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This topic provides information about asthma in teens and adults. If you are looking for information about asthma in children age 12 and younger, see the topic Asthma in Children.
Asthma causes swelling and inflammation in the airways that lead to your lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for you to breathe. These flare-ups are also called asthma attacks or exacerbations (say "ig-zas-er-BAY-shuns").
Asthma affects people in different ways. Some people have asthma attacks only during allergy season, or when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.
Even if you have few asthma attacks, you still need to treat your asthma. The swelling and inflammation in your airways can lead to permanent changes in your airways and harm your lungs.
Many people with asthma live active, full lives. Even though asthma is a lifelong disease, treatment can control it and keep you healthy.
Experts don't know exactly what causes asthma. But there are some things we do know:
Symptoms of asthma can be mild or severe. You may have mild attacks now and then, or you may have severe symptoms every day. Or you may have something in between. How often you have symptoms can also change. When you have asthma, you may:
Your symptoms may be worse at night.
Severe asthma attacks can be life-threatening and need emergency treatment.
Along with doing a physical exam and asking about your health, your doctor may order lung function tests. These tests include:
You will need routine checkups with your doctor to keep track of your asthma and decide on treatment.
There are two parts to treating asthma, which are outlined in your asthma action plan. The goals are to:
If you need to use the quick-relief inhaler more often than usual, talk to your doctor. This may be a sign that your asthma is not controlled and can cause problems.
Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your asthma action plan.
You can prevent some asthma attacks by avoiding those things that cause them. These are called triggers. A trigger can be:
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The cause of asthma isn't known. Health experts believe that inherited, environmental, and immune system factors combine to cause inflammation of the airways. This can lead to asthma and asthma attacks.
Asthma may run in families (be inherited). If this is the case in your family, you may be more likely than other people to get long-lasting (chronic) inflammation in the airways.
In some people, an allergic reaction causes asthma symptoms. An allergen makes the immune system cells release chemicals that cause inflammation.
Studies show that exposure to allergens such as dust mites, cockroaches, and animal dander may influence asthma's development. Asthma is much more common in people who have allergies. But not all people who have allergies get asthma. And not all those who have asthma have allergies.
Environmental factors and today's germ-conscious lifestyle may play a role in the development of asthma. Some experts believe that there are more cases of asthma because of pollution and less exposure to certain types of bacteria or infections.1 As a result, children's immune systems may develop in a way that makes it more likely they will also get allergies and asthma.
Asthma in adults also can be related to exposure to substances at work. This is called occupational asthma.
Symptoms of asthma can be mild or severe. You may have no symptoms, severe symptoms every day, or something in between. How often you have symptoms can also change. Symptoms of asthma may include:
An asthma attack occurs when your symptoms suddenly increase. Factors that can lead to an asthma attack or make it worse include:
Many people have symptoms that become worse at night (nocturnal asthma), such as a cough and shortness of breath.
In general, waking at night because of shortness of breath or a cough is a sign of poorly controlled asthma.
Asthma often begins during infancy or childhood, but it can start at any age. It may last throughout your life.
At times, the inflammation from asthma causes a narrowing of your airways and mucus production. This causes asthma symptoms such as shortness of breath.
Your airways narrow when they overreact to certain substances. These are known as asthma triggers. What triggers asthma symptoms varies from person to person.
When asthma symptoms suddenly occur, it is called an asthma attack (also called a flare-up or exacerbation). Asthma attacks can occur rarely or frequently. They may be mild to severe.
Although some asthma attacks occur very suddenly, many become worse gradually over a period of several days. In general, you can take care of symptoms at home by following your asthma action plan. A severe attack may need emergency treatment and in rare cases can be fatal.
Asthma is classified as intermittent, mild persistent, moderate persistent, and severe persistent.
Asthma can raise your risk for complications from lung infections, such as acute bronchitis and pneumonia.
Even mild asthma may cause changes to the airway system. It may speed up and make worse the natural decrease in lung function that occurs as we age.
Some experts believe that asthma may raise your risk for chronic obstructive pulmonary disease (COPD).2
Asthma can occur for the first time during pregnancy, or it may change during pregnancy.
When asthma is properly controlled, a woman can have a normal pregnancy with little or no increased risk to herself or the baby. But if the asthma isn't well controlled, there are risks to the pregnant woman and the baby.
Many things can increase your risk for asthma. Some of these are not within your control. Others you can control.
The main things that put you at risk for getting asthma as an adult are ongoing (chronic) wheezing when you were a child and cigarette smoking.3, 4
Triggers that may make asthma worse and may lead to asthma attacks include:
Experts aren't yet sure:
Call 911 or other emergency services right away if:
Call your doctor now or seek immediate medical care if:
Call your doctor if:
If you have not been diagnosed with asthma but have mild asthma symptoms, call your doctor and make an appointment for an evaluation.
If your teenager has symptoms of asthma, it is important to see a doctor. Many teens with frequent wheezing may have asthma but aren't diagnosed with the disease. Teens who have asthma but are less likely to be diagnosed are most often:10
Watchful waiting is a "wait and see" approach.
Watchful waiting may be appropriate if you follow your asthma action plan and stay within the green zone. Watch your symptoms, and continue to avoid your asthma triggers.
If you have been getting treatment for 1 to 3 months but aren't improving, ask your doctor if you need to see an asthma specialist.
Doctors who can diagnose and treat asthma include:
You may need to see a specialist (allergist or pulmonologist) if you have:
A diagnosis of asthma is based on your medical history, a physical exam, and lung function tests.
Lung function tests can diagnose asthma, show how severe it is, and check for complications.
Asthma can be hard to diagnose because the symptoms vary widely. And asthma-like symptoms can also be caused by other conditions, such as a viral lung infection or a vocal cord problem. So your doctor may want to do one or more extra tests.
You need to monitor your condition and have regular checkups to keep asthma under control and to review and possibly update your asthma action plan. Checkups are recommended every 1 to 6 months, depending on how well your asthma is controlled.
During checkups, your doctor will ask about information you may have tracked in an asthma diary, such as:
Based on the results, your asthma category may change, and your doctor may change the medicines you use or how much medicine you use.
If you have persistent asthma and take medicine every day, your doctor may ask about your exposure to substances (allergens) that cause an allergic reaction. For more information about testing for triggers, see the topic Allergic Rhinitis.
Allergy tests can include skin tests and a blood test. Skin tests are needed if you are interested in allergy shots (immunotherapy).
It's important to treat asthma, because even mild asthma can damage your airways.
By following your treatment plan, you can meet your goals to:11
An asthma action plan tells you which medicines to take every day and how to treat asthma attacks. It also may include an asthma diary where you record your peak expiratory flow (PEF), symptoms, and triggers. This helps you identify triggers that can be changed or avoided. It also lets you be aware of your symptoms and know how to make quick decisions about medicine and treatment. See an example of an asthma action plan(What is a PDF document?).
You'll likely take several medicines to control your asthma and to prevent attacks. Your doctor may adjust your medicines depending on how well your asthma is controlled. Medicines include:
Inhalers deliver medicine directly to the lungs. To get the best asthma control possible, be sure you know how to use your inhaler. Use a spacer with your inhaler if your doctor recommends it.
Be sure to monitor your asthma and have regular checkups. Checkups are recommended every 1 to 6 months, depending on how well your asthma is controlled.
It's easy to underestimate how severe your symptoms are. You may not notice them until your lungs are functioning at 50% of your personal best peak expiratory flow (PEF).
Measuring PEF is a way to keep track of asthma symptoms at home. It can help you know when your lung function is getting worse before it drops to a dangerously low level. You can do this with a peak flow meter.
Being around asthma triggers increases symptoms. Try to avoid irritants (such as smoke or air pollution) or things that you may be allergic to (such as animal dander). If something at work is causing your asthma or making it worse (occupational asthma), you may need to wear protective gear, switch to some other task or area, or change jobs.
If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful.
Special considerations in treating asthma include:
If your asthma isn't improving, make an appointment with your doctor to:
If your medicine isn't controlling airway inflammation, your doctor will first check to see if you are using the inhaler correctly. If you are using it the right way, your doctor may increase the dosage or switch to another medicine. Or he or she may add a medicine to your treatment.
For severe asthma that cannot be controlled with medicines, a newer treatment called bronchial thermoplasty may be used. For this treatment, heat is applied to the airways. This reduces the thickness of the airways and improves the ability to breathe.12, 13
If you have a severe asthma attack (the red zone of your asthma action plan), use medicine based on your action plan and talk with a doctor right away about what to do next. This is especially important if your peak expiratory flow (PEF) doesn't return to the green zone or if it stays in the yellow zone after you take medicine.
You may have to go to the hospital or an emergency room for treatment. Be sure to tell the emergency staff if you are pregnant.
At the hospital, you will probably receive inhaled beta2-agonists and corticosteroids. You may be given oxygen therapy. Your lung function and condition will be checked. You may need more treatment in the emergency room or a stay in the hospital.
Some people are at increased risk of death from asthma, such as people who have been admitted to an intensive care unit for asthma or who have needed a breathing tube (intubation) for asthma. If you are high-risk, seek medical care early when you have symptoms.
Although there is no certain way to prevent asthma, you can reduce airway inflammation and your risk of asthma attacks.
The goal is to reduce the number, length, and severity of asthma attacks. Start by avoiding your asthma triggers. Also be sure to:
Common irritants in the air, such as tobacco smoke and air pollution, can trigger asthma attacks in some people. They include:
Exercise is an asthma trigger for some people. If you often have asthma attacks when you exercise, use your inhaler 10 to 30 minutes before you start the activity so you can avoid an attack.
Avoid exercising outdoors in cold weather. If you are outdoors in cold weather, wear a scarf around your face and breathe through your nose.
You can control the impact of asthma with an asthma action plan. A good action plan reminds you to take your daily controller medicines and to be aware of your symptoms. It also tells you how to make quick decisions about medicine and treatment when you need to.
To manage your asthma and get the most out of your asthma action plan, know how to monitor your peak airflow, identify asthma triggers, and take your asthma medicine correctly.
It's easy to underestimate how severe your symptoms are. You may not notice symptoms until your lungs are functioning at 50% of your personal best measurement.
Measuring peak expiratory flow (PEF) is a way to keep track of asthma symptoms at home. Doing this can help you know when your lung function is getting worse before it drops to a dangerously low level. You can do this with a peak flow meter.
A trigger is anything that can lead to an asthma attack. A trigger can be smoke, air pollution, allergens, some medicines, or even stress. Avoiding triggers will help decrease the chance of having an asthma attack.
In the case of allergy triggers, avoiding them will help control inflammation in the airways. If you have asthma triggered by an allergen, taking antihistamine medicine may help you manage the allergy. It may limit the allergy's effect on your asthma.
Taking medicines is an important part of asthma treatment. But because you may need to take more than one medicine, it can be hard to remember to take them. To help yourself remember, understand the reasons people don't take their asthma medicines. Then find ways to overcome those obstacles, such as taping a note to your refrigerator.
Most people who have asthma can travel freely. But if you travel to remote areas and take part in intense physical activity, such as long hikes, you may be at increased risk for an asthma attack in an area where emergency help may be hard to find.
When traveling, keep your medicine with you, carry the prescription for it, and use it as prescribed. Also carry your asthma action plan so you know what medicines to take every day and what to do if you have an asthma attack.
Teens who have asthma may view the disease as cutting into their independence and setting them apart from their peers. Parents and other adults can offer support and encouragement to help teens stick with a treatment program. It's important to:
Medicine doesn't cure asthma. But it is an important part of managing it. Medicines for asthma treatment are used to:
Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks.
Most medicines for asthma are inhaled. Inhaled medicines are used because a specific dose can be given directly to the airways.
Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler (MDI) is used most often.
Doctors recommend using a spacer with an MDI to better deliver the medicine to the lungs. For many people, a spacer makes an MDI easier to use.
The most important asthma medicines are:
There are other long-term medicines for daily treatment. They include:
Other medicines may be given in some cases.
A quick-relief medicine, racepinephrine (Asthmanefrin), is available without a prescription. This medicine isn't used with an inhaler. It comes with an atomizer that delivers the medicine as a mist.
Medicine treatment for asthma depends on your age and type of asthma, and how well the treatment is controlling your asthma symptoms.
Your doctor will work with you to help find the number and dose of medicines that work best.
One of the best tools for managing asthma is a daily controller medicine that has a corticosteroid ("steroid"). But some people worry about taking steroid medicines because of myths they've heard about them. If you're making a decision about a steroid inhaler, it helps to know the facts.
At the start of asthma treatment, the number and dosage of medicines are chosen to get the asthma under control. Your doctor may start you at a higher dose within your asthma classification so that the inflammation is controlled right away. After the asthma has been controlled for several months, the dose of the last medicine added is reduced to the lowest possible dose that prevents symptoms. This is known as step-down care. Step-down care is believed to be a better way to control inflammation in the airways than starting at lower doses of medicine and increasing the dose if it is not enough.14
Because quick-relief medicine quickly reduces symptoms, people sometimes overuse these medicines instead of using the slower-acting long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as reducing how well these medicines will work for you in the future.15
You may have to take more than one medicine each day to manage your asthma. Help yourself remember when to take each medicine, such as taping a note to your refrigerator to remind yourself.
Tell your doctor about all the medicines you are taking, so he or she can choose asthma medicines that won't interfere with other medicines.
Some people only have symptoms during certain times of the year (seasonal asthma). If you know when you will most likely have symptoms, start using a medicine to decrease inflammation before the symptoms start.
A new treatment called bronchial thermoplasty is available for adults with severe asthma. For this treatment, bronchoscopy is used to apply heat to the airways. This reduces the thickness of the airways and improves the ability to breathe.12, 13
Allergy shots (immunotherapy) may be recommended for people who have asthma symptoms that are triggered by allergens.
For some people, allergy shots reduce asthma symptoms and the need for medicines.16 But allergy shots don't work equally well for all allergens. Allergy shots should not be given when asthma is poorly controlled.
Some people have used ephedra—a stimulant sold for weight loss and sports performance—to try to treat asthma symptoms. But the U.S. Food and Drug Administration (FDA) has banned the sale of this dietary supplement because of concerns about safety. Ephedra, also called ma huang, has been linked to heart attacks, strokes, and some deaths.
Alternative treatments such as homeopathy, acupuncture, and breathing exercises have been used to treat asthma. The research on these treatments is limited. Reviews of research show:
A review of complementary and alternative treatments for treating asthma in children concluded that none have been proved to reduce asthma symptoms and some may have harmful side effects.20 Some of these studies included teenagers and adults. The treatments reviewed include:
Talk with your doctor before trying a complementary or alternative treatment.
For more information on alternative treatments, see the topic Complementary Medicine.
The American Academy of Allergy, Asthma, and Immunology publishes an excellent series of pamphlets on allergies, asthma, and related information. It also provides physician referrals.
The American Lung Association provides programs of education, community service, and advocacy. Some of the topics available include asthma, tobacco control, emphysema, infectious disease, asbestos, carbon monoxide, radon, and ozone.
The Asthma and Allergy Foundation of America (AAFA) provides information and support for people who have allergies or asthma. The AAFA has local chapters and support groups. And its Web site has online resources, such as fact sheets, brochures, and newsletters, both free and for purchase.
The Centers for Disease Control and Prevention (CDC) is an agency of the U.S. Department of Health and Human Services. The CDC works with state and local health officials and the public to achieve better health for all people. The CDC creates the expertise, information, and tools that people and communities need to protect their health—by promoting health, preventing disease, injury, and disability, and being prepared for new health threats.
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
CitationsMcGeady SJ (2004). Immunocompetence and allergy. Pediatrics, 113(4): 1107–1113.Silva GE, et al. (2004). Asthma as a risk factor for COPD in a longitudinal study. Chest, 126(1): 59–65.Guilbert T, Krawiec M (2003). Natural history of asthma. Pediatric Clinics of North America, 50(3): 524–538.Stern DA, et al. (2008). Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: A longitudinal birth-cohort study. Lancet, 372(9643): 1058–1064.Etzel RA (2003). How environmental exposures influence the development and exacerbation of asthma. Pediatrics, 112(1): 233–239.Beuther DA, Sutherland ER (2007). Overweight, obesity, and incident asthma: A meta-analysis of prospective epidemiologic studies. American Journal Of Respiratory and Critical Care Medicine, 175(7): 661–666.Lemanske RF Jr (2003). Viruses and asthma: Inception, exacerbations, and possible prevention. Proceedings from the Consensus Conference on Treatment of Viral Respiratory Infection-Induced Asthma in Children. Journal of Pediatrics, 142(2, Suppl): S3–S7. Burgess SW, et al. (2006). Breastfeeding does not increase the risk of asthma at 14 years. Pediatrics, 117(4): 787–792.Takkouche B, et al. (2008). Exposure to furry pets and the risk of asthma and allergic rhinitis: A meta-analysis. Allergy, 63(7): 857–864.Yeatts K, et al. (2003). Who gets diagnosed with asthma? Frequent wheeze among adolescents with and without a diagnosis of asthma. Pediatrics, 111(5): 1046–1054.Joint Task Force on Practice Parameters (2005). Attaining optimal asthma control: A practice parameter. Journal of Allergy and Clinical Immunology, 116(5): S3–S11. Available online: http://www.allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/2005+Asthma+Control.pdf.Cox G, et al. (2007). Asthma control during the year after bronchial thermoplasty. New England Journal of Medicine, 356(13): 1327–1337.Castro M, et al. (2010). Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: A multicenter, randomized, double-blind, sham-controlled clinical trial. American Journal of Respiratory and Critical Care Medicine, 181(2): 116–124.National Institutes of Health (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08–5846). Available online: http://www.nhlbi.nih.gov/guidelines/asthma/index.htm.Salpeter SR, et al. (2004). Meta-analysis: Respiratory tolerance to regular beta2-agonist use in patients with asthma. Annals of Internal Medicine, 140(10): 802–813. Abramson MJ, et al. (2010). Injection allergen immunotherapy for asthma. Cochrane Database of Systematic Reviews (8). Oxford: Update Software.Györik SA, Brutsche MH (2004). Complementary and alternative medicine for bronchial asthma: Is there new evidence? Current Opinion in Pulmonary Medicine, 10(1): 37–43. Passalacqua G, et al. (2006). ARIA update: I—Systematic review of complementary and alternative medicine for rhinitis and asthma. Journal of Allergy and Clinical Immunology, 117(5): 1054–1062.O'Connor E, et al. (2012). Breathing exercises and/or retraining techniques in the treatment of asthma: Comparative effectiveness. Comparative Effectiveness Review No. 71 (AHRQ Publication No. 12-EHC092-EF). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ncbi.nlm.nih.gov/books/NBK109355.Bukutu C, et al. (2008). Asthma: A review of complementary and alternative therapies. Pediatrics in Review, 29(8): e44–e49.Other Works ConsultedGlobal Initiative for Asthma (GINA) (2011). Global strategy for asthma management and prevention. Available online: http://www.ginasthma.org/guidelines-gina-report-global-strategy-for-asthma.html.Grayson MH, Holtzman MJ (2007). Asthma. In EG Nabel, ed., ACP Medicine, section 14, chap. 19. Hamilton, ON: BC Decker.Jaeschke R, et al. (2008). The safety of long-acting beta-agonists among patients with asthma using inhaled corticosteroids. American Journal of Respiratory and Critical Care Medicine, 178(10): 1009–1016.Schatz M (2011). Asthma in adults and adolescents. In ET Bope et al., eds., Conn's Current Therapy 2011, pp. 778–786. Philadelphia: Saunders.
Last Revised: August 16, 2013
Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine & Rohit K Katial, MD - Allergy and Immunology
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