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What Is 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.  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. Overview  The airways are tubes that carry air into and out of your lungs. 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.

Asthma

Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.

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.

Outlook  Asthma can’t be cured. 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.

Asthma Causes

The exact cause of asthma is not known.

• What all people with asthma have in common is chronic airway inflammation and excessive airway sensitivity to various triggers.
• Research has focused on why some people develop asthma while others do not.
• Some people are born with the tendency to have asthma, while others are not. Scientists are trying to find the genes that cause this tendency.
• The environment you live in and the way you live partly determine whether you have asthma attacks.

An asthma attack is a reaction to a trigger. It is similar in many ways to an allergic reaction.

• An allergic reaction is a response by the body’s immune system to an “invader.”
• When the cells of the immune system sense an invader, they set off a series of reactions that help fight off the invader.
• It is this series of reactions that causes the production of mucus and bronchospasms. These responses cause the symptoms of an asthma attack.
• In asthma, the “invaders” are the triggers listed below. Triggers vary among individuals.
• Because asthma is a type of allergic reaction, it is sometimes called reactive airway disease.

Each person with asthma has his or her own unique set of triggers. Most triggers cause attacks in some people with asthma and not in others. Common triggers of asthma attacks are the following:

• exposure to tobacco or wood smoke,
• breathing polluted air,
• inhaling other respiratory irritants such as perfumes or cleaning products,
• exposure to airway irritants at the workplace,
• breathing in allergy-causing substances (allergens) such as molds, dust, or animal  dander.
• an upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis,
• exposure to cold, dry weather,
• emotional excitement or stress,
• physical exertion or exercise,
• reflux of stomach acid known as gastroesophageal reflux disease, or GERD,
• sulfites, an additive to some foods and wine, and
• menstruation: In some, not all, women, asthma symptoms are closely tied to the menstrual cycle.

Risk factors for developing asthma:

• hay fever (allergic rhinitis) and other allergies — this is the single biggest risk factor;
• eczema: another type of allergy affecting the skin; and
• genetic predisposition: a parent, brother, or sister also has asthma.

Asthma Symptoms

When the breathing passages become irritated or infected, an attack is triggered. The attack may come on suddenly or develop slowly over several days or hours. The main symptoms that signal an attack are as follows:

• wheezing,

• breathlessness,
• chest tightness,
• coughing, and
• difficulty speaking.

Symptoms may occur during the day or at night. If they happen at night, they may disturb your sleep.

Wheezing is the most common symptom of an asthma attack.

• Wheezing is a musical, whistling, or hissing sound with breathing.
• Wheezes are most often heard during exhalation, but they can occur during breathing in (inhaling).
• Not all asthmatics wheeze, and not all people who wheeze are asthmatics.

Current guidelines for the care of people with asthma include classifying the severity of asthma symptoms, as
follows:

• Mild intermittent: This includes attacks no more than twice a week and nighttime attacks no more than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies, but there are no symptoms between attacks.
• Mild persistent: This includes attacks more than twice a week, but not every day, and nighttime symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular activities.
• Moderate persistent: This includes daily attacks and nighttime symptoms more than once a week. More severe attacks occur at least twice a week and may last for days. Attacks require daily use of quick-relief (rescue) medication and changes in daily activities.
• Severe persistent: This includes frequent severe attacks, continual daytime symptoms, and frequent nighttime symptoms. Symptoms require limits on daily activities.

Just because a person has mild or moderate asthma does not mean that he or she cannot have a severe attack. The severity of asthma can change over time, either for better or for worse.

Asthma Treatment

Since asthma is a chronic disease, treatment goes on for a very long time. Some people have to stay on treatment for the rest of their lives. The best way to improve your condition and live your life on your terms is to learn all you can about your asthma and what you can do to make it better.

• Become a partner with your health-care provider and his or her support staff. Use the resources they can offer — information, education, and expertise — to help yourself.
• Become aware of your asthma triggers and do what you can to avoid them.
• Follow the treatment recommendations of your health-care provider. Understand your treatment. Know what each drug does and how it is used.
• See your health-care provider as scheduled.
• Report any changes or worsening of your symptoms promptly.
• Report any side effects you are having with your medications.

These are the goals of treatment:

• prevent ongoing and bothersome symptoms;
• prevent asthma attacks;
• prevent attacks severe enough to require a visit to your provider or an emergency department or hospitalization;
• carry on with normal activities;
• maintain normal or near-normal lung function; and
• have as few side effects of medication as possible.

Asthma

In layman’s terms, asthma makes the airways inside your lungs very sensitive, which in turn makes them inflamed. When someone with asthma breathes something that irritates their already inflamed lungs, the airways get narrower and less air flows through to lung tissues. See your health care professional if you suspect asthma. There are many treatments to help you and your loved one.

Bronchitis

Bronchitis is inflammation of the tubes that carry air to the lungs (bronchial tubes). When these tubes are inflamed, they swell and produce mucus. The swollen tubes and increased mucus trigger coughing and may make it more difficult for you to breathe.

Lung Cancer

Cancers that begin in the lungs are divided into two major types, non-small cell lung cancer and small cell lung cancer, depending on how the cells look under a microscope. More than 87 percent of lung cancers are smoking-related. However, not all smokers develop lung cancer.

Pneumonia

Pneumonia is a general term for a lung infection that can make it hard for you to breathe. In adults older than 65, pneumonia is often serious (and can be deadly) and may need to be treated in the hospital. Always see your doctor if you or your loved one has trouble breathing.

Emphysema

Emphysema is a long-term lung disease that occurs when the tiny air sacs in the lungs are damaged, often as a result of long-term smoking.

Cystic Fibrosis

Cystic fibrosis is usually diagnosed in childhood and it is a chronic disease that that causes mucus to become thick, dry, and sticky. The mucus builds up and clogs passages in many of the body’s organs. In the lungs, the mucus can lead to serious breathing problems and lung disease.

What causes migraine headaches?

The typical migraine headache is unilateral (affecting one half of the head) and pulsating, lasting from 4 to 72 hours; symptoms include nausea, vomiting, photophobia (increased sensitivity to light), and phonopia (increased sensitivity to sound). Approximately one-third of people who suffer migraine headache perceive an aura—unusual visual, olfactory, or other sensory experiences that are a sign that the migraine will soon occur.

Initial treatment is with analgesics for the headache, an antiemetic for the nausea, and the avoidance of triggering conditions. The cause of migraine headache is unknown; the most common theory is a disorder of the serotonergic control system.

The signs and symptoms of migraine vary among patients. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four phases of a migraine attack listed below are common but not necessarily experienced by all migraine sufferers. Additionally, the phases experienced and the symptoms experienced during them can vary from one migraine attack to another in the same migraineur:

1. The prodrome, which occurs hours or days before the headache.
2. The aura, which immediately precedes the headache.
3. The pain phase, also known as headache phase.
4. The postdrome.

Prodrome phase

Prodromal symptoms occur in 40–60% of migraineurs (migraine sufferers). This phase may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck), constipation or diarrhea, increased urination, and other visceral symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days, and experience teaches the patient or observant family how to detect that a migraine attack is near.

Aura phase

For the 20-30% of migraine sufferers who experience migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely. Symptoms of migraine aura can be visual, sensory, or motor in nature^.

Visual aura is the most common of the neurological events. There is a disturbance of vision consisting usually of unformed flashes of white and/or black or rarely of multicolored lights (photosia) or formations of dazzling zig zag lines (scintillating scotoma; often arranged like the battlements of a castle, hence the alternative terms “fortification spectra” or “teichopsia”. Some patients complain of blurred or shimmering or cloudy vision, as though they were looking through thick or smoked glass, or in some cases tunnel vision and hemianopsia. The somatosensory aura of migraine consists of digitolingual or cheiro-oral paresthesias, a feeling of pins-and-needles experienced in the hand and arm as well as in the nose-mouth area on the same side. Paresthesia migrate up the arm and then extend to involve the face, lips and tongue.

There are migraine headache variants, some originate in the brainstem (featuring intercellular transport dysfunction of calcium and potassium ions) and some are genetically disposed.  Studies of twins indicate a 60 to 65 percent genetic influence upon their propensity to develop migraine headache. Moreover, fluctuating hormone levels indicate a migraine relation: 75 percent of adult patients are women, although migraine affects approximately equal numbers of prepubescent boys and girls; propensity to migraine headache is known to disappear during pregnancy, although in some women migraines may become more frequent during pregnancy^.

Pain Phase

The typical migraine headache is unilateral, throbbing, and moderate to severe and can be aggravated by physical activity. Not all these features are necessary. The pain may be bilateral at the onset or start on one side and become generalized, and usually it alternates sides from one attack to the next. The onset is usually gradual. The pain peaks and then subsides and usually lasts 4 to 72 hours in adults and 1 to 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several a week, and the average migraineur experiences one to three headaches a month. The head pain varies greatly in intensity.

The pain of migraine is invariably accompanied by other features. Nuasea occurs in almost 90 percent of patients, and vomiting occurs in about one third of patients. Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, and osmophobia and seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be noted during the headache phase. There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. The extremities tend to feel cold and moist. Vertigo may be experienced; a variation of the typical migraine, called vestibular migraine, has also been described. Lightheadedness, rather than true vertigo, and a feeling of faintness may occur.

Postdrome phase

The patient may feel tired or “hungover” and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise. Often, some of the minor headache phase symptoms may continue, such as loss of appetite, photophobia, and lightheadedness. For some patients, a 5- to 6-hour nap may reduce the pain, but slight headaches may still occur when the patient stands or sits quickly. These symptoms may go away after a good night’s rest, although there is no guarantee. Some people may suffer and recover differently than others.