Asthma

Definition

Asthma is a chronic disease that affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed leading to wheezing, coughing, and tightness in your chest. When these symptoms worsen, it is called an asthma attack or flare-up. As of 2018, Black people in the United States have roughly a 40% higher risk of developing asthma than non-Hispanic white people in the U.S. Blacks are also five times more likely to visit the emergency room for symptoms. The severity of asthma also tends to be more severe for Blacks, making them three times more likely to die from an asthma episode than white people.

Causes

Genetics and your environment can play a major role in your risk of developing asthma. Different triggers have the ability to trigger different types of asthma. 

Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include:

• Dust mites
• Mold
• Pets
• Pollen from grass, trees, and weeds
• Waste from pests such as cockroaches and mice

Nonallergic asthma is caused by triggers that are not allergens, such as:

• Breathing in cold air
• Certain medicines
• Household chemicals
• Infections such as colds and the flu
• Outdoor air pollution
• Tobacco smoke

Occupational asthma is caused by breathing in chemicals or industrial dusts at work. 

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Exercise-induced asthma happens during physical exercise, especially when the air is dry.

For Blacks, in particular, studies show that the type of airway inflammation that might occur more often in Black people may lead to severe and harder-to-treat asthma. A study also showed that Black participants had greater eosinophilic airway inflammation than white participants, even when taking the same dosage of asthma medication. Eosinophilic airway inflammation which, leads to difficulty breathing,  is one of the primary causes of asthma symptoms.

Asthma can affect people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:

• Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
• Being exposed to certain substances at work, such as chemical irritants or industrial dusts
• Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if it’s your mother.
• Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
• Having other diseases or conditions such as obesity and allergies
• Often having viral respiratory infections as a young child
• Sex. In children, asthma is more common in boys. In teens and adults, it is more common in women.

Symptoms

Symptoms of asthma can vary, and they can vary in severity. The most common symptoms include:

• wheezing
• shortness of breath
• coughing
• excess mucus production
• chest tightness

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Diagnosis

Your health care provider may use several tools to diagnose asthma:

• Physical exam
• Medical history
• Lung function tests, including spirometry, to test how well your lungs work
• Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
• Peak expiratory flow (PEF) tests to measure how fast you can blow air out using maximum effort
• Fractional exhaled nitric oxide (FeNO) tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
• Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.

Treatments

When you have asthma, it is important to work closely with your healthcare provider to determine the best treatment plan to manage your symptoms and prevent attacks. The plan will include the following:

• Strategies to avoid triggers. If tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
• Short-term relief medicines, also called quick-relief medicines. These will help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines, which work quickly to help open your airways.
• Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.

If you experience a severe attack and short-term relief medicines don’t work, you should seek emergency care. Your provider may also adjust your treatments until your asthma symptoms are controlled.

In some cases, asthma may be severe and not easily controlled with medicines and other treatments.

Doctors may suggest bronchial thermoplasty for adults with uncontrolled asthma. This procedure uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway’s ability to tighten and allows you to breathe more easily. The procedure has some risks, so it’s important to discuss them with your provider.