Asthma is a chronic inflammatory disorder of the airways, caused by our reaction to allergens and irritants in the environment. The incidence of Americans with asthma has almost doubled since 1980 and is currently the leading cause of hospitalization for children under age 18.
When asthmatic airways come into contact with environmental triggers, they respond with a series of changes that lead to contraction of the smooth muscles that line the interior of the airways, a swelling of the bronchial tissue and the production of thick mucus. The result is difficulty in breathing, a feeling of chest tightness and often coughing.
These episodes usually end by themselves or with medication, but they can also be severe and life threatening. In the past, we viewed asthma as a completely reversible disease — that is we thought once acute symptoms ended, the lung function and airway architecture returned to normal. More recently, we have come to recognize that over time asthma can cause permanent damage in the health and function of the lungs.
These slow changes, which include permanent thickening of the airways, are known as remodeling. It is a process that changes asthma from an occasional reversible problem into a constant issue for pulmonary health. But with good care and an awareness of potential problems we can keep asthmatic airways clear and healthy.
Asthma usually begins in younger patients and can last a lifetime, but it can appear at any age. The symptoms of asthma are not always clearly apparent. For examples episodes of coughing that last for up to several hours and recur for weeks can actually be the first sign of asthma.
The Four Stages of Asthma
Stage I — Mild Intermittent Asthma
Stage 2 — Mild Persistent Asthma
Itís important to recognize that asthmatic attacks in mild persistent asthma can be severe and life threatening. In fact, a study published in Pediatric Pulmonology found that 30% of asthma fatalities occurred in patients with mild, persistent asthma.
Stage 3 — Moderate Persistent Asthma
Stage 4 — Severe Persistent Asthma
Asthmatics are particularly susceptible to certain factors in the environment. For example, plain cold air is a very well known trigger for asthma. Pollen from plants pets, dust, air pollution, and household cleaning solutions all can provoke over responsive airways. While more women than men are diagnosed with asthma, it may be more severe in men. A study from the Bellevue Hospital Asthma Clinic found that asthmatic men have lower lung function, more visits to the emergency room, and showed less of a response to medication intended to open blocked airways. Interestingly in children less than age five, asthma is diagnosed more frequently in boys than in girls.
Asthma tends to become worse at night, due to both physical and environmental issues. Sleep increases airway sensitivity, leading to bronco-constriction. One reason may be that the body continually releases an anti-inflammatory substance called cortisol. There is however a nighttime fall in cortisol levels, which in asthmatics may lead to increased airway inflammation.
The bedroom itself may be the unwitting source of many airway irritants. Bedrooms have a homesí highest concentration of dust mites whose allergens are among the most frequent causes of asthma symptoms. These microscopic organisms burrow into carpets and bedding, hide under the bed and bury themselves in the folds of curtains. Eight hours of close exposure to high concentrations of dust mites during the night can be a constant trigger for nighttime symptoms.
The goal of asthma management is to control the symptoms, not to let asthma control your life.