Health Care and Asthma

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning, according to the National Heart Lung and Blood Institute (NHLBI). Asthma affects people of all ages, but it most often starts in childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.

The airways are tubes that carry air into and out of your lungs, according to NHLBI. People who have asthma have inflamed airways. This makes the airways swollen and very sensitive. They tend to react strongly to certain substances that are breathed in. When the airways react, the muscles around them tighten. This causes the airways to narrow, and less air flows to your lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways may make more mucus than normal. Mucus is a sticky, thick liquid that can further narrow your airways. This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are irritated. Sometimes symptoms are mild and go away on their own or after minimal treatment with an asthma medicine. At other times, symptoms continue to get worse. When symptoms get more intense and/or additional symptoms appear, this is an asthma attack. Asthma attacks also are called flareups or exacerbations. It's important to treat symptoms when you first notice them. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can cause death.

According to WebMD.com, no one really knows the causes of asthma. What we do know is that asthma is a chronic inflammatory disease of the airways. The causes of asthma symptoms can vary for different people. Still, one thing is consistent with asthma: when airways come into contact with an asthma trigger, the airways become inflamed, narrow, and fill with mucus.When you have an asthma attack, spasms of the muscles around the airways, inflammation and swelling of the mucosal membrane lining the airways, and excessive amounts of mucus contribute to airway narrowing. This makes airway resistance increase and the work of breathing more difficult, causing shortness of breath, cough, and wheezing. You may have coughing with asthma because of the irritation inside the airway and the body’s attempt to clean out the accumulations of thick mucus. So why do you have asthma and your friend doesn’t? No one really knows for sure.

Allergies play a role in many people with asthma but not in all, according to WebMD. As with allergy, you can blame your family history, as there is a strong genetic component for asthma. If you or a loved one has asthma, it’s important to understand the many asthma triggers. Once you identify and reduce exposure to the specific triggers or causes of asthma, you can take an active role in controlling your asthma and reducing the frequency of asthma attacks. For example, if you find that allergies are the cause of your asthma, you may have allergic asthma. Being aware of allergies and avoiding them can significantly help in asthma prevention by reducing the frequency or severity of asthma attacks. Or if environmental pollution seems to cause your asthma, it’s important to stay indoors during periods of heavy air pollution. Try to find the specific triggers or causes of your asthma, and then plan to avoid these triggers and have better asthma control. More information on what triggers asthma can be found at: http://www.webmd.com/asthma/guide/asthma-triggers.

According to MedicineNet.com, asthma is now the most common chronic illness in children, affecting one in every 15. In North America, 5% of adults are also afflicted. In all, there are about 1 million Canadians and 15 million Americans who suffer from this disease. The number of new cases and the yearly rate of hospitalization for asthma have increased about 30% over the past 20 years. Even with advances in treatment, asthma deaths among young people have more that doubled. There are about 5,000 deaths annually from asthma in the U.S. and about 500 deaths per year in Canada. Non-Allergic (intrinsic) asthma is triggered by factors not related to allergies. Like allergic asthma, non-allergic asthma is characterized by airway obstruction and inflammation that is at least partially reversible with medication, however symptoms in this type of asthma are NOT associated with an allergic reaction. Many of the symptoms of allergic and non-allergic asthma are the same (coughing, wheezing, shortness of breath or rapid breathing, and chest tightness), but non-allergic asthma is triggered by other factors such as anxiety, stress, exercise, cold air, dry air, hyperventilation, smoke, viruses or other irritants. In non-allergic asthma, the immune system is not involved in the reaction.

According to the Asthma and Allergy Foundation of America (AAFA), Asthma is commonly divided into two types: allergic (extrinsic) asthma and non-allergic (intrinsic) asthma. There is still much research that needs to be done to fully understand how to prevent, treat and cure asthma. But, with proper management, people can live healthy and active lives. Allergic (extrinsic) asthma is characterized by symptoms that are triggered by an allergic reaction. And, allergic asthma is airway obstruction and inflammation that is partially reversible with medication. Allergic asthma is the most common form of asthma, affecting over 50% of the 20 million asthma sufferers. Non-Allergic (intrinsic) asthma is triggered by factors not related to allergies. Like allergic asthma, non-allergic asthma is characterized by airway obstruction and inflammation that is at least partially reversible with medication, however symptoms in this type of asthma are NOT associated with an allergic reaction. Many of the symptoms of allergic and non-allergic asthma are the same (coughing, wheezing, shortness of breath or rapid breathing, and chest tightness), but non-allergic asthma is triggered by other factors such as anxiety, stress, exercise, cold air, dry air, hyperventilation, smoke, viruses or other irritants. In non-allergic asthma, the immune system is not involved in the reaction.

Inflammation, or swelling, is a normal response of the body to injury or infection, according to MedicineNet. The blood flow increases to the affected site and cells rush in and ward off the offending problem. The healing process has begun. Usually, when the healing is complete, the inflammation subsides. Sometimes, the healing process causes scarring. The central issue in asthma, however, is that the inflammation does not resolve completely on its own. In the short term, this results in recurrent "attacks" of asthma. In the long term, it may lead to permanent thickening of the bronchial walls, called airway "remodeling." If this occurs, the narrowing of the bronchial tubes may become irreversible and poorly responsive to medications. Therefore, the goals of asthma treatment are: (1) in the short term, to control airway inflammation in order to reduce the reactivity of the airways; and (2) in the long term, to prevent airway remodeling. A lot of detail about Asthma can be found at: http://www.medicinenet.com/asthma/article.htm.

Americans spend up to 90% of their time indoors, according to EPA.gov. Therefore, indoor allergens and irritants can play a significant role in triggering asthma attacks. It is important to recognize potential asthma triggers in the indoor environment and reduce your exposure to those triggers. You may not be affected by all of the triggers listed here. Your doctor can help you to determine which triggers affect your asthma and develop a specific plan to reduce your triggers. When you and your doctor make the plan, be sure to include:
--Your child’s asthma triggers.
--Instructions for asthma medicines.
--What to do if your child has an asthma attack.
--When to call your doctor.
--Emergency telephone numbers.
Some of the most common indoor asthma triggers include secondhand smoke, dust mites, mold, cockroaches and other pests, household pets, and combustion byproducts.

Asthma can't be cured, according to NHBLI. Even when you feel fine, you still have the disease and it can flare up at any time. But with today's knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma. For successful, comprehensive, and ongoing treatment, take an active role in managing your disease. Build strong partnerships with your doctor and other clinicians on your health care team.

Until next time. Let me know what you think.