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Asthma is a chronic, inflammatory lung disease characterized by recurrent breathing problems. People with asthma have acute episodes (some people call them "attacks" or "flares") when the air passages in their lungs get narrower, and breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs' airways, which overreact to certain "triggers" and become inflamed and clogged.

Asthma varies a great deal from one person to another. Symptoms can range from mild to moderate to severe and can be life threatening. The episodes can come only occasionally or often. The symptoms of asthma are a major cause of time lost from school and work and sleep disturbances. However, with proper treatment these symptoms can almost always be controlled.

Asthma cannot be cured, but it can be controlled with proper treatment. People with asthma can use medicine prescribed by their doctor to prevent or relieve their symptoms, and they can learn ways to manage episodes. They also can learn to identify and avoid the things that trigger an episode. By educating themselves about medications and other asthma management strategies, most people with asthma can gain control of the disease and live an active life.

What causes asthma?

The basic cause of the lung abnormality in asthma is not yet known. Through research, scientists have established that this lung abnormality is a special type of inflammation of the airway that leads to contraction of airway muscle, mucus production, and swelling in the airways. The airways become "twitchy," overly responsive to environmental changes.

A variety of known triggers can set off an asthma episode. They include:

Allergens (substances to which some people are allergic) such as pollens, foods, dust, mold, feathers, or animal dander (small scales from animal hair or feathers);
Irritants in the air such as dirt, cigarette smoke, gases and odors;
Respiratory infections such as colds, flu, sore throats, and bronchitis;
Too much exertion such as running upstairs too fast or carrying heavy loads;
Emotional stress such as excessive fear or excitement;
Weather such as very cold air, windy weather, or sudden changes in the weather;
Medication such as aspirin or related drugs and some drugs used to treat glaucoma and high blood pressure.

Each person with asthma reacts to a different set of triggers. Identifying one's own triggers is a major step towards learning to control asthma attacks. Although episodes can sometimes be brought on by strong emotions, it is important to know that asthma is not caused by emotional factors such as a troubled parent-child relationship. Some people believe that asthma is "all in one's head" and therefore not a "real" illness. That could not be further from the truth. Asthma is a disease, not a psychosomatic illness or a sign of emotional disturbance.

Who gets asthma?

Asthma has been diagnosed in nearly 10 million Americans; of these 3 million are children under the age of 18. About the same number of men and women have asthma. Slightly, a higher percent of blacks have asthma than whites; 4.4 percent of American blacks have asthma, while 4.0 percent of American whites have the disease. The reported number of cases of asthma is increasing. This increase is occurring in all age, race, and sex groups.

How is asthma diagnosed?

Asthma is sometimes hard to diagnose because it can resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. For that reason, it is under-diagnosed; many people with the disease do not know they have it; and therefore are under-treated. Sometimes the only symptom is a chronic cough, especially at night. Or, coughing or wheezing may occur only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of a medical history, a thorough physical examination, and certain laboratory tests. These tests include spirometry (using an instrument that measures the air taken into and out of the lungs), peak flow monitoring (another measure of lung function), chest X-rays, and sometimes blood and allergy tests.

Is there any warning of an asthma episode?

Usually, certain signs occur hours or days before audible wheezing or before an episode is fully in progress. These early signs vary a great deal among individuals. Some people have an itchy chin or throat or a dry mouth. Others may feel very tired or grouchy. Common warning signs include light wheezing or coughing pain or a tight feeling in the chest, shortness of breath, or restlessness. Becoming aware of these signals helps patients use self-management techniques as soon as possible. This early action may ward off a severe episode.

To sum up, here are a few general guidelines that may help prevent or lessen episodes:

Identify and avoid personal asthma triggers. However, if exercise is a trigger, consider medication before exercise.
Take prescribed medicines on time, in the correct way, and in the correct dose.
Recognize early warning signs of asthma.
Take peak flow meter readings to monitor lung function.
Take action when warning signs occur.
Have a personal plan for managing attacks, worked out with a physician.
Try to stay calm if an episode may be coming on and know what to do, and do it.
Do not wait too long to get a doctor's help if needed.
Stay healthy and get enough rest, eat properly, drink plenty of liquids, and exercise regularly.