Difference between revisions of "Asthma"

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{{Infobox disease
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| Name            = Asthma
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| Image          = Asthma attack-illustration NIH.jpg
 
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| Caption        = An asthma attack causes the airways to get smaller and too much mucous to be made.  This makes it hard to breathe.
 
| DiseasesDB      = 1006
 
| ICD10          = {{ICD10|J|45||j|40}}
 
| ICD9            = {{ICD9|493}}
 
| ICDO            =
 
|  OMIM          = 600807
 
|  MedlinePlus    = 000141
 
|  eMedicineSubj  = article
 
|  eMedicineTopic = 806890
 
| MeshID          = D001249
 
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'''Asthma''' (or '''Asthma bronchiale''') is a disease that hurts the [[airways]] inside the [[lung]]s. It causes the [[tissue]] inside the airways to [[inflammation|swell]]. Asthma also causes the bands of [[muscle]] around the airways to become narrow.  This makes it hard for enough air to pass through and for the person to breathe normally. Asthma also causes [[mucus]]-making [[cell]]s inside the airways to make more mucus than normal.  This blocks the airways, which are already very narrow during an asthma attack, and makes it even more difficult to breathe.
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{{asthma videos}}
  
A person having an asthma attack often makes [[Breath sounds#Abnormal breath sounds#Wheezing|wheezing]] sounds when trying to breathe. This is the sound of air trying to pass through the very narrow airway. They also have [[dyspnea|shortness of breath]], which means they cannot take a full deep breath. Chest tightness may happen which feels like their chest is being squeezed. They may also [[cough]] a lot.
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==What Asthma Is==
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Asthma is a disease that affects your lungs. It is the most common long-term disease of children. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. It is with you all the time, but you may have asthma attacks only when something bothers your lungs.
  
Asthma attacks can be a [[medical emergency]] because they can be ''fatal'' (cause a person to die). There is no cure for asthma. There are treatments such as different kinds of medicines to help people with asthma. There are also things that people with asthma can do to help themselves to keep their asthma from getting worse.
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We know that family history contributes to susceptibility, but in most cases we don’t know what causes asthma to develop, and we don’t know how to cure asthma. You can control your asthma by knowing the warning signs of an attack, avoiding things that trigger an attack, and following the advice of your doctor. When you control your asthma, you won’t have symptoms like wheezing or coughing, you’ll sleep better, you won’t miss work or school, you’ll be able to take part in all physical activities, and you won’t have to visit the hospital.
  
There are a lot of [[Factor (medicine)|risk factors]] for getting asthma. The exact reasons for each is not yet clearly understood. Some of the factors are believed to come from [[genetics]]. A person inherits genetic [[mutation]]s from one or both of their parents that may increase the chances of developing asthma. ''Epigenetics'', which are changes in the way a [[gene]] acts, may also increase their chances of getting asthma. These epigenetic changes may also be inherited. They may happen when a baby is still growing inside its mother, or during childhood.
 
  
''[[Socioeconomic status]]'' (SES) is also believed to play a part in developing asthma. A person's socioeconomic status is based on such things as how much money their family makes, where they live, and their education level.  [[Race (biology)|Race]] and [[ethnicity]] also may play a part.  It also is related to access to medical care, personal beliefs, and [[diet]]ary habits. People of [[poverty|lower socioeconomic status]] suffer higher rates of asthma, have worse outcomes, and also have higher asthma-related death rates than people of higher economic status.
 
  
==Causes==
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==Effects of Asthma==
[[File:Asthma causes.PNG|480px|right|thumb|It is believed that a person gets asthma for different reasons, including the genes they get from their parents (genetics), changes in the way some of their genes work (epigenetics) and things in their life that are not healthy (unhealthy or ''negative'' environmental factors).]]
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In 2001, 20.3 million Americans had asthma, and 12 million had had an asthma attack in the previous year. If a person has a parent with asthma, he or she is three to six times more likely to develop asthma than is a person who does not have a parent with asthma.
The exact cause of asthma is not yet known. It is believed that it may be because of a of many different reasons:
 
  
''Genetics'':  When changes happen in a person's genes (called ''mutations'') these changes are passed on to their children. One or both parents may have these changes or ''mutations'' in their genes, and some or all of their children may be born with them, which means they ''inherited'' them. These mutations, once they happen, run in families from one generation to the next and are permanent mutations, they change the gene in the ''[[DNA]]''. These changes can make a person more likely to get certain diseases like asthma. In some diseases it may be only one change in one gene that may make a person get that disease, in asthma it may be changes in many different genes that may make a person more likely to get asthma.<ref>{{cite book| last = Smith| first = Terry L.| title = Asthma| year = 2009| publisher = Infobase Publishing| isbn = 0-7910-9663-7| page = 46 }}</ref>
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==How Asthma Is Diagnosed==
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Asthma can be difficult to diagnose, especially in children under 5 years old. Regular physical exams that include checks of lung function and for allergies can help make the right diagnosis.
  
''Epigenetics changes'' or ''modifications'' cause different kind of changes that affect how a person's genes work or 'express themselves' in three different ways (called ''epigenetic mechanisms''), but do not change the gene in the DNA. These epigenetic changes may be inherited, or they may happen ''in utero'' which is when a baby is still inside its mother. They may also happen in childhood, because of different reasons, like a respiratory [[infection]], being exposed to [[chemical]]s or [[drug]]s, diet etc. These changes can be passed from one generation to the next but are not permanent and might only be passed down one or two generations. Even though epigenetic changes affect how a person's genes work they do not permanently change a person's genes. It is believed epigenetic changes may also make a person more likely to get certain diseases like asthma.<ref>Yang IV, Schwartz DA. Epigenetic mechanisms and the development of asthma. J Allergy Clin Immunol. 2012 Dec;130(6):1243-55. PMID 23026498</ref>
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A health-care provider trying to diagnose asthma will ask you questions about coughing, especially coughing at night, and whether breathing problems are worse after physical activity or during a particular time of year. Providers also ask about other symptoms, such as chest tightness, wheezing, and colds that last more than 10 days.
  
''Environmental factors'' are things that affect a person; which can be either healthy or unhealthy. Unhealthy environmental factors are things like living in an area where there is a lot of air [[pollution]], or living somewhere where there are lots of bugs in the house, or being around [[cigarette]] smoke.
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Also, a provider will ask about your family history of asthma, allergy and other breathing problems, and your home environment. He or she also will ask about lost school or work days and limits on your activity.
  
If a person who has genetic or epigentic changes in their genes that makes them have a bigger chance of getting asthma (''genetic predisposition''), also has unhealthy environmental factors in their life, like living in a home that has a lot of ''dust mites'', then it is more likely that they will get asthma.
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Testing of lung function, called spirometry, is another way to diagnose asthma. A spirometer is a piece of equipment that measures the largest amount of air you can exhale after taking a very deep breath. Airflow can be measured before and after you use an asthma medication.
  
'''Atopy'''
 
  
[[File:Atopic triad 2.PNG|260px|right]]
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==What An Asthma Attack Is==
''Atopy'' is when there are changes in some of the genes a person is born with (''genetic inheritance''). These genetic changes make their body produce more Immunoglobulin E (IgE), a type of ''[[antibody]]''. They are also more sensitive to things things like chemicals, smoke and dust (''environmental antigens''). This ''hypersensitivity'' means they are more sensitive or ''[[allergy|allergic]]'' to things in the environment than people who do not have these changes in their genes and are not hypersensitive or ''allergic''.
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Airways are the paths that carry air to the lungs. As the air moves through the lungs, the airways become smaller, like branches of a tree. During an attack, the sides of the airways in your lungs become inflamed and swollen. Muscles around the airways tighten, and less air passes in and out of the lungs. Excess mucus forms in the airways, clogging them even more. The attack, also called an episode, can include coughing, chest tightness, wheezing, and trouble breathing.
  
This ''hypersensitivity'' causes their body to react in certain ways. Usually a person who is atopic develops ''allergic rhinitis'' which affects the ''[[nasal cavity|nasal passages]]'' which are behind the nose and they are also more likely to get ''atopic dermatitis'' which causes [[skin]] rashes and  ''atopic asthma''. Up to 40% of people with allergic rhinitis also have asthma.<ref>Crystal-Peters J, Neslusan C, Crown WH, Torres A. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits. J Allergy Clin Immunol. 2002 Jan;109(1):57-62. PMID 11799366</ref> These three medical problems, ''allergic rhinitis'', ''atopic dermatitis'' and ''atopic asthma'' are called the ''Atopic Triad'' (a ''triad'' is when there is three of something).<ref>{{cite book| last = Paul| first = William E.| title = Fundamental Immunology| year = 2008| publisher = Lippincott Williams & Wilkins| isbn = 978-0-7817-6519-0 }}</ref> People who are atopic may also have other medical problems including food and drug allergies, stinging-insect hypersensitivity, [[hives]] (''urticaria''), Quincke's [[edema]] (''angioedema''), and contact dermatitis.
 
  
If a person has one parent who is atopic they have a  chance of being atopic too. If they have two parents who are atopic they have an even bigger chance of being atopic.<ref>{{cite book| last1 = Thurlbeck| first1 = William M.| last2 = Churg| first2 = Andrew| title = Pathology of the Lung| year = 1995| publisher = Thieme| isbn = 978-0-86577-534-3| page = 144 }}</ref>
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==Causes Of An Asthma Attack==
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Environmental exposures, such as house dust mites and environmental tobacco smoke, are important triggers of an attack. Some of these triggers are listed in the box below.
  
''' Acetaminophen and asthma'''
 
[[File:Tylenol bottle closeup crop.jpg|60px|left]]
 
  
There have been studies that show a link between [[acetaminophen]] (Tylenol) and asthma. For instance a 2008 analysis of information collected from a very large study called the International Study of Asthma and Allergies in Childhood, or the "Isaac study" for short, showed that children who had taken acetaminophen for a [[fever]] during the first year of their life had a 50% higher risk of getting asthma later on.<ref>Beasley RW, Clayton TO, Crane J, ''et al'', ISAAC Phase Three Study Group. Acetaminophen use and risk of asthma, rhinoconjunctivitis, and eczema in adolescents: International Study of Asthma and Allergies in Childhood Phase Three. Am J Respir Crit Care Med. 2011 Jan 15;183(2):171-8.
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==How Asthma Is Treated==
Acetaminophen use and risk of asthma, rhinoconjunctivitis, and eczema in adolescents: International Study of Asthma and Allergies in Childhood Phase Three.
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You can control your asthma and avoid an attack by taking your medicine as prescribed and avoiding the triggers that can cause an attack. It’s just as important that you remove the triggers in your environment that you know make your asthma worse.
PMID 20709817</ref> The more acetaminophen children took the higher their risk of getting asthma. Children who took it once a month had threefold increase in their risk of getting asthma. An increase in asthma rates in multiple countries corresponded with increased sales of drugs which contained acetaminophen.<ref>International Study of Asthma and Allergies in Childhood: [http://isaac.auckland.ac.nz/phases/phasethree/phasethree.html ISAAC Phase Three]</ref><ref>{{cite book| last = Gresele| first = Paolo| title = Platelets in Thrombotic and Non-Thrombotic Disorders: Pathophysiology, Pharmacology and Therapeutics| year = 2002| publisher = Cambridge University Press| isbn = 978-0-521-80261-1| page = 861 }}</ref> Previously the American College of Physicians reported a link between non-atopic asthma and acetaminophen use based on results of  The Third National Health and Nutrition Examination Survey.<ref>American College of Physicians: Internal medicine updates ACP Press pp.239-240. 2003</ref> Not all doctors are convinced of the link between acetaminophen and asthma.
 
  
"Children with asthma or at risk for asthma should avoid the use of acetaminophen." (McBride JT, 2011<ref>McBride JT. Pediatrics. The association of acetaminophen and asthma prevalence and severity. 2011 Dec;128(6):1181-5. PMID 22065272</ref>).
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Medicine for asthma is different for each person. It can be inhaled or taken as a pill and comes in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you are using your quick-relief medicines more and more you should visit your health-care provider to change your asthma management plan. Long-term control medicines make you have fewer and milder attacks, but they don’t help you if you’re having an attack.
  
{{clear}}
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Asthma medicine can have side effects. Most are mild and go away on their own. Ask your health-care provider about the side effects of your medicines.
  
==Types of Asthma==
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The important thing to remember is that you can control your asthma. With your health-care provider’s help, make your own asthma management plan so you know what to do based on your own symptoms. Decide who should have a copy of your plan and where he or she should keep it. You can learn more about asthma management plans from the American Academy of Family Physicians [http://familydoctor.org/x2272.xml family doctor]. And remember to take your long-term control medicine even when you don’t have symptoms.
[[File:Primary bronchi cross-sectional posterior view.PNG|thumb|This is a cross-section of the ''primary bronchi'' (one is ''bronchus'', two are ''bronchi'') which shows the inside of the airways.<ref>{{cite book| last1 = White| first1 = Lois| last2 = Duncan| first2 = Gena| title = Medical-surgical Nursing: An Integrated Approach| year = 2002| publisher = Taylor & Francis| isbn = 978-0-7668-2566-6| page = 385 }}</ref> It is a ''posterior view'' which means looking from behind.<ref>[http://visual.merriam-webster.com/human-being/human-body/man/posterior-view.php posterior view: ''Merriam-Webster: Visual Dictionary Online'']</ref>]]
 
  
<font size="3">'''Atopic asthma'''</font>
 
  
''Atopic'' asthma is the most common form of asthma.
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==Important Asthma Triggers==
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Environmental Tobacco Smoke, Also Known As Secondhand Smoke
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Parents, friends, and relatives of children with asthma should try to stop smoking. Until they can successfully quit, they should smoke only outdoors, not in the home or in the family car. They should not allow others to smoke in the home, and should make sure the child's school is smoke-free.
  
<font size="3">'''Cough-variant asthma'''</font>
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==Dust Mites==
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Mattress covers and pillow case covers provide a barrier between house dust mites and the person with asthma. Natural mattresses that are hypoallergenic, such as the [http://www.latexmattress.org botanical latex foam mattress], do not contain the petrochemicals that man made mattresses do and can be beneficial for the asthma suffer. Down-filled pillows, quilts, or comforters should not be used and stuffed animals and clutter should be removed from bedrooms.
  
Cough-variant asthma is a type of asthma in which a cough is the main, and sometimes only [[Signs and symptoms (medicine)|sign]]. Cough-variant asthma usually does not cause wheezing or breathlessness and causes a dry, scratchy, mostly nonproductive cough (this means little or no [[phlegm]] is coughed up). About 30% of people who have cough-variant asthma will develop typical asthma.<ref>Juzar Ali, Warren Summer, Michael Levitzky: Pulmonary Pathophysiology, A Clinical Approach: McGraw-Hill Medical; 3 edition, 2009 p.25 {{ISBN|978-0-07-161154-1}}</ref>
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==Outdoor Air Pollution==
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Pollution caused by industrial emissions and automobile exhaust can cause an asthma episode. In large cities that have air pollution problems the number of emergency department visits for asthma episodes goes up when the air quality is very poor.
  
<font size="3">'''Work-related asthma'''</font>
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==Cockroach Allergen==
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Decreasing exposure to cockroaches in the home can help reduce asthma attacks. You may find cockroaches any place where food is eaten and crumbs are left behind. Remove as many water and food sources as you can because cockroaches need food and water to survive. Vacuum or sweep these areas at least every 2-3 days. You can also use roach traps or gels to decrease the number of cockroaches in your home.
  
[[File:Martinsugn.jpg|thumb|left|These workers are checking the furnace at a steel factory. The furnace gives off smoke, fumes and small particles. These are irritants and they can cause or trigger work-related asthma.]]
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==Pets==
Work related asthma are types of asthma that are caused or made worse by irritants in the environment at a person's place of work. The kind of jobs that may cause work related asthma are usually those in which there is a lot of smoke or chemicals are used. There are different types of work-related asthma (WRA):<ref>{{cite book| last = Brent| first = Jeffrey| title = Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient| year = 2005| publisher = Gulf Professional Publishing| isbn = 978-0-8151-4387-1| page = 1000 }}</ref>
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Furry pets may trigger an attack. The simplest solution to this situation is to find another home for the pet. However, some pet owners may be too attached to their pets or unable to locate a safe new home for the animal. Any animal causing an allergic reaction should not be allowed in the bedroom. Pets should be kept outside as much as possible and bathed weekly. People with asthma are not allergic to their pet’s fur, so trimming the pet’s fur will not help your asthma. Frequent vacuuming will reduce the presence of the allergen. If the room has a hard surface floor, it should be damp mopped weekly.
  
1. Occupational asthma with latency: this asthma type is when the signs and symptoms of asthma occur after a period of time (''latency'') after being exposed to the environmental irritants. [[Exempli gratia|e.g.]]: John starts working at a factory where chemicals are used the first week of January. At the end of March he starts developing the signs and symptoms of asthma. The period of time from when he started the job in January to when the signs and symptoms of asthma started in March is the ''latency period''.<ref>Severe Asthma: Pathogenesis and Clinical Management (Lung Biology in Health and Disease): editors:  Stanley J Szefler, Donald Y. M. Leung. CRC Press; 2 edition (2001); p.382 {{ISBN|978-0-8247-0552-7}}</ref>
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==Mold==
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When mold is inhaled, it can cause asthma attacks. Eliminating mold throughout the home can help control asthma attacks. Keep humidity levels between 35% and 50%. In hot, humid climates, this may require the use of air conditioning and/or dehumidifiers. Fixing water leaks and cleaning up any mold in the home can also help.
  
2. Irritant-Induced Asthma (IIA) is occupational asthma without latency: this is an asthma type is when the signs and symptoms of asthma can occur immediately (''without latency'') after being exposed to the environmental irritants. [[Exempli gratia|e.g.]] Frank starts a new job working as a janitor where he uses ammonia to clean. After opening the bottle of ammonia and breathing the fumes Frank starts finding it difficult to breath, his chest tightens up and he develops other signs and symptoms of asthma.<ref>{{cite book| last1 = Sullivan| first1 = John Burke| last2 = Krieger| first2 = Gary R.| title = Clinical Environmental Health and Toxic Exposures| year = 2001| publisher = Lippincott Williams & Wilkins| isbn = 978-0-683-08027-8| page = 230 }}</ref>
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==Other Triggers==
::3. Reactive Airways Dysfunction Syndrome (RADS):
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Strenuous physical exercise; adverse weather conditions like freezing temperatures, high humidity, and thunderstorms; and some foods and food additives and drugs can trigger asthma episodes. Strong emotional states also can lead to hyperventilation and an asthma episode. People with asthma should learn if these things trigger their episodes and avoid them when possible.
  
4. Work-aggravated asthma: this is when a person already has asthma and environmental triggers at their place of work makes it worse.
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{{medicine}}
 
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<font size="3">'''Exercise induced asthma'''</font>
 
 
 
Exercise induced asthma (EIA) - also called exercise induced bronchospasm - is the term used to describe asthma cases in which exercise is the main, and many times the only trigger for an asthma attack. If a person already has a form of asthma or they are ''atopic'' there is more of a chance of getting EIA.
 
 
 
<font size="3">'''Nocturnal asthma'''</font>
 
 
 
Nocturnal asthma: is the term used to describe asthma cases that get worse at night (''nocturnal'').
 
 
 
<font size="3">'''Premenstrual asthma (PMA)''':</font> is when asthma symptoms get worse during the premenstrual period. This condition may affect up to 40% of female asthma sufferers. For a diagnosis of PMA to be made it is necessary to have a detailed history of the timing of menstrual cycles along with asthma symptoms experienced, and the peak expiratory flow rate (PMA may cause the PEF to be lowered in the premenstrual period). It is helpful in making a diagnosis to keep a diary of symptoms and peak expiratory flow (PEF) rates.<ref>Tan KS. Premenstrual asthma: epidemiology, pathogenesis and treatment. Drugs. 2001;61(14):2079-86. PMID 11735634</ref><ref>{{cite book| last1 = Fritz| first1 = Marc A.| last2 = Speroff| first2 = Leon| title = Clinical Gynecologic Endocrinology and Infertility| year = 2011| publisher = Lippincott Williams & Wilkins| isbn = 0-7817-7968-5| page = 588 }}</ref>
 
 
 
<font size="3">'''Status asthmaticus'''</font>
 
 
 
Status asthmaticus is a severe form of asthma in which an asthma attack gets worse as it goes along and the medicines that are usually used to treat asthma do not work. Status asthmaticus can be fatal.<ref>{{cite book| last1 = Dolinak| first1 = David| last2 = Matshes| first2 = Evan W.| last3 = Lew| first3 = Emma O.| title = Forensic Pathology: Principles and Practice| year = 2005| publisher = Academic Press| isbn = 978-0-12-219951-6| page = 356 }}</ref>
 
 
 
==Signs and symptoms==
 
[[File:Stethoscope (PSF).png|thumb|260px|A doctor may use a [[stethoscope]] to listen for wheezing sounds in a person's [[lungs]]. Wheezing is a [[Signs and symptoms (medicine)|sign]] of asthma.
 
{{listen
 
| filename    =
 
Wheeze2O noise reduced.ogg  | title        = Wheezing
 
| description  = Wheezing sounds heard with a [[stethoscope]].
 
| format      = [[Ogg]]
 
}}]]
 
[[Signs and symptoms (medicine)|Signs and symptoms]] in medicine are the way a medical condition affects a person's body. Sometimes the signs and symptoms of asthma may be ''mild'' which does not bother the person too much. At other times they may be ''severe'' which may make the person feel very sick.
 
 
 
Not every person with asthma has all the signs and symptoms of asthma all the time. A person may have some signs and symptoms during one asthma attack and have different symptoms during another asthma attack. Some people with asthma may have long periods of time between asthma attacks where they show no signs and experience no symptoms of asthma, while others may have some or all of the signs and symptoms everyday which become more severe during an attack. It also depends on what type of asthma a person has and whether they have a mild, moderate or severe case.
 
 
 
There are also some people with asthma who might only have signs and symptoms during certain times, such as those with exercise induced asthma, where the exercise triggers the symptoms. For some the signs and symptoms of asthma may be triggered or made worse (''exacerbated'') when they have viral respiratory tract infections, often the type casued by human ''rhinoviruses''.<ref>Rosenthal LA, Avila PC, Heymann PW, ''et. al.'' Viral respiratory tract infections and asthma: the course ahead. J Allergy Clin Immunol. 2010 Jun;125(6):1212-7. doi: 10.1016/j.jaci.2010.04.002.
 
PMID 20513518</ref>
 
 
 
Early warning signs of an asthma attack are physical changes in health that a person with asthma has before they have the attack. By knowing the early warning signs a person may be able to take steps to keep from having an asthma attack or if they do have one, to keep it from getting worse.
 
 
 
'''Early warning signs'''
 
 
 
The early warning signs of asthma may include:
 
* Coughing a lot, especially at night
 
* Losing your breath easily
 
* Shortness of breath: this is when a person cannot take a ''deep breath'' which means they cannot fill their lungs all the way with air. They may be only able to take short, ''shallow'' breaths which does give their lungs enough air. When a person has shortness of breath they may also have chest tightness.
 
* Getting tired easily during exercise and feeling weak and wheezing or coughing after exercise
 
* Feeling the symptoms of a cold or allergies coming on like sneezing, a runny or stuffed up nose, coughing, sore throat, and headache
 
 
 
{{clear}}
 
 
 
==Triggers==
 
[[File:Asthma triggers 2.PNG|480px|thumb|right|These are some of the things that may make a person's asthma worse and can [[Factor (medicine)|''trigger'']] an asthma attack.]]
 
A [[Factor (medicine)|''trigger factor'']] or ''trigger'' for short, is something that causes the [[Signs and symptoms (medicine)|signs and symptoms]] of a medical condition to begin in a person who already has that medical condition.  Common triggers for asthma are:
 
* Tobacco smoke: a person does not need to smoke themselves, second-hand smoke can trigger an asthma attack. Second-hand smoke is the smoke from the end of a burning cigarette, cigar or pipe that someone else is smoking, or the smoke that they breathe out (exhale).
 
* Pets: animals give off chemicals called ''proteins'' which are '' allergens''; people can be ''allergic'' to them. These allergens can act as ''irritants'' and make someone's asthma worse and trigger an asthma attack. The ''proteins'' are in the pet's ''dander'' which is the dead flakes of skin that animals (and people) shed. They are also in their urine, feces, saliva, and  sebum which is made by glands in the skin called ''sebaceous glands''. Sebum is what makes hair and skin ''oily''. When dander, urine, feces, saliva, and ''sebum'' dry out their proteins can become airborne and breathed in. Some of the types of pets people can be allergic to are, dogs, cats, gerbils, hamsters, guinea pigs and pet birds.
 
* Bugs: different types of bugs which may be found inside homes may trigger asthma attacks. They may trigger asthma symptoms in the same way as pets; the proteins they give off are allergens and  become airborne. Some of the more common bugs which may trigger asthma are dust mites, cockroaches and also bedbugs and fleas. Many other species that may infest a home may serve as a source of allegens such as Pharaoh ants.<ref>Kim CW, Kim DI, Choi SY, ''et al.'' Pharaoh ant (Monomorium pharaonis): newly identified important inhalant allergens in bronchial asthma. J Korean Med Sci. 2005 Jun;20(3):390-6. PMID 15953858</ref>
 
* Fungus spores (mold): fungus reproduce by releasing ''spores'' into the air, if the spores land in a good place form them to grow then a new fungus starts. Breathing in these spores can trigger asthma. One of the most common types of fungus spores found in both outside and outside environments are from a group (genus) known as ''aspergillus''.
 
* Strong emotions such as anger, stress and even laughter may worsen asthma symptoms.
 
* Outdoor air pollution can come from many sources such as car and truck fumes in areas of heavy traffic and chemicals in the air near factories and refineries.
 
* Weather: changes in the weather can trigger an asthma attack. Changes in air temperature can trigger an attack not just cold air. If a person goes from being outside in the cold into a warm house the sudden change can cause a broncospasm. Sudden changes in humidity also plays a part.<ref>{{cite book| last = Porth| first = Carol| title = Essentials of Pathophysiology: Concepts of Altered Health States| year = 2011| publisher = Lippincott Williams & Wilkins| isbn = 1-58255-724-1| page = 576 }}</ref>
 
 
 
The best way to deal with asthma triggers is to learn what they are and avoid them if possible, and if not totally avoidable then adjust one's behavior to deal with them. Example: running on a cold winter day right up to the doorstep of a warm house and going immediately inside; the sudden temperature change can cause an attack and could have been avoided.  In general but especially with a medical condition such as asthma it is necessary to be aware of one's environment and what's in it, both indoors and outdoors. '''Most often the Asthma is triggered by allergens.''' '''One big source of allergens is the carpet.''' Totally replace it with a tiles floor reduce the possibility to create a good environment for the allergens and it is more simple to clean and disinfect.
 
 
 
{{clear}}
 
 
 
==Asthma attack==
 
[[File:Asthma attack-airway (bronchiole) constriction-animated.gif|thumb|<center>'''Asthma attack'''</center>
 
1.''Inflammation'' causes the airway to swell. Making the airway narrow.
 
 
 
2.The muscles around the airway ''contract''; this makes the airway even more narrow.
 
 
 
3.The small objects going inside the airway are ''irritants'' which are trapped in the mucous. In healthy lungs a thin film of mucous lines the airways to trap irritants such as dust.
 
 
 
Tiny hairs that line the airways called ''cilia'', move back and forth in a whiplike motion and bring the mucous and trapped particles up to the pharynx to be coughed up.
 
 
 
When an asthma attack happens, too much mucous is made. This makes it difficult for the cilia to bring it up. The already narrow airway now becomes blocked with mucous. This makes it difficult, or in severe cases impossible to breathe, because air cannot get through[[File:Bronchiolar epithelium 3 - SEM.jpg|thumb|right|200px|These are the tiny hairs called ''cilia'', which line the inside of the airways.]]]]
 
 
 
An asthma attack is when, after a period of time when aperson has had only a few or no symptoms of asthma, the asthma gets worse all of a sudden, usually because of being exposed to one or more triggers. When the asthma attack happens, the tissue inside the airways swell because of ''inflammation'' - which is how the body tries to protect itself from harmful things, like germs and irritants. When the tissues swell the opening (called the ''lumen'') in the airway gets very narrow.
 
 
 
The ''smooth muscles'' (which are the kind of muscles in the body that do not ''contract'' voluntarily, like the ones in the arm) around the bronchi and bronchioles begin to ''spasm'' or contract which makes the opening in the airway even narrower. This is called a ''bronchospasm''.
 
 
 
Inside the lining of the airways are glands called, ''submucosal glands'', and above them, closer to the opening in the airway are cells called ''goblet cells'' - because they are shaped kind of like a goblet, which is a type of cup. The submucosal glands and the goblet cells make mucous which helps protect the inside of the airways. The mucous in the airways of healthy lungs is a thin film which traps irritants such as dust particles and pollen so they do not damage the airways and keep them from entering the air sacs (alveoli).
 
 
 
There are tiny hairs lining the airway called ''cilia''. The cilia wave back and forth like a liitle whips, and help push the mucous and the trapped particles up the airways to the "pharynx''. From there the mucous, the trapped particles from the lower airways can be coughed up (this is called ''sputum'').
 
 
 
During an asthma attack the submucosal glands and the goblet cells start making much more mucous than normal, and the mucous is also thicker than normal. This makes it very hard for the cilia to do their job, and bring the mucous up out of the airways. So now there is too much mucous being made, and not enough being brought up by the cilia. The airways are already to narrow to breathe properly because of the tissue swelling caused by inflammation and the constriction caused by the bronchospasms, so the extra mucous blocks the airway even more. This makes breathing very difficult. In fatal asthma attacks the airways can become so constricted and/or plugged with mucous that no air can get through at all.<ref>Green FH, Williams DJ, James A, ''et al.'' Increased myoepithelial cells of bronchial submucosal glands in fatal asthma. Thorax. 2010 Jan;65(1):32-8. PMID 19996346</ref><ref>Carroll NG, Mutavdzic S, James AL. Increased mast cells and neutrophils in submucosal mucous glands and mucus plugging in patients with asthma. Thorax. 2002 Aug;57(8):677-82. PMID 12149526</ref>
 
 
 
[[File:Stop hand nuvola.svg|30px|left|alt=|link=]]
 
There are other signs of breathing difficulty as in an asthma attack, which are important to learn, and knowing them can help tell if someone who cannot talk is having breathing problems. People who may not be able to let somebody know they are having breathing problems include babies and young children.
 
[[File:Sternal retractions.JPG|thumb|left|<center>'''Intercostal retractions'''</center>The skin between the ribs appears 'sucked in' as the ''intercostal muscles'' (located between the ribs) contract more than normal. This in an effort to help the body take in more air because of difficulty in breathing.
 
 
 
Intercostal retractions are a sign of breathing difficulty and a possible [[Signs and symptoms (medicine)|sign]] of worsening asthma or an asthma attack.]]
 
Some of the other signs of asthma include:
 
 
 
:'''Chest and neck retractions'''; which cause muscles within the chest and neck not normally used too much when breathing, to begin contracting as they try and help to take in more air. Retractions are how the body tries to get enough air because of the difficulty in breathing normally because of the asthma attack. These retractions cause the skin of the chest wall, the skin of the neck and or the breastbone (sternum) to move in when breathing. There are different types of retractions which depend on which muscles start contracting, and this depends on how much difficulty a person is having breathing during an attack.<ref>{{cite book| last1 = Fleisher| first1 = Gary R.| last2 = Ludwig| first2 = Stephen| title = Textbook of Pediatric Emergency Medicine| year = 2010| publisher = Lippincott Williams & Wilkins| isbn = 1-60547-159-3| page = 651 }}</ref>
 
 
 
:'''Nasal flaring''' is when the opening of the nostrils get larger than normal during breathing. It is often a sign that a person is having difficulty in breathing.
 
 
 
:'''[[Cyanosis|Blue lips and fingertips]]''': ''oxygen'' which is in the air we breathe, is what makes blood have a red color. Blood without oxygen has a blue color. Oxygen enters the body through the air sacs (alveoli) which are at the end of the airways. During an asthma attack it difficult for the body to get enough oxygen because it is difficult to get enough air. As less air with oxygen in it makes it to the air sacs and into the blood, there is less red blood (blood with oxygen in it) and more blue blood (blood without oxygen in it). The blue color of the lips and under the fingernails is because of the blue blood, which can be seen in the small blood vessels under the skin. More parts of the body start turning blue the longer the body goes without oxygen. When parts of the body turn blue because of lack of oxygen it is called ''cyanosis''.
 
 
 
:'''Sweating''' : sweating may be noticed especially on the forehead, but the skin does not feel warm, it may feel cool and ''clammy'' to touch.
 
:'''Rapid breathing''' (''tachypnea''); breathing in and out much faster than normal.
 
:'''Rapid heart beat''': (''[[tachycardia]]''): the heart starts beating much faster than normal.<ref>{{cite book| last = Rahm| first = Stephen J.| title = Pediatric Case Studies for the Paramedic| year = 2005| publisher = Jones & Bartlett Learning| isbn = 978-0-7637-2582-2| page = 6 }}</ref>
 
 
 
 
 
{{clear}}
 
 
 
==Diagnosis==
 
[[File:Peak expiratory flow meter-pediatric use.PNG|thumb|left|A child using a ''peak flow meter'' (PFM) which measures how well air moves out ( the ''peak expiratory flow'', or "PEF") of a person's lungs when they breath out (''exhale'').]]
 
A diagnosis of asthma is based on a person's:
 
* Medical history; information such as what signs and symptoms of asthma have they had
 
* Family medical history; has anyone they are related to had asthma or related conditions such as occur with those who are ''atopic''
 
* Physical examination and testing
 
'''Diagnostic Tests'''
 
 
 
There is no specific test that can tell if a person has asthma, however there are tests that can help in the diagnosis when the results are considered along with the medical and family history and physical exam
 
* Lung function tests [Pulmonary function tests (PFTs)]
 
** Spirometry; measures how much air the lungs are able to breathe in and how much air they breathe out and how fast a person can exhale.
 
*** Bronchoprovocation test; in this test the airways (bronchi and bronchioles) are ''provoked'' (to try and make something happen) into having a bronchospasm (make the airways constrict) this is to see how sensitive they are. Some of the things done to ''provoke'' a bronchospasm are making the person exercise, breathing cold air that gets colder, or breathing in a special chemical called ''methacholine''. The results of bronchoprovocation are checked using spirometry.
 
{{clear}}
 
===Differential diagnoses===
 
''Differential diagnoses'' are different medical disorders which may cause the same symptoms. Before a doctor makes a ''final diagnosis'', which means they are sure of what medical disorder is causing the problem, they think of what other medical conditions have the same or almost the same symptoms, and make sure it's not one of them.<ref>{{cite web |url= http://www.merriam-webster.com/dictionary/differential%20diagnosis |title=Differential diagnosis  |first= |last=|work=Free Merriam-Webster Dictionary |year=2012 |accessdate=December 19, 2012}}</ref>
 
 
 
The differential diagnoses of asthma include:
 
* Bronchiectasis
 
* Chronic obstructive pulmonary disease (COPD)
 
 
 
==Airway remodeling==
 
[[File:Goblet cell hyperplasia-2.gif|thumb|<center>'''Goblet cell hyperplasia'''</center>Airway remodeling may cause the body to make more mucous-making goblet cells than normal. More goblet cells than normal equals more mucous than normal.]]
 
Airway remodeling is when there are permanent physical changes to the airways that also affects how they work. This may happen after chronic long-term asthma. After cycles of inflammation, damage and repair to the airways. permanent remodeling of the airways may occur. This is when the physical structure of the airway changes. This will cause permanent airway narrowing (they are always more narrow than normal and get narrower during an asthma attack),  bronchospasms are more easily triggered (bronchial hyperresponsivenes), airway edema (fluid in the airway), and mucus hypersecretion (too much mucous is made) as well as the build-up of collagen around the airway which is called fibrosis. Airway remodeling has been observed in chldren as young as six.<ref>{{cite book| last1 = Wheeler| first1 = Derek S.| last2 = Wong| first2 = Hector R.| title = Pediatric Critical Care Medicine: Basic Science And Clinical Evidence| year = 2007| publisher = Springer Science & Business Media| isbn = 978-1-84628-463-2| page = 46 }}</ref>
 
 
 
[[File:Stop hand nuvola.svg|30px|left|alt=|link=]]Not managing asthma properly can lead to airway remodeling and this can increase the risk of dying from an asthma attack.<ref>A.L. James, J.G. Elliot, M.J. Abramson, E.H. Walters Time to death, airway wall inflammation and remodeling in fatal asthma. Eur Respir J 2005; 26: 429–434. ERS Journals Ltd 2005</ref><ref>Therapeutic Targets in Airway Inflammation Eds. N. Tony Eissa, David P. Huston : CRC Press; 1 edition (2003) pp.752-753. {{ISBN|978-0-8247-0956-3}}</ref> One of the main problems which cause poor asthma management is not using the asthma inhaler correctly.<ref>Al-Jahdali H1, Ahmed A, Al-Harbi A, Khan M, Baharoon S, Bin Salih, ''et al.'' Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy Asthma Clin Immunol. 2013 Mar 6 ;9(1):8. doi: 10.1186/1710-1492-9-8.</ref> One of the main reasons for improper inhaler use is the asthma patient not having the proper knowledge in using the inhaler due to not receiving proper instruction.<ref>Al-Jahdali H, Anwar A, Al-Harbi A, Baharoon S, Halwani R,''et al.'' Factors associated with patient visits to the emergency department for asthma therapy. BMC Pulm Med. 2012 Dec 17; 12:80.PMID 15334198</ref>
 
 
 
'''Goblet cell and submucosal gland hyperplasia''': Among the physical changes that may happen in airway remodeling is ''goblet cell hyperplasia'' and ''submucosla gland hyperplasia''. Submucosal glands  and goblet cells make mucous which helps to protect the airways by trapping harmful particles like dust and pollen. The mucous is normally a thin film which lines the airways. The mucous and whatever particles they trap are brought up to the ''pharynx'' by tiny (microscopic) hairs on the inside of the airway that move back and forth  called ''cilia''.
 
 
 
During an asthma attack the submucosal glands and goblet cells make too much mucous, and it is thicker than normal which makes it harder for the cilia to bring the mucous up. When airway remodeling happens the body may make many more submucosal glands and  goblet cells than normal, which means even more mucous is made. There may be too much mucous for the cilia to bring up and the airway may become blocked. This is one of the reasons that people with airway remodeling often have more severe asthma. In fatal cases the airway may have become totally plugged causing ''asphyxia''.<ref>{{cite book| last1 = Barnes| first1 = Peter J.| last2 = Drazen| first2 = Jeffrey M.| last3 = Rennard| first3 = Stephen I.| title = Asthma and COPD: Basic Mechanisms and Clinical Management| year = 2009| publisher = Academic Press| isbn = 0-12-374001-0| page = 217 }}</ref>
 
 
 
{{clear}}
 
 
 
 
 
'''Airway Reconstruction Methods'''
 
 
 
Regular Breastfeeding sessions are a proven benefit to airway reconstruction. While previous studies have shown a similar effect between breastfeeding and asthma risk, this research is the first that showed a link between the length of breastfeeding and the number of wheezing episodes. Also, this study found evidence that the first asthma-related symptoms occur earlier in life if children were breastfed for shorter lengths of time or not exclusively. The study shows it’s not the nutritional benefit from the liquid, it’s the pull on lung of which dilates the smooth muscles of the air passage. Dry-nursing has actually proven to had been more beneficial in this study for strengthening airway health in both children and adults. Dilating the airways will strengthen them and the lungs themselves.
 
 
 
{{clear}}
 
 
 
==Treatment==
 
{{multiple image
 
| align    = right
 
| direction = horizontal
 
| image1    = Asthma inhaler use.PNG
 
| width1    = 228
 
| caption1  = <center>'''Asthma inhaler'''</center><br>A woman using a ''metered-dose asthma inhaler'' (or just ''inhaler'' for short), which has medicine to treat an asthma attack inside.
 
 
 
When the inhaler is put in the mouth and pressed, the medicine is sprayed into the throat and then enters the lungs.<ref>{{cite book| last = Falvo| first = Donna R.| title = Medical and Psychosocial Aspects of Chronic Illness and Disability| year = 2005| publisher = Jones & Bartlett Learning| isbn = 978-0-7637-3166-3| page = 338 }}</ref>
 
| image2    = Asthma action plan-NHLBI.PNG
 
| width2    = 253
 
| caption2  = <center>'''Asthma action plan'''</center><br>An asthma action plan or ''management plan'', is used to help a person with their asthma. It shows what kind of medicines to take, and when to take them. How to take care of their asthma everyday, AND how to take care of their asthma when it gets worse, or when they have an asthma attack. It helps them know when it is time to call the doctor or go to the emergency room.<ref>{{cite book| last1 = Douglas| first1 = J Graham| last2 = Elward| first2 = Kurtis S| title = Asthma: Clinician's Desk Reference| year = 2010| publisher = CRC Press| isbn = 978-1-84076-082-8| page = 100 }}</ref>
 
 
 
}}
 
Asthma can be controlled most often by avoiding contact with triggers and by using certain [[drug]]s.  Most asthma sufferers carry special medicines around with them. These are called '''[[inhaler]]s'''. The medicine inside the inhaler opens the tubes that go to the lungs. The inhaler is usually used to prevent an asthma attack, or to stop an attack that is already happening.[[File:Correct_way_to_use_inhaler.ogv|thumb|Many people do not use their inhalers the right way.This video shows the correct way to use a metered dose inhaler when used without a spacer.]]
 
'''Rescue medicine''' — A rescue medicine is an [[inhaler]] ("puffer") that is used if a person thinks they are having an asthma attack.
 
 
 
'''Controller medicine''' — A controller medicine is a medicine in either a pill or an [[inhaler]] taken every day to prevent asthma attacks.
 
 
 
'''Common treatment in a hospital'''
 
 
 
Hospitals have other options they can use in an emergency when the regular treatments don't work:
 
* [[Oxygen]]
 
* Certain drugs that act like an asthma spray, but are much stronger
 
* Certain drugs that can be given through an IV (intravenously).
 
* [[Steroid]]s
 
* Breathing aids (including tubes, and valves in very severe cases)
 
 
 
'''Unconventional Treatments / At Home Remedies'''
 
* Warm steam baths have often been used to help alleviate nasal congestion and airway irritation associated with asthma.
 
* Omega-3 fatty acids are often used as a natural remedy to help prevent and treat heart disease. Though some research suggests that omega-3s may also help to decrease airway inflammation and boost lung function
 
* The Buteyko Breathing Technique is based on the premise that raising blood levels of carbon dioxide through shallow breathing can help people with asthma. Carbon dioxide is believed to dilate the smooth muscles of the airways.
 
* Hot beverages are known to open breathing passages, have been said to open airways for irritated asthma symptoms. This method has been said to give temporary relief.
 
* High consumption of apples may protect against asthma. Daily intake of fruits and vegetables in childhood decreased the risk of asthma.
 
* Breastfeeding or the reflection of in adolescence and adults has been proven to strengthen and promote airway health. The strain from the pull on the lung will dilate the smooth muscles of the airways. Extended therapeutic sessions on a regular basis have been shown to dramatically improve air passage function, and promote less asthma complications.
 
 
 
'''Drugs that may worsen an asthma attack'''[[File:Stop hand nuvola.svg|30px|left|alt=|link=]]
 
 
 
There are certain types of drugs that make asthma worse or that can trigger such an attack. Certain types of drugs should only be used in very specific situations. Some of these drugs are:
 
* [[Non-steroidal anti-inflammatory drug]]s or 'NSAID' for short. [[Aspirin]] is a NSAID and some people are allergic to it, or may have a higher risk of becoming allergic to it, even if they had used it before.
 
* [[Beta blocker]]s are a kind of drug used to treat heart problems, but should not be taken by people with asthma.
 
* [[Acetaminophen]] is another drug that is believed might help not only to cause asthma, but also make asthma worse in people who already have it. Acetaminophen is an [[analgesic]], a pain reliever. Because of its pain-reliving properties, Acetaminophen is often added to other drugs. Labels should always be read when taking any kind of medicine, including over-the-counter drugs.<ref>{{cite book| title = Nursing Nonprescription Drug Handbook| year = 2001| publisher = Lippincott Williams & Wilkins| isbn = 978-1-58255-101-2| page = 390 }}</ref>
 
* '''ACE Inhibitors'''; are a type of drug usually used to treat high blood pressure and heart disease.  They usually don’t make asthma worse, but in rare cases they may cause some of the signs and symptoms of asthma, such as airway obstruction and coughing, especially in the first few weeks of taking ACE Inhibitors.<ref>Lunde H, Hedner T, Samuelsson O, ''et al.'' Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors. BMJ. 1994 Jan 1;308(6920):18-21. PMID 8298346</ref><ref>{{cite book| last1 = Gershwin| first1 = M. Eric| last2 = Albertson| first2 = Timothy| last3 = Albertson| first3 = Timothy Eugene| title = Bronchial Asthma: Principles of Diagnosis and Treatment| year = 2001| publisher = Springer Science & Business Media| isbn = 978-0-89603-861-5| page = 364 }}</ref>
 
* '''Sleeping pills and trainquilizers'''; should usually not be taken by people with asthma.<ref>{{cite book| last = Ayd| first = Frank J.| title = Lexicon of Psychiatry, Neurology, and the Neurosciences| year = 2000| publisher = Lippincott Williams & Wilkins| isbn = 978-0-7817-2468-5| page = 675 }}</ref>
 
 
 
'''Managing comorbid asthma, depression and/or anxiety'''
 
 
 
Depression and anxiety have a negative impact on asthma.<ref name="Kew, K. 2016">Kew, K., Nashed, M., Dulay, V., Yorke, J. (2016) Cognitive behavioural therapy (CBT) for adults andadolescents with asthma. Cochrane Database of Systematic Reviews 2016, Issue 9.</ref> Comorbid anxiety with asthma is particularly confusing because of the similarity of symptoms and interference in perception and treatment of asthma. The National Asthma Council Australia <ref>Australian Asthma Handbook – Quick Reference Guide, Version 1.1. (2015) National Asthma Council Australia. http://www.asthmahandbook.org.au</ref> recommends treatment for comorbid psychological symptoms. Cognitive Behaviour Therapy (CBT) is one recommended treatment for anxiety <ref>NICE (2011). National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. NICE guidelines [CG113]. Published date: January 2011. www.nice.org.uk/guidance/cg113</ref> and depression.<ref>NICE (2009). National Institute for Health and Care Excellence. Depression in adults: the treatment and management of depression in adults. NICE guidelines [CG90]. Published date: October 2009. www.nice.org.uk/guidance/cg90</ref> There is tentative research evidence suggesting that a program of CBT amended for asthma, delivered in conjunction with medical treatment and in close liaison with your medical team, can improve anxiety, asthma and quality of life.<ref name="Kew, K. 2016"/> Clinicians intending to deliver CBT for comorbid asthma, anxiety or depression should refer to <ref>Feldman, J., Giardino, N., & Lehrer, P. (2000). Asthma and panic disorder. In D. Mostofsky and D. Barlow (Eds). The management of stress and anxiety in medical disorders (pp. 220 -239). Needham Heights, MA:Allyn & Bacon.</ref>  and the research reviewed by <ref name="Kew, K. 2016"/> for guidance on safe and effective intervention.
 
 
 
==Comorbidities==
 
[[File:Asthma comorbidities 2.PNG|thumb|480px|These are some of the more common problems a person with asthma may also have.]]
 
 
 
Often, having one medical problem makes it more likely a person will also have one or more other medical or psychiatric problems. These other disorders are the "comorbid problems" or "comorbidities".<ref>[http://www.merriam-webster.com/dictionary/comorbid Comorbid &#124; Definition of Comorbid by Merriam-Webster]: Free Merriam Webster Dictionary, 2012. Retreived February 25, 2013</ref> There are various comorbid medical and psychiatric conditions associated with asthma.
 
 
 
<font size="3">'''Respiratory disorders'''</font>
 
* Chronic obstructive pulmonary disorder (COPD)
 
* Respiratory infections
 
* Chronic sinusitis<ref>{{cite book| last1 = Wilmott| first1 = Robert W.| last2 = Kendig| first2 = Edwin L.| last3 = Boat| first3 = Thomas F.| last4 = Bush| first4 = Andrew| last5 = Chernick| first5 = Victor| title = Kendig and Chernick's Disorders of the Respiratory Tract in Children| year = 2012| publisher = Elsevier Health Sciences| isbn = 1-4377-1984-8 }}</ref>
 
* Rhinitis: allergic (atopic), nonallergic
 
* Hyperventilation syndrome<ref>{{cite book| last1 = Fleisher| first1 = Gary R.| last2 = Ludwig| first2 = Stephen| title = Textbook of Pediatric Emergency Medicine| year = 2010| publisher = Lippincott Williams & Wilkins| isbn = 1-60547-159-3| page = 1652 }}</ref>
 
* Allergic bronchopulmonary aspergillosis (ABPA) is a disorder that affects the airways of the lungs which is caused by an allergic hypersensitivity to the fungus ''Aspergillus fumigatus''.
 
 
 
<font size="3">'''Gastrointestinal disorders'''</font>
 
* Gastroesophageal reflux disease (GERD)
 
* Eosinophilic esophagitis (EE)
 
 
 
<font size="3">'''Psychiatric disorders'''</font>
 
* Depression
 
* Anxiety disorders
 
** Panic disorder
 
<font size="3">'''Sleep disorders'''</font>
 
* Obstructive sleep apnea
 
 
 
<font size="3">'''Skin disorders'''</font>
 
* Atopic dermatitis (AD): is a type of [[eczema]]
 
 
 
==Epidemiology==
 
[[File:Asthma rates age sex race-United States 2011.jpg|thumb|left|Asthma rates by age, sex and race in the United States in 2011. (CDC)]]
 
[[File:Asthma global prevalence.png|thumb|220px|This map shows how many asthma cases there were in each country in 2003.<ref>[http://www.ginasthma.org/pdf/GINABurdenSummary.pdf Global Initiative for Asthma]</ref>
 
<center>'''Percentage of population'''</center>{{Multicol}}
 
{{legend|#FF0000|>10.1}}
 
{{legend|#FFA500|7.6-10.0}}
 
{{legend|#FFF200|5.1—7.5}}
 
{{legend|#00FF00|2.5-5.0}}
 
{{legend|#0000FF|0-2.5}}
 
{{legend|#b3b3b3|no data: for these areas there was not enough information.}}
 
{{Multicol-end}} ]]
 
In medicine ''epidemiology'' is the study of what causes diseases and medical conditions, how often they happen, where they happen and who they happen to.<ref>[http://www.merriam-webster.com/dictionary/epidemiology epidemiology]: ''Free Merriam Webster Dictionary'' 2013, retrieved January 11, 2013</ref>
 
 
 
It is more common in [[developed country|developed]] countries than [[developing countries]]. The [[United States]] and [[Canada]] have some of the highest asthma rates in the world even though they are not poor countries. In [[Africa]] the country of [[South Africa]] has the highest asthma rate on the whole [[continent]] even though it is one of the richest countries.
 
 
 
More than 80% of the people who die from asthma are usually from low and middle income countries, but not always, as South Africa has the fourth highest death rate in the world even though it is one of the richer countries in the world.<ref>{{cite web |author=World Health Organization |authorlink=World Health Organization|title=WHO: Asthma|url=http://www.who.int/mediacentre/factsheets/fs307/en/ |accessdate=2007-12-29|archiveurl=https://web.archive.org/web/20071215181927/http://www.who.int/mediacentre/factsheets/fs307/en/| archivedate= 15 December 2007| deadurl= no}}</ref> In the United States the death rates are higher for females, adults and people of African descent.<ref>Centers for Disease Control and Prevention: NCHS Data Brief
 
Number 94, May 2012; Trends in Asthma Prevalence, Health Care Use, and Mortality in the United States, 2001–2010. retrieved on March 3, 2013 [https://www.cdc.gov/nchs/data/databriefs/db94.htm Products - Data Briefs - Number 94 - May 2012]</ref>
 
 
 
As of 2011, 235–300 million people worldwide are affected by asthma,<ref>{{cite web |title=World Health Organization Fact Sheet Fact sheet No 307: Asthma |year=2011|url=http://www.who.int/mediacentre/factsheets/fs307/en/ |archiveurl=https://web.archive.org/web/20110629035454/http://www.who.int/mediacentre/factsheets/fs307/en/ |archivedate=2011-06-29 |accessdate=February 20 17th,2013}}</ref> and approximately 250,000 people die per year from the disease. Rates vary between countries with prevalences between 1 and 18%.
 
 
 
The amount of asthma cases reported each year has gotten much higher between the 1960s and 2008<ref>{{cite journal |author=Grant EN, Wagner R, Weiss KB |title=Observations on emerging patterns of asthma in our society |journal=[[J Allergy Clin Immunol]] |date=August 1999  |volume=104 |pages=S1–S9 |pmid=10452783 |doi=10.1016/S0091-6749(99)70268-X |issue=2 Pt 2}}</ref><ref>{{cite journal |author=Anandan C, Nurmatov U, van Schayck OC, Sheikh A |title=Is the prevalence of asthma declining? Systematic review of epidemiological studies |journal=Allergy |volume=65 |issue=2 |pages=152–67 |date=February 2010  |pmid=19912154 |doi=10.1111/j.1398-9995.2009.02244.x }}</ref><ref>{{cite book| last = Mason| first = John F. Murray| title = Murray and Nadel's textbook of respiratory medicine| edition = 5th ed.| year = 2010| publisher = Saunders/Elsevier| location = Philadelphia, PA| isbn = 978-1-4160-4710-0| pages = Chapter 38 }}</ref> Rates of asthma have plateaued in the developed world since the mid-1990s with recent increases primarily in the developing world.<ref>{{cite journal|last=Bousquet|first=J|coauthors=Bousquet, PJ; Godard, P; Daures, JP|title=The public health implications of asthma.|journal=Bulletin of the World Health Organization|date=2005 Jul|volume=83|issue=7|pages=548–54|pmid=16175830}}</ref> Asthma affects approximately 7% of the population of the United States and 5% of people in the United Kingdom.<ref>{{cite journal | last=Anderson | first=HR |author2=Gupta R |author3=Strachan DP |author4=Limb ES  | title=50 years of asthma: UK trends from 1955 to 2004 | journal=Thorax | volume=62 | issue=1 | pages=85–90 |date=January 2007 | pmid=17189533 | doi=10.1136/thx.2006.066407 | pmc=2111282 }}</ref> Canada, Australia and New Zealand have rates of about 14–15%.<ref>{{cite book|last=Masoli|first=Matthew|title=Global Burden of Asthma|year=2004|page=9|url=http://www.ginasthma.org/pdf/GINABurdenReport.pdf}}</ref>
 
{{clear}}
 
==Other websites==
 
* [https://www.youtube.com/watch?v=Rdb3p9RZoR4 How to Use an Inhaler]
 
 
 
==References==
 
{{reflist|2}}
 
 
 
[[Category:Diseases]]
 
[[Category:Pulmonology]]
 

Revision as of 19:52, 26 June 2019


Editor-In-Chief: Prab R. Tumpati M.D.. Founder, WikiMD and W8MD Weight Loss, Sleep and MedSpa Centers. Dr. Tumpati is board certified physician practicing sleep medicine, obesity medicine, aesthetic medicine and internal medicine. Dr. Tumpati’s passion is prevention rather than cure. As a physician with fellowship training in Obesity Medicine, Dr. Tumpati has a unique approach to wellness, weight loss, aesthetics with a focus on prevention rather than cure. Dr. Tumpati believes in educating the public on the true science and art of medicine, nutrition, wellness and beauty.

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What Asthma Is

Asthma is a disease that affects your lungs. It is the most common long-term disease of children. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. It is with you all the time, but you may have asthma attacks only when something bothers your lungs.

We know that family history contributes to susceptibility, but in most cases we don’t know what causes asthma to develop, and we don’t know how to cure asthma. You can control your asthma by knowing the warning signs of an attack, avoiding things that trigger an attack, and following the advice of your doctor. When you control your asthma, you won’t have symptoms like wheezing or coughing, you’ll sleep better, you won’t miss work or school, you’ll be able to take part in all physical activities, and you won’t have to visit the hospital.


Effects of Asthma

In 2001, 20.3 million Americans had asthma, and 12 million had had an asthma attack in the previous year. If a person has a parent with asthma, he or she is three to six times more likely to develop asthma than is a person who does not have a parent with asthma.

How Asthma Is Diagnosed

Asthma can be difficult to diagnose, especially in children under 5 years old. Regular physical exams that include checks of lung function and for allergies can help make the right diagnosis.

A health-care provider trying to diagnose asthma will ask you questions about coughing, especially coughing at night, and whether breathing problems are worse after physical activity or during a particular time of year. Providers also ask about other symptoms, such as chest tightness, wheezing, and colds that last more than 10 days.

Also, a provider will ask about your family history of asthma, allergy and other breathing problems, and your home environment. He or she also will ask about lost school or work days and limits on your activity.

Testing of lung function, called spirometry, is another way to diagnose asthma. A spirometer is a piece of equipment that measures the largest amount of air you can exhale after taking a very deep breath. Airflow can be measured before and after you use an asthma medication.


What An Asthma Attack Is

Airways are the paths that carry air to the lungs. As the air moves through the lungs, the airways become smaller, like branches of a tree. During an attack, the sides of the airways in your lungs become inflamed and swollen. Muscles around the airways tighten, and less air passes in and out of the lungs. Excess mucus forms in the airways, clogging them even more. The attack, also called an episode, can include coughing, chest tightness, wheezing, and trouble breathing.


Causes Of An Asthma Attack

Environmental exposures, such as house dust mites and environmental tobacco smoke, are important triggers of an attack. Some of these triggers are listed in the box below.


How Asthma Is Treated

You can control your asthma and avoid an attack by taking your medicine as prescribed and avoiding the triggers that can cause an attack. It’s just as important that you remove the triggers in your environment that you know make your asthma worse.

Medicine for asthma is different for each person. It can be inhaled or taken as a pill and comes in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you are using your quick-relief medicines more and more you should visit your health-care provider to change your asthma management plan. Long-term control medicines make you have fewer and milder attacks, but they don’t help you if you’re having an attack.

Asthma medicine can have side effects. Most are mild and go away on their own. Ask your health-care provider about the side effects of your medicines.

The important thing to remember is that you can control your asthma. With your health-care provider’s help, make your own asthma management plan so you know what to do based on your own symptoms. Decide who should have a copy of your plan and where he or she should keep it. You can learn more about asthma management plans from the American Academy of Family Physicians family doctor. And remember to take your long-term control medicine even when you don’t have symptoms.


Important Asthma Triggers

Environmental Tobacco Smoke, Also Known As Secondhand Smoke Parents, friends, and relatives of children with asthma should try to stop smoking. Until they can successfully quit, they should smoke only outdoors, not in the home or in the family car. They should not allow others to smoke in the home, and should make sure the child's school is smoke-free.

Dust Mites

Mattress covers and pillow case covers provide a barrier between house dust mites and the person with asthma. Natural mattresses that are hypoallergenic, such as the botanical latex foam mattress, do not contain the petrochemicals that man made mattresses do and can be beneficial for the asthma suffer. Down-filled pillows, quilts, or comforters should not be used and stuffed animals and clutter should be removed from bedrooms.

Outdoor Air Pollution

Pollution caused by industrial emissions and automobile exhaust can cause an asthma episode. In large cities that have air pollution problems the number of emergency department visits for asthma episodes goes up when the air quality is very poor.

Cockroach Allergen

Decreasing exposure to cockroaches in the home can help reduce asthma attacks. You may find cockroaches any place where food is eaten and crumbs are left behind. Remove as many water and food sources as you can because cockroaches need food and water to survive. Vacuum or sweep these areas at least every 2-3 days. You can also use roach traps or gels to decrease the number of cockroaches in your home.

Pets

Furry pets may trigger an attack. The simplest solution to this situation is to find another home for the pet. However, some pet owners may be too attached to their pets or unable to locate a safe new home for the animal. Any animal causing an allergic reaction should not be allowed in the bedroom. Pets should be kept outside as much as possible and bathed weekly. People with asthma are not allergic to their pet’s fur, so trimming the pet’s fur will not help your asthma. Frequent vacuuming will reduce the presence of the allergen. If the room has a hard surface floor, it should be damp mopped weekly.

Mold

When mold is inhaled, it can cause asthma attacks. Eliminating mold throughout the home can help control asthma attacks. Keep humidity levels between 35% and 50%. In hot, humid climates, this may require the use of air conditioning and/or dehumidifiers. Fixing water leaks and cleaning up any mold in the home can also help.

Other Triggers

Strenuous physical exercise; adverse weather conditions like freezing temperatures, high humidity, and thunderstorms; and some foods and food additives and drugs can trigger asthma episodes. Strong emotional states also can lead to hyperventilation and an asthma episode. People with asthma should learn if these things trigger their episodes and avoid them when possible.