What is asthma?

Chronic Obstructive Pulmonary Disease (COPD) COPD is a term that refers to a large group of lung diseases which can interfere with normal breathing. It is estimated that 11 percent of the US population has COPD. The two most common conditions of COPD are chronic bronchitis and emphysema. The causes of COPD are not fully understood. It is generally agreed that the most important cause of chronic bronchitis and emphysema is cigarette smoking. Causes such as air pollution and occupational exposures may play a role, especially when combined with cigarette smoking. Heredity also plays a contributing role in some patients' emphysema, and is especially important in a rare form -- due to alpha 1-antitrypsin deficiency. Symptoms Patients with chronic bronchitis usually have cough and sputum for many years before they develop shortness of breath. Patients with emphysema usually have shortness of breath and develop cough and sputum during a respiratory infection, or in the later stages of the illness.

Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems. The characteristics of asthma are three airway problems:

• obstruction

• inflammation

• hyper-responsiveness

What are the symptoms of asthma?
The following are the most common symptoms for asthma; however, each person may experience symptoms differently.

Sometimes the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

Asthma may resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. It is under-diagnosed -- many people with the disease do not know they have it. Consult your physician for a diagnosis.

What causes asthma?
The basic cause of the lung abnormality in asthma is not yet known, although health care professionals have established that it is a special type of inflammation of the airway that leads to:

• contraction of airway muscles

• mucus production

• swelling in the airways

It is important to know that asthma is not caused by emotional factors -- as commonly believed years ago. Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms, or aggravate an attack. However, these reactions are considered to be more of an effect than a cause.

What happens during an asthma attack?
Persons with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs and airways.

• Lungs and airways overreact to certain triggers and become inflamed and clogged.

• Breathing becomes harder and may hurt.

• There may be coughing.

• There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because:

• muscles that surround the airways tighten, and the inner lining of the airways swells and pushes inward.

• membranes that line the airways secrete extra mucus.

• the mucus can form plugs that further block the air passages.

• the rush of air through the narrowed airways produces the wheezing sounds.

What are the risk factors for an asthma attack?

Although anyone may have an asthma attack, it most commonly occurs in:

• children, by the age of 5
• adults in their 30s
• adults older than 65
• people living in urban communities

Other factors include:

• family history of asthma
• personal medical history of allergies

How is asthma diagnosed?
To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination and laboratory tests, which may include:

• spirometry (using an instrument that measures the air taken into and out of the lungs)

• peak flow monitoring (another measure of lung function)

• chest x-rays

• blood tests

• allergy tests

How is asthma treated?
Specific treatments for asthma will be determined by your physician(s) based on:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures or therapies
• expectations for the course of the disease
• your opinion or preference

As of yet, there is no cure for asthma. However, it can often be controlled with prescription medications that may help prevent or relieve symptoms, and by learning ways to manage episodes.

Managing asthma:
People with asthma can learn to identify and avoid the things that trigger an episode, and educate themselves about medications and other asthma management strategies.

According to the Guidelines for the Diagnosis and Management of Asthma, published by the National Heart, Lung and Blood Institute:

• Asthma is a chronic disease. It has to be cared for all the time -- not just when symptoms are present.

• The four parts of continually managing asthma are:

• identify and minimize contact with asthma triggers

• understand and take medications as prescribed

• monitor asthma to recognize signs when it is getting worse

• know what to do when asthma gets worse

• Working with a health care professional is the best way to take care of asthma.

• The more information a person with asthma has, the better asthma can be controlled.

Four components of asthma treatment:

1. The use of objective measures of lung function -- spirometry, peak flow expiratory flow rate -- to assess the severity of asthma, and to monitor the course of treatment.

2. The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airway.

3. The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.

4. Patient education that includes a partnership among the patient, family members and physician.