Asthma And Wheezing

What Does Asthma Mean?
Asthma, Wheezing. Asthma AttackMany people think asthma and wheezing are the same thing. Actually, wheezing is only one sign of asthma, and many other things besides asthma can cause wheezing. Because of this confusion, the term asthma is being replaced with a more accurate description: Reactive Airway Disease (RAD). Those with RAD (5% and growing in the U.S.) have bronchial (lung) passages that are more sensitive to irritation than normal. This hypersensitivity leads to inflammation (redness and swelling) in the tiny airways deep in the lungs. The inflammation in turn causes excess mucus production, and tightening of airway muscles that wind around the bronchial tubes like laces. The combination of swelling, mucus, and muscle tightening all cause narrowing of the airways. Wheezing (whistling and labored breathing) usually results, but a dry cough is sometimes the only sign. Click on the figure to see what happens in an asthma attack.

Nobody knows exactly why some people have RAD. Many times it is inherited, and is often associated with allergies (especially in children). Asthma can develop at any time, but is more common in young children. When it starts in childhood it usually improves with age. But with adult onset asthma, aging often worsens the problem. Asthma has also become more common in this country, again for unknown reasons.

What Causes an Asthma Attack?
The diagram at the right shows the chain of events in asthma or RAD that lead to a classic asthma attack. As you can see, there must be a triggering factor causing airway inflammation to begin the process. In children, allergies frequently act as asthma triggers. Cigarette smoke, weather changes, and emotional stress also bring on wheezing, but probably the most common trigger is a simple cold or other respiratory infection. For some unknown reason, the lung airways in asthmatics become inflamed very quickly with colds, even if the virus stays in the head.

Exercise induced asthma is just plain old asthma with exercise as the trigger. Cold, dry air is worse for exercise asthma; warm, moist air causes fewer problems.

Heartburn (reflux esophagitis) also leads to asthma attacks. This often occurs at night, when laying flat allows acid to seep back into the swallowing tube and throat. If the acid leaks into your breathing passages, choking and wheezing result. If your asthma attacks don’t seem to be caused by colds, allergens, or other respiratory irritation, consider reflux.

Signs of Asthma

  • Coughing or "bronchitis" with every cold.
  • Coughing (especially at night) that lingers for weeks.
  • Shortness of breath or wheezing with exercise or exposure to allergens.
  • Night time wakening with cough or shortness of breath.

Remember, RAD or asthma is just overly sensitive lung membranes. You can’t prevent the condition, but by avoiding triggering factors you can prevent the actual asthma attacks.

The first step is to figure out what triggers your asthma (see the list at right for common causes)

Common Triggering Factors For Asthma

  • Allergies
  • Weather changes (barometric pressure, humidity, and temperature).
  • Air pollution, smoke (cigarette, or wood), chemical or fuel vapors, fumes, or even perfumes and other scents
  • Dust
  • Heartburn (reflux esophagitis)
  • Exercise
  • Colds and other respiratory infections
  • Physical or emotional stress

Allergies. See the topic area [Allergies] for in-depth discussion. At least 75% of childhood asthma is allergy related. Controlling allergies with medication or immunotherapy is key to reducing the frequency of asthma attacks.

Exercise. Cold dry air is more aggravating for those with exercise induced asthma than warm moist air. If you have a choice, summer sports or indoor sports such as swimming are much more preferable for asthmatics than outdoor fall and winter sports such as football, cross country running, or skiing. Simple measures like breathing through a scarf or taking preventive medicine before exercise helps to minimize attacks.

Reflux (heartburn). See [Heartburn and Acid Indigestion] for thorough discussion on prevention. Doctors believe as much as 30% of all asthma may be caused by reflux problems. Even if you have identified other specific triggers for your asthma attacks, try following heartburn prevention techniques for a few weeks to see if it leads to better control of your asthma --- you may be surprised.

Over-the-counter treatment for asthma is controversial. The FDA has stated that OTC inhalers and tablets to relieve the wheezing symptoms should only be used by patients if their doctor is aware of their condition and has okayed the use and frequency of the over-the-counter drugs.

OTC inhalers and tablets are useful for treatment of wheezing only. As discussed in basics, the wheezing is a result rather than the underlying cause in asthma. Only prescription medications work against airway inflammation at the root of all asthma attacks. It seems then that self-treatment of asthma with OTC medications should occur only in unusual circumstances --- for temporary treatment of wheezing only if your doctor has approved it. In actuality, these OTC products are often used when an asthmatic patient’s prescription inhaler is empty and the patient desires temporary relief until the prescription can be refilled or further medical care sought. Since asthma is often much worse at night, lack of available physician care also leads to OTC self-treatment.

All OTC asthma medications are bronchodilators --- that is, they relax tight airway muscles to widen your breathing passages. They come in two forms:

Epinephrine aerosol inhaler. Inhaled epinephrine (adrenaline) can give relief from wheezing in minutes. Unfortunately, this effect only lasts for a couple of hours. This should only be considered a temporary replacement for prescription inhalers.

Ephedrine tablets. This stimulant drug is longer acting (2-4 hours) than inhaled epinephrine, but may take 30-60 minutes to take full effect.

All asthmatics should be care supervised by a physician. Frequency of visits varies based on intensity of symptoms and overall control of the condition. Of course, there are danger signs which should prompt immediate attention:

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