Asthma

Asthma is a common respiratory disease that affects millions of people worldwide. It is a chronic condition where the airways in the lungs become inflamed and spasm, causing temporary occlusions of airflow. Symptoms include wheezing, difficulty breathing, and chest tightness. While there is no cure for asthma, a variety of treatments can help manage it and keep it from controlling your life.

Key Facts

Asthma has a strong genetic component, but can also be caused by environmental factors. It may worsen during physical activity or in the presence of irritants, like allergies or smoke.
Common symptoms of asthma include shortness of breath, chest tightness, and wheezing. These can become more frequent and severe as asthma worsens.
Asthma is best treated with medications that reduce inflammation and expand the airways and avoiding environmental triggers.

Causes

There is no one single cause of asthma. Instead, a variety of genetic and environmental factors can make it more likely to develop. These include the following:

Allergies: Severe allergies have been linked to a higher likelihood of developing asthma.
Environment: Prolonged contact with irritants like smoke or pollution, especially at an early age, can cause asthma to develop in some people.
Family History: Asthma tends to run in families and can be passed down from parents to their children.

Symptoms

There are many symptoms associated with asthma. They are caused by bronchospasm, which are spasms of the airways that cause them to expand and contract, temporarily blocking airflow. The most common signs and symptoms are:

Wheezing
Coughing
Chest Tightness
Nighttime awakening from coughing or wheezing
Shortness of breath

Diagnosis

Diagnosing asthma begins with a full medical and physical exam. This involves a review of your health and family history, as well as an evaluation of your symptoms.

Lung Function Tests

Lung function tests are a common way to diagnose asthma. They measure the flow of air into and out of the lungs (FEV) to determine how well they are functioning. They include the following:

Spirometry: This test uses a device called a spirometer to measure both the capacity of the lungs and the speed of air as it is inhaled and exhaled.
Peak Flow: This is a basic test that measures how hard and fast the patient can breathe out.

Other Tests

The following are some other tests that may be used to diagnose asthma and/or determine its type:

Allergy Test: This test exposes a person to small amounts of various allergens to determine whether they trigger asthma. If a trigger is identified, it can help lead to better treatment.
Imaging Tests: These create a detailed image of the lungs, sinus cavities, and other airways so that doctors can look for any abnormalities or infections that may be obstructing breathing. They may include x-rays or computerized tomography (CT) scans.
Methacholine Challenge: This test measures how reactive the lungs are to the outside environment. The patient inhales methacholine, a medicine that causes mild restriction of the airways in those who have asthma, and a breathing test determines how the lungs react.
Nitric Oxide Test: This measures the amount of nitric oxide exhaled in each breath. High levels of nitric oxide can be a sign of swollen airways.

Treatment

Although asthma cannot be cured, treatments can help manage symptoms and prevent flare-ups. Which treatment is most effective will depend on the type of asthma, its severity, and the unique needs of the patient. For most patients, however, treatment should begin with learning what triggers their asthma (e.g., allergens, aspirin, etc) so they can avoid them.

There are also a variety of both quick-relief medications and long-term medications that asthma patients can take. The goals of these medications are to reduce swelling, relax the airways, and help make breathing easier.

Fast-Acting Medications

These medications can be taken at the onset of an asthma attack to quickly reduce symptoms. Different types include:

Anticholinergics (Ipratropium): These work by blocking certain neurotransmitters, which can help reduce inflammation and mucus build-up.
Oral and Intravenous Corticosteroids (Prednisone, Methylprednisolone): These can quickly reduce swelling and inflammation in the airways and ease breathing. However, they can have serious side effects, like weight gain and increased risk for infection, so are usually only used for severe asthma attacks.
Short-Acting Beta Antagonists (Albuterol): These medications can be inhaled through an inhaler or a nebulizer and can immediately ease symptoms for up to several hours. They are the most common quick-relief medication for asthma.

Long-Term Medications

These medications are taken daily in order to prevent symptoms before they occur. People who experience frequent night-time awakenings from asthma attacks may especially benefit from these.

Inhalable Corticosteroids: These help reduce airway inflammation over the long-term if used daily. They are not as powerful as oral corticosteroids, so it may take several days or weeks for them to take full effect.
Leukotriene Modifiers (Montelukast): These block the action of leukotrienes, which make the air passages constrict and tell the lungs to produce excess mucus.
Long-Acting Beta Antagonists: These medications are taken through an inhaler usually twice per day. They are always combined with a corticosteroid. They help open the airways quickly and can provide relief for 24 hours.

Lifestyle Changes

While the right medication can be helpful, lifestyle changes can also make a big difference when it comes to managing asthma. The following are some ways to reduce asthma symptoms:

Clean Regularly: Remove dust, dirt, pet dander, mold, and anything else that may trigger an asthma attack as often as possible. Keeping a log of your asthma flare-ups can help you identify triggers and avoid them.
Stay up to date with vaccinations: This includes the flu vaccine for all adults and the pneumococcal vaccine (PPSV23) for adults over age 65 or younger with certain conditions or smoking.
Weight loss: Maintaining a healthy weight through diet and exercise can reduce the severity of asthma.

Outlook

Asthma is a lifelong condition that must be properly managed. But with the right medications and lifestyle changes, most people can successfully minimize their symptoms and eliminate severe asthma attacks. This is why it is important to develop a treatment plan with a doctor and to pay close attention if symptoms or triggers change.

Next Steps

Although asthma is a common condition, we understand how frustrating it can be. That's why we’re fully committed to finding a treatment plan that works for you. Our team can diagnose the specific type of asthma you have, help identify any specific triggers, and create a personalized plan to reduce symptoms over both the short- and long-term.

If you need help for a lung or chest issue, we’re here for you. Call (212) 305-3408 for existing patients, (212) 304-7535 for new patients, or request an appointment online to get started today.