Asthma

Risk Factors for Asthma

Asthma affects people of all ages, but it often starts during childhood. Sometimes asthma develops in adults, particularly women. This type of asthma is called adult-onset or late-onset asthma.

You may have an increased risk of asthma because of your environment or occupation, your family history or genes, other medical conditions, your race or ethnicity, or your sex.

Environmental exposures, including those at work, may increase the risk of developing asthma or making asthma symptoms worse.

• Exposure to cigarette smoke during pregnancy or in a child’s first few years increases the risk of the child developing asthma symptoms early in life.
• Exposure to different microbes in the environment, especially early in life, can affect the development of the immune system. These effects on the immune system may either increase or protect against the risk of developing asthma.
• Exposures that occur in the workplace, such as chemical irritants or industrial dusts, may also be associated with an increased risk of developing asthma in susceptible people. This type of asthma is called occupational asthma. It may develop over a period of years, and it often lasts even after you are no longer exposed.
• Poor air quality from pollution or allergens may worsen asthma. Pollutants include gases from heaters or vehicles. Allergens in the air include pollen, dust, or other air particles.

Genes and family history increase your risk of developing asthma.

• Having a parent who has asthma, especially if the mother has asthma, increases the risk that a child will develop asthma.
• The genes you inherit may play a role in the development of asthma because they affect how the immune system develops. More than one gene is likely involved.

Other medical conditions may play a role:

• Allergies. Asthma is usually a type of allergic reaction. You may be at higher risk for developing asthma if you had food allergies or allergic reactions in early childhood to substances in the air, such as pollen, dander, mold, or dust. The more things you are allergic to, the higher your risk of asthma.
• Obesity
• Respiratory infections and wheezing. Young children who often have respiratory infections caused by viruses are at highest risk of developing asthma symptoms early in life.

Race or ethnicity: African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities. African American and Hispanic children are more likely to die from asthma-related causes than non-Hispanic white Americans.

Sex: Among children, more boys than girls have asthma. Among teens and adults, asthma is more common among women than men.

Signs, Symptoms, and Complications of Asthma

How often signs and symptoms of asthma occur may depend on how severe, or intense, the asthma is, and whether you are exposed to allergens. Some people have symptoms every day, while others have symptoms only a few days of the year. For some people, asthma may cause discomfort but does not interfere with daily activities. If you have more severe asthma, however, your asthma may limit what you are able to do.

When asthma is well controlled, it may not cause symptoms. When symptoms worsen, it is called an asthma attack, exacerbation, or flare-up. Asthma attacks can happen suddenly and may be life-threatening. Over time, uncontrolled asthma can damage the lungs.

Signs and symptoms of asthma may include:

• Chest tightness
• Coughing, especially at night or early morning
• Shortness of breath
• Wheezing, which causes a whistling sound when you exhale

While other conditions can cause the same symptoms as asthma, the pattern of symptoms in people who have asthma usually has some of the following characteristics:

• They come and go over time, or within the same day.
• They start or get worse with viral infections, such as a cold.
• They are triggered by exercise, allergies, cold air, or hyperventilation from laughing or crying.
• They are worse at night or in the morning.

Diagnosing Asthma

Your doctor may diagnose asthma based on your medical history, a physical exam, and results from diagnostic tests. The treatment you receive will depend on whether your asthma is mild, moderate, or severe.

Before diagnosing you with asthma, your doctor will rule out other medical reasons or conditions that could also cause similar signs and symptoms. You may need to see an asthma specialist, called a pulmonologist, or an allergy specialist, called an allergist.

Diagnostic tests may include:

• Pulmonary function tests such as spirometry, to measures how much and how fast the air moves when you breathe in and out with maximum effort.
• Spirometry with bronchodilator (BD) test to measure how much and how fast air moves in and out both before and after you take an inhaled medicine to relax the muscles in your airway.
• Bronchoprovocation tests to measure how your airways react to specific exposures, such as allergens or medicines that may tighten the muscles in your airways.
• Peak expiratory flow (PEF) to measure how fast you can blow air out using maximum effort.
• Allergy tests

Diagnosing asthma in children under age 6

It can be hard to tell whether a child under 6 years old has asthma or another respiratory condition because they cannot perform a pulmonary function test such as spirometry. After checking a child’s history and symptoms, the doctor may try asthma medicines for a few months to see how well a child responds. About 40 percent of children who wheeze when they get colds or respiratory infections are eventually diagnosed with asthma.

Tests for other medical conditions

Depending on the nature and severity of your symptoms, your doctor may want to test for other conditions. These tests may include:

• Chest X-ray to rule out lung infections, such as tuberculosis, or a foreign substance, such as an object that was inhaled by accident.
• Electrocardiogram (EKG) to rule out heart failure or arrhythmia while in emergency care.
• Laryngoscopy to rule out vocal cord problems. The doctor can use this test to look at your upper airways and the vocal cords.
• Sleep studies to rule out sleep apnea.
• Tests that look at your esophagus and upper digestive system to rule out gastroesophageal reflux disease (GERD).

Treatment for Asthma

If you are like most people who have asthma, treatment can manage your symptoms, allow you to resume normal activities, and prevent asthma attacks. Treatment usually depends on your age, asthma severity, and your response to a given treatment option. Your doctor may adjust your treatment until asthma symptoms are controlled.

Most people who have asthma are treated with daily medicine, called long-term control medicines, along with inhalers containing medicine for short-term relief during an asthma attack or when symptoms worsen. An inhaler allows the medicine to go into the mouth and airways.

Control medicines

Your doctor may prescribe control medicines to take daily to help prevent symptoms by reducing airway inflammation and preventing narrowing of the airways.

Control medicines include the following:

• Corticosteroids to reduce the body’s inflammatory response. Your doctor may prescribe inhaled corticosteroids that you will need to take each day or corticosteroids by mouth for short periods. Side effects may include a hoarse voice or a mouth infection called thrush, and long-term use may affect growth in young children.
• Biologic medicines, such as omalizumab, mepolizumab, resulizumab, and benralizumab, to target specific parts of the body’s response to allergens. These medicines are given by injection, either below the skin or in a vein, every few weeks.
• Leukotriene modifiers to reduce the effects of leukotrienes, which are released in the body as part of the response to allergens and cause airway muscles to tighten. These medicines block this response, allowing the airways to open, and reduce inflammation.
• Mast cell stabilizers such as cromolyn, to help prevent airway inflammation caused by exposure to allergens or other triggers. These medicines stop certain immune cells from releasing the signals that cause inflammation.
• Inhaled long-acting beta2-agonists (LABAs) keep the airways open by preventing narrowing of the airways. LABAs may be added to your inhaled corticosteroids to reduce narrowing and inflammation.

Short-term relief medicines

Short-term relief medicines, also called quick-relief medicines, help prevent symptoms or relieve symptoms during an asthma attack. They may be the only medicine needed for mild asthma or asthma that only happens with physical activity.

Your doctor will prescribe a quick-relief inhaler, sometimes called a rescue inhaler, for you or your child to carry at all times. Types of short-term relief medicines include:

• Inhaled short-acting beta2-agonists (SABAs) to quickly relax tight muscles around your airways. This allows the airways to open up so air can flow through them. Side effects can include tremors and rapid heartbeat. SABAs are usually the only medicine used to treat wheezing in children under 5 years old. If symptoms and medical history suggest asthma, doctors may treat it with inhaled corticosteroids for a trial period to see if they help. If symptoms do not improve, corticosteroids will be stopped to avoid side effects.
• Oral and intravenous (IV) corticosteroids to reduce inflammation caused by severe asthma symptoms.
• Short-acting anticholinergics to help open the airways quickly. This medicine may be less effective than SABAs, but it is an option for people who may have side effects from SABAs.

Emergency care

If you have a severe asthma attack and need emergency care, you may be treated with medicines, such as those listed above, given with a nebulizer or IV. You may also receive oxygen therapy or breathing assistance, either through a tube inserted in the airway or through noninvasive ventilation, which uses a mask with forced air that covers the face to support breathing.

Procedures

Your doctor may recommend a procedure called bronchial thermoplasty if you have severe asthma and other treatments are not working. In this procedure, your doctor will enter the airways through the mouth with a bronchoscope. This helps your doctor see inside the airways. Your doctor then will apply heat to the muscles along the airways to make them thinner and help prevent constriction.

Living With Asthma

If you or your child has been diagnosed with asthma, work with your doctor to learn how manage it yourself. Because asthma symptoms may be different at different times, it is important to know which medicines to use to prevent and relieve symptoms. Work with your doctor to develop a treatment plan, called an asthma action plan. Follow-up care will help to make sure your or your child’s asthma is well-controlled. Staying healthy also includes avoiding asthma triggers and maintaining a healthy lifestyle.

Work with your doctor to create an asthma action plan that works for you. An asthma action plan is a written treatment plan document that describes the following:

• How to identify allergens or irritants to avoid
• How to recognize and handle asthma attacks
• Which medicines to take and when to take them
• When to call your doctor or go to the emergency room
• Who to contact in case of an emergency

If your child has asthma, then all of your child’s caretakers and school staff should know about the asthma action plan. For a sample plan, see the National Heart, Lung, and Blood Institute’s (NHLBI’s) Asthma Action Plan.

Receive routine medical care

Regular checkups are important to help your doctor determine how well you are controlling your asthma and adjust treatment if needed.

Your asthma is considered well-controlled if:

• You can do all of your normal activities.
• You do not have symptoms more than twice a week.
• You do not have more than one asthma attack a year requiring corticosteroids by mouth.
• You do not take quick-relief medicines more than two days a week.
• You do not wake from sleep more than one or two times a month because of symptoms

Symptoms in young children who do not have their asthma controlled include fatigue, irritability, and mood changes.

Your doctor will also make sure you are using your inhaler correctly. There are different types of inhalers. Review the way you use your inhaler at every medical visit. Sometimes asthma may get worse because of incorrect inhaler use.

Medical care is also important for managing conditions that can make it harder to treat asthma, such as gastroesophageal reflux disease (GERD) or sinus infections. Work with your doctor to help keep them under control.

Your medicines or dosages may change over time, based on changes in your condition or in your life, such as age, pregnancy, or needing to have surgery.

Monitor your asthma at home

Monitoring and managing your asthma at home is important for your health. Ask your doctor about asthma training or support groups. Education can help you understand your asthma, the purpose of your medicines, how to prevent symptoms, how to recognize asthma attacks early, and when to seek medical attention.

Your doctor may show you how to monitor your asthma using a peak flow meter. You can compare your numbers over time to make sure your asthma is controlled. A low number can help warn you of an asthma attack, even before you notice symptoms.

Keeping a diary may help if you find it hard to follow your asthma action plan or the plan is not working well. Bring the diary with you to your appointment.

Adopt healthy lifestyle changes

Your doctor may recommend one or more of the following lifestyle changes to help keep asthma symptoms in check:

• Aiming for a healthy weight.
• Being physically active.
• Heart-healthy eating.
• Managing stress.
• Meet with a mental health professional if you have anxiety, depression, or panic attacks.
• Quitting smoking or avoiding secondhand smoke.

Prevent worsening of asthma symptoms and attacks

Certain things can set off or worsen asthma symptoms. These are called asthma triggers. Once you know what these triggers are, you can take steps to control them.

A common trigger for asthma is exposure to allergens.

• If animal fur triggers asthma symptoms, keep pets with fur out of your home or bedrooms.
• Keep your house as dust-free and mold-free as possible.
• Remove yourself from what is triggering your symptoms in the workplace. If you have occupational asthma, even low levels of the substance to which you are sensitive can trigger symptoms.
• Try to limit time outdoors if allergen levels are high.

Other asthma triggers include:

• Emotional stress. Emotional stress, such as intense anger, crying, or laughing, can cause hyperventilation and airway narrowing, triggering an asthma attack.
• Influenza (flu). Get the flu vaccine each year to help prevent the flu, which can increase the risk of an asthma attack.
• Medicines. Some people who have severe asthma may be sensitive to medicines, such as aspirin, and may experience serious respiratory problems. Tell your doctor about all medicines you or your child currently take.
• Poor air quality or very cold air. Pollution or certain kinds of weather, such as thunderstorms, can affect air quality. Make sure indoor cooking and heating devices are well-vented. Keep windows closed and avoid strenuous outdoor activity when outdoor air quality is low.
• Tobacco smoke, including secondhand smoke.

Learn the warning signs of serious complications and have a plan

Ask your doctor about when to call 9-1-1 for emergency care. It should be written in your asthma action plan. Call your doctor if:

• Your medicines do not relieve an asthma attack.
• Your peak flow number is low.

Make an Appointment With a Physician Who Can Help You Manage Your Asthma

To learn more about asthma care at Cooper or to make an appointment with a primary care physician who can help you manage your asthma, please call 800.8.COOPER (800.826.6737).