This topic provides
information about asthma in teens and adults. If you are looking for
information about asthma in children age 12 and younger, see the topic
Asthma in Children.
What is asthma?
Asthma causes swelling and
inflammation in the airways that lead to your lungs.
When asthma flares up, the airways tighten and become narrower. This keeps the
air from passing through easily and makes it hard for you to breathe. These
flare-ups are also called asthma attacks or exacerbations.
Asthma
affects people in different ways. Some people only have asthma attacks during
allergy season, or when they breathe in cold air, or when they exercise. Others
have many bad attacks that send them to the doctor often.
Even if
you have few asthma attacks, you still need to treat your asthma. The swelling
and inflammation in your airways can lead to permanent changes in your airways
and harm your lungs.
Many people with asthma live active, full
lives. Even though asthma is a lifelong disease, treatment can control it and
keep you healthy.
What causes asthma?
Experts do not know exactly
what causes asthma. But there are some things we do know:
Asthma runs in families.
Asthma
is much more common in people with allergies, though not everyone with
allergies gets asthma. And not everyone with asthma has allergies.
Pollution may cause asthma or make it worse.
What are the symptoms?
Symptoms of asthma can be
mild or severe. You may have mild attacks now and then, or you may have severe
symptoms every day, or you may have something in between. How often you have
symptoms can also change. When you have asthma, you may:
Wheeze, making
a loud or soft whistling noise that occurs when you breathe in and out.
Cough a lot.
Feel tightness in your
chest.
Feel short of breath.
Have trouble sleeping
because of coughing or having a hard time breathing.
Quickly get
tired during exercise.
Your symptoms may be worse at night.
Severe
asthma attacks can be life-threatening and need emergency treatment.
How is asthma diagnosed?
Along with doing a
physical exam and asking about your health, your doctor may order lung function
tests. These tests include:
Spirometry.
Doctors use this test to diagnose and keep track of asthma. It measures how
quickly you can move air in and out of your lungs and how much air you
move.
Peak expiratory flow (PEF). This shows how fast you
can breathe out when you try your hardest.
An exercise or
inhalation challenge. This test measures how quickly you can breathe after
exercise or after taking a medicine.
A chest
X-ray, to see if another disease is causing your
symptoms.
Allergy tests, if your doctor thinks your symptoms may be
caused by allergies.
You will need routine checkups with your doctor to keep
track of your asthma and decide on treatment.
How is it treated?
There are two parts to treating
asthma, which are outlined in the asthma action plan. The goals are to:
Control asthma over the long term. The
asthma action plan tells you which medicine to take. It also helps you track
your symptoms and know how well the treatment is working. Many people take
controller medicine—usually an inhaled
corticosteroid—every day. Taking controller medicine
every day helps to reduce the swelling of the airways and prevent attacks. Your
doctor will show you how to use your inhaler correctly. This is very important
so you get the right amount of medicine to help you breathe
better.
Treat asthma attacks when they occur. The asthma action
plan tells you what to do when you have an asthma attack. It helps you identify
triggers that can cause your attacks. You use quick-relief medicine, such as
albuterol, during an attack.
If you need to use the quick-relief inhaler more often
than usual, talk to your doctor. This is a sign that your asthma is not
controlled and can cause problems.
Asthma attacks can be
life-threatening, but you may be able to prevent them if you follow a plan.
Your doctor can teach you the skills you need to use your asthma action
plan.
How can you prevent asthma attacks?
You can
prevent some asthma attacks by avoiding those things that cause them. These are
called triggers. A trigger can be:
Irritants in the air, such as cigarette smoke
or other air pollution. Don't smoke, and try to avoid being around others when
they smoke.
Things you are allergic to, such as pet dander, dust
mites, cockroaches, or pollen. When you can, avoid those things you are
allergic to. It may also help to take certain kinds of allergy
medicine.
Exercise. Ask your doctor about using an inhaler before
you exercise if this is a trigger for you.
Other things like dry,
cold air; an infection; or some medicines, such as aspirin and other
nonsteroidal anti-inflammatory drugs (NSAIDs). Try not
to exercise outside when it is cold and dry. Talk to your doctor about vaccines
to prevent some infections, and ask about what medicines you should
avoid.
Sometimes you don't know what triggers an asthma attack.
This is why it is important to have an asthma action plan that tells you what
to do during an attack.
The cause of
asthma is not known. Health experts believe that
inherited, environmental, and
immune system factors combine to cause
inflammation of the bronchial tubes, which carry air
to the lungs. This can lead to asthma and
asthma attacks.
Asthma may run in families (be inherited). If
this is the case in your family, you may be more likely than other people to
develop long-lasting (chronic) inflammation in the bronchial tubes.
In some people,
immune system cells release chemicals that cause
inflammation in response to certain substances (allergens) that
cause
allergic reactions. Studies show that exposure to
allergens such as
dust mites, cockroaches, and
animal dander may influence asthma’s
development.1 Asthma is much more common in people
with allergies, although not all those with allergies develop asthma. And not
all people with asthma have allergies.
Environmental factors and
today's germ-conscious lifestyle may play a role in the development of asthma.
Some experts believe that there are more cases of asthma because of pollution
and less exposure to certain types of bacteria or infections.2 As a result, children's immune systems may develop in a way
that makes it more likely they will also develop allergies and asthma.
Asthma in adults also can be related to work (occupational asthma). Being around animals, plastic
resin, wood dust, grain dust, insecticides, and metals can cause asthma,
usually because your
immune system reacts to the material. Some people
continue to have asthma symptoms even after they are no longer exposed to what
caused the symptoms. But for many people, symptoms will get better or go away
when they are away from the
asthma trigger.
Symptoms of
asthma can be mild or severe. You may have no
symptoms; severe, daily symptoms; or something in between. How often you have
symptoms can also change. Symptoms of asthma may include:
Wheezing, which is a whistling noise of
varying loudness that occurs when the airways of the lungs (bronchial tubes)
narrow.
Coughing, which is the only symptom for some
people.
Many people have symptoms that become worse at night
(nocturnal asthma). In all people, lung function changes throughout the day and
night. In people with asthma, this often is very noticeable, especially at
night, and nighttime cough and shortness of breath frequently occur. In
general, waking at night because of shortness of breath or cough indicates
poorly controlled asthma.
Symptoms are used to
classify asthma by severity. They are also used along
with
peak expiratory flow to help define the green, yellow,
and red zones of your
asthma action plan. You use this plan to decide on
treatment during an asthma attack.
Asthma often
begins during infancy or childhood but may start at any age and last throughout
your life. It can increase your risk for complications from lung and airway
infections, such as acute
bronchitis and
pneumonia.
At times, the
inflammation from asthma causes a narrowing of your
airways and
mucus production, resulting in asthma symptoms such as
shortness of breath.
The airways narrow when they overreact to
certain substances. These are known as asthma
triggers and may include:
Substances you are allergic to (allergens, such as
dust mites or
animal dander). Allergens cause long-term (chronic)
inflammation and may cause asthma symptoms.
Environmental factors
that irritate your airways, such as smoke or cold air. Environmental factors
may lead to a tightening of the muscles that line the bronchial tubes (bronchospasm), which can trigger asthma
symptoms.
What triggers asthma symptoms varies from person to
person. When asthma is triggered by an allergen, it is called
allergic asthma.
When asthma symptoms
suddenly occur, it is called an
asthma attack (also called a flare-up or
exacerbation). Asthma attacks can occur rarely or frequently and may be mild to
severe. Although some asthma attacks occur very suddenly, many become worse
gradually over a period of several days. In general, you can take care of
symptoms at home with an
asthma action plan, although a severe attack may
require emergency treatment and on rare occasions can be fatal.
Asthma is
classified as intermittent, mild persistent, moderate
persistent, and severe persistent.
People with intermittent asthma often have
symptoms only after being around a trigger.
People with
intermittent asthma usually need medicines only during an asthma
attack.
People with mild persistent or moderate persistent asthma
may not always have noticeable symptoms, but they need to take medicines daily
to control the long-term inflammation in their airways.
People with
severe persistent asthma have symptoms almost all of the time. Their symptoms
need to be treated daily. These people are at increased risk for severe,
life-threatening asthma attacks known as
status asthmaticus.
Asthma—even mild asthma—may result in changes to the airway
system (airway remodeling) and may speed up and make worse the natural decrease
in lung function that occurs as we age.3 Asthma may
raise your risk for developing
chronic obstructive pulmonary disease (COPD).4
Sometimes asthma does not respond to treatment
because people are not taking their medicines, not taking them correctly, not
avoiding triggers, or otherwise not following their asthma action plan. Follow
your asthma action plan so you can keep your asthma from getting worse and
prevent an
increased risk of death.
Asthma during pregnancy
Asthma can affect your
pregnancy. It may occur for the first time during pregnancy, or it may change
during pregnancy.
When asthma is properly controlled, a pregnant
woman with asthma can have a normal pregnancy with little or no increased risk
to herself or her
fetus. But if the asthma is not well controlled, there
are risks to the pregnant woman and her fetus. The management of
asthma in pregnant women and nonpregnant women is
basically the same, although a pregnant woman may need to take different
medicines and needs to monitor the fetus's health as well as her own.
Many factors may increase
your risk of developing
asthma. Some of these are not within your control;
others you can control. The major risk factors for developing asthma as an
adult are ongoing (chronic) wheezing when you were a child and cigarette
smoking.5, 6
Asthma risk factors that you cannot control
The
following risk factors are not within your control:
Gender and age. Women and men seem to have the
same risk of developing asthma until they reach their 40s. After 40, women have
a higher risk for asthma.
A family history of allergies and asthma. People
who have an allergy and asthma usually have a family history of allergies or
asthma.
Inherited tendency (genetic predisposition) to overreaction of the bronchial tubes. People who inherit a tendency of the
bronchial tubes (which carry air to the lungs) to overreact often develop
asthma.
A history of allergy. If you have an allergy, you
are more likely than others to develop asthma. Most children and many adults
with asthma have
atopic dermatitis,
allergic rhinitis, or both. Studies indicate that 40%
to 50% of children with atopic dermatitis develop asthma. Having atopic
dermatitis as a child may also increase your risk of having more severe and
persistent asthma as an adult than someone who did not have atopic
dermatitis.7
Rhinitis. Adults who have inflamed nasal passages
(rhinitis) have a higher-than-average risk of developing asthma.
Asthma risk factors that you can control
You may
be able to change some factors to reduce your or your teen's risk of developing
asthma. These include:
Cigarette smoking. People who smoke are more
likely to get asthma. If you already have asthma and you smoke, it may make
your symptoms such as wheezing worse.
Cigarette smoking during pregnancy. Women who
smoke during pregnancy increase the risk of wheezing in their babies. Babies
whose mothers smoked during pregnancy also have worse lung function than those
whose mothers did not smoke.
Workplace exposure to irritants.Occupational asthma may develop after exposure to a
specific inhaled irritant or
allergen in the workplace. Such substances also can
make symptoms worse in people with existing asthma.
Dust mites. Exposure to
dust mites is a risk factor in the development of
asthma.8
Cockroaches. In one study, children who had high
levels of cockroach droppings in their homes were 4 times more likely to have a
new diagnosis of asthma than children whose homes had low levels.8
Obesity. Studies have found that obese children
may be more likely to have asthma. But the reason for this is unclear. Experts
don't know whether one condition contributes to the other or whether some
unknown mechanism contributes to both.9 Some people
who are obese and who lose weight may have fewer asthma symptoms. And sometimes
symptoms caused by obesity are thought to be asthma symptoms.
No one is sure if breast-feeding affects a child's
risk of getting asthma. Some studies show that breast-feeding protects a child
from getting asthma.10, 11 Other
studies show that breast-feeding, especially when mothers with asthma
breast-feed, may actually raise a child's risk of getting asthma.12 A large study following children until 14 years of age found
that breast-feeding had no effect on the development of asthma.13 Mothers are encouraged to breast-feed their children for all
the other proven health benefits that come from breast-feeding.
Experts are also not sure about the effect that pets in the home have on
getting asthma. Some research shows that having cats or dogs in the home raises
an adult's risk of getting asthma.14 But other research
has seemed to show that being around pets early in life might actually protect
a child against getting asthma.15 If your child already
has asthma and allergies to pets, having a pet in the home will make his or her
asthma worse.
Risk factors that may make asthma worse (triggers)
Triggers that may make asthma worse and may lead to
asthma attacks include:
Call 911 or other emergency services immediately if you are having
severe asthma symptoms (in the
red zone of your asthma action plan) and you have followed the plan,
but:
20 to 30
minutes after taking the extra medicine, you do not feel better and/or your
peak expiratory flow (PEF) is still less than 50% of
your personal best measurement.
Call your doctor immediately if
you:
Are in the red zone, and 6 hours after taking
the extra medicine the following are true:
You still require inhaler medicine every 1
to 3 hours.
Your PEF is below 70% of your personal best
measurement.
Are in the
yellow zone of the asthma action plan and continue to
have a PEF below 70% of your personal best measurement in spite of home
treatment using your asthma action plan.
Have mild asthma symptoms
that get worse, and you feel there is nothing else you can do at
home.
Are having a first attack of asthma symptoms, and your
symptoms include wheezing, chest tightness, and
moderate difficulty breathing.
Are
coughing up green, dark brown, or bloody
mucus.
Call your doctor if you:
Have asthma symptoms, you do not have an asthma
action plan, and your symptoms are mild (chest tightness, cough, and slight
shortness of breath or tiring easily during exercise).
Are having
symptoms in the yellow zone almost every day, and you need to use your
quick-relief inhaler medicine to control your symptoms.
Have asthma
and your PEF has been getting worse for 2 to 3 days.
If you have not been diagnosed with asthma but have mild
asthma symptoms, call your doctor and make an appointment for an
evaluation.
If your teenager has symptoms of asthma, it is
important to see a doctor. A large portion of teens with frequent wheezing may
have asthma but are not diagnosed with the disease. Teens who have asthma but
are less likely to be diagnosed are most often:18
Girls.
Smokers, or teens who are
exposed to household cigarette smoke.
Those with low socioeconomic
status.
Those who have allergies.
African Americans,
Native Americans, or Mexican Americans.
Watchful Waiting
Watchful waiting is a period of
time during which you and your doctor observe your symptoms or condition
without using medical treatment. Self-treatment is not appropriate if you have
asthma symptoms. See your doctor, even if you are taking nonprescription
medicines and they relieve your symptoms.
If you have been getting
treatment for 1 to 3 months but are not improving, ask your doctor whether you
need to see an asthma specialist.
A diagnosis of
asthma is based on your
medical history, a
physical exam, and lung function tests. If you
developed asthma in adulthood, your doctor will ask about your job to determine
whether you have
occupational asthma.
Spirometry is the most common test used
to diagnose asthma. It measures how quickly you can move air in and out of your
lungs and how much air is moved. The test helps your doctor decide whether
airflow is decreased because of
inflammation in the bronchial tubes and whether the
tubes can return to their usual size in a short time after using medicine.
Doctors also recommend the test at least every 1 to 2 years after asthma
treatment has begun.
Testing of daytime changes in
peak expiratory flow (PEF) is done over 1 to 2 weeks.
This test is needed when you have symptoms off and on but have normal
spirometry test results.
An
exercise or inhalation challenge may be used if the
spirometry test results have been normal or near normal but asthma is still
suspected. These tests measure how quickly you can breathe in and out after
exercise or after using a medicine. An inhalation challenge also may be done
using a specific irritant or
allergen if your doctor suspects occupational
asthma.
Regular checkups
You need to
monitor your condition and have regular checkups to
keep asthma under control and to review and possibly update your
asthma action plan. Checkups are recommended every 1
to 6 months, depending on how well your asthma is controlled.
During checkups, your doctor will ask whether your symptoms and
peak expiratory flow have held steady, improved, or
become worse and will ask about asthma attacks during exercise or at night. You
track this information in an
asthma diary. You may be asked to bring your
peak expiratory flow meter to an appointment so your
doctor can see how you use it. Based on the results, your asthma category may
change, and your doctor may change the medicines you use or how much medicine
you use.
Tests for other diseases
Asthma sometimes is hard
to diagnose because symptoms vary widely from person to person and within each
person over time. Symptoms may be the same as those of other conditions, such
as
influenza or other viral respiratory infections or
vocal cord dysfunction. Tests done to determine
whether diseases other than asthma are causing your symptoms include the
following:
An
electrocardiogram (EKG, ECG) measures the electrical
signals that control the rhythm of your heartbeat. This test might be done to
rule out serious conditions with similar symptoms, such as
chronic heart failure.
A
bronchoscopy involves using a flexible scope called a
bronchoscope to examine the airways. Occasionally airway problems such as
tumors or foreign bodies will create symptoms that mimic those of asthma. The
test might be done if you have unequal wheezing in the lungs or a poor response
to asthma therapy.
Biopsies of the airways can be done to look for
changes characteristic of asthma.
A
chest X-ray may be used to see whether other lung
diseases, such as fibrous tissue caused by chronic inflammation (pulmonary
fibrosis), are causing symptoms.
Blood tests may be done. For
example, a
complete blood count (CBC) may be done to look for
signs of an infection or other condition.
A
sweat test, which measures the amount of salt in
sweat, may be used to see whether
cystic fibrosis is the cause of your symptoms.
Tests to identify triggers
If you have persistent
asthma and take medicine every day, your doctor may ask about your exposure to
substances (allergens) that cause an allergic reaction. For more
information about the following tests, see the topic
Allergic Rhinitis.
Skin tests. The skin on the back or arms is
pricked with one or more small doses of allergens that might cause an allergy.
The amount of swelling and redness at the sites of the skin pricks is measured
to see which allergens cause a reaction. Skin tests are quick, simple, and
relatively safe. Skin tests are necessary if you are interested in allergy
shots (immunotherapy).
Enzyme-linked immunosorbent assay (ELISA).
A blood sample is taken from a vein and tested for immunoglobulin E (IgE)
antibodies, which are produced in response to particular allergens.
Although
asthma cannot be cured, you can manage the symptoms
with medicines, especially inhaled corticosteroids and beta2-agonists. You will
probably work with your doctor to develop an asthma action plan. This plan will
help you meet
treatment goals and get your asthma under control. The
goals of asthma treatment are to:19
Prevent symptoms.
Keep your peak
flow and lung function as close to normal as possible.
Be able to
do your normal daily activities, including work, school, exercise, and
recreation.
If you have a severe asthma
attack (the
red zone of your asthma action plan), use medicine based on your
action plan and talk with a doctor immediately about
what to do next. This is especially important if your
peak expiratory flow (PEF) does not return to the
green zone or stays within the
yellow zone after you take medicine. You may have to
go to the hospital or an emergency room for treatment. Be sure to tell the
emergency staff if you are pregnant.
At the hospital, you will
probably receive inhaled beta2-agonists and
corticosteroids. You may be given
oxygen therapy. Your lung function and condition will
be assessed. Depending on your response, further treatment in the emergency
room or a stay in the hospital may be necessary.
Some people are
at increased risk of death from asthma, such as people
who have been admitted to an intensive care unit for asthma or who have needed
a breathing tube (intubation) for asthma. These people need to seek medical
care early when they have symptoms.
Medical checkups
You need to
monitor your asthma and have regular checkups to keep
it under control and to ensure correct treatment. Checkups are recommended
every 1 to 6 months, depending on how well your asthma is controlled.
During checkups, your doctor will ask whether your symptoms and
peak expiratory flow have held steady, improved, or
become worse and will ask about asthma attacks during exercise or at night. You
track this information in an
asthma diary. You may be asked to bring your inhaler
and
peak expiratory flow meter to an appointment so your
doctor can see how you use them.
Initial treatment
There are many components to
managing
asthma. After your diagnosis, your doctor may only
discuss the components you need to know immediately. These include:
Oral or injected corticosteroids
(systemic corticosteroids). These medicines may be used to get your asthma
under control before you start taking daily medicine. In the future, you also
may take oral or injected corticosteroids to treat any sudden and severe
symptoms (asthma attacks), such as shortness of breath. Oral
corticosteroids are used more than injected corticosteroids.
Oral corticosteroids include prednisone and
methylprednisolone.
Inhaled corticosteroids. These are the preferred
medicines for long-term treatment of asthma. They reduce the
inflammation of your airways, and you take them every
day to keep asthma under control and to prevent asthma attacks. Inhaled
corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and
ciclesonide.
Short-acting beta2-agonists. These medicines are used
for asthma attacks. They relax the airways, allowing you to breathe easier.
Short-acting beta2-agonists include albuterol and pirbuterol.
A
combination of an inhaled corticosteroid and
long-acting beta2-agonist. This combination is often
used to treat persistent asthma.
Basic
education about asthma. The more you know about
asthma, the more likely it is you will control symptoms and reduce the risk of
asthma attacks. Keep in mind that even severe asthma can be controlled, and
cases where the condition cannot be controlled are unusual.
Instruction on how to use a metered-dose
inhaler (MDI) or dry powder inhaler (DPI). Inhalers
deliver medicine directly to the lungs. If you use your inhaler correctly, you
can control your symptoms and avoid asthma attacks that can send you to the
emergency room. Most doctors recommend using a
spacer with an MDI. For more information, see:
Your short-term goal is to control your current symptoms.
Long-term, your
goal is to prevent symptoms so that asthma does not
impact your daily activities.
Special considerations in treating
asthma include:
Managing asthma during pregnancy. If a
woman had asthma before becoming pregnant, her symptoms may get better or worse
during pregnancy. Pregnant women whose asthma is not well controlled may be at
risk for a number of complications.
Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher
risk of death from asthma than younger people. They may also have one or more
other health conditions or take other medicines that can make asthma symptoms
worse.
Managing exercise-induced asthma. Exercise often
causes asthma symptoms. Steps you can take to reduce the risk of this include
using medicine immediately before you exercise.
Managing asthma before surgery. People with moderate to severe asthma are at
higher risk of developing problems during and after surgery than people who do
not have asthma.
Managing asthma symptoms at night. Sometimes
allergens that get in the airway can cause problems up to 8 hours later. This
is called a late allergic response (LAR). Or your controller medicine may wear
off during sleep, causing you to wake up. Your doctor may be able to change the
dose or timing of medicine to make sure it lasts through the night.
Ongoing treatment
After your initial treatment for
asthma, it is important to learn more about the
condition and develop an overall plan to manage the disease. You and your
doctor will work together to do this. Because asthma develops from a complex
interaction of genetics, environmental factors, and the reaction of the
immune system, no one management plan is effective for
everyone.
Asthma management consists of:
An asthma action plan.
An asthma action plan tells you which medicines to take
every day and how to treat
asthma attacks. It also may include an
asthma diary where you record your
peak expiratory flow (PEF), symptoms, and triggers.
This helps you identify triggers that can be changed or avoided, be aware of
your symptoms, and know how to make quick decisions about medicine and
treatment. See an
example of an asthma action plan(What is a PDF document?). For more information, see:
Monitoring peak expiratory flow. It is easy to underestimate the severity of your symptoms. You may
not notice them until your lungs are functioning at 50% of your
personal best peak expiratory flow (PEF). Measuring
PEF is a way to keep track of asthma symptoms at home. It can help you know
when your lung function is becoming worse before it drops to a dangerously low
level. You can do this with a
peak flow meter. For more information, see:
A plan to deal with factors that can make asthma worse (triggers). Being around
triggers increases symptoms. Try to avoid situations
that expose you to irritants (such as smoke or air pollution) or to substances
(such as
animal dander) to which you may be allergic. If
substances at work are causing your asthma or making it worse (occupational asthma), you may have to change jobs. See
information on:
A plan to treat other health problems. If you also have other health problems, such as inflammation
and infection of the sinuses (sinusitis) or
gastroesophageal reflux disease (GERD), you will need
treatment for those conditions.
Using your prescribed medicines correctly. Your doctor may adjust your medicines depending on
how well your asthma is controlled. Medicines include:
Inhaled corticosteroids. These are the
preferred medicines for long-term treatment of asthma. Inhaled corticosteroids
include mometasone, triamcinolone, fluticasone, budesonide, and
ciclesonide.
Long-acting beta2-agonists (such as salmeterol and
formoterol), which are used along with inhaled
corticosteroids.
Oral or injected corticosteroids
(systemic corticosteroids) to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used
more than injected corticosteroids.
Oral corticosteroids include prednisone and
methylprednisolone.
Quick-relief medicine, such as
short-acting beta2-agonists and
anticholinergics (ipratropium) for asthma attacks. If
you are using quick-relief medicine on more than 2 days a week (except for
exercise), you probably need to add or change controller medicine treatment.
Overuse of quick-relief medicine can be
harmful.
Education. Continue to
learn about asthma. This
questionnaire can help you determine what you already
know about asthma and what you may need to discuss with your doctor.
If you have persistent asthma and react to
allergens, you may need to have
skin testing for allergies.
Allergy shots (immunotherapy) may be helpful. For more
information, see:
You can expect to live a normal life if you control
symptoms by following your asthma action plan. Control of your asthma symptoms
can help keep your lungs as healthy as possible.
Special
considerations in treating asthma include:
Managing asthma during pregnancy. If a
woman had asthma before becoming pregnant, her symptoms may become better or
worse during pregnancy. Pregnant women whose asthma is not well controlled may
be at risk for a number of complications.
Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher
risk of death from asthma than younger people. They may also have one or more
other health conditions or be taking other medicines that can make asthma
symptoms worse.
Managing exercise-induced asthma. Exercise often
causes asthma symptoms. Steps you can take to reduce the risk of this include
using medicine immediately before you exercise.
Managing asthma before surgery. People with moderate to severe asthma are at
higher risk of developing problems during and after surgery than people who do
not have asthma.
Treatment if the condition gets worse
If your
asthma is not improving, make an appointment with your
doctor to:
Review your asthma diary to see if you have a
new or previously unidentified
trigger, such as
animal dander. Talk to your doctor about how best to
avoid triggers.
If your medicine is not working to control airway
inflammation, your doctor will first check to see whether you are using the
inhaler correctly. If you are using it correctly, your
doctor may increase the dosage, switch to another medicine, or add a medicine
to the existing treatment.
If your
asthma does not improve with treatment, you may require more intensive
treatment, including larger doses of corticosteroids or other medicine. An
asthma specialist typically prescribes these medicines.
If you
have persistent asthma and react to
allergens, you may need to have
skin testing for allergies.
Allergy shots (immunotherapy) may be helpful.
What to think about
If you have been diagnosed
with asthma, it is important that you treat it. You may feel good most of the
time—so much so that you find it hard to believe you have a long-lasting
condition. But all asthma—even mild asthma—may result in changes to your
airways that speed up and make worse the natural decrease in lung function that
occurs as we age.3
The main focus of
prevention is to reduce the number, length, and severity of asthma attacks. By
avoiding
triggers, you may be able to prevent or reduce the
severity of symptoms. For more information on identifying your triggers,
see:
If you can predict or often have asthma attacks when you
exercise, use your inhaler 10 minutes before you start the activity so you can
avoid an attack.
The following is information about specific
triggers. If you know that any of these cause your symptoms to become worse,
you should avoid or limit your exposure to them.
Irritants in the air
Common irritants in the air,
such as tobacco smoke and air pollution, can trigger asthma attacks in some
people.
Controlling tobacco smoke is important because it is a
major cause of asthma symptoms in children and adults. If you have asthma, try
to avoid being around others who are smoking, and ask people not to smoke in
your house.
Pregnant women who smoke cigarettes during
pregnancy increase the risk of
wheezing in their newborn babies.
Exposing
young children to secondhand tobacco smoke increases the likelihood that they
will develop asthma and increases the severity of symptoms if they already have
the disease.
Some household cleaning products cause asthma symptoms or
make them worse. If a cleaning product seems to trigger your asthma, stop using
it or use another product that does not cause symptoms.
Consider
staying inside when air pollution levels are high. Other irritants in the air
(such as fumes from gas, oil, or kerosene or wood-burning stoves) can sometimes
irritate the bronchial tubes, which carry air to the lungs. Avoiding these may
decrease your asthma symptoms.
Allergens
If you are allergic to certain
substances (allergens), you may decrease your asthma symptoms by
limiting exposure to these substances.
To help reduce your
exposure to allergens:
Control cockroaches, especially if you
live in an inner-city area or the southern part of the United
States.
Control dust mites. House dust mites have been linked
with the development of asthma in children.1
Control animal dander and pet allergens. If you know your pet is a trigger, you may need to think
about giving it away. If that is too hard, taking steps such as keeping your
pet out of your bedroom and dusting and vacuuming often may help your
asthma.
Control your exposure to
pollens in the air if you are allergic to them. Check
your local weather report or newspaper for pollen counts in your area.
Avoid exercising outdoors in cold weather. The air may irritate
your airways. If you are outdoors in cold weather, wear a scarf around your
face and breathe through your nose.
Avoid foods that may cause
asthma symptoms. Some people have symptoms after eating processed potatoes,
shrimp, nuts, and dried fruit, or after drinking beer or wine. These foods and
liquids contain sulfites, which may cause asthma symptoms.
Avoid
taking aspirin, ibuprofen, or other similar medicines if they increase asthma
symptoms. Consider using acetaminophen (Tylenol) instead. (Do not give aspirin to anyone younger than 20 because of the risk of
Reye syndrome.)
You can control the impact
asthma has on your life by following your asthma
action plan consistently. A management plan can help you reduce
inflammation to decrease the severity, frequency, and
duration of
asthma attacks. Following your action plan may be hard
because of the many different factors involved.
To help yourself
remain consistent in following your asthma action plan:
Educate yourself about asthma. By doing so, you can
learn to control symptoms and reduce the risk of asthma attacks. This
questionnaire can help you determine what you already
know about asthma and what you may need to discuss with your doctor.
Understand your
barriers and solutions. What may prevent you from
following your plans? These may be physical barriers, such as living far from
your doctor or pharmacy, or emotional barriers, such as having undiscussed
fears about the condition or unrealistic expectations. Discuss your barriers
with your doctor, and work to find solutions.
Develop goals that
relate to your quality of life. Being able to measure your success gives you
greater motivation to follow asthma plans consistently. Decide what you want to
be able to do. Have symptom-free nights? Be able to exercise on a regular
basis? Feel secure in knowing you can deal with an asthma attack? Work with
your doctor to see if your goals are realistic and how to meet them.
Your asthma action plan generally consists of the
following:
Seeing your doctor regularly to
monitor your asthma. The frequency of checkups depends
on how well your asthma is controlled. Checkups are recommended every 1 to 6
months. Bring your asthma plans to appointments.
Following your
asthma action plan. The plan describes which medicines
to take every day to help delay the long-term effects of asthma. The action
plan also contains the steps to treat asthma attacks. It helps you better
control your asthma attacks by keeping you aware of symptoms and of how to make
quick decisions about medicine and treatment. See an
example of an asthma action plan(What is a PDF document?). You may also have an
asthma diary where you record your
peak expiratory flow, symptoms, and triggers of asthma
attacks. This tool can help you manage your asthma too.
For more information on how to monitor and treat asthma,
see:
To effectively manage your asthma and use your asthma
action plan, you will have to know how to monitor your peak airflow, identify
asthma triggers, and take your asthma medicine correctly.
Monitoring peak expiratory flow
People often
underestimate the severity of their symptoms. They may not notice symptoms
until their lungs are functioning at 50% of their personal best measurement.
Measuring
peak expiratory flow (PEF) is a way to keep track of
asthma symptoms at home; it can help you know when your lung function is
becoming worse before it drops to a dangerously low level. You can do this with
a
peak flow meter. For more information, see:
Other factors, such as a
viral infection, exercise, stress, or dry, cold air.
Avoiding triggers will help decrease the chance of
having an asthma attack and, in the case of allergens, will help control
inflammation in the bronchial tubes, which carry air to the lungs. For more
information, see:
If you have asthma triggered by an allergen, taking
antihistamine medicine may help you manage the allergy
and thus limit its effect on your asthma.
Taking your asthma medicine
Taking medicines is an
important part of asthma treatment. But because you may need to take more than
one medicine, it can be difficult to remember to take them. To help yourself
remember, understand the reasons people don't take their asthma medicines, and
then find
ways to overcome those obstacles, such as taping a
note to your refrigerator.
Most medicines for asthma are inhaled.
Inhaled medicines give a specific dose of the medicine directly to the
bronchial tubes, avoiding or decreasing the effects of the medicine on the rest
of the body.
Delivery systems for inhaled medicines include
metered-dose and dry powder
inhalers and
nebulizers. A metered-dose inhaler is used most
often.
Sometimes doctors recommend the use of a
spacer with a metered-dose inhaler (MDI). The spacer
is attached to the MDI. A spacer may deliver the medicine to your lungs better
than an inhaler alone, and for many people it is easier to use than an MDI
alone. Using a spacer with inhaled
corticosteroids can help reduce their side effects and
result in less use of oral corticosteroids.
It is important to
keep track of the inhaler doses and discard the inhaler when you have used the
number of doses indicated on the package labeling. This not only prevents you
from having an empty inhaler when you need medicine, but it also prevents you
from inhaling only propellant after the medicine has run out. Some metered-dose
inhalers and dry powder inhalers have counters that let you know how much
medicine is left. For more information, see:
Most people with asthma can travel freely.
But if you travel to remote areas and participate in intensive physical
activity, such as long hikes, you may be at increased risk for an asthma attack
in an area where emergency help may be difficult to find.
When
traveling, always bring your medicine with you, carry the prescription for it,
and use it as prescribed. Also carry your asthma action plan so you know what
medicines to take every day and what to do if you have an asthma attack.
Give teens extra attention
Teens who have asthma
may view the disease as cutting into their independence and setting them apart
from their peers. Parents and other adults should offer support and
encouragement to help teens stick with a treatment program. It's important
to:
Help your teen remember that asthma is only
one part of life.
Allow your teen to meet with the doctor alone.
This will encourage your teen to become involved in his or her
care.
Work out a daily management plan that allows a teen to
continue daily activities, especially sports. Exercise is important for
maintaining strong lungs and overall health.
Talk to your teen
about the dangers of smoking and drug use.
Encourage your teen to
meet others who have asthma so they can support each other.
Medicine does not cure
asthma. But it is an important part of managing the
condition. Medicines for asthma treatment are used to:
Prevent and control the underlying airway
inflammation, to minimize asthma symptoms.
Decrease the severity, frequency, and duration of
asthma attacks.
Treat the attacks as they
occur.
Asthma medicines are divided into two groups: those for
prevention and long-term control of
inflammation and those that provide quick relief for
asthma attacks. Most people with
persistent asthma need to use long-term medicines
daily. Quick-relief medicines are used as needed and provide rapid relief of
symptoms during asthma attacks.
Because asthma develops from a
complex interaction of genetics, environmental factors, and the reaction of the
immune system, different people may use different
medicines and doses of medicines. Special consideration may be necessary if
you:
Are pregnant. If a woman had asthma
before becoming pregnant, her symptoms may become better or worse during
pregnancy. Pregnant women whose asthma is not well controlled may be at risk
for a number of complications.
Are an older adult.
Older adults tend to have worse asthma symptoms and a higher risk of death from
asthma than younger people. They may also have one or more other health
conditions or take other medicines that can make asthma symptoms worse.
Have exercise-induced asthma. Exercise often causes
asthma symptoms. Steps you can take to reduce the risk of this include using
medicine immediately before you exercise.
Need surgery. People
with moderate to severe asthma are at higher risk than people who do not have
asthma of developing problems during and after surgery.
Medicine delivery
Most medicines for asthma are
inhaled. Inhaled medicines are used because a specific dose of the medicine can
be given directly to the bronchial tubes. Different types of
delivery systems may be used to do this, and one type
may be more suitable for certain people or age groups than another. Delivery
systems include metered-dose and dry powder
inhalers and
nebulizers. A metered-dose inhaler is used most
often.
Sometimes doctors recommend the use of a
spacer with a metered-dose inhaler (MDI). The spacer
is attached to the MDI. A spacer may deliver the medicine to your lungs better
than an inhaler alone, and for many people it is easier to use than an MDI
alone. Using a spacer with inhaled
corticosteroids can help reduce their side effects and
result in less use of oral corticosteroids.
It is important to
keep track of the inhaler doses and discard the inhaler when you have used the
number of doses indicated on the package labeling. This not only prevents you
from having an empty inhaler when you need medicine, but it also prevents you
from inhaling only propellant after the medicine has run out. Some metered-dose
inhalers and dry powder inhalers have counters that let you know how much
medicine is left. For more information, see:
Inhaled corticosteroids. These are the
preferred medicines for long-term treatment of asthma. They reduce inflammation
of your airways and are taken every day to keep asthma under control and to
prevent sudden and severe symptoms (asthma attacks). Inhaled
corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and
ciclesonide.
Oral or injected corticosteroids (systemic
corticosteroids) to get your asthma under control before you start taking daily
medicine. You may also need these medicines to treat asthma attacks. Oral
corticosteroids are used much more than injected corticosteroids. Oral
corticosteroids include prednisone and methylprednisolone.
Short-acting beta2-agonists for asthma attacks. They
relax the airways, allowing you to breathe easier. These medicines include
albuterol and pirbuterol.
Other long-term medicines for daily treatment
include:
Anticholinergics (such as ipratropium) are usually
used for severe asthma attacks.
Other medicine such as
omalizumab may be used if asthma does not improve with
treatment. An asthma specialist typically prescribes this medicine.
Medicine treatment for asthma depends on a person’s age,
his or her type of asthma, and how well the treatment is controlling asthma
symptoms.
The least amount of medicine that controls the asthma
symptoms is used.
The amount of medicine and number of medicines
are increased in steps. So if asthma is not controlled at a low dose of one
controller medicine, the dose may be increased. Or another medicine may be
added.
If the asthma has been under control for several months at a
certain dose of medicine, the dose may be reduced. This can help find the least
amount of medicine that will control the asthma.
Quick-relief
medicine is used to treat asthma attacks. But if you or your child needs to use
quick-relief medicine a lot, the amount and number of controller medicines may
be changed.
Your doctor will work with you to help find the number and
dose of medicines that work best.
What to Think About
At the start of asthma
treatment, the number and dosage of medicines are chosen to get the asthma
under control. Your doctor may start you at a higher dose within your asthma
classification so that the inflammation is immediately
controlled. After the asthma has been controlled for several months, the dose
of the last medicine added is reduced to the lowest possible dose that prevents
symptoms. This is known as step-down care. Step-down care is believed to be a
better way to control inflammation in the bronchial tubes than starting at
lower doses of medicine and increasing the dose if it is not enough.20
Because quick-relief medicine quickly reduces
symptoms, people sometimes overuse these medicines instead of using the
slower-acting long-term medicines. But
overuse of quick-relief medicines may have harmful
effects, such as decreasing the future effectiveness of these
medicines.21 Overuse of quick-relief medicine is also
an indication that asthma symptoms are not being controlled. Be sure to talk
with your doctor immediately.
You may have to take more than one
medicine daily to manage your asthma. It can be difficult to remember when to
take your medicine and which medicine to take. To help yourself remember,
understand the reasons people don't take their asthma medicines, and then find
ways to overcome those obstacles, such as taping a
note to your refrigerator to remind yourself.
Using the fewest
medicines possible is important for older people, because they may be taking
medicines for other conditions. Tell your doctor about all the medicines you
are taking, so he or she can select asthma medicines that won't interfere with
other medicines.
Some people only have symptoms during certain
times of the year (seasonal asthma). If you know when you will most likely have
symptoms, start using a medicine to decrease inflammation before the symptoms
start.
Allergy shots
(immunotherapy) may be recommended for people who have
asthma symptoms when they are around substances to
which they are allergic (allergens). In some people, allergy
shots have been shown to reduce asthma symptoms and the need for
medicines.22 But allergy shots are not equally
effective for all allergens. Allergy shots should not be given when asthma is
poorly controlled. For more information, see:
Allergy shots are similar to vaccinations, because they
contain small doses of one or more substances to which you are allergic so that
your body can become less responsive to them over time.
Complementary medicine
Alternative treatments such
as homeopathy, acupuncture, and breathing exercises have been used to treat
asthma. The research on these treatments is limited. Reviews of research
show:23, 24
A possible but not
clearly established role for using
antioxidants.
Breathing exercises
practiced in
yoga may improve lung function.
Some people have used
ephedra—a stimulant sold for weight loss and sports
performance—to try to treat asthma symptoms. But the U.S. Food and Drug
Administration (FDA) has banned the sale of this dietary supplement because of
concerns about safety. Ephedra, also called ma huang, has been linked to
heart attacks,
strokes, and some deaths.
A review of
complementary and alternative treatments for treating asthma in children
concluded that none have been proved to reduce asthma symptoms and some may
have harmful side effects.25 Some of these studies
included teenagers and adults. The therapies reviewed include:
Herbal products such as ivy leaf,
butterbur, and Tylophora indica
(T. indica).
Dietary supplements such as
fatty acids and
probiotics.
1-800-LUNG-USA (1-800-586-4872) 1-800-548-8252 (to speak with a lung professional) (212) 315-8700
Web Address:
www.lungusa.org
The American Lung Association provides programs of
education, community service, and advocacy. Some of the topics available
include asthma, tobacco control, emphysema, asbestos, carbon monoxide, radon,
and ozone.
Centers for Disease Control and Prevention
(CDC)
1600 Clifton Road
Atlanta, GA 30333
Phone:
1-800-CDC-INFO (1-800-232-4636)
TDD:
1-888-232-6348
E-mail:
cdcinfo@cdc.gov
Web Address:
www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
threats.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
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Kull I (2004). Breast-feeding reduces the risk of asthma during the first 4 years of life. Journal of Allergy and Clinical Immunology, 114(4): 755–760.
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Jaakkola JJK, et al. (2002). Pets, parental atopy, and asthma in adults. Journal of Allergy and Clinical Immunology, 109(5): 784–788.
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