Asthma is a disease of the airways, or branches of the lungs (bronchial tubes), that carry air in and out of the lungs. Asthma makes breathing difficult and causes a feeling of not getting enough air into the lungs. The changes that occur in the airways (bronchi) during an asthma attack include:
- The bands of muscle that surround the bronchi tighten and make the airway narrow (bronchospasm).
- The lining of the airways becomes swollen (inflammation).
- The cells that line the airways produce excess mucus.
What causes asthma?
- It tends to run in families.
- The airways are very sensitive and react to many things, or “triggers.”
- Contact with the triggers brings on asthma symptoms.
Common asthma triggers:
- Weather (cold air, changes in temperature)
- Tobacco smoke and air pollution
- Allergens such as dust mites, pollens, pets, mold and cockroaches
- Strong odors
- Strong emotions such as crying or laughing hard
- Aspirin (in some people)
How is asthma diagnosed?
The usual starting point is to visit your doctor for a medical history and physical examination.
Tests may be done to check the general condition of the lungs. Tests may include:
- Chest X-ray – A test that uses high-energy radiation to create images of the lungs
- Pulmonary function test – A test that measures how much air is in the lungs and how forcefully this air can be exhaled
- Methacholine challenge test – A test to see if the airways are sensitive
How is asthma treated?
- Avoid triggers
- Monitor daily symptoms
- Proper use of medications
What medications are used to treat asthma?
These medications relax the muscles that tighten around the airway. Most of the medications are delivered by metered dose inhaler (MDI). Some are available by aerosol treatment and a few are available in oral form. In general, they are used to relieve or stop asthma symptoms and are very helpful during an asthma episode.
Bronchodilators used for treatment of asthma symptoms include:
- Albuterol (Proventil HFA®, Ventolin HFA®, ProAir®), levalbuterol (Xoponex HFA®) and pirbuterol (Maxair®) – These medications work quickly and last for a short time(4 to 6 hours). They have several possible side effects, including a rapid heart rate, nervousness, and shaking. Most of the time these side effects do not occur and if they do are short lived. These medications are available as an inhaler and/or an aerosol.
- Ipratopium (Atrovent®) – This medication is available as an inhaler or as an aerosol.
- Albuterol and ipatropium (Combivent®) – This medication comes as an inhaler or an aerosol (Duo-Neb®)
Bronchodilators used to prevent symptoms of asthma include:
- Salmeterol (Serevent®) and formoterol (Foradil®) – These are long-acting bronchodilators. They are not to be used as a rescue inhaler and must always be used with an inhaled corticosteroid in the treatment of asthma.
- Theophylline (Theo-dur®, Uniphyl®, Slo-bid®, Aminophylline®) – This medication is taken either orally (by mouth) or through a vein (intravenous, or IV). The patient must be monitored while taking this medication, which can have side effects–including nausea, vomiting, headache, irregular heartbeat and shaking–and can interact with some other medications. This medication is not commonly used in the initial treatment of asthma but reserved for more difficult to control asthma if deemed necessary.
Anti-inflammatory medications are generally used to control asthma symptoms and make the airways stable. These medications are available as MDIs, DPI (dry powder inhalers) or in oral form. These medications include:
- Inhaled corticosteroids (Alvesco HFA®, Advair HFA® and Advair DPI® (combination of fluticasone and salmeterol), Asmanex DPI® (mometasone), Azmacort® (triamcinolone), Flovent HFA®(fluticasone) and Flovent DPI®, Pulmicort® DPI (budesonide), Qvar®, Symbicort® (combination of budesonide and formoterol).
- Oral or IV corticosteroids (Prednisone®, Medrol®), mast cell stabilizers (cromolyn – soon only in nebulizer form)
- Leukotriene inhibitors (Singulair®, Accolate®, Zyflo®)
In patients who have allergic asthma that is moderate to severe in nature, the medication Xolair®(omalizumab) may be used. Xolair® prevents allergens from attaching to a natural substance in the body called IgE. This prevents the allergic reaction (which causes inflammation) and can prevent asthma attacks in some patients. This medication is administered in an asthma specialist’s office and is in injection form.
Asthma is a chronic, inflammatory disease of the lungs that can be effectively treated and controlled despite the fact that there is no cure. Proper control of asthma allows for a full and active life without limitations.