Asthma is inflammation and narrowing of the bronchial tubes. Air travels in and out of the lungs through these tubes.

The cause of asthma is not known. It does seem to run in some families. Current research suggests a combination of environment, genetics and biology may lead to asthma. Possible triggers of an asthma attack in a person with asthma include:

• Exercise
• Cold weather
• Viral illness
• Sinusitis
• Gastroesophageal reflux disease (GERD)
• Sulfites used in dried fruits and wine
• Medications, such as aspirin , ibuprofen , and beta-blockers
• Exposure to irritants or allergens, including:
  • Cigarette smoke, smoke from a wood-burning stove
  • Pet dander
  • Dust
  • Chemicals
  • Mold and mildew
  • Pollen
  • Smog or air pollution
  • Perfumed products

These factors increase your chance of developing asthma. Tell your doctor if you have any of these risk factors:

• Living in a large urban area
• Regularly breathing in cigarette smoke (including second-hand smoke)
• Regularly breathing in industrial or agricultural chemicals
• A parent who has asthma
• History of multiple respiratory infections during childhood
• Low birth weight
• Being overweight
• Gastroesophageal reflux disease (GERD)

Symptoms include:

• Wheezing
• Tightness in the chest
• Trouble breathing
• Shortness of breath
• Cough
• Chest pain
• Self-limited exercise, difficulty keeping up with peers

The doctor will ask about your symptoms and medical history and perform a physical exam:

Tests may include:

• Peak flow examination—blowing quickly and forcefully into a special instrument that measures your output of air
• Pulmonary function tests (PFTs)—breathing into a machine that records information about the function of your lungs
• Bronchoprovocation tests—lung function tests performed after exposure to methacholine, histamine, or cold or dry air to stimulate asthma; can help to confirm asthma in unclear cases
• Exhaled nitric oxide (a marker of airway inflammation)—to suggest the diagnosis and manage medications
• Allergy tests —usually skin or sometimes blood tests to find out if allergies may be contributing to the symptoms

The treatment strategy for asthma is four-fold:

• Regular assessment and monitoring—Online programs aimed at helping patients to manage their own symptoms can improve asthma control and lung function. (See American Lung Association or Asthma and Allergy Foundation of America .)
• Control of contributing factors (eg, gastroesophageal reflux and sinusitis ) and avoidance of allergens or irritants
• Patient education
• Medications

You and your doctor should also create an asthma action plan. This is a plan you will follow to help control your asthma and handle asthma attacks. In addition, it may be helpful to learn breathing techniques from a physical therapist.

These medications are used to control the condition and avoid asthma attacks, not to treat an acute attack:

• Inhaled corticosteroid—used daily to reduce inflammation in your airways
• Long-acting beta agonists—(eg, inhaled salmeterol ) used daily to prevent asthma attacks; should not be taken without an inhaled corticosteroid
  • May increase the risk of asthma-related death, intubation (putting a tube in the windpipe to breath), and hospitalization—If you have any concerns, talk to your doctor.
• Cromolyn sodium or nedocromil sodium inhaler—used daily to prevent asthma flare-ups or to prevent exercise-induced symptoms
• Zafirlukast , zileuton , and montelukast —taken daily to help prevent asthma attacks
• Omalizumab (Xolair)—a monoclonal antibody against immunoglobulin E (IgE), given as an injection under the skin, used along with other medications
• Theophylline —taken daily to help prevent asthma attacks, not as commonly used because of interactions with other drugs

These medications are used to treat an asthma attack:

• Quick-acting beta agonists—(eg, inhaled albuterol , xopenex ) relax your airways so that they become wider again, may also be used to avoid exercise-induced asthma attacks
• Anticholinergic agents—inhaled medications, such as ipratropium , that function as a bronchodilator, typically only used in an emergency setting
• Corticosteroids—pills, injections, or intravenous (IV) medications given to treat acute flare-up of symptoms
  • Pills may be taken for a longer period of time if you have severe asthma that isn't responding to other treatments.
• Epinephrine —a shot given to stop an asthma attack