CLEAN AIR FOR ASTHMA
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ASTHMA TYPES ...... ASTHMA TRIGGERS ...... SELF-CARE
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ASTHMA BEHIND THE SCENE
FREQUENTLY ASKED QUESTIONS
Question: What is asthma?
Answer: It is a respiratory disease, in which
air passages in the lungs occasionally become narrowed,
obstructed, or even blocked. It interferes with the process of
delivering oxygen to the body’s cells which is necessary to
sustain life.
Question: What is an asthma attack?
Answer: It is the term used to describe the
period in which breathing is difficult. Sufferers frequenty
experience wheezing, coughing, chest tightness and shortness of
breath.
Question: How serious can these attacks be?
Answer: It may be so mild that the person who
has asthma barely notices it, or it can so severe that the
sufferers life is in danger and he requires hospital care. It may
be an isolated event, or part of a pattern of daily, weekly or
monthly attacks. Often, attacks become more severe as they
increase in frequency, but this is not always the case. It
affects every individual differently.
Question: How many people have asthma?
Answer: According to the National Institute of
allergy and Infectious Diseases, the number of people with
self-reported asthma has increased between 1990 and 1994 form
10.4 million to 14.6 million.
Question: Do more children have asthma than
adults?
Answer: Asthma usually develops in childhood,
sometime even in infancy. Roughly 7 percent of children and 5
percent of adults in the U.S. develop asthma. The disease
affected 4.8 million children under age 18 in 1994. Sometimes
youth grown out of their asthma. Others experience a period of
relief from asthma in their teens or early 20s but later develop
it again in adulthood. Adults with no previous history of asthma
can develop it any time from their late 20s onward.
Question: Do males develop asthma more often
than females?
Answer: Yes. Boys develop the disorder twice as
often as girls. However, men and women are equally affected. But
all people with this disorder have difficulty breathing.
Question: What causes breathing difficulty?
Answer: The airways narrow as a reaction usually
to something that the person inhaled. These stimuli are commonly
refered to as triggers. The asthma sufferer’s passages are
supersensitive and respond to irritants that don’t affect
ofther people. The process of airway narrowing is called
hyperresponsiveness.
Question: What exactly causes airway narrowing?
Answer: Let us look athe the respiratory system
of a healthy person to explain how asthma affects breathing.
Air enters the nose or mouth and flows through the throat
(pharynx), through the voice box (larynx) and into the windpipe
(trachea). The trachea branches into two tubes called bronchi
(one serving the right lung, the other the left), which then
divide into smaller bronchi. These in turn branch out into
bronchioles. At the tips of the bronchioles are little air sacs
called alveoli, which contain minute blood vessels called
capillaries. This network of bronchi, bronchioles and alveoli is
known as the bronchial tree. The job of the bronchi and
bronchioles is to funnel air to the alveoli. The alveoli remove
carbon dioxide from the capillaries and replace it with oxygen.
This is the basic process by which oxygen gets into our blood.
This is known as oxygen exchange. Then this oxygen-rich blood
travels to our hearts and through the rest of our bodies.
Question: How does asthma change this process?
Answer: When a person has asthma, the process of
inhalation and oxygen exchange occurs just as it does in someone
without the disease. However, when the person with asthma meets
up with a trigger there are three abnormal reactions. These
reactions cause asthma symptoms.
Question: What is the first reaction?
Answer: The air flow is reduced by muscles that
encircle and squeeze the bronchial air passages. The contraction
of muscles - known as bronchospasms or bronchial spasms - are
tiny muscle spasms that start quite suddenly and last a
relatively short period of time.
Question: What is the second reation in an
asthma attack?
Answer: A large amount of thick mucus is
produced by the cells along the bronchial airway walls (called
the mucosa, or mucous membranes). The function of mucus is to
lubricate the airways so air flows smoothly, but during an asthma
episode, the amount of mucus increases substantially. The
collection of mucus along the bronchial walls narrows the
airways. In more severe attacks, the mucus may form sticky plugs
that clog the air passages.
Question: What is the third reaction?
Answer: The airways become puffy and swollen
because the linings of the bronchial tubes - the mucosa - become
inflamed. The swelling narrows the airways. This restricts the
amount of air that can pass through. Unlike bronchospasms, which
occur over a relatively short time span and then go away, airway
inflammation tends to linger for a longer time. It can last
hours, days or even longer.
Question: Does every asthmatic person experience
all three of these reactions:
Answer: Yes. Some people with mild asthma think
that bronchospasms and a slight amount of mucus production are
their only signs of asthma. However, recent scientific research
has found that inflammation is present in most asthma, even mild
cases. To put it plainly, an asthma attack is a period of
breathing difficulty with evidence of three factors-
bronchospasms, mucus production and inflammation. Because of
these three together, the amount of airflow to the lungs is
reduced. This airway narrowing (sometimes called
bronchoconstriction) may worsen gradually and persist even when
asthma medications are taken, but it can also develop suddenly
and produce severe respiratory distress.
Question: Is that because airway narrowing makes
it difficult to inhale?
Answer: Asthma is a problem of getting air out
of the lungs, not into the lungs. When an asthmatic person
inhales, the lungs pull air in and down the airways, past areas
of inflammation and mucus buildup, all the way to the alveoli.
However, when exhaling-normally a smooth and easy deflation of
the lungs-air gets trapped behind areas of inflammation or behind
clumps of mucus. These air blockages - one-way ”valves”
- trap air in part of the lungs. When the valves are closed, it
takes more effort to exhale, and the person may wheeze or cough.
The person really has difficulty trying to force the air out of
the blocked air passages.
Question: How long does an asthma attack last?
Answer: They may go on for hours or even days,
or they may last just several minutes. Wheezing and excessive
mucus production increase as an attack progresses. Some attacks
resolve themselves spontaneously; others must be stopped with
medications. The longer an attack persists, the more dangerous it
is.
Question: Why is that?
Answer: The lungs become overinflated with
stale, carbon-dioxide-laden air when airway obstructions let air
in but limit the amount of air that goes out. Since there is a
decreasing amount of fresh, oxygenated air reaching the
obstructed areas of the lungs, less oxygen gets into the blood to
nourish cells.
Question: How dangerous is this?
Answer: This is very dangerous. Carbon dioxide
can build up in the body and the person may experience
respiratory failure if the situation persists - meaning, in
effect, he could pass out and die.
Question: How long before this severe response
occurs?
Answer: It usually takes days or weeks for
inflammation and obstructions to reach a point where oxygen
transfer is severely impaired. Once that point is reached,
however, breathing function can deteriorate in a matter of hours.
Question: So asthma is a disease that should be
taken seriously?
Answer: Absolutely. If you recognize the
disease’s signs and symptoms if is essential to do something
about it.
Question: What are those symptoms again?
Answer: These are the most commom and easily
recognized:
• Shortness of breath is one of the first signs. This may be recognized by breathlessness, choking, labored breathing, panting or gasping for air. Known as dyspnea in medical terms, shortness of breath is thought to be caused by bronchospasms.
• Chest tightness may be signified by a feeling of
pressure in the front of the chest, in the area surrounding the
breastbone (sternum). This too is a result of bronchospasms.
• Wheezing is the result of air being forced
through narrowed or constricted air passages. It may be so loud
that bystanders may hear it, but it can also be so faint that
only a doctor can hear it through his stethoscope. Wheezing, a
whistling or rasping sound, is initially heard when exhaling. But
as asthma worsens there is wheezing when inhaling air as well.
Question: Is it true that wheezing disappears
when the asthma attack is over?
Answer: This is not necessarily a sign that
asthma is improving. In very severe attacks the wheezing and
other breath sounds may become more and more faint as the asthma
sufferer becomes extremely fatigued. If this state does not
improve or is not resolved in some way, it may develop into
silent chest, where the chest becomes ominously quiet. This state
may lead to respiratory failure.
Question: Are there any other asthma symptoms
that I should know about?
Answer: Yes. They include these:
• Excess mucus is formed during an attack, and this
obstructs or clogs the airways. This is a symptom of asthma, but
it is also a cause of the next symptom.
• Coughing occurs because the body is trying to
clear obstructions from the lungs. The cough may be deep, loose
and brings up mucus. The person may also cough up mucus plugs,
which are small chunks or spirals of mucus that have formed in
the bronchioles. Or the cough may be dry and hacking. A cough
that does not bring up mucus, called nonproductive in medical
terms, can eventually irritate the lungs and in itself produce
bronchospasms.
• Anxiety or apprehension, often because of
breathlessness, accompanies an asthma attack. One the attack has
ended, the anxiety, apprehension or feeling of panic may dissolve
into a feeling of exhaustion.
Question: Does someone with asthma experience
all those symptoms?
Answer: No. Each person is different, and not
every symptom must be present during an asthma attack.
Question: If someone has those symptoms, does it
mean he has asthma?
Answer: Not always. Several condition have
symptoms like asthma, including, cystic fibrosis (a hereditary
lung and pancreatic disease) in children is accompanied by
wheezing and coughing, emphysema (a respiratory disorder in which
the alveoli become damaged), chronic bronchitis (an inflammation
in the lungs that leads up to choughing up large amounts of mucus
daily), heart failure, and lung cancer. Coughing may even
indicate something as simple as an upper respiratory infection.
Question: How can doctors be sure someone has
asthma?
Answer: Asthma attacks are episodic, whereas the
breathing difficulty associated with the similar conditions of
other diseases is mostly permanent. In diagnosing asthma, doctors
look for indications that episodes of breathing difficulty come
and go. They may ask: Is it hard to breath one week and not the
next? Do the lungs seem to operate perfectly between the attacks?
Do the attacks resolve themselves spontaneously or with
medication? If you answer yes to these questions, it may indicate
that you have asthma.
Question: Can a person feel perfectly fine while
having asthma?
Answer: Many times, yes. The person may breath
freely with the lungs and air passages appearing completely
normal if the lungs are not in a “symptomatic state” -
meaning no bronchospasms, mucus production or inflammation is
causing asthma symptoms. During symptom-free periods, even a
physical exam by a doctor may not uncover signs of asthma.
Most people can contol their asthma with conscientious self-care
and sound medical treatment which reduces the number of attacks
and may even eliminate them. This is good news! This means that
most people with asthma can live normal lives.
Questions: Is asthma a new disease? It seems we
hear more about asthma today than we did years ago.
Answer: Not at all. Asthma has been written
about since the time of ancient Greeks. The word asthma comes
from the Greek verb “to pant,” which describes the way
some sufferers appear to breathe when their asthma is active.
Question: Is it true when I read that more
people are developing asthma?
Answer: Sadly, yes. Although asthma is a
reversible and controllable disease, its incidence is increasing.
Self-reported asthma rised 29 percent between 1990 and 1994, with
the largest increase being among children. Deaths caused by
asthma increased 58 percent between 1979 and 1992. Annually about
5,550 patients die. Approximately 500,000 people are hospitalized
each year because of the disease.
Although the death rate of asthma sufferers
is low compared with may other chronic diseases, its economic
costs are outrageous - an estimated 6.2 billion dollars in the
U.S. in 1990, the latest year for which data are available. This
figue reprsents nearly 1 percent of U.S. health care costs. The
lost of work days yearly - about 3 million - cost millions of
dollars each year. Children miss more than 10 million school days
annually due to athma.
Question: Is this a problem only in the U.S.?
Answer: Although the incidence of asthma in
Western countries has doubled in the past 20 years, developing
nations are also seeing increases in reports of asthma.
Question: Why is asthma on the upswing?
Answer: Some experts believe this is because of
better awareness, diagnosis and reporting of the disease. Others
say it is the increased air pollution, the greater number of
chemicals in the home, and the work and outdoor environment. Some
especially point to city living. Urban areas seem the biggest
target. The reasons for this may be because of issues of poverty:
more exposure to substances that trigger asthma and lack of
access to medical care.
Once people develop asthma, they may not get
the proper care from physicians. This may account for many of the
deaths. Contributing to the inadequate treatment of asthma,
according to Michael Kaliner, M.D., chief of the allergy section
of the National Institute of Allergy and Infectious disease, is
not being willing to use anti-inflammatory drugs to treat
underlying inflammation, the misunderstanding of the role of
allergies as triggers, and a lack of physician training. He
quotes, “In terms of hospital care, medicine and lost work -
and school days, asthma is a serious and expensive disease that
could be treated more cost effectively with preventive measures
and improved care from primary physicians.” Foods we eat or,
more precisely, don’t eat may also be the culpit.
Question: Why is that?
Answer: Changes in diet in Western countries may
be leading to a greater incidence of asthma. According to a 1997
study from Scotland, people with the lowest intakes of vitamin C
and manganese showed a more than fivefold increased risk of
hyperresponsiveness. This study also indicates that the reduction
of antioxidant-rich fruits and vegetables in the diet over the
past two decades has been a factor in the prevalence of asthma.
Question: Is asthma contagious?
Answer: No. You cannot “catch” asthma
from someone.
Question: Is asthma psychosomatic?
Answer: No. Some physicians are convinced that a
person’s asthma is more of a psychological problem than a
physical one, but this may be an attitude some doctors assume
when the treatment plan they recommend proves ineffective.
Emotions and stress do play a role in making asthma worse, but
they do not produce asthma in someone who doesn’t already
have the disease.
Question: Can you inherit asthma?
Answer: People do no “inherit” asthma,
but they may be born with a genetic predisposition to develop the
disease. Take note of the word may. The chances of having the
predisposition to asthma are greater if somone in the immediate
family has asthma - a parent, sibling or grandparent.
Question: What are the chances of inheriting the
predisposition?
Answer: A study in 1993 found that in families
with one parent who was hyperresponsive, close to 28 percent of
the children had the same condition. The more blood relatives
with asthma, the greater the chance a child may be born with a
predisposition to asthma. People with a family history of hay
fever or allergies stand a greater chance of having the asthmatic
predisposition, but this does not guarantee that a person will
develop the disease.
Question: What is the role of genetics in
asthma?
Answer: Despite several studies, discovery of an
asthma gene has remained elusive. Rather, researchers have found
several sets of genes that deal with various aspects of asthma,
most recently one responsible for anti-inflammatory secretion in
the air passages. The findings are being used to determine asthma
risk and to develop improved asthma treatments. Identifying an
asthma gene is particularly difficult because of the multiple
triggers and types and its varying severity, but work in this
area continues.
Question: Is there a test to determine whether
someone will develop asthma?
Answer: Not yet. Medical science has yet to come
up with a way to spot asthma before it appears in its classic
manifestation: shortness of breath, wheezing, coughing, and chest
tightnes. Even if there is a strong family history of asthma,
doctors can’t tell whether it will develop, if it will be
intermittent or chronic, when it will become active or what will
trigger it.
In children, however, a skin problem known a atopic dermatitis is
often a red flag for asthma in the future.
Question: What is atopic dermatitis?
Answer: It is a form of eczema that lasts a long
time and is sometimes severe. It is an itchy red rash that can
appear on the face, wrists, elbows, back, knees and ankles. One
in ten children develops atopic dermatitis. According to Hugh
Sampson, M.D., writing in Understanding Asthma: A Blueprint for
Breathing (American College of Allergy and Immunology, 1990),
about half of those youth with atopic dermatitis later develop
asthma; about three-quarters of the children develop asthma, hay
fever or both. Like asthma, atopic dermatitis is provoked or
exacerbated by triggers that may include allergies, dry skin,
skin infections, sweating and stress.
Question: You mentioned earlier that there are
different types of asthma. What are these?
Answer: The medical field has come up with
several ways of classifying asthma and of distinguishing one form
of the disease from another. Depending upon the types of stimuli
that trigger episodes of the disease, doctors have separated
asthma into two general categories - extrinsic asthma and
intrinsic asthma. Let’s look at some of these
classifications now.
ASTHMA TYPES ...... ASTHMA TRIGGERS ...... SELF-CARE
CALL TOLL-FREE 1-800-701-1959
International Calls - Dial international code then 330-823-0691