Asthma

What is asthma?

You can get asthma at any age. Approximately 5% of the general population in the U.S. have asthma. Often there is a history of allergies and/or asthma in a family member.

Asthma is caused by spasm and inflammation of the airways in the lungs. Like branches of a tree, your breathing airways get smaller and smaller until they reach the air sacs that make up the lungs. When asthma is under control, the airways are clear and air flows in and out of your chest easily. When asthma is not under control, the airways become constricted and inflamed, with increased mucus production that further obstructs the airways.

During an asthma attack, less air can get in and out of the lungs, causing coughing, wheezing, and shortness of breath. Coughing for more than 10 days after a cold can also be a symptom of asthma. Sometimes prolonged coughing is the only symptom that people experience.

What sets off an asthma attack?

Factors that cause asthma attacks are called triggers. Triggers can be animals with fur, cigarette smoke, dust, feather or down bedding, perfumes, pollen, cold air, upper respiratory infections, exercise and acid reflux. It is important to note which triggers may be causing your asthma symptoms.

How is asthma diagnosed?

Your medical provider can often diagnose asthma in the office. If this is your first episode, laboratory tests or x-rays may be ordered. Using a peak flow meter is a quick and easy method of measuring the amount of air flowing through your airways. If your asthma is moderate to severe, your provider may have you repeat this breathing measurement at home to help you adjust your medicine.

Can I make an appointment at Health Services?

If you are a Brown student and you are concerned about asthma, you can make a confidential appointment at Health Services by calling 401.863-3953.  Health Services provides a range of services including general health care, inpatient services and emergency medical care. You can request a medical provider by gender or by name. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets.

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Do people react differently to asthma attacks?

Asthma attacks can vary in severity. With intermittent asthma, symptoms occur sporadically in response to a trigger, and there are no symptoms between episodes.

In cases of mild persisitent asthma, there may be symptoms less than 2 times per week and night coughing 3 to 4 times per month.

Moderate persisitent asthma occurs when there are symptoms present daily, a peak flow 60% to 80% of the predicted norm and night coughing greater than once per week.

With severe persisitent asthma, there are daily symptoms with limited physical activity, night wakening daily or very frequently, and a peak flow of less than 60% of the predicted norm.

How are attacks prevented?

Taking any asthma medications as directed and avoiding triggers that can set off your asthma is the best way of preventing attacks. Your medical provider can help you determine which steps to take to help avoid triggers.

Another important step to help minimize asthma attacks is to drink plenty of water. Fluids keep normal lung mucus from becoming sticky. Try to drink 1 glass of water every 2 hours while awake.

Common steps for preventing attacks by controlling or avoiding triggers:

Dust/dust mite allergy
Remove rugs, carpet and extra pillows. Use mattress and pillow coverings to avoid dust mites. Do not use down comforters or pillows. Wash sheets and blankets in hot water weekly. Vacuum often.

Allergies/hay fever
Take antihistamines and other allergy medications as prescribed to control symptoms. Your medical provider may suggest an evaluation by an allergist if the allergies are a significant trigger for your asthma attacks.

Upper respiratory infections
Discuss with your medical provider whether or not a flu shot is appropriate. Careful hand washing can help to prevent frequent colds. Do not directly share food, drinks or eating utensils. Start the asthma inhaler at the first sign of shortness of breath or wheezing, or as directed by your provider.

Smoke or odors
Avoid smoke-filled places, use unscented soaps and detergents. Do not use perfumes or colognes.

Animal fur
Avoid animals with fur. Keep pets outside if you cannot avoid them completely.

Cold air
Wear a scarf over your mouth and nose to warm the air you breathe.

Exercise
Use medicines prescribed by your medical provider before exercising to help prevent attacks. Always carry medication with you while exercising, and be prepared to stop at the first sign of an asthma attack.

Measure your peak flow regularly
This will help you assess your own level of asthma control and identify when you are in trouble. Peak flow readings provide an objective measure to help your medical provider evaluate your status and give you the right treatment advice.

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Which medicines are used to control asthma?

While avoiding triggers is the first approach to asthma management, medicines will help keep your symptoms under control. It is very important that you use the medicines correctly, and at the correct intervals as prescribed.

Four classes of medicines are most commonly used to treat asthma symptoms. Your medical provider will choose one or more of these medicines based on the causes and severity of your asthma symptoms. Most of the medicines are inhaled so that the maximum effects go straight to the airways. To improve the dose of the inhaled medicine that gets to your lungs, your medical provider may prescribe a spacer device to be attached to the inhaler.

Short-acting inhaled bronchodilators (e.g.,Ventolin, Albuterol, Proventil)
These rescue or quick-relief medicines act on the smooth muscle lining the airways to help reverse the spasm and narrowing of the airways. The effects are felt immediately. This medicine may be prescribed on a regular basis, or as needed for symptoms which are intermittent. You may feel a little jittery, light-headed or racy after starting this medicine. These symptoms usually diminish with subsequent doses.

If your symptoms are not relieved with the prescribed inhalations, call your medical provider. Do not exceed the prescribed number of inhalations. If you need this rescue medicine more than 6 times in one day to control asthma attacks, you need immediate help from your medical provider.

Sometimes short-acting bronchodilaotrs are prescribed for use 20 minutes before exercise to control exercise induced asthma symptoms.

Long-acting inhaled bronchodilators (e.g., Serevent)
These medications have the same action on the airways as short-acting bronchodilators but deliver that effect over a prolonged period, often making them useful for people with nighttime symptoms. They are not to be used for quick relief of asthma symptoms and should never be used more often than prescribed.

Steroids (e.g., Flovent, Beclovent, Vanceril, Aerobid)
These medicines reverse the inflammation in the airways which is present in patients with chronic asthma symptoms.

Inhaled steroids need to be used on a regular, ongoing basis to be effective. They have no effect on acute shortness of breath and should not be used on an intermittent basis. Remember to rinse out your mouth with water after each use of inhaled steroids.

In some cases, your asthma symptoms may be severe enough to require a short course of oral steroids to decrease inflammation. Oral steroids are best taken in the morning. Be sure to take this medication exactly as prescribed.

Combination asthma medication (e.g., Advair, Symbicort)
Inhaled steroids are sometimes prescribed in combination with long-acting broncholdilators. It is important not to use these more often than prescribed by your provider, as excessive doses of long-acting agends can have serious side effects.

Leukotiene receptor antagonists (e.g., Singulaire)
These oral medicines are sometimes additionally used to improve asthma control, and for exercise-induced symptoms.

Cromolyn products (e.g., Intal, Alocril)
This class of medicines is sometimes used for prevention of exercise-induced asthma symptoms or predictable allergic exposures (e.g., visiting a home with a cat).

What do I do if I'm experiencing an asthma attack?

  • Act fast if an asthma attack starts:
  • Know that coughing, wheezing, tight chest, and waking up at night are signs of an asthma attack.
  • Move away from the thing that started the attack, if you can identify it.
  • Take a quick-relief asthma medicine.
  • Stay calm for 1 hour to be sure breathing gets better.

Get emergency help if you experience any of these asthma danger signs:

  • If your quick-relief medicine does not help for very long or does not help at all.
  • Breathing is still fast and hard.
  • It is hard to talk.
  • Your lips or fingernails turn gray or blue.
  • Your heartbeat or pulse is very fast.
  • You can see the skin around your ribs pulling in when breathing.
  • It is hard to walk.

Links you can use

To learn more about asthma, you can visit:

American Lung Association

MEDLINE Plus

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Disclaimer: BWell Health Promiotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.