Asthma

What Is Asthma? back to top

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

In most cases, we don't know what causes asthma, and we don't know how to cure it. We know that if someone in your family has asthma, you are also more likely to have it.

You can control your asthma by knowing the warning signs of an attack, staying away from things that trigger an attack, and following the advice of your doctor or other medical professional. When you control your asthma:

• you won't have symptoms such as wheezing or coughing,
• you'll sleep better,
• you won't miss work or school,
• you can take part in all physical activities, and
• you won't have to go to the hospital.

How Is Asthma Diagnosed? back to top

Asthma can be hard to diagnose, especially in children younger than 5 years of age. Regular physical checkups that include checking your lung function and checking for allergies can help your doctor or other medical professional make the right diagnosis.

During a checkup, the doctor or other medical professional will ask you questions about whether you cough a lot, especially at night, and whether your breathing problems are worse after physical activity or during a particular time of year. Doctors will also ask about other symptoms, such as chest tightness, wheezing, and colds that last more than 10 days. They will ask you whether your family members have or have had asthma, allergies, or other breathing problems, and they will ask you questions about your home. The doctor will also ask you about missing school or work and about any trouble you may have doing certain activities.

A lung function test, called spirometry (spy-rom-e-tree), is another way to diagnose asthma. A spirometer (spy-rom-e-ter) measures the largest amount of air you can exhale, or breathe out, after taking a very deep breath. The spirometer can measure airflow before and after you use asthma medicine.

What Is an Asthma Attack? back to top An asthma attack happens in your body's airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucus that your body produces clogs up the airways even more. The attack may include coughing, chest tightness, wheezing, and trouble breathing. Some people call an asthma attack an episode. What Causes an Asthma Attack? back to top An asthma attack can occur when you are exposed to things in the environment, such as house dust mites and tobacco smoke. These are called asthma triggers.

How Is Asthma Treated? back to top

You can control your asthma and avoid an attack by taking your medicine exactly as your doctor or other medical professional tells you to do and by avoiding things that can cause an attack.

Not everyone with asthma takes the same medicine. Some medicines can be inhaled, or breathed in, and some can be taken as a pill. Asthma medicines come in two types—quick relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you need to use your quick-relief medicines more and more, you should visit your doctor or other medical professional to see if you need a different medicine. Long-term control medicines help you have fewer and milder attacks, but they don’t help you if you’re having an asthma attack.

Asthma medicines can have side effects, but most side effects are mild and soon go away. Ask your doctor or other medical professional about the side effects of your medicines.

The important thing to remember is that you can control your asthma. With your doctor’s or other medical professional’s help, make your own asthma action plan (management plan) so that 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.

All people with asthma should have an asthma action plan. An asthma action plan is a written plan that you develop with your doctor to help control your asthma.

The asthma action plan shows your daily treatment, such as what kind of medicines to take and when to take them. Your plan describes how to control asthma long term AND how to handle worsening asthma, or attacks. The plan explains when to call the doctor or go to the emergency room.

If your child has asthma, all of the people who care for him or her should know about the child's asthma action plan. These caregivers include babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.

People with Asthma Should Receive a Flu Vaccination Every Year.

Influenza, commonly called "the flu," is caused by the influenza virus, which infects the respiratory tract (nose, throat, lungs). People with asthma are more likely to have serious health problems from getting the flu, yet most people with asthma don’t receive a flu shot every year. Respiratory infections like influenza are more serious in patients with asthma, and such infections can often lead to pneumonia and acute respiratory disease.

If you have asthma, you need to take steps to prevent getting the flu. Respiratory infections such as the flu can affect your lungs, causing an asthma attack. Flu vaccine is the first and most important step you can take to protect yourself and your loved ones from the flu.

Important Asthma Triggers back to top

Americans spend up to 90% of their time indoors. Therefore, indoor allergens and irritants can play a significant role in triggering asthma attacks. It is important to recognize potential asthma triggers in the indoor environment and reduce your exposure to those triggers. You may not be affected by all of the triggers listed here. Your doctor can help you to determine which triggers affect your asthma and develop a specific plan to reduce your triggers.

Asthma attacks may include coughing, chest tightness, wheezing, and trouble breathing. An asthma attack can occur when you are exposed to things in the environment, such as house dust mites and tobacco smoke. These are called asthma triggers.

Your personal triggers can be very different from those of another person with asthma. Nonetheless, in every case, it's important to avoid your triggers to keep airway inflammation to a minimum and reduce the symptoms. Some of the most important triggers are listed below:

Environmental Tobacco Smoke (Secondhand Smoke) back to top

Environmental tobacco smoke is often called secondhand smoke because the smoke created by a smoker is breathed in by a second person nearby. Parents, friends, and relatives of children with asthma should try to stop smoking and should never smoke around a person with asthma. They should only smoke outdoors and not in the family home or car. They should not allow others to smoke in the home, and they should make sure their child's school is smoke-free.

Secondhand smoke, also known as Environmental Tobacco Smoke (ETS), consists of exhaled smoke from smokers and side stream smoke from the burning end of a cigarette, cigar or pipe. Secondhand smoke contains more than 4,000 substances, including several compounds that are known carcinogens.

Secondhand smoke can trigger asthma episodes and increase the severity of attacks. Secondhand smoke is also a risk factor for new cases of asthma in preschool aged children who have not already exhibited asthma symptoms. Scientists believe that secondhand smoke irritates the chronically inflamed bronchial passages of people with asthma. Secondhand smoke is linked to other health problems, including lung cancer, ear infections and other chronic respiratory illnesses, such as bronchitis and pneumonia.

Many of the health effects of secondhand smoke, including asthma, are most clearly seen in children because children are most vulnerable to its effects. Most likely, children's developing bodies make them more susceptible to secondhand smoke's effects and, due to their small size, they breathe more rapidly than adults thereby taking in more secondhand smoke. Children receiving high doses of secondhand smoke, such as those with smoking mothers, run the greatest relative risk of experiencing damaging health effects.

Dust Mites back to top

Dust mites are in almost everybody’s homes, but they don’t cause everybody to have asthma attacks. If you have asthma, dust mites may be a trigger for an attack. To help prevent asthma attacks, use mattress covers and pillowcase covers to make a barrier between dust mites and yourself. Don’t use down-filled pillows, quilts, or comforters. Remove stuffed animals and clutter from your bedroom.

Dust mites are tiny insects that are invisible to the naked eye. Every home has dust mites. They feed on human skin flakes and are found in mattresses, pillows, carpets, upholstered furniture, bedcovers, clothes, stuffed toys and fabric and fabric-covered items. Body parts and feces from dust mites can trigger asthma in individuals with allergic reactions to dust mites, and exposure to dust mites can cause asthma in children who have not previously exhibited asthma symptoms.

Actions You Can Take

• Cover mattresses and pillows with dust proof ("allergen-impermeable") zippered covers.
• Wash bedding (sheets, blankets and bedcovers) once per week in hot water.
• Choose washable stuffed toys, wash them often in hot water and dry them thoroughly.
• Keep stuffed toys off beds.
• Maintain low indoor humidity, ideally between 30-50% relative humidity. Humidity levels can be measured by hygrometers which are available at local hardware stores.
• Remove dust often with a damp cloth.
• Vacuum carpet and fabric-covered furniture to reduce dust build-up.
• Using vacuums with high efficiency filters or central vacuums may be helpful.
• People with asthma or allergies should leave the area being vacuumed.

Outdoor Air Pollution back to top

Pollution caused by industrial emissions and automobile exhaust can cause an asthma attack. Pay attention to air quality forecasts on radio, television, and Internet and plan your activities for when air pollution levels will be low if air pollution aggravates your asthma.

Transportation-related pollutants are one of the largest contributors to unhealthy air quality. Exposure to traffic emissions has been linked to many adverse health effects including: Exacerbation of asthma symptoms, diminished lung function, adverse birth outcomes, and childhood cancer.

Common transportation-related air pollutants include carbon monoxide, nitrogen dioxide, and particulate matter (found in haze, smoke, and dust). Ozone, formed when nitrogen dioxide and sunlight react, is also a common pollutant (found in smog). Particulate matter and ozone are known respiratory irritants that can aggravate asthma either by themselves or when combined with other environmental factors. Recent health studies also suggest that particulate matter is a risk factor for cardiovascular disease.

Ozone is often worst on hot summer days, especially in the afternoons and early evenings.

Particle pollution can be bad any time of year, even in winter. It can be especially bad when the weather is calm, allowing air pollution to build up. Particle levels can also be high:

— Near busy roads, during rush hour, and around factories.
— When there is smoke in the air from wood stoves, fireplaces, or burning vegetation.

Motor vehicles contribute to more than 50% of air pollution in urban areas. The design of communities and transportation systems impacts how often automobiles are used, how many automobile trips are taken, and how long those trips are. Reducing automobile trips by increasing mass transit use, carpooling, walking, and bicycling can help reduce air pollution, especially in urban areas.

Several years ago, researchers took advantage of a natural experiment to learn about the impact on pediatric asthma of decreased traffic levels and improved air quality. During the 1996 Summer Olympics Games in Atlanta, when peak morning traffic decreased 23% and peak ozone levels decreased 28%, emergency visits for asthma events in children decreased 42%. At the same time, children’s emergency room visits for causes other than asthma did not change. These results suggest that efforts to reduce traffic congestion and improve air quality can also help improve the respiratory health of a community.

Pay attention to your what your body is telling you. Notice your asthma symptoms when you are physically active. Do they happen more often when the air is more polluted? If so, you may be sensitive to air pollution.

Also notice any asthma symptoms that begin up to a day after you have been outdoors in polluted air. Air pollution can make you more sensitive to asthma triggers, like mold and dust mites. If you are more sensitive than usual to indoor asthma triggers, it could be due to air pollution outdoors.

Plan activities when and where pollution levels are lower. Regular exercise is important for staying healthy, especially for people with asthma. By adjusting when and where you exercise, you can lead a healthy lifestyle and help reduce your asthma symptoms when the air is polluted. In summer, plan your most vigorous activities for the morning. Try to exercise away from busy roads or industrial areas. On hot, smoggy days when ozone levels are high, think about exercising indoors.

Change your activity level. When the air is polluted, try to take it easier if you are active outdoors. This will reduce how much pollution you breathe. Even if you can’t change your schedule, you might be able to change your activity so it is less intense. For example, go for a walk instead of a jog. Or, spend less time on the activity. For example, jog for 20 minutes instead of 30.

Listen to your body. If you get asthma symptoms when the air is polluted, stop your activity. Find another, less intense activity. Keep your quick-relief medicine on hand when you’re active outdoors. That way, if you do have symptoms, you’ll be prepared. This is especially important if you’re starting a new activity that is more intense than you are used to.

Consult your health care provider. If you have asthma symptoms when the air is polluted, talk with your health care provider.

If you will be exercising more than usual, discuss this with your health care provider. Ask whether you should use medicine before you start outdoor activities.

Get up-to-date information about your local air quality: Sometimes you can tell that the air is polluted—for example, on a smoggy or hazy day. But often you can’t. In many areas, you can find air quality forecasts and reports on local TV or radio. These reports use the Air Quality Index, or AQI, a simple color scale, to tell you how clean or polluted the air is. You can also find these reports on the Internet at: www.epa.gov/airnow. You can use the AQI to plan your activities each day to help reduce your asthma symptoms.

Cockroach Allergen back to top

Cockroaches and their droppings may trigger an asthma attack. Get rid of cockroaches in your home and keep them from coming back by taking away their food and water. Cockroaches are usually found 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. At least every 2 to 3 days, vacuum or sweep areas that might attract cockroaches. You can also use roach traps or gels to decrease the number of cockroaches in your home.

Droppings or body parts of cockroaches and other pests can trigger asthma. Certain proteins, called allergens, are found in cockroach feces and saliva and can cause allergic reactions, or trigger asthma symptoms, in some individuals. Cockroaches are commonly found in crowded cities and the southern regions of the United States. Cockroach allergens likely play a significant role in asthma in many inner-city areas.

Actions You Can Take

An important key to pest management is to remove places in your home for pests to hide and to keep exposed areas free of food and water. But remember, pesticides you may spray to prevent pests are not only toxic to pests, they can harm people too. Try to use pest management methods that pose less of a risk. Tips to prevent pests:

• Do not leave food or garbage out.
• Store food in airtight containers.
• Clean all food crumbs or spilled liquids right away.
• Wash dishes as soon as you are done using them.
• Keep counters, sinks, tables and floors clean and clear of clutter.
• Fix plumbing leaks and other moisture problems.
• Seal cracks or openings around or inside cabinets.
• Remove piles of boxes, newspapers and other hiding places for pests from your home.
• Make sure trash is stored in containers with lids that close securely, and remove trash daily.
• Try using poison baits, boric acid or traps first before using pesticide sprays.
• If sprays are used:

• Limit the spray to the infested area.
• Do not spray where you prepare or store food, or where young children play, crawl or sleep.
• Carefully follow instructions on the label.
• Make sure there is plenty of fresh air when you spray and keep people with asthma out of the room while spraying.
• After spraying, the room should be thoroughly aired out.

Pets back to top

Furry pets may trigger an asthma attack. When a furry pet is suspected of causing asthma attacks, the simplest solution is to find the pet another home. If pet owners are too attached to their pets or are unable to locate a safe, new home for the pet, they should keep the pet out of the bedroom of the person with asthma.

Pets should be bathed weekly and kept outside as much as possible. People with asthma are not allergic to their pet’s fur, so trimming your pet’s fur will not help your asthma. If you have a furry pet, vacuum often to clean up anything that could cause an asthma attack. If your floors have a hard surface, such as wood or tile, and are not carpeted, damp mop them every week.

Your pet's dead skin flakes, urine, feces, saliva and hair can trigger asthma. Dogs, cats, rodents (including hamsters and guinea pigs) and other mammals can trigger asthma in individuals with an allergic reaction to animal dander. Proteins in the dander, urine or saliva of warm-blooded animals (e.g., cats, dogs, mice, rats, gerbils, birds, etc.) have been reported to sensitize individuals and cause allergic reactions or trigger asthma episodes in individuals sensitive to animal allergens.

The most effective method to control animal allergens in the home is to not allow animals in the home. If you remove an animal from the home, it is important to clean the home (including floors and walls, but especially carpets and upholstered furniture) thoroughly.

Pet allergen levels are reported to stay in the home for several months after the pet is removed even with cleaning. Isolation methods to reduce animal allergen in the home have also been suggested by reputable health authorities (e.g., keeping the animal in only one area of the home, keeping the animal outside or ensuring that people with allergies or asthma stay away from the animal) but the effectiveness of these methods has not been determined. Several reports in the literature indicate that animal allergen is carried in the air and by residents of the home on their clothing to all parts of the home, even when the animal is isolated. In fact, animal allergen is often detected in locations where no animals were housed.

Often, people sensitive to animal allergens are advised to wash their pets regularly. Recent research indicates that washing pets may only provide temporary reductions in allergen levels. There is no evidence that this short term reduction is effective in reducing symptoms and it has been suggested that during the washing of the animal the sensitive individual may be initially exposed to higher levels of allergens.

Thus, the most effective method to control exposure to animal allergens is to keep your home pet free. However, some individuals may find isolation measures to be sufficiently effective. Isolation measures that have been suggested include keeping pets out of the sleeping areas, keeping pets away from upholstered furniture, carpets, and stuffed toys, keeping the pet outdoors as much as possible and isolating sensitive individuals from the pet as much as possible.

Actions You Can Take

• If pets are one of your asthma triggers, strongly consider finding a new home for your pets.
• Keep pets out of the bedroom and other sleeping areas at all times and keep the door closed.
• Keep pets away from fabric-covered furniture, carpets and stuffed toys.
• Vacuum carpets, rugs and furniture two or more times per week.

Mold back to top

Inhaling or breathing in mold can cause an asthma attack. Get rid of mold in all parts of your home to help control your asthma attacks. Keep the humidity level in your home between 35% and 50%. In hot, humid climates, you may need to use an air conditioner or a dehumidifier or both. Fix water leaks, which allow mold to grow behind walls and under floors.

Molds are microscopic fungi that live on plant and animal matter. Molds can be found almost anywhere; they grow on virtually any substance when moisture is present.

Molds produce tiny spores to reproduce, just as plants produce seeds. Mold spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot indoors, they may begin growing and digesting whatever they are growing on in order to survive. Some molds can grow on wood, paper, carpet, foods and even dynamite.

There is no practical way to eliminate all molds indoors; the way to control indoor mold growth is to control moisture. If you think you have a mold problem and can see mold growth, you do not need environmental testing to determine what kind of mold you have. Instead, simply clean the mold from the surface it's growing on and dry the surface thoroughly.

If mold is a problem in your home, you need to clean up the mold and eliminate sources of moisture.

• Wash mold off hard surfaces and dry completely. Absorbent materials, such as ceiling tiles and carpet, may have to be replaced if they are contaminated with mold.
• Fix leaky plumbing or other sources of water.
• Keep drip pans in your air conditioner, refrigerator and dehumidifier clean and dry.
• Use exhaust fans or open windows in kitchens and bathrooms when showering, cooking or using the dishwasher.
• Vent clothes dryers to the outside.

Nitrogen Dioxide back to top

Nitrogen Dioxide (NO₂) can be a byproduct of fuel-burning appliances, such as gas stoves, gas or oil furnaces, fireplaces, wood stoves and unvented kerosene or gas space heaters. NO₂ is an odorless gas that can irritate your eyes, nose and throat and cause shortness of breath. In people with asthma, exposure to low levels of NO₂ may cause increased bronchial reactivity and make young children more susceptible to respiratory infections. Long-term exposure to high levels of NO₂ can lead to chronic bronchitis.

Actions You Can Take

• Properly ventilate a room where a fuel-burning appliance is used and use appliances that vent to the outside whenever possible.
• Do not idle the car inside your garage.
• Have the entire heating system -- including furnace, flues and chimneys -- professionally inspected and cleaned annually.
• Always open the flue on your fireplace before building a fire to ensure that smoke escapes through the chimney.
• Make sure the doors are tight fitting on your wood-burning stove and follow the manufacturer's directions for starting, stoking and putting out the fire.
• Follow the manufacturer's directions for proper fuel use on unvented kerosene or gas space heaters and keep the heater properly adjusted. Open a window slightly or use an exhaust fan in the room while using the heater.
• Install and use an exhaust fan over a gas stove and vent it outdoors.

Other Triggers back to top

Strenuous physical exercise; some medicines; bad weather, such as thunderstorms, high humidity, or freezing temperatures; and some foods and food additives can trigger an asthma attack.

Strong emotional states can also lead to hyperventilation and an asthma attack.

Learn what triggers your attacks so that you can avoid the triggers whenever possible. Be alert for a possible attack when the triggers cannot be avoided.

Remember, you can control your asthma!