Asthma in Adult
Alerts and Notices
Synopsis
An estimated 26 million people in the United States have asthma (19 million adults and 7 million children), and the condition is a leading cause of absence from work and school.
Adults with asthma often experience accelerated loss of lung function compared to adults without asthma, but the clinical significance of this and the extent to which these declines contribute to the development of fixed airflow obstruction are unknown.
The condition has genetic as well as environmental determinants. Roughly half of cases are due to genetic susceptibility and half are related to environmental factors.
Immunohistopathologic features of asthma include inflammatory cell infiltration with neutrophils, eosinophils, lymphocytes, mast cell activation, and epithelial injury.
Asthma occurs at all ages but predominantly in early life. Half of cases develop in the first decade of life, and another third present in the first 4 decades of life. Asthma is generally divided into 2 types: allergic asthma (caused by exposure to an allergen) and nonallergic asthma.
The single largest risk factor for the development of asthma is atopy, and allergic asthma is associated with a familial or personal history of allergic diseases. These patients may have positive skin test reactions to intradermal antigen testing and/or elevated levels of immunoglobulin E (IgE). Nonallergic asthma patients do not have histories of allergy and have negative skin testing and normal IgE levels.
Exacerbations are manifested by widespread narrowing of airways that may resolve spontaneously or with therapy. Narrowed airways result in the experience of dyspnea, cough, and wheezing. Triggers for such exacerbations include allergens, exercise, cold air, viral or bacterial infection, etc. These episodes last for minutes to hours, can be self-resolving, or may be severe enough to cause respiratory failure and death in the absence of emergency and intensive care.
The clinical examination is most notable for widespread, high-pitched wheezing generally noted on expiration. Wheeze may not be present if the patient is asymptomatic and in between exacerbations. It may also be absent in the setting of severe disease and limited air movement.
Other physical findings of severe obstruction include nasal flaring, subcostal retractions, use of accessory muscles such as the sternocleidomastoids, sitting in a tripod position, and a prolonged expiratory phase. Hypertension is frequently increased in patients with asthma.
Codes
ICD10CM:J45.901 – Unspecified asthma with (acute) exacerbation
SNOMEDCT:
195967001 – Asthma
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Wheezing:- Airway obstruction by foreign body or mass
- Vocal cord dysfunction
- Heart failure
- Anaphylaxis
- Vascular rings or aneurysms
- Mediastinal mass
- Bronchiolitis
- Parasitic infection (ascariasis, strongyloides, filarial infection)
- Plastic bronchitis – A rare condition involving branching casts in the bronchial tree or trachea. Sometimes associated with cardiac surgery or inflammatory disease.
- Rhinitis or rhinosinusitis (post-nasal drip)
- Chronic obstructive pulmonary disease (COPD)
- Gastroesophageal reflux disease (GERD)
- Angiotensin-converting enzyme (ACE) inhibitor-induced cough (see drug-induced cough)
- Bronchiectasis
- Pulmonary embolism
- Sarcoidosis
- Congestive heart failure
- Anemia
- Constrictive bronchiolitis / bronchiolitis obliterans – Usually seen following organ or stem cell transplant, after inhalational injury, or in the context of a rheumatologic disorder such as rheumatoid arthritis or inflammatory bowel disease.
- Diffuse panbronchiolitis – Generally affects nonsmokers; patients commonly have coexistent sinusitis.
- Lymphangioleiomyomatosis – Seen in women of childbearing age. Centrilobular thin-walled cysts can be mistaken for emphysematous blebs. Can lead to pneumothorax. Airflow obstruction is generally mild.
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:11/09/2017
Last Updated:03/09/2022
Last Updated:03/09/2022
Patient Information for Asthma in Adult
Overview
Asthma is difficulty breathing due to the narrowing and swelling of your airways and production of extra mucus. Asthma also causes coughing and wheezing. There is no cure for this chronic respiratory disease at this time, but symptoms can be controlled and asthma attacks can be prevented.Who’s At Risk
The cause of asthma is unknown. Genetic and environmental factors may play a role.For people diagnosed with asthma, certain triggers may cause asthma attacks, such as airborne or food allergens, respiratory infections, cold air, pollutants, exertion, and stress.
Signs & Symptoms
Some people have infrequent spells of asthma. Others have symptoms at certain times, or even all the time. An asthma attack is when a trigger causes severe symptoms that limit your ability to breathe. A very bad asthma attack can be life-threatening.The symptoms of asthma are:
- Shortness of breath
- Chest tightness
- Difficulty sleeping
- Wheezing when exhaling
Self-Care Guidelines
Measures can be taken to reduce the symptoms of asthma:- Use an air conditioner to reduce pollen and dust mites indoors.
- Talk to your health care provider about maintaining the right humidity level in your home.
- Clean damp areas in your home to prevent mold from growing and producing spores.
- Clean your home regularly to avoid build-up of dust.
When to Seek Medical Care
Seek medical care if you have trouble sleeping due to symptoms of asthma. If your shortness of breath or wheezing rapidly worsens, seek medical attention. If symptoms do not improve after inhaler or nebulizer use, contact your health care provider.Treatments
Your health care provider may recommend some of the following treatments:- Corticosteroids are anti-inflammatory drugs that help open the airways. They are taken daily for long-term control of asthma.
- Leukotriene modifiers also reduce airway inflammation and can reduce asthma attacks when taken regularly.
- Allergy medications may help limit asthma attacks.
- The influenza vaccine prevents viral infections from triggering asthma attacks.
- For asthma attack treatment, short-acting beta agonists are quick-relief medications inhaled with an inhaler or nebulizer.