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asthma [2016/02/01 07:46]
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asthma [2018/02/26 18:10] (current)
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-====== Asthma ======+Return to [[Disease glossary]], Return to the list of [[Ayurvedic herbs]], [[Chinese herbs]], [[Western herbs]] or of Ayurvedic Consultations [[CLN301]]
  
-[[Ayurveda ​Dharma]] is distributed ​[[copyleft]] via this [[GNU Free Documentation License]] (FDL) and/or under [[Creative Commons License]] Attribution-Share Alike 3.0 United States +See Ayurveda ​Chinese Western Herbal Materia Medica ​[[Master Herbalist Certification]] [[Course Code]] [[HRB301]]
----- +
-Return to the list of [[Ayurvedic herbs]], [[Chinese herbs]], [[Western herbs]] or of Ayurvedic Consultations ​[[CLN301]]+
  
-See Ayurveda Chinese Western Herbal Materia Medica ​[[Master Herbalist Certification]] [[Course Code]]+According to the [[Centers for Disease Control and Prevention]], '''​Asthma'''​ is "a chronic medical condition where the [[bronchial tubes]] (in the [[lungs]]) become easily irritated. ​ This leads to constriction of the airways resulting in wheezing, coughing, difficulty breathing and production of thick mucus. The cause of asthma is not yet known but environmental triggers, [[drugs]], [[allergies]],​ [[exercise]],​ [[infection]],​ and [[stress]] have all been implicated."<​ref>​http://​www.cdc.gov/​vaccines/​about/​terms/​glossary.htm</​ref>​ There is also strong correlating evidence of a genetic defect. ​
  
-[[HRB301]]+==Complementary Medicine Treatment== 
 +* Use [[Sitopaladi]] for [[Vata]] and [[Pitta]] type of asthma 
 +* Use [[Talisadi]] for [[Kapha]] type of asthma 
 +* Use [[meditation]] and [[pranayama]]
  
-----+==External Links== 
 +* Search [[wp>​MedLine]] [[wp>​PubMed]] for Piper longum ([[wp>​Latin]] [[wp>​Botanical name]]) http://​www.ncbi.nlm.nih.gov/​entrez/​query.fcgi?​cmd=Search&​db=PubMed&​term=Piper%20longum
  
 +==References==
 +<​references/>​
  
-[[wp>​Asthma]] +[[Category:​Diseases]] 
- +[[Category:​Asthma| ​]] 
-Search ​[[wp>​MedLine]] [[wp>​PubMed]] for Piper longum ([[wp>Latin]] [[wp>​Botanical name]]) http://​www.ncbi.nlm.nih.gov/​entrez/​query.fcgi?​cmd=Search&​db=PubMed&​term=Piper%20longum +[[Category:​Chronic Lower Respiratory Diseases]] 
- +[[Category:​Respiratory Therapy]]
-http://​ayurveda-tcm.com/​ayurvedic-chinese-medicine-distance-learning/​doku.php?​id=asthma+
  
 +----
 ASTHMA ASTHMA
 svasam svasam
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 adjust the sympathetic and parasympathetic nervous system in order to expand the walls of the airways ​ adjust the sympathetic and parasympathetic nervous system in order to expand the walls of the airways ​
 reduce and withdraw mucus and phlegm ​ reduce and withdraw mucus and phlegm ​
- increase the capacity of the lungs + increase the capacity of the lungs 
 In most of the cases, acupuncture and Chinese herbs are very effective. After a series of treatments, asthmatic symptoms such as wheezing, coughing, chest tightness and shortness of breath are reduced. The frequency of an asthmatic episode can also be minimized. In fact, many people can usually resume an active lifestyle. ​ In most of the cases, acupuncture and Chinese herbs are very effective. After a series of treatments, asthmatic symptoms such as wheezing, coughing, chest tightness and shortness of breath are reduced. The frequency of an asthmatic episode can also be minimized. In fact, many people can usually resume an active lifestyle. ​
 The symptoms of asthma can vary. Some people may have only slight chest tightness or coughing and wheezing, while some may have even more serious symptoms such as, shortness of breath and other breathing difficulties. It can be life threatening during a serious attack! The airways can become so constricted that not enough oxygen can get to your vital organs. Therefore, you should always keep a quick-relief inhaler with you at all times, even if your symptoms are under control. Please remember that asthma is about long-term management. Get check ups and treatments regularly. Contact your acupuncturist about an asthma treatment plan. You should always try to keep your environment under control. Prevent asthmatic triggers, such as household dust mites, pets, smoke, mold, pollens and high humidity. Prevent and treat common colds and respiratory viral infections in their early stages. Also, watch your diet and try to avoid dairy and sugar. It is also wise to manage your stress levels. Take action now. You could control asthma. Do not let asthma control you. The symptoms of asthma can vary. Some people may have only slight chest tightness or coughing and wheezing, while some may have even more serious symptoms such as, shortness of breath and other breathing difficulties. It can be life threatening during a serious attack! The airways can become so constricted that not enough oxygen can get to your vital organs. Therefore, you should always keep a quick-relief inhaler with you at all times, even if your symptoms are under control. Please remember that asthma is about long-term management. Get check ups and treatments regularly. Contact your acupuncturist about an asthma treatment plan. You should always try to keep your environment under control. Prevent asthmatic triggers, such as household dust mites, pets, smoke, mold, pollens and high humidity. Prevent and treat common colds and respiratory viral infections in their early stages. Also, watch your diet and try to avoid dairy and sugar. It is also wise to manage your stress levels. Take action now. You could control asthma. Do not let asthma control you.
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-Fair Use Compilation Sources for the Above Material on the Teachings of the [[Buddha]] [[Dharma]] and [[Sangha]]:+---- 
 +{{wp>​Asthma}}
  
 +'''​Asthma'''​ (from the Greek ἅσθμα,​ ''​ásthma'',​ "​panting"​) ​ is a common [[chronic (medicine)|chronic]] [[inflammation|inflammatory]] [[disease]] of the [[bronchi|airways]] characterized by variable and recurring symptoms, reversible [[Airway obstruction|airflow obstruction]] and [[bronchospasm]].<​ref name=NHLBI07p11-12>​{{harvnb|NHLBI Guideline|2007|pp=11–12}}</​ref>​ Common symptoms include [[wheezing]],​ [[coughing]],​ chest tightness, and [[shortness of breath]].<​ref name=bts2009p4>​{{harvnb|British Guideline|2009|p=4}}</​ref>​
  
 +Asthma is thought to be caused by a combination of [[Genetics|genetic]] and [[environmental factor]]s.<​ref name=Martinez_geneenvir>​{{cite journal |author=Martinez FD |title=Genes,​ environments,​ development and asthma: a reappraisal |journal=European Respiratory Journal |volume=29 |issue=1 |pages=179–84 |year=2007 |pmid=17197483 |doi=10.1183/​09031936.00087906}}</​ref>​ Its [[medical diagnosis|diagnosis]] is usually based on the pattern of symptoms, response to therapy over time and [[spirometry]].<​ref name=lemanske>​{{cite journal |last1=Lemanske |first1=R.F. |last2=Busse |first2=W.W. |title=Asthma:​ clinical expression and molecular mechanisms|journal=J. Allergy Clin. Immunol. |volume=125 |issue=2 Suppl 2 |pages=S95–102 |date=February 2010|pmid=20176271 |pmc=2853245 |doi=10.1016/​j.jaci.2009.10.047 }}</​ref>​ It is clinically classified according to the frequency of symptoms, forced expiratory volume in one second ([[Spirometry|FEV1]]),​ and [[peak expiratory flow rate]].<​ref name=Yawn2008/>​ Asthma may also be classified as [[Atopy|atopic]] (extrinsic) or non-atopic (intrinsic)<​ref name=RobbinsCotran2010/>​ where atopy refers to a predisposition toward developing [[type 1 hypersensitivity]] reactions.<​ref>​{{cite book | title=Stedman'​s Medical Dictionary | publisher=Lippincott Williams and Wilkins | edition=28 | year=2005 | isbn=0-7817-3390-1 }}</​ref>​
  
-Click here for a list of [[Buddhist Distance Learning Programs]] without Ayurveda included.+Treatment ​of acute symptoms is usually with an inhaled short-acting ​[[Beta2-adrenergic agonist|beta-2 agonist]] (such as [[salbutamol]]) and oral [[corticosteroids]].<​ref name=NHLBI07p214>​{{harvnb|NHLBI Guideline|2007|p=214}}</​ref>​ In very severe cases, intravenous corticosteroids,​ [[magnesium sulfate]], and hospitalization may be required.<​ref name=NHLBI07p373>​{{harvnb|NHLBI Guideline|2007|pp=373–375}}</​ref>​ Symptoms can be prevented by avoiding triggers, such as [[allergens]]<​ref name="​NHLBI07p169">​{{harvnb|NHLBI Guideline|2007|pp=169–172}}</​ref>​ and [[irritation|irritants]],​ and by the use of inhaled corticosteroids.<​ref name=GINA_2011_page71>​{{harvnb|GINA|2011|p=71}}</​ref>​ [[Long-acting beta-adrenoceptor agonist|Long-acting beta agonists]] (LABA) or [[antileukotriene agent]]s may be used in addition to inhaled corticosteroids if asthma symptoms remain uncontrolled.<​ref name=GINA_2011_page33>​{{harvnb|GINA|2011|p=33}}</​ref><​ref name="​Antileukotriene agents">​{{cite journal | author = Scott JP, Peters-Golden M | title = Antileukotriene agents for the treatment of lung disease | journal = Am. J. Respir. Crit. Care Med. | volume = 188 | issue = 5 | pages = 538–544 | date = September 2013 | pmid = 23822826 | doi = 10.1164/​rccm.201301-0023PP | url = }}</​ref>​ The occurrence of asthma has increased significantly since the 1970s. In 2011, 235–300 million people globally were diagnosed with asthma,<​ref name=WHO2011/><​ref name=GINA_2011_page3/>​ and it caused 250,000 deaths.<ref name=GINA_2011_page3>​{{harvnb|GINA|2011|p=3}}</​ref>​ 
 +{{TOC limit|limit=3}}
  
----- +=={{anchor|Asthma attack}}Signs and symptoms== 
-----+{{listen 
 + | filename ​    = 
 +Wheeze2O noise reduced.ogg ​  | title        = Wheezing 
 + | description ​ = The sound of wheezing as heard with a stethoscope. 
 + | format ​      = [[Ogg]] 
 +}} 
 +Asthma is characterized by recurrent episodes of [[wheezing]],​ [[shortness of breath]], chest tightness, and [[cough]]ing.<​ref name=GINA2011p2>​{{harvnb|GINA|2011|pp=2–5}}</​ref>​ [[Sputum]] may be produced from the lung by coughing but is often hard to bring up.<​ref>​{{cite book|last=Jindal|first=editor-in-chief SK|title=Textbook of pulmonary and critical care medicine|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|year=2011|isbn=978-93-5025-073-0|page=242|url=https://​books.google.com/​books?​id=EvGTw3wn-zEC&​pg=PA242}}</​ref>​ During recovery from an attack, it may appear [[pus|pus-like]] due to high levels of white blood cells called [[eosinophils]].<​ref>​{{cite book|last=George|first=Ronald B.|title=Chest medicine : essentials of pulmonary and critical care medicine|year=2005|publisher=Lippincott Williams & Wilkins|location=Philadelphia,​ PA|isbn=978-0-7817-5273-2|page=62|url=https://​books.google.com/​books?​id=ZzlX2zJMbdgC&​pg=PA62|edition=5th}}</​ref>​ Symptoms are usually worse at night and in the early morning or in response to exercise or cold air.<ref name=bts2009p14>​{{harvnb|British Guideline|2009|p=14}}</​ref>​ Some people with asthma rarely experience symptoms, usually in response to triggers, whereas others may have marked and persistent symptoms.<​ref name=GINA2011_p8-9>​{{harvnb|GINA|2011|pp=8–9}}</​ref>​
  
-For affordable donation-only extensive Buddhist Ayurveda Traditional Chinese Medicine (TCM) Distance Learning Program Certification,​ call Medicine Buddha Healing Center at 1-510-292-6696.+===Associated conditions===
  
-The [[non-profit]] [[Ayurveda Healing Arts Institute]] (part of the [[Medicine Buddha Healing Center]]offers affordable yet comprehensive ​[[distance learning]] (online ​[[correspondence course]] with regular phone support) and in-person ​[[apprenticeship]] formats leading to specialized Indian ​and Tibetan Ayur-Vedic Herbal ​[[Certifications]] and Ayur-Veda [[Diplomas]].+A number of other health conditions occur more frequently in those with asthma, including ​[[gastro-esophageal reflux disease]] (GERD)[[rhinosinusitis]], and [[obstructive sleep apnea]].<ref name=Boulet2009>​{{cite journal |author=Boulet LP |title=Influence of comorbid conditions on asthma |journal=European Respiratory Journal |volume=33 |issue=4 |pages=897–906 |date=April 2009 |pmid=19336592 |doi=10.1183/​09031936.00121308 }}</​ref>​ Psychological disorders are also more common,<​ref name=Boulay2011>​{{cite journal|last=Boulet|first=LP|author2=Boulay,​ MÈ|title=Asthma-related comorbidities|journal=Expert review of respiratory medicine|date=June 2011|volume=5|issue=3|pages=377–93|pmid=21702660|doi=10.1586/​ers.11.34|ref=harv}}</​ref>​ with [[anxiety disorder]]s occurring in between 16–52% ​and [[mood disorder]]s in 14–41%.<​ref name=Andrew2010>​{{cite book|last=editors|first=Andrew Harver, Harry Kotses,​|title=Asthma,​ health ​and society a public health perspective|year=2010|publisher=Springer|location=New York|isbn=978-0-387-78285-0|page=315|url=https://​books.google.com/​books?​id=nkP8_h_ewLMC&​pg=PA315}}</​ref>​ However, it is not known if asthma causes psychological problems or if psychological problems lead to asthma.<​ref>​{{cite journal|last=Thomas|first=M|author2=Bruton,​ A; Moffat, M; Cleland, J|title=Asthma and psychological dysfunction|journal=Primary care respiratory journal : journal of the General Practice Airways Group|date=September 2011|volume=20|issue=3|pages=250–6|pmid=21674122|doi=10.4104/​pcrj.2011.00058|ref=harv}}</​ref>​ Those with asthma, especially if it is poorly controlled, are at high risk for [[radiocontrast]] reactions.<​ref>​{{cite book|last1=Webb|first1=edited by Henrik S. Thomsen, Judith A. W.|title=Contrast media : safety issues and ESUR guidelines.|date=2014|publisher=Springer|location=Dordrecht|isbn=978-3-642-36724-3|page=54|edition=Third|url=https://​books.google.ca/​books?​id=W1O-BAAAQBAJ&​pg=PA54}}</​ref>​
  
-• Taught by highly experienced degreed [[faculty]] clinicians and scholars. Our [[main teacher]] has served over 5800 patients since 1996, 1900 patients with Dr. [[Vasant Lad]] during his formal six-year, 1800 hour clinical apprenticeship.+==Causes==
  
-• The most comprehensive Clinical ​[[multimedia]] audio and [[HDTV]] video-based Ayurvedic ​[[distance learning]] program on the Planet.+Asthma is caused by a combination of complex and incompletely understood environmental and genetic interactions.<​ref name=Martinez_geneenvir/><​ref>​{{cite journal | last=Miller | first=RL |author2=Ho SM|title=Environmental epigenetics and asthma: current concepts and call for studies | journal=American Journal of Respiratory and Critical Care Medicine | volume=177 | issue=6 | pages=567–573 |date=March 2008 | pmid=18187692| doi=10.1164/​rccm.200710-1511PP | pmc=2267336 }}</​ref>​ These factors influence both its severity and its responsiveness to treatment.<​ref>​{{cite journal |author=Choudhry S, Seibold MA, Borrell LN ""​ |title=Dissecting complex diseases in complex populations:​ asthma in latino americans |journal=Proc Am Thorac Soc |volume=4 |issue=3 |pages=226–33 |year=2007 |pmid=17607004 |doi=10.1513/​pats.200701-029AW |pmc=2647623|author2=and others |displayauthors=1 }}</​ref>​ It is believed that the recent increased rates of asthma are due to changing ​[[epigenetic]]s ([[heritable]] factors other than those related to the [[DNA sequence]]) and a changing living environment.<​ref name="​pmid21575714">​{{cite journal|last=Dietert|first=RR|title=Maternal and childhood asthma: risk factors, interactions,​ and ramifications|journal=Reproductive toxicology (Elmsford, N.Y.)|date=September 2011|volume=32|issue=2|pages=198–204|pmid=21575714|doi=10.1016/​j.reprotox.2011.04.007|ref=harv}}</​ref>​
  
-• [[MP3]] recordings of over 1000 [[Patient Consultations]] for Clinical Experience. Searchable database of photographs of [[tongue diagnosis]] and [[iPod]] - [[iPhone]] compatible audio files of our [[main Berkeley Ayurvedic Practitioner]]'​s client visits.+===Environmental===
  
-• The [[Ayurveda Healing Arts Institute]] is currently the only educational program ​in the world to offer such an extensive collection of organized Ayurvedic ​[[clinical research]] of patient ​[[case studies]] (over 1500 hours worth of consultation audio recordings).+{{See also|Asthma-related microbes}} 
 +Many environmental factors have been associated with asthma'​s development and exacerbation including allergens, air pollution, and other environmental chemicals.<​ref name="​pmid21623970">​{{cite journal|last=Kelly|first=FJ|author2=Fussell,​ JC|title=Air pollution and airway disease|journal=Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology|date=August 2011|volume=41|issue=8|pages=1059–71|pmid=21623970|doi=10.1111/​j.1365-2222.2011.03776.x|ref=harv}}</​ref> ​[[Smoking and pregnancy|Smoking during pregnancy]] and after delivery ​is associated with a greater risk of asthma-like symptoms.<​ref name=GINA2011_p6>​{{harvnb|GINA|2011|p=6}}</​ref>​ Low [[air Quality Index|air quality]] from factors such as traffic pollution or high [[ozone]] levels,<​ref name=GINA2011_p61>​{{harvnb|GINA|2011|p=61}}</​ref>​ has been associated with both asthma development and increased asthma severity.<​ref name=Gold>​{{cite journal |last1=Gold |first1=D.R. |last2=Wright |first2=R. |title=Population disparities ​in asthma |journal=Annu Rev Public Health |volume=26 |pages=89–113|year=2005 |pmid=15760282 |doi=10.1146/​annurev.publhealth.26.021304.144528 }}</​ref>​ Exposure ​to indoor ​[[volatile organic compounds]] may be a trigger for asthma; [[formaldehyde]] exposure, for example, has a positive association.<​ref name="​pmid20064771">​{{cite journal|last=McGwin|first=G|author2=Lienert,​ J; Kennedy, JI|title=Formaldehyde exposure and asthma in children: a systematic review|journal=Environmental health perspectives|date=March 2010|volume=118|issue=3|pages=313–7|pmid=20064771|doi=10.1289/​ehp.0901143|pmc=2854756|ref=harv}}</​ref>​ Also, [[phthalates]] in certain types of [[PVC]] are associated with asthma in children and adults.<​ref>​{{cite journal |last1=Jaakkola |first1=J.J. |last2=Knight |first2=T.L. |title=The role of exposure to phthalates from polyvinyl chloride products in the development of asthma and allergies: a systematic review and meta-analysis|journal= Environ Health Perspect |volume=116 |issue=7 |pages=845–53 |date=July 2008 |pmid=18629304 |pmc=2453150 |doi=10.1289/​ehp.10846 }}</​ref><​ref name="​pmid20059582">​{{cite journal|last=Bornehag|first=CG|author2=Nanberg,​ E|title=Phthalate exposure and asthma in children|journal=International journal of andrology|date=April 2010|volume=33|issue=2|pages=333–45|pmid=20059582|doi=10.1111/​j.1365-2605.2009.01023.x|ref=harv}}</​ref>​
  
-----+There is an association between [[acetaminophen]] (paracetamol) use and asthma.<​ref name=Henderson>​{{cite journal|last=Henderson|first=AJ|author2=Shaheen,​ SO|title=Acetaminophen and asthma.|journal=Paediatric Respiratory Reviews|date=Mar 2013|volume=14|issue=1|pages=9–15;​ quiz 16|pmid=23347656|doi=10.1016/​j.prrv.2012.04.004}}</​ref>​ The majority of the evidence does not, however, support a causal role.<​ref>​{{cite journal|last=Heintze|first=K|author2=Petersen,​ KU |title=The case of drug causation of childhood asthma: antibiotics and paracetamol.|journal=European journal of clinical pharmacology|date=Jun 2013|volume=69|issue=6|pages=1197–209|pmid=23292157|doi=10.1007/​s00228-012-1463-7|pmc=3651816}}</​ref>​ A 2014 review found that the association disappeared when respiratory infections were taken into account.<​ref>​{{cite journal|last1=Cheelo|first1=M|last2=Lodge|first2=CJ|last3=Dharmage|first3=SC|last4=Simpson|first4=JA|last5=Matheson|first5=M|last6=Heinrich|first6=J|last7=Lowe|first7=AJ|title=Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: a systematic review and meta-analysis.|journal=Archives of Disease in Childhood|date=26 November 2014|pmid=25429049|doi=10.1136/​archdischild-2012-303043|volume=100|pages=81–9}}</​ref>​ Use by a mother during pregnancy is also associated with an increased risk.<​ref>​{{cite journal|last=Eyers|first=S|author2=Weatherall,​ M |author3=Jefferies,​ S |author4= Beasley, R |title=Paracetamol in pregnancy and the risk of wheezing in offspring: a systematic review and meta-analysis.|journal=Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology|date=Apr 2011|volume=41|issue=4|pages=482–9|pmid=21338428|doi=10.1111/​j.1365-2222.2010.03691.x}}</​ref>​
  
-http://www.archive.org/details/​ayurveda_institute +<​!--Allergens ​ --> 
-http://www.archive.org/search.php?query=HRB108 +Asthma is associated with exposure to indoor allergens.<ref name="​pmid21301330">​{{cite journal|last=Ahluwalia|first=SK|author2=Matsui,​ EC|title=The indoor environment and its effects on childhood asthma|journal=Current Opinion in Allergy and Clinical Immunology|date=April 2011|volume=11|issue=2|pages=137–43|pmid=21301330|doi=10.1097/ACI.0b013e3283445921|ref=harv}}<​/ref> Common indoor allergens include [[dust mite]]s, [[cockroach]]es,​ animal dander, and mold.<ref name=Arshad>​{{cite journal|last=Arshad|first=SH|title=Does exposure to indoor allergens contribute to the development of asthma and allergy?|journal=Current allergy and asthma reports|date=January 2010|volume=10|issue=1|pages=49–55|pmid=20425514|doi=10.1007/s11882-009-0082-6}}<​/ref><​ref>​{{cite journal|last=Custovic|first=A|author2=Simpson,​ A|title=The role of inhalant allergens in allergic airways disease|journal=Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunologia|year=2012|volume=22|issue=6|pages=393–401;​ qiuz follow 401|pmid=23101182}}<​/ref> Efforts to decrease dust mites have been found to be ineffective.<ref name=Gotzsche2008/> Certain viral respiratory infections, such as [[respiratory syncytial virus]] and [[rhinovirus]],<​ref name=M38/> may increase the risk of developing asthma when acquired as young children.<ref name=NHLBI07p11>​{{harvnb|NHLBI Guideline|2007|p=11}}<​/ref> Certain other infections, however, may decrease the risk.<ref name=M38/>
-http://www.archive.org/search.php?query=AYR220 +
-http://www.archive.org/search.php?query=CLN301+
  
-To enroll as an [[Apprenticeship]] Intern Student, please see http://​Ayurveda-TCM.com/​videos+====Hygiene hypothesis====
  
-http://www.youtube.com/user/AyurvedicMedicine ​9 minute Indo-Tibetan Medicine Video Clips -- Do please Subscribe to our Ayurved Channel ​on YouTube!+The [[hygiene hypothesis]] attempts to explain the increased rates of asthma worldwide as a direct and unintended result of reduced exposure, during childhood, to non-pathogenic bacteria and viruses.<​ref>​{{cite journal| last=Ramsey | first=CD |author2=Celedón JC | title=The hygiene hypothesis and asthma | journal=Current Opinion in Pulmonary Medicine| volume=11 | issue=1 | pages=14–20 |date=January 2005 | pmid=15591883 | doi=10.1097/01.mcp.0000145791.13714.ae }}</ref><​ref>​{{cite journal | last=Bufford | first=JD |author2=Gern JE | title=The hygiene hypothesis revisited | journal=Immunology and Allergy Clinics of North America | volume=25 | issue=2 | pages=247–262 |date=May 2005 | pmid=15878454 | doi=10.1016/​j.iac.2005.03.005 }}</ref> It has been proposed that the reduced exposure to bacteria and viruses is due, in part, to increased cleanliness and decreased family size in modern societies.<​ref name=Brook2013>​{{cite journal|last=Brooks|first=C|author2=Pearce,​ N |author3=Douwes,​ J |title=The hygiene hypothesis in allergy and asthma: an update|journal=Current Opinion in Allergy and Clinical Immunology|date=February 2013|volume=13|issue=1|pages=70–7|pmid=23103806|doi=10.1097/ACI.0b013e32835ad0d2}}</​ref>​ Exposure to bacterial [[endotoxin]] in early childhood may prevent the development of asthma, but exposure at an older age may provoke bronchoconstriction.<​ref>​{{cite journal|last=Rao|first=D|author2=Phipatanakul,​ W|title=Impact of environmental controls on childhood asthma.|journal=Current allergy and asthma reports|date=October 2011|volume=11|issue=5|pages=414–20|pmid=21710109|doi=10.1007/​s11882-011-0206-7}}</​ref>​ Evidence supporting the hygiene hypothesis includes lower rates of asthma ​on farms and in households with pets.<​ref name=Brook2013/>​
  
-http://Ayurvedic.blip.tv +Use of [[antibiotic]]s in early life has been linked to the development of asthma.<​ref>​{{cite journal|last=Murk|first=W|author2=Risnes,​ KR|author3=Bracken,​ MB|title=Prenatal or early-life exposure to antibiotics and risk of childhood asthmaa systematic review|journal=Pediatrics|date=June 2011|volume=127|issue=6|pages=1125–38|pmid=21606151|doi=10.1542/peds.2010-2092}}<​/ref> Also, delivery via [[caesarean section]] is associated with an increased risk (estimated at 20–80%) of asthma—this increased risk is attributed to the lack of healthy bacterial colonization that the newborn would have acquired from passage through the birth canal.<​ref>​{{harvnb|British Guideline|2009|p=72}}<​/ref><​ref name="​pmid21645799">​{{cite journal|last=Neu|first=J|author2=Rushing,​ J|title=Cesarean versus vaginal deliverylong-term infant outcomes and the hygiene hypothesis|journal=Clinics in perinatology|date=June 2011|volume=38|issue=2|pages=321–31|pmid=21645799|doi=10.1016/j.clp.2011.03.008|pmc=3110651}}<​/ref> There is a link between asthma and the degree of affluence.<ref name="​pmid14763924">​{{cite journal|last=Von Hertzen|first=LC|author2=Haahtela,​ T|title=Asthma and atopy -the price of affluence?​|journal=Allergy|date=February 2004|volume=59|issue=2|pages=124–37|pmid=14763924|doi=10.1046/j.1398-9995.2003.00433.x}}</ref>
-http://vimeo.com/ayurveda +
-http://www.flickr.com/photos/​ayurvedic +
-http://www.myspace.com/ayurvedic_college+
  
 +===Genetic===
  
 +{| class="​wikitable"​ style = "​float:​ right; margin-left:​15px;​ text-align:​center"​
 +|+ CD14-endotoxin interaction based on CD14 SNP C-159T<​ref name=Martinez_CD14 />
 +|-
 +! Endotoxin levels !! CC genotype !! TT genotype
 +|-
 +! High exposure
 +| Low risk || High risk
 +|-
 +! Low exposure
 +|High risk || Low risk
 +|}
 +Family history is a risk factor for asthma, with many different genes being implicated.<​ref name=El2010>​{{cite book|last=Elward|first=Graham Douglas, Kurtis S.|title=Asthma|year=2010|publisher=Manson Pub.|location=London|isbn=978-1-84076-513-7|pages=27–29|url=https://​books.google.com/​books?​id=gS4BsugTBvoC&​pg=PA27}}</​ref>​ If one identical twin is affected, the probability of the other having the disease is approximately 25%.<ref name=El2010/>​ By the end of 2005, 25 genes had been associated with asthma in six or more separate populations,​ including [[Glutathione S-transferase Mu 1|GSTM1]], [[Interleukin 10|IL10]], [[CTLA-4]], [[SPINK5]], [[Leukotriene C4 synthase|LTC4S]],​ [[Interleukin-4 receptor|IL4R]] and [[ADAM33]], among others.<​ref name=Hoffjan/>​ Many of these genes are related to the immune system or modulating inflammation. Even among this list of genes supported by highly replicated studies, results have not been consistent among all populations tested.<​ref name=Hoffjan />  In 2006 over 100 [[gene]]s were associated with asthma in one [[genetic association]] study alone;<​ref name=Hoffjan>​{{cite journal |author=Ober C, Hoffjan S |title=Asthma genetics 2006: the long and winding road to gene discovery |journal=Genes Immun |volume=7 |issue=2 |pages=95–100 |year=2006 |pmid=16395390 |doi=10.1038/​sj.gene.6364284 }}</​ref>​ more continue to be found.<​ref name="​pmid20298365">​{{cite journal|last=Halapi|first=E|author2=Bjornsdottir,​ US|title=Overview on the current status of asthma genetics|journal=The clinical respiratory journal|date=January 2009|volume=3|issue=1|pages=2–7|pmid=20298365|doi=10.1111/​j.1752-699X.2008.00119.x}}</​ref>​
  
-[[Dedication of Merit]] +Some genetic variants may only cause asthma when they are combined with specific environmental exposures.<​ref name=Martinez_geneenvir /> An example is a specific ​[[single nucleotide polymorphism]] in the [[CD14]] region and exposure to [[endotoxin]] (a bacterial product). Endotoxin exposure can come from several environmental sources including tobacco smoke, dogs, and farms. Risk for asthma, then, is determined by both a person'​s genetics and the level of endotoxin exposure.<​ref name=Martinez_CD14>​{{cite journal |author=Martinez FD |title=CD14,​ endotoxin, and asthma risk: actions and interactions |journal=Proc Am Thorac Soc |volume=4 |issue=3 |pages=221–5 |year=2007 |pmid=17607003 |doi=10.1513/​pats.200702-035AW |pmc=2647622}}</​ref>​
-[[Contents]]  ​|  ​[[Main Page]] -  +
-[[Ayurvedic Distance Learning Programs]] - [[Ayurveda Correspondence Courses]]+
  
-http://​Ayurveda-TCM.com/​ayurvedic-chinese-medicine-distance-learning+===Medical conditions===
  
-http://CorrespondenceCourse.Ayurveda-DistanceLearning.com+A triad of [[atopic eczema]], [[allergic rhinitis]] and asthma is called atopy.<​ref name="​Bolognia"​/> The strongest risk factor for developing asthma is a history of [[atopy|atopic disease]];<​ref name=NHLBI07p11/> with asthma occurring at a much greater rate in those who have either [[eczema]] or [[rhinitis|hay fever]].<ref name=GINA2011_p4>​{{harvnb|GINA|2011|p=4}}</​ref>​ Asthma has been associated with [[Churg–Strauss syndrome]], an autoimmune disease and [[vasculitis]]. Individuals with certain types of [[urticaria]] may also experience symptoms of asthma.<​ref name="​Bolognia">​{{cite book |author=Rapini,​ Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L.|title=Dermatology:​ 2-Volume Set |publisher=Mosby |location=StLouis |year=2007 |isbn=1-4160-2999-0 }}</​ref>​
  
-http://www.Ayurveda-School.net  ​ ​http:/​/www.Bhaisajya-Guru.com +There is a correlation between [[obesity]] and the risk of asthma with both having increased in recent years.<​ref>​{{cite journal |author=Beuther DA |title=Recent insight into obesity and asthma |journal=Current Opinion in Pulmonary Medicine|volume=16 |issue=1 |pages=64–70 |date=January 2010 |pmid=19844182 |doi=10.1097/MCP.0b013e3283338fa7}}<​/ref><​ref name=holguin>​{{cite journal |author=Holguin F, Fitzpatrick A |title=Obesity,​ asthma, and oxidative stress|journal=JAppl. Physiol. |volume=108 |issue=3 |pages=754–9 |date=March 2010 |pmid=19926826|doi=10.1152/japplphysiol.00702.2009 }}</​ref>​ Several factors may be at play including decreased respiratory function due to a buildup of fat and the fact that adipose tissue leads to a pro-inflammatory state.<​ref name="​Woods 2009">​{{cite journal |author=Wood LG, Gibson PG |title=Dietary factors lead to innate immune activation in asthma |journal=Pharmacol. Ther.|volume=123 |issue=1 |pages=37–53 |date=July 2009 |pmid=19375453|doi=10.1016/​j.pharmthera.2009.03.015 }}</​ref>​
-----+
  
-http://www.Nalanda-University.com  ​ http://www.BhaisajyaGuru.com+[[Beta blocker]] medications such as [[propranolol]] can trigger asthma in those who are susceptible.<​ref name="​pmid17998992">​{{cite journal|author=O'​Rourke ST |title=Antianginal actions of beta-adrenoceptor antagonists |journal=Am J Pharm Educ |volume=71|issue=5 |page=95 |date=October 2007 |pmid=17998992 |pmc=2064893|doi=10.5688/aj710595 }}</ref> [[Cardioselective beta-blockers]],​ however, appear safe in those with mild or moderate disease.<​ref>​{{cite journal|last1=Salpeter|first1=S|last2=Ormiston|first2=T|last3=Salpeter|first3=E|title=Cardioselective beta-blockers for reversible airway disease.|journal=The Cochrane database of systematic reviews|date=2002|issue=4|pages=CD002992|pmid=12519582}}</​ref><​ref>​{{cite journal|last=Morales|first=DR|author2=Jackson,​ C |author3=Lipworth,​ BJ |author4=Donnan,​ PT |author5= Guthrie, B |title=Adverse respiratory effect of acute beta-blocker exposure in asthmaa systematic review and meta-analysis of randomized controlled trials.|journal=Chest|date=Nov 7, 2013|pmid=24202435 |doi=10.1378/chest.13-1235 |volume=145 |issue=4 |pages=779–86}}<​/ref> Other medications that can cause problems in asthmatics are [[angiotensin-converting enzyme inhibitors]],​ [[Acetylsalicylic acid|aspirin]],​ and [[NSAIDs]].<ref name="​pmid15579370">​{{cite journal|last=Covar|first=RA|author2=Macomber,​ BA |author3=Szefler,​ SJ |title=Medications as asthma triggers|journal=Immunology and allergy clinics of North America|date=February 2005|volume=25|issue=1|pages=169–90|pmid=15579370|doi=10.1016/​j.iac.2004.09.009}}</​ref>​
  
----- +===Exacerbation===
-----+
  
-The [[Dharma]] is a Priceless [[Jewel]],  +Some individuals will have stable asthma for weeks or months ​and then suddenly develop an episode ​of acute asthma. Different individuals react to various factors in different ways.<​ref name=Baxi2010>​{{cite journal |author=Baxi SN, Phipatanakul W |title=The role of allergen exposure and avoidance ​in asthma |journal=Adolesc Med State Art Rev |volume=21 |issue=1 |pages=57–71,​ viii–ix |date=April 2010 |pmid=20568555 |pmc=2975603 }}</​ref>​ Most individuals can develop severe exacerbation from number of triggering agents.<ref name=Baxi2010/>​
-thus these research compilations of [[Ayurveda Dharma]] +
-and audio and video teaching materials are  +
-[[offered]] [[free-of-charge]] by this [[anonymous]] practitioner +
-for the [[Bodhi Resolve benefit]] ​of [[All Sentient Beings]] ​in the [[Universe]] +
-under [[Creative Commons License]].+
  
-The rights ​to textual segments ("​quotedparaphrased,​ or excerpted"​of the are owned by the [[author-publisher]] indicated ​in the brackets next to each segment ​and are make available and commented on (under the "[[shastra]] tradition"​) under [[Fair Use]]. For rights regarding ​the Buddhist Encyclopaedia - Glossary - Dictionary compilation as a whole, please know that it is offered under this [[Creative Commons License]]:  +Home factors that can lead to exacerbation of asthma include [[dust]]animal [[dander]] (especially cat and dog hair), cockroach ​[[allergen]]s and [[mold]].<​ref name=Baxi2010/><​ref>​{{cite journal|last1=Sharpe|first1=RA|last2=Bearman|first2=N|last3=Thornton|first3=CR|last4=Husk|first4=K|last5=Osborne|first5=NJ|title=Indoor fungal diversity and asthma: a meta-analysis and systematic review of risk factors.|journal=The Journal of allergy and clinical immunology|date=January 2015|volume=135|issue=1|pages=110–22|pmid=25159468}}</​ref>​ [[Perfume]]s are a common cause of acute attacks ​in women and children. Both [[virus|viral]] and bacterial ​[[infection]]s of the upper respiratory tract can worsen the disease.<​ref name=Baxi2010/>​ Psychological ​[[stress (biological)|stress]] may worsen symptoms—it is thought that stress alters the immune system and thus increases the airway inflammatory response to allergens and irritants.<ref name=Gold/><ref name="​Chen2007">​{{cite journal |author=Chen E, Miller GE |title=Stress and inflammation in exacerbations of asthma|journal=Brain Behav Immun|volume=21 |issue=8 |pages=993–9 |year=2007 |pmid=17493786|doi=10.1016/j.bbi.2007.03.009|pmc=2077080}}<​/ref>
-Attribution-Share Alike 3.0 United States: http://​creativecommons.org/licenses/​by-sa/​3.0/us/  +
-----+
  
-[[Ayurveda Dharma]] is distributed via this [[GNU Free Documentation License]] (FDL) and/or under [[Creative Commons License]] Attribution-Share Alike 3.0 United States: http://​creativecommons.org/licenses/by-sa/3.0/us/​legalcode Since words create our reality (see [[prajna]])there are certain words to avoid: Please see also: [[Words to Avoid]]+==Pathophysiology== 
 +{{Main|Pathophysiology of asthma}} 
 +[[File:Asthma attack-illustration NIH.jpg|thumb|Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.]] 
 +[[File:​Asthma .jpg|thumb|alt=A tissue cross section of the airway showing a stained pink wall and an inside full of white mucous|Obstruction of the lumen of a [[bronchiole]] by mucoid exudate, [[goblet cell]] [[metaplasia]], ​and epithelial ​[[basement membrane]] thickening in a person with asthma.]] 
 +Asthma is the result of chronic [[inflammation]] of the airways which subsequently results in increased contractability of the surrounding [[smooth muscle]]s.<​!-- <ref name=GINA2011p2/>​ --> This among other factors leads to bouts of narrowing of the airway and the classic symptoms of wheezing.<!-- <ref name=GINA2011p2/> --> The narrowing is typically reversible with or without treatment.<!-- <ref name=GINA2011p2/--> Occasionally the airways themselves change.<​ref name=GINA2011p2/> Typical changes in the airways include an increase in [[eosinophils]] and thickening of the [[lamina reticularis]].<!-- <ref name=M38/> --> Chronically the airways'​ smooth muscle may increase in size along with an increase in the numbers of mucous glands.<!-- <ref name=M38/>​ --> Other cell types involved include: ​[[T lymphocytes]], [[macrophages]],​ and [[neutrophils]].<​!-- <ref name=M38/>​ --> There may also be involvement of other components of the [[immune system]] including: [[cytokines]], [[chemokines]],​ [[histamine]],​ and [[leukotrienes]] among others.<​ref name=M38/>​
  
----- +==Diagnosis== 
-----+ 
 +While asthma is a well recognized condition, there is not one universal agreed upon definition.<​ref name=M38/>​ It is defined by the [[Global Initiative for Asthma]] as "a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness,​ chest tightness and coughing particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment"​.<​ref name=GINA2011p2 /> 
 + 
 +There is currently no precise test with the diagnosis typically based on the pattern of symptoms and response to therapy over time.<​ref name=lemanske/><​ref name=M38/>​ A diagnosis of asthma should be suspected if there is a history of: recurrent wheezing, coughing or difficulty breathing and these symptoms occur or worsen due to exercise, viral infections, allergens or air pollution.<​ref name=NAEPP42>​{{harvnb|NHLBI Guideline|2007|p=42}}</​ref>​ [[Spirometry]] is then used to confirm the diagnosis.<​ref name=NAEPP42/>​ In children under the age of six the diagnosis is more difficult as they are too young for spirometry.<​ref name=GINA2011p20>​{{harvnb|GINA|2011|p=20}}</​ref>​ 
 + 
 +===Spirometry=== 
 + 
 +[[Spirometry]] is recommended to aid in diagnosis and management.<​ref name="​AAAAIfive">​{{Cite journal |author1 = American Academy of Allergy, Asthma, and Immunology |author1-link=American Academy of Allergy, Asthma, and Immunology |title=Five things physicians and patients should question |publisher=[[American Academy of Allergy, Asthma, and Immunology]] |work=Choosing wisely: an initiative of the [[ABIM Foundation]] |url=http://​choosingwisely.org/​wp-content/​uploads/​2012/​04/​5things_12_factsheet_AAAAI.pdf |accessdate=August 14, 2012}}</​ref><​ref name="​NIHasthmaguide">​{{cite book |author=Third Expert Panel on the Diagnosis and Management of Asthma |title=Guidelines for the diagnosis and management of asthma |year=2007 |publisher=National Heart, Lung, and Blood Institute (US) |url=http://​www.ncbi.nlm.nih.gov/​books/​NBK7232/​ |id=07-4051}}</​ref>​ It is the single best test for asthma.<​!-- <ref name=M38/>​ --> If the [[FEV1]] measured by this technique improves more than 12% following administration of a [[bronchodilator]] such as [[salbutamol]],​ this is supportive of the diagnosis.<​!-- <ref name=M38/>​ --> It however may be normal in those with a history of mild asthma, not currently acting up.<ref name=M38/>​ As [[caffeine]] is a bronchodilator in people with asthma, the use of caffeine before a lung function test may interfere with the results.<​ref name="​pmid20091514">​{{Cite journal ​ | last1 = Welsh | first1 = EJ. | last2 = Bara | first2 = A. | last3 = Barley | first3 = E. | last4 = Cates | first4 = CJ. | editor1-last = Welsh  | editor1-first = Emma J | title = Caffeine for asthma | journal = Cochrane Database of Systematic Reviews | pages = CD001112 | year = 2010 | doi = 10.1002/​14651858.CD001112.pub2 | pmid = 20091514 }}</​ref>​ [[Single-breath diffusing capacity]] can help differentiate asthma from [[COPD]].<​ref name=M38/>​ It is reasonable to perform spirometry every one or two years to follow how well a person'​s asthma is controlled.<​ref name=NHLBI07p58>​{{harvnb|NHLBI Guideline|2007|p=58}}</​ref>​ 
 + 
 +===Others=== 
 + 
 +The [[methacholine challenge test|methacholine challenge]] involves the inhalation of increasing concentrations of a substance that causes airway narrowing in those predisposed.<​!-- <ref name=M38/> ​--> If negative it means that a person does not have asthma; if positive, however, it is not specific for the disease.<​ref name=M38/>​ 
 + 
 +Other supportive evidence includes: a ≥20% difference in [[peak expiratory flow rate]] on at least three days in a week for at least two weeks, a ≥20% improvement of peak flow following treatment with either salbutamol, inhaled corticosteroids or prednisone, or a ≥20% decrease in peak flow following exposure to a trigger.<​ref>​{{cite journal |author=Pinnock H, Shah R |title=Asthma |journal=BMJ |volume=334 |issue=7598 |pages=847–50 |year=2007 |pmid=17446617 |doi=10.1136/​bmj.39140.634896.BE |pmc=1853223}}</​ref>​ Testing peak expiratory flow is more variable than spirometry, however, and thus not recommended for routine diagnosis.<​!-- <ref name=NAEPP2007p59/>​ --> It may be useful for daily self-monitoring in those with moderate to severe disease and for checking the effectiveness of new medications.<​!-- <ref name=NAEPP2007p59/>​ --> It may also be helpful in guiding treatment in those with acute exacerbations.<​ref name=NAEPP2007p59>​{{harvnb|NHLBI Guideline|2007|p=59}}</​ref>​ 
 + 
 +===Classification=== 
 + 
 +{| class="​wikitable"​ style="​clear:​right;​ float:​right;​ margin-left:​1em;​ text-align:​center"​ 
 +|+ Clinical classification (≥ 12 years old)<ref name=Yawn2008/>​ 
 +|- 
 +! scope="​col"​ style="​width:​6em;"​ | Severity 
 +! scope="​col"​ style="​width:​4em;"​ | Symptom frequency 
 +! scope="​col"​ style="​width:​4em;"​ | Night time symptoms 
 +! scope="​col"​ style="​width:​4em;"​ | %FEV<​sub>​1</​sub>​ of predicted 
 +! scope="​col"​ style="​width:​4em;"​ | FEV<​sub>​1</​sub>​ Variability 
 +! scope="​col"​ style="​width:​4em;"​ | SABA use 
 +|- 
 +! scope="​row"​ | Intermittent 
 +| ≤2/week 
 +| ≤2/​month 
 +| ≥80% 
 +| <20% 
 +| ≤2 days/week 
 +|- 
 +! scope="​row"​ | Mild persistent 
 +| >​2/​week 
 +| 3–4/​month 
 +| ≥80% 
 +| 20–30% 
 +| >2 days/week 
 +|- 
 +! scope="​row"​ | Moderate persistent 
 +| Daily 
 +| >​1/​week 
 +| 60–80% 
 +| >30% 
 +| daily 
 +|- 
 +! scope="​row"​ | Severe persistent 
 +| Continuously 
 +| Frequent (7×/​week) 
 +| <60% 
 +| >30% 
 +| ≥twice/​day 
 +|} 
 +Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in one second ([[spirometry|FEV<​sub>​1</​sub>​]]),​ and [[peak expiratory flow rate]].<​ref name=Yawn2008>​{{cite journal |author=Yawn BP |title=Factors accounting for asthma variability:​ achieving optimal symptom control for individual patients |journal=Primary Care Respiratory Journal |volume=17 |issue=3 |pages=138–147 |date=September 2008 |url=http://​www.thepcrj.org/​journ/​vol17/​17_3_138_147.pdf |archiveurl=http://​www.webcitation.org/​5nySCf5x8 |archivedate=2010-03-04 |pmid=18264646 |doi=10.3132/​pcrj.2008.00004 }}</​ref>​ Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic),​ based on whether symptoms are precipitated by allergens (atopic) or not (non-atopic).<​ref name="​RobbinsCotran2010">​{{cite book |editor1-last=Kumar |editor1-first=Vinay |editor2-last=Abbas |editor2-first=Abul K |editor3-last=Fausto |editor3-first=Nelson |editor4-last=Aster |editor4-first=Jon |displayeditors=4|title=Robbins and Cotran pathologic basis of disease |publisher=Saunders |edition=8th |year=2010 |isbn=978-1-4160-3121-5 |page=688 |oclc=643462931 }}</​ref>​ While asthma is classified based on severity, at the moment there is no clear method for classifying different subgroups of asthma beyond this system.<​ref name=Moore2010>​{{cite journal |author=Moore WC, Pascual RM |title=Update in asthma 2009 |journal=American Journal of Respiratory and Critical Care Medicine |volume=181 |issue=11 |pages=1181–7 |date=June 2010 |pmid=20516492 |doi=10.1164/​rccm.201003-0321UP |pmc=3269238 }}</​ref>​ Finding ways to identify subgroups that respond well to different types of treatments is a current critical goal of asthma research.<​ref name=Moore2010/>​ 
 + 
 +Although asthma is a chronic [[obstructive lung disease|obstructive]] condition, it is not considered as a part of [[chronic obstructive pulmonary disease]] as this term refers specifically to combinations of disease that are irreversible such as [[bronchiectasis]],​ [[chronic bronchitis]],​ and [[emphysema]].<​ref name="​Self,​ Timothy 2009">​{{cite book |editor=Mary Anne Koda-Kimble,​ Brian K Alldredge |author1=Self,​ Timothy |author2=Chrisman,​ Cary |author3=Finch,​ Christopher |title=Applied therapeutics:​ the clinical use of drugs |edition=9th |location=Philadelphia |publisher=Lippincott Williams & Wilkins |year=2009 |chapter=22. Asthma |oclc=230848069 |display-editors=etal}}</​ref>​ Unlike these diseases, the airway obstruction in asthma is usually reversible; however, if left untreated, the chronic inflammation from asthma can lead the lungs to become irreversibly obstructed due to airway remodeling.<​ref name=Delacourt2004>​{{cite journal |last=Delacourt |first=C |title=Conséquences bronchiques de l'​asthme non traité |trans_title=Bronchial changes in untreated asthma |journal=Archives de Pédiatrie |volume=11 |issue=Suppl. 2 |pages=71s–73s |date=June 2004 |pmid=15301800 |doi=10.1016/​S0929-693X(04)90003-6}}</​ref>​ In contrast to [[emphysema]],​ asthma affects the bronchi, not the [[alveoli]].<​ref name=Schiffman2009>​{{cite web|url=http://​www.medicinenet.com/​chronic_obstructive_pulmonary_disease_copd/​article.htm |title=Chronic obstructive pulmonary disease |first=George |last=Schiffman |date=18 December 2009 |publisher=MedicineNet |accessdate=2 September 2010 |archiveurl=https://​web.archive.org/​web/​20100828011049/​http://​www.medicinenet.com/​chronic_obstructive_pulmonary_disease_copd/​article.htm |archivedate= 28 August 2010 |deadurl=no}}</​ref>​ 
 + 
 +====Asthma exacerbation==== 
 + 
 +{| class="​wikitable"​ style="​clear:​right;​ float:​right;​ margin-left:​15px;​ text-align:​center"​ 
 +|+ Severity of an acute exacerbation<​ref name=BTS58/>​ 
 +|- 
 +! style="​border-top:​3px solid darkgrey;"​| Near-fatal 
 +| colspan="​2"​ style="​border-top:​3px solid darkgrey;"​| High [[Arterial blood gas|PaCO<​sub>​2</​sub>​]] and/or requiring mechanical ventilation 
 +|- 
 +! rowspan="​9"​ style="​border-top:​3px solid darkgrey;"​| Life-threatening<​br>​(any one of) 
 +|- 
 +! Clinical signs 
 +! Measurements 
 +|- 
 +| Altered [[level of consciousness]] 
 +| [[Peak flow]] < 33% 
 +|- 
 +| Exhaustion 
 +| [[Oxygen saturation]] < 92% 
 +|- 
 +| [[Arrhythmia]] 
 +| [[Arterial blood gas|PaO<​sub>​2</​sub>​]] < 8 kPa 
 +|- 
 +| Low [[blood pressure]] 
 +| "​Normal"​ PaCO<​sub>​2</​sub>​ 
 +|- 
 +| [[Cyanosis]] 
 +
 +|- 
 +| Silent chest 
 +
 +|- 
 +| Poor respiratory effort 
 +
 +|- 
 +! rowspan="​5"​ style="​border-top:​3px solid darkgrey;"​| Acute severe<​br>​(any one of) 
 +|- 
 +| colspan="​2"​ | Peak flow 33–50% 
 +|- 
 +| colspan="​2"​ | Respiratory rate ≥ 25 breaths per minute 
 +|- 
 +| colspan="​2"​ | Heart rate ≥ 110 beats per minute 
 +|- 
 +| colspan="​2"​ | Unable to complete sentences in one breath 
 +|- 
 +! rowspan="​3"​ style="​border-top:​3px solid darkgrey; border-bottom:​3 px solid darkgrey;"​| Moderate 
 +| colspan="​2"​ style="​border-top:​3px solid darkgrey;"​| Worsening symptoms 
 +|- 
 +| colspan="​2"​ | Peak flow 50–80% best or predicted 
 +|- 
 +| colspan="​2"​ style="​border-bottom:​3 px solid darkgrey;"​| No features of acute severe asthma 
 +|} 
 +An acute asthma exacerbation is commonly referred to as an ''​asthma attack''​. The classic symptoms are [[shortness of breath]], [[wheeze|wheezing]],​ and [[chest tightness]].<​ref name=M38/>​ The wheezing is most often when breathing out.<​ref>​{{cite book|title=Current Review of Asthma|date=2003|publisher=Current Medicine Group|location=London|isbn=978-1-4613-1095-2|page=42|url=https://​books.google.ca/​books?​id=MCEBCAAAQBAJ&​pg=PA42}}</​ref>​ While these are the primary symptoms of asthma,<​ref name=Barnes2008>​{{cite book|last=Barnes |first=PJ |chapter=Asthma |title=Harrison'​s Principles of Internal Medicine|editor1-last=Fauci|editor1-first=Anthony S |editor2-last=Braunwald |editor2-first=E,​ |editor3-last=Kasper|editor3-first=DL |location=New York |publisher=McGraw-Hill |year=2008 |edition=17th |isbn=978-0-07-146633-2|pages=1596–1607}}</​ref>​ some people present primarily with [[cough]]ing,​ and in severe cases, air motion may be significantly impaired such that no wheezing is heard.<​ref name=BTS58/>​ 
 + 
 +Signs which occur during an asthma attack include the use of accessory [[muscle]]s of respiration ([[sternocleidomastoid]] and [[scalene muscles]] of the neck), there may be a [[pulsus paradoxus|paradoxical pulse]] (a pulse that is weaker during inhalation and stronger during exhalation),​ and over-inflation of the chest.<​ref name=Maitre1995>​{{cite journal |author=Maitre B, Similowski T, Derenne JP |title=Physical examination of the adult patient with respiratory diseases: inspection and palpation |journal=European Respiratory Journal |volume=8 |issue=9|pages=1584–93|date=September 1995 |pmid=8575588 |url=http://​erj.ersjournals.com/​content/​8/​9/​1584.long}}</​ref>​ A [[cyanosis|blue color]] of the skin and nails may occur from lack of oxygen.<​ref name=Werner2001>​{{cite journal|last=Werner |first=HA |title=Status asthmaticus in children: a review|journal=Chest |volume=119 |issue=6|pages=1596–1607 |date=June 2001|pmid=11399724|doi=10.1378/​chest.119.6.1913 }}</​ref>​ 
 + 
 +In a mild exacerbation the [[peak expiratory flow rate]] (PEFR) is ≥200&​nbsp;​L/​min or ≥50% of the predicted best.<​ref name=Shiber2006>​{{cite journal |author=Shiber JR, Santana J |title=Dyspnea |journal=Med. Clin. North Am. |volume=90|issue=3 |pages=453–79 |date=May 2006|pmid=16473100 |doi=10.1016/​j.mcna.2005.11.006 }}</​ref>​ Moderate is defined as between 80 and 200&​nbsp;​L/​min or 25% and 50% of the predicted best while severe is defined as ≤&​nbsp;​80 L/min or ≤25% of the predicted best.<​ref name=Shiber2006/>​ 
 + 
 +[[Acute severe asthma]], previously known as status asthmaticus,​ is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and corticosteroids.<​ref name=Shah2012/>​ Half of cases are due to infections with others caused by allergen, air pollution, or insufficient or inappropriate medication use.<ref name=Shah2012>​{{cite journal|last=Shah|first=R|author2=Saltoun,​ CA|title=Chapter 14: Acute severe asthma (status asthmaticus)|journal=Allergy and asthma proceedings : the official journal of regional and state allergy societies|date=May–Jun 2012|volume=33 Suppl 1|issue=3|pages=S47–50|pmid=22794687|doi=10.2500/​aap.2012.33.3547}}</​ref>​ 
 + 
 +[[Brittle asthma]] is a kind of asthma distinguishable by recurrent, severe attacks.<​ref name=BTS58>​{{harvnb|British Guideline|2009|p=54}}</​ref>​ Type 1 brittle asthma is a disease with wide peak flow variability,​ despite intense medication. Type 2 brittle asthma is background well-controlled asthma with sudden severe exacerbations.<​ref name=BTS58/>​ 
 + 
 +====Exercise-induced==== 
 +{{Main|Exercise-induced bronchoconstriction}} 
 +Exercise can trigger [[bronchoconstriction]] both in people with or without asthma.<​ref name=EIB2012>​{{cite journal|last=Khan|first=DA|title=Exercise-induced bronchoconstriction:​ burden and prevalence|journal=Allergy and asthma proceedings : the official journal of regional and state allergy societies|date=Jan–Feb 2012|volume=33|issue=1|pages=1–6|pmid=22370526|doi=10.2500/​aap.2012.33.3507}}</​ref>​ It occurs in most people with asthma and up to 20% of people without asthma.<​ref name=EIB2012/>​ Exercise-induced bronchoconstriction is common in professional athletes. The highest rates are among cyclists (up to 45%), swimmers, and cross-country skiers.<​ref name="​Wuestenfeld">​{{cite journal | last=Wuestenfeld | first=JC | author2=Wolfarth B | title=Special considerations for adolescent athletic and asthmatic patients | journal=Open Access Journal of Sports Medicine | date=Jan 2013 | volume=4 | pages=1&​ndash;​7 | pmid=24379703 | pmc=3871903 | doi=10.2147/​OAJSM.S23438 }}</​ref>​ While it may occur with any weather conditions it is more common when it is dry and cold.<​ref name=GINA_2011_page17>​{{harvnb|GINA|2011|p=17}}</​ref>​ Inhaled beta2-agonists do not appear to improve athletic performance among those without asthma<​ref name="​pmid18394123">​{{cite journal|last=Carlsen|first=KH|author2=Anderson,​ SD; Bjermer, L; Bonini, S; Brusasco, V; Canonica, W; Cummiskey, J; Delgado, L; Del Giacco, SR; Drobnic, F; Haahtela, T; Larsson, K; Palange, P; Popov, T; van Cauwenberge,​ P; European Respiratory,​ Society; European Academy of Allergy and Clinical, Immunology; GA(2)LEN,​|title=Treatment of exercise-induced asthma, respiratory and allergic disorders in sports and the relationship to doping: Part II of the report from the Joint Task Force of European Respiratory Society (ERS) and European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA(2)LEN|journal=Allergy|date=May 2008|volume=63|issue=5|pages=492–505|pmid=18394123|doi=10.1111/​j.1398-9995.2008.01663.x}}</​ref>​ however oral doses may improve endurance and strength.<​ref name="​pmid17241101">​{{cite journal|last=Kindermann|first=W|title=Do inhaled beta(2)-agonists have an ergogenic potential in non-asthmatic competitive athletes?​|journal=Sports medicine (Auckland, N.Z.)|year=2007|volume=37|issue=2|pages=95–102|pmid=17241101|doi=10.2165/​00007256-200737020-00001}}</​ref><​ref name="​pmid21142283">​{{cite journal|last=Pluim|first=BM|author2=de Hon, O; Staal, JB; Limpens, J; Kuipers, H; Overbeek, SE; Zwinderman, AH; Scholten, RJ|title=β₂-Agonists and physical performance:​ a systematic review and meta-analysis of randomized controlled trials|journal=Sports medicine (Auckland, N.Z.)|date=Jan 1, 2011|volume=41|issue=1|pages=39–57|pmid=21142283|doi=10.2165/​11537540-000000000-00000}}</​ref>​ 
 + 
 +====Occupational==== 
 +{{Main|Occupational asthma}} 
 +Asthma as a result of (or worsened by) workplace exposures, is a commonly reported [[occupational disease]].<​ref name=Baur2012/>​ Many cases however are not reported or recognized as such.<​ref>​{{cite book|last=Kunnamo|first=ed.-in-chief:​ Ilkka|title=Evidence-based medicine guidelines|year=2005|publisher=Wiley|location=Chichester|isbn=978-0-470-01184-3|page=214|url=https://​books.google.com/​books?​id=frYEiHYtOv0C&​pg=PA214}}</​ref><​ref>​{{cite book|last=Kraft|first=editors,​ Mario Castro, Monica|title=Clinical asthma|year=2008|publisher=Mosby / Elsevier|location=Philadelphia|isbn=978-0-323-07081-2|pages=Chapter 42|url=https://​books.google.com/​books?​id=y9WYwLVn7pgC&​pg=PT1185}}</​ref>​ It is estimated that 5–25% of asthma cases in adults are work–related.<​!-- <ref name=Baur2012/>​ --> A few hundred different agents have been implicated with the most common being: [[isocyanates]],​ grain and wood dust, [[colophony]],​ [[soldering flux]], [[latex]], animals, and [[aldehydes]].<​!-- <ref name=Baur2012/>​ --> The employment associated with the highest risk of problems include: those who [[spray paint]], bakers and those who process food, nurses, chemical workers, those who work with animals, [[welders]],​ hairdressers and timber workers.<​ref name=Baur2012>​{{cite journal|last=Baur|first=X|author2=Aasen,​ TB |author3=Burge,​ PS |author4=Heederik,​ D |author5=Henneberger,​ PK |author6=Maestrelli,​ P |author7=Schlünssen,​ V |author8=Vandenplas,​ O |author9=Wilken,​ D |author10= ERS Task Force on the Management of Work-related,​ Asthma |title=The management of work-related asthma guidelines: a broader perspective|journal=European Respiratory Review|date=Jun 1, 2012|volume=21|issue=124|pages=125–39|pmid=22654084|doi=10.1183/​09059180.00004711}}</​ref>​ 
 + 
 +====Aspirin-induced asthma==== 
 +{{Main|Aspirin-induced asthma}} 
 +[[Aspirin]]-exacerbated respiratory disease, also known as [[aspirin-induced asthma]], affects up to 9% of asthmatics.<​ref>​{{cite journal|last1=Chang|first1=JE|last2=White|first2=A|last3=Simon|first3=RA|last4=Stevenson|first4=DD|title=Aspirin-exacerbated respiratory disease: burden of disease.|journal=Allergy and asthma proceedings : the official journal of regional and state allergy societies|date=2012|volume=33|issue=2|pages=117–21|pmid=22525387}}</​ref>​ Reactions may also occur to other [[NSAID]]s.<​ref name=Allergy2011>​{{cite journal|last1=Kowalski|first1=ML|last2=Makowska|first2=JS|last3=Blanca|first3=M|last4=Bavbek|first4=S|last5=Bochenek|first5=G|last6=Bousquet|first6=J|last7=Bousquet|first7=P|last8=Celik|first8=G|last9=Demoly|first9=P|last10=Gomes|first10=ER|last11=Niżankowska-Mogilnicka|first11=E|last12=Romano|first12=A|last13=Sanchez-Borges|first13=M|last14=Sanz|first14=M|last15=Torres|first15=MJ|last16=De Weck|first16=A|last17=Szczeklik|first17=A|last18=Brockow|first18=K|title=Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification,​ diagnosis and management: review of the EAACI/​ENDA(#​) and GA2LEN/​HANNA*.|journal=Allergy|date=July 2011|volume=66|issue=7|pages=818–29|pmid=21631520}}</​ref>​ People affected often also have trouble with [[nasal polyps]].<​ref name=Allergy2011/>​ In people who are affected low doses [[paracetamol]] or COX-2 inhibitors are generally safe.<​ref>​{{cite journal|last1=Knowles|first1=SR|last2=Drucker|first2=AM|last3=Weber|first3=EA|last4=Shear|first4=NH|title=Management options for patients with aspirin and nonsteroidal antiinflammatory drug sensitivity.|journal=The Annals of pharmacotherapy|date=July 2007|volume=41|issue=7|pages=1191–200|pmid=17609236}}</​ref>​ 
 + 
 +====Alcohol-induced asthma==== 
 +{{Main|Alcohol-induced respiratory reactions}} 
 +Alcohol may worsen asthmatic symptoms in up to a third of people.<​ref name=Adams2013/>​ This may be even more common in some ethnic groups such as the [[Japanese people|Japanese]] and those with aspirin-induced asthma.<​ref name=Adams2013/>​ Other studies have found improvement in asthmatic symptoms from alcohol.<​ref name=Adams2013>​{{cite journal|last1=Adams|first1=KE|last2=Rans|first2=TS|title=Adverse reactions to alcohol and alcoholic beverages.|journal=Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology|date=December 2013|volume=111|issue=6|pages=439–45|pmid=24267355}}</​ref>​ 
 + 
 +===Differential diagnosis=== 
 + 
 +Many other conditions can cause symptoms similar to those of asthma.<​!-- <ref name=NAEPP46/>​ --> In children, other upper airway diseases such as [[allergic rhinitis]] and [[sinusitis]] should be considered as well as other causes of airway obstruction including: [[foreign body aspiration]],​ [[tracheal stenosis]] or [[laryngotracheomalacia]],​ [[vascular ring]]s, enlarged [[lymph nodes]] or neck masses.<​ref name=NAEPP46/>​ [[Bronchiolitis]] and other viral infections may also produce wheezing.<​ref>​{{cite book|last1=Lichtenstein|first1=Richard|title=Pediatric emergencies|date=2013|publisher=Elsevier|location=Philadelphia,​ Pa.|isbn=978-0-323-22733-9|page=1022|url=https://​books.google.ca/​books?​id=H_oxAgAAQBAJ&​pg=PA1022}}</​ref>​ In adults, [[COPD]], [[congestive heart failure]], airway masses, as well as drug-induced coughing due to [[ACE inhibitor]]s should be considered.<​!-- <ref name=NAEPP46>​ --> In both populations [[vocal cord dysfunction]] may present similarly.<​ref name=NAEPP46>​{{harvnb|NHLBI Guideline|2007|p=46}}</​ref>​ 
 + 
 +[[Chronic obstructive pulmonary disease]] can coexist with asthma and can occur as a complication of chronic asthma. ​ After the age of 65 most people with obstructive airway disease will have asthma and COPD.  In this setting, COPD can be differentiated by increased airway neutrophils,​ abnormally increased wall thickness, and increased smooth muscle in the bronchi. ​ However, this level of investigation is not performed due to COPD and asthma sharing similar principles of management: corticosteroids,​ long acting beta agonists, and smoking cessation.<​ref name=Gibson>​{{cite journal |author=Gibson PG, McDonald VM, Marks GB |title=Asthma in older adults |journal=Lancet |volume=376 |issue=9743 |pages=803–13 |date=September 2010 |pmid=20816547 |doi=10.1016/​S0140-6736(10)61087-2 }}</​ref>​ It closely resembles asthma in symptoms, is correlated with more exposure to cigarette smoke, an older age, less symptom reversibility after bronchodilator administration,​ and decreased likelihood of family history of atopy.<​ref name="​pmid16880365">​{{cite journal|last=Hargreave|first=FE|author2=Parameswaran,​ K|title=Asthma,​ COPD and bronchitis are just components of airway disease|journal=European Respiratory Journal|date=August 2006|volume=28|issue=2|pages=264–7|doi=10.1183/​09031936.06.00056106|pmid=16880365}}</​ref><​ref name="​Applied Therapeutics 2009">​{{cite book|author=Diaz,​ P. Knoell |title=Applied therapeutics:​ the clinical use of drugs |edition=9th |location=Philadelphia |publisher=Lippincott Williams & Wilkins |year=2009 |chapter=23. Chronic obstructive pulmonary disease }}</​ref>​ 
 + 
 +==Prevention== 
 + 
 +The evidence for the effectiveness of measures to prevent the development of asthma is weak.<​ref name="​NHLBI07p184"/>​ Some show promise including: limiting smoke exposure both [[in utero]] and after delivery, [[breastfeeding]],​ and increased exposure to daycare or large families but none are well supported enough to be recommended for this indication.<​ref name="​NHLBI07p184">​{{harvnb|NHLBI Guideline|2007|pp=184–5}}</​ref>​ Early pet exposure may be useful.<​ref name="​pmid22235226">​{{cite journal|last=Lodge|first=CJ|author2=Allen,​ KJ |author3=Lowe,​ AJ |author4=Hill,​ DJ |author5=Hosking,​ CS |author6=Abramson,​ MJ |author7= Dharmage, SC |title=Perinatal cat and dog exposure and the risk of asthma and allergy in the urban environment:​ a systematic review of longitudinal studies|journal=Clinical & developmental immunology|year=2012|volume=2012|page=176484|pmid=22235226|doi=10.1155/​2012/​176484|pmc=3251799}}</​ref>​ Results from exposure to pets at other times are inconclusive<​ref name="​pmid20053584">​{{cite journal|last=Chen|first=CM|author2=Tischer,​ C |author3=Schnappinger,​ M |author4= Heinrich, J |title=The role of cats and dogs in asthma and allergy—a systematic review|journal=International journal of hygiene and environmental health|date=January 2010|volume=213|issue=1|pages=1–31|pmid=20053584|doi=10.1016/​j.ijheh.2009.12.003}}</​ref>​ and it is only recommended that pets be removed from the home if a person has allergic symptoms to said pet.<ref name=Au2005/>​ Dietary restrictions during pregnancy or when breast feeding have not been found to be effective and thus are not recommended.<​ref name=Au2005>​{{cite journal|last=Prescott|first=SL|author2=Tang,​ ML; Australasian Society of Clinical Immunology and, Allergy|title=The Australasian Society of Clinical Immunology and Allergy position statement: Summary of allergy prevention in children|journal=The Medical journal of Australia|date=May 2, 2005|volume=182|issue=9|pages=464–7|pmid=15865590}}</​ref>​ Reducing or eliminating compounds known to sensitive people from the work place may be effective.<​ref name=Baur2012/>​ It is not clear if annual [[influenza vaccines|influenza vaccinations]] effects the risk of exacerbations.<​ref>​{{cite journal|last=Cates|first=CJ|author2=Rowe,​ BH|title=Vaccines for preventing influenza in people with asthma.|journal=The Cochrane database of systematic reviews|date=Feb 28, 2013|volume=2|pages=CD000364|pmid=23450529|doi=10.1002/​14651858.CD000364.pub4}}</​ref>​ Immunization;​ however, is recommended by the [[World Health Organization]].<​ref>​{{cite journal|title=Strategic Advisory Group of Experts on Immunization – report of the extraordinary meeting on the influenza A (H1N1) 2009 pandemic, 7 July 2009.|journal=Wkly Epidemiol Rec|date=Jul 24, 2009|volume=84|issue=30|pages=301–4|pmid=19630186}}</​ref>​ Smoking bans are effective in decreasing exacerbations of asthma.<​ref>​{{cite journal|last1=Been|first1=JV|last2=Nurmatov|first2=UB|last3=Cox|first3=B|last4=Nawrot|first4=TS|last5=van Schayck|first5=CP|last6=Sheikh|first6=A|title=Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis.|journal=Lancet|date=May 3, 2014|volume=383|issue=9928|pages=1549–60|pmid=24680633|doi=10.1016/​S0140-6736(14)60082-9}}</​ref>​ 
 + 
 +==Management== 
 + 
 +While there is no cure for asthma, symptoms can typically be improved.<​ref>​{{cite book|last=Ripoll|first=Brian C. Leutholtz, Ignacio|title=Exercise and disease management|publisher=CRC Press|location=Boca Raton|isbn=978-1-4398-2759-8|page=100|url=https://​books.google.com/​books?​id=eAn9-bm_pi8C&​pg=PA100|edition=2nd|year=2011}}</​ref>​ A specific, customized plan for proactively monitoring and managing symptoms should be created. This plan should include the reduction of exposure to allergens, testing to assess the severity of symptoms, and the usage of medications. The treatment plan should be written down and advise adjustments to treatment according to changes in symptoms.<​ref name=GINA_2011_page56>​{{harvnb|GINA|2011|p=56}}</​ref>​ 
 + 
 +The most effective treatment for asthma is identifying triggers, such as [[Health effects of tobacco smoking|cigarette smoke]], pets, or [[aspirin-induced asthma|aspirin]],​ and eliminating exposure to them. If trigger avoidance is insufficient,​ the use of medication is recommended. ​ Pharmaceutical drugs are selected based on, among other things, the severity of illness and the frequency of symptoms. Specific medications for asthma are broadly classified into fast-acting and long-acting categories.<​ref name=NHLBI07p213>​{{harvnb|NHLBI Guideline|2007|p=213}}</​ref><​ref name=BGMA08>​{{cite web |url=http://​www.sign.ac.uk/​pdf/​sign101.pdf |title=British Guideline on the Management of Asthma|format=PDF|publisher=Scottish Intercollegiate Guidelines Network|year=2008 |accessdate=2008-08-04| archiveurl= https://​web.archive.org/​web/​20080819203455/​http://​www.sign.ac.uk/​pdf/​sign101.pdf| archivedate= 19 August 2008 <​!--DASHBot-->​| deadurl= no}}</​ref>​ 
 + 
 +[[Bronchodilators]] are recommended for short-term relief of symptoms.<​!-- <ref name=NAEPP/>​ --> In those with occasional attacks, no other medication is needed.<​!-- <ref name=NAEPP/>​ --> If mild persistent disease is present (more than two attacks a week), low-dose inhaled corticosteroids or alternatively,​ an oral [[leukotriene antagonist]] or a [[mast cell stabilizer]] is recommended.<​!-- <ref name=NAEPP/>​ --> For those who have daily attacks, a higher dose of inhaled corticosteroids is used. In a moderate or severe exacerbation,​ oral corticosteroids are added to these treatments.<​ref name="​NHLBI07p214"​ /> 
 + 
 +===Lifestyle modification=== 
 + 
 +Avoidance of triggers is a key component of improving control and preventing attacks. The most common triggers include [[allergen]]s,​ smoke (tobacco and other), air pollution, [[Beta blocker#​Nonselective agents|non selective beta-blockers]],​ and sulfite-containing foods.<​ref name=NAEPP2007p69>​{{harvnb|NHLBI Guideline|2007|p=69}}</​ref><​ref name=thomson>​{{cite journal |author=Thomson NC, Spears M |title=The influence of smoking on the treatment response in patients with asthma |journal=Current Opinion in Allergy and Clinical Immunology |volume=5 |issue=1 |pages=57–63 |year=2005 |pmid=15643345 |doi=10.1097/​00130832-200502000-00011}}</​ref>​ Cigarette smoking and [[second-hand smoke]] (passive smoke) may reduce the effectiveness of medications such as corticosteroids.<​ref name=Stap2011>​{{cite journal| author=Stapleton M, Howard-Thompson A, George C, Hoover RM, Self TH| title=Smoking and asthma | journal=J Am Board Fam Med | year= 2011 | volume= 24 | issue= 3 | pages= 313–22 | pmid=21551404 | doi=10.3122/​jabfm.2011.03.100180}}</​ref>​ Laws that limit smoking decrease the number of people hospitalized for asthma.<​ref>​{{cite journal|last=Been|first=Jasper|title=Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis|journal=Lancet|date=Mar 28, 2014|doi=10.1016/​S0140-6736(14)60082-9|pmid=24680633|volume=383|issue=9928|pages=1549–60}}</​ref>​ Dust mite control measures, including air filtration, chemicals to kill mites, vacuuming, mattress covers and others methods had no effect on asthma symptoms.<​ref name=Gotzsche2008>​{{cite journal |author=[[Peter C. Gøtzsche|PC Gøtzsche]],​ HK Johansen |title=House dust mite control measures for asthma|journal=Cochrane Database of Systematic Reviews |issue=2 |pages=CD001187 |year=2008 |doi=10.1002/​14651858.CD001187.pub3 |pmid=18425868 |editor1-last=Gøtzsche |editor1-first=Peter C}}</​ref>​ Overall, exercise is beneficial in people with stable asthma.<​ref name=Chandra2012>​{{cite journal|last=Chandratilleke|first=MG|author2=Carson,​ KV |author3=Picot,​ J |author4=Brinn,​ MP |author5=Esterman,​ AJ |author6= Smith, BJ |editor1-last=Carson|editor1-first=Kristin V|title=Physical training for asthma|journal=Cochrane Database of Systematic Reviews|date=May 16, 2012|volume=5|pages=CD001116|pmid=22592674|doi=10.1002/​14651858.CD001116.pub3}}</​ref>​{{Update inline|reason=Updated version https://​www.ncbi.nlm.nih.gov/​pubmed/​24085631|date=September 2015}} 
 + 
 +===Medications=== 
 + 
 +Medications used to treat asthma are divided into two general classes: quick-relief medications used to treat acute symptoms; and long-term control medications used to prevent further exacerbation.<​ref name="​NHLBI07p213"​ /> 
 + 
 +====Fast–acting==== 
 +[[File:​Salbutamol2.JPG|thumb|alt=A round canister above a blue plastic holder|[[Salbutamol]] metered dose inhaler commonly used to treat asthma attacks.]] 
 +* Short-acting [[beta2-adrenergic agonist|beta<​sub>​2</​sub>​-adrenoceptor agonists]] (SABA), such as [[salbutamol]] (''​albuterol''​ [[United States Adopted Name|USAN]]) are the first line treatment for asthma symptoms.<​ref name="​NHLBI07p214"​ /> They are recommended before exercise in those with exercise induced symptoms.<​ref>​{{cite journal |author=Parsons JP, Hallstrand TS, Mastronarde JG |title=An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction |journal=Am. J. Respir. Crit. Care Med. |volume=187 |issue=9 |pages=1016–27 |date=May 2013 |pmid=23634861 |doi=10.1164/​rccm.201303-0437ST |url=|display-authors=etal}}</​ref>​ 
 +* [[Anticholinergic]] medications,​ such as [[ipratropium|ipratropium bromide]], provide additional benefit when used in combination with SABA in those with moderate or severe symptoms.<​ref name="​NHLBI07p214"​ /> Anticholinergic bronchodilators can also be used if a person cannot tolerate a SABA.<​ref name="​Self,​ Timothy 2009"/>​ If a child requires admission to hospital additional ipratropium does not appear to help over a SABA.<​ref>​{{cite journal|last1=Vézina|first1=K|last2=Chauhan|first2=BF|last3=Ducharme|first3=FM|title=Inhaled anticholinergics and short-acting beta(2)-agonists versus short-acting beta2-agonists alone for children with acute asthma in hospital.|journal=The Cochrane database of systematic reviews|date=Jul 31, 2014|volume=7|pages=CD010283|pmid=25080126|doi=10.1002/​14651858.CD010283.pub2}}</​ref>​ 
 +* Older, less selective [[adrenergic receptor|adrenergic agonists]], such as inhaled [[epinephrine]],​ have similar efficacy to SABAs.<​ref name=Rodrigo>​{{cite journal |author=Rodrigo GJ, Nannini LJ |title=Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials |journal=Am J Emerg Med |volume=24 |issue=2 |pages=217–22 |year=2006 |pmid=16490653 |doi=10.1016/​j.ajem.2005.10.008}}</​ref>​ They are however not recommended due to concerns regarding excessive cardiac stimulation.<​ref name="​NHLBI07p351">​{{harvnb|NHLBI Guideline|2007|p=351}}</​ref>​ 
 + 
 +====Long–term control==== 
 +[[File:​Fluticasone.JPG|thumb|alt=A round canister above an orange plastic holder|[[Fluticasone propionate]] metered dose inhaler commonly used for long-term control.]] 
 +* Corticosteroids are generally considered the most effective treatment available for long-term control.<​ref name=NHLBI07p213/>​ Inhaled forms such as [[beclomethasone]] are usually used except in the case of severe persistent disease, in which oral corticosteroids may be needed.<​ref name=NHLBI07p213/>​ It is usually recommended that inhaled formulations be used once or twice daily, depending on the severity of symptoms.<​ref name="​NHLBI07p218">​{{harvnb|NHLBI Guideline|2007|p=218}}</​ref>​ 
 +* [[Long-acting beta-adrenoceptor agonist]]s (LABA) such as [[salmeterol]] and [[formoterol]] can improve asthma control, at least in adults, when given in combination with inhaled corticosteroids.<​ref name=Ducharme2010>​{{cite journal|last=Ducharme|first=FM|author2=Ni Chroinin, M; Greenstone, I; Lasserson, TJ|editor1-last=Ducharme|editor1-first=Francine M|title=Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children|journal=Cochrane Database of Systematic Reviews|date=May 12, 2010|issue=5|pages=CD005535|pmid=20464739|doi=10.1002/​14651858.CD005535.pub2}}</​ref>​ In children this benefit is uncertain.<​ref name=Ducharme2010/><​ref name="​pmid20393943">​{{cite journal|last=Ducharme|first=FM|author2=Ni Chroinin, M; Greenstone, I; Lasserson, TJ|editor1-last=Ducharme|editor1-first=Francine M|title=Addition of long-acting beta2-agonists to inhaled steroids versus higher dose inhaled corticosteroids in adults and children with persistent asthma|journal=Cochrane Database of Systematic Reviews|date=Apr 14, 2010|issue=4|pages=CD005533|pmid=20393943|doi=10.1002/​14651858.CD005533.pub2}}</​ref>​ When used without steroids they increase the risk of severe [[side-effect]]s<​ref name=Fanta2009>​{{cite journal |author=Fanta CH|title=Asthma |journal=New England Journal of Medicine |volume=360|issue=10 |pages=1002–14 |date=March 2009 |pmid=19264689 |doi=10.1056/​NEJMra0804579 }}</​ref>​ and even with corticosteroids they may slightly increase the risk.<​ref name=Cates2012>​{{cite journal|last=Cates|first=CJ|author2=Cates,​ MJ|editor1-last=Cates|editor1-first=Christopher J|title=Regular treatment with formoterol for chronic asthma: serious adverse events|journal=Cochrane Database of Systematic Reviews|date=Apr 18, 2012|volume=4|pages=CD006923|pmid=22513944|doi=10.1002/​14651858.CD006923.pub3}}</​ref><​ref name="​pmid18646149">​{{cite journal|last=Cates|first=CJ|author2=Cates,​ MJ|editor1-last=Cates|editor1-first=Christopher J|title=Regular treatment with salmeterol for chronic asthma: serious adverse events|journal=Cochrane Database of Systematic Reviews|date=Jul 16, 2008|issue=3|pages=CD006363|pmid=18646149|doi=10.1002/​14651858.CD006363.pub2}}</​ref>​ 
 +* [[Antileukotriene agents|Leukotriene receptor antagonist]]s (such as [[montelukast]] and [[zafirlukast]]) may be used in addition to inhaled corticosteroids,​ typically also in conjunction with a LABA.<​ref name="​Antileukotriene agents"​ /><​ref name=NHLBI07p213/>​ Evidence is insufficient to support use in acute exacerbations.<​ref name=GINA_2011_page74>​{{harvnb|GINA|2011|p=74}}</​ref><​ref name="​pmid22592708">​{{cite journal|last=Watts|first=K|author2=Chavasse,​ RJ|editor1-last=Watts|editor1-first=Kirsty|title=Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children|journal=Cochrane Database of Systematic Reviews|date=May 16, 2012|volume=5|pages=CD006100|pmid=22592708|doi=10.1002/​14651858.CD006100.pub2}}</​ref>​ In children they appear to be of little benefit when added to inhaled steroids,<​ref>​{{cite journal|last=Chauhan|first=BF|author2=Ben Salah, R; Ducharme, FM|title=Addition of anti-leukotriene agents to inhaled corticosteroids in children with persistent asthma.|journal=The Cochrane database of systematic reviews|date=Oct 2, 2013|volume=10|pages=CD009585|pmid=24089325|doi=10.1002/​14651858.CD009585.pub2}}</​ref>​ and the same applies in adolescents and adults.<​ref>​{{cite journal|last1=Miligkos|first1=Michael|last2=Bannuru|first2=Raveendhara R.|last3=Alkofide|first3=Hadeel|last4=Kher|first4=Sucharita R.|last5=Schmid|first5=Christopher H.|last6=Balk|first6=Ethan M.|title=Leukotriene-Receptor Antagonists Versus Placebo in the Treatment of Asthma in Adults and Adolescents|journal=Annals of Internal Medicine|date=22 September 2015|volume=163|issue=10|pages=756|doi=10.7326/​M15-1059|pmid=26390230}}</​ref>​ In those under five years of age, they were the preferred add-on therapy after inhaled corticosteroids by the British Thoracic Society in 2009.<​ref name=bts2009p43>​{{harvnb|British Guideline|2009|p=43}}</​ref>​ A similar class of drugs, [[Arachidonate 5-lipoxygenase|5-LOX]] inhibitors, may be used as an alternative in the chronic treatment of mild to moderate asthma among older children and adults.<​ref name="​Antileukotriene agents"​ /><​ref name="​USFDA Zileuton">​{{cite web|title=Zyflo (Zileuton tablets)|url=http://​www.accessdata.fda.gov/​drugsatfda_docs/​label/​2012/​020471s017lbl.pdf|website=United States Food and Drug Administration|publisher=Cornerstone Therapeutics Inc.|accessdate=12 December 2014|page=1|date=June 2012}}</​ref>​ As of 2013 there is one medication in this family known as [[zileuton]].<​ref name="​Antileukotriene agents"​ /> 
 +* [[Mast cell stabilizer]]s (such as [[cromolyn sodium]]) are another non-preferred alternative to corticosteroids.<​ref name=NHLBI07p213/>​ 
 + 
 +====Delivery methods==== 
 + 
 +Medications are typically provided as [[metered-dose inhaler]]s (MDIs) in combination with an [[asthma spacer]] or as a [[dry powder inhaler]]. The spacer is a plastic cylinder that mixes the medication with air, making it easier to receive a full dose of the drug. A [[nebulizer]] may also be used. Nebulizers and spacers are equally effective in those with mild to moderate symptoms. However, insufficient evidence is available to determine whether a difference exists in those with severe disease.<​ref name="​NHLBI07p250">​{{harvnb|NHLBI Guideline|2007|p=250}}</​ref>​ 
 + 
 +====Adverse effects==== 
 + 
 +Long-term use of inhaled corticosteroids at conventional doses carries a minor risk of adverse effects.<​ref name=Safe09>​{{cite journal|last=Rachelefsky|first=G|title=Inhaled corticosteroids and asthma control in children: assessing impairment and risk|journal=Pediatrics|date=January 2009|volume=123|issue=1|pages=353–66|pmid=19117903|doi=10.1542/​peds.2007-3273}}</​ref>​ Risks include the development of [[cataract]]s and a mild regression in stature.<​ref name=Safe09/><​ref>​{{cite journal |author=Dahl R |title=Systemic side effects of inhaled corticosteroids in patients with asthma |journal=Respir Med |volume=100 |issue=8 |pages=1307–17 |date=August 2006 |pmid=16412623|doi=10.1016/​j.rmed.2005.11.020}}</​ref>​ 
 + 
 +===Others=== 
 + 
 +When asthma is unresponsive to usual medications,​ other options are available for both emergency management and prevention of flareups. For emergency management other options include: 
 + 
 +* [[Oxygen]] to alleviate [[hypoxia (medical)|hypoxia]] if [[oxygen saturation|saturations]] fall below 92%.<ref name=rodrigo>​{{cite journal |author=Rodrigo GJ, Rodrigo C, Hall JB |title=Acute asthma in adults: a review |journal=Chest |volume=125 |issue=3 |pages=1081–102 |year=2004 |pmid=15006973| doi = 10.1378/​chest.125.3.1081}}</​ref>​ 
 +* Oral corticosteroid are recommended with five days of [[prednisone]] being the same 2 days of [[dexamethasone]].<​ref>​{{cite journal|last=Keeney|first=GE|author2=Gray,​ MP |author3=Morrison,​ AK |author4=Levas,​ MN |author5=Kessler,​ EA |author6=Hill,​ GD |author7=Gorelick,​ MH |author8= Jackson, JL |title=Dexamethasone for acute asthma exacerbations in children: a meta-analysis.|journal=Pediatrics|date=Mar 2014|volume=133|issue=3|pages=493–9|pmid=24515516|doi=10.1542/​peds.2013-2273}}</​ref>​ 
 +* [[Magnesium sulfate]] intravenous treatment increases bronchodilation when used in addition to other treatment in severe acute asthma attacks.<​ref name="​NHLBI07p373"/><​ref>​{{cite journal |journal=Chest |volume=122 |issue=2 |pages=396–8 |date = August 2002|doi=10.1378/​chest.122.2.396 |title=Magnesium Treatment for Asthma : Where Do We Stand? |last1=Noppen |first1=M. |pmid=12171805 }}</​ref>​ In adults it results in a reduction of hospital admissions.<​ref>​{{cite journal|last1=Kew|first1=KM|last2=Kirtchuk|first2=L|last3=Michell|first3=CI|title=Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department.|journal=The Cochrane database of systematic reviews|date=28 May 2014|volume=5|pages=CD010909|pmid=24865567|doi=10.1002/​14651858.CD010909.pub2}}</​ref>​ 
 +* [[Heliox]], a mixture of helium and oxygen, may also be considered in severe unresponsive cases.<​ref name="​NHLBI07p373"/>​ 
 +* Intravenous salbutamol is not supported by available evidence and is thus used only in extreme cases.<​ref name=rodrigo/>​ 
 +* [[Methylxanthines]] (such as [[theophylline]]) were once widely used, but do not add significantly to the effects of inhaled beta-agonists.<​ref name=rodrigo/>​ Their use in acute exacerbations is controversial.<​ref name=GINA_2011_page37>​{{harvnb|GINA|2011|p=37}}</​ref>​ 
 +* The dissociative anesthetic [[ketamine]] is theoretically useful if [[intubation]] and [[mechanical ventilation]] is needed in people who are approaching respiratory arrest; however, there is no evidence from clinical trials to support this.<​ref name="​NHLBI07p399">​{{harvnb|NHLBI Guideline|2007|p=399}}</​ref>​ 
 +For those with severe persistent asthma not controlled by inhaled corticosteroids and LABAs, [[bronchial thermoplasty]] may be an option.<​ref name=Bronch10>​{{cite journal|last=Castro|first=M|author2=Musani,​ AI|author3=Mayse,​ ML|author4=Shargill,​ NS|title=Bronchial thermoplasty:​ a novel technique in the treatment of severe asthma|journal=Therapeutic advances in respiratory disease|date=April 2010|volume=4|issue=2|pages=101–16|pmid=20435668|doi=10.1177/​1753465810367505}}</​ref>​ It involves the delivery of controlled thermal energy to the airway wall during a series of [[bronchoscopy|bronchoscopies]].<​ref name=Bronch10/><​ref>​{{cite journal|last=Boulet|first=LP|author2=Laviolette,​ M|title=Is there a role for bronchial thermoplasty in the treatment of asthma?​|journal=Canadian respiratory journal : journal of the Canadian Thoracic Society|date=May–Jun 2012|volume=19|issue=3|pages=191–2|pmid=22679610|pmc=3418092}}</​ref>​ While it may increase exacerbation frequency in the first few months it appears to decrease the subsequent rate.<​!-- <ref name=GINA_2011_page70>​ --> Effects beyond one year are unknown.<​ref name=GINA_2011_page70>​{{harvnb|GINA|2011|p=70}}</​ref>​ Evidence suggests that [[sublingual immunotherapy]] in those with both [[allergic rhinitis]] and asthma improve outcomes.<​ref name="​pmid23532243">​{{cite journal |last=Lin |first=SY |first2=N |last2=Erekosima |first3=JM |last3=Kim |first4=M |last4=Ramanathan |first5=C |last5=Suarez-Cuervo |first6=Y |last6=Chelladurai |first7=D |last7=Ward |first8=JB |last8=Segal |title=Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma A Systematic Review|journal=JAMA|date=27 March 2013|volume=309|issue=12|pages=1278–88|pmid=23532243|doi=10.1001/​jama.2013.2049 |url=http://​www.ncbi.nlm.nih.gov/​pubmedhealth/​PMH0054631}}</​ref>​ 
 + 
 +===Alternative medicine=== 
 + 
 +Many people with asthma, like those with other chronic disorders, use [[alternative medicine|alternative treatments]];​ surveys show that roughly 50% use some form of unconventional therapy.<​ref name=blanc>​{{cite journal |author=Blanc PD, Trupin L, Earnest G, Katz PP, Yelin EH, Eisner MD |title=Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis : data from a population-based survey |journal=Chest |volume=120 |issue=5 |pages=1461–7 |year=2001 |pmid=11713120| doi = 10.1378/​chest.120.5.1461}}</​ref><​ref name=shenfield>​{{cite journal |author=Shenfield G, Lim E, Allen H |title=Survey of the use of complementary medicines and therapies in children with asthma |journal=J Paediatr Child Health |volume=38 |issue=3 |pages=252–7 |year=2002 |pmid=12047692| doi = 10.1046/​j.1440-1754.2002.00770.x}}</​ref>​ There is little data to support the effectiveness of most of these therapies. ​ Evidence is insufficient to support the usage of Vitamin C.<ref name="​pmid19160185">​{{cite journal | author=Kaur B, Rowe BH, Arnold E | editor1-last=Welsh | editor1-first=Emma J | title=Vitamin C supplementation for asthma | journal=Cochrane Database of Systematic Reviews | issue=1 | pages=CD000993 | year=2009 | pmid=19160185 | doi=10.1002/​14651858.CD000993.pub3 }}</​ref>​ There is tentative support for its use in exercise induced brochospasm.<​ref>​{{cite journal|last=Hemilä|first=H|title=Vitamin C may alleviate exercise-induced bronchoconstriction:​ a meta-analysis.|journal=BMJ open|year=2013|volume=3|issue=6|pmid=23794586|doi=10.1136/​bmjopen-2012-002416|pages=e002416}}</​ref>​ 
 + 
 +[[Acupuncture]] is not recommended for the treatment as there is insufficient evidence to support its use.<ref name="​NHLBI07p240"/><​ref name=mccartney>​{{cite journal |author=McCarney RW, Brinkhaus B, Lasserson TJ, Linde K |title=Acupuncture for chronic asthma |journal=Cochrane Database of Systematic Reviews |issue=1 |pages=CD000008 |year=2004 |pmid=14973944 |doi=10.1002/​14651858.CD000008.pub2 |editor1-last=McCarney |editor1-first=Robert W}}</​ref>​ [[Air ioniser]]s show no evidence that they improve asthma symptoms or benefit lung function; this applied equally to positive and negative ion generators.<​ref name="​pmid22972060">​{{cite journal|last=Blackhall|first=K|author2=Appleton,​ S |author3=Cates,​ CJ |editor1-last=Blackhall|editor1-first=Karen|title=Ionisers for chronic asthma|journal=Cochrane Database of Systematic Reviews|date=Sep 12, 2012|volume=9|pages=CD002986|pmid=22972060|doi=10.1002/​14651858.CD002986.pub2}}</​ref>​ 
 + 
 +Manual therapies, including [[osteopathy|osteopathic]],​ [[chiropractic]],​ [[physical therapy|physiotherapeutic]] and [[respiratory therapy|respiratory therapeutic]] maneuvers, have insufficient evidence to support their use in treating asthma.<​ref name=hondras>​{{cite journal |author=Hondras MA, Linde K, Jones AP |title=Manual therapy for asthma |journal=Cochrane Database of Systematic Reviews |issue=2 |pages=CD001002 |year=2005 |pmid=15846609 |doi=10.1002/​14651858.CD001002.pub2 |editor1-last=Hondras |editor1-first=Maria A}}</​ref> ​ The [[Buteyko breathing technique]] for controlling hyperventilation may result in a reduction in medication use; however, the technique does not have any effect on lung function.<​ref name=BGMA08/> ​ Thus an expert panel felt that evidence was insufficient to support its use.<ref name="​NHLBI07p240">​{{harvnb|NHLBI Guideline|2007|p=240}}</​ref>​ 
 + 
 +==Prognosis== 
 + 
 +[[File:​Asthma world map - DALY - WHO2004.svg|thumb|alt=A map of the world with Europe shaded yellow, most of North and South America orange and Southern Africa a dark red|[[Disability-adjusted life year]] for asthma per 100,​000&​nbsp;​inhabitants in 2004.<​ref>​{{cite web|url=http://​www.who.int/​healthinfo/​global_burden_disease/​estimates_country/​en/​index.html |title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization |accessdate=November 11, 2009| archiveurl=https://​web.archive.org/​web/​20091111101009/​http://​www.who.int/​healthinfo/​global_burden_disease/​estimates_country/​en/​index.html|archivedate= 11 November 2009 <​!--DASHBot-->​| deadurl= no}}</​ref>​ 
 +{{Multicol}} 
 +{{legend|#​b3b3b3|no data}} 
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 +{{Multicol-end}} ]] 
 +The prognosis for asthma is generally good, especially for children with mild disease.<​ref>​{{cite book |editor1-first=Allan B. |editor1-last=Wolfson |editor2-first=Ann |editor2-last=Harwood-Nuss |title=Harwood-Nuss'​ Clinical Practice of Emergency Medicine |chapterurl=https://​books.google.com/​books?​id=Idb0Z658lFQC&​pg=PT465 |date=September 2009 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-8943-1 |pages=432– |first1=Michelle J. |last1=Sergel |first2=Rita K. |last2=Cydulka |chapter=Ch. 75: Asthma |edition=5th}}</​ref> ​ Mortality has decreased over the last few decades due to better recognition and improvement in care.<​ref name=NHLBI07p1>​{{harvnb|NHLBI Guideline|2007|p=1}}</​ref>​ Globally it causes moderate or severe disability in 19.4&​nbsp;​million people as of 2004 (16&​nbsp;​million of which are in low and middle income countries).<​ref>​{{cite book|last=Organization|first=World Health|title=The global burden of disease : 2004 update.|year=2008|publisher=World Health Organization|location=Geneva,​ Switzerland|isbn=978-92-4-156371-0|page=35|edition=[Online-Ausg.]}}</​ref>​ Of asthma diagnosed during childhood, half of cases will no longer carry the diagnosis after a decade.<​ref name=El2010/>​ Airway remodeling is observed, but it is unknown whether these represent harmful or beneficial changes.<​ref name=Maddox>​{{cite journal |author=Maddox L, Schwartz DA |title=The pathophysiology of asthma |journal=Annu. Rev. Med. |volume=53 |pages=477–98 |year=2002 |pmid=11818486 |doi=10.1146/​annurev.med.53.082901.103921}}</​ref>​ Early treatment with corticosteroids seems to prevent or ameliorates a decline in lung function.<​ref name=beckett>​{{cite journal |author=Beckett PA, Howarth PH |title=Pharmacotherapy and airway remodelling in asthma? |journal=Thorax |volume=58 |issue=2 |pages=163–74 |year=2003 |pmid=12554904| doi = 10.1136/​thorax.58.2.163 |pmc=1746582}}</​ref>​ 
 + 
 +==Epidemiology== 
 +{{Main|Epidemiology of asthma}} 
 +[[File:​Prevalence of Clinical Asthma world map - GINA2004.svg|thumb|left|alt=A map of the world with Europe, North America, Australia and much of South America shaded red, much of Asia is yellow, and most of Africa is grey|Rates of asthma in different countries of the world as of 2004. 
 +{{Multicol}} 
 +{{legend|#​e0e0e0|no data}} 
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 +{{legend|#​ff8400|6–7%}} 
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 +{{legend|#​ff2c00|12.5–15%}} 
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 +{{Multicol-end}}]] 
 +As of 2011, 235–330 million people worldwide are affected by asthma,<​ref name=WHO2011>​{{cite web |title=World Health Organization Fact Sheet Fact sheet No 307: Asthma |year=2011|url=http://​www.who.int/​mediacentre/​factsheets/​fs307/​en/​ |archiveurl=https://​web.archive.org/​web/​20110629035454/​http://​www.who.int/​mediacentre/​factsheets/​fs307/​en/​ |archivedate=2011-06-29 |accessdate=Jan 17, 2013}}</​ref><​ref name=GINA_2011_page3/><​ref name=LancetEpi2012>​{{cite journal|last=Vos|first=T |title=Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010:​ a systematic analysis for the Global Burden of Disease Study 2010|journal=Lancet |date=December 2012|volume=380|issue=9859|pages=2163–96|pmid=23245607|doi=10.1016/​S0140-6736(12)61729-2|display-authors=etal}}</​ref>​ and approximately 250,​000–345,​000 people die per year from the disease.<​ref name=GINA2011p2/><​ref name=Loz2012>​{{cite journal|last=Lozano|first=R|title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.|journal=Lancet|date=Dec 15, 2012|volume=380|issue=9859|pages=2095–128|pmid=23245604|doi=10.1016/​S0140-6736(12)61728-0}}</​ref>​ Rates vary between countries with prevalences between 1 and 18%.<ref name=GINA2011p2/>​ It is more common in [[developed country|developed]] than [[developing countries]].<​ref name=GINA2011p2/>​ One thus sees lower rates in Asia, Eastern Europe and Africa.<​ref name=M38/>​ Within developed countries it is more common in those who are economically disadvantaged while in contrast in developing countries it is more common in the affluent.<​ref name=GINA2011p2/>​ The reason for these differences is not well known.<​ref name=GINA2011p2/>​ Low and middle income countries make up more than 80% of the mortality.<​ref>​{{cite web |author=World Health Organization |authorlink=World Health Organization|title=WHO:​ Asthma|url=http://​www.who.int/​mediacentre/​factsheets/​fs307/​en/​ |accessdate=2007-12-29|archiveurl=https://​web.archive.org/​web/​20071215181927/​http://​www.who.int/​mediacentre/​factsheets/​fs307/​en/​| archivedate= 15 December 2007| deadurl= no}}</​ref>​ 
 + 
 +While asthma is twice as common in boys as girls,<​ref name=GINA2011p2/>​ severe asthma occurs at equal rates.<​ref name=Bush2009>​{{cite journal|author=Bush A, Menzies-Gow A |title=Phenotypic differences between pediatric and adult asthma |journal=Proc Am Thorac Soc |volume=6|issue=8 |pages=712–9 |date=December 2009 |pmid=20008882 |doi=10.1513/​pats.200906-046DP }}</​ref>​ In contrast adult women have a higher rate of asthma than men<ref name=GINA2011p2/>​ and it is more common in the young than the old.<ref name=M38/>​ In children, asthma was the most common reason for admission to the hospital following an emergency department visit in the US in 2011.<​ref>​{{cite web | author = Weiss AJ, Wier LM, Stocks C, Blanchard J | title =  Overview of Emergency Department Visits in the United States, 2011 | work = HCUP Statistical Brief #174 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = June 2014 | url = https://​www.hcup-us.ahrq.gov/​reports/​statbriefs/​sb174-Emergency-Department-Visits-Overview.jsp}}</​ref>​ 
 + 
 +Global rates of asthma have increased significantly between the 1960s and 2008<​ref>​{{cite journal |author=Grant EN, Wagner R, Weiss KB |title=Observations on emerging patterns of asthma in our society |journal=[[J Allergy Clin Immunol]] |date=August 1999 |volume=104 |pages=S1–S9 |pmid=10452783 |doi=10.1016/​S0091-6749(99)70268-X |issue=2 Pt 2}}</​ref><​ref>​{{cite journal |author=Anandan C, Nurmatov U, van Schayck OC, Sheikh A |title=Is the prevalence of asthma declining? Systematic review of epidemiological studies |journal=Allergy |volume=65 |issue=2 |pages=152–67 |date=February 2010 |pmid=19912154 |doi=10.1111/​j.1398-9995.2009.02244.x }}</​ref>​ with it being recognized as a major public health problem since the 1970s.<​ref name=M38>​{{cite book |first=John F. |last=Murray |title=Murray and Nadel'​s textbook of respiratory medicine |editor-first=Robert J. |editor-last=Mason |editor2-first=John F. |editor2-last=Murray |editor3-first=V. Courtney |editor3-last=Broaddus |editor4-first=Jay A. |editor4-last=Nadel |editor5-last=Martin|editor5-first=Thomas R.|editor6-last=King,​ Jr.|editor6-first=Talmadge E.|editor7-last=Schraufnagel|editor7-first=Dean E.|year=2010|publisher=Elsevier|isbn=1-4160-4710-7 |chapter=Ch. 38 Asthma |edition=5th}}</​ref>​ Rates of asthma have plateaued in the developed world since the mid-1990s with recent increases primarily in the developing world.<​ref name="​pmid16175830">​{{cite journal|last=Bousquet|first=J|author2=Bousquet,​ PJ |author3=Godard,​ P |author4= Daures, JP |title=The public health implications of asthma|journal=Bulletin of the World Health Organization|date=July 2005|volume=83|issue=7|pages=548–54|pmid=16175830|pmc=2626301}}</​ref>​ Asthma affects approximately 7% of the population of the United States<​ref name=Fanta2009/>​ and 5% of people in the United Kingdom.<​ref name=Anderson2007>​{{cite journal | last=Anderson | first=HR |author2=Gupta R|author3=Strachan DP|author4=Limb ES | title=50 years of asthma: UK trends from 1955 to 2004 | journal=Thorax | volume=62 | issue=1 | pages=85–90 |date=January 2007 | pmid=17189533 | doi=10.1136/​thx.2006.066407 | pmc=2111282 }}</​ref>​ Canada, Australia and New Zealand have rates of about 14–15%.<​ref>​{{cite book|last=Masoli|first=Matthew|title=Global Burden of Asthma|year=2004|page=9|url=http://​www.ginasthma.org/​pdf/​GINABurdenReport.pdf}}</​ref>​ 
 + 
 +==Economics== 
 + 
 +From 2000 to 2010, the average cost per asthma-related hospital stay in the United States for children remained relatively stable at about $3,600, whereas the average cost per asthma-related hospital stay for adults increased from $5,200 to $6,​600.<​ref name=USEco2014>​{{cite web | author = Barrett ML, Wier LM, and Washington R. | title = Trends in Pediatric and Adult Hospital Stays for Asthma, 2000–2010. | work = HCUP Statistical Brief #169 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = January 2014 | url = http://​hcup-us.ahrq.gov/​reports/​statbriefs/​sb169-Asthma-Trends-Hospital-Stays.jsp }}</​ref>​ In 2010, Medicaid was the most frequent primary payer among children and adults aged 18–44 years in the United States; private insurance was the second most frequent payer.<​ref name=USEco2014/>​ Among both children and adults in the lowest income communities in the United States there is a higher rates of hospital stays for asthma in 2010 than those in the highest income communities.<​ref name=USEco2014/>​ 
 + 
 +== History == 
 +[[File:​Grimaults cigarette ad.jpg|thumb|right|upright|1907 advertisement for Grimault'​s Indian Cigarettes, emphasising their alleged efficacy for the relief of asthma and other respiratory conditions]] 
 +Asthma was recognized in [[Ancient Egypt]] and was treated by drinking an [[incense]] mixture known as [[kyphi]].<​ref name="​Manniche1999">​{{cite book | author = Manniche L | title = Sacred luxuries: fragrance, aromatherapy,​ and cosmetics in ancient Egypt | pages = [https://​books.google.com/​books?​id=ZCgVdm7UKhIC&​pg=PA49 49] | year = 1999 | publisher = [[Cornell University Press]] | isbn=978-0-8014-3720-5 }}</​ref>​ It was officially named as a specific respiratory problem by [[Hippocrates]] circa 450 BC, with the Greek word for "​panting"​ forming the basis of our modern name.<​ref name=M38/>​ In 200 BC it was believed to be at least partly related to the emotions.<​ref name=Andrew2010/>​ 
 + 
 +In 1873, one of the first papers in modern medicine on the subject tried to explain the [[pathophysiology]] of the disease while one in 1872, concluded that asthma can be cured by rubbing the chest with [[A.B.C. Liniment|chloroform liniment]].<​ref name="​pmid20747287">​{{cite journal | author = Thorowgood JC | title = On bronchial asthma | journal =[[British Medical Journal]] | volume = 2 | issue = 673 | page = 600 |date=November 1873 | pmid = 20747287| pmc = 2294647 |doi = 10.1136/​bmj.2.673.600 }}</​ref><​ref name="​pmid20746575">​{{cite journal | author = Gaskoin G | title = On the treatment of asthma | journal = [[British Medical Journal]] | volume = 1 | issue = 587 | page = 339 |date=March 1872 | pmid = 20746575 | pmc = 2297349 | doi = 10.1136/​bmj.1.587.339 }}</​ref>​ [[Pharmaceutical drug|Medical treatment]] in 1880, included the use of [[Intravenous therapy|intravenous]] doses of a drug called [[pilocarpin]].<​ref name="​pmid20749537">​{{cite journal | author = Berkart JB | title = The treatment of asthma | journal = [[British Medical Journal]] | volume = 1 | issue = 1016 | pages = 917–8 |date=June 1880| pmid = 20749537 | pmc = 2240555 | doi = 10.1136/​bmj.1.1016.917 }}<​br/>​{{cite journal | author = Berkart JB | title = The treatment of asthma | journal = [[British Medical Journal]] | volume = 1 | issue = 1017 | pages = 960–2 |date=June 1880 | pmid = 20749546 | pmc = 2240530 | doi = 10.1136/​bmj.1.1017.960 }}</​ref>​ In 1886, F.H. Bosworth theorized a connection between asthma and [[hay fever]].<​ref name="​pmid21407325">​{{cite journal | author = Bosworth FH| title = Hay fever, asthma, and allied affections | journal = Transactions of the Annual Meeting of the American Climatological Association | volume = 2 | pages = 151–70 | year = 1886 | pmid = 21407325 | pmc = 2526599}}</​ref>​ [[Epinephrine]] was first referred to in the treatment of asthma in 1905.<​ref name="​pmid18733372">​{{cite journal |author = Doig RL | title = Epinephrin; especially in asthma | journal = California State Journal of Medicine | volume = 3 | issue = 2 | pages = 54–5 |date=February 1905 | pmid = 18733372 | pmc = 1650334 }}</​ref>​ Oral corticosteroids began to be used for this condition in the 1950s while inhaled corticosteroids and selective short acting beta agonist came into wide use in the 1960s.<​ref name="​pmid22375974">​{{cite journal|last=von Mutius|first=E|author2=Drazen,​ JM|title=A patient with asthma seeks medical advice in 1828, 1928, and 2012|journal=New England Journal of Medicine|date=Mar 1, 2012|volume=366|issue=9|pages=827–34|pmid=22375974|doi=10.1056/​NEJMra1102783}}</​ref><​ref name="​pmid17092772">​{{cite journal|author=Crompton G |title=A brief history of inhaled asthma therapy over the last fifty years |journal=Primary care respiratory journal : journal of the General Practice Airways Group|date=December 2006|volume=15|issue=6|pages=326–31|pmid=17092772|doi=10.1016/​j.pcrj.2006.09.002}}</​ref>​ 
 + 
 +A notable and well-documented case in the 19th century was that of young [[Theodore Roosevelt#​Early life and family|Theodore Roosevelt]] (1858–1919). At that time there was no effective treatment. Roosevelt'​s youth was in large part shaped by his poor health partly related to his asthma. He experienced recurring nighttime asthma attacks that caused the experience of being smothered to death, terrifying the boy and his parents.<​ref>​{{cite book|author=David McCullough|title=Mornings on Horseback: The Story of an Extraordinary Family, a Vanished Way of Life and the Unique Child Who Became Theodore Roosevelt|url=https://​books.google.com/​books?​id=nuzmvrqPvdIC&​pg=PA93|year=1981|publisher=Simon and Schuster|pages=93–108}}</​ref>​ 
 + 
 +During the 1930s–1950s,​ asthma was known as one of the "holy seven" [[psychosomatic illness]]es. Its cause was considered to be psychological,​ with treatment often based on psychoanalysis and other [[talking cure]]s.<​ref name="​pmid16185365"/>​ As these psychoanalysts interpreted the asthmatic wheeze as the suppressed cry of the child for its mother, they considered the treatment of depression to be especially important for individuals with asthma.<​ref name="​pmid16185365">​{{cite journal |author=Opolski M, Wilson I |title=Asthma and depression: a pragmatic review of the literature and recommendations for future research |journal=Clin Pract Epidemol Ment Health |volume=1 |page=18 |date=September 2005 |pmid=16185365 |pmc=1253523 |doi=10.1186/​1745-0179-1-18 }}</​ref>​ 
 +{{Clear}} 
 + 
 +==References== 
 +{{Reflist|2}} 
 + 
 +;​References 
 +{{Refbegin}} 
 +*{{cite web |author=National Asthma Education and Prevention Program (NAEPP) | url=http://​www.nhlbi.nih.gov/​guidelines/​asthma/​asthgdln.pdf | title=Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma | format=PDF | work=[[National Heart Lung and Blood Institute]] | year=2007 |ref={{harvid|NHLBI Guideline|2007}}}} 
 +*{{cite web | url=http://​www.sign.ac.uk/​pdf/​sign101.pdf|format=PDF |title=British Guideline on the Management of Asthma | work=[[British Thoracic Society]] | origyear=2008| year=2012|ref={{harvid|British Guideline|2009}}}} 
 +*{{cite web | url=http://​www.ginasthma.org/​uploads/​users/​files/​GINA_Report2011_May4.pdf |format=PDF |title=Global Strategy for Asthma Management and Prevention | publisher=Global Initiative for Asthma |year=2011 |ref={{harvid|GINA|2011}}}} 
 +{{Refend}} 
 + 
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 +{{Respiratory pathology}}
  
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 +[[Category:​Asthma| ]]
 +[[Category:​Chronic lower respiratory diseases]]
 +[[Category:​Respiratory therapy]]
  
asthma.txt · Last modified: 2018/02/26 18:10 (external edit)