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Library of Congress Control Number: 2023940211
ISBN: 978-1-119-90808-1 (pbk); ISBN 978-1-119-90809-8 (ebk); ISBN 978-1-119-90810-4 (ebk)
Contents at a Glance
Part 1: Getting Started with Asthma
Part 2: Knowing
Part 3: Controlling Your Asthma
Understanding
Part 4: Special Asthma Conditions
Part 5: Finding
PART 4: SPECIAL ASTHMA CONDITIONS
PART 6: THE PART OF TENS
Introduction
“
I
feel like I’m breathing through a straw.” “Oh, my aching sinuses.” “I can’t stop coughing.” “My child keeps wheezing.” If you’ve ever uttered words like these, you’re not alone. These types of statements often describe asthma symptoms and are some of the most common medical complaints reported by people in the United States and around the world.
Asthma affects more than 25 million people in the United States and is the most common chronic childhood disease. Asthma also leads to almost 2 million emergency room visits and more than 10 million doctor’s appointments per year. In fact, costs associated with asthma, including treatment, medications, and lost productivity, exceed $80 billion each year. The incidence of asthma is rising dramatically in the United States and across the globe, particularly in highly developed parts of the world, including Western Europe, Australia, and New Zealand. In fact, many experts now consider asthma a global epidemic.
But enough about facts and figures. We want to talk about you: How are you feeling? Do you, or someone you know, think that feeling unwell is normal just because you have asthma and that the condition can never improve? Unfortunately, many people answer “yes” to this question. However, as we explain throughout this book, the plain, simple, and accurate medical truth is this: Although no cure for asthma exists, when you receive effective, appropriate care from your doctor and you’re a motivated participant in your asthma management plan, you can lead a normal, active, and fulfilling life.
About This Book
We wrote this book to give you sound, up-to-date, practical advice — based on our more than 50 years of experience with numerous patients — about dealing with asthma effectively and appropriately. For that reason, the book is structured so that you can jump to sections that most directly apply to your medical condition. You don’t need to read this book from cover to cover, although we won’t object if you do. (Be careful, though, because when you start reading, you may have a really hard time putting it down!)
This book can also serve as a reference and source of information about the many facets of diagnosing, treating, and managing asthma. Although you may pick up this book to find out more about one aspect of asthma, you may realize later that other topics also apply to you or a loved one.
Don’t worry about remembering where related subjects are in the book. We provide ample cross-references in every chapter that remind you where to look for the information you may need within other sections of the chapter you’re currently reading or in other chapters.
The information in this book is designed to empower you as a person with asthma, thus helping you
» Set goals for your treatment
» Ensure that you receive the most appropriate and effective medical care for your respiratory condition
» Do your part as a patient by adhering to the treatment plan that you and your physician develop
Foolish Assumptions
We don’t think it’s too foolish to assume that you want substantive, scientifically accurate, relevant information about asthma, presented in everyday language, without a lot of medical mumbo jumbo. In this book, you find straightforward explanations of important scientific aspects of asthma and key medical terms. (You also get a chance to work on your Latin and Greek.)
If you’ve chosen to read our book, we know you’re no dummy, so we’re willing to go out on a limb and make some further assumptions about you, dear reader:
» You or someone you care about suffers from asthma.
» You want to find out more about asthma as part of improving your medical condition (in consultation with your doctor, of course).
» You want to feel better.
» You really like doctors named Bill.
Icons Used in This Book
You may notice the following icons throughout the margins of the book. They’re intended to catch your attention and alert you to the type of information presented in particular paragraphs. Here’s what they mean:
The Author Says icon represents us expressing our opinions.
A Warning icon advises you about potential problems, such as symptoms you shouldn’t ignore or treatments you may not want to undergo.
Myths and misconceptions about asthma abound. The Myth Buster icon indicates a myth or mistaken belief that many people hold about asthma and debunks it with the truth.
The Remember icon indicates things you shouldn’t forget because you may find the information useful in the future.
The See Your Doctor icon alerts you to matters that you should discuss with your physician.
To give you as complete a picture as possible, we occasionally get into more complex details of medical science. The Technical Stuff icon lets you know that’s what we’re doing so you can delve into the topic further — or skip it. You don’t have to read these paragraphs to understand the subject at hand. (However, reading the information with these icons may give you a better handle on managing your medical condition, as well as provide some great material for impressing your friends at your next party.)
You can find plenty of helpful information and advice in paragraphs marked with the Tip icon.
Beyond the Book
The online Cheat Sheet at www.dummies.com provides an important list of myths and misconceptions about asthma and allergies, as well as a list of problems that often affect asthma patients. We’ve also included a Top Ten List of Common Asthma Triggers.
Where to Go from Here
Although you can read this book from cover to cover if you want, we suggest turning to the table of contents and finding the sections that apply to your immediate concern. Then begin reading your way to better management of your asthma.
1 Getting Started with Asthma
IN THIS PART . . .
Understand what asthma is, who gets it, and why.
Line up a healthcare team and find out how to work well with them.
Deal with doctor visits, tests, and setting goals.
Personalize your asthma care and stay informed about your condition.
Recognize asthma severity levels, manage asthma for the long term, and improve your quality of life.
IN THIS CHAPTER
» Understanding what asthma is and who gets it
» Digging into the types of asthma
» Figuring out if you have asthma
» Creating an asthma management plan
Chapter 1 Understanding Asthma Basics
According to many experts, asthma is now a global epidemic, and its prevalence and severity continue to grow in many parts of the world, including the United States, Western Europe, Australia, and New Zealand. More than 25 million people in the United States alone and more than 330 million globally have some form of asthma. Taking care of asthma means taking care of your whole body — from your brain to your nose to your lungs — and we are here to help you along the journey as you discover what asthma is, how to treat and manage it, and how to prevent complications.
This chapter starts with the basics of asthma: what it is and how it affects you. Although much of this may seem like high school biology, it’s helpful to understand the contributing factors of asthma, as well as how to live a full life with the condition. You may be surprised to also find out who else lives with asthma since it affects so many people . . . even famous ones, as we highlight in the sidebar “Famous folks with asthma.”
Defining Asthma
You or someone you love has just been diagnosed with asthma. That isn’t easy to hear, and it’s natural to feel afraid or overwhelmed by this unsettling news. The good news is that scientists now know more than ever before about asthma and
how to manage it, and the following sections will help you develop a basic understanding of how asthma affects you.
Asthma is a chronic condition that starts with the immune system and can impact many organs, including the lungs. A wide range of factors can trigger an asthma attack or flare: exercise, cold air, a virus, pollution, smoke, and, for many, a host of allergens. In fact, about 80 percent of children with asthma also have allergies. We talk more about allergies and other asthma triggers in Chapter 6.
Your lung airways are vital to your health. This network of bronchial tubes enables your lungs to absorb oxygen into the blood and get rid of carbon dioxide; the process is called respiration or breathing. Most people take breathing for granted; you usually don’t need to even think about it unless something interferes with the process by obstructing your airways.
How normal breathing works
To better understand how asthma adversely affects your airways, consider what happens in normal breathing:
» The air you inhale flows into your nose and/or mouth and into your trachea, or windpipe.
» Your trachea then divides in the lung into right and left main bronchi, or branches, funneling the air into each of your lungs.
» The main bronchi continue branching out into your lungs and dividing into a network of airways called bronchial tubes. The outside of your bronchial tubes consists of layers of muscles that relax and tighten as you inhale and exhale. Doctors refer to airway relaxation as bronchodilation and to the tightening that can help your lungs push out air when you exhale as bronchoconstriction
» Your network of airways ultimately leads to the alveoli, tiny air sacs that look like small clusters of grapes. They contain blood vessels and provide the means for vital respiratory exchange. Oxygen from the air you breathe is absorbed into the bloodstream, while carbon dioxide gas from your blood exits your body as you exhale. In asthma, airway obstruction is most often the result of an underlying airway inflammation that leads to one or more of the following inflammatory responses: airway hyperresponsiveness, airway constriction, or airway congestion. (See the next section for more information.) Eventually, these inflammatory responses can lead to a vicious cycle in which your airways become more and more sensitive and inflamed because they’re constantly reacting to allergens, irritants, and other factors.
What you can’t see can hurt you
If your lungs were external organs — like gills — or if your body were transparent so that you could see what happens internally, more doctors would treat asthma earlier and more aggressively, because you and your doctor could easily see how the underlying disease affects you.
As we explain in the section “Testing your lungs,” later in the chapter, you need to make sure that your doctor performs appropriate pulmonary (lung) function tests if you have bouts of wheezing, recurring coughs, lingering colds, or other symptoms that may indicate an underlying respiratory ailment.
How airway obstruction develops
Here’s an overview of how the mechanisms of asthma interact. Although we’ve itemized these processes to explain them, keep in mind that they’re often ongoing events that can occur simultaneously in your lungs. As you read these descriptions, take a look at Figure 1-1, which compares a normal airway with an asthmatic airway.
» Airway constriction: When a trigger or precipitating factor irritates your airways, causing the release of chemical mediators such as histamine and leukotrienes (see Chapter 13) from the mast cells — which release chemical mediators that cause inflammatory responses — of the epithelium (the lining of the airway), the muscles around your bronchial tubes can tighten, leading to airway constriction. This process results in narrowing airways and breathing difficulty. Airway constriction can also occur in people who don’t have asthma or allergies if they’re exposed to substances that can harm their respiratory systems, such as poisonous gases or smoke from a burning building.
» Airway hyperresponsiveness: The underlying airway inflammation in asthma can cause airway hyperresponsiveness as the muscles around your bronchial tubes twitch or feel ticklish. This twitchy or ticklish feeling indicates that your muscles overreact and tighten, causing acute bronchoconstriction or bronchospasms even if you’re exposed only to otherwise harmless substances, such as allergens and irritants that rarely provoke reactions in people without asthma and allergies (see the section “Uncovering the Many Facets of Asthma,” later in this chapter).
» Airway congestion: Mucus and fluids are released as part of the inflammatory process and can accumulate in your airways, overwhelming the cilia (tiny hairlike projections from certain cells that sweep debris-laden mucus through your airways) and leading to airway congestion. This accumulation of mucus and fluids may make you feel the urge to cough up phlegm to relieve your chest congestion.
FIGURE 1-1:
A normal airway and an asthmatic airway. Note the muscle contractions (bronchospasms) and airway inflammation.
» Airway edema: The long-term release of inflammatory fluids in constricted, hyperresponsive, and congested airways can lead to airway edema (swelling of the airway), causing bronchial tubes to become more rigid and further interfering with airflow. In severe cases of airway congestion and edema, a chronic buildup of mucus secretion leads to the formation of mucus plugs in the airway, which limits airflow.
» Airway remodeling: If airway inflammation is left untreated or poorly managed for many years, the constant injury to your bronchial tubes due to ongoing airway constriction, airway hyperresponsiveness, and airway congestion can lead to airway remodeling, as scar tissue permanently replaces your normal airway tissue. As a result of airway remodeling, airway obstruction can persist and may not respond to treatment, leading to the eventual loss of your airway function as well as potentially irreversible lung damage.
» Cellular infiltration: This complex cellular mechanism, characterized by either predominant eosinophils or neutrophils, is involved in the airway remodeling seen in chronic asthma. As researchers continue to gain a greater understanding of this process, improved novel therapeutic approaches will allow for more targeted treatments of asthma and allergic diseases (see Chapter 13).
This vicious cycle of asthma can develop gradually, over hours or even days following exposure to triggers or precipitating factors. After this cycle is set in motion, you can suffer severe and long-lasting consequences.
Understanding Who Gets Asthma and Why
The strongest predictor that an individual may develop asthma is a family history of allergies and asthma and/or atopy, an inherited tendency to develop hypersensitivities to allergic triggers. This tendency is almost always due to an overactive immune system that produces elevated levels of immunoglobulin E (IgE) antibodies to allergens. (See Chapter 11 for an extensive discussion of this process.)
The predisposition to asthma is inherited. This genetic inheritance can be a significant factor in developing the condition: Two-thirds of asthma patients have a family member who also has the disease.
Most cases of asthma are of an allergic nature (known as allergic asthma), and usually begin to manifest during childhood, affecting boys more often than girls. In fact, asthma is the most common chronic disease of childhood. Other allergic disorders, such as food allergies, atopic dermatitis (allergic eczema), or allergic rhinitis (hay fever), which are also indicators of atopy in young children, can precede this form of the ailment, often referred to as childhood-onset asthma.
Adult-onset asthma, which is less common than childhood-onset asthma, develops in adults older than 40, more often in women. Atopy doesn’t appear to play a role in these cases. Rather, adult-onset asthma more often seems to be triggered by various nonallergic factors, including sinusitis, upper respiratory infections, nasal polyps, gastroesophageal reflux disease (GERD), sensitivities to aspirin and related nonsteroidal anti-inflammatory drugs (NSAIDs), as well as occupational exposures to chemicals, such as those found in fumes, gases, resins, dust, and insecticides. However, many episodes seem to occur spontaneously without known triggers.
Keep these points in mind about asthma:
» Important symptoms of asthma in infancy and early childhood include persistent coughing, wheezing, and recurring or lingering chest colds.
» Inflammation of the airways is the single most important underlying factor in asthma. If you have asthma, your symptoms may come and go, but the underlying inflammation usually persists. Episodes of asthma symptoms can vary in length from minutes to hours and even from days to weeks, depending on your medical treatment (see Chapter 5), the severity of your symptoms (see Chapter 14), and the character of the triggering mechanism (see Chapter 6).
» Although no cure for asthma exists, in most cases you can manage and even reverse the effects of the disease. However, poorly managed or undertreated asthma may lead to loss of airway functions and, in some cases, irreversible lung damage as a result of airway remodeling. (Read about airway remodeling earlier in this chapter in the section “How airway obstruction develops.”)
» Early, aggressive treatment with appropriate medication is vital to effectively managing your asthma.
Identifying triggers, attacks, episodes, and symptoms
A wide variety of allergens, irritants, and other factors, such as colds, flu, exercise, and drug sensitivities, can trigger asthma symptoms — what you may refer to as asthma attacks or asthma episodes. (See Chapter 6 for more information about asthma triggers and how to avoid them.) Asthma symptoms can range from decreased tolerance to exercise, to feeling completely out of breath, and from persistent coughing to wheezing, chest tightness, or life-threatening respiratory distress. In many cases, a bothersome cough may be the only symptom of asthma you even notice.
WHY AREN’T ANTIBIOTICS CURING MY BRONCHITIS?
Bronchitis is a general term for inflammation of the bronchi, or airways. (Itis is Greek for swelling or inflammation.) The most frequent causes of bronchial or airway inflammation are viral or bacterial infections, smoking, or asthma.
Because the coughing symptoms in different types of airway inflammation can appear similar and because bacterial infections of the airway are common, some patients who actually have asthma are mistakenly treated with antibiotics. Although these drugs can clear bacterial infections of the airways, they don’t relieve or control asthma symptoms.
If you experience lingering coughs, recurring colds, or similar symptoms that can indicate bronchitis, make sure your doctor performs appropriate lung-function tests to check for reversible airflow obstruction, a hallmark of asthma. Performing such tests gives doctors the information they need to prescribe appropriate and effective treatment for your condition.
