Understanding Asthma |

Asthma is a chronic condition that limits your ability to breathe. It affects the airways, which are the tubes that transport air to your lungs. When people with asthma are exposed to a substance to which they are allergic (an “allergen”), airways become swollen and filled with mucus. As a result, air can’t pass through to reach the part of the lungs that absorbs oxygen (the “alveoli”).

During an episode of asthma, you will develop shortness of breath, tightness in your chest, and start to wheeze and cough. This is referred to as an “asthma attack”. In rare situations, the airways can become so constricted that a person could suffocate from lack of air.

Here are common allergens that trigger an asthmatic attack:

• Pet or wild animal dander
• Dust or the excrement of dust mites
• Mold and mildew
• Smoke
• Pollen
• Severe stress
• Pollutants in the air
• Some medicines
• Exercise

There are many myths associated with asthma; the below are just some:

• Asthma is contagious. (False)

• You will grow out of it. (False; it might become dormant for a time but you are always at risk for it returning)

• It’s all in your mind. (False)

• If you move to a new area, your asthma will go away. (False; it may go away for a while, but eventually you will become sensitized to something else and it will likely return)

Here’s a “true” myth: Asthma is, indeed, hereditary. If both parents have asthma, you have a 70% chance of developing it compared to only 6% if neither parent has it.

Physical signs and symptoms of asthma

Asthmatic symptoms may be different from attack to attack and from individual to individual. Some of the symptoms are also seen in heart conditions and other respiratory illnesses, so it’s important to make the right diagnosis. Symptoms may include:

• Cough
• Shortness of Breath
• Wheezing (usually sudden)
• Chest tightness (sometimes confused with coronary artery spasms/heart attack)
• Rapid pulse rate and respiration rate
• Anxiety

Besides these main symptoms, there are others that are signals of a life-threatening episode. If you notice that your patient has become “cyanotic”, they are in trouble. Someone with cyanosis will have a blue/gray color to their lips, fingertips, and face.

You might also notice that it takes longer for them to exhale than to inhale. As an asthma attack worsens, wheezing may take on a higher pitch. Once the patient has spent enough time without adequate oxygen, they will become confused, drowsy, and possibly lose consciousness.

To make the diagnosis, use your stethoscope to listen to the lungs on both sides. Make sure that you listen closely to the bottom, middle, and top lung areas.

In a mild asthmatic attack, you will hear relatively loud, musical noises when the patient breathes for you. As the asthma worsens, less air is passing through the airways and the pitch of the wheezes will be higher and perhaps not as loud. If no air is passing through, you will hear nothing, not even when you ask the patient to inhale forcibly. This person may become cyanotic.

Sometimes a person might become so anxious that they become short of breath and think they are having an asthma attack. To resolve this question, you can measure how open the airways are with a simple diagnostic instrument known as a peak flow meter. A peak flow meter measures the ability of your lungs to expel air, a major problem for an asthmatic. It can help you identify if a patient’s cough is part of an asthma attack or whether they are, instead, having a panic attack or other issue.

To determine what is normal for a member of your group, you should first document a peak flow measurement when they are feeling well. Have your patient purse their lips over the mouthpiece of the peak flow meter and forcefully exhale into it. Now you know their baseline measurement. If they develop shortness of breath, have them blow into it again.

In moderate asthma, peak flow will be reduced 20-40%. Greater than 50% is a sign of a severe episode. In a non-asthma related cough or upper respiratory infection, peak flow measurements will be close to normal. The same goes for a panic attack; even though you may feel short of breath, your peak flow measurement is still about normal.

In our next article, we’ll discuss conventional and alternative ways to treat asthma.

Joe Alton, MD