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Asthma Triggers and Treatments

Asthma can be a debilitating disease, but doctors say most patients can control their symptoms with proper treatment. Here, a look at what triggers attacks, and a guide to the most common medical treatments.

What is asthma?

Asthma is a chronic disease that leads to a narrowing of the airways in the lungs. Symptoms include wheezing, coughing, chest tightness, and trouble breathing. During an asthma attack, symptoms become more severe. Though the condition cannot be cured, symptoms can be controlled and frequently prevented.

How do people get asthma?

It's not exactly understood why some people get asthma and others don't, but the disease tends to run in families. Dr. Robert F. Lemanske, a professor of Pediatrics and Medicine at the University of Wisconsin – Madison School of Medicine and Public Health, says there is no single gene responsible for asthma. He says multiple genes probably contribute to the tendency to develop asthma, in different ways that are not yet fully understood.

Environmental factors also seem to contribute to asthma. For example, Lemanske says, if a woman smokes while pregnant or when her infant is very young, the child is more likely to go on to develop asthma.

"Asthma is not one disease, it is multiple diseases, which present with a series of one or more components or symptoms which we then designate as asthma," says Dr. Stuart W. Stoloff, a Clinical Professor of Family and Community Medicine the University of Nevada.

What triggers an asthma attack?

Different people have different triggers. Many asthma-prone people develop symptoms after a cold or other virus causes swelling inside the airways. Others develop asthma symptoms during exercise. In this case, the smooth muscles around the airways tighten — which happens more often in cold weather, commonly during running. Some people begin wheezing after exposure to allergens such as grasses or animals. Stress can be a trigger, too.

How is asthma treated?

Asthma is treated with medicines, and also by avoiding common triggers, such as allergens. The goal is to avoid serious attacks by damping down early symptoms. Sometimes avoiding triggers is enough, and a patient can use a "rescue inhaler", usually an albuterol inhaler, to treat the occasional flare-up. If a patient finds they need to use that inhaler frequently, a doctor might prescribe a different daily medicine to prevent symptoms.

"Many of the treatments we use are not because you're symptomatic today, but because there's a risk of a bad outcome if you don't treat it," explains Stoloff.

What kinds of asthma medicine are there?

The most common kind of "rescue inhaler" is an albuterol inhaler. This is a bronchodilator that helps open up the airways in the lungs. It provides relief within a few minutes, and lasts for three to four hours.

If the rescue inhaler is needed more than two days a week, or if the patient wakes up more than two nights a month with asthma symptoms, doctors often prescribe a different daily medication to stop symptoms before they start.

The daily medicine most commonly prescribed is a low-dose inhaled corticosteroid. Doses can be adjusted, and other drugs might also be used, if patients continue to have difficulties.

Much higher doses of corticosteroids, taken orally, may also be prescribed when an asthma attack is severe. They are typically used for short periods of time, and only when inhaled corticosteroids have failed to control the symptoms.

Are the steroids used to treat asthma the same ones athletes get in trouble for taking?

No. "Inhaled corticosteroids not the anabolic steroides athletes are taking and getting disciplined for," explains Stoloff. The effects—and side effects--are very different.

Because of the bad reputation that anabolic steroids have earned, some parents of asthmatic children are overly concerned about the risks of corticosteroids, Lemanske says. "But there are risks and benefits with any medicine used for any disease," he explains. "The goal is to have the benefits far outweigh the risks."

Lemanske says the recommended doses of corticosteroids generally used to control asthma symptoms are safe. Doctors do monitor patients for adverse affects if it's necessary to increase the dose to control the symptoms.

What is the best way to use an inhaler?

A spacer – a tube that fits over the mouthpiece of the inhaler – can be very helpful, especially for children with asthma, says Lemanske. The spacer slows the speed of the particles coming out of the inhaler and helps them stay in the air longer, so they can be inhaled deep into the lungs.

Current inhalers, which rely on a less forceful propellant system than in the past, need to be primed to make sure they deliver the proper dose. Lemanske says when the inhaler is new, or hasn't been used for a couple of weeks, patients should shake it well and pump it a few times before each use.

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Anna Vigran