Albany Internal Medicine



Asthma is a chronic lung disease that makes it difficult to breathe. Asthma symptoms include wheezing (a whistling sound during exhalation), coughing, chest tightness, and feeling short of breath.

Asthma cannot be cured, but most people with asthma can control it so that they have fewer asthma attacks and less frequent symptoms.

Key Points

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  • Sometimes asthma symptoms are mild and go away on their own or after minimal treatment. Other times, the asthma symptoms continue to get worse. Severe asthma attacks may require emergency care.
  • An asthma attack or flare describes the worsening of asthma of symptoms.
  • Asthma usually starts in childhood, but it can affect people of all ages and can even begin in adulthood.
  • Asthma medications can help people with asthma lead active lives.There are two types of asthma medicines: long-term control medicines and quick-relief medicines. Long-term control medicines must be taken regularly to help control asthma. Quick relief medication, also called "rescue medication", is used during an asthma attack.
  • Track your asthma by recording your symptoms in an asthma diary, using a peak flow meter, and seeing your doctor regularly. Let your doctor know if your asthma is getting worse.
  • The goal of asthma treatment is to control the disease by following a treatment plan created with one's doctor. An asthma treatment plan may include taking asthma medicines as prescribed, taking steps to avoid exposure asthma triggers, tracking your asthma symptoms and responding quickly to worsening symptoms.
  • It's important to treat asthma symptoms when you first notice them. This will help prevent the symptoms from worsening and leading to a severe attack.
  • Call 911 if you have trouble walking and talking because you're out of breath or you have blue lips or fingernails.

What is Asthma?

Asthma is due to inflammation in the airways. The inflammation makes the airways narrower which obstructs the flow of air into and out of the lungs. It also makes the airways more sensitive to certain substances that might be inhaled called allergens.

When your asthma symptoms become worse than usual, it is called an "asthma attack" or "flare". Asthma triggers are things that are known to lead to an asthma attack in some individuals. Different people tend to have different asthma triggers. Exercise is a common trigger of asthma.

During an asthma attack, muscles around the airways tighten up, making the airways narrower so less air flows through. This is referred to as "bronchospasm". Cells in the airways may also make more mucus. This also narrows the airways and makes it harder to breathe.

Some asthma attacks are worse than others. In a severe asthma attack, the airways can close so much that not enough oxygen gets to vital organs, such as the brain. Severe asthma attacks require immediate medical attention.

What are the signs and symptoms of asthma?

Common asthma symptoms include:

  • Coughing. Coughing from asthma is often worse at night or early in the morning, making it hard to sleep.
  • Wheezing. Wheezing is a whistling or squeaky sound when you exhale (breathe out).
  • Chest tightness. This can feel like something is squeezing or sitting on your chest.
  • Shortness of breath. Some people say they can't catch their breath, or they feel breathless or out of breath. You may feel like you can't get enough air in or out of your lungs.
  • Faster breathing or noisy breathing.

Not all people have these symptoms, and symptoms may vary from one asthma attack to another. They can also range from being mildly annoying to life threatening.

Asthma symptoms also differ in how often they occur. Some people with asthma have symptoms only once every few months, others have symptoms every week, and still other people have symptoms every day. However, with proper treatment, most people with asthma can expect to have few or no symptoms.

How is asthma treated?

The recommended asthma treatment is based on several variables, including:

  • the person's age (child vs. eldery)
  • type of asthma (nocturnal asthma vs. exercise-induced asthma)
  • severity of symptoms (mild intermittent vs. moderate persistent vs. severe persistent)
  • existence of other medical conditions (pregnancy, heart disease..etc.)
  • response to past treatments

Your doctor may work with you to develop an asthma management plan for controlling your asthma on a daily basis and an emergency action plan for stopping asthma attacks. These plans will tell you what medicines you should take and other things you should do to keep your asthma under control.

Asthma Medications

There are two main types of medications used in the treatment of asthma;

  1. Quick-relief medications, also called "rescue medication", improve breathing within minutes. They are bronchodilators that open the airways.
  2. Long-term control medications are taken every day, usually over long periods of time, to prevent symptoms and asthma episodes or attacks. These do not offer any benefit until after several weeks of use.

Many people with asthma need both a rescue medication to use when symptoms worsen and long-term daily asthma control medicines to treat the ongoing inflammation in the lungs.

Most of these asthma medicines are inhaled by mouth through inhalers. There are many kinds of inhalers, and many require different techniques. It is important to know how to use your inhaler correctly.

Quick-relief Asthma Medications

Most people with asthma should have a quick-relief or "rescue" medication to stop asthma symptoms before they get worse. You should carry your quick-relief inhaler with you at all times in case of an asthma attack.

These are taken at the first signs of asthma symptoms for immediate relief of these symptoms.

Short-acting inhaled beta-agonists are the most commonly prescribed medication in this category. These medicines, called "bronchodilators" include albuterol. They act quickly to relax tightened muscles around your airways so that the airways can open up and allow more air to flow through.

Your doctor may recommend that you take your quick-relief medicines, before exercise or when your peak flow meter results drop to a certain level.

Over time, your doctor may need to make changes in your asthma medicine. You may need to increase your dose, lower your dose, or try a combination of medicines. The goal is to use the least amount of medicine necessary to control your asthma.

Long-term Control Asthma Medications

People with persistent asthma need long-term control medicines. The most effective, long-term control medicine for asthma is an inhaled corticosteroid. This medicine reduces the airway swelling that makes asthma attacks more likely with the lowest risk of side effects.

Inhaled corticosteroids are the preferred medicine for controlling mild, moderate, and severe persistent asthma. They are generally safe when taken as directed by your doctor.

In some cases, an oral corticosteroids, such as prednisone, may be used for short periods of time to bring severe asthma under control.

Monitoring Your Asthma

As part of your asthma management plan, your doctor may recommend that you use a hand-held device called a peak flow meter at home to monitor how well your lungs are working.

Your peak flow meter can help warn you of a possible asthma attack even before you notice symptoms. If your peak flow meter shows that your breathing is getting worse, you should follow your emergency asthma action plan. Take your quick-relief or other medicines as your doctor directed. Then you can use the peak flow meter to see how your airways are responding to the medicine.

Ask your doctor about how you can take care of your asthma. You should know:

  • What things tend to make your asthma worse and how to avoid them
  • Early signs to watch for that mean your asthma is starting to get worse (like a drop in your peak flow number or an increase in symptoms)
  • How and when to use your peak flow meter
  • What medicines to take, how much to take, when to take them, and how to take them correctly
  • When to call or see your doctor
  • When you should get emergency treatment

Asthma Prevention

We don't yet know how to prevent asthma, but there are some things that can lower your chances of having an asthma attack.

To prevent asthma symptoms:

  • Learn about your asthma and how to control it.
  • Use your asthma medicines as directed by your doctor to prevent or stop attacks.
  • Avoid things that make your asthma worse as much as possible.
  • Keep an asthma diary to track your asthma symptoms
  • Get regular checkups from your doctor.
  • Follow your asthma self-management plan.

Reference: The National Heart, Lung and Blood Institute

Last updated Feb 7, 2017