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Asthma

Asthma is a disease in which inflammation of the airways restricts airflow in and out of the lungs. The word asthma comes from the Greek word for “panting.” The panting and wheezing sound characteristic of asthma occur because of the restricted flow of air.

Normally, when you breathe in an irritant or are subjected to a stressor such as exercise, your airways relax and open, allowing the lungs to get rid of irritants or take in more air. In a person with asthma, muscles in the airways tighten and the lining of the air passages swells. The immune system gets involved, but instead of helping, it causes inflammation.

Asthma is a disease of both adults and children. In fact, asthma is the most common chronic childhood illness. About half of all cases of asthma develop before the age of 10. Many children with asthma also have allergies. While there is no cure for asthma, it can be controlled.

Signs and Symptoms

Most people with asthma have periodic attacks separated by symptom-free periods. Some asthmatics have chronic shortness of breath with episodes of increased shortness of breath. Asthma attacks can last minutes to days and can become dangerous if the airflow becomes severely restricted.

The primary symptoms of asthma include:

Shortness of breath

Wheezing -- usually begins suddenly; may be worse at night or early in the morning; aggravated by exposure to cold air, exercise, heartburn and relieved with the use of bronchodilators (drugs that open the airways; see Medications)

Chest tightness

Cough (dry or with sputum) -- sometimes this is the only symptom

Call for emergency assistance if you have or are with someone having any of these serious symptoms:

Extreme difficulty breathing or cessation of breathing

Bluish color to the lips and face (called cyanosis)

Severe anxiety

Rapid pulse

Profuse sweating

Decreased level of consciousness (such as drowsiness or confusion)

Additional symptoms that may be associated with an asthma attack include:

Flared nostrils

Abnormal breathing pattern, in which exhalation takes more than twice as long as inhalation

Use of the muscles between the ribs (called intercostals) to help with the increased work of breathing

Coughing up blood (called hemoptysis)

Causes

Asthma is most likely caused by a combination of several factors. Experts suggest that in people who are susceptible (genetically predisposed), factors such as allergens (substances that commonly induce an allergic reaction), infections, dietary patterns, exercise, cigarette smoke, and stress can bring on an asthma attack.

Risk Factors

The following factors may increase the risk of developing asthma:

Allergies -- children with asthma often have allergies as well

Family history of asthma or allergies

Cigarette smoke, including second hand smoke from, for example, parents or a spouse

Food allergies – a true food allergy, particularly one that induces asthma, is difficult to identify and, therefore, it is not clear exactly how frequently (or infrequently) this contributes to asthma; it seems to be more common in children than in adults and the responsible foods include eggs, milk, wheat, soy, peanuts, fish, shellfish, and sulfite food perservatives.

Living in a Western or industrialized country – some experts believe that dietary habits (more processed foods, less fruits and vegetables), indoor living (resulting in overexposure to indoor allergens), energy-efficient homes (trapping allergenic dust mites inside), immunizations, and possibly, declining rates of breastfeeding contribute to the rising rates of asthma

Urban living

Gender -- among younger children, asthma develops twice as frequently in boys as in girls, but after puberty it may be more common in girls

Obesity – controversial; a recent study suggests that asthma is over-diagnosed among obese people

Triggers

Childhood asthma in particular can be triggered by almost all of the same things that trigger allergies, such as the following:

Sensitivity to allergens in the air, such as dust, cockroach waste, animal dander, indoor and outdoor mold, pollens

Respiratory infections

Air pollutants, such as smoke from tobacco or a fireplace, aerosols, perfumes, fresh newsprint, diesel particles, sulfur dioxide, elevated ozone levels, and fumes from paint, cleaning products, and gas stoves

Changes in the weather, especially in temperature (particularly cold) and humidity

Other triggers include:

Behaviors that affect breathing (exercising, laughing, crying, yelling)

Stress

Diagnosis

The symptoms of asthma can mimic several other conditions, and a doctor must take a thorough history to rule out other diseases. Questions will likely be asked about how and when symptoms occur, and if there is a family history of allergies and asthma or occupational exposure to chemicals. If asthma is suspected, tests (called pulmonary function tests) will probably be done to measure, among other things, the volume of your lungs and how much air you exhale. Other tests may include chest and sinus x-rays, blood tests, or allergy tests.

Preventive Care

Although there is no method guaranteed to prevent asthma, there are a number of measures parents can take to reduce their child’s risk of developing asthma. These include:

Exclusively breastfeeding for the first 3 to 6 months of life; this issue is controversial, however, with the most recent (and largest) study suggesting that breastfeeding for the first 6 months of life helps to protect the child.

Delaying the introduction of solid food until age 6 months

Manipulating the child's environment (not smoking during pregnancy or around infants, eliminating household allergens such as mites and cockroaches. For example, to reduce exposure to dust mites, encase mattresses and pillows in special covers that are impermeable to allergens; also, remove carpets from bedrooms.)

According to certain studies on adults, apples and selenium-rich food in the diet may protect against asthma, and moderate consumption of red wine may be associated with less severe asthma attacks. These foods are high in antioxidants (namely, flavonoids). It is too early to say definitively that these nutrients protect against asthma, however. Plus, it is important to note that in certain individuals, red wine may actually induce asthma symptoms if you have an allergy to sulfites, a food additive, or any other substance found in wine. Often, wine labels indicate if sulfites are present.

Key steps in preventing asthma attacks include identifying the allergens and the triggers that bring on or worsen your asthma symptoms and then working to eliminate or avoid them. Sometimes it takes exposure to more than one of these factors before an asthma episode is triggered. Keeping a diary to determine triggers may be helpful.

The following conditions are common triggers for asthma. Reduce your chances of exposure to them by taking some common-sense steps:

Viral infections (colds, flu, bronchitis, pneumonia) – stay away from people who you know are ill

Sinusitis and allergic rhinitis (hay fever or year-round allergies) – avoid seasonal allergens by staying indoors in air conditioning as much as possible and eliminating indoor allergens; fewer allergy attacks generally means fewer cases of sinusitis and asthma

Gastroesophageal reflux (heartburn) – avoid provoking foods, medication, and mealtime habits

Avoid the following altogether:

If sensitive or allergic, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)

Beta-blockers (such as acebutolol, atenolol, esmolol, labetalol, metoprolol, nadolol, pindolol, propranolol, and timolol) including those in eye medication

If sensitive or allergic, processed potatoes, shrimp, dried fruit, beer, and wine – these often contain sulfite food preservatives

Allergy desensitization, if you have a known allergy, may decrease the number of asthma attacks you experience, diminish the intensity of each attack, and lower the amount of medication that you need.

Treatment Approach

Avoiding asthma attacks, reducing inflammation, and preventing lung damage are the primary goals of treatment. This requires educating yourself about asthma, working closely with your doctor to determine the severity of your asthma and to define a treatment plan, and following recommendations. Adjusting your environment as much as possible to prevent exposure to allergens or irritants are important for the successful control of asthma. Certain nutritional changes, particularly increasing the amount of omega-3 fatty acids in your diet and decreasing omega-6 fatty acids, and acupuncture may be useful adjuncts.

Lifestyle

Quit smoking

Lose weight if you are overweight and already have asthma; although the connection between obesity and asthma is not entirely understood, excess weight may put pressure on the lungs and trigger an inflammatory response.

Keep a diary of respiratory complaints – this may help determine triggers

Nutrition and Dietary Supplements

Studies indicate that people with asthma tend to have low levels of certain nutrients (for example, selenium and potassium) and that the Western diet (high in fast foods and low in fresh fruits and vegetables) has been associated with higher rates of asthma. In fact, fried foods and margarine may be particularly bad, especially in children. On the other hand, it has been suggested that adding onion, garlic, pungent spices, and antioxidants (such as foods rich in vitamin C, vitamin E, flavonoids, and beta-carotene) to the diet may help reduce symptoms.

Magnesium

Two large studies found that low dietary magnesium intake may be associated with risk of developing asthma in both children and adults.

N-acetylcysteine

A review of scientific studies suggests that N-acetylcysteine may help dissolve mucus and improve symptoms associated with asthma.

Omega-3 Fatty Acids

Preliminary research on adults with asthma suggests that an omega-3 fatty acid supplement may reduce inflammation and improve lung function.

One thing that can be said about omega-3 fatty acids is that if you enrich your diet with this type of essential fatty acid (from foods such as cold-water fish, flaxseeds, pumpkin seeds, and walnuts) and reduce your intake of omega-6 fatty acids (from foods like meat, egg yolks, and certain cooking oils), this is likely to help improve your symptoms.

Potassium

Data from several studies suggest that compared to diets with normal amounts of potassium, diets low in potassium are associated with poor lung function and even asthma in children. Improving dietary intake of potassium through foods such as fish, fruits, and vegetables may therefore be valuable for preventing or treating asthma. Adequate amounts of magnesium are needed to maintain normal levels of potassium. In addition, the drug theophylline (used sometimes for asthma) may deplete potassium, as can excessive intake of salt or caffeine in the diet.

Quercetin

Quercetin, which is a member of a group of antioxidants called flavonoids, inhibits the production and release of histamine and other allergic/inflammatory substances. Histamine is a substance that contributes to allergy symptoms such as a runny nose, watery eyes, and hives. Like other flavonoids, quercetin is a plant pigment responsible for colors seen in fruits and vegetables.

Selenium

Studies suggest that people with asthma tend to have low blood levels of selenium. In addition, a population-based study (studies that evaluate groups of people) suggested that eating selenium-rich foods may have a protective effect against asthma. Plus, taking selenium supplements may prove to be helpful as well. In a study of 24 people with asthma, for example, those who received selenium supplements for 14 weeks demonstrated a significant improvement in symptoms compared to those who received placebo. More studies, with larger numbers of people and lasting longer than 14 weeks, are needed to determine whether selenium supplementation is truly safe and effective for people with asthma.

Vitamin C

Although research is limited, there is some indication that vitamin C, particularly from fresh fruit in your diet, may be useful for treating allergy-related conditions such as asthma.

Other

Other supplements that may have benefit for asthma include:

Coenzyme Q 10 (CoQ10) – if you have asthma, you may have low levels of this antioxidant in your blood. It is not known at this time, however, whether taking CoQ10 supplements will make any difference in your symptoms.

Lactobacillus acidophilus – there is some evidence that this "good" organism (called a probiotic), which is found naturally in the gut, may reduce the risk of developing an allergic reaction, including asthma. In fact, some early evidence suggests that if mothers who have at least one relative with asthma, or some other allergy-related illness, take this probiotic while pregnant and breastfeeding, their babies may be less likely to develop asthma.

Lycopene and beta-carotene – preliminary data suggests that each of these two antioxidants may prove useful for preventing exercise induced asthma symptoms when taken daily.

Vitamin B6 – may be needed if you are taking theophylline because this medication can lower blood levels of this nutrient.

Dietary Suggestions

Anti-Inflammatory Diet

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