Asthma


Nation-wide and Colorado statistics about Asthma 

Who gets Asthma?

Which type of Asthma do you have?

What are your symptoms?

What Do You Do During an Asthma Episode?  

What is asthma?

Asthma is a condition caused by inflammation in the airways (called bronchi) that lead to the lungs. This inflammation causes airways to tighten and narrow, which blocks air from flowing freely into the lungs, making it hard to breathe. The inflammation may be completely or partially reversed with or without medicines.

Asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).

Common asthma triggers include:

  • Animals (pet hair or dander)
  • Dust
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Exercise
  • Mold
  • Pollen
  • Respiratory infections, such as the common cold
  • Strong emotions (stress)
  • Tobacco smoke
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) provoke asthma in some patients.
  • Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.

 

 Who gets Asthma?

Anyone can have asthma, including infants and adolescents. The tendency to develop asthma is often inherited; in other words, asthma can be more common in certain families. Moreover, certain environmental factors, such as viral infections, may bring the onset of asthma. Other environmental factors, such as exposure to smoke, allergens, automobile emissions, and environmental pollutants, have been associated with asthma.

Many children with asthma can breathe normally for weeks or months between flares. When flares do occur, they often seem to happen without warning. Actually, a flare usually develops over time, involving a complicated process of increasing airway obstruction.

Approximately 17 million Americans have asthma. The cost of illness related to asthma is around $19.7 billion per year in the United States. Each year, an estimated 1.81 million people with asthma require treatment in the emergency department with approximately 500,000 hospitalizations. Children younger than 18 years of age account for 47.8% of the emergency department visits and 34.6% of the hospitalizations due to asthma exacerbations. The magnitude of the impacts of asthma in children is illustrated by the fact that asthma accounts for more hospitalizations in children than any other chronic illness. Moreover, asthma causes children and adolescents to miss school and causes parents to miss days at work. As might be expected, asthma also accounts for more school absences than any other chronic illness.

About one third of Colorado’s hospitalizations for children are due to asthma. Asthma is a chronic disease that can be managed through education, medication, and avoidance of triggers.  Many children with asthma and their families however, are unaware of their “triggers,” and despite the numerous drugs available, asthma is still poorly controlled.  In fact, almost 75% of admissions for asthma are avoidable, and potentially preventable factors are common in deaths from asthma.   In addition, studies show that children with asthma are hesitant to let people know about their asthma because they are embarrassed by it.

 About Asthma

  • Over 8.5 million children in the U.S. suffer from asthma.
  • There are approximately 135,790 children in Colorado living with asthma.
  • Asthma can be a life-threatening disease if not properly managed. In 2009, 3,388 deaths were attributed to asthma. However, deaths due to asthma are rare among children. The number of deaths increases with age.
  • Asthma is the leading chronic illness among children and the #1 cause of school absenteeism due to chronic illness. It accounts for 10.5 million lost school days annually.
  • The annual cost in the U.S. of treating asthma is estimated to be $20.7 billion.
  • Asthma is very hard to diagnose. As many as 80% of children with asthma develop symptoms before age 5.
  • In Colorado, approximately 1 out of 10 children have asthma.
  • Child prevalence of current asthma is slightly higher for Colorado at 9.1% than the 8.9% for the nation overall.
  • More than 25% of the children diagnosed with asthma reported an emergency room or urgent care visit due to their asthma in the past year and 9% reported an overnight stay.  On average, children with uncontrolled asthma visit the Emergency Room 3 times a year.
  • Over 40% of Colorado children with asthma reported missing at least one day of school last year due to asthma. Considering the high prevalence of asthma, this correlates to nearly half a million missed school days per year.  More than one-third of elementary school-aged children missed three or more days of school due to asthma episodes. This impacts the children, the education system and parents who are missing work to care for their child.
  • An asthma management, or action plan is a form that is specific to each person and describes when to change the amount of medicine, when to call the doctor for advice, and when to go to an emergency room, less than 50% of children have asthma action plans.
  • Caregivers' time tending to children absent from school is estimated to be valued at $227 million per year.
  • Studies show that children with asthma tend to miss more school, have poorer school performance, as well as have poorer social and intellectual growth.
  • Evidence suggests that the likelihood of developing asthma is greater when children are around second hand smoke.  An estimated 11% of all asthma cases and more than half a million physician visits for asthma are due to smoking in the home.
  • In Colorado, approximately 4,400 cases of asthma in children under age 15 are caused by exposure to secondhand smoke. Smoking is allowed inside 7% of Colorado homes with children ages 1-14 years old. 

 Types of Asthma

Allergic Asthma
Allergic asthma is triggered by an allergic reaction to allergens such as pollen or pet dander. If you have allergic asthma, you probably have a personal and/or family history of allergies, such as allergic rhinitis or hay fever, and/or eczema (a skin problem resulting in itching, a red rash, and sometimes small blisters).

Keep in mind that one form of allergic asthma is seasonal asthma, which usually affects people in the spring or early autumn. For example, you may find that your asthma is worse in the spring when there is an increase in flowering plants, while others find their asthma is worse in the late summer or early fall due to ragweed or mold from leaves on trees.

Other triggers for allergic asthma include respiratory infections such as the common cold, the flu, or a sinus infection, as well as exercise, cold air, sudden changes in air temperature, and even gastroesophageal reflux (heartburn).

Learn more about Allergies and Asthma

Nonallergic Asthma
Your asthma may be triggered or made worse by one or more nonallergic asthma triggers, including substances (irritants) in the air, such as tobacco smoke, wood smoke, room deodorizers, pine odors, fresh paint, household cleaning products, cooking odors, perfumes, and outdoor air pollution. People with nonallergic asthma may have the same symptoms as those with allergic asthma, but they are not bothered by allergens from the natural world like pollen or mold.

Other triggers for nonallergic asthma include respiratory infections, such as the common cold, the flu, or a sinus infection, as well as exercise, cold air, sudden changes in air temperature, and even gastroesophageal reflux (heartburn).

Nocturnal Asthma
Nocturnal asthma refers to asthma symptoms that seem worse in the middle of the night, typically between 2AM and 4AM. Interestingly, nocturnal asthma can affect someone with any type of asthma.

Factors that can cause your asthma symptoms to worsen at night may include sinus infections or postnasal drip caused by allergens such as dust mites or pet dander. Your body clock may also play some role. The body makes adrenaline and corticosteroids, which protect against asthma. Levels of these two substances are lowest between midnight and 4AM, making it more likely you will experience symptoms during these times.

Find out more about Nocturnal Asthma

Asthma in Pregnancy
Among pregnant patients who have asthma, one-third will experience improvement in their asthma, one-third will remain stable, and one-third will experience worsening of their asthma. Improved asthma control during pregnancy is associated with lower rates of pregnancy-related complications. So if you have asthma and are pregnant, talk to your doctor about what you might expect and what you can do about your asthma symptoms.

Occupational Asthma
Occupational asthma refers to asthma that is newly diagnosed and caused by exposure to a substance (chemicals or animal proteins, for example) in the workplace. If you can reduce your exposure to these triggers, you may be able to reduce your asthma symptoms. Keep in mind that occupational asthma does not refer to people already diagnosed with asthma who are more prone to flare-ups when exposed to irritant dusts or fumes in their work environment.

 Symptoms

Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom.

Asthma attacks can last for minutes to days, and can become dangerous if the airflow is severely restricted.

Symptoms include:

  • Cough with or without sputum (phlegm) production
  • Pulling in of the skin between the ribs when breathing (intercostal retractions)
  • Shortness of breath that gets worse with exercise or activity
  • Wheezing, which comes in episodes with symptom-free periods in between
  • May be worse at night or in early morning
  • May go away on its own
  • Gets better when using drugs that open the airways (bronchodilators)
  • Gets worse when breathing in cold air
  • Gets worse with exercise
  • Gets worse with heartburn (reflux)
  • Usually begins suddenly

Emergency symptoms:

  • Bluish color to the lips and face
  • Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack
  • Extreme difficulty breathing
  • Rapid pulse
  • Severe anxiety due to shortness of breath
  • Sweating

Other symptoms that may occur with this disease:

  • Abnormal breathing pattern --breathing out takes more than twice as long as breathing in
  • Breathing temporarily stops
  • Chest pain
  • Nasal flaring
  • Tightness in the chest

The inflammation of the airways makes them very sensitive ("twitchy"), resulting in spasm of the airways that tend to narrow, particularly when the lungs are exposed to an insult such as viral infection, allergens, cold air, exposure to smoke, and exercise. Reduced caliber of the airways results in a reduction in the amount of air going into lungs, making it hard to breathe. Things that trigger asthma differ from person to person. So an asthma flare is caused by three important changes in the airways that make breathing more difficult:

  • Inflammation of the airways
  • Excess mucus that results in congestion and mucus "plugs" that get caught in the narrowed airways
  • Narrowed airways or bronchoconstriction (bands of muscle lining the airways tighten up).

 What to do during an asthma attack 

1. Have the person STOP whatever activity he/she is doing. Send another person to get help. DO NOT leave the person alone.

2. Follow the person’s Asthma Action Plan or emergency plan if there is one.

3. If the individual has a RESCUE INHALER or NEBULIZER (with medicines such as albuterol, proventil, ventolin or xopenex), have him/her USE IT IMMEDIATELY (preferably with a spacer or valved holding chamber).

Generally, during an asthma attack an individual should: Prepare inhaler for use by shaking canister for several seconds. Exhale or empty all air out of lungs, and follow as listed below with or without a spacer:

  • Inhaler With a Spacer or Holding Chamber: Inhale 1 puff of medication by depressing the canister once, breathe in slowly and deeply, hold breath for 10 seconds and then exhale.
  • Inhaler Without a Spacer or Holding Chamber: Place inhaler at the opening of the lips or a distance of 1 inch from open mouth; depress canister 1 time and inhale medicine quickly at the same time; hold breath for 10 seconds and then exhale.

Wait 30 seconds to 1 minute between puffs of inhaled medication.

Shake inhaler canister between puffs.

Repeat process, depress canister, inhale another puff, hold breath for 10 seconds and exhale.

Continue as needed, typically 4 to 8 puffs (depending on severity of symptoms).

Have the individual sit up and slowly breathe in through the nose and out through pursed lips (pursed lip breathing).

Pursed lip breathing technique is as follows:

  • Start by sitting comfortably in a chair. Do not lie down.
  • Relax your shoulders and neck. Concentrate on not gasping for air as you drop your shoulders.
  • Breathe in slowly through your nose. Concentrate.
  • Purse your lips together tightly as if trying to whistle, and blow out slowly through your mouth. Take as much time as possible to exhale in this way.
  • Relax. Keep using the pursed-lip breathing until the breathless feeling goes away. Rest between breaths if you feel dizzy. Give sips of room temperature water.

4. REPEAT above steps if symptoms continue.

5. IF SYMPTOMS CONTINUE OR WORSEN SEEK IMMEDIATE MEDICAL HELP.

Rescue Inhaled Medications such as Albuterol and Xopenex should provide relief of immediate asthma symtoms (wheezing, shortness of breath, coughing) within 5 to 10 minutes of use.

Per National Guidelines (NHLBI: EPR3) for “Home” management of asthma attacks – Up to two treatments (either nebulizer or metered dose inhaler) 20 minutes apart may be administered, assessing condition throughout both treatments to determine if emergency transport/emergency department treatment is necessary. This guideline is for all age groups from infants to adults.

CALL 911 IF:

  • YOU are not sure what to do – or
  • Rescue medications are not working (symptoms are getting worse, not better) or, meds are unavailable – or
  • The person’s lips or fingernails are BLUE – or
  • The individual is having difficulty talking, walking, or drinking liquids – or
  • The person’s nostrils are flaring out – or
  • You see neck, throat or chest muscle retractions – or
  • The person is in obvious distress, there is a change in level of consciousness, or the individual is showing signs of confusion – or the individual’s condition is deteriorating.
     1 American Lung Association: Estimated Prevalence and Incidence 2011 http://www.lungusa.org/finding-cures/our-research/trend-reports/estimated-prevalence.pdf
    2  American Lung Association: Estimated Prevalence and Incidence 2011 http://www.lungusa.org/finding-cures/our-research/trend-reports/estimated-prevalence.pdf
    3 http://www.cdc.gov/nchs/fastats/asthma.htm 
    4 http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf 
    5 American Lung Association. “Trends in Morbidity and Mortality.” Research and Program Services Division. February 2010: 10. 
    6  http://www.aafa-ca.com/Asthma_Children.php 
    7 Colorado Department of Public Health and Environment. Colorado Child Health Survey. Colorado Asthma Surveillance Report, 2008. 
    8 Colorado Department of Public Health and Environment. Colorado Asthma Program Quarterly Data Brief. Asthma in Colorado Children. 2006. 
    9 http://www.cdphe.state.co.us/ps/asthma/documents/Spring06_QDB.pdf 
    10 Douglas E. Levy, PhD, Jonathan P. Winickoff, MD, MPH, Nancy A. Rigotti, MD. “School Absenteeism Among Children Living with Smokers.” Pediatrics. September, 2011. 
    11 Center for Chronic Disease Control. “Asthma Prevalence, Health Care Use, and Mortality: United States, 2005–2009.” January, 2011. 
    12 Centers for Disease Control and Prevention. National Center for Health Statistics. Final Vital Statistics Report. Deaths: Final Data for 2007. Vol 58 No 19. May 2010.