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Asthma—Adult

Definition

Asthma is a chronic disease that affects the function and lining of the airways or tubes of the lungs. It narrows the airways and makes it difficult to breathe.
Inflamed Bronchus in the Lungs
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Causes

Asthma symptoms are caused by an increased sensitivity of the airways to certain triggers. The triggers cause the lining of the airways to swell and produce extra fluid called mucus. At the same time, the muscles around the outside of the airway tighten in response to the irritation. All of these reactions narrow the airways and make it difficult to breathe. This response is often referred to as an asthma attack.
Possible triggers of an asthma attack in a person with asthma include:

Risk Factors

Factors that may increase your chance of asthma include:

Symptoms

Symptoms include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Your doctor may also do some tests to measure lung function. They may include:
Your doctor may also do some allergy tests. The test will help determine if allergies are causing symptoms. The test may include skin pricks or blood tests.

Treatment

The treatment strategy for asthma includes:
You and your doctor should also create an asthma action plan. This is a plan you will follow to help control your asthma and handle asthma attacks.

Asthma Medications

Medications Used to Control Asthma
These medications are used to avoid asthma attacks, but will not treat an existing attack. Medication may include any of or combinations of:
  • Inhaled corticosteroids to prevent airway swelling and inflammation
  • Inhaled long-acting beta agonists to relax the airways and keep them from tightening
  • Oral leukotriene modifiers to prevent airway inflammation and swelling, decrease the amount of mucus in the lungs, and open the airways
  • Inhaled cromolyn or nedocromil to prevent airways from swelling from contact with an asthma trigger
Medications Used to Treat an Asthma Attack
These medications are used to treat an asthma attack.
Medication may include any or combinations of:
  • Inhaled quick-acting beta agonists and anticholinergic agents to open the airways
  • Oral corticosteroids to reduce severe airway inflammation

Other Treatments

Bronchial thermoplasty to reduce excessive smooth muscle in the lungs and decrease the ability of the airways to constrict.
Prevention is an important step in asthma care. Allergy avoidance can be effective with asthma that is made worse by allergens. Some general tips for allergen avoidance include:
  • Avoid outside activities if there are high levels of air pollution, pollen, or mold spores.
  • Keep your windows closed during seasons with high pollen or mold spores. Air conditioning may help filter out allergens during warm seasons.
  • Consider getting a portable HEPA unit air cleaner to use in sleeping areas.
  • Consider getting HEPA filters for your heating/cooling system and your vacuum cleaner.
  • Have someone else vacuum for you. Avoid a room that has been freshly vacuumed. If you do vacuum, use a dust mask.
  • Keep the humidity down in your house. This may help prevent the growth of mold.
  • Treat allergies and sinusitis as advised by your doctor.
  • If allergies trigger your asthma attacks, ask your doctor about ways to manage your allergies.
It may be helpful to learn breathing techniques or doing breathing exercises. Improved fitness may also increase exercise tolerance and reduce attacks. Ask your doctor for advice.

Monitoring

Your asthma plan may need to be adjusted to adapt to changes in your life or health. Staying in contact with your doctor between visits can help you have better control of your asthma.
Online programs aimed at helping you manage your own symptoms can improve asthma control and lung function. Some examples of programs include American Lung Association or Asthma and Allergy Foundation of America.

Prevention

There are no guidelines for preventing asthma because the cause is unknown. However, you can help prevent asthma attacks by avoiding things that trigger your attacks. Triggers can vary from person to person but some general guidelines include:
Talk to your doctor about:

RESOURCES

American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org

Asthma and Allergy Foundation of America http://www.aafa.org

CANADIAN RESOURCES

Allergy Asthma Information Association http://aaia.ca

The Lung Association http://www.lung.ca

References

Asthma in adults and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 13, 2015. Accessed August 5, 2015.

Asthma exacerbation in adults and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 15, 2014. Accessed August 5, 2015.

Asthma stepwise management in adults and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 2, 2011. Accessed August 5, 2015.

Asthma overview. Asthma and Allergy Foundation of America website. Available at: http://www.aafa.org/display.cfm?id=8. Accessed August 5, 2015.

Breathing exercises and or retraining techniques in management of asthma. Agency for Healthcare Research and Quality website. Available at: http://www.effectivehealthcare.ahrq.gov/ehc/products/222/1251/CER71%5FBreathingExercises%5FFinalReport%5F20120905.pdf. Accessed August 5, 2015.

Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ. 2009;181(9):E181-E190.

Sublett JL, Seltzer J, Burkhead R, et al. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. J Allergy Clin Immunol. 2010;125(1):32-38.

Flu and people with asthma. Center for Disease Control and Prevention website. Available at: http://www.cdc.gov/flu/asthma. Updated September 25, 2013. Accessed August 5, 2015.

10/29/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Howden-Chapman P, Pierse N, Nicholls S, Gillespie-Bennett J, et al. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial. BMJ. 2008;337:a1411.

1/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Levenson M. Long-acting beta-agonists and adverse asthma events meta-analysis. Joint Meeting of the Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee and Pediatric Advisory Committee. December 10-11, 2008.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Bailey EJ, Cates CJ, Kruske S, et al. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2009;(1):CD006580.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Thomas M, McKinley RK, Mellor S, et al. Breathing exercises for asthma: a randomised controlled trial. Thorax. 2009;64(1):55-61.

9/2/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Van der Meer V, Bakker MJ, van den Hout WB, et al. Internet based self-management plus education compared with usual care in asthma: a randomized trial. Ann Intern Med. 2009;151(2):110-120.

10/8/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Ducharme F, Chroinin M, Greenstone I, et al. Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev. 2010;(5):CD005535.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: McLean S, Chandler D, Nurmatov U, et al. Telehealthcare for asthma. Cochrane Database Syst Rev. 2010;(10):CD007717.

11/12/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Freitas DA, Holloway EA, Bruno SS, et al. Breathing exercises for adults with asthma.Cochrane Database Syst Rev. 2013 Oct 1;10:CD001277.

11/2/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Normansell R, Kew KM, et al. Sublingual immunotherapy for asthma. Cochrane Database Syst Rev. 2015 Aug 28;8:CD011293.

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