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This topic provides
information about asthma in teens and adults. If you are looking for
information about asthma in children age 12 and younger, see the topic
Asthma in Children.
Asthma causes swelling and
inflammation in the airways that lead to your lungs.
When asthma flares up, the airways tighten and become narrower. This keeps the
air from passing through easily and makes it hard for you to breathe. These
flare-ups are also called asthma attacks or exacerbations (say "ig-zas-er-BAY-shuns").
affects people in different ways. Some people only have asthma attacks during
allergy season, or when they breathe in cold air, or when they exercise. Others
have many bad attacks that send them to the doctor often.
you have few asthma attacks, you still need to treat your asthma. The swelling
and inflammation in your airways can lead to permanent changes in your airways
and harm your lungs.
Many people with asthma live active, full
lives. Even though asthma is a lifelong disease, treatment can control it and
keep you healthy.
Experts don't know exactly
what causes asthma. But there are some things we do know:
Symptoms of asthma can be
mild or severe. You may have mild attacks now and then, or you may have severe
symptoms every day. Or you may have something in between. How often you have
symptoms can also change. When you have asthma, you may:
Your symptoms may be worse at night.
asthma attacks can be life-threatening and need emergency treatment.
Along with doing a
physical exam and asking about your health, your doctor may order lung function
tests. These tests include:
You will need routine checkups with your doctor to keep
track of your asthma and decide on treatment.
There are two parts to treating
asthma, which are outlined in your asthma action plan. The goals are to:
If you need to use the quick-relief inhaler more often
than usual, talk to your doctor. This is a sign that your asthma is not
controlled and can cause problems.
Asthma attacks can be
life-threatening, but you may be able to prevent them if you follow a plan.
Your doctor can teach you the skills you need to use your asthma action
prevent some asthma attacks by avoiding those things that cause them. These are
called triggers. A trigger can be:
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Learning about asthma:
Living with asthma:
The cause of
asthma isn't known. Health experts believe that
inherited, environmental, and
immune system factors combine to cause
inflammation of the airways. This can lead to asthma and
Asthma may run in families (be inherited). If
this is the case in your family, you may be more likely than other people to
get long-lasting (chronic) inflammation in the airways.
In some people,
an allergic reaction causes asthma symptoms. An allergen makes the immune system cells release chemicals that cause
Studies show that exposure to
allergens such as
dust mites, cockroaches, and
animal dander may influence asthma's
development.1 Asthma is much more common in people
with allergies, although not all those who have allergies get asthma. And not
all people with asthma have allergies.
Environmental factors and
today's germ-conscious lifestyle may play a role in the development of asthma.
Some experts believe that there are more cases of asthma because of pollution
and less exposure to certain types of bacteria or infections.2 As a result, children's immune systems may develop in a way
that makes it more likely they will also get allergies and asthma.
Asthma in adults also can be related to work. This is called occupational asthma.
asthma can be mild or severe. You may have no
symptoms, severe symptoms every day, or something in between. How often you have
symptoms can also change. Symptoms of asthma may include:
asthma attack occurs when your symptoms suddenly
increase. Factors that can lead to an asthma attack or make it worse
Many people have symptoms that become worse at night
(nocturnal asthma), such as cough and shortness of breath.
general, waking at night because of shortness of breath or a cough is a sign of
poorly controlled asthma.
begins during infancy or childhood, but it can start at any age. It may last throughout
At times, the
inflammation from asthma causes a narrowing of your
mucus production. This causes asthma symptoms such as
shortness of breath.
Your airways narrow when they overreact to
certain substances. These are known as asthma
triggers. What triggers asthma symptoms varies from person to
When asthma symptoms
suddenly occur, it is called an
asthma attack (also called a flare-up or
exacerbation). Asthma attacks can occur rarely or frequently. They may be mild to
Although some asthma attacks occur very suddenly, many become worse
gradually over a period of several days. In general, you can take care of
symptoms at home by following your
asthma action plan. A severe attack may
need emergency treatment and in rare cases can be fatal.
classified as intermittent, mild persistent, moderate
persistent, and severe persistent.
Asthma can raise your risk for complications from lung
infections, such as acute
Even mild asthma may cause changes to the airway
system. It may speed up and worsen the natural decrease
in lung function that occurs as we age.3
Some experts believe that asthma may
raise your risk for chronic obstructive pulmonary disease (COPD).4
Asthma can occur for the first time during pregnancy, or it may change
When asthma is properly controlled, a
woman can have a normal pregnancy with little or no increased risk
to herself or the baby. But if the asthma isn't well controlled, there
are risks to the pregnant woman and the baby.
Many things can increase
your risk for
asthma. Some of these are not within your control. Others you can control.
The main things that put you at risk for getting asthma as an
adult are ongoing (chronic) wheezing when you were a child and cigarette
Triggers that may make asthma worse and may lead to
asthma attacks include:
Experts aren't yet sure:
Call 911 or other emergency services right away if:
Call your doctor now or seek immediate medical care if:
Call your doctor if:
If you have not been diagnosed with asthma but have mild
asthma symptoms, call your doctor and make an appointment for an
If your teenager has symptoms of asthma, it is
important to see a doctor. Many teens with frequent wheezing may
have asthma but aren't diagnosed with the disease. Teens who have asthma but
are less likely to be diagnosed are most often:14
Watchful waiting is a "wait and see" approach.
Watchful waiting may be
appropriate if you follow your
asthma action plan and stay within the
green zone. Watch your symptoms, and continue to avoid
your asthma triggers.
If you have been getting
treatment for 1 to 3 months but aren't improving, ask your doctor if you
need to see an asthma specialist.
Doctors who can diagnose and treat
You may need to see a specialist (allergist or
pulmonologist) if you have:
A diagnosis of
asthma is based on your
medical history, a
physical exam, and lung function tests.
Lung function tests can diagnose asthma, show how
severe it is, and check for complications.
Asthma can be hard
to diagnose because the symptoms vary widely. And asthma-like symptoms can also be caused by other conditions, such
as a viral lung infection or a
vocal cord problem. So your doctor may want to do one or more extra tests.
You need to
monitor your condition and have regular checkups to
keep asthma under control and to review and possibly update your
asthma action plan. Checkups are recommended every 1
to 6 months, depending on how well your asthma is controlled.
During checkups, your doctor will ask about information you may have tracked in an
asthma diary, such as:
Based on the results, your asthma category may
change, and your doctor may change the medicines you use or how much medicine
If you have persistent
asthma and take medicine every day, your doctor may ask about your exposure to
substances (allergens) that cause an allergic reaction. For more
information about testing for triggers, see the topic
Allergy tests can include skin tests and a blood test. Skin tests are needed if you are interested in allergy
It's important to treat asthma, because even mild asthma can damage your airways.
By following your treatment plan, you can meet your goals to:15
An asthma action plan tells you which medicines to take
every day and how to treat
asthma attacks. It also may include an
asthma diary where you record your
peak expiratory flow (PEF), symptoms, and triggers.
This helps you identify triggers that can be changed or avoided. It also lets you be aware of
your symptoms and know how to make quick decisions about medicine and
treatment. See an
example of an asthma action planexample of an asthma action plan(What is a PDF document?).
You'll likely take several medicines to control your asthma and to prevent attacks. Your doctor may adjust your medicines depending on
how well your asthma is controlled. Medicines include:
deliver medicine directly to the lungs. To get the best asthma control possible, be sure you know how to use your inhaler. Use a spacer with your inhaler if your doctor recommends it.
Be sure to monitor your asthma and have regular checkups. Checkups are recommended
every 1 to 6 months, depending on how well your asthma is controlled.
It's easy to underestimate how severe your symptoms are. You may
not notice them until your lungs are functioning at 50% of your
personal best peak expiratory flow (PEF).
PEF is a way to keep track of asthma symptoms at home. It can help you know
when your lung function is getting worse before it drops to a dangerously low
level. You can do this with a
peak flow meter.
asthma triggers increases symptoms. Try to avoid irritants (such as smoke or air pollution) or things
that you may be allergic to (such as
animal dander). If
something at work is causing your asthma or making it worse (occupational asthma), you may have to change jobs.
If you have persistent asthma and react to
allergens, you may need to have
skin testing for allergies.
Allergy shots (immunotherapy) may be helpful.
considerations in treating asthma include:
asthma isn't improving, make an appointment with your
If your medicine isn't working to control airway
inflammation, your doctor will first check to see if you are using the
inhaler correctly. If you are using it the right way, your
doctor may increase the dosage, switch to another medicine, or add a medicine
to your treatment.
For severe asthma that cannot be controlled with medicines, a newer treatment called bronchial thermoplasty may be used. For this treatment, heat is applied to the airways. This reduces the thickness of the airways and improves the ability to breathe.16, 17
If you have a severe asthma
red zone of your asthma action plan), use medicine based on your
action plan and talk with a doctor right away about
what to do next. This is especially important if your
peak expiratory flow (PEF) doesn't return to the
green zone or if it stays in the
yellow zone after you take medicine.
You may have to
go to the hospital or an emergency room for treatment. Be sure to tell the
emergency staff if you are pregnant.
At the hospital, you will
probably receive inhaled beta2-agonists and
corticosteroids. You may be given
oxygen therapy. Your lung function and condition will
be checked. You may need more treatment in the emergency
room or a stay in the hospital.
Some people are
at increased risk of death from asthma, such as people
who have been admitted to an intensive care unit for asthma or who have needed
a breathing tube (intubation) for asthma. If you are high-risk, seek medical
care early when you have symptoms.
Although there is no certain way to
asthma, you can reduce
airway inflammation and your risk of
The goal is to reduce the number, length, and severity of asthma attacks. Start by
your asthma triggers. Also be sure to:
Common irritants in the air, such as tobacco smoke and air pollution, can trigger asthma attacks in some
people. They include:
Exercise is an asthma trigger for some people. If you often have asthma attacks when you
exercise, use your inhaler 10 to 30 minutes before you start the activity so you can
avoid an attack.
Avoid exercising outdoors in cold weather. If you are outdoors in cold weather, wear a scarf around your
face and breathe through your nose.
You can control the impact
of asthma with an asthma action plan. A good action plan reminds you to take your daily controller medicines and to be aware of your symptoms. It also tells you how to make
quick decisions about medicine and treatment when you need to.
To manage your asthma and get the most out of your asthma
action plan, know how to monitor your peak airflow, identify
asthma triggers, and take your asthma medicine correctly.
It's easy to
underestimate how severe your symptoms are. You may not notice symptoms
until your lungs are functioning at 50% of your personal best measurement.
peak expiratory flow (PEF) is a way to keep track of
asthma symptoms at home. Doing this can help you know when your lung function is
getting worse before it drops to a dangerously low level. You can do this with
peak flow meter.
trigger is anything that can lead to an asthma attack. A trigger can be smoke, air pollution, allergens, some medicines, or even stress. Avoiding triggers will help decrease the chance of
having an asthma attack.
In the case of allergy triggers, avoiding them will help control
inflammation in the airways. If you have asthma triggered by an allergen, taking
antihistamine medicine may help you manage the allergy. It may limit the allergy's effect on your asthma.
Taking medicines is an
important part of asthma treatment. But because you may need to take more than
one medicine, it can be hard to remember to take them. To help yourself
remember, understand the reasons people don't take their asthma medicines. Then find
ways to overcome those obstacles, such as taping a
note to your refrigerator.
Most people with asthma can travel freely.
But if you travel to remote areas and take part in intense physical
activity, such as long hikes, you may be at increased risk for an asthma attack
in an area where emergency help may be hard to find.
traveling, keep your medicine with you, carry the prescription for it,
and use it as prescribed. Also carry your asthma action plan so you know what
medicines to take every day and what to do if you have an asthma attack.
Teens who have asthma
may view the disease as cutting into their independence and setting them apart
from their peers. Parents and other adults can offer support and
encouragement to help teens stick with a treatment program. It's important
Medicine doesn't cure
asthma. But it is an important part of managing it. Medicines for asthma treatment are used to:
Asthma medicines are divided into two groups: those for
prevention and long-term control of
inflammation and those that provide quick relief for
Most medicines for asthma are
inhaled. Inhaled medicines are used because a specific dose can
be given directly to the airways.
Delivery systems include metered-dose and dry powder
nebulizers. A metered-dose inhaler (MDI) is used most
Sometimes doctors recommend attaching a
spacer to an MDI to better deliver the medicine to the lungs. For many people, a spacer makes an MDI
easier to use.
The most important asthma
There are other long-term medicines for daily treatment. They
Other medicines may be given in some cases.
Medicine treatment for asthma depends on your age and type of asthma, and how well the treatment is controlling your asthma
Your doctor will work with you to help find the number and
dose of medicines that work best.
One of the best tools for managing asthma is a daily controller medicine that has a corticosteroid ("steroid"). But some people worry about taking steroid medicines because of myths they've heard about them. If you're making a decision about a steroid inhaler, it helps to know the facts.
At the start of asthma
treatment, the number and dosage of medicines are chosen to get the asthma
under control. Your doctor may start you at a higher dose within your asthma
classification so that the inflammation is controlled right away. After the asthma has been controlled for several months, the dose
of the last medicine added is reduced to the lowest possible dose that prevents
symptoms. This is known as step-down care. Step-down care is believed to be a
better way to control inflammation in the airways than starting at
lower doses of medicine and increasing the dose if it is not enough.18
Because quick-relief medicine quickly reduces
symptoms, people sometimes overuse these medicines instead of using the
slower-acting long-term medicines. But
overuse of quick-relief medicines may have harmful
effects, such as reducing how well these
medicines will work for you in the future.19
You may have to take more than one
medicine each day to manage your asthma. Help yourself remember when to take each medicine, such as taping a
note to your refrigerator to remind yourself.
Tell your doctor about all the medicines you
are taking, so he or she can choose asthma medicines that won't interfere with
Some people only have symptoms during certain
times of the year (seasonal asthma). If you know when you will most likely have
symptoms, start using a medicine to decrease inflammation before the symptoms
A new treatment called bronchial thermoplasty is available for adults with severe asthma. For this treatment, bronchoscopy is used to apply heat to the airways. This reduces the thickness of the airways and improves the ability to breathe.16, 17
(immunotherapy) may be recommended for people who have
asthma symptoms that are triggered by allergens.
For some people, allergy
shots reduce asthma symptoms and the need for
medicines.20 But allergy shots don't work equally well for all allergens. Allergy shots should not be given when asthma is
Some people have used
ephedra—a stimulant sold for weight loss and sports
performance—to try to treat asthma symptoms. But the U.S. Food and Drug
Administration (FDA) has banned the sale of this dietary supplement because of
concerns about safety. Ephedra, also called ma huang, has been linked to
strokes, and some deaths.
Alternative treatments such
as homeopathy, acupuncture, and breathing exercises have been used to treat
asthma. The research on these treatments is limited. Reviews of research
A review of
complementary and alternative treatments for treating asthma in children
concluded that none have been proved to reduce asthma symptoms and some may
have harmful side effects.23 Some of these studies
included teenagers and adults. The treatments reviewed include:
Talk to your doctor before trying a complementary or
For more information on alternative
treatments, see the topic
The American Academy of Allergy, Asthma, and Immunology
publishes an excellent series of pamphlets on allergies, asthma, and related
information. It also provides physician referrals.
The American Lung Association provides programs of
education, community service, and advocacy. Some of the topics available
include asthma, tobacco control, emphysema, infectious disease, asbestos, carbon monoxide, radon,
The Asthma and Allergy Foundation of America (AAFA)
provides information and support for people who have allergies or asthma. The
AAFA has local chapters and support groups. And its Web site has online
resources, such as fact sheets, brochures, and newsletters, both free and for
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
Bush RK (2002). Environmental controls on the management of allergic asthma. Medical Clinics of North America, 86(3): 973–989.
McGeady SJ (2004). Immunocompetence and allergy. Pediatrics, 113(4): 1107–1113.
Jarjour NN, Kelly EAB (2002). Pathogenesis of asthma. Medical Clinics of North America, 86(3): 926–936.
Silva GE, et al. (2004). Asthma as a risk factor for COPD in a longitudinal study. Chest, 126(1): 59–65.
Guilbert T, Krawiec M (2003). Natural history of asthma. Pediatric Clinics of North America, 50(3): 524–538.
Stern DA, et al. (2008). Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: A longitudinal birth-cohort study. Lancet, 372(9643): 1058–1064.
Etzel RA (2003). How environmental exposures influence the development and exacerbation of asthma. Pediatrics, 112(1): 233–239.
Rodriguez MA, et al. (2002). Identification of population subgroups of children and adolescents with high asthma prevalence: Findings from the third National Health and Nutrition Examination. Archives of Pediatrics and Adolescent Medicine, 156(3): 269–275.
Lemanske RF Jr (2003). Viruses and asthma: Inception, exacerbations, and possible prevention. Proceedings from the Consensus Conference on Treatment of Viral Respiratory Infection-Induced Asthma in Children. Journal of Pediatrics, 142(2, Suppl): S3–S7.
Sutherland ER, Martin RJ (2002). Is infection important in the pathogenesis and clinical expression of asthma? In SL Johnston, ST Holgate, eds., Asthma: Critical Debates, pp. 69–84. London: Blackwell Science.
Burgess SW, et al. (2006). Breastfeeding does not increase the risk of asthma at 14 years. Pediatrics, 117(4): 787–792.
Jaakkola JJK, et al. (2002). Pets, parental atopy, and asthma in adults. Journal of Allergy and Clinical Immunology, 109(5): 784–788.
Ownby DR, et al. (2002). Exposure to dogs and cats in the first year of life and risk of allergic sensitization at 6 to 7 years of age. JAMA, 288(8): 963–972.
Yeatts K, et al. (2003). Who gets diagnosed with asthma? Frequent wheeze among adolescents with and without a diagnosis of asthma. Pediatrics, 111(5): 1046–1054.
Joint Task Force on Practice Parameters (2005). Attaining optimal asthma control: A practice parameter. Journal of Allergy and Clinical Immunology, 116(5): S3–S11. Available online: http://www.allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/2005+Asthma+Control.pdf.
Cox G, et al. (2007). Asthma control during the year after bronchial thermoplasty. New England Journal of Medicine, 356(13): 1327–1337.
Castro M, et al. (2010). Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: A multicenter, randomized, double-blind, sham-controlled clinical trial.
American Journal of Respiratory and Critical Care Medicine, 181(2): 116–124.
National Institutes of Health (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08–5846). Available online: http://www.nhlbi.nih.gov/guidelines/asthma/index.htm.
Salpeter SR, et al. (2004). Meta-analysis: Respiratory tolerance to regular beta2-agonist use in patients with asthma. Annals of Internal Medicine, 140(10): 802–813.
Abramson MJ, et al. (2010). Injection allergen immunotherapy for asthma. Cochrane Database of Systematic Reviews (8). Oxford: Update Software.
Györik SA, Brutsche MH (2004). Complementary and alternative medicine for bronchial asthma: Is there new evidence? Current Opinion in Pulmonary Medicine, 10(1): 37–43.
Passalacqua G, et al. (2006). ARIA update: I—Systematic review of complementary and alternative medicine for rhinitis and asthma. Journal of Allergy and Clinical Immunology, 117(5): 1054–1062.
Bukutu C, et al. (2008). Asthma: A review of complementary and alternative therapies. Pediatrics in Review, 29(8): e44–e49.
Other Works Consulted
Grayson MH, Holtzman MJ (2007). Asthma. In EG Nabel, ed., ACP Medicine, section 14, chap. 19. Hamilton, ON: BC Decker.
Jaeschke R, et al. (2008). The safety of long-acting beta-agonists among patients with asthma using inhaled corticosteroids. American Journal of Respiratory and Critical Care Medicine, 178(10): 1009–1016.
February 13, 2011
E. Gregory Thompson, MD - Internal Medicine & Rohit K Katial, MD - Allergy and Immunology
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