Asthma

Many things just seem to come naturally to some people. Maybe you know a girl who's a natural at sports — put her in a uniform and she's off and running. Some people are naturals at playing an instrument; it's like they were born knowing how to count in 4/4 time. Others are naturals at math; give them a test on theorems or equations and they're happy.

But some people have a problem with something that you'd think would come naturally to everyone: breathing. When someone has asthma, it can make breathing very difficult. And when it's hard to breathe, it can affect a person's game, that trumpet solo, and even the all-important geometry test.


What Is Asthma?

Asthma (pronounced: az-muh) is a lung condition that causes difficulty breathing. Asthma is a common condition: About 7 million kids and teens in the United States have it.

Asthma affects the bronchial(pronounced: brahn-kee-ul)tubes, also known as airways. When a person breathes normally, air is taken in through the nose or mouth and then goes into the trachea (windpipe), passing through the bronchial tubes, into the lungs, and finally back out again.

But people with asthma have airways that are inflamed. This means that they swell and produce lots of thick mucus. They are also overly sensitive, or hyperreactive, to certain things, like exercise, dust, or cigarette smoke. This hyperreactivity causes the smooth muscle that surrounds the airways to tighten up.

The combination of airway inflammation and muscle tightening narrows the airways and makes it difficult for air to move through.

In most people with asthma, the difficulty breathing happens periodically. When it does happen, it is known as an asthma flare-up also known as an asthma attack, flare, episode, or exacerbation.

Asthma Flare-Ups

Someone having an asthma flare-up may cough, wheeze (make a whistling sound while breathing), be short of breath, and feel an intense tightness in the chest. Many people with asthma compare a flare-up to the sensation of trying to breathe through a straw —it feels extremely hard to get air in and out of their lungs.

An asthma flare-up can last for several hours or longer if a person doesn't use asthma medication. When an asthma flare-up is over, the person usually feels better.

Between flare-ups, breathing can seem completely normal, or a person may continue to have some symptoms, such as coughing. Some people with asthma feel as if they are always short of breath. Others may only cough at night or while exercising and they might never have a noticeable flare-up.

What Causes It?

No one knows exactly what causes asthma. It's thought to be a combination of environmental and genetic (hereditary) factors. A teen with asthma may have a parent or other close relative who has asthma or had it as a child. Teens who are overweight may be more likely to have asthma, although a person doesn't have to be overweight to have it.

Asthma isn't contagious, so you can't catch it from someone who has it.

Asthma symptoms can be brought on by dozens of different things, and what causes asthma flare-ups in one person might not bother another at all. The things that set off asthma symptoms are called triggers.

These are some common triggers:

Allergens. Some people with asthma find that allergens — certain substances that cause an allergic reaction in some people — can be a major trigger. Common allergens are dust mites (microscopic bugs that live in dust), molds, pollen, animal dander, and cockroaches.

Airborne irritants and pollutants. Certain substances in the air, such as chalk dust or smoke, can trigger asthma because they irritate the airways. Cigarette smoke is a major cause of asthma symptoms, and not just for smokers — secondhand smoke can trigger asthma symptoms in people who are around smokers.

Scented products such as perfumes, cosmetics, and cleaning solutions can trigger symptoms, as can strong odors from fresh paint or gasoline fumes. And high levels of air pollutants such as ozone may irritate the sensitive tissues in the bronchial tubes and can aggravate the symptoms of asthma in some people with the condition.

Exercise. Some people have what's called exercise-induced asthma, which is triggered by physical activity. Although it can be especially frustrating, most cases of exercise-induced asthma can be treated so that people can still enjoy the sports they love.

Weather. Cold or dry air can sometimes trigger asthma symptoms in certain people, as can extreme heat or humidity.

Respiratory tract infections. Colds, flu, and other viral infections can trigger asthma in some people.

Lots of other things can trigger asthma symptoms. For example, a girl's asthma can get worse just before her period. And even laughing, crying, and yelling can sometimes cause the airways to tighten in sensitive lungs, triggering an asthma flare-up.

How Do Doctors Diagnose Asthma?

Many people with asthma are diagnosed with the condition when they're kids, but some don't find out that they have it until their teen years or even later. In diagnosing asthma, a doctor will ask about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.

The doctor will also perform a physical exam and may recommend that you take some tests, such as spirometry (pronounced: spye-rah-muh-tree) and peak flow meter tests, which involve blowing into devices that can measure how well your lungs are performing.

Your doctor may also recommend allergy tests to see if allergies are causing your symptoms, or special exercise tests to see whether your asthma symptoms may be brought on by physical activity. Doctors occasionally use X-rays in diagnosing asthma, but these are usually only to rule out other possible problems.

Your family doctor may refer you to a specialist for diagnosis and treatment. Doctors who specialize in the treatment of asthma include those who have been trained in the fields of allergy, immunology (how the immune system works), and pulmonology (affecting the lungs).

How Is It Treated?

There's no cure for asthma, but it can usually be managed and flare-ups can be prevented. Asthma is treated in two ways: by avoiding potential triggers and with medication.

Teens who have asthma need to avoid the things that can cause their symptoms. Of course, some things that can cause symptoms can't be completely avoided (like catching a cold!), but people can control their exposure to some triggers, such as pet dander, for example.

In the case of exercise-induced asthma, the trigger (physical activity) needs to be managed rather than avoided. Exercise can help a person stay healthier overall, and doctors can help athletes find treatments that allow them to them participate in their sports.

Doctors treat every asthma case individually because the severity of each person's asthma and what triggers the symptoms are different. For this reason, doctors have a variety of treatment medications at their disposal.

Most asthma medications are inhaled (which means that a person takes the medication by breathing it into the lungs), but asthma medications can also take the form of pills or liquids. They fall into two categories:

Rescue medications that act quickly to halt asthma symptoms once they start. Some medications can be used as needed to stop asthma symptoms (such as wheezing, coughing, and shortness of breath) when a person first notices them. These medications act fast to stop the symptoms, but they're not long lasting. They are also known as "reliever," "quick-relief, " or "fast-acting" medications.

Controller medications to manage asthma and prevent symptoms from occurring in the first place. Many people with asthma need to take medication every day to control the condition overall. Controller medications (also called "preventive" or "maintenance" medications) work differently from rescue medications. They treat the problem of airway inflammation instead of the symptoms (coughing, wheezing, etc.) that it causes.

Controller medications are slow acting and can take days or even weeks to begin working. Although you may not notice them working in the same way as rescue medications, regular use of controller medications should lessen your need for the rescue medications. Doctors also prescribe controller medications as a way to minimize any permanent lung changes that may be associated with having asthma.

Some people with asthma rely only on rescue medications; others use rescue medications together with controller medications to keep their asthma in check overall. Each person needs to work closely with a doctor to create an asthma action plan that's right for them.

Monitoring

In addition to avoiding triggers and treating symptoms, people with asthma usually need to monitor their condition to prevent flare-ups and help their doctors adjust medications if necessary.

Two of the tools doctors give people to do this are:

Peak flow meter. This handheld device measures how well a person can blow out air from the lungs. A peak flow meter reading that falls in the meter's green (or good) zone means the airways are open. A reading in the yellow zone means there's potential for an asthma flare-up. A reading in the red zone means the flare-up is serious and could mean that a person needs medication or treatment immediately — maybe even a trip to the doctor or emergency room.

Teens who take daily medicine to control their asthma symptoms should use a peak flow meter at least one to two times a day and whenever they are having symptoms.

Asthma diary. Keeping a diary can also be an effective way to help prevent problems. A daily log of peak flow meter readings, times when symptoms occur, and when medications are taken can help a doctor develop the most appropriate treatment methods.

Dealing With Asthma
The best way to control asthma is prevention. Although medications can play an essential role in preventing flare-ups, environmental control is also very important.

Here are some things you can do to help prevent coming into contact with the allergens or irritants that cause your asthma flare-ups:

Keep your environment clear of potential allergens. For example, if dust is a trigger for you, vacuum (or remove) rugs and drapes where dust mites can hide. Placing pillows and mattresses in dust-proof covers can help. If pets trigger your symptoms, keep a pet-free household. If you can't part with Fido or Fluffy, keep certain rooms pet free and bathe your pet frequently to get rid of dander.

Pay attention to the weather and take precautions when you know weather or air pollution conditions may affect you. You may need to stay indoors or limit your exercise to indoor activities.

Don't smoke (or, if you're a smoker, quit). Smoking is always a bad idea for the lungs, but it's especially bad for someone who has asthma.

Be smart about exercise. It's a great way to keep the body and mind healthy, so if you're prone to exercise-induced asthma flare-ups, talk to your doctor about how to manage your symptoms. If you get flare-ups during a game or workout, stop what you're doing until the flare-up has cleared or you've taken rescue medication. When the symptoms have gone, you can start exercising again.

Asthma doesn't have to prevent you from doing what you love! Sure, it takes a bit of work (and remembering!) but if you follow your asthma action plan, take your medications properly, recognize your symptoms and triggers, and check in with your doctor regularly, you can do anything that other teens do. 

That includes any sports activity, even cross-country skiing, swimming, or playing basketball.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: October 2010