Diabetic ketoacidosis, Excessive Ketones

Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.

Diabetic ketoacidosis develops when your body is unable to produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as an alternate fuel. This process produces a buildup of toxic acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care.

Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice:

  • Excessive thirst
  • Frequent urination
  • Nausea and vomiting
  • Abdominal pain
  • Weakness or fatigue
  • Shortness of breath
  • Fruity-scented breath
  • Confusion

More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include:

  • High blood sugar level (hyperglycemia)
  • High ketone levels in your urine

When to see a doctor
If you feel ill or stressed, or you’ve had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit.

Contact your doctor immediately if:

  • You’re vomiting and unable to tolerate any food or liquid
  • Your blood sugar level is higher than your target range and doesn’t respond to home treatment
  • Your urine ketone level is moderate or high

Seek emergency care if:

  • Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
  • You have ketones in your urine and can’t reach your doctor for advice
  • You have multiple signs and symptoms of diabetic ketoacidosis — excessive thirst or frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion

Remember, untreated diabetic ketoacidosis can be fatal.

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Blood glucose meter: How to choose

If you have diabetes, you likely need a blood glucose meter — a small computerized device — to measure and display your blood glucose level. Exercise, food, medications, stress and other factors affect your blood glucose level. Using a blood glucose meter can help you better manage your diabetes by tracking any fluctuations caused by these factors.

Many types of blood glucose meters are available, from basic models to more-advanced meters with multiple features and options. The cost of blood glucose meters and test strips varies, as can insurance coverage. Study all of your options before deciding which model to buy. Here’s what to look for.

Choosing the right meter

When selecting a blood glucose meter, it can help to know the basics of how they work. To use most blood glucose meters, you first insert one end of a test strip into the device. Then, you prick a clean fingertip with a special needle (lancet) so that you can draw a drop of blood. You carefully touch the other end of the test strip to the blood and wait for a blood glucose reading to appear on the screen.

Blood glucose meters are usually accurate in how they measure glucose, but they differ in the type and number of features they offer. Here are several factors to consider when choosing a blood glucose meter:

  • Insurance. Check with your insurance provider for coverage details before you buy. Some insurance providers limit coverage to specific models or limit the total number of test strips allowed.
  • Cost. Meters vary in price, so shop around. Be sure to factor in the cost of test strips, especially if insurance doesn’t pay for them. Test strips are the most expensive part of monitoring because they’re used so often. A meter may be the cheapest one on the market, but may not be a good deal if the strips cost twice as much. Also, individually packaged strips tend to cost more, but you might not use all the strips in a container before the expiration date or within the required number of days after opening the container. Figure out which type of strip is most cost-effective for you.
  • Ease of use and maintenance. Some meters are easier to use than others. Are both the meter and test strips comfortable to hold? Can you easily see the numbers on the screen? How easy is it to get blood onto the strips? Does it require a small or large drop of blood? Also, some brands of meters need to be coded and others have no coding. Code numbers are used to calibrate your meter with the test strips for accurate results.
  • Special features. Ask about the features to see what meets your specific needs. For example, some meters are large with strips that are easier to handle. Some are compact and easier to carry. People with impaired vision can buy a meter with a large screen or a “talking” meter that announces the results. Colorful meters that give a quick reading are available for children. Some models have a backlight, which is handy for nighttime readings. Others are manufactured to withstand extreme temperatures, which may be useful for people who spend a lot of time outdoors, such as hikers or construction workers.
  • Information storage and retrieval. Consider how the meter stores and retrieves information. Some can track all the information you’d normally write in a log, such as the time and date of a test, the result, and trends over time. Some meters offer the ability to download your blood glucose readings to a computer or your cell phone, then email the test results to your doctor.
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Slide Show : How to test blood sugar at home/office/travelling

http://www.mayoclinic.com/health/blood-sugar/DA00062

 

Mayo Clinic

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Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.

People with COPD have difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction.

Typical symptoms of COPD include:

  • increasing breathlessness when active
  • a persistent cough with phlegm
  • frequent chest infections

Read more about the symptoms of chronic obstructive pulmonary disease.

Why does COPD happen?

The main cause of COPD is smoking. The likelihood of developing COPD increases the more you smoke and the longer you’ve been smoking. This is because smoking irritates and inflames the lungs, which results in scarring.

Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more mucus is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed. These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD.

Some cases of COPD are caused by fumes, dust, air pollution and genetic disorders, but these are rarer.

Read more about the causes of chronic obstructive pulmonary disease.

Who is affected?

COPD is one of the most common respiratory diseases in the UK. It usually affects people over the age of 35, although most people are not diagnosed until they are in their fifties.

It is thought there are over 3 million people living with the disease in the UK, of which only about 900,000 have been diagnosed. This is because many people who develop symptoms of COPD do not get medical help because they often dismiss their symptoms as a ‘smoker’s cough’.

COPD affects more men than women, although rates in women are increasing.

Diagnosis

It is important that COPD is diagnosed as early as possible so treatment can be used to try to slow down the deterioration of your lungs. You should see your GP if you have any of the symptoms mentioned above.

COPD is usually diagnosed after a consultation with your doctor, which may be followed by breathing tests.

Read more about diagnosing chronic obstructive pulmonary disease.

Treating COPD

Although the damage that has already occurred to your lungs cannot be reversed, you can slow down the progression of the disease. Stopping smoking is particularly effective at doing this.

Treatments for COPD usually involve relieving the symptoms with medication, for example by using an inhaler to make breathing easier.

Surgery is only an option for a small number of people with COPD.

Read more about treating chronic obstructive pulmonary disease.

Living with COPD

COPD can affect your life in many ways, but help is available to reduce its impact.

Simple steps such as keeping healthy, being as active as possible, learning breathing techniques, and taking your medication can help you to reduce the symptoms of COPD.

Financial support and advice about relationships and end of life care is also available for people with COPD.

Read more about living with chronic obstructive pulmonary disease.

Want to know more?

  • British Lung Foundation: COPD

Treatment

Whether it’s a short course of antibiotics to treat a mild infection, or a permanent supply of oxygen to help you to breathe, most lung conditions require treatment in some form or another.

This section provides information on the following types of treatments:

  • Complementary therapies – everything from acupuncture to tai chi
  • Lung transplantation – the replacement of one or both diseased lungs with the healthy lungs of a donor
  • Lung volume reduction surgery – the removal of the damaged air spaces of the lung so that healthy parts can inflate and work better
  • Nebulisers – a powerful drug delivery system to get medication into the lungs effectively
  • Non-invasive ventilation – treatment to get oxygen into the lungs via a ventilator and a face mask
  • Oxygen – used to correct a low oxygen level in the blood and help to ease breathlessness
  • Pulmonary rehabilitation – a programme of physical exercise and advice on lung health
  • Steroids – medication prescribed in oral or inhaled form, used to treat a number of different conditions
  • Antibiotics – medication used to treat infections caused by bacteria

NHS

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Lung Cancer

What Is Lung Cancer?

Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via the blood.

The Genetic Basis of Lung Cancer

All cells in the body contain the genetic material called deoxyribonucleic acid (DNA). Every time a mature cell divides into two new cells, its DNA is exactly duplicated. The cells are copies of the original cell, identical in every way. In this way our bodies continually replenish themselves. Old cells die off and the next generation replaces them.

A cancer begins with an error, or mutation, in a cell’s DNA. DNA mutations can be caused by the normal aging process or through environmental factors, such as cigarette smoke, breathing in asbestos fibers, and to exposure to radon gas.

Researchers have found that it takes a series of mutations to create a lung cancer cell. Before becoming fully cancerous, cells can be precancerous, in that they have some mutations but still function normally as lung cells. When a cell with a genetic mutation divides, it passes along its abnormal genes to the two new cells, which then divide into four cells with errors in their DNA and so on. With each new mutation, the lung tissue cell becomes more mutated and may not be as effective in carrying out its function as a lung cell. At a later stage of disease, some cells may travel away from the original tumor and start growing in other parts of the body. This process is call metastasis and the new distant sites are referred to as metastases.

Primary Versus Secondary Lung Cancer

Primary lung cancer starts in the lungs. The cancer cells are abnormal lung cells. Sometimes, people will have cancer travel from another part of their body or metastasize to their lungs. This is called secondary lung cancer because the lungs are a secondary site compared to the original primary location of the cancer. So, for example, breast cancer cells which have traveled to the lung are not lung cancer but rather metastatic breast cancer, and will require treatment prescribed for breast cancer rather than lung cancer.

Symptoms of Lung Cancer

It’s important to report any unusual physical feelings to your doctor. Often, these unusual feelings can be attributed to other causes, such as bronchitis. But a doctor should check anything that is unusual or worrisome. The signs and symptoms of lung cancer can take years to develop and they may not appear until the disease is advanced.

Symptoms of lung cancer that are in the chest:

  • Coughing, especially if it persists or becomes intense
  • Pain in the chest, shoulder, or back unrelated to pain from coughing
  • A change in color or volume of sputum
  • Shortness of breath
  • Changes in the voice or being hoarse
  • Harsh sounds with each breath (stridor)
  • Recurrent lung problems, such as bronchitis or pneumonia
  • Coughing up phlegm or mucus, especially if it is tinged with blood
  • Coughing up blood

If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands.

Symptoms of lung cancer that may occur elsewhere in the body:

  • Loss of appetite or unexplained weight loss
  • Muscle wasting (also known as cachexia)
  • Fatigue
  • Headaches, bone or joint pain
  • Bone fractures not related to accidental injury
  • Neurological symptoms, such as unsteady gait or memory loss
  • Neck or facial swelling
  • General weakness
  • Bleeding
  • Blood clots

Diagnosing Lung Cancer

If lung cancer is suspected as a result of a screening procedure, a small piece of tissue from the lung must be examined under a microscope to look for cancer cells. Called a biopsy, this procedure can be performed in different ways. In some cases, the doctor passes a needle through the skin into the lungs to remove a small piece of tissue; this procedure is often called a needle biopsy.

In other cases, a biopsy may be done during a bronchoscopy. To perform a bronchoscopy, the doctor inserts a small tube through the mouth or nose and into the lungs. The tube, which has a light on the end, allows the doctor to see inside the lungs and to remove a small tissue sample.

When a person is diagnosed with lung cancer, looking at biopsied cells under the microscope also helps doctors determine the type of lung cancer. It is important to know the specific type because this information helps doctors recommend the best treatment.

Types and Staging of Lung Cancer

There are two major types of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Staging lung cancer is based on whether the cancer is local or has spread from the lungs to the lymph nodes or other organs. Because the lungs are large, tumors can grow in them for a long time before they are found. Even when symptoms—such as coughing and fatigue—do occur, people think they are due to other causes. For this reason, early-stage lung cancer (stages I and II) is difficult to detect. Most people with lung cancer are diagnosed at stages III and IV.

Non-Small Cell Lung Cancer

Non-small cell lung cancer accounts for about 85 percent of lung cancers. Among them are these types of tumors:

  • Adenocarcinoma is the most common form of lung cancer in the United States among both men and women.
  • Squamous cell carcinoma (which is also called epidermoid carcinoma) forms in the lining of the bronchial tubes.
  • Large cell carcinomas refer to non-small cell lung cancers that are neither adenocarcinomas nor epidermoid cancers.

STAGES OF NON-SMALL CELL LUNG CANCER

Stage I: The cancer is located only in the lungs and has not spread to any lymph nodes.

Stage II: The cancer is in the lung and nearby lymph nodes.

Stage III: Cancer is found in the lung and in the lymph nodes in the middle of the chest, also described as locally advanced disease. Stage III has two subtypes:

  • If the cancer has spread only to lymph nodes on the same side of the chest where the cancer started, it is called stage IIIA.
  • If the cancer has spread to the lymph nodes on the opposite side of the chest, or above the collar bone, it is called stage IIIB.

Stage IV: This is the most advanced stage of lung cancer, and is also described as advanced disease. This is when the cancer has spread to both lungs, to fluid in the area around the lungs, or to another part of the body, such as the liver or other organs.

Small Cell Lung Cancer

Small cell lung cancer accounts for the remaining 15 percent of lung cancers in the United States. Small cell lung cancer results from smoking even more so than non-small cell lung cancer, and grows more rapidly and spreads to other parts of the body earlier than non-small cell lung cancer. It is also more responsive to chemotherapy.

Stages of Small Cell Lung Cancer

Limited stage: In this stage, cancer is found on one side of the chest, involving just one part of the lung and nearby lymph nodes.

Extensive stage: In this stage, cancer has spread to other regions of the chest or other parts of the body.

More recently, the American Joint Commission on Cancer implemented a more detailed staging system in which the stages of small cell lung cancer are described using Roman numerals and letters (for example, Stage IIA). This is the same method that is used for non-small cell lung cancer in describing the growth and spread of the cancer.

Non-Small Cell Lung Cancer Treatment

Surgery, radiation, chemotherapy, and targeted treatments—alone or in combination—are used to treat lung cancer. Each of these types of treatments may cause different side effects.

Surgery

Most stage I and stage II non-small cell lung cancers are treated with surgery to remove the tumor. For this procedure, a surgeon removes the lobe, or section, of the lung containing the tumor.

Some surgeons use video-assisted thoracoscopic surgery (VATS). For this procedure, the surgeon makes a small incision, or cut, in the chest and inserts a tube called a thoracoscope. The thoracoscope has a light and a tiny camera connected to a video monitor so that the surgeon can see inside the chest. A lung lobe can then be removed through the scope, without making a large incision in the chest.

Chemotherapy and Radiation

For people with non-small cell lung tumors that can be surgically removed, evidence suggests that chemotherapy after surgery, known as “adjuvant chemotherapy,” may help prevent the cancer from returning. This is particularly true for patients with stage II and IIIA disease. Questions remain about whether adjuvant chemotherapy applies to other patients and how much they benefit.

For people with stage III lung cancer that cannot be removed surgically, doctors typically recommend chemotherapy in combination with definitive (high-dose) radiation treatments. In stage IV lung cancer, chemotherapy is typically the main treatment. In stage IV patients, radiation is used only for palliation of symptoms.

The chemotherapy treatment plan for lung cancer often consists of a combination of drugs. Among the drugs most commonly used are cisplatin (Platinol) or carboplatin (Paraplatin) plus docetaxel (Taxotere), gemcitabine (Gemzar), paclitaxel (Taxol and others), vinorelbine (Navelbine and others), or pemetrexed (Alimta).

There are times when these treatments may not work. Or, after these drugs work for a while, the lung cancer may come back. In such cases, doctors often prescribe a second course of drug treatment referred to as second-line chemotherapy.

Recently, the concept of maintenance chemotherapy has been tested in clinical trials, either as a switch to another drug before the cancer progresses; or to continue one of the drugs used initially for a longer period of time. Both of these strategies have shown advantages in selected patients.

Chemotherapy Before Other Treatments (Neoadjuvant Treatment)

Receiving chemotherapy before radiation or surgery may help people with lung cancer by shrinking the tumor enough to make it easier to remove with surgery, increasing the effectiveness of radiation and destroying hidden cancer cells at the earliest possible time.

If a tumor doesn’t shrink with chemotherapy, the medication can be stopped right away, allowing the doctor to try a different treatment. In addition, research shows that people with lung cancer are much more able to cope with the side effects of chemotherapy when it is given before surgery.

Sometimes, a short trial period of treatment with the drug shrinks the tumor before surgery. If that is the case, then continued treatment with the same drug after surgery is more likely to benefit the patient. Because many lung cancer specialists around the world are giving chemotherapy to their patients before surgery, patients should discuss it with their doctor.

Targeted Treatments

One of the most exciting developments in lung cancer medicine is the introduction of targeted treatments. Unlike chemotherapy drugs, which cannot tell the difference between normal cells and cancer cells, targeted therapies are designed specifically to attack cancer cells by attaching to or blocking targets that appear on the surfaces of those cells. People who have advanced lung cancer with certain molecular biomarkers may receive treatment with a targeted drug alone or in combination with chemotherapy. These treatments for lung cancer include:

Erlotinib (Tarceva) A targeted treatment called erlotinib has been shown to benefit some people with non-small cell lung cancer. This drug blocks a specific kind of receptor on the cell surface—the epidermal growth factor receptor (EGFR). Receptors such as EGFR act as doorways by allowing substances in that they can encourage a cancer cell to grow and spread. Lung cancer cells that have a mutation on the EGFR are likely to respond to treatment with erlotinib instead of chemotherapy. For patients who have received chemotherapy, and are in need of additional treatment, erlotinib can be used even without the presence of the mutation.

Bevacizumab (Avastin) Just like normal tissues, tumors need a blood supply to survive. Blood vessels grow in several ways. One way is through the presence of a substance called vascular endothelial growth factor (VEGF). This substance stimulates blood vessels to penetrate tumors and supply oxygen, minerals, and other nutrients to feed the tumor. When tumors spread throughout the body, they release VEGF to create new blood vessels.

Bevacizumab works by stopping VEGF from stimulating the growth of new blood vessels. (Because normal tissues have an established blood supply, they are not affected by the drug.) When combined with chemotherapy, bevacizumab has been shown to improve survival in people with certain types of non-small lung cancer, such as adenocarcinoma and large cell carcinoma.

Crizotinib (Xalkori) is a newly available treatment that has shown benefits for people with advanced non–small cell lung cancer who have the ALK biomarker. Mutations in the way cells program ALK result in changes to the way it functions, leading to increased tumor cell growth. Crizotinib works by blocking ALK and stopping the growth of the tumor.

Chemotherapy and Radiation Therapy

For people with small cell lung cancer, regardless of stage, chemotherapy is an essential part of treatment. Radiation treatment may be used as well depending on the stage of cancer.

For people with limited-stage small cell lung cancer, combination chemotherapy plus radiation therapy given at the same time is the recommended treatment. The most commonly used initial chemotherapy regimen is etoposide (Toposar or Vepesid) plus cisplatin (Platinol), known as EP.

For people with extensive-stage small cell lung cancer, chemotherapy alone using the EP regimen is the standard treatment. However, another regimen that may be used is carboplatin (Paraplatin) plus irinotecan (Camptosar)

Radiation therapy of the brain may be used before or after chemotherapy for some people whose cancer has spread to the brain.

Preventive Radiation Therapy to the Brain

In more than half of the people with small cell lung cancer, the cancer also spreads to the brain. For people whose lung cancer has responded to chemotherapy, doctors may prescribe radiation therapy to the brain to help prevent the cancer from spreading to the brain. This procedure is known as prophylactic cranial irradiation (PCI). This can benefit patient with both limited-stage and extensive-stage small cell lung cancers.

Surgery

A very small percentage of people who have limited-stage small cell lung cancer and no lymph node tumors may benefit from surgery, after which adjuvant chemotherapy is given.

lung cancer.org

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Respiratory Failure

Respiratory failure happens when not enough oxygen passes from your lungs into your blood. Your body’s organs, such as your heart and brain, need oxygen-rich blood to work well. Respiratory failure also can happen if your lungs can’t remove carbon dioxide (a waste gas) from your blood. Too much carbon dioxide in your blood can harm your body’s organs.

Diseases and conditions that affect your breathing can cause respiratory failure. Examples include

  • Lung diseases such as COPD (chronic obstructive pulmonary disease), pneumonia, pulmonary embolism, and cystic fibrosis
  • Conditions that affect the nerves and muscles that control breathing, such as spinal cord injuries, muscular dystrophy and stroke
  • Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
  • Drug or alcohol overdose
  • Injuries from inhaling smoke or harmful fumes

Treatment for respiratory failure depends on whether the condition is acute (short-term) or chronic (ongoing) and how severe it is. It also depends on the underlying cause. You may receive oxygen therapy and other treatment to help you breathe.

NIH: National Heart, Lung, and Blood Institute

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Asthama

What Is Asthma?

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the Illustration of the lungs airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.

Overview

To understand asthma, it helps to know how the airways work. The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. This makes them swollen and very sensitive. They tend to react strongly to certain inhaled substances.

When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid that can further narrow the airways.

This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.

Asthma

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.

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.

Sometimes asthma symptoms are mild and go away on their own or after minimal treatment with asthma medicine. Other times, symptoms continue to get worse.

When symptoms get more intense and/or more symptoms occur, you’re having an asthma attack. Asthma attacks also are called flareups or exacerbations (eg-zas-er-BA-shuns).

Treating symptoms when you first notice them is important. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.

Outlook

Asthma has no cure. Even when you feel fine, you still have the disease and it can flare up at any time.

However, with today’s knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.

If you have asthma, you can take an active role in managing the disease. For successful, thorough, and ongoing treatment, build strong partnerships with your doctor and other health care providers.

What Causes Asthma?

The exact cause of asthma isn’t known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:

  • An inherited tendency to develop allergies, called atopy (AT-o-pe)
  • Parents who have asthma
  • Certain respiratory infections during childhood
  • Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing

If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) might make your airways more reactive to substances in the air.

Some factors might be more likely to cause asthma in certain people than in others. Researchers continue to explore what causes asthma.

The Hygiene Hypothesis

One theory researchers have for what causes asthma is called the hygiene hypothesis. They believe that our Western lifestyle—with its emphasis on hygiene and sanitation—has resulted in changes in our living conditions and an overall decline in infections in early childhood.

Many young children no longer have the same types of environmental exposures and infections as children did in the past. This affects the way that young children’s immune systems develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions.

Who Is at Risk for Asthma?

Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.

Young children who often wheeze and have respiratory infections—as well as certain other risk factors—are at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.

Among children, more boys have asthma than girls. But among adults, the disease affects men and women equally. It’s not clear whether or how sex and sex hormones play a role in causing asthma.

Most, but not all, people who have asthma have allergies.

Some people develop asthma because of contact with certain chemical irritants or industrial dusts in the workplace. This type of asthma is called occupational asthma.

What Are the Signs and Symptoms of Asthma?

Common signs and symptoms of asthma include:

  • Coughing. Coughing from asthma often is worse at night or early in the morning, making it hard to sleep.
  • Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
  • Chest tightness. This may feel like something is squeezing or sitting on your chest.
  • Shortness of breath. Some people who have asthma say they can’t catch their breath or they feel out of breath. You may feel like you can’t get air out of your lungs.

Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn’t always mean that you have asthma. The best way doctors have to diagnose asthma is to use a lung function test, ask about medical history (including type and frequency of symptoms), and do a physical exam.

The type of asthma symptoms you have, how often they occur, and how severe they are may vary over time. Sometimes your symptoms may just annoy you. Other times, they may be troublesome enough to limit your daily routine.

Severe symptoms can be fatal. Thus, treating symptoms when you first notice them is important, so they don’t become severe.

With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.

What Causes Asthma Symptoms To Occur?

Many things can trigger or worsen asthma symptoms. Your doctor will help you find out which things (called triggers) may cause your asthma to flare up if you come in contact with them. Triggers can include:

  • Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers
  • Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home décor products, and sprays (such as hairspray)
  • Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and nonselective beta-blockers
  • Sulfites in foods and drinks
  • Viral upper respiratory infections, such as colds
  • Physical activity, including exercise

Other health conditions can make asthma harder to manage. Examples of these conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions should be treated as part of an overall asthma care plan.

Asthma is different for each person. Some of the triggers listed above may not affect you. Other triggers that do affect you might not be on the list. Talk with your doctor about the things that seem to make your asthma worse.

How Is Asthma Diagnosed?

Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.

Your doctor also will figure out the severity of your asthma—that is, whether it’s intermittent, mild, moderate, or severe. The treatment your doctor prescribes will depend on the level of severity.

Your doctor may recommend that you see an asthma specialist if:

  • You need special tests to help diagnose asthma
  • You’ve had a life-threatening asthma attack
  • You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall problems getting your asthma well controlled
  • You’re thinking about getting allergy treatments

Medical and Family Histories

Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms and when and how often they occur.

Let your doctor know whether your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night.

Your doctor also may want to know what factors seem to trigger your symptoms or worsen them.

Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea.

Physical Exam

Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema).

Keep in mind that you can still have asthma even if you don’t have these signs when your doctor examines you.

Diagnostic Tests

Lung Function Test

Your doctor will use a test called spirometry (spi-ROM-eh-tre) to check how your lungs are working. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out.

Your doctor may give you medicine and then retest you to see whether the results have improved.

If your test results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your doctor will likely diagnose you with asthma.

Other Tests

Your doctor may recommend other tests if he or she needs more information to make a diagnosis. Other tests may include:

  • Allergy testing to find out which allergens affect you, if any.
  • A test to measure how sensitive your airways are. This is called a bronchoprovocation (brong-KO-prav-eh-KA-shun) test. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in.
  • A test to show whether you have another condition with symptoms similar to asthma, such as reflux disease, vocal cord dysfunction, or sleep apnea.
  • chest x ray or an EKG (electrocardiogram). These tests will help find out whether a foreign object in your airways or another disease might be causing your symptoms.

Diagnosing Asthma in Young Children

Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (infants to children 5 years old) can be hard to diagnose.

Sometimes it’s hard to tell whether a child has asthma or another childhood condition. The symptoms of asthma are similar to the symptoms of other conditions.

Also, many young children who wheeze when they get colds or respiratory infections don’t go on to have asthma. A child may wheeze because he or she has small airways that become narrow during colds or respiratory infections. The airways grow as the child grows, so wheezing no longer occurs as the child gets older.

A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:

  • One or both parents have asthma
  • The child has signs of allergies, including the allergic skin condition eczema
  • The child has allergic reactions to pollens or other airborne allergens
  • The child wheezes even when he or she doesn’t have a cold or other infection

The most certain way to diagnose asthma is with a lung function test, a medical history, and a physical exam. However, it’s hard to do lung function tests in children younger than 5 years. Thus, doctors must rely on children’s medical histories, signs and symptoms, and physical exams to make a diagnosis.

Doctors also may use a 4–6 week trial of asthma medicines to see how well a child responds.

How Is Asthma Treated and Controlled?

Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will:

  • Prevent chronic and troublesome symptoms, such as coughing and shortness of breath
  • Reduce your need for quick-relief medicines (see below)
  • Help you maintain good lung function
  • Let you maintain your normal activity level and sleep through the night
  • Prevent asthma attacks that could result in an emergency room visit or hospital stay

To control asthma, partner with your doctor to manage your asthma or your child’s asthma. Children aged 10 or older—and younger children who are able—should take an active role in their asthma care.

Taking an active role to control your asthma involves:

  • Working with your doctor to treat other conditions that can interfere with asthma management.
  • Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
  • Working with your doctor and other health care providers to create and follow an asthma action plan.

An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed.

Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or “rescue,” medicines relieve asthma symptoms that may flare up.

Your initial treatment will depend on the severity of your asthma. Followup asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.

Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you’re exposed to the factors that can worsen your asthma.

Your doctor may need to increase your medicine if your asthma doesn’t stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.

Asthma treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will be adjusted to meet their special needs.

Follow an Asthma Action Plan

You can work with your doctor to create a personal asthma action plan. The plan will describe your daily treatments, such as which medicines to take and when to take them. The plan also will explain when to call your doctor or go to the emergency room.

If your child has asthma, all of the people who care for him or her should know about the child’s asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.

Go to the National Heart, Lung, and Blood Institute’s (NHLBI’s) “Asthma Action Plan” for a sample plan.

Avoid Things That Can Worsen Your Asthma

Many common things (called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these things are, you can take steps to control many of them. (For more information about asthma triggers, go to “What Are the Signs and Symptoms of Asthma?”)

For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom.

One possible asthma trigger you shouldn’t avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

The NHLBI offers many useful tips for controlling asthma triggers. For more information, go to page 2 of NHLBI’s “Asthma Action Plan.”

If your asthma symptoms are clearly related to allergens, and you can’t avoid exposure to those allergens, your doctor may advise you to get allergy shots.

You may need to see a specialist if you’re thinking about getting allergy shots. These shots can lessen or prevent your asthma symptoms, but they can’t cure your asthma.

Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, andsleep apnea. Your doctor will treat these conditions as well.

Medicines

Your doctor will consider many things when deciding which asthma medicines are best for you. He or she will check to see how well a medicine works for you. Then, he or she will adjust the dose or medicine as needed.

Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs.

Not all inhalers are used the same way. Ask your doctor or another health care provider to show you the right way to use your inhaler. Review the way you use your inhaler at every medical visit.

Long-Term Control Medicines

Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. The most effective long-term medicines reduce airway inflammation, which helps prevent symptoms from starting. These medicines don’t give you quick relief from symptoms.

Inhaled corticosteroids. Inhaled corticosteroids are the preferred medicine for long-term control of asthma. They’re the most effective option for long-term relief of the inflammation and swelling that makes your airways sensitive to certain inhaled substances.

Reducing inflammation helps prevent the chain reaction that causes asthma symptoms. Most people who take these medicines daily find they greatly reduce the severity of symptoms and how often they occur.

Inhaled corticosteroids generally are safe when taken as prescribed. These medicines are different from the illegal anabolic steroids taken by some athletes. Inhaled corticosteroids aren’t habit-forming, even if you take them every day for many years.

Like many other medicines, though, inhaled corticosteroids can have side effects. Most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risk of side effects.

One common side effect from inhaled corticosteroids is a mouth infection called thrush. You might be able to use a spacer or holding chamber on your inhaler to avoid thrush. These devices attach to your inhaler. They help prevent the medicine from landing in your mouth or on the back of your throat.

Check with your doctor to see whether a spacer or holding chamber should be used with the inhaler you have. Also, work with your health care team if you have any questions about how to use a spacer or holding chamber. Rinsing your mouth out with water after taking inhaled corticosteroids also can lower your risk for thrush.

If you have severe asthma, you may have to take corticosteroid pills or liquid for short periods to get your asthma under control.

If taken for long periods, these medicines raise your risk for cataracts and osteoporosis (OS-te-o-po-RO-sis). A cataract is the clouding of the lens in your eye. Osteoporosis is a disorder that makes your bones weak and more likely to break.

Your doctor may have you add another long-term asthma control medicine so he or she can lower your dose of corticosteroids. Or, your doctor may suggest you take calcium and vitamin D pills to protect your bones.

Other long-term control medicines. Other long-term control medicines include:

  • Cromolynexternal link icon. This medicine is taken using a device called a nebulizer. As you breathe in, the nebulizer sends a fine mist of medicine to your lungs. Cromolyn helps prevent airway inflammation.
  • Omalizumabexternal link icon (anti-IgE). This medicine is given as a shot (injection) one or two times a month. It helps prevent your body from reacting to asthma triggers, such as pollen and dust. Anti-IgE might be used if other asthma medicines have not worked well.
  • Inhaled long-acting beta2-agonistsexternal link icon. These medicines open the airways. They might be added to low-dose inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used for long-term asthma control unless they’re used with inhaled corticosteroids.
  • Leukotriene modifiersexternal link icon. These medicines are taken by mouth. They help block the chain reaction that increases inflammation in your airways.
  • Theophyllineexternal link icon. This medicine is taken by mouth. Theophylline helps open the airways.

If your doctor prescribes a long-term control medicine, take it every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine.

Long-term control medicines can have side effects. Talk with your doctor about these side effects and ways to reduce or avoid them.

With some medicines, like theophylline, your doctor will check the level of medicine in your blood. This helps ensure that you’re getting enough medicine to relieve your asthma symptoms, but not so much that it causes dangerous side effects.

Quick-Relief Medicines

All people who have asthma need quick-relief medicines to help relieve asthma symptoms that may flare up. Inhaled short-acting beta2-agonistsexternal link icon are the first choice for quick relief.

These medicines act quickly to relax tight muscles around your airways when you’re having a flareup. This allows the airways to open up so air can flow through them.

You should take your quick-relief medicine when you first notice asthma symptoms. If you use this medicine more than 2 days a week, talk with your doctor about your asthma control. You may need to make changes to your asthma action plan.

Carry your quick-relief inhaler with you at all times in case you need it. If your child has asthma, make sure that anyone caring for him or her has the child’s quick-relief medicines, including staff at the child’s school. They should understand when and how to use these medicines and when to seek medical care for your child.

You shouldn’t use quick-relief medicines in place of prescribed long-term control medicines. Quick-relief medicines don’t reduce inflammation.

Track Your Asthma

To track your asthma, keep records of your symptoms, check your peak flow number using a peak flow meter, and get regular asthma checkups.

Record Your Symptoms

You can record your asthma symptoms in a diary to see how well your treatments are controlling your asthma.

Asthma is well controlled if:

  • You have symptoms no more than 2 days a week, and these symptoms don’t wake you from sleep more than 1 or 2 nights a month.
  • You can do all your normal activities.
  • You take quick-relief medicines no more than 2 days a week.
  • You have no more than one asthma attack a year that requires you to take corticosteroids by mouth.
  • Your peak flow doesn’t drop below 80 percent of your personal best number.

If your asthma isn’t well controlled, contact your doctor. He or she may need to change your asthma action plan.

Use a Peak Flow Meter

This small, hand-held device shows how well air moves out of your lungs. You blow into the device and it gives you a score, or peak flow number. Your score shows how well your lungs are working at the time of the test.

Your doctor will tell you how and when to use your peak flow meter. He or she also will teach you how to take your medicines based on your score.

Your doctor and other health care providers may ask you to use your peak flow meter each morning and keep a record of your results. You may find it very useful to record peak flow scores for a couple of weeks before each medical visit and take the results with you.

When you’re first diagnosed with asthma, it’s important to find your “personal best” peak flow number. To do this, you record your score each day for a 2- to 3-week period when your asthma is well-controlled. The highest number you get during that time is your personal best. You can compare this number to future numbers to make sure your asthma is controlled.

Your peak flow meter can help warn you of an asthma attack, even before you notice symptoms. If your score shows that your breathing is getting worse, you should take your quick-relief medicines the way your asthma action plan directs. Then you can use the peak flow meter to check how well the medicine worked.

Get Asthma Checkups

When you first begin treatment, you’ll see your doctor about every 2 to 6 weeks. Once your asthma is controlled, your doctor may want to see you from once a month to twice a year.

During these checkups, your doctor may ask whether you’ve had an asthma attack since the last visit or any changes in symptoms or peak flow measurements. He or she also may ask about your daily activities. This information will help your doctor assess your level of asthma control.

Your doctor also may ask whether you have any problems or concerns with taking your medicines or following your asthma action plan. Based on your answers to these questions, your doctor may change the dose of your medicine or give you a new medicine.

If your control is very good, you might be able to take less medicine. The goal is to use the least amount of medicine needed to control your asthma.

Emergency Care

Most people who have asthma, including many children, can safely manage their symptoms by following their asthma action plans. However, you might need medical attention at times.

Call your doctor for advice if:

  • Your medicines don’t relieve an asthma attack.
  • Your peak flow is less than half of your personal best peak flow number.

Call 9–1–1 for emergency care if:

  • You have trouble walking and talking because you’re out of breath.
  • You have blue lips or fingernails.

At the hospital, you’ll be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life.

Asthma Treatment for Special Groups

The treatments described above generally apply to all people who have asthma. However, some aspects of treatment differ for people in certain age groups and those who have special needs.

Children

It’s hard to diagnose asthma in children younger than 5 years. Thus, it’s hard to know whether young children who wheeze or have other asthma symptoms will benefit from long-term control medicines. (Quick-relief medicines tend to relieve wheezing in young children whether they have asthma or not.)

Doctors will treat infants and young children who have asthma symptoms with long-term control medicines if, after assessing a child, they feel that the symptoms are persistent and likely to continue after 6 years of age. (For more information, go to “How Is Asthma Diagnosed?”)

Inhaled corticosteroids are the preferred treatment for young children. Montelukast and cromolyn are other options. Treatment might be given for a trial period of 1 month to 6 weeks. Treatment usually is stopped if benefits aren’t seen during that time and the doctor and parents are confident the medicine was used properly.

Inhaled corticosteroids can possibly slow the growth of children of all ages. Slowed growth usually is apparent in the first several months of treatment, is generally small, and doesn’t get worse over time. Poorly controlled asthma also may reduce a child’s growth rate.

Many experts think the benefits of inhaled corticosteroids for children who need them to control their asthma far outweigh the risk of slowed growth.

Older Adults

Doctors may need to adjust asthma treatment for older adults who take certain other medicines, such as beta blockers, aspirin and other pain relievers, and anti-inflammatory medicines. These medicines can prevent asthma medicines from working well and may worsen asthma symptoms.

Be sure to tell your doctor about all of the medicines you take, including over-the-counter medicines.

Older adults may develop weak bones from using inhaled corticosteroids, especially at high doses. Talk with your doctor about taking calcium and vitamin D pills, as well as other ways to help keep your bones strong.

Pregnant Women

Pregnant women who have asthma need to control the disease to ensure a good supply of oxygen to their babies. Poor asthma control increases the risk that a baby will be born early and have a low birth weight. Poor asthma control can even risk the baby’s life.

Studies show that it’s safer to take asthma medicines while pregnant than to risk having an asthma attack.

Talk with your doctor if you have asthma and are pregnant or planning a pregnancy. Your level of asthma control may get better or it may get worse while you’re pregnant. Your health care team will check your asthma control often and adjust your treatment as needed.

People Whose Asthma Symptoms Occur With Physical Activity

Physical activity is an important part of a healthy lifestyle. Adults need physical activity to maintain good health. Children need it for growth and development.

In some people, however, physical activity can trigger asthma symptoms. If this happens to you or your child, talk with your doctor about the best ways to control asthma so you can stay active.

The following medicines may help prevent asthma symptoms caused by physical activity:

  • Short-acting beta2-agonists (quick-relief medicine) taken shortly before physical activity can last 2 to 3 hours and prevent exercise-related symptoms in most people who take them.
  • Long-acting beta2-agonists can be protective for up to 12 hours. However, with daily use, they’ll no longer give up to 12 hours of protection. Also, frequent use of these medicines for physical activity might be a sign that asthma is poorly controlled.
  • Leukotriene modifiers. These pills are taken several hours before physical activity. They can help relieve asthma symptoms brought on by physical activity.
  • Long-term control medicines. Frequent or severe symptoms due to physical activity may suggest poorly controlled asthma and the need to either start or increase long-term control medicines that reduce inflammation. This will help prevent exercise-related symptoms.

Easing into physical activity with a warmup period may be helpful. You also may want to wear a mask or scarf over your mouth when exercising in cold weather.

If you use your asthma medicines as your doctor directs, you should be able to take part in any physical activity or sport you choose.

People Having Surgery

Asthma may add to the risk of having problems during and after surgery. For instance, having a tube put into your throat may cause an asthma attack.

Tell your surgeon about your asthma when you first talk with him or her. The surgeon can take steps to lower your risk, such as giving you asthma medicines before or during surgery.

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