Asthma Q & A

What is asthma?

Asthma is a chronic lung disease that causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs.

Asthma most often starts in childhood. It is one of the most common long-term diseases of children, but many adults have asthma as well. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children; children under four are increasingly affected, as this age group had the highest rate of hospitalization for asthma.

What is an asthma attack?

As an asthma sufferer, your airways will always have some irritation, though when you have an asthma attack, this irritation gets worse. Asthma attacks, also called episodes, can be recognized by the occurrence of coughing, chest tightness, wheezing, and having trouble breathing.

The attack happens in your body’s airways—the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucus that your body produces clogs up the airways even more.

What causes asthma?

Generally, it is hard to pinpoint exactly what causes asthma, though if someone in your family has asthma, you are more likely to have it. While asthma is genetic, outside factors are what truly set off, or trigger asthma.

An asthma attack can occur when you are exposed to things in the environment, such as house dust mites, outdoor air pollution, and tobacco smoke. These are called asthma triggers. For a guide of important asthma triggers, click here.

Does gender make a difference in asthma prevalance?

According to findings from the CDC’s National Center for Health Statistics, more women than men die of asthma; overall, women account for nearly 65% of asthma deaths.

Can asthma be cured?

There is no cure for asthma. The best way to manage asthma is to know your triggers and the warning signs of an attack, as well as following the advice of your doctor.

Can my child’s life be relatively normal if their asthma is controlled?

Yes, if you effectively and responsibly control your child’s asthma by being aware of triggers and the warning signs of an attack, as well as carefully following your doctor’s advice your child should

not have symptoms such as wheezing or coughing
sleep better
not miss school
be able to take part in all physical activities
not have to go to the hospital

What are asthma triggers?

Things that set off asthma attacks are called asthma triggers. Your triggers can be very different from those of another person with asthma. It is important to be aware of what your, or your child’s, triggers are. Click here for a list of important asthma triggers. More important information on asthma triggers from the American Lung Association.

Is asthma worse at night?

According to the American Lung Association, there is such thing as nocturnal asthma. Nocturnal asthma refers to asthma symptoms that seem worse in the middle of the night, typically between 2AM and 4AM. Interestingly, nocturnal asthma can affect someone with any type of asthma.

Factors that can cause your asthma symptoms to worsen at night may include sinus infections or postnasal drip caused by allergens such as dust mites or pet dander. Your body clock may also play some role. The body makes adrenaline and corticosteroids, which protect against asthma. Levels of these two substances are lowest between midnight and 4AM, making it more likely you will experience symptoms during these times.

Is there a connection between asthma and allergies?

Yes. In fact, allergic asthma is a type of asthma that is triggered by allergens—such as dust mites, pollen and mold. According to the American Academy of Allergy, Asthma and Immunology, half of the 20 million Americans with asthma have allergic asthma, and about 70% of asthmatics also have allergies.

How does air pollution affect asthma?

A 2-year study supported by the National Institutes of Health NIH and the EPA showed that even modestly increased levels of air pollution cause more frequent asthma symptoms and lower lung function in children who have persistent asthma and live in inner city areas of the United States. Even air pollution levels within EPA’s safety standards made asthma worse in vulnerable children.

According to the study, high levels of nitrogen dioxide, a component of motor vehicle emissions, had the greatest effect, leading to many asthma-related school absences.

Past research has shown that ozone and particle pollution can also affect asthma.

Additional asthma triggers include nitrogen oxides, formaldehyde and environmental tobacco smoke, and biological agents such as respiratory infections and allergens. Other toxic air contaminants like pesticides are suspected of contributing to asthma attacks but have not been conclusively proven to do so.

Nearly two-thirds of those suffering from asthma live in an area where at least one federal air-quality standard is not being met.

It is important to pay attention to air quality forecasts in your region, and plan your outdoor activities during times of low air pollution levels. Click here to learn about air quality in your area.

Is asthma worse during certain seasons?

As MCAF blogger Gina Carroll explains, fall and winter are allergy and asthma high-alert, high-incidence periods. In fact, the steep increase in fall asthma emergencies is so prevalent; it has been referred to as the “September epidemic” in a 2004 study published in the Journal of Allergy and Clinical Immunology. Therefore, it is important to be extra careful about day-to-day asthma maintenance.

3 Ways Winter Is Tough on Kids With Asthma and Their Families:

1. Kids are indoors and exposed to more germs and pollutants.
2. Kids with asthma miss more school in the colder months.
3. There are more emergency room visits from asthma suffers.

Unfortunately there is little escape, as hot summer months are tough on asthma patients as well. Ozone levels increase during the summer, for ozone is exacerbated by sunlight and hot weather–leading to unhealthy concentrations of ozone in the air. People with asthma are known to be especially susceptible to the effects of ozone exposure.

Tell me about asthma and school attendance?

Among children ages 5 to 17, asthma is the leading cause of school absences due to a chronic illness. It accounts for an annual loss of more than 14 million school days per year (approximately 8 days for each student with asthma).

Click here for some wonderful resources from the American Lung Association on how you can work with your child’s school to ensure that your child’s asthma is best managed and that they stay safe and healthy.

What about asthma and African Americans?

When it comes to asthma, communities of color are particularly hard-hit. In 2008, asthma prevalence was 35% higher in African Americans than in whites. A recent study revealed that one-quarter of the children in New York City’s Harlem have asthma. The following national statistics are even more jarring:

African American children have a:

• 260% higher emergency room visit rate.

• 250% higher hospitalization rate.

• 500% higher death rate from asthma, as compared with White children.

African Americans are often at a disadvantage because 68% of African-Americans (compared to 56% of Whites) live within 30 miles of a coal-fired power plant—the distance within which the maximum ill effects of the emissions from smokestacks occur.

What about asthma in pregnancy?

According to the American Lung Association, among pregnant patients who have asthma, one-third will experience improvement in their asthma, one-third will remain stable, and one-third will experience worsening of their asthma. Improved asthma control during pregnancy is associated with lower rates of pregnancy-related complications.

Statistics from the American Medical Association show that asthma symptoms usually become most severe between the 29th and 36th weeks of pregnancy. About 1 in 10 women with asthma experience it during labor and delivery.

If you have asthma and are pregnant, talk to your doctor about what you might expect and what you can do about your asthma symptoms.

What are some tips on managing my child’s asthma?

It is important to be aware of your child’s asthma triggers, and to minimize exposure to these triggers. Since asthma triggers are not always completely within your control, it is also important to be especially diligent about sticking to prescribed medication regimens, as advised by your doctor. If you don’t already have an asthma action plan in place, use this helpful asthma action plan sheet from Kids Health. Your child’s doctor can advise you when filling out the form.

Germ control is important as well; ensuring everyone in the household gets flu shots, and mindful of environmental irritants such as using low allergy cleansers and non-toxic household products are key steps you can take to minimize asthma triggers.

It is also important to pay attention to air quality forecasts in your region, and plan your outdoor activities during times of low air pollution levels. Click here to learn about air quality in your area.

How else does asthma affect kids’ health?

New studies have emerged that link air pollution to two of this country’s most pressing (and expensive) health epidemics: obesity and type II diabetes. Harvard researchers found a “consistent and significant” relationship between Type II diabetes prevalence and exposure to fine particulate matter in a recent study.

Last year, the U.S. Department of Veterans Affairs decided that the link between air-borne dioxin (an ingredient in Agent Orange, and also a common air-borne pollutant emitted by waste incineration, some chemical manufacturing processes, cars and trucks, and other industrial sources that burn fuel) and diabetes was so strong, it compensated 270,000 veterans for diabetes linked to dioxin exposure.

How many people die from asthma?

More than 4,000 people lose their lives each year from this disease (with African-American children five times more likely to die than Caucasians).

According to the Centers for Disease Control and Prevention, 11 Americans die from asthma every day. Additionally, asthma is indicated as a “contributing factor” for nearly 7,000 other deaths each year.

What are the health costs of asthma?

Every year, asthma is responsible for 9 million visits to health care professionals. In 2000, more than 1.8 million emergency room visits (including 728,000 visits for children under 17) and more than 460,000 hospitalizations were attributed to asthma attacks.

Asthma is one of the leading causes of school absenteeism, accounting for over 14 million missed school days annually.

What are the economic costs of asthma?

The economic burden of asthma has been estimated at $14 billion in 2002. Families with an asthmatic member suffer a severe emotional toll, through lost sleep, disrupted routines and restricted activities. Many families may also suffer undue financial burden with high medical bills.

According to the Center for Disease Control, the cost of treating asthma in children 18 and under alone is $3.2 billion per year. For adults, asthma is the fourth leading cause of work absenteeism and “presenteeism,” resulting in nearly 15 million missed or lost workdays each year, leading to a total cost of nearly $3 billion in total lost productivity.

What if I can’t afford prescription asthma medications?

Part of properly controlling asthma is through appropriate medication. Unfortunately, asthma medications can often come at a steep price; the annual direct cost of asthma in the US is approximately $11.5 billion. The indirect costs (such as productivity) add another $4.6 billion, totaling $16.1 billion per year. Prescription drugs represent the single largest indirect cost at $5 billion.

Here are some resources that may be helpful when it comes to paying for these prescriptions:

Partnership for Prescription Assistance can help those without prescription drug coverage who qualify, get the medicines they need for free or nearly free. They offer a single point of access to more than 475 public and private programs, including nearly 200 offered by pharmaceutical companies.
RxAssist offers a comprehensive database of patient assistance programs
Bridges to Access and GSK access are GlaxoSmithKline’s patient assistance programs. This is an important resource for asthma patients needing the pricey Advair, manufactured by GlaxoSmithKline. (GSK access is for Medicare patients)
Healthwell Foundation is a non-profit organization established to assist individuals with insurance who cannot afford their co-payments, coinsurance, and premiums for important medical treatments.
Genentech’s Xolair Assistance Programs is for folks who are prescribed the expensive medication, XOLAIR. The manufacturer has several programs to help the uninsured (XOLAIR Access Solutions and Genentech Access to Care Foundation) and those who need help with co-pays (XOLAIR Debit Card Program).
If you find you can no longer afford medications for yourself or your child, BEFORE you stop taking your meds, ask your doctor or a hospital social worker for options. Hospital social workers are equipped to help you find grants and other resources to cost-free or reduced medicines.