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What is Asthma?

  • Asthma is a condition of chronic inflammation in the airways with episodes of shortness of breath, cough and/or wheezing.
  • Asthma is characterized by bronchospasm or tightening and narrowing of the airway, which is reversible. This means that periods with symptoms alternate with periods without symptoms.
  • During an asthma episode, the airways produce a larger quantity of thicker mucus which is difficult to move in an inflamed and narrowed airway.
  • Asthma can be well controlled in most patients.
  • The management of asthma requires regular monitoring and therapy.
  • The number of asthma cases in the United States has doubled in the last 20 years. Today, there are over 17 million cases of asthma in the U.S. On average, 175 people die of asthma every year in Los Angeles County, 600 in California.
  • In 1995, 42,000 reported cases of asthma-related hospitalizations were noted in California. They cost the state $350 million — $136 million of which is funded by Medi-Cal.
  • Boys 2 to 5 years old are 8 times more likely to have asthma symptoms than girls at the same age. By age 20, women are 3 times more likely than men to have severe asthma.
  • Children who have one asthmatic parent have a 40% chance of inheriting asthma. Those who have 2 asthmatic parents have a 70% chance of developing asthma.
  • Hispanics and African-Americans have a greater chance of developing asthma. African Americans are 3 times more likely to die from asthma as Caucasians.
  • Low birth weight, premature birth and maternal smoking are all risk factors for developing asthma.
  • Persons who have asthma differ from each other in a number ways:
  • 1The trigger of their condition
  • 2The location and amount of the blockage
  • 3The percentage of the blockage that is reversible with treatment
  • 4The response to medication
  • 4The amount of medication for a satisfactory response
  • Based on frequency and severity of symptoms, asthma can be classified into these categories:
  • 1Mild intermittent asthma: daytime symptoms which occur less than twice a week and nighttime symptoms not more than twice a month.
  • 2Mild persistent asthma: daytime symptoms occur more than twice a week but not everyday and nighttime symptoms occur no more than twice per month.
  • 3Moderate persistent asthma: daytime symptoms occur almost daily and nighttime symptoms once a week or more.
  • 4Severe persistent asthma: continuous symptoms of varying amount.
  • Asthma may be a fatal illness with up to 6,000 deaths each year worldwide.
  • The most common causes of asthma flares are infection, exercise, allergens and air pollution.
  • In addition, viral infections, sinusitis and sensitivity to medications play an important role in aggravating an asthma attack.
  • Emotional upset as well as crying, laughing or yelling may occasionally trigger asthma.

Symptoms

  • The 4 primary symptoms of asthma are cough, shortness of breath, wheezing and chest tightness.
  • Asthma often has early warning signs that can help one avert an attack if acted upon promptly. Some of these signs are:
  • 1Runny nose – associated with a cold
  • 2Fatigue
  • 3Cough
  • 4Itching of throat or chin or anterior neck or upper chest
  • 5Difficulty sleeping
  • 6Problem exercising
  • 7Shortness of breath
  • 8Reduction of peak flow measurements
  • Symptoms of severe asthma are:
  • 1Severe coughing, chest tightness, shortness of breath and wheezing
  • 2Inability to speak in complete sentences
  • 3Hunched shoulders
  • 4Chest and neck straining when breathing
  • 5Gray or bluish tint of lips and fingernails
  • 6Signs of panic
  • 7Flaring of nostrils

Conditions that may be mistaken for Asthma

  • Acute bronchitis is usually a viral infection of the large air tubes (bronchi) which has relatively sudden onset. Usual symptoms include coughing, green/yellow sputum, fever and shortness of breath. Wheezing is not common. Acute bronchitis may worsen asthma. Treatment of the viral nature of bronchitis focuses on symptoms but antibiotics may be helpful against bacterial causes of acute bronchitis.
  • Chronic bronchitis is a longstanding infection/inflammation of the bronchi which lasts months or years and is characterized by productive coughing, shortness of breath and chest congestion. It is usually associated with cigarette smoking. Wheezing may be apparent because of air whistling around mucous secretions. The primary treatment includes anti-inflammatories and bronchodilators. Occasional antibiotics will be needed.
  • Emphysema is a chronic, obstructive lung condition where there is structural damage to the air sacks in the lungs and to the bronchial tubes. Emphysema is invariably caused by many years of cigarette smoking. The damaged air tubes lose their elasticity, or ability to collapse and force air out. Consequently, there may be more air trapped in the lungs but very poor air exchange. Symptoms include cough, wheezing, and shortness of breath (especially with exertion). Treatment focuses on smoking cessation and supportive medications. Supplemental oxygen may be needed for advanced illness.
  • Croup is usually a viral infection of the area just below the vocal chords, which commonly affects young children. Onset is usually progressive over a few days and is punctuated by a barking, seal-like cough. It is more pronounced at night and may be associated with fever, runny nose and nasal stuffiness. Wheezing is not usually apparent, although it may occur. Severe cases may need hospitalization for supplemental oxygen, but most children can be managed at home with mist vaporizers and treatment of symptoms.
  • Bronchiolitis is an acute viral infection (usually due to “respiratory syncytial virus” – RSV) of the smaller airways in very young children. Wheezing, cough and retractions (use of accessory muscles to help breathing) are common symptoms. A child with bronchiolitis may appear to have viral induced asthma. In fact, there is a predisposition to develop asthma in children who have RSV bronchiolitis. Children may be treated with bronchodilators, if necessary; they may be hospitalized for specific antiviral therapy and oxygen.
  • Pneumonia may afflict any age group but is more likely in the very young and very old. It is an infection of the small air sacs (alveoli) or spaces in between them. Pneumonia is usually caused by viruses or bacteria. Severity may range from mild to life threatening. Treatment is aimed at the cause of infection. Appropriate antibiotics are the most effective treatment.
  • Gastroesophageal reflux is a very common condition where acidic stomach contents are backed up into the esophagus. There may be inflammation of the esophagus which may cause burning and chest tightness. There is an association between reflux and asthma. Especially at night, reflux and asthma may precipitate coughing and moderately severe wheezing and choking. Paradoxically, some asthma medications may worsen reflux. At times, treatment of reflux may significantly improve asthma symptoms.
  • Cardiac Asthma occurs in patients who have primarily heart disease that results in abnormally increased blood in the venous system of the lungs leading to wheezing and shortness of breath. Rarely, this may occur in patients who have asthma as well, which complicates diagnosis and treatment. Chest x-ray and ultrasound of the heart may be necessary for diagnosis. Treatment of the underlying heart disease lessens wheezing and shortness of breath.
  • Hypersensitivity pneumonitis is an immunologic disorder of the lungs caused by inhalation of biologic dusts, chemicals or even certain medications. Agents that cause this disorder include certain bacteria that grow on mushrooms, in humidifiers, on grain or compost. Fungi on wood dust, cheese or damp areas as well as bird or mammal proteins may cause hypersensitivity pneumonitis. Symptoms of acute disease may be confused with acute bronchitis since both have symptoms of coughing, fever and malaise. Chronic exposure may result in permanent lung damage with marked shortness of breath, coughing and weight loss. Treatment involves identifying the causative agent and avoiding it. Oral corticosteroids are used in the chronic form.
  • Medication-induced cough. Medications such as beta-blockers or ACE inhibitors (for high blood pressure) can sometimes cause cough. However, they rarely cause wheezing and shortness of breath.

Treatment for Asthma

There are many options for treatment, we will find the best one suited for you.