Cardiac asthma is a medical symptom, also known as paroxysmal dyspnea or paroxysmal nocturnal dyspnea ("PND").

It is defined as sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing. It is most closely associated with congestive heart failure. PND commonly occurs several hours after a person with heart failure has fallen asleep. PND is often relieved by sitting upright, but not as quickly as simple orthopnea. Also unlike orthopnea, it does not develop immediately upon lying down. PND is caused by increasing amounts of fluid entering the lung during sleep and filling the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere. This fluid typically rests in the legs, filling interstitial spaces in the peripheral vascular system (peripheral edema) during the day when the individual is upright. At night, when recumbent for an extended period, this fluid is reabsorbed, increasing total blood volume and blood pressure, leading to pulmonary hypertension in people with underlying left ventricular dysfunction. The pulmonary hypertension leads to the accumulation of fluid in the lungs, or pulmonary edema. PND is a symptom of heart failure and other associated conditions such as mitral stenosis, aortic insufficiency, and systemic hypertension. It was first described by Charles Lepois in the 16th century. The experience of PND is often described as awakening suddenly to a feeling that one is suffocating, with wheezing respirations and coughing. It can be quite frightening.[1]
Breathing difficulty associated with congestive heart failure is known as cardiac asthma. Not considered a truly asthmatic condition, cardiac asthma results from a collection of fluid in the lungs, known as pulmonary edema. Symptoms associated with this condition can mimic those of traditional asthma, so determining the presence of heart failure is essential to appropriate treatment. Heart failure-induced asthma is considered a serious condition which can become life-threatening if proper treatment is not utilized. Congestive heart failure is characterized by the impaired functioning of the heart muscle, which adversely affects the circulatory system and major organ function. Asthma related to heart failure results from the heart's inability to pump effectively, which negatively impacts proper lung function. As the heart's pumping becomes impaired, fluid begins to accumulate in the lungs, narrowing air passages and reducing the flow of oxygen. The resulting airflow blockage causes the individual to wheeze and develop additional symptoms associated with breathing difficulty.

Individuals with cardiac asthma may wheeze or experience difficulty breathing when exercising, during everyday activities, or at night when lying in bed. The collection of fluid in the lungs induces symptoms that include coughing, wheezing, and shortness of breath. Individuals with cardiac asthma may also develop pronounced swelling of the legs and ankles, an increased heart rate and blood pressure, and anxiety. Those with heart failureinduced asthma may find that they are able to breathe better at night if they sleep sitting upright in a chair, otherwise they awaken uneasy and breathless when they try to sleep lying down.

A diagnosis of congestive heart failure may be made through the application of a variety of tests. Individuals may undergo tests that include a chest X-ray, an echocardiogram, and a magnetic resonance imaging (MRI) test of the heart. A heart catheterization and a cardiac stress test may also be conducted to evaluate heart function and determine any rhythm disturbances within the heart muscle. The existence of a pleural effusion, or fluid buildup around the lungs, may be detected during a physical examination. Proper diagnosis is essential to the successful treatment of cardiac asthma. Treatment for individuals with cardiac asthma centers on improving heart function. Corrective procedures or surgery may be required to restore heart functionality, such as valve replacement or coronary bypass surgery. Some individuals may receive a single or dual chamber pacemaker or an implantable cardioverter-defibrillator to restore proper heart rhythm and pumping ability. To ease asthmatic symptoms, supplementary oxygen and bronchodilators may be given in addition to treatment administered for the heart failure. Medications may be utilized as part of an individuals treatment regimen when a diagnosis of congestive heart failure has been confirmed. Diuretics aid with alleviating fluid collection in the lungs and allow for easier breathing without wheezing. Additional medications may be prescribed to aid with strengthening the heart muscle to regulate its pumping ability and restore functionality, such as digitalis glycosides, angiotensin-converting enzyme (ACE) inhibitors, and beta-blockers. Lifestyle and dietary changes may be required as part of the individuals treatment regimen. Individuals of advanced age who have been diagnosed with congestive heart failure and who commonly experience shortness of breath or breathing difficulty are at an increased risk for developing cardiac asthma. Those who have not received a diagnosis of congestive heart failure, but are experiencing symptoms associated with cardiac asthma, should not use traditional asthma medications excessively. Use of such medications by those without asthma may induce heart arrhythmias and worsen existing symptoms further complicating the existing heart failure. Acute bronchitis. Acute bronchitis is an infection, usually viral or bacterial, of the bronchi, the larger airways or breathing tubes. The symptoms of acute bronchitis include fever, cough, yellow or green sputum, and, sometimes, wheezing. This combination of coughing and wheezing is sometimes referred to as "asthmatic bronchitis" or post-viral bronchial hyperreactivity of the airways. Acute bronchitis is generally treated with antibiotics and/or antiinflammatory medications such as corticosteroids. The coughing and wheezing usually subside within a few weeks. Some patients with asthma can produce green mucus that may not reflect an ongoing infection but the consequence of airway inflammation or allergic response. Chronic bronchitis. Chronic bronchitis usually is defined as a daily cough with production of sputum for three months for two years in a row. The most common cause of chronic bronchitis is cigarette smoking. With chronic bronchitis, there is longstanding inflammation and swelling of the inner lining of the airways, and the inflammation and swelling cause narrowing of the airways. The inflammation also stimulates production of mucous within the airways that becomes the sputum produced by coughing. Infections of the airways with viruses or bacteria are common among individuals with chronic bronchitis. Infections further aggravate the inflammation and narrowing of the airways, worsening the symptoms of shortness of breath, coughing, and wheezing. Treatments include antibiotics, quitting

cigarette smoking, bronchodilators to expand the airways, and corticosteroids to reduce the inflammation. Emphysema. Emphysema is a disease where there is permanent destruction of the walls of the air sacs (alveoli) and the small airways (bronchioles). The destruction of the alveolar walls reduces the elasticity of the lung. Loss of elasticity leads to the collapse of the bronchioles, obstructing airflow out of the alveoli. Air becomes permanently "trapped" in the alveoli. Air trapped in the alveoli cannot be exchanged for room air, and this reduces the ability of the lung to get rid of carbon dioxide and take in oxygen. Emphysema is most often caused by years of cigarette smoking; however, a genetic disease, alpha-1 antitrypsin deficiency, also causes emphysema. The combination of chronic bronchitis and emphysema is called chronic obstructive pulmonary disease (COPD). The major symptom of emphysema is shortness of breath. Patients with emphysema also may wheeze if they also suffer from chronic bronchitis and/or asthma. Treatment of these latter patients begins with smoking cessation and the use of inhalers to deliver bronchodilators and corticosteroids to the lungs. Antibiotics, oxygen, and surgery in the advanced stages of these diseases also can be helpful. Bronchiectasis. Bronchiectasis is a chronic condition in which the bronchial tubes (larger airways) are damaged by repeated bronchial infections. The major symptom of bronchiectasis is a persistent cough with thick and usually green mucus. Bronchiectasis is treated with bronchodilators, antibiotics, and corticosteroids when flare-ups occur. Cystic fibrosis is an inherited condition in which the affected patients can produce thick mucus that plugs the bronchial tubes. The plugging of the bronchial tubes causes repeated bouts of bronchitis and pneumonia, leading to the development of bronchiectasis. Localized bronchial obstruction. Wheezing and coughing can be symptoms of a localized obstruction of the airways (the bronchial tubes or trachea). The wheezing represents the sound of air rushing around the blockage, and the coughing is the body's effort to clear the blockage. The most common causes of localized airway obstruction are foreign bodies such as accidentally inhaled peanuts, bronchial tumors, and the narrowing of the trachea that occurs after a tracheostomy. The wheezing and coughing due to a localized obstruction will not respond to medications for asthma. The treatment is to relieve the obstruction.

Cardiac asthma
In cardiac asthma, the reduced pumping efficiency of the left side of the heart leads to a build up of fluid in the lungs (pulmonary oedema). This fluid build-up can cause breathlessness and wheezing. Cardiac asthma has very similar symptoms to bronchial asthma. The main symptoms and signs of cardiac asthma are:

shortness of breath with or without wheezing; cough; rapid and shallow breathing; an increase in blood pressure and heart rate; and a feeling of apprehension.

The pattern of shortness of breath helps doctors determine which type of asthma you have people with bronchial asthma tend to experience shortness of breath early in the morning, whereas people with heart failure and cardiac asthma often find they wake up breathless a few hours after going to bed, and have to sit upright to catch their breath. This is because in people with heart failure, lying down for prolonged periods will cause fluid to accumulate in the lungs leading to shortness of breath. Both bronchial and cardiac asthma can make people short of breath when they exert themselves. In bronchial asthma, symptoms are usually brought on by vigorous exercise and tend to be worse after the exercise than during it. On the other hand, cardiac asthma tends to happen during less vigorous exertion someone with heart failure can find themselves short of breath while climbing stairs, or in severe cases, while getting dressed. People with heart failure also often have problems with swollen ankles that worsen during the course of the day. They may also feel very tired, put on weight and have to urinate frequently. Cardiac asthma can be a life-threatening condition, and you should consult your doctor if you think you have symptoms of cardiac asthma.

Bronchial asthma
For most people with bronchial asthma, the pattern is periodic attacks of wheezing alternating with periods of quite normal breathing. However, some people with bronchial asthma alternate between chronic (long-term) shortness of breath and episodes in which they feel even more breathless than usual. Risks for developing bronchial asthma include being a person who is genetically susceptible to asthma and being exposed early in life to indoor allergens, such as dust mites and cockroaches, and having a family history of asthma or allergy. Exposure to the effects of tobacco smoke before birth or during early childhood also increases the risk of developing bronchial asthma. Bronchial asthma attacks can be triggered (precipitated or aggravated) by various factors, including:

respiratory tract infections; cold weather; exercise; allergens (substances that trigger an allergic reaction) such as pollen and house dust mites; cigarette smoke and other air pollutants; and stress.

Some people can develop asthma due to an intolerance that their body develops to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) (in which case exposure to aspirin or NSAIDs can trigger an asthma attack). Other medicines, such as beta-blockers, can worsen or unmask bronchial asthma. Other people develop asthma due to an allergy that they develop to certain chemicals in the workplace (this is called occupational asthma, in which case exposure to the chemical triggers an asthma attack).

The symptoms of bronchial asthma include:

a feeling of tightness in the chest; difficulty in breathing or shortness of breath; wheezing; and coughing (particularly at night).

Although there is currently no cure for bronchial asthma, it can be controlled. There is little reason why you cannot continue to do many of the activities you enjoy. Work with your doctor to develop an asthma action plan and learn to control your asthma dont let it control you!