for air to come into and go out of the lungs, which means that fresh oxygen isn’t making its way into the body.”

What causes asthma?

Experts don’t know the exact cause of chronic asthma — they believe it is partly inherited. Different people react to different triggers. For some asthma sufferers, it might be related to the environment or chemicals. For others, their symptoms might be caused by a respiratory infection or moments of stress and anxiety. Exercise can also be a trigger. So can smoking.

“Understanding your unique asthma triggers can be challenging but is vital if you want to control your disease,” said Kahwash. “Seeing an asthma specialist can make a huge difference.”

Asthma is most common in children and teens ages 5 to 17. However, there are other factors that put patients at risk. These include:

• Personal or family history of asthma or allergies
• Exposure to secondhand tobacco smoke
• Children with a family history of asthma
• Children who have allergies or atopic dermatitis
• Children exposed to secondhand and tobacco smoke
• Living in areas with high levels of environmental air pollution

What are the symptoms of asthma?

Asthma symptoms range from individual to individual, but may include:

• Trouble breathing or shortness of breath
• Chest tightness
• Wheezing or a whistling sound when breathing
• Coughing
• Breathing that becomes forced and painful
• Trouble talking or sleeping (with severe symptoms)

How is chronic asthma treated?

“Unfortunately, there is no cure for asthma,” Kahwash said. “The good news is it’s very treatable, and can often be controlled by staying away from triggers and by taking medicines as recommended by your healthcare provider.”

“Unfortunately, there is no cure for asthma. The good news is it’s very treatable, and can often be controlled by staying away from triggers and by taking medicines as recommended by your healthcare provider.”

Watching for symptoms and taking early, appropriate action is a key part of asthma treatment. So is knowing what to do if symptoms get worse. Experts advise making an action plan with your asthma specialists and educating your family and close friends about it. This will help them provide correct asthma care if you are ill and can’t care for yourself.

Medications for chronic asthma

The two categories of asthma medicines are long-term control and short-term (quick-relief) medicines. Long-term control medicines are often taken every day to help prevent symptoms. Quick-relief medicines calm asthma symptoms fast, but they only last for a short time. Depending on the setting, one or both of these types of medications may be appropriate.

Long-term control medicines

At first, it may take a few weeks for long-term control medicines to work. You must take these medicines every day. These medicines include:

• Inhaled anti-inflammatory medicines. These medicines reduce or prevent airway swelling.
• Inhaled bronchodilators. These relax muscles around the airways.
• Leukotriene modifiers. These block the action of chemicals called leukotrienes, which are chemicals that cause airways to be inflamed and narrowed. 
• Biologic therapy. These medicines target the inflammatory cells in the body that start the asthma reaction. They are often given by injection or infusion.

Quick-relief medicines

Quick-relief medicines quickly relax the muscles around the airways, but the relief only lasts about 2 to 3 hours. These medicines may include:

• Inhaled short-acting beta2-agonists. These help relax muscles around the airways.
• Inhaled anticholinergics. These block a chemical in the body called acetylcholine. This chemical makes airway muscles contract. It also causes more mucus in the airways.

Inhalation devices for asthma

Inhaled medicines go right to the lungs and have fewer side effects than medicines taken by mouth. Inhaled medicines may be anti-inflammatory or bronchodilating. Or they may be both. The devices used are:

• Metered-dose inhaler (MDI). This is the most common type of inhaler. It uses a chemical to push the medicine out of the inhaler. MDIs are held in front of or put into the mouth and then the medicine is released in puffs.
• Nebulizer. This device sprays a fine mist of medicine. This is done through a mask using air under pressure, or an ultrasonic machine. A mouthpiece or mask is connected to a machine by plastic tubing to deliver medicine.
• Dry powder or rotary inhaler.  These inhalers deliver powered medicine as you breathe.

Living with chronic asthma

“The key to managing asthma is to learn what your individual triggers are, and to avoid them or learn how to minimize their effect,” Kahwash said. “By closely monitoring triggers, taking medications as prescribed and working with your care team, it’s absolutely possible to keep your asthma under control.”