Respiration is a complex process. The air you inhale travels through your nose and mouth and enters your trachea, commonly known as your windpipe. The trachea then divides into two branches, called “bronchial tubes.” These tubes enter your lungs and divide into smaller and smaller tubes, called “bronchioles” until they end in tiny, balloon-like air sacs called “alveoli.” Your body has around three hundred million alveoli, surrounded by tiny blood vessels called capillaries.  This is where inhaled oxygen passes into the blood, and waste gases such as carbon dioxide and water vapor are collected from the blood and exhaled. The oxygen is then carried, via blood circulation, to all the cells of the tissues and organs in the body.

Asthma is a chronic disease of the lungs, specifically, the bronchial tubes. During normal breathing, the bands of muscle that enclose the airways are relaxed, and facilitate free flow of the air. During an asthma attack, these muscles become constricted, tightening the airways and obstructing the free flow of air. This is called a bronchospasm. The inside layer of the airways becomes inflamed and swollen, and mucus in the airways thickens.  These three factors, occurring simultaneously, are an asthma attack. Symptoms of an attack include breathlessness, panting, coughing, and wheezing. Asthma attacks must be taken seriously; a severe attack can be fatal.

Managing Asthma

Asthma is a chronic disease.  You and your doctor should formulate a plan to deal with your asthma and review it regularly.

You should also learn what triggers your asthma. Examples of asthma triggers include pollen, dust, fumes, air pollution, and molds. You need to identify these triggers and take necessary steps to avoid or minimize exposure.

Monitor your breathing, and learn the signs of an impending asthma attack. When you identify an impending asthma attack, act fast! Take your quick relief medicine, and, if possible, get away from the irritant that caused the asthma attack.

If you take a controller medicine, be sure to keep using it as directed, even after you feel your asthma has improved. If you find yourself relying more and more on your rescue medicines, you may need to adjust your medicines. Consult your doctor.

Treatment

Though asthma cannot be cured, it can be managed with medication. The correct medication depends on a number of factors, including age, symptoms, and asthma triggers. Asthma medicines are classified into two categories: rescue medicines that stop symptoms of asthma and controller medicines that prevent the occurrence of asthma attacks in the first place.

Asthma Controller Medicines

Controller medicines need to be taken regularly every day to prevent asthma symptoms from occurring. There are various types of controller medicines and each type works in a unique and special way to prevent asthma symptoms.

• Inhaled corticosteroids (ICS): These medications are inhaled synthetic steroid hormones that have anti-inflammatory properties, meaning they keep the airways from becoming swollen. Some of the commonly prescribed inhaled corticosteroids include beclomethasone, fluticasone, budesonide, mometasone, and flunisolide. These medications need to be used continuously for an extended period of time to obtain maximal results. Side effects can include sore throat, hoarseness, and – on rare occasions – a fungus infection in the mouth.

 

• Leukotriene antagonists (leukotriene modifiers): Leukotrienes are fatty substances produced by the immune system that cause inflammation and swelling of the airways. These drugs, taken orally, block leukotrienes from causing inflammation, and are used alone or along with inhaled corticosteroids to relieve the symptoms of chronic asthma. Leukotriene antagonists include montelukast, zafirlukast, and zileuton. Side effects of leukotriene antagonists can include vomiting, diarrhea, and, in rare cases, liver damage.

 

• Long-acting beta-agonists (LABAs): Long-acting beta-agonists cause relaxation and dilation of the smooth muscles that encircle airways, allowing freer airflow. These inhaled medications include salmeterol and formoterol. Long-acting beta-agonists should only be taken accompanying inhaled corticosteroid and under a doctor’s care. Side effects can include throat irritation, hoarseness, rapid heartbeat, and headaches.

 

• Immunomodulators: This is a new class of drug for fighting asthma in people who do not respond to more standard treatment. Immunomodulators can be effective, but carry significant risks including nausea, vomiting, diarrhea, stomach ulcers, and liver problems. Consult your doctor.

Asthma Rescue Medicines

Rescue medicines, also known as “quick relief medicines,” are used for immediate relief of an asthma attack.

These medications include:

• Short-acting beta-agonists: These inhalants dilate the bronchi and provide immediate relief. Common short-acting beta-agonists include albuterol, levalbuterol, and pirbuterol. These medications act within minutes of inhalation and can last for many hours. Side effects can include headaches, nausea, anxiety, and hives.

 

• Anticholinergics: These prescription inhalants dilate the bronchi, making breathing easier. This medication is used to treat inflammation of the bronchi, emphysema (an obstructive lung disease), and asthma. Ipratropium is a common anticholinergic. Although anticholinergics are sometimes used alone, they are most often paired with a short acting beta-2 agonist. Side effects may include dry mouth and increased wheezing.

 

• Oral and intravenous corticosteroids: These medicines include prednisone and methylprednisolone, and are used to alleviate inflammation of the airways. These drugs can cause severe side effects – including slow or stunted growth in children, hypertension, diabetes, and weakened bones – if used for extended periods.

 

If you are using your quick-relief medication every day, it is likely that you also need a controller medicine to treat your asthma. Consult your doctor.

• Hold the inhaler upright after removing the cap.

• Shake the inhaler.

• Bend your head backwards and exhale.

• Point the mouthpiece toward yourself, put it between your teeth, and place your lips firmly on the mouthpiece (you can also keep the inhaler one or two inches away from your mouth). If you are using a spacer, a tube that attaches to your inhaler, then put the exposed end of the spacer into your mouth, and wrap your lips around it.

• Push the inhaler down, to release the medicine as gently as possible for 3 to 5 seconds.

• Once you inhale the medicine, hold your breath for 10 seconds so that the medicine can reach your lungs.

• Repeat as many times as recommended by your doctor.

In the event any of the following symptoms occur, seek emergency medical care immediately:

• If you fail to respond to your quick-relief medicine

• If breathing suddenly becomes very difficult

• If talking or walking require significant exertion

• If your face, lips, or fingernails turn gray or blue

• If the skin around your ribcage and neck tightens when you breathe

• If your heartbeat and/or pulse are elevated

Outlook

Asthma is a lifelong condition that cannot be cured. However, with the help of controller medicines for long-term treatment and rescue medicines for immediate relief, your asthma can be managed. You should work with your doctor to create a personal plan to best manage your asthma.