Michigan Lung and Critical Care MLCC sleep lab Grand Blanc Sleep Apnea Gregory Streff Mark Rittenger Pradeep Ramachandran


Asthma is an inflammatory disease of the airways in the lungs that is characterized by periodic attacks of wheezing, shortness of breath, coughing and chest tightness. During these attacks, inflammation in the airways causes decreased airflow into and out of the lungs. In addition, the muscles lining the airways constrict causing the airways to narrow (bronchoconstriction), which causes the characteristic wheezing sound, and mucus production in the airways is increased.

Asthma attacks can last minutes or days and can become dangerous if the airflow becomes too severely restricted.

Causes, incidence & risk factors
Asthma symptoms may be triggered by inhaled allergens (allergy triggers) such as pollens, dust, molds, pet dander, perfumes, smoke, dust mites, grass etc. Asthma symptoms can also be triggered by cold air, exercise, respiratory infections, stress or even certain types of medications.

Asthma may be diagnosed in childhood or adulthood. In most people, asthma symptoms decrease over time, but for some, symptoms actually get worse. A large majority of people (but not all) with asthma have a family member with asthma, allergies or eczema.


  • Usually begins suddenly
  • Is episodic
  • May be worse at night or in the early morning
  • May be aggravated by exposure to cold air, exercise, heartburn
  • May resolve spontaneously
  • Is relieved by bronchodilator medications


  • With or without sputum production

Shortness of breath

  • Inability to take a deep breath or exhale completely
  • Decreased exercise tolerance

Intercostal retractions (pulling of the skin between the ribs with breathing)

Chest tightness


  • Extreme difficulty breathing
  • Bluish color to the lips and face
  • Severe anxiety due to shortness of breath
  • Rapid pulse
  • Decreased level of consciousness

Tests that may be done to help diagnose and treat asthma include:

  • Pulmonary function tests
  • Peak flow measurements
  • Chest x-ray
  • Allergy testing
  • Arterial blood gas testing
  • Eosinophil count ( a type of white blood cell that is often increased with asthma)

Treatment has two goals: (1) avoidance of triggers (2) controlling severity and frequency of symptoms.

Two groups of medications are used to control the severity and frequency of asthma symptoms:

Short-term (rescue) medications

    • Short-acting bronchodilators (i.e. albuterol, Xopenex)
    • Oral or intravenous steroids

Long-term (maintenance) medications

    • Long-acting bronchodilators (i.e. Serevent, Foradil) which help open airways
    • Leukotriene inhibitors (Singulair, Accolate) which modify the immune response
    • Anticholinergics (iIpratropium, tiotropium) which help prevent bronchoconstriction
    • Cromolyn or theophylline
    • Inhaled steroids (Flovent, Azmacort) which help reduce airway inflammation
    • Anti-IgE therapy (Xolair), which is new injectable medication that is used to modify the immune response in severe asthma.

The types, dosage, and frequency of medications used in the treatment of asthma depends on the severity and frequency of symptoms. People who are only having occasional mild symptoms may only need a rescue medication, whereas, those with more frequent and severe symptoms may need several different short-acting and long-acting medications.

A peak flow meter is a simple device that is used to measure lung volumes, can be used on a regular basis to track asthma symptoms and is often a good early indicator of an asthma flare-up.



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