Care Advice For Asthma Attack
Pathophysiology And Pathogenesis Of Asthma
Airflow limitation in asthma is recurrent and caused by a variety of changes in the airway. These include:
CYTOKINE BALANCE Numerous factors, including alterations in the number or type of infections early in life, the widespread use of antibiotics, adoption of the Western lifestyle, and repeated exposure to allergens, may affect the balance between Th1-type
There also appears to be a reciprocal interaction between the two subpopulations in which Th1 cytokines can inhibit Th2 generation and vice versa. Allergic inflammation may be the result of an excessive expression of Th2 cytokines. Alternatively, recent studies have suggested the possibility that the loss of normal immune balance arises from a cytokine dysregulation in which Th1 activity in asthma is diminished. The focus on actions of cytokines and chemokines to regulate and activate the inflammatory profile in asthma has provided ongoing and new insight into the pattern of airway injury that may lead to new therapeutic targets.
Genetics
Sex
In early life, the prevalence of asthma is higher in boys. At puberty, however, the sex ratio shifts, and asthma appears predominantly in women . How specifically sex and sex hormones, or related hormone generation, are linked to asthma has not been established, but they may contribute to the onset and persistence of the disease.
Environmental Factors
Allergens
Respiratory infections
Other environmental exposures
Diagnosing Asthma In Older People
Older people are more likely to have other lung diseases that also cause shortness of breath , so doctors have to determine how much of the person’s breathing difficulty is related to asthma and reversible with the appropriate anti-asthma therapy. Often, in these people diagnosis involves a brief trial of drugs that are used to treat asthma to see whether the person’s condition improves.
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Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Services National Institutes of Health the Nations biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including asthma. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.
What Should I Do If I Have A Severe Asthma Attack
A severe asthma attack needs immediate medical care. The first step is your rescue inhaler. A rescue inhaler uses fast-acting medicines to open up your airways. Its different than your normal maintenance inhaler, which you use every day. You should only use the rescue inhaler in an emergency.
If your rescue inhaler doesnt help or you dont have it with you, go to the emergency department if you have:
- Anxiety or panic.
- Bluish fingernails, bluish lips or gray or whitish lips or gums .
- Chest pain or pressure.
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What Types Of Asthma Are There
Healthcare providers identify asthma as intermittent or persistent . Persistent asthma can be mild, moderate or severe. Healthcare providers base asthma severity on how often you have attacks. They also consider how well you can do things during an attack.
Asthma can be:
- Allergic: Some peoples allergies can cause an asthma attack. Molds, pollens and other allergens can cause an attack.
- Non-allergic: Outside factors can cause asthma to flare up. Exercise, stress, illness and weather may cause a flare.
I Can’t Do Anything But Focus On Getting Oxygen Into My Lungs
Dairy triggers the majority of Susan S.s asthma attacks, she tells SELF.
It feels like I am suffocating, she says. I have to focus on breathing and can’t talk. In fact, I can’t do anything but focus on getting oxygen into my lungs. Imagine you are drowning. You can’t get a breath. You would do anything to breathe.
Susan says she hasnt found an inhaler that works for her, so shes trying to avoid dairy altogether for the time being.
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Key Differences From 1997 And 2002 Expert Panel Reports
- The critical role of inflammation has been further substantiated, but evidence is emerging for considerable variability in the pattern of inflammation, thus indicating phenotypic differences that may influence treatment responses.
- Gene-by-environmental interactions are important to the development and expression of asthma. Of the environmental factors, allergic reactions remain important. Evidence also suggests a key and expanding role for viral respiratory infections in these processes.
- The onset of asthma for most patients begins early in life with the pattern of disease persistence determined by early, recognizable risk factors including atopic disease, recurrent wheezing, and a parental history of asthma.
- Current asthma treatment with anti-inflammatory therapy does not appear to prevent progression of the underlying disease severity.
Asthma is a common chronic disorder of the airways that involves a complex interaction of airflow obstruction, bronchial hyperresponsiveness and an underlying inflammation. This interaction can be highly variable among patients and within patients over time. This section presents a definition of asthma, a description of the processes on which that definition is basedthe pathophysiology and pathogenesis of asthma, and the natural history of asthma.
Symptoms Of Asthma Emergencies In Children
The signs of an asthma emergency include when the child:
- finds it very difficult to breathe or is not breathing
- is unable to speak comfortably or complete sentences without losing breath
- has lips turn blue
- has symptoms that get worse very quickly
- has tugging in of the skin between ribs or at the base of the neck
- is getting little or no relief from their reliever inhaler, or their reliever inhaler is not available.
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What Are Some Common Medications Used To Treat Asthma
Asthma is treated and controlled primarily with two types of medications:
- Inhaled corticosteroids are used to control lung swelling over the long-term
- Quick-relief beta2-agonists like albuterol are used as “rescue” inhalers when symptoms occur.
Quick-relief inhalers don’t reduce lung swelling and should not be used in place of long-term, inhaled corticosteroid treatment.
- A long-acting beta2-agonist bronchodilator and corticosteroid combination, such as Advair , may be needed in more severe asthma. Bronchodilators help your breathing by relaxing the smooth muscle around the lung airways.
- Other brands of fluticasone and salmeterol include AirDuo Digihaler, AirDuo Respiclick, and Wixela Inhub.
- Warning: The use of long-acting beta-2 agonists without a corticosteroid is associated with an increased risk of asthma-related deaths.
There are many other long-term asthma control drugs available, including: cromolyn inhalation, oral theophylline, tiotropium , fluticasone and vilanterol and omalizumab .
I Try To Yawn To Get More Air In And My Chest Literally Stops The Yawn From Happening Because Its So Tight And Inflamed
Paige J. says that her triggers include exposure to pollen, dust, and animals like cats and dogs. I can be fine around a dog or cat for minutes or even hours at a time during the day, but later that night Ill wake up with terrible asthma and tightness of my chest, she tells SELF. Its important that family and friends realize this, because those around you cant always see your symptoms and thus might not always take them seriously.
In fact, Paige often gets quiet during asthma attacks. Talking can feel like too much effort I become 100 percent absorbed in just trying to breathe, but this often doesnt look like a big deal from the outside, she says. On the inside, though, shes dealing with the terrible feeling that her lungs arent working. I try to yawn to get more air in, and my chest literally stops the yawn from happening because its so tight and inflamed.
Paige says she usually carries her rescue inhaler with her, but if for some reason she doesnt have it, she tries to get fresh air, drink coffee, or eat dark chocolate.
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Learning To Live With Asthma
When my doctor first diagnosed me with asthma, I started taking the medications he prescribed. He gave me a tablet called Singulair to take once a day. I also had to use a Flovent inhaler twice a day. He prescribed a stronger inhaler containing albuterol for me to use when I was having an attack or dealing with sudden bursts of cold weather.
At first, things went well. I wasnt always diligent about taking the medication, though. This led to a few visits to the emergency room when I was a kid. As I got older, I was able to settle into the routine. I began having attacks less frequently. When I did have them, they werent as severe.
I moved away from strenuous sports and stopped playing soccer. I also started spending less time outside. Instead, I began doing yoga, running on a treadmill, and lifting weights indoors. This new exercise regimen lead to fewer asthma attacks during my teen years.
I went to college in New York City, and I had to learn how to get around in the ever-changing weather. I went through a particularly stressful time during my third year of school. I stopped taking my medications regularly and often dressed improperly for the weather. One time I even wore shorts in 40° weather. Eventually, it all caught up to me.
Asthma Patterns In Children
Every childs asthma is different. Some children have mild, occasional episodes of asthma or only show symptoms after exercising, or when they have a cold. Some experience daily symptoms, while others have symptoms continuously, which limit their level of activity.
Each pattern of asthma requires a different treatment approach. It is important to remember that children can still have a severe and even life-threatening attack, even if they generally have mild or occasional asthma.
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Why Do People Get Asthma
Research has yet to show a definitive cause of asthma. However, researchers have determined several risk factors that can lead to asthma development.
Family History and Genetics
Children of mothers with asthma are three times more likely to suffer from asthma, and 2.5 times more likely if the father has asthma. More than 30 genes have been linked to asthma so far, and gene-gene interactions, gene-environment interactions and epigenetic modifications also play a part. Genetic differences also play a role in differences in response to treatment.
Allergies
People are more likely to have asthma if they have certain types of allergies, such ones which can affect the eyes and nose. However, not everyone who has allergies will get asthma and not everyone who has asthma is affected by allergies. Respiratory allergies and some types of asthma are related to an antibody called immunoglobulin E , which the immune system produces in response to allergens. To protect the body, the IgE causes allergic reactions that can affect the eyes, nose, throat, lungs and skin.
Premature Birth
Children born before 37 weeks are at increased risk of developing asthma later in life.
Lung Infections
Babies or small children may be at risk of developing asthma later in life if they had certain lung infections at a very early age.
Occupational Exposures
Hormones
Women can develop adult-onset asthma during or after menopause.
Environment Air Quality
Obesity
The Pathophysiology Of Early Childhood Asthma
There are only limited studies of the pathophysiology of asthma in preschool-age children. Such studies are obviously hindered by the ethical dilemma of subjecting nonconsenting and vulnerable children to intrusive pathologic and physiologic assessment procedures.46 Autopsy and bronchial biopsy data are rare in infants and young children because of the rare occurrence of death in this age group and the evident difficulty of obtaining endobronchial biopsies in children.4749 One study examined mucosal biopsies in a small number of highly selected children 1 to 3 years of age with severe, recurrent wheeze, most of whom were atopic. They observed in those children increased thickness of reticular basement membrane and increased eosinophil density consistent with the characteristic pathologic features of asthma in adults and older children.50 In contrast, another highly selected group of much younger infants referred for severe wheeze at a median age of 12 months had no evidence of airway inflammation or structural change on bronchial biopsy,51 which implies that these changes develop between 1 and 3 years of age.
Andrew B Lumb MB BS FRCA, in, 2017
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How Is Asthma Treated And Controlled
Asthma treatment is aimed at controlling airway inflammation and avoiding known allergy triggers, like pet dander and pollen. The main goals are to restore normal breathing, prevent asthma attacks and restore daily activities.
Daily asthma treatment helps to prevent symptoms, and asthma inhalers are the preferred method because the drug can be delivered directly into the lungs in smaller doses with less side effects. Some agents are given by injection or in pill form, too.
There’s only one over-the-counter inhaler for asthma. In November 2018, the FDA announced that Primatene Mist inhaler would return as the only FDA-approved asthma inhaler available without a prescription in the U.S. Primatene Mist is used to temporarily relieve mild symptoms of intermittent asthma in people ages 12 and older.
- You can view the new step-by-step directions for the new Primatene Mist.
- See your doctor for advice about use of any asthma treatment.
What To Do If You Have An Asthma Attack
If you think you’re having an asthma attack, you should:
Never be frightened of calling for help in an emergency.
Try to take the details of your medicines with you to hospital if possible.
If your symptoms improve and you do not need to call 999, get an urgent same-day appointment to see a GP or asthma nurse.
This advice is not for people on SMART or MART treatment. If this applies to you, ask a GP or asthma nurse what to do if you have an asthma attack.
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Diagnosing Asthma In Children Younger Than 6
It can be hard to tell whether a child under age 6 has asthma or another respiratory condition, because young children often cannot perform a pulmonary function test such as spirometry. After checking a childs history and symptoms, the doctor may try asthma medicines for a few months to see how well a child responds. About 40% of children who wheeze when they get colds or respiratory infections are eventually diagnosed with asthma.
What Is The Cause
No one knows exactly what causes asthma.5 However, it runs in families, so there may be a genetic link. Exposure to certain allergens, viruses, chemicals, and secondhand smoke before birth or as an infant might have a role. These exposures might change the way the immune system develops. Additionally, having frequent colds as a child might affect long-term lung function.
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Asthma Signs & Symptoms
People with asthma experience symptoms due to inflammation in the airways. They might only occur when you encounter an asthma trigger. Common symptoms that can lead to a diagnosis of asthma include:
- Persistent or recurring coughing: which often occurs at night or early in the morning, although it can happen at any time. Coughing is a major feature of asthma, especially in children and can sometimes be the only sign of asthma.
- Wheezing: is difficulty breathing accompanied by a whistling sound coming from your airways
- Shortness of breath: gives you the feeling that you cant get enough air into your lungs, and may even find it difficult to eat, sleep or speak
- Chest tightness: an unpleasant sensation of heaviness or pressure in the chest that can make it hard to breathe
- Increased mucus production: is characterized by high levels of thick fluid or phlegm accumulating in your airways
- Difficulty breathing while exercising: having trouble breathing while performing physical activities can be a sign of asthma
- Losing Sleep: Being unable to sleep through the night because of breathing troubles
What Causes Asthma Attacks
Having asthma is like having a touchy airway, says Richard Castriotta, MD, director of the Division of Pulmonary and Sleep Medicine at the McGovern Medical School at the University of Texas Health Science Center in Houston and medical director of the Sleep Disorders Center at the Memorial Hermann-Texas Medical Center. This airway i.e., the bronchial tubes that usher air in and out of our lungs overreacts to a large number of irritants that don’t bother other people, he explains.
Some doctors also describe an asthma attack as an asthma exacerbation. Thats because the airways may become tightly constricted during an asthma attack. But constriction isnt the only problem these airways also become inflamed and swollen. The exact cause of asthma is not known, but it’s probably a combination of genetic risk and environmental factors.
Asthma attacks often occur in response to “triggers,” or elements in your environment that increase the irritation in your airways. Triggers vary from person to person. You may be able to tell immediately if something causes asthma symptoms, or you might need to be tested for allergies to find out what’s causing your symptoms.
According to the AAAAI, some of the most common asthma triggers are:
- Smoke
- Ozone
- Nitrogen dioxide from gas heaters and stoves
- Dust mites or cockroaches
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