What Is Intermittent Asthma
Intermittent asthma means that you only have symptoms sometimes. People with intermittent asthma usually have symptoms 2 days a week or less often.1
If you have intermittent asthma, it should not interfere with your normal activity, such as school, work, or hobbies. Your asthma symptoms will rarely wake you up at night. You might use a rescue inhaler 2 days a week or less often. When your doctor tests your lung function with a spirometer, the results are most often normal or near-normal.1
What Is The Main Cause Of Asthma
Several factors may cause asthma. Based on the triggers that cause an asthma episode, asthma can be classified as:
- Exercise-induced asthma: Exercise can worsen the symptoms of asthma. Simple exercise may exacerbate the symptoms in people with highly inflamed airways.
- Nocturnal asthma: Aggravation of asthma at night is common in people with nocturnal asthma.
- Occupational asthma: Exposure to dirt, chemicals, and irritants in the workplace can induce asthma.
- Steroid-resistant asthma: Some severe cases of asthma may not respond to steroid therapy .
- Allergic asthma: Allergens such as pollen, mite, dust, mold, latex, and pets can trigger asthma in some people.
- Nonallergic asthma: Extreme weather, stress, and infections such as sinusitis, colds, and the flu could be some of the trigger factors that induce nonallergic asthma.
- Aspirin-induced asthma: Aspirin may induce asthma symptoms in some people.
- Eosinophilic asthma: High levels of white blood cells called eosinophils can cause this type of asthma.
Asthma may also be triggered by
- Gastroesophageal disease
- Intense emotions such as anxiety, laughter, sadness, or stress
- Sulfites, which are used as a food preservative in shrimp, pickles, beer, wine, dried fruits, and bottled lemon and lime juices
A Personalized Treatment Plan May Include:
Macrolide antibiotics are used to help the body fight infection. These medicines control the number of white blood cells found in your airways. One study showed positive results using macrolide antibiotics in people with high counts of neutrophils in blood or sputum samples. Doctors dont suggest these medications be used long term though because side effects, such as antibiotic resistance, can be very serious.
Oral corticosteroids are medicines that help to control inflammation. While experts recommend these medicines only for short-term use, doctors may prescribe them long-term for people with more frequent asthma flare-ups. Severe asthma patients use these medications in combination with quick-relief medicine, high-dose inhaled corticosteroids and long-acting bronchodilators. Side effects from using oral corticosteroids can pose a risk to the function of other bodily organs, but the benefits may at times outweigh the risk. The hope is that by using these powerful drugs for a short period of time, patients can gain better control and will eventually not need them at all. This treatment option is approved for adults and children, although long-term use in children is not recommended due to the higher risk side effects. If symptoms are still not controlled with long-term use of an oral corticosteroid, another treatment option should be considered.
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Type of severe asthma |
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What Are The 4 Categories Of Asthma Topic Guide
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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Second Stage: Mild Persistent Asthma
Although this stage is still relatively mild, asthma is beginning to become more noticeable and starting to interfere with your quality of life.
Symptoms. In mild persistent asthma, daytime symptoms are occurring 3 to 6 times a week. Nighttime symptoms interfere with sleep nearly every week, or 3 to 4 times a month. Flare-ups are more severe and may affect activity levels.
Lung function tests. As with intermittent asthma, the FEV1 is 80% or more above normal values. Peak flow readings show less than 20-30% variability.
Treatment. A low dose inhaled steroid will be used as a controller medication to prevent and control symptoms. Less common alternatives might include cromolyn, a leukotriene receptor antagonist , or theophylline. The doctor will also prescribe a quick-relief inhaler for flare-ups.
How Do Doctors Diagnose Asthma
Personal and medical history: Your doctor will ask questions to understand your symptoms and their causes. Bring notes to help you answer your doctors questions. Be ready to answer questions about your family history of asthma and allergies, the medicines you take, and your lifestyle. Be ready to share current physical issues, conditions, and concerns. This also includes all previous medical conditions.
For example, if you have a history of allergies or eczema, you have a higher chance of having asthma. In addition, a family history of asthma, allergies, or eczema increases your chance of having asthma, too. This information can help your doctor make a diagnosis.
Tell your doctor about any home or work exposure to environmental factors that can worsen asthma. For example, these might include pet dander, pollen, dust mites, mold, cockroaches, and specific foods in some people. Environmental irritants including cleaning chemicals and tobacco smoke can cause asthma.
The doctor may also ask if you get chest symptoms when you:
- Get a head cold
- Use specific medicines
- Are under increased amounts of stress
Lung function tests: To confirm asthma, your doctor may have you take one or more breathing tests known as lung function tests. Lung function tests detect how well you inhale and exhale air from your lungs. These tests measure your breathing.
Common tests used to assess your airways include:
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Difficult To Treat Asthma
People whose asthma remains uncontrolled despite using high dose controller medicines are described as having difficult to treat asthma. Factors that may make an asthma patient more difficult to treat are having another chronic health condition, incorrect inhaler technique, and/or inconsistent use of prescription medicine.
Diagnostic Challenges And Differential Diagnosis
Children aged 5yrs
The diagnosis of asthma in early childhood is challenging and has to be based largely on clinical judgment and an assessment of symptoms and physical findings. Since the use of the label asthma for wheezing in children has important clinical consequences, it must be distinguished from other causes of persistent and recurrent wheeze. The categories of symptoms that are highly suggestive of a diagnosis of asthma include frequent episodes of wheeze , activity-induced cough or wheeze, nocturnal cough in periods without viral infections, absence of seasonal variation in wheeze, and symptoms that persist after 3yrs of age. A large number of alternative causes of recurrent wheezing must be considered and excluded in this age group.
A useful method for confirming the diagnosis of asthma in children aged 5yrs is a trial of treatment with short-acting bronchodilators and inhaled glucocorticosteroids. Marked clinical improvement during the treatment, and deterioration when treatment is stopped, supports a diagnosis of asthma.
Older children and adults
The elderly
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Factors Influencing The Development And Expression Of Asthma
Factors that influence the risk of asthma can be divided into those that cause the development of asthma and those that trigger asthma symptoms some do both.
The former include host factors and the latter are usually environmental factors. However, the mechanisms whereby these factors influence the development and expression of asthma are complex and interactive. For example, genes probably interact both with other genes and with environmental factors to determine asthma susceptibility 16, 17. In addition, developmental aspects, such as the maturation of the immune response and the timing of infectious exposures during the first years of life, are emerging as important factors that modify the risk of asthma in the genetically susceptible person. The apparent racial and ethnic differences in the prevalence of asthma reflect underlying genetic variances with a significant overlay of socioeconomic and environmental factors. The higher prevalence of asthma in developed than in developing nations, and in affluent compared with poor populations in developing nations, is likely to reflect lifestyle differences, such as exposure to allergens, access to healthcare, etc.
Occupational sensitisers account, in part, for the higher prevalence of asthma in urban populations and are risk factors for both developing asthma and asthma symptoms. In contrast, air pollution and some allergens cause symptoms but have not been clearly linked to the development of asthma.
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Why Is My Asthma Worse At Night
Asthma that gets worse at night is sometimes called nighttime asthma or nocturnal asthma. There are no definite reasons that this happens, but there are some educated guesses. These include:
- The way you sleep: Sleeping on your back can result in mucus dripping into your throat or acid reflux coming back up from your stomach. Also, sleeping on your back puts pressure on your chest and lungs, which makes breathing more difficult. However, lying face down or on your side can put pressure on your lungs.
- Triggers in your bedroom and triggers that happen in the evening: You may find your blankets, sheets and pillows have dust mites, mold or pet hair on them. If youve been outside in the early evening, you may have brought pollen in with you.
- Medication side effects: Some drugs that treat asthma, such as steroids and montelukast, can affect your sleep.
- Air thats too hot or too cold: Hot air can cause airways to narrow when you breathe in. Cold air is an asthma trigger for some people.
- Lung function changes: Lung function lessens at night as a natural process.
- Asthma is poorly controlled during the day: Symptoms that arent controlled during the day wont be better at night. Its important to work with your provider to make sure your asthma symptoms are controlled both day and night. Treating nighttime symptoms is very important. Serious asthma attacks, and sometimes deaths, can happen at night.
Moderate Persistent Asthma: Step 3
Doctors also use long-term daily medication to treat moderate asthma that persists over long periods. These medications are often different from those that treat milder forms of asthma.
For moderate persistent asthma, doctors prefer to use either:
- a combination of a low-dose ICS and a long-acting beta agonist
- a medium-dose ICS
Alternative therapies include a low-dose ICS along with an LTRA or, less commonly, theophylline.
In addition, a person can use a SABA inhaler when needed to relieve symptoms.
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Ology And Summary Of New Recommendations
Since the 2001 GINA report, the Science Committee has continued its programme of keeping the GINA documents current by reviewing published research, evaluating the impact of this research on the management and prevention of asthma and has posted yearly updates of these documents on the GINA website 3. The 2006 GINA report is a complete revision, commenced in January 2005 and completed in November 2006. Several reviewers were invited to submit comments. The report recommends the following.
1) An overall concept for asthma management is presented and oriented around the focus on asthma control. Achieving and maintaining asthma control is emphasised as the goal of asthma treatment.
2) Classification of asthma by level of control is recommended: controlled, partly controlled or uncontrolled.
3) The previous classification of asthma by severity into intermittent, mild persistent, moderate persistent and severe persistent is recommended only for research purposes.
4) Effective management of asthma requires the development of a partnership between the person with asthma and his or her healthcare professional .
5) Treatment options are organised into five steps reflecting increasing intensity of treatment required to achieve control. At all steps, a reliever medication should be provided for as-needed use. At steps 25, a variety of controller medications are available.
What Are The Different Types Of Asthma
There are four levels of asthma, based on the severity of your asthma. How often you have symptoms, and your lung function determines your asthma level. Your doctor will ask you questions such as:
The answers to these questions help figure out the severity of your asthma. There are different treatment options if your asthma is intermittent or persistent .
You may also hear about different types of asthma from your doctor or others. These names may describe what is causing the asthma. Here are some types of asthma:
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Pearls And Other Issues
Disposition
If the patient requires nebulized salbutamol and is not ordinarily on home nebulizers, he or she should be admitted. Anyone who has presented with severe or life-threatening asthma should usually be monitored to ensure that the disease does not return when the medication has worn off.
Pitfalls
Issues include forgetting to remove the nebulizer mask once the nebulizer is done , not assessing inhaler technique, and neglecting to stress the importance of maintenance therapy with inhaled steroids even when the patient is well.
The Analysis Of Hotspots And Trends
High-frequency keywords mainly reflect current issues and frontier trends in a specific research field thus, the statistical analysis of keywords can quickly and effectively clarify the research hotspots and trends in this field . Research hotspots can be identified by keyword co-occurrence networks and cluster analysis.
4.2.1 Asthma
The keywords could be grouped by the thematic area, and for asthma drug-related research works, the following keywords were subsequently used:
a. Conventional asthma drugs: ICSs, budesonide, salbutamol, salmeterol, and montelukast.
b. Monoclonal antibody: omalizumab.
c. The basis of asthma: inflammation and airway inflammation.
d. Pulmonary drug delivery: metered-dose inhalers, dry powder inhalers, single inhalers, and inhalation techniques.
e. Phenotypes: allergic asthma, eosinophilic asthma, and exercise-induced asthma.
f. Children and pregnant women.
g. Advise to asthma patients: adherence.
Children, pregnant women, and other groups have special physiological states thus, it is essential to develop a more easy-to-operate and efficient pulmonary drug delivery system. Third, it is suggested to continue to explore potential targets for severe asthma or other phenotypes.
4.2.2 Severe asthma
For severe asthma drug-related research works, the following keywords were subsequently used:
a. Monoclonal antibodies: omalizumab, mepolizumab, and benralizumab.
b. Conventional asthma drugs: ICSs, salbutamol, albuterol, and corticosteroids.
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What Are The 4 Most Common Types Of Asthma
- Adult-Onset Asthma. Though people often associate the onset of asthma with childhood, that’s not always the case. …
- Allergic Asthma. Allergic asthma is the most common form of asthma, affecting roughly 16 million people around the world. …
- Exercise-Induced Asthma. …
First Stage: Intermittent Asthma
At this stage, asthma is likely more of on occasional bothersome occurrence, rather than a disease that interferes significantly with day to day quality of life. I speak from experience — my asthma has been at this stage for some years, although when I was younger and living in a different climate, it was more severe.
Symptoms. With intermittent asthma, daytime symptoms generally occur less than twice a week. Nighttime symptoms that interfere with sleep occur less than twice a month. Although symptoms might intensify into a flare-up at times, severity varies and the flare is brief. In between flare-ups, there are no active symptoms.
Lung function tests. To aid with diagnosis and treatment, the doctor may order a lung function test that measures your ability to breathe effectively. The test is expressed in terms of FEV, or Forced Expiratory Volume, and the resultant FEV1 will be 80% or more above normal values. If a peak flow meter is used, the readings show less than 20% variability am-to-am or am-to-pm, day-to-day.
Treatment. In terms of treatment for intermittent asthma, a daily controller medicine is usually not needed. However, a quick-relief, or rescue, inhaler will be prescribed to be used when symptoms do arise or flare-up.
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Component : Identify And Reduce Exposure To Risk Factors
Although pharmacological intervention to treat established asthma is highly effective in controlling symptoms and improving quality of life, measures to prevent the development of asthma, asthma symptoms, and asthma by avoiding or reducing exposure to risk factors should be implemented wherever possible 233. Few measures can be recommended for prevention of asthma because the development of the disease is complex and incompletely understood. Until such measures are developed, prevention efforts must primarily focus on prevention of asthma symptoms and attacks.
Asthma prevention
Other than preventing tobacco exposure both in utero and after birth, there are no proven and widely accepted interventions that can prevent the development of asthma.
Allergic sensitisation can occur pre-natally 234, 235 but there is insufficient information on the critical doses and timing of allergen exposure to permit intervention in this process, and no strategies can be recommended to prevent allergic sensitisation pre-natally. The role of diet, particularly breast-feeding, in relation to the development of asthma has been extensively studied and, in general, infants fed formulas of intact cow’s milk or soy protein compared with breast milk have a higher incidence of wheezing illnesses in early childhood 236. Exclusive breast-feeding during the first months after birth is associated with lower asthma rates during childhood 237.
Prevention of asthma symptoms and exacerbations
Indoor allergens