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Related definitions
Classifications of asthma
Types of asthma
Severity of asthma
Predisposition to asthma
Types of inhalers

Related definitions
  • Chronic obstructive pulmonary disease (COPD) or chronic obstructive lung disease: Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease, is a general term for diseases that damage the lungs. It is estimated that more than 16 million Americans have some form of COPD. The two main COPDs include chronic bronchitis and emphysema. Asthma is also considered a COPD.
  • COPD develops over many years, and smoking tobacco is almost always the cause of the disease.
  • The most common symptoms of COPD are chronic coughing and shortness of breath. Individuals who have COPD may be more susceptible to colds and the flu. The heart may become enlarged because it is strained. In addition, many COPD patients may experience high blood pressure.
  • There is no cure for COPD. Treatment varies, depending on the specific condition. It can range from medication and oxygen supplementation to transplant surgery. Bronchodilators are commonly used to relax the bronchi muscles that can cause bronchospasms and restrict the airways. Bronchodilators are either short-acting or long-acting.
  • Emphysema: Nearly three million Americans have been diagnosed with emphysema, and it is estimated that millions more are in the early, asymptomatic stages of the disease.
  • The most common cause of emphysema is smoking tobacco. Tobacco smoke temporarily paralyzes the cilia (small hairs) the line the bronchial tubes. The cilia are designed to filter irritants out of the airways. However, when the cilia are paralyzed, irritants remain in the bronchial tubes and infiltrate the alveoli, inflaming the tissue and breaking down the elastic fibers.
  • A minority of patients develop emphysema as a result of low levels of alpha-1-antitrypsin (AAt). This protein protects the elastic fibers in the lungs from being destroyed by certain enzymes. Therefore, this hereditary condition causes progressive lung damage, which can result in emphysema.
  • Emphysema causes the air sacs in the walls of the lungs lose elasticity. Eventually, the walls stretch and break, which creates larger, less efficient air sacs. It becomes difficult for the patient to breathe. Common symptoms include chronic, mild cough, loss of appetite, weight loss and fatigue.
  • There is currently no cure for emphysema. Treatment focuses on managing symptoms and preventing complications. Smokers are advised to abstain from smoking in order to prevent the symptoms from worsening. Medications often include bronchodilators, inhaled steroids, supplemental oxygen, protein therapy, antibiotics (for respiratory infections), lung volume reduction surgery and lung transplant. Pulmonary rehabilitation therapy is also available for patients.
  • Since smoking causes most cases of emphysema, the best prevention method is to abstain from smoking tobacco.
  • Dyspnea: Dyspnea is a term that describes difficulty breathing or shortness of breath. This is a common symptom of many medical disorders, especially COPD.
  • Airway obstruction: Airway obstruction describes partial or complete blockage of the airway passages to the lungs. The cause of this condition varies greatly. Possible causes include allergic reactions, infections, anatomical abnormalities, trauma and foreign substances (e.g. choking). An early sign of airway obstruction is agitation, which may cause individuals to cough suddenly. Signs of respiratory distress include labored, ineffective breathing and loss of consciousness if the obstruction is not removed or relieved.
  • Treatment for airway constriction depends on the underlying cause. If it is an allergic reaction, medication may be prescribed and the patient should avoid exposure to the allergen. Anatomical abnormalities may require surgery to open the airways. Infections may require antibiotics. If an adult is choking, the Heimlich maneuver should be performed.

Classifications of asthma
  • Asthma is classified as either allergic or non-allergic. Both conditions cause airway obstruction and inflammation that is partly reversible by medication. They also produce the same symptoms. The main difference, however, is their cause.
  • Allergic (extrinsic) asthma: An allergic reaction triggers what is known as allergic asthma. Inhaled allergens like dust mites, mold spores, pollen and pet dander may trigger allergic asthma. It is the most common form of asthma, affecting more than 50% of asthma sufferers.
  • Non-allergic (intrinsic) asthma: Non-allergic asthma is not related to allergies and does not involve the immune system. Instead, factors like anxiety, stress, exercise, cold air, dry air, smoke, hyperventilation, viruses and other irritants trigger the disease.

Types of asthma
  • Childhood asthma:
  • Nine million U.S. children, from newborns to 18-year-olds, have been diagnosed with asthma, according to a 2002 National Health Interview Survey.
  • Asthma rates in children younger than five years old have increased more than 160% from 1980 to 1994. One study found a strong correlation between obesity and asthma, but no similar relationship between obesity and allergies. Researchers believe that asthma was the result of the increased physical exertion of the lungs in obese individuals.
  • Many children with asthma have what is known as allergic asthma. In such cases, exposure to allergens like dust mites, pollen, mold and animal dander may irritate the airways, causing even more constriction, as well as causing the production of excess mucus and inflammation of the airway passages.
  • Adult onset asthma:
  • Asthma symptoms may appear at any time in life. Individuals who develop asthma as adults have what is known as adult onset asthma. It is possible to develop asthma at the age of 50 or later.
  • Unlike children who usually experience intermittent symptoms, individuals with adult onset asthma are more likely to experience persistent symptoms.
  • The cause of adult onset asthma is unknown. However, some evidence suggests that allergy and asthma may be genetically inherited.
  • In addition, obesity appears to significantly increase the risk of developing asthma as an adult.
  • Pregnancy and asthma:
  • Asthma is one of the most common, potentially serious medical problems that occur during pregnancy. According to some studies, asthma may complicate up to seven percent of all pregnancies.
  • Researchers estimate that about one-third of pregnant women with asthma will experience increased symptoms during the pregnancy; another third will experience the same symptoms, while the last third will experience a lessening of symptoms.
  • Pregnant women with asthma have an increased risk of delivering prematurely or giving birth to an infant with low birth weight. In addition, pregnant women with asthma are more likely to experience hypertension (high blood pressure) or a related condition called pre-eclampsia (swelling, high blood pressure and kidney malfunction).
  • If asthma is not controlled, the mother has lower levels of oxygen in her blood. This may result in decreased oxygen in the fetal blood, which may also cause growth deficiencies or death in the fetus.
  • However, proper treatment and management of asthma symptoms helps reduce the risk of complications, according to research.
  • Aspirin-induced asthma:
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil® or Motrin®), may cause asthma symptoms, nasal congestion, watery eyes and, occassionally, facial flushing and swelling in about 10% of asthmatics. Since sensitization and IgE production are not involved in aspirin-sensitive asthma, it is not considered an allergic reaction.
  • In the body, these drugs inhibit the cyclooxygenase-1 (COX-1) enzyme, which produces inflammation and fever. Their ability to inhibit the enzyme allows NSAIDs to reduce pain, inflammation and fever.
  • Inhibiting the enzyme also allows NSAIDs to clear the way for different enzymes that have adverse effects in some people. One of these enzymes triggers the release of chemicals that can cause the airways to swell and increase mucus production, leading to an asthma attack. The process is an unwanted side effect NSAIDs, not an immune-system reaction to NSAIDs.
  • Asthmatics and especially asthmatics who also have nasal polyps, are vulnerable to asthma as a side effect of aspirin and aspirin-like drugs.

Severity of asthma
  • Mild intermittent: Symptoms occur twice a week or less. Exacerbations are short and the intensity varies. Nighttime symptoms occur twice a month or less.
  • Mild persistent: Symptoms occur more than twice a week but less than once a day. Exacerbations may affect daily activities. Nighttime symptoms occur more than twice a month.
  • Moderate persistent: Symptoms occur daily. Exacerbations occur twice a week or more. Nighttime symptoms occur more than once a week.
  • Severe persistent: Symptoms are constant and limit the individual's physical activities. Frequent exacerbations disrupt daily activities, and nighttime symptoms occur more than twice a week.

Predisposition to asthma
  • Infants or young children who wheeze and suffer from viral upper respiratory infections.
  • Individuals with strong allergies.
  • Individuals with a family history of asthma and/or allergy.
  • Perinatal exposure to tobacco smoke and allergens.

Types of inhalers
  • Dry powder-inhaler: Dry-powder inhalers are the most common inhalers used today. This type of inhaler does not need a propellant. Instead, the individual inhales the medicine so it can reach the lung. Children, people with severe asthma and people suffering from acute attacks may be unable to produce enough airflow to use these inhalers successfully.
  • Metered-dose inhaler: The most efficient way to get asthma medication into the airways is with a metered-dose inhaler (MDI). When used properly, about 12-14% of the medication is inhaled deep into the lungs with each puff of the MDI. They are especially important for delivering quick relief medication - short-acting beta agonists - that relieve an acute asthma attack. MDIs are also used to deliver some long-term control medications, including anti-inflammatories and long-acting bronchodilators, which are taken routinely to manage asthma symptoms. An MDI is especially recommended for use with inhaled steroids because it reduces the amount of drug dispersed into the mouth, which reduces the risk of side effects.
  • Metered-dose inhalers are designed to release a pre-measured amount of medication into the lungs. There are several different types, but in general, they all have a chamber that holds the medication and a propellant that turns the medication into a fine mist. A button is pushed to force the medication out through the mouthpiece.
  • Medication that is inhaled acts more quickly than medication taken by mouth. It also causes few adverse effects because the medication goes directly to the lungs and not to other parts of the body.
  • If an MDI is not used correctly, symptoms may persist or worsen. Individuals who have trouble using the device correctly may use a spacer to help them get the medication they need. Spacers are attached to the mouthpiece, and they hold the discharged, pre-measured medication in a chamber until the patient breathes in. Spacers are recommended for young children and older adults who have trouble coordinating breathing and activating the MDI.
  • Nebulizer: A nebulizer is an electrical device that sends medicine directly into the mouth by a tube (or mask in children). This method does not require hand-breath coordination. The patient puts the prescribed amount of medication into the tube, and then places the tube in the mouth (or places the mask over the child's nose and mouth). Then the patient breathes normally until all of the medication is gone.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.