Asthma Causes, Symptoms, Signs, Diagnosis, Triggers and Treatment Information on EMedicineHealth

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7/21/2019 Asthma Causes, Symptoms, Signs, Diagnosis, Triggers and Treatment Information on EMedicineHealth http://slidepdf.com/reader/full/asthma-causes-symptoms-signs-diagnosis-triggers-and-treatment-information 1/19 7 Recommend Print Close © 2011 WebMD, LLC.  All rights reserved. Asthma  Asthma Overview  Asthma Causes  Asthma Symptoms When to Seek Medical Care Exams and Tests  Asthma Treatment Self-Care at Home Medical Treatment Medications Next Steps Follow-up Prevention Outlook Support Groups and Counseling For More Information Web Links Multimedia Synonyms and Keywords  Authors and Editors Viewer Comments: Asthma - Effective Treatments Asthma Overview  Asthma is a disease that affects the breathing passages of the lungs (bronchioles). Asthma is caused by chronic (ongoing, long-term) inflammation of these passages. This makes the breathing passages, or airways, of the person with asthma highly sensitive to various "triggers." When the inflammation is "triggered" by any number of external and internal factors, the passages swell and fill with mucus. Muscles within the breathing passages contract (bronchospasm), causing even further narrowing of the airways. This narrowing makes it difficult for air to be breathed out (exhaled) from the lungs. This resistance to exhaling leads to the typical symptoms of an asthma attack. ma Causes, Symptoms, Signs, Diagnosis, Triggers and Treatment Inf... http://www.emedicinehealth.com/script/main/art.asp?articlekey=5 9 3/23/2011

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Asthma

 Asthma Overview Asthma Causes Asthma SymptomsWhen to Seek Medical CareExams and Tests

 Asthma TreatmentSelf-Care at HomeMedical TreatmentMedications

Next StepsFollow-upPreventionOutlookSupport Groups and CounselingFor More InformationWeb LinksMultimediaSynonyms and Keywords

 Authors and Editors

Viewer Comments: Asthma - Effective Treatments

Asthma Overview

 Asthma is a disease that affects the breathing passages of the lungs (bronchioles). Asthma iscaused by chronic (ongoing, long-term) inflammation of these passages. This makes thebreathing passages, or airways, of the person with asthma highly sensitive to various"triggers."

When the inflammation is "triggered" by any number of external and internalfactors, the passages swell and fill with mucus.

Muscles within the breathing passages contract (bronchospasm), causingeven further narrowing of the airways.

This narrowing makes it difficult for air to be breathed out (exhaled) from thelungs.

This resistance to exhaling leads to the typical symptoms of an asthmaattack.

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Because asthma causes resistance, or obstruction, to exhaled air, it is called an obstructivelung disease. The medical term for such lung conditions is chronic obstructive pulmonarydisease or COPD. COPD is actually a group of diseases that includes not only asthma butalso chronic bronchitis and emphysema.

Like any other chronic disease, asthma is a condition you live with every day of your life. Youcan have an attack any time you are exposed to one of your triggers. Unlike other chronicobstructive lung diseases, asthma is reversible.

 Asthma cannot be cured, but it can be controlled.

You have a better chance of controlling your asthma if it is diagnosed earlyand treatment is begun right away.

With proper treatment, people with asthma can have fewer and less severeattacks.

Without treatment, they will have more frequent and more severe asthmaattacks and can even die.

 Asthma is on the rise in the United States and other developed countries. We are not sureexactly why this is, but these factors may contribute.

We grow up as children with less exposure to infection than did our ancestors, which has made our immune systems more sensitive.

We spend more and more time indoors, where we are exposed to indoor allergens such as dust and mold.

The air we breathe is more polluted than the air most of our ancestorsbreathed.

Our lifestyle has led to our getting less exercise and an epidemic of obesity.There is some evidence to suggest an association between obesity andasthma.

 Asthma is a very common disease in the United States, where more than 17 million people

are affected. A third of these are children. Asthma affects all races and is slightly morecommon in African Americans than in other races.

 Asthma affects all ages, although it is more common in younger people.The frequency and severity of asthma attacks tend to decrease as a personages.

 Asthma is the most common chronic disease of children.

 Asthma has many costs to society as well as to the individual affected.

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Many people are forced to make compromises in their lifestyle toaccommodate their disease.

 Asthma is a major cause of work and school absence and lost productivity.

 Asthma is one of the most common reasons for emergency department

visits and hospitalization.

 Asthma costs the U.S. economy nearly $13 billion each year.

 Approximately 5,000 people die of asthma each year in this country.

The good news for people with asthma is that you can live your life to the fullest. Currenttreatments for asthma, if followed closely, allow most people with asthma to limit the number of attacks they have. With the help of your health-care provider, you can take control of your 

care and your life.

Asthma Causes

The exact cause of asthma is not known.

What all people with asthma have in common is chronic airway inflammationand excessive airway sensitivity to various triggers.

Research has focused on why some people develop asthma while others donot.

Some people are born with the tendency to have asthma, while others arenot. Scientists are trying to find the genes that cause this tendency.

The environment you live in and the way you live partly determine whether you have asthma attacks.

 An asthma attack is a reaction to a trigger . It is similar in many ways to an allergic reaction.

 An allergic reaction is a response by the body's immune system to an"invader."

When the cells of the immune system sense an invader, they set off aseries of reactions that help fight off the invader.

It is this series of reactions that causes the production of mucus andbronchospasms. These responses cause the symptoms of an asthmaattack.

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In asthma, the "invaders" are the triggers listed below. Triggers vary amongindividuals.

Because asthma is a type of allergic reaction, it is sometimes called reactiveairway disease.

Each person with asthma has his or her own unique set of triggers. Most triggers causeattacks in some people with asthma and not in others. Common triggers of asthma attacksare the following:

exposure to tobacco or wood smoke,

breathing polluted air,

inhaling other respiratory irritants such as perfumes or cleaning products,

exposure to airway irritants at the workplace,

breathing in allergy-causing substances (allergens) such as molds, dust, or animal dander ,

an upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis,

exposure to cold, dry weather,

emotional excitement or stress,

physical exertion or exercise,

reflux of stomach acid known as gastroesophageal reflux disease, or GERD,

sulfites, an additive to some foods and wine, and

menstruation: In some, not all, women, asthma symptoms are closely tied tothe menstrual cycle.

Risk factors for developing asthma:

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hay fever  (allergic rhinitis) and other allergies -- this is the single biggest riskfactor ;

eczema: another type of allergy affecting the skin; and

genetic predisposition: a parent, brother, or sister also has asthma.

Asthma Symptoms

When the breathing passages become irritated or infected, an attack is triggered. The attackmay come on suddenly or develop slowly over several days or hours. The main symptomsthat signal an attack are as follows:

wheezing,

breathlessness,

chest tightness,

coughing, and

difficulty speaking.

Symptoms may occur during the day or at night. If they happen at night, they may disturb your sleep.

Wheezing is the most common symptom of an asthma attack.

Wheezing is a musical, whistling, or hissing sound with breathing.

Wheezes are most often heard during exhalation, but they can occur duringbreathing in (inhaling).

Not all asthmatics wheeze, and not all people who wheeze are asthmatics.

Current guidelines for the care of people with asthma include classifying the severity of asthma symptoms, as follows:

Mild intermittent: This includes attacks no more than twice a week andnighttime attacks no more than twice a month. Attacks last no more than afew hours to days. Severity of attacks varies, but there are no symptomsbetween attacks.

Mild persistent: This includes attacks more than twice a week, but not every

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day, and nighttime symptoms more than twice a month. Attacks aresometimes severe enough to interrupt regular activities.

Moderate persistent: This includes daily attacks and nighttime symptomsmore than once a week. More severe attacks occur at least twice a weekand may last for days. Attacks require daily use of quick-relief (rescue)medication and changes in daily activities.

Severe persistent: This includes frequent severe attacks, continual daytimesymptoms, and frequent nighttime symptoms. Symptoms require limits ondaily activities.

Just because a person has mild or moderate asthma does not mean that he or she cannothave a severe attack. The severity of asthma can change over time, either for better or for worse.

When to Seek Medical Care

If you think you or your child may have asthma, make an appointment with your health-careprovider. Some clues pointing to asthma include the following:

wheezing,

difficulty breathing,

pain or tightness in your chest, and

recurrent, spasmodic cough that is worse at night.

If you or your child has asthma, you should have an action plan worked out in advance withyour health-care provider. This plan should include instructions on what to do when an asthmaattack occurs, when to call the health-care provider, and when to go to a hospital emergencydepartment. The following are general guidelines only. If your provider recommends another plan for you, follow that plan.

Take two puffs of an inhaled beta-agonist (a rescue medication), with oneminute between puffs. If there is no relief, take an additional puff of inhaledbeta-agonist every five minutes. If there is no response after eight puffs,which is 40 minutes, your health-care provider should be called.

Your provider also should be called if you have an asthma attack when youare already taking oral or inhaled steroids or if your inhaler treatments arenot lasting four hours.

 Although asthma is a reversible disease, and treatments are available, people can die from asevere asthma attack.

If you are having an asthma attack and have severe shortness of breath or 

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are unable to reach your health-care provider in a short period of time, youmust go to the nearest hospital emergency department.

Do not drive yourself to the hospital. Have a friend or family member drive. If you are alone, call 911 immediately for emergency medical transport.

Exams and Tests

If you go to the emergency department for an asthma attack, the health care provider will firstassess how severe the attack is. Attacks are usually classified as mild, moderate, or severe.This assessment is based on several factors:

symptom severity and duration,

degree of airway obstruction, and

the extent to which the attack is interfering with regular activities.Mild and moderate attacks usually involve the following symptoms, which may come ongradually:

chest tightness,

coughing or spitting up mucus,

restlessness or trouble sleeping, and

wheezing.

Severe attacks are less common. They may involve the following symptoms:

breathlessness,

difficulty talking,

tightness in neck muscles,

slight gray or bluish color in your l ips and fingernail beds,

skin appear "sucked in" around the rib cage, and

"silent" chest (no wheezing on inhalation or exhalation)

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.

If you are able to speak, the health-care provider will ask you questions about your symptoms, your medical history, and your medications. Answer as completely as you can. Heor she will also examine you and observe you as you breathe.

If this is your first attack, or the first time you have sought medical attention for your symptoms, the health-care provider will ask questions and perform tests to search for andrule out other causes of the symptoms.

Measurements of how well you are breathing include the following:

Spirometer: This device measures how much air you can exhale and howforcefully you can breathe out. The test may be done before and after youtake inhaled medication. Spirometry is a good way to see how much your breathing is impaired during an attack.

Peak flow meter: This is another way of measuring how forcefully you canbreathe out during an attack.

Oximetry: A painless probe, called a pulse oximeter, will be placed on your fingertip to measure the amount of oxygen in your bloodstream.

There is no blood test than can pinpoint the cause of asthma.

Your blood may be checked for signs of an infection that might becontributing to this attack.

In severe attacks, it may be necessary to sample blood from an artery to

determine exactly how much oxygen and carbon dioxide are present in your body.

 A chest x-ray may also be taken. This is mostly to rule out other conditions that can causesimilar symptoms.

Asthma Treatment

Since asthma is a chronic disease, treatment goes on for a very long time. Some peoplehave to stay on treatment for the rest of their lives. The best way to improve your conditionand live your life on your terms is to learn all you can about your asthma and what you can doto make it better.

Become a partner with your health-care provider and his or her supportstaff. Use the resources they can offer -- information, education, andexpertise -- to help yourself.

Become aware of your asthma triggers and do what you can to avoid them.

Follow the treatment recommendations of your health-care provider.

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Understand your treatment. Know what each drug does and how it is used.

See your health-care provider as scheduled.

Report any changes or worsening of your symptoms promptly.

Report any side effects you are having with your medications.

These are the goals of treatment:

prevent ongoing and bothersome symptoms;

prevent asthma attacks;

prevent attacks severe enough to require a visit to your provider or anemergency department or hospitalization;

carry on with normal activities;

maintain normal or near-normal lung function; and

have as few side effects of medication as possible.

Self-Care at Home

Current treatment regimens are designed to minimize discomfort, inconvenience, and theextent to which you have to limit your activities. If you follow your treatment plan closely, youshould be able to avoid or reduce your visits to your health-care provider or the emergencydepartment.

Know your triggers and do what you can to avoid them.

If you smoke, quit.

Do not take cough medicine. These medicines do not help asthma and maycause unwanted side effects.

 Aspirin and nonsteroidal antiinflammatory drugs, such as ibuprofen, cancause asthma to worsen in certain individuals. These medications shouldnot be taken without the advice of your health-care provider.

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Do not use nonprescription inhalers. These contain very short-acting drugsthat may not last long enough to relieve an asthma attack and may causeunwanted side effects.

Take only the medications your health-care provider has prescribed for your asthma. Take them as directed.

Do not take any nonprescription preparations, herbs, or dietarysupplements, even if they are completely "natural," without talking to your health-care provider first. Some of these may have unwanted side effects or interfere with your medications.

If the medication is not working, do not take more than you have beendirected to take. Overusing asthma medications can be dangerous.

Be prepared to go on to the next step of your action plan if necessary.

If you think your medication is not working, let your health-care provider knowright away.

Medical Treatment

If you are in the emergency room, treatment will be started while the evaluation is still goingon.

You may be given oxygen through a face mask or a tube that goes in your 

nose.

You may be given aerosolized beta-agonist medications through a facemask or a nebulizer , with or without an anticholinergic agent.

 Another method of providing inhaled beta-agonists is by using a metereddose inhaler  or MDI. An MDI delivers a standard dose of medication per puff. MDIs are often used along with a "spacer" or holding chamber. A doseof six to eight puffs is sprayed into the spacer, which is then inhaled. The

advantage of an MDI with a spacer is that it requires little or no assistancefrom the respiratory therapist.

If you are already on steroid medications, or have recently stopped takingsteroid medications, or if this appears to be a very severe attack, you maybe given a dose of IV steroids.

If you are taking a methylxanthine, such as theophylline or aminophylline,

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the blood level of this drug will be checked, and you may be given thismedication through an IV.

People who respond poorly to inhaled beta-agonists may be given aninjection or IV dose of a beta-agonist such as terbutaline or epinephrine.

You will be observed for at least several hours while your test results areobtained and evaluated. You will be monitored for signs of improvement or worsening.

If you respond well to treatment, you will probably be released from thehospital. Be on the lookout over the next several hours for a return of symptoms. If symptoms should return or worsen, return to the emergencydepartment right away.

Your response will likely be monitored by a peak flow meter.

In certain circumstances, you may need to be admitted to the hospital. There you can bewatched carefully and treated should your condition worsen. Conditions for hospitalizationinclude the following:

an attack that is very severe or does not respond well to treatment;

poor lung function observed on spirometry;

elevated carbon dioxide or low oxygen levels in your blood;

a history of being admitted to the hospital or placed on a ventilator  for your asthma attacks;

other serious disease that may jeopardize your recovery; and

other serious lung illnesses or injuries, such as pneumonia or pneumothorax (a "collapsed" lung).

If your asthma has just been diagnosed, you may be started on a regimen of medications andmonitoring. You will be given two types of medications:

Controller medications: These are for long-term control of persistentasthma. They help to reduce the inflammation in the lungs that underliesasthma attacks. You take these every day regardless of whether you arehaving symptoms or not.

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Rescue medications: These are for short-term control of asthma attacks.You take these only when you are having symptoms or are more likely tohave an attack -- for example, when you have an infection in your respiratory tract.

Your treatment plan will also include other parts:

awareness of your triggers and avoiding the triggers as much as possible;

recommendations for coping with asthma in your daily life;

regular follow-up visits to your health care provider; and

use of a peak flow meter.

 At your follow-up visits, your health-care provider will review how you have been doing.

He or she will ask you about frequency and severity of attacks, use of rescue medications, and peak flow measurements.

Lung function tests may be done to see how your lungs are responding toyour treatment.

This is a good time to discuss medication side effects or any problems youare having with your treatment.

The peak flow meter is a simple, inexpensive device that measures how forcefully you areable to exhale.

 Ask your health-care provider or an assistant to show you how to use thepeak flow meter. He or she should watch you use it until you can do itcorrectly.

Keep one in your home and use it regularly. Your health-care provider willmake suggestions as to when you should measure your peak flow.

Checking your peak flow is a good way to help you and your health-careprovider assess what triggers your asthma and its severity.

Check your peak flow regularly and keep a record of the results. Over time,your health-care provider may be able to use this record to determineappropriate medications, reducing dose or side effects.

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Peak flow measures fall just before an asthma attack. If you use your peakflow meter regularly, you may be able to predict when you are going to havean attack.

It can also be used to check your response to rescue medications.

Together, you and your health-care provider will develop an action plan for you in case of 

asthma attack. The action plan will include the following:

how to use the controller medication;

how to use rescue medication in case of an attack;

what to do if the rescue medication does not work right away;

when to call the health-care provider; and

when to go directly to the hospital emergency department.

Medications

Controller medicines help minimize the inflammation that causes an acute asthma attack.

Long-acting beta-agonists: This class of drugs is chemically related toadrenaline, a hormone produced by the adrenal glands. Inhaled long-actingbeta-agonists work to keep breathing passages open for 12 hours or longer.

They relax the muscles of the breathing passages, dilating the passagesand decreasing the resistance to exhaled airflow, making it easier tobreathe. They may also help to reduce inflammation, but they have noeffect on the underlying cause of the asthma attack. Side effects includerapid heartbeat and shakiness. Salmeterol (Serevent) and formoterol(Foradil) are long-acting beta-agonists.

Inhaled corticosteroids are the main class of medications in this group. Theinhaled steroids act locally by concentrating their effects directly within thebreathing passages, with very few side effects outside of the lungs.Beclomethasone (Vancenase, Beclovent) and triamcinolone (Nasacort,

 Atolone) are examples of inhaled corticosteroids.

Leukotriene inhibitors are another group of controller medications.Leukotrienes are powerful chemical substances that promote theinflammatory response seen during an acute asthma attack. By blockingthese chemicals, leukotriene inhibitors reduce inflammation. The leukotrieneinhibitors are considered a second line of defense against asthma andusually are used for asthma that is not severe enough to require oral

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corticosteroids.

Zileuton (Zyflo), zafirlukast (Accolate), and montelukast (Singulair) areexamples of leukotriene inhibitors.

Methylxanthines are another group of controller medications useful in the

treatment of asthma. This group of medications is chemically related tocaffeine. Methylxanthines work as long-acting bronchodilators. At one time,methylxanthines were commonly used to treat asthma. Today, because of significant caffeine-like side effects, they are being used less frequently inthe routine management of asthma. Theophylline and aminophylline areexamples of methylxanthine medications.

Cromolyn sodium is another medication that can prevent the release of chemicals that cause asthma-related inflammation. This drug is especiallyuseful for people who develop asthma attacks in response to certain types

of allergic exposures. When taken regularly prior to an exposure, cromolynsodium can prevent the development of an asthma attack. However, thismedicine is of no use once an asthma attack has begun.

Omalizumab belongs to a newer class of agents that works with the body'simmune system. In people with asthma who have an elevated level of Immunoglobulin E (Ig E), an allergy antibody, this drug given by injectionmay be helpful with symptoms that are more difficult to control. This agentinhibits IgE binding to cells that release chemicals that worsen asthmasymptoms. This binding prevents release of these mediators, thereby

helping in controlling the disease.

Rescue medications are taken after an asthma attack has already begun. These do not takethe place of controller drugs. Do not stop taking your controller drug(s) during an asthmaattack.

Short-acting beta-agonists are the most commonly used rescuemedications. Inhaled short-acting beta-agonists work rapidly, withinminutes, to open the breathing passages, and the effects usually last four hours. Albuterol (Proventil, Ventolin) is the most frequently used short-acting beta-agonist medication.

 Anticholinergics are another class of drugs useful as rescue medicationsduring asthma attacks. Inhaled anticholinergic drugs open the breathingpassages, similar to the action of the beta-agonists. Inhaled anticholinergicstake slightly longer than beta-agonists to achieve their effect, but they lastlonger than the beta-agonists. An anticholinergic drug is often usedtogether with a beta-agonist drug to produce a greater effect than either drug can achieve by itself. Ipratropium bromide (Atrovent) is the inhaledanticholinergic drug currently used as a rescue asthma medication.

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 Next Steps

Follow-up

If you have been treated in a hospital emergency department, you will be discharged onceyou respond well to the treatment.

You may be asked to see your primary-care provider  or an asthma specialist

(allergist) in the next day or two.

If your symptoms return, or if you begin to feel worse, you shouldimmediately contact your health-care provider or return to the emergencydepartment.

 Asthma is a long-term disease, but it can be managed. Your active involvement in treatingthis disease is vitally important.

Take your prescribed medications as directed, both controller and rescue

medications.

See your health-care provider regularly according to the recommendedschedule.

 Avoid any known triggers.

If you smoke, quit.

By following these steps, you can help minimize the frequency and severityof your asthma attacks.

 Asthma is now treated in a step-wise approach.

Intermittent asthma is treated with a rescue inhaler which is only used for symptoms.

Persistent asthma requires the use of maintenance medication, usually

initially an inhaled steroid, but other medications such as leukotrieneinhibitors are also used. The more severe the asthmatic condition, the moremaintenance medications are required, and therapy is "stepped up." Theseadditional medications include the long-acting beta agonists, oral steroids,and in some cases, theophyllines or omalizumab.

 As asthma improves, decreasing the amount of medication (under aphysician's guidance) and in some cases, stopping some of the medicationmay be indicated. This is referred to as "stepping down" therapy.

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Prevention

You need to know how to prevent or minimize future asthma attacks.

If your asthma attacks are triggered by an allergic reaction, avoid your triggers as much as possible.

Keep taking your asthma medications after you are discharged. This isextremely important. Although the symptoms of an acute asthma attack goaway after appropriate treatment, asthma itself never goes away.

Outlook 

Most people with asthma are able to control their condition if they work together with ahealth-care provider and follow their treatment regimen carefully.

People who do not seek medical care or do not follow an appropriate treatment plan are likelyto experience worsening of their asthma and deterioration in their ability to function normally.

Support Groups and Counseling

 Allergy & Asthma Network Mothers of Asthmatics2751 Prosperity Avenue, Suite 150Fairfax, VA 22031(800) 878-4403

 American Lung Association61 Broadway, 6th Floor New York, NY 10006(212) 315-8700

 Asthma and Allergy Foundation of America1233 20th St NW, Suite 402Washington, DC 20636(202) 466-7643

For More Information

Web Links

 Allergy and Asthma Network Mothers of Asthmatics

 American Academy of Allergy, Asthma and Immunology

 American College of Allergy, Asthma and Immunology

 American Lung Association

 Asthma and Allergy Foundation of America

National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute(NHLBI), National Institutes of Health, Lung Diseases Information

National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health

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Multimedia

Media file 1: A child with asthma using a metered dose inhaler.

Media type: Photo

Media file 2: An adult with asthma using a spirometer to measure how forcefullyshe can exhale.

Media type: Photo

Media file 3: A pulse oximeter measures the amount of oxygen in your bloodstream.

Media type: Photo

Media file 4: A person with asthma receives an inhalation treatment using ahand-held nebulizer.

Media type: Photo

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Media file 5: A child with asthma uses a metered dose inhaler with a spacer.

Media type: Photo

Synonyms and Keywords

allergies, allergy, allergic reaction, asthmatic bronchitis, bronchitis, atopic state, atopy,breathing problem, bronchial asthma, bronchospasm, chronic obstructive pulmonary disease,COPD, inflammation, lung hypersensitivity, metered dose inhaler, MDI, nebulizer, reactiveairway disease, respiratory disorder, spirometer, spirometry, asthma FAQs, asthma

frequently asked questions, asthma, asthma attack, occupational asthma, exercise-inducedasthma, adult-onset asthma, nocturnal asthma, asthma in pregnancy, asthma in schoolchildren, asthmatic, breathing passages, airways, chronic airway inflammation, allergen,wheeze, bronchiolitis, acute asthma, asthma medications, bronchial airways, bronchial airwaynarrowing, inflammation of the bronchi, wheezing, dyspnea, airway narrowing, noisybreathing, difficulty breathing, reactive airways disease, RAD, reversible airway obstruction,increased bronchial reactivity, airway inflammation, passive smoke inhalation, allergicdisease, aeroallergen exposure, viral respiratory illness, airway hyperreactivity, AHR, airwayremodeling, asthma triggers, nonallergic rhinitis, early allergic response, EAR, late allergicresponse, LAR, chest tightness, breathlessness, bronchial hyperresponsiveness, BHR,exposure to allergens, exposure to environmental irritants, exposure to viruses, exposure tocold air, allergic rhinitis, acute bronchoconstriction, airway edema, chronic mucous plug

formation, hay fever , indoor allergies, indoor allergy, indoor allergens, indoor allergen, asthmaassessment, asthma quiz

Authors and Editors

 Author: George C. Schiffman, MD, FCCP

Editor: Melissa Conrad Stöppler, MD

 Author: Jeffrey Rubins, MD, Director Clinical Operations, Associate Professor,Department of Internal Medicine, Division of Pulmonary, Minneapolis VA MedicalCenter, University of Minnesota-Twin Cities.

Coauthor(s): Kathryn L Hale, MS, PA-C, Medical Writer, eMedicine.com, Inc.

Editors: Ryland P Byrd Jr, MD, Chief of Pulmonary Medicine, Medical Director of Respiratory Therapy, Quillen VA Medical Center; Professor, Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine,James H Quillen College of Medicine, East Tennessee State University;Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; ZabMosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine,Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center,

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© 2011 WebMD, LLC.

 All rights reserved.eMedicineHealth does not provide medical advice, diagnosis or treatment. See

 Additional Information.

Professor of Medicine, University of California at Los Angeles School of Medicine.

Last Editorial Review: 3/27/2009

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