Definitions & Treatment

Definition of Asthma | Exercise-Induced Asthma | Diagnosing Children | Pulmonary Function Tests | Allergy Testing | Treating Allergies & Asthma | Environmental Controls | Allergy Injections | Medications Conclusions


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Definition of Asthma

Asthma is a disease of the lungs, and more specifically, of the bronchial tubes. These are the airways that bring oxygen to the lungs. For reasons which are not entirely clear, patients with asthma have very sensitive bronchial tubes and respond to a variety of different stimuli; these include allergens such as grass, trees, and ragweed pollen, as well as dander from cats, dogs, and other animals. In addition, nonspecific stimuli can affect the bronchial tubes of patients with asthma. These include weather changes, pollution, exercise, and cold air. Emotions and the manifestations of emotions, such as laughing and crying, can also precipitate cough and wheezing. All of these can make the bronchial tubes close off. Other names for asthma include reversible obstructive airway disease, twitchy lung syndrome, wheezy bronchitis, allergic asthma, and asthmatic bronchitis.

The manifestations of asthma are several:

  • Wheezing, a high-pitched musical whistling sound when breathing, that frequently can be heard without a stethoscope.
  • Cough, although this is not always appreciated as a sign of asthma. If the patient is still coughing with asthma, this is not a good sign — it is usually a mark of uncontrolled asthma.
  • Shortness of breath and difficulty breathing can develop, along with wheezing and coughing, if the attack becomes more severe.
  • At other times, the exact symptom is not quite clear and may be described as chronic chest congestion or rattling in the chest.

Spectrum of Symptoms

Asthma can present itself in a variety of ways. The classical concept of asthma is the patient who wheezes, has difficulty breathing, experiences shortness of breath, and may or may not be coughing. A more insidious form — that does not necessarily come to the doctor's and patient's attention — is frequent coughing during the day or night, with no real difficulty breathing. These patients, when they laugh, cry, or get excited, frequently start coughing. In addition, when they exert themselves, they often become short of breath and also start coughing. Gradually, we have become aware of asthma as a heterogeneous disorder — in other words, just calling it asthma does not specifically describe what the symptoms are. Those can vary from a life-threatening illness, where the patient may be turning blue and have difficulty breathing to a patient with a chronic cough, but no difficulty breathing. In between, there is a combination of wheezing and coughing. At different times in the same individual, one or another symptom may predominate. However, it is important to emphasize that a patient with asthma who is still coughing has uncontrolled asthma.

Are You Sick All the Time?

If a patient does have asthma, she may have the usual number of colds — anywhere from 4 to 8 upper-respiratory infections per year — this is entirely normal. However, if she has asthmatic lungs and gets a cold, it may last for two, three, or even four weeks. The main symptom may not necessarily be wheezing, but rather a chronic, hacking cough. So if a person has four colds a year, lasting for 3 to 4 weeks at a time, she may indeed seem to be sick most of the time. The problem may not be recognized as asthma. If treated with antihistamines, decongestants, cough medications, and antibiotics, these symptoms may very well persist.

Bronchitis

These patients who are sick all the time may be described as having frequent episodes of bronchitis. If a patient has had bronchitis more than two or three times, there is a good reason to suspect asthma. Bronchitis is more frequent in adults than in children; however, even in adults, there are many undiagnosed cases of asthma that have been erroneously called bronchitis.

History & Considerations

When we view an illness, we talk about the natural history of the illness; that is, what is the future of the specific illness? Will it last for a week, a month, a year, or many years? Will it come and go? Will it go away for ten years only to recur? There is no way to predict whether a person will outgrow her asthma. One must recognize the symptoms of cough and wheeze as a sign of uncontrolled asthma and act accordingly.