Asthma: What You Need to Know

To Breathe or Not to Breathe: Living with Asthma

By Michelle Abbo, M.D., Scripps Memorial Hospital La Jolla

Animals. Dust mites. Mold. Exercise. For people with asthma, sometimes it seems that these and other “triggers” things that set off an asthma attack—lurk just about everywhere in our environment. If you have asthma or suspect you might, it can be helpful to understand what asthma is, why it happens, and how to help keep it under control.

All About Asthma
Asthma is a chronic disease that affects the airways of the lungs and interferes with normal breathing. An asthma “attack” happens when asthma triggers irritate the airways and cause them to overreact. During an attack, three things happen: the airways become inflamed and swollen; the muscles around them constrict and make the airways even smaller; and the mucous glands in the airways step up production, further blocking the opening. As you can imagine, there’s not much room left for air to pass freely to and from the lungs.

For some asthma sufferers, the result is a hacking cough, wheezing and a sensation of having a metal band around the chest that makes it difficult to take a full breath. For others, it is a life-threatening inability to breathe at all. Without treatment, asthma attacks can kill, not just because fresh air can’t get in, but because carbon dioxide buildup in the lungs can’t get out.

No one knows what makes some people’s airways so sensitive. Fortunately, we do know a great deal about what triggers asthma, and how to help prevent attacks.
Allergies are one of the most powerful asthma triggers. More than half of adults with asthma, and 80 percent of asthmatic children, are allergic to such everyday things like dust, mold, pollen and animal dander. When they encounter offending substances, their bodies’ immune systems react with a vengeance, releasing an arsenal of chemicals to fight them off. Along with setting off runny noses, watery eyes and itchiness, these chemicals inflame the airways and tighten surrounding muscles.

Asthma also may be triggered by environmental factors such as cigarette smoke, perfumes, foods, even changes in the weather. Lifestyle may play a role: some attacks are brought on by exercise, illness, strong emotions, or stress. Though these triggers don’t bring on the chemicals released during a true allergic reaction, they can cause asthmatic airways to swell and constrict. A Family Affair Asthma runs in the family, so if both parents have asthma, a child’s chance of getting it is over 60 percent. It affects boys more often than girls, although it evens out around puberty.

While it’s a myth that children “outgrow” their asthma (lungs remain sensitive for a lifetime), symptoms may go away as lungs grow and create more room for air flow. Symptoms may reappear later in life; in fact, some people who develop asthma after age 20 may have had it as a child and not been aware of it.

Signs of asthma in infants and children may include rapid breathing, wheezing, breathlessness, coughing after running or other activity, frequent respiratory infections and a chest that appears caved in.

Asthma Rx
In addition to avoiding triggers as much as possible, asthma can also be helped through medication. Bronchodilators help relax constricted muscles to let air flow through to the lungs. Anti-inflammatories tame the airways’ reaction to triggers and keep them from swelling. Leukotrine modifiers, a newer category of drugs, help ward off the chemicals that cause airways to swell and tighten, and also halt the production of mucous. If you have asthma, your doctor can recommend the best medication for you.

Also, ask your doctor for a written treatment plan that tells you how to manage your asthma both day-to-day and in emergencies. Many people find that a solid, written guide to working, exercising, sleeping and enjoying life with asthma enables them to feel in control of their condition and makes their everyday lives easier.

If you suspect you or someone in your family may have asthma, contact your doctor or pediatrician. He or she may take a detailed medical history, review symptoms, do a physical exam and possibly order blood, allergy or other tests. Never ignore possible signs of asthma, downplay its severity or try to treat symptoms yourself with over-the-counter medications; remember, left untreated, asthma can be fatal. Consult a doctor, and breathe easy!

Michelle Abbo, M.D., is an internal medicine physician at Scripps Memorial Hospital La Jolla. To learn more about asthma or for a physician referral, please call 1-800-SCRIPPS 1-800-727-4777.