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When you have asthma, two main
things are happening in your lungs:
1 - Constriction (The tightening of the muscles
around the airways)
2 - Inflammation (The swelling of the airways) |
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| Constriction and inflammation
narrow your airways, which can cause symptoms such
as wheezing, coughing, chest tightness and shortness
of breath. There is increasing evidence that if
left untreated, asthma may cause a long-term decline
in lung function. |
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| For many patients, optimal
therapy requires treating both main components of
asthma. |
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| Most people with asthma have
wheezing attacks separated by symptom-free periods.
Some patients have long-term shortness of breath
with episodes of increased shortness of breath.
Still, in others, a cough may be the main symptom.
Asthma attacks can last minutes to days and can
become dangerous if the airflow becomes severely
restricted. |
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| In sensitive individuals, asthma
symptoms can be triggered by breathing in allergy-causing
substances (called allergens or triggers). Triggers
include pet dander, dust mites, cockroach allergens,
molds or pollens. Asthma symptoms can also be triggered
by respiratory infections, exercise, cold air, tobacco
smoke and other pollutants, stress, food or drug
allergies. Aspirin and other non-steroidal anti-inflammatory
medications |
| (NSAIDS) provoke asthma
in some patients. |
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| Symptoms |
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- Wheezing usually begins suddenly
- Comes in episodes
- May be worse at night or in early morning
- Gets worse with cold aira, exercise and heartburn
(reflux)
- May go away on its own
- Is relieved by bronchodilators (drugs that
open the airways)
- Cough with or without sputum production
- Shortness of breath that gets worse with activity
- Intercostal retractions (pulling of the skin
between the ribs when breathing)
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| Emergency symptoms: |
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Decreased level of alertness, such as severe drowsiness
or confusion during an asthma attack. |
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| Exams and Tests |
| Allergy testing may be helpful
in identifying allergens in patients with persistent
asthma. Common allergens include pet dander, dust
mites, cockroach allergens, molds and pollens. Common
respiratory irritants include tobacco smoke, pollution
and fumes from burning wood or gas. |
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Tests may include:
- Pulmonary function testing
- Chest
x-ray
- Blood tests, including eosinophil count (a
type of white blood cell)
- Arterial blood gas
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| Treatment |
| Treatment is aimed at avoiding
known allergens and respiratory irritants and controlling
symptoms and airway inflammation through medication.
There are two basic kinds of medication for the
treatment of asthma: |
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Long-term control medications
are used on a regular basis to prevent attacks,
not for treatment during an attack. Types include:
- Inhaled steroids (such as Azmacort, Vanceril,
AeroBid, Flovent) prevent inflammation
- Leukotriene inhibitors (such as Singulair
and Accolate)
- Anti-IgE therapy (Xolair), a medicine given
by injection to patients with more severe asthma
- Long-acting bronchodilators (such as Serevent)
help open airways
- Cromolyn sodium (Intal) or nedocromil sodium
- Aminophylline or theophylline (not used as
frequently as in the past)
Sometimes a combination of steroids and bronchodilators
are used, using either separate inhalers or a
single inhaler (such as Advair Diskus). |
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Quick relief or rescue, medications
are used to relieve symptoms during an attack.
These include:
- Short-acting bronchodilators (inhalers), such
as Proventil, Ventolin, Xopenex and others.
- Short-acting bronchodilators (inhalers), such
as Proventil, Ventolin, Xopenex and others.
- Corticosteroids, such as prednisone or methylprednisolone)
given by mouth or into a vein
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| Persons with mild asthma (infrequent
attacks) may use quick relief medication as needed.
Those with persistent asthma should take control
medications on a regular basis to prevent symptoms.
A severe asthma attack requires a medical evaluation
and may require a hospital stay, oxygen and intravenous
medications. |
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| A peak flow meter, a simple
device to measure lung volume, can be used at home
to help you "see an attack coming" and
take the appropriate action, sometimes even before
any symptoms appear. If you are not monitoring asthma
on a regular basis an attack can take you by surprise. |
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| Peak flow measurements can
help show when medication is needed or other action
needs to be taken. Peak flow values of 50-80% of
an individual’s personal best results indicate
a moderate asthma attack, while values below 50%
indicate a severe attack. |
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