Asthma & Wheezing

What Does Asthma Mean?

Many people think asthma and wheezing are the
same thing. Actually, wheezing is only once sign of
asthma, and many other things besides asthma
can cause wheezing. Because of this confusion,
the term asthma is being replaced with a more
accurate description: Reactive Airway Disease
(RAD). Those with RAD (5% and growing in the
U.S.) have bronchial (lung) passages that are
more sensitive to irritation than normal. This
hypersensitivity leads to inflammation (redness
and swelling) in the tiny airways deep in the lungs.
The inflammation in turn causes excess mucus
production, and tightening of airway muscles that
wind around the bronchial tubes like laces. The combination of swelling, mucus, and
muscle tightening all cause narrowing of the airways. Wheezing (whistling and
labored breathing) usually results, but a dry cough is sometimes the only sign. Click
on the figure to see what happens in an asthma attack.

Nobody knows exactly why some people have RAD. Many times it is inherited, and
is often associated with allergies (especially in children). Asthma can develop at any
time, but is more common in young children. When it starts in childhood it usually
improves with age. But with adult onset asthma, aging often worsens the problem.
Asthma has also become more common in this country, again for unknown reasons.

What Causes an Asthma Attack?

The diagram at the right shows the chain of events in asthma or RAD that lead to a
classic asthma attack. As you can see, there must be a triggering factor causing
airway inflammation to begin the process. In children, allergies frequently act as
asthma triggers. Cigarette smoke, weather changes, and emotional stress also bring
on wheezing, but probably the most common trigger is a simple cold or other
respiratory infection. For some unknown reason, the lung airways in asthmatics
become inflamed very quickly with colds, even if the virus stays in the head.
Exercise induced asthma is just plain old asthma with exercise as the trigger. Cold,
dry air is worse for exercise asthma; warm, moist air causes fewer problems.

Heartburn (reflux esophagitis) also leads to asthma attacks. This often occurs at
night, when laying flat allows acid to seep back into the swallowing tube and throat. If
the acid leaks into your breathing passages, choking and wheezing result. If your
asthma attacks don’t seem to be caused by colds, allergens, or other respiratory
irritation, consider reflux.

Signs of Asthma

 Coughing or "bronchitis" with every cold.

 Coughing (especially at night) that lingers for weeks.

 Shortness of breath or wheezing with exercise or exposure to

allergens.

 Night time wakening with cough or shortness of breath.

Remember, RAD or asthma is just overly sensitive lung membranes. You can’t
prevent the condition, but by avoiding triggering factors you can prevent the actual
asthma attacks.

The first step is to figure out what
triggers your asthma (see the list at
right for common causes)
Common Triggering Factors For Asthma
 Allergies
 Weather changes (barometric pressure,
humidity, and temperature).
 Air pollution, smoke (cigarette, or wood),
chemical or fuel vapors, fumes, or even
perfumes and other scents.
 Dust.
 Heartburn (reflux esophagitis)
 Exercise
 Colds and other respiratory infections
 Physical or emotional stress

Allergies. See the topic area [Allergies] for in-depth discussion. At least 75% of
childhood asthma is allergy related. Controlling allergies with medication or
immunotherapy is key to reducing the frequency of asthma attacks.

Exercise. Cold dry air is more aggravating for those with exerciseinduced asthma
than warm moist air. If you have a choice, summer sports or indoor sports such as
swimming are much preferable for asthmatics than outdoor fall and winter sports
such as football, cross country running, or skiing. Simple measures like breathing
through a scarf or taking preventive medicine before exercise help to minimize
attacks.

Reflux (heartburn). See [Heartburn and Acid Indigestion] for thorough discussion on
prevention. Doctors believe as much as 30% of all asthma may be caused by reflux
problems. Even if you have identified other specific triggers for your asthma attacks,
try following heartburn prevention techniques for a few weeks to see if it leads to
better control of your asthma --- you may be surprised.

Over-the-counter treatment for asthma is controversial. The FDA has stated that
OTC inhalers and tablets to relieve the wheezing symptoms should only be used by
patients if their doctor is aware of their condition and has okayed the use and
frequency of the over-the-counter drugs.

OTC inhalers and tablets are useful for treatment of wheezing only. As discussed in
basics, the wheezing is a result rather than the underlying cause in asthma. Only
prescription medications work against airway inflammation at the root of all asthma
attacks. It seems then that self-treatment of asthma with OTC medications should
occur only in unusual circumstances --- for temporary treatment of wheezing only if
your doctor has approved it. In actuality, these OTC products are often used when
an asthmatic patient’s prescription inhaler is empty and the patient desires temporary
relief until the prescription can be refilled or further medical care sought. Since
asthma is often much worse at night, lack of available physician care also leads to
OTC self-treatment.

All OTC asthma medications are bronchodilators --- that is, they relax tight airway
muscles to widen your breathing passages. They come in two forms:

Epinephrine aerosol inhaler. Inhaled epinephrine (adrenaline) can give relief from
wheezing in minutes. Unfortunately, this effect only lasts for a couple of hours. This
should only be considered a temporary replacement for prescription inhalers.

Ephedrine tablets. This stimulant drug is longer acting (2-4 hours) than inhaled
epinephrine, but may take 30-60 minutes to take full effect.

 Primatene Mist (epinephrine 5.5 mg/ml). This inhaler product gives fast
acting, reliable relief from wheezing attacks.

 Primatene Tablets (ephedrine 12.5 mg/tab). See the description in

[Treatment].

All asthmatics should be care supervised by a physician. Frequency of visits varies

based on intensity of symptoms and overall control of the condition. Of course, there
are danger signs which should prompt immediate attention:

 Shortness of breath or rapid breathing even at rest.

 Chest wall retraction (seeing the muscles between the ribs sucked inwards
with each breath). This danger sign means that too much force is required to
suck air in through the bronchial tubes. Treatment to widen the airway
passages must be very prompt.

 Disturbed sleep due to coughing or wheezing.

 Progressively increasing use of inhalers. If you find yourself needing your

inhalers more often than your doctor has recommended, or if your average
usage increases by more than 50%, then readjustment of your treatment
program by your physician may be necessary