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What is asthma?

Asthma is a common chest condition in which there is temporary narrowing of the breathing tubes in the lungs (airways) because they are hyperreactive (oversensitive). In asthma these tubes have inflammation and swelling of their linings, increased mucus inside, tightening of the muscles in their walls and therefore less flow of air in and out. Many people think asthma and wheezing are the same thing. Actually, wheezing is only once sign of asthma, and many other things besides asthma can cause wheezing. Because of this confusion, the term asthma is being replaced with a more accurate description: Reactive Airway Disease (RAD). Those with RAD (5% and growing in the U.S.) have bronchial (lung) passages that are more sensitive to irritation than normal. This hypersensitivity leads to inflammation (redness and swelling) in the tiny airways deep in the lungs. The inflammation in turn causes excess mucus production, and tightening of airway muscles that wind around the bronchial tubes like laces. The combination of swelling, mucus, and muscle tightening all cause narrowing of the airways. Wheezing (whistling and labored breathing) usually results, but a dry cough is sometimes the only sign.

Nobody knows exactly why some people have RAD. Many times it is inherited, and is often associated with allergies (especially in children). Asthma can develop at any time, but is more common in young children. When it starts in childhood it usually improves with age. But with adult onset asthma, aging often worsens the problem. Asthma has also become more common in this country, again for unknown reasons.

What causes an attack?

  • No single cause has been found, but a variety of factors may trigger an attack.
  • A check list of trigger factors is:
  • infections, especially colds
  • allergies (e.g. to animal fur, feathers, pollens, mould)
  • house dust, especially the dust mites
  • cigarette smoke; other smoke and fumes
  • sudden changes in weather or temperature
  • occupational irritants (e.g. wood dust, synthetic sprays, chemicals)
  • drugs (e.g. aspirin, drugs to treat arthritis, heart problems and glaucoma)
  • certain foods and food additives
  • exercise, especially in a cold atmosphere
  • emotional upsets or stress

What are the symptoms?

The main symptoms are breathlessness, tightness in the chest, wheezing and coughing (especially at night).

Symptoms or signs of very severe asthma are anxiety, blue colour of the lips (cyanosis), ashen grey colour of the skin, fast pulse, rapid breathing, indrawing of the chest wall, difficulty speaking, no response to asthma medication and feeling very sick. These uncommon severe symptoms mean that you should seek urgent medical attention-they are 'call the ambulance' signs.

How common is Asthma?

About 1 child in 4 or 5 has asthma, usually in a mild form. It usually comes on between

the ages of 2 and 7. Most children 'grow out of it' by puberty, but a small number get it again as adults. Others continue with it. About 1 in 10 adults has asthma.

What are the risks?

Severe asthma can retard the growth of children, but the biggest worry (although uncommon) is the number of deaths (including sudden deaths), especially in those who do not realise how severe the attack really is. With correct treatment, almost all children should be able to lead normal lives.

Know your asthma

  • Read all about it.
  • Try to identify trigger factors and avoid them.
  • Become expert at using your medicine and inhalers. A big problem is incorrect inhaler technique (35% of patients).
  • Know and recognize the danger signs and act promptly.
  • Have regular checks with your doctor.
  • Have physiotherapy: learn breathing exercises.
  • Work out a clear management plan and an action plan for when trouble strikes.
  • Learn the value of a peak expiratory flow meter (for anyone over 6).
  • Always carry your bronchodilator inhaler and check that it is not empty. (Learn about the water flotation test.)

Key Points

  • Get to know how severe your asthma is.
  • Avoid trigger factors such as tobacco smoke.
  • Keep at your best with suitable medicines.
  • Get urgent help when danger signs appear.
  • Have an action plan for severe asthma.
  • Use your inhalers correctly and use a spacer if necessary.
  • Get a peak flow meter to help assess severity and work out your best lung function.

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Date of Last Update: 07/27/12