Asthma is a chronic, yet reversible, lung disease that constricts the bronchial tubes (breathing passages). It affects an estimated 17 million Americans, including close to 5 million children with asthma. It's believed that many more have undetected asthma and go untreated.
Although asthma frequently begins in childhood, with half of all cases first occurring in children under the age of 10, it's no longer considered a disease that children "outgrow" when they become teens. Asthma can strike at any age and any time, causing even the most fit person to wheeze, cough, and gasp. These attacks can last for anywhere from a few minutes to more than a day.
During an asthma episode, the breathing passages are narrowed in three ways: the muscles surrounding the bronchial tubes constrict, the lining (mucosa) of the tubes becomes swollen, and there is increased mucus secretion. In all instances breathing becomes very difficult.
Experts now believe that asthma is an inflammatory disease that develops within the first few years of life. The air passages of people who have asthma, even those who suffer their first acute attack long after childhood, progressively become inflamed. This causes them to be swollen and to react strongly to inhaled irritants such as dust, pollen, tobacco smoke, air pollution, and cat dander. Even changes in weather can trigger an asthma episode. The main goal of asthma treatment is now to reduce this airway inflammation.
Patterns of asthma attacks differ from person to person, with symptoms ranging from mild and intermittent—shortness of breath and chest tightness, which require quick-relief medication—to severe and persistent, which require long-term control medications to keep the airways open.
It’s critical that individuals understand the disease and their own symptoms and triggers. Asthma attacks may be predictable, occurring, for example, whenever a person comes into contact with a cat or performs strenuous exercise in cold weather. Conversely, the attacks may come on unexpectedly. Some people experience seasonal variations; some have nighttime episodes; some have continuous symptoms. Severe cases may warrant emergency hospitalization.
Asthma may stop on its own or with medication. Once an episode has subsided, breathing returns to normal. To date, there is no known cure for the disorder, but with new medications and techniques it can be managed to the point that most people with asthma can expect to have few or no symptoms or complications.
The number of Americans who have asthma has grown steadily in the past several years, but even more alarming has been the death rate, which has risen sharply. The disease now kills more than 5,000 Americans each year. No one knows the reason for the increase, but some researchers suggest it’s the greater amount of time people now spend in tightly sealed homes and workplaces where they are exposed to dust mites, pet dander, and other allergens. Most of these deaths are preventable if the asthma is properly diagnosed and treated.
Symptoms of Asthma
- Shortness of breath or breathing difficulty; coughing, sneezing, wheezing, or rapid, sore throat, shallow breathing that’s eased by sitting up; coughing, especially at night, possibly with production of a thick, clear, or yellow sputum; a whistling sound when breathing; a sense of suffocation; painless tightness in the chest
More severe symptoms
- Inability to speak more than a few words without gasping for breath; clenched or constricted neck muscles; rapid pulse
- Bluish tinge to the fingertips, lips, or face; extremely labored breathing; profound feeling of exhaustion
What Causes Asthma?
Asthma can be either extrinsic or intrinsic. Extrinsic asthma is caused by an overreaction or hypersensitivity to certain external triggers. These triggers aren’t obvious with intrinsic asthma.
The triggers that cause extrinsic asthma episodes are many and varied. They include viral respiratory infections; exposure to pollen, mold, and dust mites; cockroach and animal dander (more than half the people with asthma have allergies); exposure to chemicals or allergens; exposure to tobacco smoke, perfumes, hairsprays, air pollutants, vapors, gases and aerosols; emotional expressions such as fear, anger, frustration, crying, and laughing; medications such as aspirin, food additives, and preservatives; and changes in weather, humidity, and air temperature.
It’s ironic that aerobic exercise, which helps strengthen the body and makes it more efficient in its use of oxygen, may also be a major trigger of asthma. This type of asthma, called exercise-induced asthma, or EIA, affects 1 in 10 people (60 to 80 percent of people with asthma). Because exertion soon triggers an uncomfortable attack, many people with asthma are afraid to exercise.
In cases of intrinsic asthma, no external allergen can be identified. However, a severe respiratory infection, such as bronchitis, generally precedes an intrinsic asthma episode. The asthma can then be aggravated by emotional stress, pollution, fatigue, and changes in temperature.
Dealing with Dust Mites
Dust mites—tiny members of the spider family—are not a problem for the great majority of nonasthmatics, but they may be the major indoor trigger of asthma attacks. It’s estimated that 50 to 90 percent of asthmatics react adversely to dust. Actually, the main allergens in dust are certain proteins from dust mite droppings. The droppings are so small and light that they easily float in the air and are inhaled.
The mites live in carpeting, mattresses, clothing, and upholstered furniture. Bedrooms—particularly mattresses and pillows—are hot spots for them. They thrive in humid conditions, but even in cold winters dead mites and the droppings left behind can trigger allergic reactions.
Simply dusting or vacuuming can actually put more dust (and mite droppings) into the air. If you have asthma (or a dust allergy), take the following steps to combat dust mites.
- Vacuum your home regularly, especially the bedroom. Vacuuming is a necessary evil for those sensitive to dust, since even the best conventional machines spew out fine particles each time they are used. If possible, get someone else to vacuum while you’re out of the house. Or wear a dust mask while vacuuming.
- Consider getting special microfiltration bags for your vacuum cleaner, or electrostatic filters that fit over the exhaust of some models. Make sure your vacuum cleaner doesn’t leak a lot—for instance, through poorly fitting hoses. If your machine is old and leaky, consider replacing it (ask your allergist about specific models).
- Dust frequently with a damp or oiled cloth.
- Remove some or all carpets and upholstered furnishings, especially in the bedroom. To kill dust mites in area rugs, place them outdoors in direct sunlight. Vacuum the rugs afterwards to remove the dead mites.
- To reduce humidity (to below 50 percent), install an air conditioner and dehumidifier. Change or clean filters regularly. Don’t use a humidifier in the winter.
- Wash all bedding weekly in hot water (at least 130°F). Use washable blankets and spreads. Dry cleaning is a little less effective in killing mites.
- Enclose your mattress, box springs, and pillows in zippered, nonallergenic casings. Some manufacturers now apply a special antimicrobial treatment to their bedding products, but this does not kill mites. It’s unclear whether the treatment will help reduce dust-mite allergies.
- Wash curtains and draperies. Or replace them with blinds or shades.
- Get rid of stuffed toys, which collect dust mites, or wash them regularly. Don’t allow pets into the bedroom.
You can measure your breathing capacity at home using a simple and inexpensive device called a peak-flow meter. This gadget measures how fast and how hard you are able to exhale air from your lungs. Flow rates may decrease several hours before an actual asthma episode occurs, so the meter can serve as an early warning long before you feel your first symptoms.
The peak-flow meter gives you a number indicating the velocity of air expelled in liters per second or liters per minute. You can compare the results with your predicted level and with your previous results. A drop of more than 10 percent below your normal readings may signal increased airflow resistance. A drop of 50 percent indicates you are in the danger zone. What you should do next will depend on the guidelines established by you and your physician.
The reason for the drop in the reading may be that your airways are constricted and swollen and mucus is accumulating; or that your particular medications may not be working as well as they usually do; or that you may be coming down with a cold.
Using a meter twice daily is especially helpful in teaching people with asthma, especially children, how to become attuned to reading their bodily sensations. The person with asthma soon learns, “So this is what it feels like when I’m beginning to have an asthma episode,” and then he or she can better manage his or her condition.
Peak-flow meters are available through your physician, your local pharmacy, or by ordering directly from a manufacturer.
What If You Do Nothing?
Although there is no cure for asthma, trying to ignore asthma symptoms, however mild, is a mistake because the breathing difficulties it causes will prevent you from living a full and active life. While seldom fatal, asthma is a chronic disease that needs constant monitoring and medical attention.
Home Remedies for Asthma
If you have asthma, you need to work with a physician to manage and control your condition. There is no known cure for asthma, but most asthma can be controlled by a two-pronged strategy aimed at preventing acute episodes and stopping those episodes that do occur. In addition to medications and other measures you will obtain from your doctor, take the following steps.
- Remain calm. Panic can worsen your condition during an asthma episode.
- Breathe deeply. When experiencing asthma, sit upright and lean forward, taking in deep, rhythmic breaths.
- Perform the yoga. Yoga can help you to breathe in a controlled manner, strengthens the lungs and reduces asthma risk.
- Avoid triggers. Stay away from substances that cause your asthma attacks.
- Monitor your lung capacity. A peak-flow meter is a hand-held device that measures how fast you can blow air out of your lungs; it should be an indispensable part of your treatment program. Since peak airflow often drops as much as a day or two before actual asthma symptoms become profound, regular peak-flow testing will help you assess the severity of your asthma.
Prevention of Asthma
- Identify your asthma triggers. Keep a diary and note when your episodes occur and what seems to trigger them. Include emotional and situational factors as well as environmental stimuli and foods. Check at home and at work. Common triggers include pollen, dust mites, aspirin, cat dander, chocolate, milk, nuts, and fish; avoid as many of these as possible.
- Don’t smoke. If you do, quit. Avoid secondary smoke as well.
- Vacuum regularly. Reducing the amount of dust in your home may ease asthma symptoms. Get rid of (and avoid installing) carpets that are difficult to clean.
- Drink plenty of water. You will need at least eight glasses of liquid a day to help loosen airway secretions and maintain hydration.
- Take precautions in cold weather. Cold air can trigger an asthma attack. In cold weather, cover your nose and mouth with a scarf in order to filter, humidify, and warm the air that you breathe in.
- Exercise regularly. By staying physically fit, you will strengthen your body, especially your lungs. Water aerobics and swimming are two good choices since these exercises will allow you to be breathing humidified air. If a particular exercise triggers an asthma episode, talk with your physician about adjusting or changing your medication.
Beyond Home Remedies: When To Call Your Doctor
Contact your doctor if you develop symptoms of asthma for the first time. If you have been diagnosed with asthma and you have an episode that does not respond to self-treatment, contact your physician immediately or go to a hospital emergency room.
Also contact your physician if your asthma medication isn’t working as it’s supposed to or if you develop new and unexplained symptoms.
What Your Doctor Will Do
A thorough medical history and physical exam focusing on the upper respiratory tract will be performed. Special tests may be taken to determine what triggers your acute attacks. Chest x-rays may be taken and a pulmonary function exam, a test to measure how much air you inhale and exhale, may be given.
Once a positive diagnosis has been made, the key is to work with your physician to find effective drugs and dosages that can prevent acute asthma episodes. Various asthma drugs may be prescribed to prevent attacks and halt symptoms when they occur. You should become thoroughly familiar with the medications prescribed for you and with how and when to take them. (Many of these drugs are available in oral inhalers; using an inhaler properly greatly increases the effectiveness of the medication.)
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media