June 2014

Managing Asthma
Learn To Breathe Easier

Illustration of a girl blowing into a peak flow meter while sitting alongside her mother.

Most people have little trouble climbing a flight of stairs or taking a brisk walk, but these simple activities can be tough for someone with asthma. Although there’s no cure, you can breathe easier by knowing how to keep the condition under control.

Asthma is a common, long-lasting disease that affects the lungs. It can begin in childhood or adulthood. More than 25 million Americans have asthma, including 7 million children. Without proper care, asthma can become serious, even deadly. But most people with asthma learn to manage the disease so they have few symptoms or none at all.

Major symptoms of asthma include wheezing (a whistling sound when breathing), shortness of breath, coughing that’s worse at night and early morning, and chest tightness. These symptoms arise from reactions that narrow the airways, the tubes that carry air into and out of your lungs. When symptoms flare up, it’s called an asthma attack.

The airways of people with asthma are prone to inflammation, which causes the airways to swell and narrow. They become extra sensitive to certain substances that are breathed in. These are called “triggers.”

Asthma triggers can worsen inflammation and cause the muscles around the airways to tighten, further shrinking air passages and making it harder to breathe. Cells in the airways might also produce excess mucus (a sticky, thick liquid), making the airways even narrower.

Common asthma triggers include cigarette smoke, air pollution, mold, house dust mites, and furry animal dander. Other asthma triggers include weather changes, exercise, stress, and respiratory infections like common colds.

“Preventing such infections is important,” stresses Dr. Stewart Levine, an asthma expert at NIH. “People who have asthma should also obtain a flu shot, as they may be at higher risk for flu-related complications.”

Asthma is one of the most common causes of chronic (long-term) illness in children—and some symptoms appear more often in children than in adults. “Children have smaller airways, so if they have asthma, they tend to wheeze more often, particularly during the night,” says Dr. Robert Lemanske, Jr., a pediatric asthma expert at the University of Wisconsin.

Some preschool age children frequently wheeze when they get colds but don’t go on to develop chronic asthma. “But some kids start wheezing at age 3, and the problem continues,” says Lemanske. “These kids also tend to be more allergic.”

A doctor will test for asthma by doing a physical exam and asking about your medical history to learn when and how often your symptoms occur. Your doctor may also ask you to breathe in and blow out into the tube of a spirometer. This device measures how much air you can breathe out and how fast you can do it.

“It’s sometimes tough to do a spirometry test on young children,” says Dr. Michelle Freemer, an NIH asthma expert. For youngsters, a doctor will do a physical exam and may perform other tests to identify possible asthma triggers.

Whether you’re young or older, it’s important to know how to manage your asthma. Work with your doctor to develop a written asthma action plan. (Here’s a sample asthma action plan from NIH). Your action plan should spell out the daily treatment plan to help control your asthma. This may include recommendations for medications and for avoiding exposure to your triggers. The action plan should also give specific instructions for what to do when asthma symptoms start and what actions to take if symptoms worsen, including when to seek medical attention, go to the hospital, or call an ambulance.

“Patients with asthma should have an action plan, so they know if they’re getting into trouble and what to do about it,” Freemer says.

For some patients, Freemer notes that a hand-held device called a peak flow meter can help you monitor your asthma. You blow into the device to measure how strongly your lungs can force air out. If the meter shows that your air flow is lower than normal, you can use your action plan to adjust your treatment.

“There are 2 main types of medicines for managing asthma: quick-relief and long-term controllers,” says Levine. Quick-relief medicines—such as short-acting bronchodilator inhalers—are used to relax the muscles in the airways to make it easier to breathe within a few minutes. If exercise is an asthma trigger, doctors may recommend taking this medicine 5 to 15 minutes before exercise or strenuous activity.

Long-term control medicines—such as inhaled corticosteroids—are used every day to help control symptoms and prevent asthma attacks. “Inhaled corticosteroids are recommended as the preferred long-term control medications for most children and adults,” says Freemer. “Taken daily, they help reduce inflammation to control the disease.”

If young children have trouble taking inhaled medications, there are masks and other devices that can help. Some kids are given a nebulizer, a portable machine that releases medicine in a mist.

A small percentage of people with asthma have a hard time controlling their symptoms even when they take their medicines regularly. Their airways become extremely inflamed and particularly sensitive to asthma triggers. They wheeze more, wake more throughout the night, and are at greater risk for breathing failure and trips to urgent care. If your asthma is severe, see a specialist to identify the most appropriate, personalized treatment.

The underlying causes of asthma are still unclear. Researchers believe asthma is caused by a combination of your genes and environmental factors. If you have allergies or a parent who has asthma, you’re at increased risk for the disease. Obesity and exposure to cigarette smoke may also raise the risk of developing asthma. NIH scientists are continuing to investigate the causes of this disease.

Researchers are also working to develop new approaches to help prevent and treat asthma. Levine’s team is studying the effects of house dust mites inside the home. While exposing mice to dust mites, the researchers identified a protein in the lung that blocked the development of asthma. With further research, the finding may eventually lead to new approaches for preventing or controlling asthma symptoms in people.

If you or your loved ones have asthma, identify your triggers and try to avoid them. Monitor your symptoms, and take prescribed medications regularly.

“For most people with asthma, if you take your prescribed medicines and stay away from the triggers, you’ll do well,” Levine says. Keep your asthma under control so you can keep living life to the fullest.