Let’s Talk About Asthma

无论你是刚才been diagnosed with asthma or worry you could have it, you’re probably nervous, confused, and maybe a little scared. That’s normal, and everyone featured on HealthCentral with a chronic illness felt like you do now. But we—and they—are here for you. The best way to conquer those worries is to understand the challenges you’ll face with this condition, as well as the best treatments, helpful lifestyle changes, and other crucial information that will help you not just manage this condition, but thrive with it. We’re sure you’ve got a lot of questions … and we’ve got the answers you need.

哮喘

我们的专业面板

We went to some of the nation’s top experts on asthma to bring you the most up-to-date information possible.

Albert J. Polito，M.D.

肺部医学和医学司司长

慈善医疗中心的肺中心

Baltimore, MD

Leonard B. Bacharier, M.D.

儿科教学教授，过敏/免疫学/肺药

Vanderbilt University

纳什维尔，TN.

Reynold Panettieri, M.D.

肺病学和医学教授

罗格斯大学

New Brunswick, NJ

What Is Asthma?

大多数时候，我们都不会思考呼吸。我们的身体在自动驾驶仪上，这是移动空气进出肺部的这种基本功能。也就是说，直到我们无法呼吸呼吸 - 突然，我们对我们的氧气摄入系统的复杂程度进行了新的欣赏。

Unlike a sudden struggle to breathe caused by seasonal allergies or a garden-variety cold that will get better, asthma is a chronic disease that continuously affects the airways, otherwise known as the bronchial tubes. If you have asthma, your airways are inflamed, which causes swelling that narrows the passageway into your lungs. As a result, the air you breathe in has less room, leaving you gasping, coughing, wheezing, and feeling short of breath.

根据疾病控制和预防（CDC）的中心，超过25 millionpeople in the U.S. have asthma—a greater number than ever before—including over 5 million children under 18. That translates to1 in 13 peoplein the U.S. currently living with this chronic condition. While most cases of asthma (80% to 90%) begin in childhood, it’s possible for asthma to develop at any age. Asthma can also evolve over time. If you had mild or even moderate asthma as a young child, it may improve to the extent that you barely notice it. On the other hand, it can also resurface as an adult when triggered by, say, another respiratory infection, the adoption of a pet, or a change in living environment.

哮喘can’t be cured, but it can be effectively controlled, allowing you to continue living a full and active life. An asthma diagnosis doesn’t have to turn your life upside down, if you’re vigilant about following your treatment plan. What might that look like? Take a deep breath—and let’s dive in.

哮喘的原因

与其他许多其他慢性疾病一样，所有专家都可以肯定会觉得哮喘是由遗传与环境之间的互动引起的。遗传倾向于发挥作用：出生于哮喘的父母的儿童增加了自己发展的风险。所以有过敏史的孩子们，这通常会携手共进哮喘。某些早期生命事件也可能增加某人哮喘的风险，例如具有湿疹，呼吸道合胞病毒（RSV）或支气管炎，以及暴露于二手烟等污染物。

Environmental Triggers

Along with a family history and possibly a genetic component, the place you live and things you come in contact with daily play a role in determining the likelihood of you getting this condition. Experts look to specific triggers in the environment that swollen airways may become extra sensitive to, including:

• 过敏触发器：Pollen, mold spores, or pet dander top the list.

• Air irritants:These include cigarette smoke, air pollution, wood fires, charcoal grills, chemicals, and strong fumes, vapors, or odors like paint or perfume.

• 锻炼：Ironically, activities aimed at improving lung capacity can sometimes trigger an attack.

• Medications:Common meds, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or beta blockers can lead to an asthma attack.

• Other health conditions:食物过敏，胃食管反流疾病（GERD），阻塞性睡眠呼吸暂停和呼吸道感染（仅限名称）提高您发育哮喘的风险。

• Stress:Feeling and expressing strong emotions like anger, excitement, crying, and yelling are asthma contributors.

• Weather:湿度水平的变化或向冷温度的摆动可以有助于哮喘。

• Workplace triggers:化学烟雾，气体和施工粉尘会导致哮喘。

We know what you’re thinking—and yes, that’s quite a list. But relax. Asthma is a uniquely subjective illness and not every person with it reacts to every trigger—some people are bothered by only a few. At first, you’ll need to do some detective work to figure out your specific triggers because asthma symptoms don’t always develop right after exposure—it can be a few hours later. But once you and your healthcare provider get a handle on your triggers, you can work together to develop an asthma action plan that will include which medications to take when, as well as signs you need to seek medical help.

哮喘Symptoms

Make no mistake: Asthma is different from other respiratory problems. We’ve all had the cough that won’t quit, phlegmy chests, or moments of labored breathing, but usually they’re temporary annoyances that we recover from. Asthma doesn’t go away, however, and although it’s very treatable, in the worst-case scenario, it can threaten your life.

哮喘Attacks

虽然哮喘是慢性病的，但哮喘发作是急性发生的特异性症状。这是在您有哮喘攻击时发生的峰值：

• Airway muscles constrict.限制气流的紧固被称为支气管痉挛。你的胸部会感到紧张，很难喘息。当你尝试这样做时，你可能会喘息 - 制作吱吱作响或吹口哨的声音。

• Inflammation increases.Your already hypersensitive airways become even more inflamed and swollen.

• Congestion occurs.Your body produces a thick mucus that further clogs the airway.

This narrowing of the airways may happen very quickly or over time. Either way, it results in its own set of symptoms, which can range from very mild to very severe. You can expect:

• Chest tightening, pain, or pressure

• 咳嗽

• Rapid breathing

• Shortness of breath

• Trouble sleeping due to coughing or wheezing

• Wheezing (especially common in children)

一个asthma attack, also called an asthma episode or asthma flare-up, can occur at any time. Mild symptoms may last for only a few minutes, while more severe symptoms can go on for hours or days and can lead to a medical emergency. In fact, asthma attacks are responsible for 1.8 million emergency department visits annually in the U.S., and are the third ranking cause of hospitalizations in children under the age of 15, according to the哮喘and Allergy Foundation of America。

如果您有以下任何严重哮喘攻击的迹象，您应该立即寻求医疗帮助：

• 肤色的变化：面部，嘴唇和指甲中非常苍白或蓝色着色

• Expanded chest:Chest does not deflate when you exhale

• 未能回复：婴儿可能不会响应或认识到父母

• Fast breathing:Breathing so rapidly that your chest retracts when you inhale

• 没有回应药物：Quick-relief meds are not helping ease symptoms

• 快速鼻孔运动：Visible inhale/exhale through the nose (more common in children)

• Rapid ribs or stomach movement:Ribs and stomach are moving in and out deeply and rapidly (more common in children)

• 烦恼：Lack of air makes conversation impossible

When to Call Your Doctor

由于其他疾病，您可能会遇到与哮喘相似的上呼吸系统症状，但在急性时期通过后，它们将会消失，这通常大约两周。哮喘的大线索是那些症状似乎从未清除过，表明潜在的条件可能是责任。首先查看您的初级保健医师，谁在许多情况下可以诊断和治疗哮喘。根据您的触发和症状，您也可能需要一个专家。例如，更有可能具有过敏性哮喘的儿童也可能需要过敏症。前者或目前吸烟者的成年人也可能需要称为肺部学家的肺部专家。任何哮喘在证明难以管理的人也应该看到其中一个专家。

哮喘如何被诊断出来？

没有一个测试可以确认你有哮喘。相反，您的医生将通过审查您的病史，家族史和复发性症状来诊断它，同时在您开始哮喘药物时也会看待改善。还有许多测试可以作为评估的一部分进行，包括胸部X射线，血液测试和过敏测试。也可以进行肺功能测试，但它们与警告一起出现：如果您在管理时没有经历哮喘症状，则这些测试可能正常回来。尽管如此，他们还可以为难题添加重要件。让我们仔细看看你的医生可以使用的一些测试。

Spirometry

在这种简单的呼吸测试中，您将吹入一个被称为肺部计的设备的吹嘴，看看您可以吸气和呼气的空气，以及您可以呼气的速度。你会被告知首先深呼吸，然后尽可能快地吹出肺部，进入喉舌。您可能需要几次重复此过程。如果结果显示肺功量的降低，那么您将获得称为支气管扩张剂的吸入药物以打开气道。然后你会在药物有时间工作后再次重复测试，看看你的肺功能是否有所改善。预计经常遇到此测试：您的医生可能会继续在每座检查中使用它，以跟踪肺功能的变化，并确定您的药物是否正在运行。

FeNO Test

FeNO是缩写部分呼出氮oxide. By measuring the amount of nitric oxide in your breath, your doctor can tell how much inflammation you have in your airways. It’s quick and non-invasive—you just blow into a handheld device for about 10 seconds at a steady pace and get immediate results. A FeNO test early on can support or rule out an asthma diagnosis. Later it may be used to identify the type of asthma you have, track inflammation over time, and determine if your medications and asthma action plan are working.

挑战测试

Also known as provocation or trigger tests, these determine how sensitive your lungs are. Challenge tests may be performed if your symptoms and other tests don’t convincingly establish a diagnosis of asthma, or if your doctor is trying to determine which asthma triggers you react to. There are three types of challenge tests:

• 甲胆碱挑战：甲素是一种药物，如果你有哮喘，你的气道将以低剂量拧紧。在测试期间，您将通过雾化器呼吸增加剂量的甲素 - 一种将液体药物转化为细雾的装置 - 随后测量肺功能变化。如果甲素导致呼吸能力下降20％，则认为应该考虑阳性，应考虑哮喘的诊断。

• 刺激性挑战：您的医生将使您暴露于特定的空中哮喘触发器，如香水，化学品或烟雾，那么您将呼吸测试以了解您的回应。

• 运动挑战：在这个测试中,您将运行在跑步机上while your oxygen and heart rate are monitored to determine if exercise triggers your symptoms.

• Peak flow test:峰值流量计是一种手持设备，可以测量空气进出肺部的空气。你将空气快速爆炸到嘴上，并在内置尺度上获得阅读。在诊断后，峰值流动测试用于帮助保持哮喘。

哮喘Treatment

The goal of哮喘治疗is to control your symptoms so you can live your normal life and rarely need to use your rescue inhaler, a fast-acting treatment for asthma attacks. Happily, there are many effective medications that are highly likely to keep your asthma under control and your life normal. The caveat: There is a learning curve when it comes to figuring out which medications you’ll need and how often. That prescription might also change over time.

作为一般规则，哮喘药物分为两类长期维护药物，您每天服用，以及您可以根据需要使用的哮喘攻击时使用的上述快速浮雕或救援药物。这些药物中的大多数都是吸入的，但有些药物以丸形式。以下是诊断后你的药物柜中可能需要的播放，并且在您学习控制您的症状时，您可能需要。

Long-Term Control and Maintenance Medication

By taking these drugs daily, you are working with your body to prevent a future asthma flareup.

• Inhaled corticosteroids:这些是用于预防和减少气道肿胀和减少粘液的最有效的日药。它们包括：Alvesco（冠甲酸酯），arnuity eltipta（氟酮浮酸盐），asmanex（mometasone），投注（氟替卡松丙酸酯）和pulmicort（presononide）。

• 吸入长效β激动剂（Laba）：这些药物与吸入的皮质类固醇组合使用。他们在呼吸道周围放松所谓的平滑肌，以帮助保持打开状态。Labas包括Formoterol，Salmeterol和Vilanterol。

• Combination inhaled medicines:This drug category features both a corticosteroid and beta-agonist in one convenient dose and includes Advair (fluticasone and salmeterol), Breo (fluticasone furoate and vilanterol), Dulera (mometasone and formoterol), Symbicort (budesonide and formoterol), and Trelegy (fluticasone, umeclidinium, and vilanterol).

• 生物学：每隔几周将这种药物递送为注射或输注。他们通过针对身体中的细​​胞或蛋白质来防止气道炎症。然而，生物制剂非常昂贵，通常仅针对严重的哮喘规定，这一直难以控制。生物学包括Cinqair（Reslizumab），Dupimerent（Dupilumab），Fasenra（Benralizumab），Nucala（Mepolizumab）和Xolair（omalizumab）。

• 白酮修饰符：This medicine is available in pill or liquid form and is used to reduce airway swelling and relax the smooth muscles surrounding the airways. They include Accolate (zafirlukast), Singulair (montelukast), and Zyflo (zileuton).

• Cromolyn sodium:这种通用吸入的非类固醇在与触发器接触时防止气道肿胀。

• Theophylline:This medication also helps open the airways and comes as a tablet, capsule, or liquid. Brand names include Theo-24, TheoDur, and Uniphyl.

• Oral corticosteroids:如果其他药物在控制中不保持哮喘，则可以在短时间内以丸剂或液体形式在捕蝇或甲基己酮等皮质类固醇中排列。

Quick Relief and Rescue Medicines

When you feel a sudden asthma attack coming on you’re in the middle of nowhere and struggling to breathe, these meds can help you get your breathing under control.

• 短代β激动剂：这些吸入药物通常的第一选择r quick relief of asthma symptoms and include Asthmanefrin and Primatene Mist (epinephrine); ProAir and Ventolin (albuterol); and Xopenex (levalbuterol).

• 一个ticholinergics:Also known as long-acting muscarinic antagonists (LAMA), these drugs reduce mucus and help open your airways, but will take longer to work than your rescue inhaler so should not be used in place of one. Brand names include Atrovent (ipratropium) and Spiriva (tiotropium).

• 组合快速救济药物：These feature both a short-acting beta-agonist and an anticholinergic and are sold as Combivent (ipratropium and albuterol) and DuoNeb (ipratropium and albuterol).

Side Effects of Asthma Meds

All medicines come with them, but most asthma medications are well-tolerated and the benefits outweigh the consequences, with minimal side effects reported. Depending on what your doc prescribes you, the dose, and how it’s taken (i.e. orally or inhaled), side effects can range from thrush (a fungal infection of the mouth) to headache and dizziness to decreased bone density. Your doctor will fill you in on potential side effects for your specific treatment plan, as well as how to manage them.

Despite the downsides to some meds, the reality is that you will be far better off with these meds than without them. Also, good-to-know info on the inhaled corticosteroids which you will likely be taking every day: They do not pose nearly the same risks as oral corticosteroids because they are inhaled in much lower doses and they only target the airways and lungs. When you take steroids orally, they have a systemic effect—meaning they travel throughout your entire body—that results in greater side effects, which is why you should only take them short term (no more than three months and ideally only a few weeks).

Surgery for Severe Asthma

Never heard of asthma surgery? That’s not surprising: Only very rarely is a surgery-like procedure used to treat asthma and it’s reserved for those with severe uncontrolled asthma who have evidence of long-standing irreversible changes to their airways that are making it difficult to breathe. In these cases, a procedure known as bronchial thermoplasty may be done. It involves using a bronchoscope—a tube inserted through the nose or mouth into the lungs—to deliver thermal energy into the airways to reduce the swelling and thickness of the smooth muscles that are constricting the airways.

What’s It Like Living With Asthma?

That depends. With well-controlled asthma you can enjoy the life you want; uncontrolled asthma, however, will result in more frequent and serious symptoms that limit and perhaps even threaten your life. Making sure that doesn’t happen is in large part up to you and how committed you are to following your treatment plan. For starters, you’ll need to incorporate using your long-term control medications into your daily routine (yes, even when you feel good) and carry your rescue inhaler with you at all times in case symptoms occur. Sure, it’s a bit of a hassle to bring your inhaler to work, school, vacation, gym, or a special night out. But that’s the trade-off for avoiding a trip to the ER: The most common reason people with asthma seek emergency care is because they don't have treatment available when symptoms occur.

You’ll also need to pay close attention to your triggers—and how to avoid them. That may mean staying inside with the windows closed during pollen season, covering your mouth and nose with a scarf when you go outside in cold weather, pretreating with your rescue inhaler before you exercise, and passing up the opportunity to adopt a dog to avoid pet dander. And it goes without saying (but we’ll say it anyway) that smoking cigarettes, marijuana, or e-cigarettes puts you on the fast track to an asthma attack.

By taking precautions and sticking religiously to your asthma treatment plan, you should be able to live your best life with very few limitations to your daily activities. If that’s not the case, then discuss it with your doctor, a board-certified allergist, or pulmonologist. We know enough about asthma at this point that if one treatment doesn’t work, another one will. Life with asthma isn’t easy, but we’re here to help you gain control.

Meet Our Writer

Stephanie Wood

Stephanie Wood is a award-winning freelance writer and former magazine editor specializing in health, nutrition, wellness, and parenting.

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