Asthma is a disease of the airways that makes it difficult to move air in and out of the lungs. Symptoms, such as wheezing, coughing and shortness of breath, result when the airways, or 'bronchi,' in the lungs become inflamed; the bronchi respond to inflammation by constricting (becoming narrower) and producing mucus. Both responses contribute to difficulty breathing.

People with asthma usually experience periods of asthma symptoms, followed by symptom-free periods. Periods when symptoms occur are referred to as "asthma attacks." Some people experience a few mild asthma attacks, while others may experience more severe episodes several times a week. Frequent or severe attacks can disrupt a person's ability to function and can be serious if they are not controlled.¹

An estimated 15 to 20 million Americans have asthma, one third of whom are children. While people can develop asthma at any age, it typically begins in childhood. Interestingly, in children, more boys than girls develop asthma, while in adults, more women than men have asthma.¹ ZYFLO CR is indicated in adults and children above the age of 12.

Symptoms of asthma include:¹

• Coughing - coughing related to asthma is often worse at night and early in the morning
• Wheezing - a whistling sound from the chest during breathing
• Tightness of the chest - a feeling of pressure or squeezing in the chest
• Difficulty breathing - difficulty breathing in or out; a sensation that there is not enough air getting into the lungs
• Rapid breathing
• Coughing and wheezing brought on by laughter or crying

In many cases, asthma attacks are triggered by exposure to allergens, substances that cause allergies.

Common allergens related to asthma are:¹

• Animal dander
• Dust mites (tiny insects that reside in household dust)
• Cockroaches
• Pollen from trees and grasses
• Mold

Airborne irritants can also trigger asthma. Common airborne irritants include:¹

• Cigarette smoke
• Air pollution (e.g., car exhaust, fumes produced by factories)
• Chemical odors
• Perfume and perfumed products

Medicines, chemicals and medical conditions that can trigger asthma include:¹

• Aspirin
• Beta-blockers (a type of blood pressure-reducing medicine)
• Sulfites (a preservative used in foods and wine)
• Gastroesophageal reflux disease (GERD) - a condition in which contents of the stomach "come back up" into the esophagus, causing heartburn; this most commonly triggers asthma symptoms at night
• Infections

In some people, breathing cold air, laughing or crying, exercise, emotional stress or anxiety may also trigger asthma attacks.

It is likely that people with asthma will react to a few different triggers. It is important for people with asthma to determine which triggers bring on asthma attacks so that they can try to avoid them or make sure treatment is handy when exposure can't be avoided.

Doctors may suspect asthma when patients complain of a cold that will not clear up, coughing that wakes them up at night, wheezing, sensations of chest tightness and/or shortness of breath. As part of a diagnostic work-up, doctors may ask if there are allergies or a history of asthma in the family, when these symptoms occur, and what medicines the patient is taking.¹

If the answers to these questions suggest asthma, doctors may order a test called spirometry, which measures how much air is inhaled and exhaled during forced breathing. A lower than normal amount of air indicates that there is inflammation in the airways causing constriction. A diagnosis of asthma can be confirmed by giving a medication to help open the airways (called a bronchodilator) and re-running the test. If breathing improves after the medication is taken, asthma is the likely cause of symptoms.¹

In addition to confirming a diagnosis of asthma, doctors may also ask questions that will help determine how severe the condition is. According to guidelines released by the National Institutes of Health (NIH), asthma severity can be classified into the following four categories:¹

• Intermittent asthma - symptoms occur during the day twice a week or less; symptoms occur twice a month or less at night
• Mild persistent asthma - symptoms occur more than twice a week during the day, or 3-4 times a month at night
• Moderate persistent asthma - symptoms occur daily or nightly.
• Severe persistent asthma - symptoms occur several times throughout the day, and frequently at night. Symptoms make it difficult to engage in physical activity

Determining the type and severity of asthma can help doctors decide which types of treatments a person may need and how often they should be taken. It is important to note that, even though intermittent asthma occurs less frequently than persistent asthma, it is still important to control asthma episodes.¹

The NIH guidelines stress the importance of managing asthma and keeping symptoms under control. The goals for treating asthma are to:²

• Prevent asthma symptoms
• Maintain near-normal lung function
• Reduce the need for "rescue" medications (short-acting bronchodilators, or systemic steroids that are administered to relieve acute asthma attacks)
• Maintain normal activity levels
• Prevent loss of lung function

Asthma is considered "well-controlled" when:

• Symptoms occur no more than two days per week
• Nighttime awakenings occur no more than two nights per month
• Rescue medicine is used no more than two days per week
• Asthma does not interfere with normal activity

Effective asthma management includes medication and lifestyle changes to minimize exposure to known triggers. Depending on individual triggers, these changes may include avoiding areas that allow smoking, use of special sheets and pillowcases to reduce exposure to dust mites, use of air purifiers and filters, or avoiding certain chemicals or perfumes. Treating known allergies is also an important part of asthma management.^1,2 It is important for anyone diagnosed with asthma to discuss triggers and ways to avoid them with a healthcare professional.

There are a number of medications that are used to treat asthma. Treatment choices depend on how well-controlled a person's asthma is.

The NIH describes asthma medications as being either rescue/quick-relief medications or long-term control medications. Rescue medications include:¹

• Short-acting inhaled bronchodilators (SABAs) - medications that open up constricted airways
• Oral steroids - used as an adjunct to SABAs to speed recovering and prevent recurrence of exacerbations in moderate to severe asthma attacks

Long-term control medications include:¹

• Inhaled corticosteroids - medications that reduce inflammation in the airways. These should be taken daily to control mild, moderate or severe persistent asthma symptoms
• Long-acting bronchodilators (LABAs) - these are taken daily with inhaled corticosteroids to help control moderate to severe persistent asthma symptoms
• Immunomodulators - medicine that blocks immunoglobulin
• Leukotriene Receptor Antagonists - medications that inhibit chemicals called leukotrienes. These chemicals are in part responsible for the inflammatory response that leads to asthma attacks
• Leukotriene Synthesis Inhibitors - medications that stop the production of chemicals called leukotrienes
• Oral bronchodilators - medications that help open up constricted airways
• Cromolyn sodium or nedocromil - medications that help prevent inflammation in the airways

Although asthma is a chronic, sometimes serious disorder, as stated earlier, with the right treatment, asthma can be effectively controlled. Its impact on health and quality of life can be minimized.

1. Asthma. National Institutes of Health: National Heart, Lung and Blood Institute.
   Available at:
   www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_All.html
   Accessed 8/15/05.
2. Tips to Remember: Asthma Triggers and Management. American Academy of Allergy, Asthma and Immunology.
   Available at: www.aaaai.org/patients/publicedmat/tips/asthmatriggersandmgmt.stm
   Accessed 8/14/05.