Asthma

Asthma is a disease in which the airways become so narrow that it is difficult to breathe, either temporarily or permanently. This condition is also sometimes referred to as bronchial asthma. Asthma typically comes in episodes or attacks of wheezing, coughing and shortness of breath. Without proper treatment, the lungs may gradually take in less and less oxygen from the air and general physical fitness can worsen.
But asthma does not always get worse. Nowadays asthma can be treated quite effectively using medicine and other interventions. This means that most people with asthma can manage their illness and live a life largely free of symptoms. It is important to understand what you can do on your own, and to find out what kind of therapy is best suited to you.



Symptoms

Common asthma symptoms in children include coughing and whistling or wheezing sounds when breathing. Other typical signs of asthma are usually not yet present at that age. In teenagers and adults, asthma is characterized by the following symptoms:

• Shortness of breath (often in sudden attacks)
• Breathlessness following physical activity
• Sounds when breathing (out): e.g. wheezing, whistling, rattling
• Tightness in the chest
• Coughing and/or the urge to cough

These symptoms mostly happen in episodes or attacks, commonly at night too. This is one of the reasons why people who have this chronic illness often feel so tired and groggy during the day. During an asthma attack, initial minor breathing difficulties can worsen and develop into more serious shortness of breath.

In people with asthma, the airways are overly sensitive. This chronic disease typically comes in episodes or attacks of wheezing, coughing and shortness of breath. But other diseases can have similar symptoms. So before starting with treatment, it is important to find out what exactly is causing the breathing problems.
The mucous membranes lining the airways of people with chronic asthma are constantly on stand-by, ready to trigger an inflammatory response. This means that certain substances can set off a very rapid and very intense reaction. Compared to people who have healthy lungs, their mucous membranes are red and swollen, and more blood flows through them. The cells in the membranes start producing thicker mucus. If an asthma trigger is also present, the muscles surrounding the walls of the airways tighten as well. Together, all of these factors cause the bronchi (lung airway passages) to narrow and prevent air from flowing freely in and out of the lungs. This leads to shortness of breath.
A severe asthma attack feels somewhat like trying to breathe only through a straw for a few minutes. Even if you blow air into it and suck air out of it as hard as you can, you are unable to get enough air into and out of your lungs.

Breathing out is usually more difficult than breathing in during an asthma attack. Exhaling then sounds like wheezing – breathing that sounds like whistling or rattling. The person might have to cough or feel the urge to cough a lot.
During an asthma attack, breathing difficulties, coughing or wheezing that is only minor at first can worsen and develop into more serious shortness of breath. Because it becomes more and more difficult to breathe out, it also becomes difficult to breathe in. Worsening shortness of breath is often associated with chest tightness – a situation that can be frightening.
Being more frightened can make the symptoms even worse. Seeing your child, or someone else you are close to, gasping for breath is an alarming experience and difficult to cope with.
But the situation only becomes dangerous if the labored and exhausting breathing leads to a lack of oxygen. This can usually be avoided by using effective medication.
 
Asthma symptoms can range from an occasional, mild urge to cough to extreme shortness of breath during an asthma attack. Asthma used to be classified into four general severity categories, mostly depending on how frequent and how severe the symptoms were. Nowadays, asthma symptoms tend to be assessed based on the degree of asthma control. There are three levels of asthma control: controlled, partly controlled, and uncontrolled.
This classification is based on factors such as

• how many times a week someone has symptoms during the day,
• how much their daily activities are affected by the asthma,
• whether they also have symptoms at night, and
• how much the asthma affects their lung function.

The frequency of acute episodes (exacerbations) with shortness of breath, wheezing, coughing and chest tightness is also taken into account.
 

Causes and risk factors

Asthma is more common in some families than in others, which suggests that genes might play a role. Further risk factors for children include having other allergic disorders, such as hay fever or eczema, either themselves or in their family. Being born with low birth weight is another risk factor. Asthma is more common in boys than in girls. Children are more likely to get asthma if they are exposed to cigarette smoke. Parents who smoke can reduce this risk by kicking the habit.
Asthma symptoms are the result of a combination of two factors working together: People with asthma have an immune system that permanently tends to overact. This tendency goes mostly unnoticed until the mucous membranes that line the insides of the bronchi come into contact with specific triggers.
Depending on the type of trigger, asthma is classified as being either allergic or non-allergic.

• Allergic asthma is also called “extrinsic asthma” because the trigger is breathed in with the air. Different people may have reactions to very different types of triggers, including cigarette smoke (active and passive smoking), plant pollen, animal fur, dust mite excrement, and some kinds of food as well as cold air, perfume, exhaust fumes or certain chemicals.
• Non-allergic asthma (also called “intrinsic asthma”) is caused by triggers released by the body. These triggers include bacterial or viral inflammations of the airways in particular. Sometimes taking certain kinds of painkillers causes asthma. These painkillers include acetylsalicylic acid (ASA, the drug in medicines like Aspirin) and other non-steroidal anti-inflammatory drugs (NSAIDs). In some people, physical or emotional stress that causes their breathing to speed up can also induce asthma symptoms.

In many people, both intrinsic and extrinsic factors play a role, so it is not always possible to clearly distinguish between allergic and non-allergic asthma. The effects on the lungs and breathing are nearly the same though:

• Immune system cells in the membranes lining the bronchi are activated,
• the muscles surrounding the airways tense up,
• the membranes lining the airways become inflamed and swollen, and
• very viscous mucus is often produced.

The muscles tensing up, the swelling of the mucous membranes and the extra mucus production all cause the airways to become narrower and narrower, which can result in an asthma attack.

Frequency and outlook

About 10% of children and 5% of adults in Germany have asthma. It is the most common chronic (long-lasting) disease among children.
Although asthma is a chronic condition, it can develop in many different ways over time, and symptoms will not automatically get progressively worse. Some people who have asthma as children or teenagers have hardly any symptoms, or even none at all, as adults. Others have the same symptoms, or the symptoms get worse. A lot depends on how easy it is to avoid the asthma triggers, how effective the asthma treatment is, and how you cope with the disease yourself. Medication and other interventions can help make it possible to live an almost normal life.
Asthma can develop at any age. But it often first occurs in childhood or teenage years. People who have asthma frequently also have allergies such as hay fever, allergic conjunctivitis, or eczema. So their symptoms can change depending on the season or other environmental factors, or may disappear for a while, or even for good. Sometimes other allergic disorders then come to the fore again. If adults with asthma experience a long symptom-free period, however, it does not mean that their asthma has been “cured.”


Diagnosis

Doctors are only able to determine whether the symptoms are caused by asthma or another illness if they consider their patient’s symptom descriptions and the results of various tests together. The main diagnostic procedures for asthma are:

• an in-depth talk with the doctor (anamnesis). This will cover, among other things, the type of symptoms, medical history and aspects of the person's lifestyle.
• A physical examination: Your lungs, heart and circulation are checked, as well as your general health.

Lung performance can be measured using a lung function test (peak flow measurement and /or spirometry). The peak flow meter measures how fast you can blow air out of your lungs. In spirometry, both the amount of air you breathe out and how fast you blow it out are measured.
Other tests may be needed to be absolutely sure of the diagnosis.
 
Asthma, or a tendency to have asthma attacks, is often already diagnosed in childhood or puberty. Diagnosing young children is difficult, though. This is because they often have colds or bronchitis, which cause very similar symptoms to asthma when it first starts developing. All of these illnesses are associated with coughing or slight wheezing. Asthma-like symptoms in bronchitis tend to become less common as children get older, though. In children, chronic (long-lasting) asthma is often associated with an allergy. Other typical signs of asthma are usually not yet present.
It usually takes some time before people who have asthma, or the parents of a child with asthma, go to see a doctor. By that point they have usually already been concerned for quite a while. Once the cause of the breathing difficulties has been clarified, though, it is possible to start treatment. In asthma, this means relieving symptoms as well as preventing asthma attacks.
The most important tools for diagnosing asthma are an in-depth talk with the doctor, a physical examination and lung function tests (peak flow measurement and/or spirometry). Other tests may be needed to be absolutely sure of the diagnosis.

Asthma is diagnosed based on an in-depth talk with a doctor (anamnesis) followed by a physical examination. The symptoms associated with asthma can also be signs of other health problems, so when you describe your (child’s) symptoms to the doctor, it is important to tell him or her everything you have observed and experienced related to the symptoms. This includes worries and concerns, as well as how the symptoms affect everyday life. Any of these clues may help to track down the cause.
In order to get a clearer picture, your doctor will ask you a number of questions, such as:

• what symptoms you experience and when,
• under what conditions they go away,
• whether you have any other illnesses, especially allergies,
• whether you frequently had coughs or wheezing as a child,
• whether any family members have asthma or any allergies,
• whether you are taking medication and, if so, which medication.
• whether you are exposed to specific substances (fumes, smoke or sprays) at home or at work, and
• whether you have any particular physical or emotional problems.

In the physical examination the doctor will then check your general health as well as the function of your lungs, heart and circulation. This is also done to rule out any other illnesses.

A lung function test can tell us how well the lungs are performing. If someone has asthma, it is important to determine whether inhaled air can flow freely through their airways or whether their breathing is obstructed by narrow bronchi. This can usually be done using just two tests known as peak flow measurement and spirometry.
Peak flow measurement is an important lung function test that can be carried out on your own at home. The measuring device, known as a “peak flow meter,” is easy to use. After taking a deep breath, you blow into it as hard as you can. This measures how fast you can blow air out of your lungs. The peak flow reading indicates whether the bronchi are narrowed.
In spirometry (“breath measurement”), both the amount of air you breathe out and how fast you blow it out are measured. Here you blow hard into the mouthpiece of the device, called a spirometer. This measures the amount of air that you exhale in one second when blowing as hard as you can. Doctors call this the “forced expiratory volume in 1 second” (FEV1). The test can usually be done by your family doctor and can also be used to monitor the progress of the illness. By comparing old and new spirometry readings, you can see whether your lung capacity has improved or worsened over time.

Asthma symptoms can vary a lot. Even if you have asthma, your doctor may not find any signs of asthma when checking your lung function for the first time. Nearly all of the tests aim to measure how narrow your bronchi are. But if you happen to be symptom-free when the test is done, your bronchi will be almost normal too. To make sure you get an accurate result, the following things may be done after the first reading:

• You may be given a substance which causes the airways of people with asthma to temporarily become narrower (bronchial provocation test).
• You may be asked to get on a treadmill or an exercise bike. In people with asthma, the second lung function reading is often worse following vigorous physical activity (exercise test).
• You may be given an asthma inhaler to open your airways. If your lung capacity improves after using the inhaler, it is a sign that you have asthma (reversibility testing).

Asthma is diagnosed using the tools and tests described above. Other tests, like blood tests or provocation tests, can be used to find out whether the asthma is a reaction to substances that trigger allergies (known as allergens). Provocation tests are done in a doctor's office to look at whether a particular allergen triggers asthma attacks.
Allergens are often triggers for asthma as well, but not always. First you have to find out whether you are even prone to allergies. Only then can you start trying to find out what is causing the allergy, for example using special skin tests. But an allergic reaction triggered by a skin test is not enough to diagnose asthma.
It is important to let your doctor know if you have noticed any patterns related to when, and in what situations, your symptoms arise. For instance, do you have them on sunny days in early summer, in cold winter air, in the morning or evening, at home or at work, after having certain kinds of food or drink, after touching pets or when cleaning your home?
A lung x-ray or blood test is usually only part of the initial examination if the symptoms and findings are not very typical of asthma, and the doctor would like to rule out another possible disease, such as pneumonia.
This is because the breathing difficulties could also be caused by other illnesses such as chronic bronchitis. People who smoke, are overweight, or generally unfit may also show typical signs of asthma like shortness of breath, despite not having asthma.
  

Prevention
 
Good management of chronic asthma involves both treating symptoms and preventing asthma attacks. The best way to do this is by avoiding the asthma triggers as much as possible. Medications for keeping symptoms under control are another important part of prevention.
But it is not always that easy to avoid asthma triggers in everyday life, and in some situations it may be almost impossible. Although it is helpful to know what your triggers are – be they animal fur, dust or cold air – avoiding those triggers does not guarantee that asthma symptoms can always be prevented. Most people who have asthma do not need to worry too much about the triggers if they use their medication correctly.
A treatment called allergen-specific immunotherapy may be an option for people who are allergic to certain substances. It can help make their bodies react less sensitively to those substances.
In a lot of people, asthma is closely linked to an allergy. Their asthma attacks are mainly triggered by allergy-causing substances such as pollen, dust mites or animal fur. Allergen-specific immunotherapy might be considered as a treatment for this kind of asthma.
The aim of this treatment is to prevent asthma attacks by making the body less sensitive to the allergy-causing substances. It is also known as desensitization or hyposensitization.
In allergen-specific immunotherapy (SIT), people are repeatedly given small amounts of the substances that they are allergic to. This is meant to gradually make them less oversensitive to the substances. Allergen-specific immunotherapy is only possible if extracts of the allergen (the substance that triggers the allergy) are available for the treatment. This is currently the case for things like animal hair, dust mites, pollen, mold and the poison in insect stings.


Treatment

The first goal of asthma treatment is to reduce the frequency and the severity of the symptoms as much as possible. The treatment should also help people with asthma to lead a normal life and maintain an active lifestyle as far as possible. It is important to know that asthma treatment has very few side effects. This is also the case for women with asthma who are pregnant. A doctor can help you decide which medications are right for you.
Two main groups of medications are used to treat asthma: long-acting controller medications and short-acting reliever medications. Controller medications soothe the chronically inflamed airways to help prevent asthma attacks. These medications are usually used regularly every day. Reliever medications are used as needed. The choice of treatment always depends on how severe the symptoms are.
Many people with asthma usually only take medication when they already have symptoms, and tend to forget about their controller medication. This can be dangerous because controller medication helps reduce the frequency and severity of asthma attacks over time. Long-term treatment can only be effective if controller medication is used regularly.

Two types of medication, known as “controllers” and “relievers,” are used in the treatment of asthma. Controller medication works slowly over time and is taken regularly to try to prevent asthma attacks. Reliever medication works quickly and is used to treat acute symptoms.
Most people who have chronic asthma will have repeated episodes of typical symptoms such as shortness of breath, wheezing, coughing and chest tightness. But even if they do not have any symptoms, the disease is active and still needs to be treated: If chronic asthma is not treated properly, asthma attacks can start occurring more frequently, and people’s physical fitness and quality of life may become worse.
But it is usually possible to keep even severe asthma under control with the help of certain medications and measures. To do this, though, it is important to understand your own asthma and the related treatments.

What medications can be used for asthma?

Reliever or “rescue” medication is used to treat asthma attacks or other acute symptoms. Simply treating asthma attacks when they happen is usually not enough to cope well with asthma in the long term. Controller (“preventer”) medication is used regularly, regardless of current symptoms, to soothe the airways and prevent asthma attacks.
The dose of medication and the way in which it is used mainly depend on the frequency and severity of symptoms. These range from occasional mild symptoms, for which regular medication is not necessary, to severe persistent asthma, requiring continuous treatment with medication. Possible forms of administration include metered-dose inhalers (liquid sprays), dry powder inhalers (“puffers”), tablets and – for severe attacks – injection.
Depending on the intensity of asthma therapy, particular combinations of medication are also used. Some medications are prescribed at a fixed dose, for others the dose can and should be adjusted according to your own needs.
To make sure that the medication reaches even the smaller bronchi, you have to learn how to breathe it in ("inhale" it) properly. This is sometimes difficult, especially for children. There are a number of devices which aim to make it easier to inhale medication deeply into the lungs.

Reliever medication

Medication that is used because you want to do something like sports, or to treat acute symptoms, is called reliever or rescue medication. These fast-acting medications can quickly make it easier to breathe again. Examples of this kind of medication include short-acting beta2-agonists, which are commonly used. They relax tightened airway muscles and open up the airways again.
Rescue medications like this are usually used with a metered-dose inhaler. However, during severe asthma attacks the airways are very narrow and contain a lot of mucus, so it is difficult to breathe in enough of the medication. In such urgent cases, it therefore has to be given in the form of an injection or an intravenous drip.
Having to use a reliever several times per week is a sign that your asthma is poorly controlled. Then long-term controller medications can be taken regularly and continuously to treat the underlying inflammation in the airways.

Controller medication

Controller medication is taken every day, and not only when needed. It can reduce the inflammatory response in the airways, considerably reducing the frequency of asthma attacks. When used regularly, they prevent permanent symptoms such as shortness of breath.
Corticosteroids (glucocorticosteroids), also commonly referred to as “corticoids,” “steroids” or “cortisone," are the main controller medications. Corticosteroids can reduce the chronic inflammation, preventing constriction of the airways and shortness of breath. If the asthma is not well controlled despite inhaling corticosteroids, the dose can be increased. It is also possible to combine different medications.
For instance, to gain better long-term control over the condition, a long-acting beta2-agonist such as salmeterol or formoterol can be used. This is probably more effective than increasing the corticosteroid dose. But both of these drugs have to be used together with a corticosteroid drug because they can make the symptoms worse, and even cause severe asthma attacks, when taken on their own. The beta2-agonist and corticosteroid can either be inhaled separately or together. There are also inhalers that allow you to inhale both medications at the same time. This is known as a fixed combination.
Apart from steroids and long-acting beta2-agonists, other medications are used for the long-term treatment of asthma too. For instance, leukotriene antagonists are used to block the effect of "leukotrienes." Leukotrienes are chemical messengers that play a role in the inflammatory response in the airways. But combination treatment with a leukotriene antagonist and corticosteroid is less effective at preventing asthma attacks than combination treatment with a beta2-agonist and a corticosteroid.
For each type of medication (corticosteroids, beta2-agonists, leukotriene antagonists), there are a number of different drugs that can be used. According to current scientific knowledge, these different drugs work just as well as each other.

What side effects can occur?

The side effects depend on the type of medication, how large a dose you take and how you take it. You will find comprehensive information about this in the package insert that comes with the medication.
Inhaling asthma medication usually causes fewer side effects than swallowing them in the form of tablets. In mild asthma, the side effects of some medications could outweigh their potential benefits. If that is the case, it might be better not to take them. In moderate to severe asthma, though, the consequences of the condition are considerably worse than the long-term side effects of the medication.

Corticosteroids

Many people are worried about long-term side effects of steroids. But long-term steroid treatment usually does not have negative effects if the medication is chosen and used correctly.
There are concerns that long-term use of corticosteroids in children could impair their growth. But there is currently no evidence that inhaling corticosteroids affects children’s height. Research has shown that they grow a little more slowly in the first year of treatment, but develop normally after that. This suggests that they grow to the same final adult height as other children with asthma who do not inhale corticosteroids. Still, to be on the safe side, young patients are usually only prescribed the lowest possible doses of steroids and, if possible, only steroids which are inhaled.
Corticosteroids can cause coughing and hoarseness, and increase the risk of fungal infections in the mouth. To prevent these side effects, people are advised to rinse their mouth out after inhaling corticosteroids. In older people corticosteroids can somewhat increase the risk of cataracts. This side effect is more likely at higher doses and when corticosteroids are taken for longer periods of time.

Beta2-agonists

Long-acting beta2-agonists (LABAs) should always be taken together with steroids because they may have disadvantages otherwise. Research suggests that controller therapy with LABAs alone could lead to life-threatening asthma attacks.

Leukotriene antagonists

These medications are usually well tolerated. Upper respiratory tract infections might occur. There are also occasional reports of irritability, sleep problems with nightmares, hallucinations and depression.


Non-drug interventions for asthma

Medication is important in the treatment of asthma, to prevent asthma attacks and keep the condition under control. But many people would like to do more than just take medication. Some of the additional things that can be done have been scientifically proven to help, whereas others have not.
A lot of people use special breathing techniques to try to cope better with asthma attacks. If someone reacts to certain asthma triggers, they can try to avoid them as best as possible. Regular exercise and appropriate levels of sport can help you keep fit and prevent asthma symptoms. One of the most important things you can do is stop smoking – or not start smoking in the first place.
Many people with asthma also try out “alternative” treatments like herbal medicine or acupuncture. But it is often not clear whether, and how well, these approaches work and what side effects they might have.

Breathing exercises

There are many different breathing exercises and techniques for people with asthma to choose from. They are meant to have a general relaxing effect, as well as help you breathe in a calm and controlled way during asthma attacks.
Relaxation and breathing techniques such as those practiced in yoga may help prevent asthma symptoms and improve your overall wellbeing. But there are only a small number of studies on the use of these techniques in people with asthma, and those studies are not of particularly good quality. Although they suggest that the techniques might help, these findings should be interpreted with caution.
Certain techniques are meant to help people breathe more easily during serious asthma attacks. These include techniques to help you breathe calmly and in a controlled way during an attack, or at the beginning of an attack. Panic and fear can lead to rapid and ineffective breathing (hyperventilation) in such situations. Most people can still inhale (breathe in) quite well during asthma attacks, even during more severe ones. Exhaling (breathing out) can be a problem, though. People with asthma can learn how to use breathing techniques such as “pursed-lip breathing,” and how to adopt certain postures. These aim to relax their breathing organs and help them breathe out more easily.

Sports and exercise

Sports and physical activity are important for most people who have asthma. Regular physical activity helps improve your heart and lung capacity. It increases the uptake of oxygen and the amount of air that is exhaled when you breathe out.
Because physical exertion is a relatively common asthma trigger ("exercise-induced asthma"), many affected people think they ought to avoid exercise. But special asthma treatment can prevent problems due to physical activity. Research suggests that sports and exercise can actually reduce asthma symptoms in the long term. There is also some evidence that interval training can prevent exercise-induced asthma. In interval training, high-energy exercise is alternated with periods of rest.
It is important to choose physical activities that match your level of fitness, though. This may mean, for example, taking a break or doing something less strenuous if you notice signs of breathing difficulties. Warming up before doing sports, and gradually increasing the intensity of exercise, helps too. It is also important to have reliever medication on you so you can react quickly if you do have an asthma attack. Sometimes using reliever medication before physical exertion can help as well.

Avoiding allergy triggers

If children have a higher risk of developing asthma because it runs in their family, you can try to prevent them coming into contact with as many allergy triggers and other risk factors as possible right from the start. Allergy triggers include animal fur, dust mites and allergy-causing foods (like cow’s milk or nuts). Cigarette smoke increases the risk of asthma too.
People with asthma that is caused by an allergy can generally prevent asthma attacks by avoiding allergy triggers. But this is not always possible. For instance, it is easier to avoid animal fur and certain foods than it is to avoid things like pollen. People who are allergic to dust mites might be able to prevent allergic reactions by making various changes in their home. These include wiping the floor with a damp cloth, using mite-proof mattress and bed covers, regularly washing their bedding at temperatures above 55° C (130°F), and removing “dust traps” such as upholstered furniture and carpets from their home.
Individual interventions like using special mite-proof mattress covers or dust mite sprays have not been proven to prevent asthma symptoms, though. There is also not enough research on whether the type of bedcovers you use (filled with feathers or something else) makes a difference. And it is not known whether things like special air filters can help prevent asthma problems due to animal-related allergies.

Quitting smoking

Smoking tobacco, in any form, can cause a number of medical conditions or make them worse. People with asthma have oversensitive airways, so it is particularly important for them to stop smoking, or not start smoking in the first place. When cigarette smoke is inhaled, many substances other than nicotine and tar are deposited directly in the airways. Some, such as heavy metals and pesticides, are toxic. Just like other triggers, the substances in cigarette smoke can make the inflammation in the linings of the airways worse, causing the airways to become even narrower.
Besides this, cigarette smoke can lead to chronic bronchitis over time – even in passive smokers. Children are often exposed to cigarette smoke at home. Having parents who smoke is one of the main risk factors for asthma.
If teenagers who have asthma start smoking, their symptoms can become worse. Yet this does not seem to bother them: Some evidence suggests that teenagers with asthma are just as likely, or even more likely, to smoke than other teenagers.
People who smoke will know how difficult it is to quit smoking. There are several therapies that can help make quitting a bit easier.

Dieting

Being very overweight (having a body mass index, also called “BMI,” over 30) can make asthma worse in some people. But only a few studies have looked at how losing weight affects asthma symptoms. Their findings suggest that losing a lot of weight can help keep asthma under control.
In the studies that came to this positive conclusion, people followed a low-calorie diet under the guidance of experts. Other studies also looked at the effects of exercise programs or appetite-suppressing medication. The people in the studies lost at least about ten kilos on average. Unfortunately there were some problems with the quality of the studies, and side effects were not considered enough. This means that it is currently not possible to draw reliable conclusions about the advantages and disadvantages of these measures, or about how long their effects last.

Complementary medicine

Many people with asthma use complementary medicine. Common approaches include homeopathy, herbal products and traditional Chinese medicine (TCM) treatments like acupuncture. There is a lack of evidence that complementary medicine approaches work. Some have not been tested yet. Here are the findings of studies on the other approaches:

• Acupuncture: Several studies looked into whether acupuncture can relieve asthma symptoms. This was not found to be the case.
• Herbal medicine: Some studies looked at whether herbal medicines (mostly from Asia) can relieve asthma. None of the tested products were found to help, though. And herbal medicine can have side effects too.
• Salt cave therapy: This involves repeatedly spending several hours in caves or mines that are believed to have a positive effect on asthma due to special conditions like clean air, mineral content, air pressure or the climate. There is no scientific proof that this approach works.
• Alexander technique: This technique aims to help you improve your breathing by learning to be more aware of your body, as well as by correcting postures and movements that are considered to be unfavorable. There is no research on the effects of this approach in asthma.
• Manual therapy: Here special hands-on manipulation of parts of the body is believed to release tension in the rib cage area, making it easier to breathe. There is not enough research to say whether this approach actually helps. It is not clear whether massages are effective either.
• Homeopathy: A number of studies on homeopathic medicines for the treatment of asthma found that they did not affect asthma symptoms.

Everyday life

Like most chronic diseases, asthma does not only affect one single organ – in this case, the lungs – but the entire person. For example, asthma attacks at night can disturb sleep, making people tired and unable to concentrate properly during the day. Physical fitness can also be affected.
It often takes some time to learn to live with a chronic disease. This may also be the case for other family members. Yet people with asthma do not want to be seen as being ill or weak.
Getting enough information and managing your disease well (good self-management) can help both children and adults to cope better with asthma and become more independent. This can also make them more prepared to deal with critical situations such as an acute asthma attack. The right kind of disease management can prevent emergencies that would require hospitalization.


Exercise induced asthma

Suddenly getting out of breath or gasping for air when doing sports can be frightening. But physical activity is also important in people who have exercise-induced asthma. The key is finding the right balance: Too much can set off an asthma attack, but too little affects your lung performance.
Some children, teenagers and adults who have asthma avoid physical exertion because they associate it with the unpleasant experience of having breathing difficulties. But it is still possible to do sports safely even if you have asthma. It is important to know how to deal with asthma symptoms and relieve an asthma attack. Medications can help lower the risk of asthma attacks.
If children and adults manage their asthma well and are prepared for strenuous physical activities, there is no reason why they should avoid doing them. Exercise and sports not only help you improve your stamina and become physically fitter, they can also help you to relax and simply have fun. Asthma need not be a barrier to leading an active life.
Many people with chronic (long-lasting) asthma will have already had severe breathing problems after doing sports. But sometimes people who do not have asthma have these kinds of symptoms after doing sports too. When physical exertion leads to typical asthma symptoms like breathlessness, it is called exercise-induced asthma. About 70 to 90 out of 100 people with asthma are affected by this.
When we breathe in, our nose cleans, warms and moistens the air. During physical exercise, though, we breathe faster, deeper, and more through our mouth. This means that the air that enters our lungs is colder and drier than usual. The membranes lining the bronchi (lung airway passages) might swell up as a result. In people with asthma, these membranes are very sensitive anyway, and they tend to react very strongly. Cold and dry air can heighten this effect. That is why people are more likely to have exercise-induced asthma when doing winter sports.
The severity of exercise-induced asthma attacks may be influenced by a number of factors, including air temperature and humidity, the intensity and time of the physical exertion, as well as additional triggers like pollen in the air. Exercise-induced asthma attacks usually start about five to ten minutes after the physical activity is stopped. They are less common during exercise. The symptoms usually disappear on their own again after about 30 to 45 minutes.
Exercise-induced asthma often first arises in childhood or puberty. Because children and teenagers are very active in general, susceptibility may be detected quite early on due to shortness of breath. It is then a good idea to have things checked out by a doctor, to find out whether it is asthma.
To see whether physical activity triggers asthma attacks, an exercise test is often done. This may involve, for example, getting on a treadmill or exercise bike for several minutes. Tests are done before and after the person exercises to see how much the physical activity affects their breathing.
One commonly used way to test lung function is called spirometry. Spirometers are electronic or mechanical devices that measure the amount of air you breathe out and how fast you can blow it out. In this test you breathe into and out of the spirometer through a tube. Another kind of lung function test involves a device called a peak flow meter. Here you breathe into the device as hard and as fast as you can. The peak flow meter measures how fast you can blow air out of your lungs. These measurements provide information about how much the bronchi are constricted.
Physical activity also has important health benefits for people with asthma. Once you have learned how to deal with asthma attacks and how to use medication in order to prevent the symptoms from getting worse, you can still do sports if you have asthma. You have to know your own limits, though.
Research suggests that sports and exercise reduce asthma symptoms in the long term. But it is important to choose activities that match your level of fitness. This may mean, for example, taking a break or doing something less strenuous if you notice signs of breathing difficulties. Warming up before doing sports and gradually increasing the intensity of physical exertion can help too. Studies also suggest that interval training can prevent exercise-induced asthma. In interval training high-energy exercise is alternated with periods of rest.
It is important to keep a reliever medication on hand so you can react quickly if you have an asthma attack. Sometimes it may help to use reliever medication before physical exertion. You can ask your doctor for more information.
It is difficult to say whether some types of sports are more “asthma-friendly” than others because there is too little scientific research in this area. People with asthma who do outdoor sports need to be aware that cold and dry air is more likely to trigger exercise-induced asthma. This is one of the main reasons why asthma attacks are more common during, for example, winter sports than when swimming, where the air is warm and moist.
Whatever type of sports you do, it is a good idea to increase the intensity step by step. In other words, if you have asthma it is better to not start off sprinting or lifting heavy weights right away. Starting slowly and warming up properly before more strenous physical activities is the right approach. If you have not been working out much, you could start out with endurance sports like brisk walking, swimming or hiking. The main thing is that you enjoy whatever you do and it makes you feel good.
There are also special sports groups for people with asthma or lung problems. Here you can train with others who have asthma and learn from each other's experience.
If your asthma medication has been adapted to your specific situation and you can effectively control your asthma, you are far less likely to have sudden breathing difficulties when you do sports. Your doctor can help you find the medication that best suits your physical activities.
There are two main groups of asthma medications: controllers and relievers. Controller or “preventer” medication is used as a long-term treatment to “control” asthma. The effect of this medication is felt slowly over time. Reliever or “rescue” medication has a short-term effect. It can be used before doing strenuous physical activities, as well as to relieve acute asthma attacks. For safety reasons, though, is important to talk to your doctor about how often you can use reliever medication on one day.
The following medications can be used before strenuous activities to prevent exercise-induced asthma:

• Short-acting beta2-agonists are inhaled as a spray and have a fast effect. They cause the airways to expand, making it easier to breathe. When used just before strenuous physical activities, they can prevent an asthma attack. The effect is strongest about 30 minutes after being inhaled and lasts about three to five hours. Short-acting beta2-agonists can also be used to treat acute asthma attacks: They start working after a few minutes and can help you breathe better.
• Leukotriene antagonists: These medications, taken in the form of tablets, block the effect of leukotrienes. Leukotrienes are chemical messengers that play a key role in the inflammatory response in the airways. The leukotriene antagonists currently approved in Germany are montelukast and zafirlukast. They can be used before strenuous activities to prevent exercise-induced asthma.
• Mast cell stabilizers (cromones) are inhaled using a puffer. They reduce allergic and inflammatory reactions by preventing the release of histamine from the body’s cells. Histamine is a chemical messenger that also plays a key role in allergic reactions. But cromones are not as good at preventing exercise-induced asthma as beta2-agonists are. Even when used together with short-acting beta2-agonists, they do not work better than beta2-agonists alone.
• Anticholinergics affect the nervous system, causing the bronchi to dilate (open up). They can help in exercise-induced asthma, too. But they are not as good at preventing exercise-related breathing problems as beta2-agonists and mast cell stabilizers are.

It is often not easy to find out which medications best prevent exercise-induced asthma in an individual person. You may have to try out different medications to find out which medication is right for you.


Pregnancy and asthma

Many pregnant women who have asthma worry that their medication might harm their child. But most asthma medications are considered to be safe in pregnancy too. Untreated asthma, on the other hand, can have serious consequences.
It is estimated that about 1 out of 5 pregnant women with asthma need treatment for asthma attacks. But good asthma control, particularly with the regular use of inhaled corticosteroids, can prevent these attacks. And there are a number of things you can do to avoid possible triggers of asthma attacks.
In many women who have asthma, being pregnant does not affect their symptoms. Their symptoms sometimes even get better at first. But the physical changes that happen during pregnancy make asthma worse in 1 out of 3 women. Towards the end of pregnancy it often becomes increasingly difficult to stay physically active. Carrying the extra weight around can even make women who do not have asthma feel out of breath. Many cannot sleep properly, and feel tired and exhausted.
Mild or well-controlled asthma normally does not cause any major health problems for either the woman or her baby. But asthma that is not well-controlled can have serious consequences for the woman and, more often, her baby. The unborn child needs a reliable supply of oxygen. If the mother has trouble getting enough oxygen herself during an asthma attack, her child might not get enough oxygen either. Although babies do not breathe when they are inside the womb (uterus), they do need to get a steady supply of oxygen from their mothers' blood to stay healthy and develop well.
If a pregnant woman who has moderate or severe asthma does not control her asthma with preventive medications, she is at increased risk of having severe asthma attacks. This risk is higher in pregnancy because the hormonal changes and extra physical exertion make it more difficult to cope with more severe asthma attacks. Poorly controlled asthma increases the risk of:

• Preterm birth: Where the baby is born too early and is then often underdeveloped.
• Pre-eclampsia: This condition can develop during pregnancy, and is sometimes life-threatening for both mother and child. Pre-eclampsia is associated with a sudden increase in blood pressure, and higher amounts of proteins in the mother’s urine (proteinuria). It also increases the risk of having seizures (convulsions).
• Reduced growth and low birth weight: A lack of oxygen can affect the development of the child, who might then be born too small for his or her age, even after the full nine months of pregnancy.
  
  

The negative consequences of leaving asthma untreated are worse than the possible side effects of asthma medication. So pregnant women who have asthma can usually carry on using the same medication as they did before they were pregnant. Although most asthma medications have not been specifically tested to see whether they are safe for use in pregnancy, there are no major safety concerns. The best-studied type of medication is inhaled corticosteroids ("steroids"). There are also no concerns about the use of long-acting beta2-agonists. However, these drugs should only be used in combination with a corticosteroid drug. This is because long-acting beta2-agonists can lead to severe asthma attacks if used on their own.
The use of inhaled corticosteroids is considered to be suitable and safe in pregnancy and while breastfeeding. But taking corticosteroid tablets regularly might have negative effects on the baby in the first three months of pregnancy. Compared to tablets, inhaled corticosteroids have less of an effect on the body as a whole. When inhaled, the drug goes straight to the lungs – only small amounts enter the rest of the body and reach the child. Similarly, only small amounts of the drug get into the mother’s breast milk.
The doctor will always try to find the lowest possible dose needed to keep the asthma under good control. It is also important to be informed about your own illness. Learning to manage asthma yourself ("self-management") helps to keep asthma under control. As well as managing their asthma, it is important for pregnant women with this condition to have regular check-ups to monitor their health and their child’s health.

Many women who have allergies and would like to have children try out allergen-specific immunotherapy or "desensitization." This treatment aims to help people become immune to their allergens (allergy triggers). Immunotherapy usually takes three years or longer to complete.
Some women might consider starting this kind of treatment during pregnancy. This is not recommended, though, because too little is known about the benefits and dangers of immunotherapy in pregnancy. There is also a small risk of serious side effects that could even become life-threatening. Women who started allergen-specific immunotherapy before becoming pregnant are usually only advised to continue the therapy if it is well tolerated. But the dose should not be increased during pregnancy.


Possible ways to prevent asthma attacks and lower the risk of the baby being born too small include:

• Avoiding places where people smoke, because cigarette smoke can increase the risk of having an asthma attack. If a woman who has asthma still smokes herself, a (planned) pregnancy is a good reason to stop smoking – to gain better control over the asthma and protect the unborn child. The toxic substances in tobacco can have various harmful effects, including restricting the baby’s growth and causing health problems after birth.
• Avoiding other things that trigger asthma attacks whenever possible. Depending on the type of allergy, triggers might include animal fur, pollen, cold air or dust mites.
• Preventing heartburn. Heartburn is caused by stomach acid flowing back (reflux) into the food pipe, and is a common problem in pregnancy. Severe heartburn can trigger asthma attacks. Many women try to prevent or reduce heartburn by keeping their head higher than the rest of their body when they lie down. It can also help to eat several small meals a day so that your stomach does not become too full.
  
  

If both the mother and father stop smoking, they can reduce the chances of their child developing asthma. But there is no special "pregnancy diet" that has been shown to protect babies from asthma or allergies. In other words: Although it is important for pregnant women to avoid foods that can trigger asthma attacks, there is no reason for them to change their diet in order to protect their child from developing allergies later on.
It is generally important to pay attention to your own health during pregnancy. In women who have asthma, this also means making sure your asthma is well-controlled. But there is no point in constantly worrying about asthma triggers, the foods you eat and other things. If asthma is well-controlled, there is every reason to believe that the pregnancy will go well for both mother and child.


Source:  Institute for Quality and Efficiency in Health Care