Asthma Types

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ASTHMA TYPES

EXTRINSIC ASTHMA ...... INTRINSIC ASTHMA ...... NOCTURNAL ASTHMA ...... SEASONAL ASTHMA

EXERCISE-INDUCED ASTHMA ...... INTERMITTENT ASTHMA ...... CHRONIC ASTHMA

EXTRINSIC ASTHMA

Question: What does extrinsic asthma mean?

Answer: This is asthma that is triggered by allergies. It is also known as Allergic or atopic asthma. The attack is clearly because of the body’s response to something inhaled or occasionally, ingested, in this form of the disease. Allergens is the term used to describe what the person is allergic to.

Question: What sort of things can be allergens?

Answer: A few examples, which are the most commom, are tree and grass pollen, mold, animal dander (pieces of sloughed-off skin, much like dandruff) and dust mites.

Question: Who develops extrinsic asthma?

Answer: Usually athma that develops in childhood is extrinsic. Over 90 percent of children, who are under the age of 16, with asthma have allergies. Seventy percent of people who range from ages 16 to 30 have allergies. This is according to the National Institute of Allergy and Infectious Diseases. Symptoms of extrinsic asthma can vary seasonally and occur intermittently. In over 50 percent of the cases of people with extrinsic asthma, there is usally a personal or family history of other allergies, such as hay fever and skin conditions.

INTRINSIC ASTHMA

Question: What is intrinsic asthma?

Answer: Usually people over the age of 30 develop that develop asthma have intrinsic asthma. This is referred to also as nonallergic asthma. As told by the name, this asthma is not related to allergies.

Question: What is it related to?

Answer: Respiratory infections, stress, inhalation of chemical irritants (cleaning fluids or fresh paint), air pollution, and exercise can all be triggers. Doctors don’t understand the origins of intrinsic asthma. However, they do believe that it is caused by an overactive immune system.

Question: Does it really matter if I know what form of asthma I have?

Answer: Yes. It can help you understand your disease better and which medical treatment path is best for you. However, you should know that most people with asthma have both forms. It is very commom for someone with extrinsic asthma to experience attacks when she has a cold or the flu - both which are intrinsic triggers.

Extrinsic and intrinsic are both terms that attempt to describe the source and trigger of the asthma. Nocturnal asthma, seasonal asthma and exercise-induced asthma all describe the particular situations in which they occur.

NOCTURNAL ASTHMA

Question: What is this?

Answer: This is asthma that suddenly becomes worse in the middle of the night, often between 2 and 4 a.m.

Question: Is this common?

Answer: Yes. Although an episode can happen anytime, researchers who keep records have discovered that attacks occur more frequently at night and early in the morning. According to surveys from England and Scotland fifty percent of asthmatic people are woke up in the night by an attack at least 20 times a year, 70 percent at least one night a week, and 85 percent are occasionally.

Question: Who gets nocturnal asthma?

Answer: It affects people who have extrinsic and/or intrinsic forms of asthma.

Question: What causes it?

Answer: Scientists still have to discover the “mechanism” behind it, but they do have several theories. One points to obstructions that are caused by mucus in the airway walls. This mucus is less likely to drain or be cleared naturally when the sufferer is lying down. So it accumulates in the bronchial tubes, which causes obstruction to the airflow.

Another theory blames exposure to allergens in the bedroom (such as dust or animal dander). A hypotheseis that relates to this is that nighttime symptoms may be the result of a delayed reaction to exposure to an allergen hours earlier in the day. However, none of these theories can explain the problem for people with intrinsic asthma.

Question: Are there any other theories?

Answer: Yes. Another theory links nocturnal asthma to circadian rhythm, the body’s natural 24-hour cycle, which causes nighttime fluctuations in hormone levels. Two hormones that help keep bronchial tubes open, epinephrine and cortisol, have falling blood levels between midnight and six o’clock in the morning. Histamine, a natural chemical that worsens asthma, reaches its highest levels during the night. All these factors, plus other changes related to circadian rhythm, may be triggers for these asthma attacks.

Nocturnal asthma should be taken very seriously by the sufferer and the physician. Surveys show a high frequency of respiratory arrest and death due to asthma in the early morning hours. Although these problems don’t happen to everyone, loss of sleep can affect performance at school and work and make asthma more of a burden.

SEASONAL ASTHMA

Question: Does this asthma happen only at a certain time of the year?

Answer: Yes. The season varies from one person to another. Seasonal asthma is linked to extrinsic, or allergic, asthma. Some experts think it strikes more often in the summer. This would explain why asthma deaths are almost 15 percent higher in the summer than during the rest of the year.

EXERCISE-INDUCED ASTHMA

Question: Is this asthma caused by exercise?

Answer: Yes. The sufferer experiences shortness of breath, chest pain or tightness, wheezing, coughting or endurance problems during exercise. It is now believed that, depending on the exercise intensity, exercise-induced asthma affects all people with asthma.

Question: What causes it?

Answer: It is caused mainy by bronchospasms. This results from the loss of heat or water or both from the lung during exercise because of the rapid inhalation of air that is cooler and drier than that of the air passages. Bronchospasms can come as quickly as a few minutes after exercise has started. It reaches its peak 5 to 10 minutes after the vigorous activity has stopped, an usually disappears 20 to 60 minutes later. Medications are ofter prescribed to prevent this type of attack.

Question: Are there any other types of athma?

Answer: The two main categories of a more descriptive classification system, built around the frequency and severity of symptoms, are intermittent asthma and chronic asthma.

INTERMITTENT ASTHMA

Question: What is intermittent asthma?

Answer: Although asthma flare-ups come and go, people with intermittent asthma (also called occasional asthma) have extended symptom-free periods. Then they may fo months without experiencing any sign of asthma. In Between attacks , such people lead normal lives.

Seasonal asthma can sometimes fall into this category.

CHRONIC ASTHMA

Question: Is this more frequent asthma attacks?

Answer: People with this type of asthma have symptoms for long stretches at a time: more than five days a month for more than three months and more than half of the days in any one month. They go for long periods in which they have trouble breathing. Their lungs don’t completely recuperate between attacks.

Question: I just want to know how to tell is my asthma is severe. Is there help?

Answer: Yes. To assist health-care practitioners in diagnosing asthma and devise sound treatment plans for medical consumer the National Asthma Education and Prevention Program updated detailed asthma-management guidelines in 1997. The report divides chronic asthma into four subcategories according to severity.

• Mild intermittent asthma: Intermittent and brief (from a few hours to a few days) episodes of coughing, wheezing, shortness of breath or chest tightness up to two times a week. No symptoms would occur between attakcs.

• Mild persistent asthma: Symptoms more than two times a week but fewer than once a day. Physical activity may be affected. Nighttime symptoms occur more than twice a month.

• Moderate persistent asthma: Symptoms occur daily with use of inhaled short-acting beta-agonist. The attacks affect activity, occur more than twice a week and may last for days. Nighttime symptoms occur more than once a week.

• Severe persistent asthma: Symptoms are continous, physical activity is limited, and attacks are frequent. Nighttime symptoms occur frequently.

Question: Are attacks predicatable?

Answer: If you know the trigger, you can be almost sure that your airway will react unless you are able to counter the effects of the trigger with medication or other appropriate self-care. Usually, attacks are notoriously unpredictable. You don’t know when an attack my occur; nor can you forecast its intensity or its length.

Questions: Why do some attacks last longer than others?

Answer: Part of the reason is the airway inflammation which makes the bronchial walls swollen and puffy. A bronchospasm may end in minutes, but the inflammation may take days or weeks to pass. This puts the sufferer at risk of more frequent attacks as time goes on.

Question: So, what causes the inflammation?

Answer: One theory is that the immune system is overactive in the person. When triggers are inhaled, the immune system releases immunoglobulins, or protein antibodies, which attach themselves to mast cells found throughout the bronchial tree. These immunoglobulins attack and combine with the inhaled trigger, and the mast cells take this as a signal to release inflammatory chemicals into the tissues lining the nose and airway. These are called mediators. These provoke swelling and inflammation and sometimes propel mucus production and bronchospasms. One mediator is histamine. There are may other mediators and many other theories to explain inflammation.

Question: Why is this inflammation a problem?

Answer: It can make the asthmatic episode more severe. If the airways are already narrowed because of inflammation, then any other narrowing will worsen the attack. The inflammation in a key factor influencing the frequency and severity of attacks.

Question: How long does inflammation last?

Answer: It tends to linger, unlike bronchospasms which occur over a relatively short time span and go away. According the recent research, people with asthma may have low-level inflammation in the bronchial passageway for months or years after a severe attack. They have also uncovered recent evidence that inflammation is present in most asthma cases.

Question: How can that be?

Answer: Usually, a person experiences problems shortly after being exposed to an allergen or irritant. This is called immediate reaction. This takes pleace 15 to 30 minutes of the exposure. Normal breathing resumes an hour or two later. The attack isn’t always over for everyone though. In about 50 percent of people with asthma, the attack will worsen 4 to 12 hours after initial exposure. This second episode will include shortness of breath, chest tightness and maybe even wheezing, and these symptoms may be severe and last longer than the immediate reaction. This second episode is called a delayed reaction or a late response.

Question: What causes the delayed response?

Answer: Many doctors believe that it is caused by inflammation, a hidden problem that develops slowly in the bronchial walls.

Question: Is the delayed response a problem?

Answer: The person might assume that he is experienceing a new asthma attack, not a continuation of the first one, so it is often disarming. Because of this , he may try to treat the second episode as if it were bronchospasms. Inflammation doesn’t respong to medications designed to treat bronchospasms. With improper treatment, the person’s asthma might continue to get worse.

Question: Can anyone have a delayed response?

Answer: People with extrinsic asthma are more likely to experience these. Anyone who has had a delayed reaction in the past is apt to have one again. So, anyone with asthma needs to determine if he is likely to have a delayed response. This will influence what steps he’ll take to control his exposure to triggers and what kind of medications he will use.

Related to inflammation is a situation that physicians call hypersensitivity.

Question: What is hypersensitivity?

Answer: This is what people with asthma call lungs that feel “twitchy”.
Having been frequently exposed to triggers, their airways ultimately become more sensitive to all irritants. They become supersensitive and highly reactive. This means that the attack can be provoked by the slightest exposure.

Question: What if the attack is left untreated?

Answer: Many times nothing happens. Some attacks that are mild will disappear on their own. The role of inflammation in asthma, however, stresses the need to treat even mild episodes of the disease. The inflammation can add to airway narrowing and intensify the effect of bronchospasms or mucus production. There can be more areas of the lung impeded if the inflammation spreads. Untreated asthma may lengthen the amount of time an asthmatic person feels miserable. It could also progress to a severe attack.

Question: How does a severe attack develop?

Answer: It begins with the common asthma symptoms. As it continues, the sufferer becomes extremely anxious and apprehensive. The breathing becomes hard work, as indicated by flaring nostrils and bulging neck muscles. The person sweats, his breath becomes shallow, his heart beats rapidly and his blood pressure may surge up and down. He experiences hyperventilation - shallow inhalations which become more rapid as air gets trapped in the lungs. They lungs may become overinflated.

Eventually, too much air will be trapped in the lungs, and carbon dioxide will begin to build up there. The skin will develop a purple tint, particularly around the lips - which indicates insufficient oxygen in the blood. This condition is known ads cyanosis. The lungs don’t function well, wheezing diminishes (“silent lung”) and the sufferer becomes speechless, exhausted and confuse.

The persons medication is powerless to control this sudden, serious attack known as status asthmaticus and acute severe asthma. Status asthmaticus can be fatal. Therefore, immediate emergency treatment is vital.

Question: How lond does it take status asthmaticus to develop?

Answer: It may take hours, but often it comes on suddenly and not in the particular order we just listed. Sometimes it can all happen in just a couple of minutes. You can tell that it is developing by the failure of usual medications to control the attack. Additional medical treatment is needed.

Question: Can a severe attack permanently damage the lungs?

Answer: Because asthma is a reversible disease, it means that it’s attacks do not lead to permanent damage in the lungs, except in rare cases. The lungs will operate efficiently once bronchospasms have passed, mucus production has slowed and inflammation has gone down.

Question: How are asthma deaths preventable?

Answer: Ninety percent of asthma deaths are preventable. Death can take place when the sufferer and his doctor fail to recognize the severity or the speed of the attack, and thus the asthmatic person doesn’t get effective medical treatment. Another thing that may cause deaths which could have been avoided is the failure to closely monitor a hospitalized asthmatic person. Also contributing is the inappropriate prescription of drugs and sedatives. (Sedatives inhibit the lungs’ function and should never be used during an asthma attack.) Better medical care is the key to preventing asthma-related deaths.

Question: Is there a profile of the person who may be at risk?

Answer: Risk factors include a history of acute severe asthma and hospitalization; lack of adequate and ongoing medical care with preventive and follow-up therapy; complacency or underestimation of the disease’s severity - underestimations by the person with asthma, his family, his physician or his hospital. Issues of race and poverty also play a role: Among African Americans, the asthma death rate is almost three times higher than among Caucasians. In the younger group, ages 5 to 24 , the death rate for African Americans is four to eight times higher than for Caucasians. The racial disparity is due largely to poverty, urban air quality and lack of education and access to medical care.

Question: Can asthma be treated with a vaccine?

Answer: There are several being developed, although none are currently available. In one study, 74 percent of asthmatic adults and 60 percent of asthmatic children ages three and under who received the vaccine through the nose and mouth saw their asthma decrease in severity. More studies are needed to prove the effectiveness of such vaccines before they can become available to the public.