When you have asthma, your airways narrow and swell. They produce extra mucus, and breathing becomes difficult. The most common asthma signs and symptoms are coughing, wheezing and shortness of breath. For some people, asthma symptoms are a minor nuisance. For others, they are a major problem that interferes with daily activities. If you have severe asthma, you may be at risk of a life-threatening asthma attack. Asthma cannot be cured, but its symptoms can be controlled. Treatments include taking steps to avoid your particular asthma triggers, using long-term control medications to prevent flare-ups and using a quick-relief inhaler to control symptoms once they start. Because asthma changes over time, you will work with your doctor to track your signs and symptoms and adjust treatment as needed.

Symptoms

Asthma symptoms range from minor to severe and vary from person to person. You may have mild symptoms and asthma attacks may be infrequent. Between asthma flare-ups you may feel normal and have no trouble breathing. You may have symptoms primarily at night, during exercise or when you are exposed to specific triggers. Or you may have asthma symptoms all the time. Asthma signs and symptoms include:

1)Shortness of breath
2)Chest tightness or pain
3)Trouble sleeping caused by shortness of breath, coughing or wheezing
4)An audible whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
5)Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu

Signs that your asthma is probably getting worse include:

1)More frequent and bothersome asthma signs and symptoms
2)Increasing difficulty breathing (this can be measured by a peak flow meter, a simple device used to check how well your lungs are working)
3)An increasingly frequent need to use a quick-relief inhaler

For some people, asthma symptoms flare up in certain situations:

1)Exercise-induced asthma occurs during exercise. For many people, exercise-induced asthma is worse when the air is cold and dry.
2)Occupational asthma is asthma that is caused or worsened by breathing in a workplace irritant such as chemical fumes, gases or dust.
3)Allergy-induced asthma. Some people have asthma symptoms that are triggered by particular allergens, such as pet dander, cockroaches or pollen.

Causes

It is not clear why some people get asthma and others do not, but it is probably due to a combination of environmental and genetic (inherited) factors.

Asthma triggers are different from person to person. Exposure to a number of different allergens and irritants can trigger signs and symptoms of asthma, including:

1)Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
2)Respiratory infections, such as the common cold
3)Physical activity (exercise-induced asthma)
4)Cold air
5)Air pollutants and irritants, such as smoke
6)Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs
7)Strong emotions and stress
8)Sulfites, preservatives added to some types of foods and beverages
9)Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat
10)Menstrual cycle in some women
11)Allergic reactions to some foods, such as peanuts or shellfish

Western Medicine Treatment

Prevention and long-term control is the key to preventing asthma attacks. Treatment usually involves learning to recognize your triggers and taking steps to avoid them, and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler such as albuterol.

The right medications for you depend on a number of things, including your age, your symptoms, your asthma triggers and what seems to work best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, medications to treat specific allergies are needed.

Long-term control medications

In most cases, these medications need to be taken every day. Types of long-term control medications include:

1)Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), flunisolide (Aerobid), beclomethasone (Qvar) and others. They are the most commonly prescribed type of long-term asthma medication. You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.

2)Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR). They help prevent asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction.

3)Long-acting beta agonists (LABAs). These inhaled medications include salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). LABAs open the airways and reduce inflammation. However, they have been linked to severe asthma attacks. LABAs should be taken only in combination with an inhaled corticosteroid.

4)Combination inhalers such as fluticasone and salmeterol (Advair Diskus) and budesonide and formoterol (Symbicort). These medications contain a LABA along with a corticosteroid. Like other LABA medications, these medications may increase your risk of having a severe asthma attack.

5)Theophylline. This is a daily pill that helps keep the airways open (bronchodilator). Theophylline (Theo-24, Elixophyllin, others) relaxes the muscles around the airways to make breathing easier. It is not used as often now as in past years.

Quick-relief medications

Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack -- or before exercise if your doctor recommends it. Types of quick-relief medications include:

1)Short-acting beta agonists. These inhaled, quick-relief bronchodilators can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). These medications act within minutes, and effects last several hours.

2)Ipratropium (Atrovent). Your doctor might prescribe this inhaled medication for immediate relief of your symptoms. Like other bronchodilators, ipratropium relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it is sometimes used to treat asthma attacks.

3)Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they are used only on a short-term basis to treat severe asthma symptoms.

If your asthma is triggered or worsened by allergies, you may benefit from allergy treatment as well. Allergy treatments include:

1)Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune system reaction to specific allergens.

2)Omalizumab (Xolair). This medication is specifically for people who have allergies and severe asthma. It acts by altering the immune system. Omalizumab is delivered by injection every two to four weeks.

3)Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.

Do not rely on quick-relief medications

Long-term asthma control medications -- such as inhaled corticosteroids -- are the cornerstone of asthma treatment. These
medications keep asthma under control on a day-to-day basis and make it less likely you will have an asthma attack.

If you do have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you should not need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication.

Bronchial thermoplasty

This treatment is used for severe asthma that does not improve with inhaled corticosteroids or other long-term asthma medications. Generally done in three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and may reduce asthma attacks. Bronchial thermoplasty is not widely available. More research is needed to determine whether the benefits of this treatment outweigh the possible risks and potential side effects.

Adopted from Wei Laboratories, Inc.