Your Chest Constantly Feels Tight
Minor chest tightness is common for people with asthma. But frequent and intense chest tightness can mean your severe asthma is getting worse.
Chest tightness is often the result of the muscles surrounding your airways contracting in reaction to asthma triggers. It may feel as though theres something squeezing or sitting on top of your chest. If you experience unusually intense chest tightness, particularly while sitting still, speak with your doctor.
How Is Asthma Classified According To Its Severity
Based on the severity of symptoms, the National Asthma Education and Prevention Program has grouped asthma into 4 categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. This classification system is used to guide treatment. Symptoms occur less than 2 days per week.
What happens when you have a mild asthma attack?
If you have a flare-up of mild persistent asthma, you may not be able to do all of your normal daily activities. For example, a push can prevent you from taking the stairs or cleaning your house. You may have difficulty walking a normal distance.
What are the symptoms of severe asthma in children?
With severe persistent asthma, symptoms occur daily and often. They also frequently reduce the childs activities or disturb their sleep. Lung function is less than 60% of normal without treatment. Severe is the least common level of asthma.
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- Dont have written asthma action plan from your doctor
- Use an inhaler, but dont have a spacer
- Miss more than 1 day of school per month for asthma
- Asthma limits exercise or sports
- Asthma attacks wake child up from sleep
- Use more than 1 inhaler per month
- No asthma check-up in more than 1 year
- You have other questions or concerns
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How Will The Doctor Determine Which Type Of Asthma I Have
In general, a doctor will establish your type of asthma by:
- Examining your medical history, including your family history
- Performing a physical examination to inspect your upper airway for signs of allergic rhinitis, check your chest for deformity, or determine the presence of polyps
- Measuring the amount of air you can breathe in and out of your lungs with a spirometry or lung function test
- Determining the age of onset
- Discovering the types of cells involved in inflammation
- Looking at the results of allergy tests
- Examining the characteristics of your lung and tissue
- Observing your responses to past medications
What Should I Do If I Have A Severe Asthma Attack
If you have a severe asthma attack, you need to get immediate medical care.
The first thing you should do is use your rescue inhaler. A rescue inhaler uses fast-acting medicines to open up your airways. Its different than a maintenance inhaler, which you use every day. You should use the rescue inhaler when symptoms are bothering you and you can use it more frequently if your flare is severe.
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.
- Very quick or rapid breathing.
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Why Does My Asthma Act Up At Night
Asthma can get worse at night. If you have symptoms at night, it’s called nighttime asthma. This is often a sign of uncontrolled asthma. It probably has to do with natural body rhythms and changes in your body’s hormones. With the right asthma management and treatment, you should be able to sleep through the night.
Who Is At Risk For Asthma
Asthma affects people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:
- Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
- Being exposed to certain substances at work, such as chemical irritants or industrial dusts
- Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if it’s your mother.
- Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
- Having other diseases or conditions such as obesity and allergies
- Often having viral respiratory infections as a young child
- Sex. In children, asthma is more common in boys. In teens and adults, it is more common in women.
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How Do Healthcare Providers Diagnose Asthma
Your healthcare provider will review your medical history, including information about your parents and siblings. Your provider will also ask you about your symptoms. Your provider will need to know any history of allergies, eczema and other lung diseases.
Your provider may order spirometry. This test measures airflow through your lungs and is used to diagnose and monitor your progress with treatment. Your healthcare provider may order a chest X-ray, blood test or skin test.
Why Are Asthma Cases Rising
The total number of asthma cases is on the risethe American Thoracic Society estimates the number of Americans with asthma will grow 10% by 2039. That means asthma is also a serious public health issue, and one study projects that uncontrolled asthma could cost the U.S. health system around $300 billion in that timeframe5.
Scientists dont know for sure why asthma rates are increasing, but its thought that increased urbanization, lifestyle changes, and even growing rates of obesity could play a role.
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Control As A Guide To Medication Adjustment
After targeted, step-based initiation of pharmacologic therapy, the classification of asthma control is used to adjust medication, stepping up or down depending on the level of control. Patients whose asthma can be classified as well controlled can be maintained on their current medications and, if stable for at least three months, a step down in therapy can be considered . Patients whose asthma is classified as not well controlled on their initial therapy are advised to step up one step and be reevaluated in two to six weeks for patients with very poorly controlled asthma, consider short-term oral systemic corticosteroid use and stepping up one or two steps, then reassessing in another two to four weeks.
ACQ = Asthma Control Questionnaire ACT = Asthma Control Test ATAQ = Asthma Therapy Assessment Questionnaire FEV1 = forced expiratory volume in one second.
note:The stepwise approach is meant to assist, not replace, the clinical decision making required to meet individual patient needs. Before step-up therapy: review adherence to medication, inhaler technique, environmental control, and comorbid conditions and, if an alternative treatment option was used in a step, discontinue and use the preferred treatment for that step.
ACQ values of 0.76 to 1.4 are indeterminate regarding well-controlled asthma.
How Is Asthma Diagnosed
There is no one test available that confirms you have asthma. Instead, your doctor will diagnose it by reviewing your medical history, family history, and your recurrent symptoms, while also watching for improvement when you start on asthma medications. There are also a number of tests that may be done as part of your evaluation, including chest x-rays, blood tests, and allergy tests. Pulmonary function tests may also be performed, but they come with a caveat: If youre not experiencing asthma symptoms at the time theyre administered, these tests may come back as normal. Still, they can add important pieces to the puzzle. Lets take a closer look at some of the tests your doctor may use.
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The Importance Of Controlling Your Asthma
Regardless of the type or severity of asthma you have, your physician should focus on controlling it. You cannot control the type or severity of asthma you have BUT you can focus on achieving control of your disease.
Uncontrolled asthma is defined as:
- Poor symptom control OR
- More than two exacerbations/year OR
- At least one hospitalization or ICU stay per year OR
- Low lung function
Achieving asthma control is the central focus in the management of patients with asthma. Your goal should be to be able to live a productive and symptom-free life with asthma.
What Are Common Asthma Attack Triggers
You can have an asthma attack if you come in contact with substances that irritate you. Healthcare providers call these substances triggers. Knowing what triggers your asthma makes it easier to avoid asthma attacks.
For some people, a trigger can bring on an attack right away. For other people, or at other times, an attack may start hours or days later.
Triggers can be different for each person. But some common triggers include:
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What Are The Treatments For Asthma
If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include:
- Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
- Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
- Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.
If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.
Your provider may adjust your treatment until asthma symptoms are controlled.
Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway’s ability to tighten and allows you to breathe more easily. The procedure has some risks, so it’s important to discuss them with your provider.
How To Tell If You Have Asthma
Asthma is a respiratory condition caused by inflammation and constriction of the airways. Its a long-term condition that requires lifelong management and treatment to help prevent symptoms and reduce your chances of having an asthma attack.
But how do you know for sure if you have asthma? If youre experiencing a cough or shortness of breath, learn what differentiates asthma from other respiratory conditions and how a doctor can confirm a diagnosis, so you can get the right treatment for your symptoms.
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Whats Different About Severe Asthma
But someone with severe asthma struggles to manage their symptoms even with high doses of medicines.
And sometimes it can take a while to find a combination of medicines and doses that works best for you.
Even if your asthma is difficult to control, its not the same as severe asthma. If you have difficult to control asthma you should be able to get on top of your symptoms with support from your GP or asthma nurse, with an action plan, regular reviews and a good routine of taking your asthma medicines.
What Asthma Treatment Options Are There
You have options to help manage your asthma. Your healthcare provider may prescribe medications to control symptoms. These include:
- Bronchodilators: These medicines relax the muscles around your airways. The relaxed muscles let the airways move air. They also let mucus move more easily through the airways. These medicines relieve your symptoms when they happen and are used for intermittent and chronic asthma.
- Anti-inflammatory medicines: These medicines reduce swelling and mucus production in your airways. They make it easier for air to enter and exit your lungs. Your healthcare provider may prescribe them to take every day to control or prevent your symptoms of chronic asthma.
- Biologic therapies for asthma: These are used for severe asthma when symptoms persist despite proper inhaler therapy.
You can take asthma medicines in several different ways. You may breathe in the medicines using a metered-dose inhaler, nebulizer or another type of asthma inhaler. Your healthcare provider may prescribe oral medications that you swallow.
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Medication Keeps My Asthma Attacks At Bay
15 years ago I had been ill with pneumonia and it left me with a long-term cough. One warm summer evening I was walking with my friend when suddenly I felt like I couldnt breathe. The feeling of suffocating was so strong that I had to stop and sit down on a bench. My friend wanted to call an ambulance, but I asked her to wait. After calming down and resting a little, I felt better and she was able to walk me back home.
Still, the heavy feeling in my chest only passed after I took a hot shower at home. The next morning, I visited my doctor and I was asked to track down my peak flow measurements. The diagnosis was clear: I had asthma.
I have learned to recognise the first signs of an attack. Normally I start wheezing after exercising. But a couple of times I have woken up in the night feeling I cant breathe. Its always such a scary experience. Thats why I normally keep my rescue inhaler next to me on my nightstand. I also carry another one in my golf bag when I am out playing. These days I rarely need them because my asthma is well managed with regular preventive medication. Overall, asthma doesnt much affect my daily life even though I exercise and play golf a lot. Only if I get a cold or a flu, my symptoms seem to become worse and it takes a while to get better. Thats why during the flu season, I double my medication and take a flu vaccination as my doctor has advised.
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Whats An Asthma Attack
When you breathe normally, muscles around your airways are relaxed, letting air move easily. During an asthma attack, three things can happen:
- Bronchospasm: The muscles around the airways constrict . When they tighten, it makes the airways narrow. Air cannot flow freely through constricted airways.
- Inflammation: The airway linings become swollen. Swollen airways dont let as much air in or out of the lungs.
- Mucus production: During the attack, your body creates more mucus. This thick mucus clogs airways.
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Classification Of Asthma Control
The guideline recommends that every patient with asthma be able to recognize symptoms that suggest inadequate asthma control.4,5 As with asthma severity, assessment of control is determined by current impairment and future risk. The symptoms and history used to determine current impairment are the same as those used to determine impairment in evaluating disease severity, namely daytime symptoms, nighttime awakenings, frequent use of short-acting beta agonists for symptom relief, and inability to do normal activities because of symptoms.
Several questionnaires have been validated for the evaluation of symptom control.69 The Asthma Therapy Assessment Questionnaire ,10 the Asthma Control Questionnaire ,11 and the Asthma Control Test 12 provide validated control scores that can be used to categorize asthma into three control categories: well controlled, not well controlled, and very poorly controlled.
Who Gets Severe Asthma
Severe asthma affects both adults and children. It can develop at any age. Most people who are diagnosed with severe asthma already have an asthma diagnosis: perhaps their asthma changed over time, or developed into severe asthma because of hormonal changes, or pneumonia for example.
Some people are diagnosed right away with severe asthma, but its likely that they had asthma for some time before without it being diagnosed as severe. And it can take time to get a diagnosis of severe asthma.
I was diagnosed with asthma at 35, but my GP said Ive probably always had it. I spent a lot of time in hospital with chest infections and croup as a child. In the lead-up to my severe asthma diagnosis, aged 40, I had pneumonia and started getting a lot of infections. My asthma changed and I could barely walk or move.
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How Can I Prevent And Treat Asthma Symptoms
There is no cure for asthma, but it can be managed. There are two steps to controlling asthma: taking medicines and avoiding or limiting asthma triggers.
To prevent asthma symptoms:
- Avoid or limit contact with your asthma triggers andallergens. Use AAFAs Healthier Home Checklist to identify asthma triggers and allergens in your home and make your indoor environment healthier.
- Get vaccinated. Respiratory infections like colds and the flu can worsen asthma. Get a flu vaccine every year. Keep your lungs healthy by getting other vaccinations as recommended.
- Create an Asthma Action Plan with your doctor. Follow it when you have symptoms. If you are having trouble staying in the Green/Go Zone, your asthma may not be well-controlled. Talk with your doctor about your treatment plan.
- Take your asthma medicines as directed. If your doctor prescribed a medicine to control your asthma, take it as directed. This may be as needed or every day. Follow your Asthma Action Plan.
- Take care of your general health. It can be hard to take care of your health but doing so can help you better manage asthma. Try to get plenty of sleep and exercise. Eat healthy foods as much as possible, stay hydrated, and find ways to manage stress.
To treat sudden asthma symptoms:
Asthma Medicines: Control and Quick-Relief or a Combination