health

1. What Is Asthma?
2. What Are the Severities of Asthma?
3. What Triggers Asthma?
   
4. Who Gets Asthma?
5. The Symptomes.
6. Diagnosis.
7. Why Is Treatment Needed?
8. Treatment.
9. Breathing Easier.

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When Stacy was young, her parents noticed that she seemed to get tired
more quickly than her friends while playing. She also had repeated coughing
spells, and her breathing was sometimes noisy. After examining Stacy,
asking lots of questions, and having her use a little machine to measure
her breathing, the doctor diagnosed her problem as asthma. As part of the
way Stacy took care of herself, she sometimes had to take asthma medicine
at school. This made her teachers and friends interested in learning more
about asthma. When Stacy was 12, she began a school-wide project with
the help of her teacher and the nurse. The goal was to make her school
more comfortable for those who have asthma. No smoking was allowed,
even during after-school events. Extra measures were taken to keep the
school as free as possible of substances that can trigger asthma flares, such
as dust, mold, cockroaches, and strong fumes from paint and chemicals.
A plan was set up that allowed students with asthma to take their own
medicines at school. Special lessons were offered to all students and teachers
about what asthma is and how to help a classmate who has it. The result
was a school that was a healthier place not just for Stacy but for everyone.

Asthma is a condition that causes episodic breathing difficulties. These
episodes are caused by narrowed and inflamed airways of the lungs.
Asthma “flares” or “attacks” can be triggered by dust, pollutants, smoke,
allergies, cold air, or infections.

Several changes happen inside the airways in the lungs of people who
have asthma. First, there is inflammation, or swelling, of the lining of
the airways. Second, the swollen tissues make a thick, slippery substance
called mucus*. Third, the muscles around the airways may squeeze tight,
causing the airways to narrow. These three processes—inflammation,
mucus production, and muscle constriction—combine to reduce the size
(the diameter) of the airways. That makes it harder to breathe, like trying
to blow air through a narrow straw.
During an asthma attack, these changes get worse. The airways swell
on the inside while they are being squeezed on the outside. At the same
time, thick mucus plugs the smaller airways. The person may start to
make whistling or hissing sounds with each breath. The person’s chest
may also feel tight. In addition, the person may cough to try to clear the
lungs.


A Breathless Story

Cases of asthma vary in severity. Some people may have only mild
symptoms a few times per month, whereas others may have severe symptoms
every day. Asthma is has four levels, depending on how severe each
case is.

Mild intermittent A person with this type of asthma has daytime
symptoms less than twice per week and nighttime symptoms less than
twice per month. Attacks are brief and usually do not affect activities.
Intermittent means the symptoms come and go.

Mild persistent A person with this type of asthma has mild symptoms
more than twice per week, never more than once per day. Nighttime
symptoms occur more than two times a month.

Moderate persistent A person with this type of asthma has symptoms
every day and flare-ups more than twice per week. Nighttime symptoms
occur more than once per week. When symptoms do occur, they can last
for days and can make it hard for the sufferer to participate in certain
activities.

Severe persistent A person with this type of severe asthma has symptoms
throughout the day and night. The asthma makes it hard or impossible
for a person to participate in many physical activities.

People with asthma have what are sometimes called “sensitized” airways.
Everyday factors that cause little or no trouble for most people can sometimes
cause people with asthma to have a flare-up or attack. These factors
are known as asthma triggers. There are two main kinds of triggers: allergic
and non-allergic triggers. An allergic trigger results from substances
called allergens*, which trigger an allergy. Examples of allergens that may
trigger asthma are pollens, molds, animal dander (small scales from fur
or feathers), dust mites*, cockroaches, and certain foods and medicines.
Most of these allergy-causing substances enter the body through the air
people breathe, but some are swallowed.
The second kind of asthma trigger is called an environmental or nonallergic
trigger. It has nothing to do with an allergy but causes the same
kind of reaction in the airways. Irritating substances in the air, such as
tobacco smoke, wood smoke, fresh paint, cleaning products, perfumes,
workplace chemicals, and air pollution can trigger or make asthma worse.
Other non-allergic triggers include cold air, sudden changes in air temperature,
exercise, heartburn, and infections of the airways, such as a cold
or the flu. Exactly which of these might trigger a reaction varies from
person to person.

Asthma is one of the most common health problems in the United States.
The number of people with the condition grew rapidly in the late 1990s
and early 2000s. The reason for this increase is not yet known. Asthma can
affect both children and adults. It is the most common chronic* health
problem seen among children and teenagers. Childhood asthma is slightly
more common in boys than girls. The condition is also more common
among African American children than white children, although the reason
for this difference is not clear. It may have to do with environmental
conditions.

Following are the most common symptoms of asthma. A person may
have all, some, or just one of these symptoms:

• Shortness of breath
  
• Coughing, particularly if it lasts longer than a week
• Wheezing (whistling or hissing sounds made primarily when
  breathing out)
  
• A feeling of tightness or discomfort in the chest

The degree to which asthma interferes with a person’s daily life varies
significantly. Some people have ongoing problems. The frequency of their
attacks may range from several times per week to almost constantly. Their
ability to take part in physical activities may be limited until, with treatment,
they are able to get their asthma under control. Those with milder
problems are usually able to do whatever they want to do, so long as they
reduce their environmental triggers, take their medicine as directed, and
follow any other advice from their doctors.

Childhood asthma Babies often wheeze when they have a cold or other
infection of the airways, blockage of the airways, or other problems. This
symptom may go away on its own with no ill effects. However, if the problem
is severe, lasts a long time, or comes back, treatment may be needed. In
older children, normal breathing should be quiet. Wheezing may be a sign
of asthma, but it can also signal an infection, lung disease, heartburn, heart
disease, a blood vessel blocking the airways, or even a piece of food or other
object (such as part of a toy) lodged in the airway. In addition to noisy breathing,
asthma in children can cause rapid breathing and frequent coughing
spells. Parents may also notice that the child tires quickly during active play.

Nighttime asthma Asthma tends to get worse at night. Nocturnal
(or nighttime) asthma occurs while a person is sleeping. For some people,
nocturnal asthma is one of many symptoms; other people seem to have
coughing or wheezing only at night.

Exercise-related asthma Many people with asthma have trouble
with noisy breathing during or after exercise, a condition known as
exercise-induced asthma. Other symptoms include coughing, a rapid
heartbeat, and a feeling of tightness in the chest five to ten minutes after
exercise. For some people, exercise is the only asthma trigger. That means
they only have asthma symptoms after exercise-like activities and do not
have symptoms at any other time. Cold or dry air, high pollen counts,
air pollution, a stuffed-up nose, and an infection of the airways are all
factors that tend to make the problem worse. Types of exercise that may
lead to wheezing include running, using a treadmill, and playing basketball—
in short, exercises that are aerobic (designed to increase oxygen
consumption).

Job-related asthma Occupational asthma is caused by breathing in
fumes, gases, or dust while on the job. Asthma can start for the first time
in a worker who was previously healthy, or it can get worse in a worker
who already had the condition. Symptoms include wheezing, chest tightness,
and coughing. Other symptoms that may go along with the asthma
include a runny or stuffed-up nose and red, sore, itchy eyes. The asthma
may last for a long time, even after the worker is no longer around the
substance that caused it.

Severe attacks Status asthmaticus (STA-tus az-MAT-i-kus) is a
severe asthma attack that does not get better when individuals take their
medicine as usual. This kind of attack is an emergency that must be
treated right away in a hospital or doctor’s office, where other medicines
may be used.

The doctor performs a physical checkup and ask questions about symptoms
and when they occur. In addition, the doctor may do various tests
to help identify asthma and its causes. Some of the tests are described
below.

Allergy tests Allergy tests help identify those substances to which a
person is allergic. Skin tests are most common. Tiny amounts of possible
allergens are put on the skin, and the skin is checked to see which substances,
if any, cause a reaction. In another type of allergy test, a blood
sample is checked for certain antibodies, which are substances made in
the blood that fight foreign or harmful substances. People with allergies
may have high levels of immunoglobulin E (IgE) antibodies. However,
the blood test is generally not considered as precise as the skin test, and it
cannot check for as many allergens.

Chest x-ray An x-ray is an invisible wave that goes through most solid
matter depending on its density and produces an image on film. After
the film is developed, a special picture can be viewed that shows how the
lungs and other structures look. An x-ray can help rule out other causes
of wheezing.

Lung-function tests These tests show how well the lungs are working.
In one test, the person blows into a device called a spirometer (spi-
ROM-i-ter), which measures the amount of air going in and out of the
lungs. Another test uses a peak flow meter to measure how fast the person
can breathe air out of the lungs. A peak flow meter is a simple, hand-held
device that can be used at home. Many people with asthma use peak flow
meters regularly to check for early warning signs of an upcoming asthma
attack. Doing so gives them time to take certain medicines that can often
stop the attack.

Asthma that is not under control can cause many problems. People miss
school or work, must go to the hospital, and can even die (rarely) because
of asthma. With a doctor’s help, though, most people can control their
asthma. People with well-controlled asthma have few, if any, symptoms
during the day and can sleep well at night. They can also take part in their
usual activities, including sports and exercise. However, asthma does not
go away just because its symptoms do. Individuals need to continue taking
care of their condition: avoiding triggers, not smoking, and living in
a healthy, clean environment. Ongoing attention is required even in mild
asthma cases.

Besides avoiding exposure to asthma triggers, asthma is mostly treated
with medicines. There are two characteristics of asthma: inflammation
and spasms (or constriction) of the muscles in the airways. Asthma
treatment focuses on both. Asthma medicines fall into two groups: those
used to prevent symptoms and control the disease for a long time, and
those that give short-term relief during an asthma attack. Taking the right
medicine at the right time is important.

Long-term control medicines Long-term control medicines are
taken every day to help prevent symptoms from starting. It may take several
weeks for these medicines to produce their best results, though. The
most effective ones work by reducing swelling in the airways. Many are
inhaled (breathed into the lungs). Not everyone needs such medicines.
However, they may be very helpful for people who have daytime asthma
symptoms three or more times per week or nighttime symptoms three
or more times per month. Medicines for long-term control of asthma
include the following:

• Inhaled corticosteroids* (kor-ti-ko-STER-oids). These strong drugs
  prevent and reduce swelling in the airways. They also make the airways
  less sensitive to triggers. However, they work only if they are
  used regularly. These drugs are taken every day by people with longlasting
  asthma. They are not the same as the unsafe steroids some
  athletes use to build muscles.
  
• Other inhaled drugs. These medications also help prevent and reduce
  swelling in the airways and make the airways less sensitive. However,
  it can take four to six weeks of regular use before they start to work.
  These drugs are taken every day by people with long-term asthma,
  but they can also be used before exercise or contact with a trigger.
  
• Oral corticosteroids. These drugs are taken by mouth in pill or liquid
  form. Unlike inhaled corticosteroids, they sometimes cause serious
  side effects when used for a long time. However, they can often
  be used safely for a short time to treat severe asthma attacks and to
  quickly bring asthma under control. They are sometimes taken every
  day or every other day by people with the most severe asthma.
  
• Long-acting bronchodilators (brong-ko-DY-lay-tors). These drugs
  relax the muscles around the airways, making breathing easier. They
  can prevent or reduce narrowing of the airways. However, they keep
  working only if they are used regularly. These drugs are inhaled or
  taken by mouth in a pill. Some are especially useful for preventing
  nighttime or exercise-related asthma.
  
• Inhaled anticholinergics (AN-tih-ko-lin-ER-jek). This medicine
  is a type of bronchodilator. It relaxes the muscles around the airways,
  making breathing easier. The medicine takes about an hour
  to work, so it should not when quick relief is needed. The drug can
  be breathed in using an inhaler or nebulizer. It works best when
  taken with a short-acting bronchodilator; however, it is not commonly
  used to treat asthma.
• Leukotriene modifiers (loo-ko-TRY-een). These drugs prevent and
  reduce swelling in the airways and make the airways less sensitive to triggers. They also prevent squeezing of the muscles around the
  airways. These drugs are taken regularly by mouth in a pill.
• Anti-IgE therapy. This is a newer type of medicine that blocks
  the substances in the blood that cause allergy-related asthma symptoms.
  The drug is for people who have moderate to severe asthma
  symptoms that continue despite other treatments. In the early
  2000s, anti-IgE therapy was only approved for persons age 12 and
  older. It is given by injection.
  
• Allergy vaccines. In some cases, a person’s asthma symptoms can
  be prevented or lessened if the individual takes a course of special
  allergy injections over months or years. These shots contain
  small amounts of the allergens that trigger the person’s asthma. The
  course of injections causes the person to become less sensitive to
  the allergen when exposed to it.

Short-term relief medicines Short-term relief medicines are taken
only when needed to relax and open the airways quickly. They can be used
to relieve symptoms or to prevent them if a person’s peak flow meter readings
begin to drop, signaling an upcoming asthma attack. However, the
effects last for only a few hours. They cannot keep the symptoms from coming
back the way long-term control medicines can. These drugs are inhaled
and are taken at the first sign of trouble or before contact with a trigger.
Medicines that provide short-term relief of asthma are called shortacting
bronchodilators. These drugs relax the muscles around the airways,
making breathing easier. They begin to work within five minutes, and
their effects last for four to six hours. Such drugs are taken right after
symptoms start or just before exercise.

How Are Inhaled Medicines Taken?
Many asthma medicines are made to be breathed into the lungs. Such inhaled
drugs go straight to the place where they are needed. The most popular
device for taking inhaled medicines is a metered dose inhaler, which gets the
drug to the lungs in exact amounts. The inhaler is a small, hand-held canister
with a button that the person pushes to make the medicine spray out. Often
a tube, called a spacer, is attached to the canister to make it easier to use.
Another type of device that is sometimes used to take inhaled medicines
is a nebulizer (NEB-you-lyz-er), which turns liquid medicine into a
very fine mist. These devices are helpful for babies, young children, and
elderly or very sick adults who would have trouble handling a metered
dose inhaler.

People with asthma should try to figure out what makes their symptoms
worse and take steps to avoid or control those substances or situations.
Here are a few ways that many people control some common asthma triggers.
Not all of them will work for everyone

Pollens and outdoor molds To control pollens and outdoor molds,
people with asthma often do the following:

• keep windows and doors closed when pollen or mold spore counts
  are high
• avoid walking in gardens and fields when they are in bloom and
  when pollen and mold spore counts are highest
• ride with the car windows shut and the air conditioner on during
  pollen season
• ask their doctors about starting or increasing a long-term control
  medicine before peak pollen season begins

Indoor molds To control indoor molds, people with asthma often do
the following:

• fix leaky faucets, pipes, and other sources of water
  
• clean moldy surfaces with a product that contains bleach
• remove wallpaper, which can have mold growing on it
  
• get rid of houseplants, which can gather mold and dust

Animal dander Dander is small scales from the hair of animals, such
as cats, and from bird feathers. Some people are allergic to it, and people
with asthma often take the following steps:

• keep pets with fur or feathers out of their homes, if possible
  
• have pets stay out of bedrooms, in particular, and keep bedroom
  doors closed
  
• remove carpets and cloth-covered furniture or keep pets away from
  these materials
  
• use polyester-fill rather than feather pillows and avoid down
  comforters

Dust mites People with asthma often find that they are allergic to dust
because of the tiny animals that live in the dust, called mites. Many people
with asthma find that it helps to keep their homes especially free of
dust. For example, they take the following steps:

• wash their bedding each week in hot water (it must be hotter than
  130 degrees F to kill mites)
  
• enclose mattresses and pillows in special dust-proof covers or wash
  pillows each week in hot water
  
• try not to sleep or lie on cloth-covered furniture or cushions
  
• remove carpets in bedrooms and those laid on concrete
  
• keep stuffed toys out of beds and wash the toys each week in hot
  water
  
• wear a dust mask while vacuuming or have someone else do the
  vacuuming

Cockroaches Many people with asthma are sensitive to cockroach
droppings and make a special effort to get rid of these stubborn creatures
by taking the following steps:

• keeping all food out of bedrooms
  
• storing food and garbage in closed containers and never leaving
  food or crumbs sitting around
  
• using poison bait, powder, gel, paste, or traps (following label
  instructions) to kill cockroaches
  
• staying out of the room until the odor goes away if a spray is used
  to kill roaches

Certain foods and medicines It is important to do the following:

• avoid foods that have caused problems in the past
  
• tell the doctor about any past reactions to medicines

Smoke and strong odors Smoking is not good for people, not good
for the person smoking or people who are in the same room with tobacco
smoke. People with asthma are especially endangered by tobacco smoke
and find it is best not to smoke, to ask other family members to quit
smoking, and to ask visitors not to smoke.
People with asthma also do the following:

• avoid using a wood-burning stove, kerosene heater, or fireplace, if
  possible
  
• try to stay away from strong odors and fumes, such as perfume,
  hairspray, and fresh paint

Exercise It is healthy for just about everyone to exercise, and people
with asthma are no exception. To make their exercise and sports activities
more enjoyable, people with asthma usually do the following:

• warm up for six to ten minutes before exercising
  
• avoid exercising outside when air pollution or pollen counts are
  high or when the air is cold
  
• pick activities that do not cause symptoms (sports that involve running
  are the most likely to trigger problems)
  
• ask a doctor about taking medicine before exercise to prevent
  symptoms