The Need For Understanding
Despite of thousands of studies, the major problem to progress with diagnosis and therapy of asthma seems to be the lack of understanding how different cell types and pro-inflammatory, as well as inflammatory mechanisms affect each other. It would be a big step forward if future studies would be able to monitor a small cohort of patients from the first diagnosis of asthma over several years with unchanged methods of analysis. These studies should obtain samples like blood, sputum, or bronchial fluids on a regular basis of short intervals , and compare the clinical parameters with metabolomic, proteomic, and transcriptomic analyse. The aim of such studies should be to determine if biomarkers and therapeutic targets for asthma vary with time, and condition, or if they are stable indicators for the disease. Only when we know if the biomarkers are stable or specific for a condition such as exacerbation or allergic response we will be able to use them as diagnostic tools.
What Asthma Types Have In Common
Asthma has certain features that remain the same across most types:
- Classic symptoms:Wheezing, chest tightness, shortness of breath, cough, asthma attacks
- Causes/risk factors: Genetics and environmental exposures
- Diagnosis:Pulmonary function tests and assessing response to asthma medications
- Treatment: A rescue inhaler for asthma attacks and possibly daily inhaled or oral medications to prevent symptoms
Because of this, it’s easy to assume that all types of asthma are fundamentally the same. While that’s true to a certain extent, the differences between the types matter. That makes an accurate diagnosis crucial.
You Developed It For The First Time In Adulthood
Sometimes adults who have never had any symptoms before will develop asthma, and it can happen in your 40s, 50s, 60s or any age.
Known as adult-onset asthma, it may have no known cause, but most of the time the new asthma is triggered by an environmental irritant , a viral infection , or an allergy.
Women are more likely to develop asthma in adulthood, and there are certain things, like obesity, smoking, and stressful life events that are known risk factors for adult-onset asthma.
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Vaping And Lung Damage
- Talk with your teen about the dangers of vaping.
- Vaping can cause severe lung damage. It can become permanent.
- Vaping can even cause death .
- Vaping tobacco also causes nicotine addiction.
- For these reasons, the legal age to purchase vaping products is 21 in the US.
- Encourage your teen to not start vaping or to give it up.
- Warning: home-made or street-purchased vaping solutions are the most dangerous.
The Symptoms Of Adult
When you have asthma, the condition causes the airways to narrow, swell and produce extra mucus. When this occurs, you may experience a number of symptoms, including:
- Chest congestion
- Shortness of breath, particularly after being physically active
- Wheezing when you exhale
Those who have adult-onset asthma may also find it more difficult to recover after seemingly minor viruses, such as the common cold. Colds and other viruses may be more likely to move into the chest and linger, causing coughing and other symptoms to flare up.
While asthma may come and go during childhood, its more likely to persist in adults. This makes it important to take steps to manage the condition.
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Asthma Related To Sensitising Or Irritant Exposure In The Workplace
Occupational asthma has become the most common type of adult-onset asthma in many industrialised countries, having been implicated in 915% of adult-onset asthma . Two types of occupational asthma have been defined: sensitiser induced and irritant induced .
Sensitiser-induced asthma is a subtype of occupational asthma typically presenting with a latent period of exposure, followed by the onset of clinical disease. After sensitisation, airway reactions develop from levels of exposure to the sensitising agents that were tolerated before sensitisation. Although the mechanism causing occupational asthma from some sensitisers has been demonstrated to have an immunological basis , the mechanisms for some suspected sensitisers are yet to be defined. There are more than 250 agents that have been adequately documented to cause sensitiser-induced asthma . Some sensitising agents have differential effects on asthma onset depending on the dose. For example, in farmers, exposure to low-dose endotoxins and fungal spores appears to have a protective effect on the development of atopic asthma but may induce non-atopic adult-onset asthma at higher doses .
Asthma Is Not Just A Childhood Condition That Everyone Outgrows
Like Sommer, some people do outgrow childhood asthma or have much milder symptoms as adults.
For others, symptoms persist into adulthood. Imhoff says, I was diagnosed at age 4, and as I got older, my asthma actually got worse instead of improving. I dont remember not worrying about it.
And others wont develop asthma until theyre well into adulthood. ONeal was 40 years old when she first experienced symptoms.
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How Is Asthma Classified
Asthma is classified into four categories based upon frequency of symptoms and objective measures, such as peak flow measurements and/or spirometry results. These categories are: mild intermittent mild persistent moderate persistent and severe persistent. Your physician will determine the severity and control of your asthma based on how frequently you have symptoms and on lung function tests. It is important to note that a person’s asthma symptoms can change from one category to another.
Action Plans And Self
Action plans for exacerbations are effective in asthma, allowing patients to develop coping skills, anticipate early exacerbation symptoms, self-initiate appropriate treatment, and seek medical advice prior to significant deterioration. Trials assessing the effects of action plans in COPD management have shown conflicting results, with variable adjuncts to patient care likely contributors. Those with positive results, such as expedited exacerbation recovery and reduced hospital admissions, have included additional supports, such as intensive education and case management. In contrast, action plans with limited or no SME and no case management have little beneficial effect.
A recent randomized controlled trial that suggested an unexpected increase in all-cause and COPD-specific mortality with a comprehensive care management program including a COPD action plan for US veterans, highlighted the value of identifying those with adult-onset asthma for whom the benefits are well-documented. Putting this disturbing finding into the context of the COPD literature is important, and identifying factors predisposing to a poor outcome will be a challenge for those involved in developing clinical practice guidelines. While the association did not appear related to increasing age or COPD severity, these findings suggest that self-management programs may not be appropriate for all patients with COPD.
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People Who Develop Asthma Later In Life Are Also Less Likely To Experience Remission
The age of asthma onset may also be a factor. One old, large 1999 study found that middle-aged and elderly adults who developed asthma later in life were less likely to experience remission.
Researchers in the study above determined that of 6,610 people, only 6 percent reportedly entered remission within 10 years.
Treatment Of Asthma In Adults
The medications and treatments for adult asthma are:
- Anti-inflammatories inhaled corticosteroids are taken daily to prevent asthma symptoms by reducing airway sensitivity and inflammation. Steroid tablets can be taken for acute flare-ups and more severe asthma.
- Bronchodilators inhaled short-acting and long-acting bronchodilators are taken occasionally to relieve symptoms. They work within a few minutes and shouldnt be needed more than three times a week.
- Leukotriene receptor antagonists daily tablets to improve prevention if needed.
- Theophylline taken daily to prevent symptoms if they are still not well controlled.
- Monoclonal antibody therapy also called biological medicines or biologics, these injections block some of the bodys immune response to triggers.
- Bronchial thermoplasty is a surgical procedure done on the airway itself to reduce its thickness.
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Breathing Tests For Diagnosing Adult
The breathing tests for asthma include:
- Spirometry how much air you can breathe out in a set time.
- Bronchodilator reversibility this is when two spirometry tests are done before and after a one-off dose of bronchodilator medication to see if the treatment helps. A positive BDR test usually confirms an asthma diagnosis.
- Peak expiratory flow monitoring measures how fast you can breathe out. You might be asked to monitor your PEF, often referred to simply as peak flow, at home for two to four weeks.
- Fractional exhaled nitric oxide measures the level of inflammation in your airways.
- Bronchial challenge investigates how sensitive your airways are to a deliberately administered irritant . This specialist test is only done under medical supervision in hospital.
Most people need just one or two tests to reach a diagnosis. After asthma is confirmed you might have one or more allergy tests to try to identify potential triggers.
Bronchiolitis And Croup In Babies And Young Children
If your child has had a few episodes of bronchiolitis, they could be more at risk of getting asthma as they get older.
Bronchiolitis is caused by a virus, usually the respiratory syncytial virus . Its mostly babies and young children under two years old who get bronchiolitis. It leads to swelling in the lungs and airways, cough, and wheeze.
Your baby is more at risk of bronchiolitis if you smoke.
Find out more about bronchiolitis at our sister charity the British Lung Foundation.
Children with a history of croup may also be more at risk of developing asthma. Like asthma, croup has symptoms like coughing and feeling breathless.
Sometimes asthma gets missed because parents think its croup. But croup is very rare after the age of five, so if your child is still being treated for croup after this age, your GP should check to see if they have asthma.
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How Can Adult Onset Asthma Be Managed
If you manage your asthma, you can expect to lead a normal lifestyle. Basically, there are four key steps to managing asthma successfully:
1. Learn about asthma and stay up-to-date on new developments.
2. Take prescribed medications. Dont make any changes until you check with your physician. Dont use over- the-counter medications unless prescribed by your physician!
3. Check your lungs daily at home by using a peak flow meter. Asthma patients often can detect lung changes with a peak flow meter before they actually experience any changes. Visit your physician regularly for further in-office tests. Lung testing is painless and provides valuable data that helps your physician make adjustments in your medication.
4. Make an asthma management plan with your physician. A plan establishes guidelines that tell you what to do if your asthma symptoms get worse.
What Is Asthma Anyway
First up, a little anatomy refresher: Your airways, which extend between your nose and mouth and your lungs, have the very important job of carrying air in and out of your body, according to the National Heart, Lung, and Blood Institute . When you have asthma, triggers like animal fur, pollen, mold, cold air, cigarette smoke, exercise, and respiratory infections like colds cause your airways to get inflamed, according to the NHLBI. That inflammation can cause swelling, which in turn can prompt the muscles around your airways to tighten, making it hard to get air in and out. At the same time, your airways might also expel more mucus than they usually do, making it even harder to breathe.
Experts dont know exactly what causes some people to get asthma when others dont, but its pretty safe to assume that its probably a combination of environmental factors and genetic factors. For example, if someone in your immediate family has asthma, youre more likely to have it too, according to the Centers for Disease Control and Prevention . Beyond that, the general cause is a stronger-than-normal response from your immune system to certain triggers, which is why you get all that inflammation when people without asthma dont, says the NHLBI.
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Are There Any Special Considerations For Adults Who Develop Asthma
People with multiple medical conditions need to be aware of how their illnesses and the medications they use may affect one another.
If you take more than one medication, talk with your physician about ways to simplify your medication program. Explore the possibility of combining medications or using alternate ones that will have the same desired effect. Be sure to discuss potential drug interactions with anything you take including vitamins or herbal supplements.
Are There Any Special Considerations For Adults With Asthma
Many adults take several medications and/or use over-the counter medications, such as ibuprofen or aspirin, regularly. Work with your doctor to simplify your medication program as much as possible. Explore the possibility of combining medications or using alternate ones that will have the same desired effect. Be sure to discuss potential drug interactions with anything you take, including vitamins. Some asthma medications increase heart rate. If you have a heart condition, discuss those side affects with your health care provider. Older first generation antihistamines can cause men with enlarged prostates to retain urine. Oral steroids can make symptoms of glaucoma, cataracts and osteoporosis worse. Adults with arthritis may need special inhalers that are easier to operate. Anyone with asthma should consider getting an annual flu shot. Older adults also should talk with their doctor about getting a pneumonia vaccination. People with multiple medical conditions need to be aware of how their illnesses may affect one another.
This article was published by AAFA, copyright 1995. It can be accessed online at the following
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How Is Asthma Treated
Asthma can be controlled, but there’s no asthma cure. There are, however, certain goals in asthma treatment. If you are unable to achieve all of these goals, it means your asthma is not under control. You should contact your asthma care provider for help with asthma.
Treatment goals include the following:
- Live an active, normal life
- Prevent chronic and troublesome symptoms
- Attend work or school every day
- Perform daily activities without difficulty
- Stop urgent visits to the doctor, emergency room, or hospital
- Use and adjust medications to control asthma with little or no side effects
Properly using asthma medication, as prescribed by your doctor, is the basis of good asthma control, in addition to avoiding triggers and monitoring daily asthma symptoms. There are two main types of asthma medications:
Asthma medications can be taken by inhaling the medications or by swallowing oral medications . If you are also taking drugs for other conditions, you should work with your providers to check drug interactions and simplify medications when possible.
Is It Triggered By Allergies
There are numerous triggers for asthma, and people will often soon work out what their individual trigger is.
The NHS says common triggers include
- Allergies to house dust mites, animal fur or pollen
- Smoke, pollution and cold air
- Infections like colds or flu
But in adults, asthma triggers are less likely to be allergies, such as pets, pollen, house or dust mites, and more likely brought on by hormonal changes or work-related.
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What Causes Asthma In Children
The exact cause of asthma is unknown. Genetics and environment likely play a role in which children get asthma.
An asthma attack can happen when your child is exposed to an asthma trigger. An asthma trigger is something that can set off or worsen asthma symptoms. Different triggers can cause different types of asthma:
- Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
- Dust mites
Asthma triggers may be different for each child and can change over time.
So Does Asthma Ever Go Away Completely
The short answer is: Yes, some kids stop experiencing asthma symptoms as they get older, Robert Giusti, MD, a pediatric pulmonologist at NYU Langone, tells Health. This is especially true for children who start wheezing at a young age. In some, the wheezing clears up, and they go on to live an asthma-free life. Doctors don’t know exactly why asthma clears up for some children but not others.
Asthma symptoms can become less and less frequents for adults, too, Marilyn Li, MD, an allergist at the Los Angeles County University of Southern California Medical Center, tells Health. “As to the about asthma persistence, it really is a multifaceted issue,” Dr. Li says. “Yes, in some adults asthma can go from persistent to intermittent.”
Total remissionmeaning the patient no longer experiences asthma symptoms at allis very rare. According to information from a clinical trial on asthma remission, which was published by the National Institutes of Health , only about 15 to 25% of people see complete asthma remission. “In a small subset of patients, their asthma resolves spontaneously. This phenomenon is called asthma remission,” the study reads. “Unfortunately asthma remission occurs only in a small subset of asthma patients.”
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Spacers For Asthma Medication
It is recommended that all people with asthma, regardless of age, use a spacer when taking medication via a metered-dose inhaler .
Spacers help to improve the delivery of asthma medication to the lungs and minimise side effects from medications. Talk to your doctor or pharmacist about spacers and how they might help you manage your asthma.
which demonstrate how to use a puffer and spacer.
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Cigarette Smoke And Asthma
Cigarette smoke is a common trigger for asthma symptoms. Many other respiratory illnesses are caused and made worse by smoking, including emphysema and chronic bronchitis.
Managing symptoms will become easier for people with asthma if they are able to quit smoking or avoid being around people who are smoking.
Although quitting can be difficult, there are many effective treatment options available which you can discuss with your doctor or pharmacist.
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