Asthma is a chronic condition marked by periodic attacks of wheezing and difficulty in breathing. The cause of asthma attacks is partial obstruction of the bronchi and bronchioles due to contraction of the muscles in the bronchial walls. Whereas with bronchitis, you have constant wheeziness until you recover from the disease, with asthma, attacks come and go and there are wide variations in the degree of obstruction at different times. Asthma cannot be cured, but an attack can be relieved by treatment. If asthma attacks are not treated, they usually end naturally.

Most asthma is triggered by an allergy to such things as pollen, skin particles (dander) or hairs of cats or dogs, or miniscule mites in house dust. Some attacks start for no apparent reason. Attacks can also be caused by infections (especially of the respiratory tract), certain drugs, inhaled irritants, vigorous exercise, and psychological stress.

What are the symptoms?

The main symptoms of asthma are difficulty in breathing, a painless tightness in the chest, and varying amounts of wheezing. At times, the wheezing is audible only with a stethoscope, but sometimes it is loud enough to hear across a crowded room. In severe cases, breathing becomes so difficult that it may cause sweating, an increased pulse rate, and severe anxiety. In very severe attacks the face and lips may turn bluish because of the diminishing supply of oxygen in the body.

What are the risks?

Asthma is quite common in school age children. Most children outgrow the condition, and no more than two or three per cent of the adult population is asthmatic.

A succession of severe asthma attacks can be very disabling. Each year several thousand people die during an attack. However, most of these people are elderly and have other illnesses as well. Today, because of some recent medical discoveries, there is little risk of lasting disability or death for people who take their asthma seriously and consult a physician about it.

What should be done?

If you have asthma, there are some steps you can take to control asthma attacks. Study your own disease, take the self-help measures recommended below, and see your physician whenever you have a severe and persistent period of breathlessness. Asthma is an illness that you and your physician can work together to control. You can never be sure that the symptoms you have at home will be the same when your physician puts a stethoscope to your chest, so you must be able to give a clear description of what happened both before and during the attack.

What is the treatment?

Self-help: Because asthma is most often caused by an allergy, your first step in controlling the disease is to try to identify the allergen, or irritant, that bothers you. Your physician may be able to help by arranging skin tests with suspected allergens, but you can do much of the detective work yourself. Do you have your asthma attacks mainly at one time of the year, and do you also have hay fever? If so, your allergens are probably pollen grains. Do your attacks occur more often on certain days of the week than on others? This might suggest a link with dusts at work, such as flour in a bakery, or with something you are around only when you pursue a hobby, such as flowers in a greenhouse, or with some stressful situations, such as regular visits to a hospital. Is your asthma worse in one room of your house than another? You may be allergic to mites in house dust, especially in bedrooms, or to hair or feathers from a pet.

Another possibility is an allergy to a food or a drink. Shellfish, eggs, and chocolate are some common examples of foods that trigger asthma attacks in some people.

You can test your theory of what causes your asthma attacks by keeping a record of the frequency and severity of your attacks. Keep track of how often the attacks coincide with your exposure to the suspected allergen or allergens. One way to measure the severity of an attack is by means of a small peak-flow meter. Your physician may be able to lend you one if you cannot buy one. By measuring the maximum flow of air with the meter when you breathe out, you can keep precise records of how much the air passages in your lungs narrow during an attack.

Once you have identified an allergen, the best treatment for your asthma is to avoid exposure to that substance. This is fairly simple if the allergen is a particular food or a domestic animal. If it is something like grass pollen, you can only take precautions such as staying away from the countryside in mid summer. You will have to work in cooperation with your physician to try to control most of your symptoms.

Even if you cannot identify your allergen, you may have fewer attacks if you reduce the amount of dust in your house. Either replace feather pillows and fiber filled mattresses with those filled with urethane foam, foam rubber or other non allergic materials, or put airtight plastic covers on them. Use a vacuum cleaner to remove dust from crevices, and eliminate rugs or carpets or choose types that can be kept dust free. Be aware, too, that other factors such as some forms of exercise or psychological stresses like tests in school can bring on attacks.

Professional help: Once the diagnosis is made, much can be done for you. The accuracy of your account of symptoms and probable allergens may help your physician make the diagnosis without allergy tests. In the past few years the treatment of asthma has been improved enormously with the introduction of new drugs, which can be taken as pills, liquid, or inhalants. These drugs fall into two categories. They are prophylactics, and bronchodilators. Prophylactics are taken regularly to prevent attacks. These are taken primarily by people who get very frequent attacks or who can predict when an attack is likely to occur. Bronchodilators, which are best for people who have only occasional asthma attacks, are taken only after an attack has started, to relieve the symptoms.

Some prophylactic drugs are inhaled four to six times a day to prevent attacks. These drugs relax the bronchial muscles and open obstructed airways. The best way to use these is to inhale them, since an inhalent goes directly to the site of the obstruction in the lungs. But they can be taken orally by anyone who finds inhalants difficult to use. If no pill, liquid, or inhalant succeeds in relieving a severe case of asthma, a bronchodilator drug may be injected into the bloodstream. This method almost always works. One group of drugs, steroids, is effective both in preventing asthma attacks and in relieving their symptoms once they are underway.

If your asthma attacks are clearly due to an allergen such as grass pollen, it may be possible to desensitize your lungs to that allergen with a series of injections . But the drugs discussed above are effective enough that physicians seldom recommend such desensitization as a treatment for asthma.

Despite the success of drug treatment, an asthma attack is sometimes severe enough to require hospitalization. There are three things that can be done for you in the hospital

that you cannot do yourself at home. First, some drug treatments are most effective in the form of a fine mist which is given to the patient through a breathing apparatus. This apparatus requires professional maintenance. Second, if you are hospitalized, you can be given muscle-relaxant drugs and connected to a mechanical respirator. This treatment eliminates muscle spasms in the air passages inside the lungs. Your chest muscles can relax, also, since the work of breathing is done by the respirator. This gives your respiratory system a chance to recover from a severe attack. Third, the presence of nursing and medical staff 24 hours a day may relieve your anxiety about being unable to breathe. What to do for an acute attack ?

A sudden, acute attack of asthma can be frightening for you and your family. In most cases the physician will have prescribed an inhalant of a bronchodilator or steroid drug. If one dose does not relieve your wheezing, you can repeat it in 30 minutes if this is suggested by your physician. However, you should not use the inhalant again if the second dose is ineffective. An overdose may be dangerous. Instead, call your physician. It is better to get in touch with a physician too soon than to wait until it is too late, since even with today's drugs severe asthma (status asthmaticus) may be difficult to treat.

Members of the family of an asthmatic are often alarmed by a severe attack, but feel helpless because they do not know what to do about it. Here is what to do:

1. Get the drugs and inhaling apparatus together on a table, and note the time the asthmatic takes the first dose of whatever medicine or medicines that the physician has prescribed for emergencies.

2. Help the asthmatic find the most comfortable position. Usually the best position is sitting up, leaning slightly forward, and resting on the elbows or arms. Plenty of fresh air is also important.

3. Don't stand around in a worried group. This only raises the asthmatic's level of anxiety. Someone calm and level headed should stay with the patient. Everyone else should quietly go into another room.

4. Get the telephone number of the asthmatic's physician and be ready to call. If you call and the doctor is not in, be ready to take the asthmatic, quickly but calmly, to the nearest hospital emergency room.