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What organs are affected by asthma?

Asthma

Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems. The characteristics of asthma are three airway problems:

  • Obstruction
  • Inflammation
  • Hyperresponsiveness

What are the symptoms of asthma?

Common symptoms of asthma are listed below. However, each individual may experience symptoms differently.

In some cases, the only symptom is a chronic cough, especially at night, or tightness, noisy breathing, or wheezing. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

Asthma may resemble other respiratory problems, such as emphysema, bronchitis, and lower respiratory infections. Many people with asthma do not know they have it. Consult your doctor for a diagnosis.

What causes asthma?

The basic cause of the lung abnormality in asthma is not yet known, although health care professionals have established that it is a special type of inflammation of the airway that leads to the following:

  • Contraction of airway muscles
  • Mucus production
  • Swelling in the airways

It is important to know that asthma is not caused by emotional factors—as was commonly believed years ago. Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms or aggravate an attack. However, these reactions are considered to be more of an effect than a cause.

What happens during an asthma attack?

People with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs and airways:

  • Lungs and airways overreact to certain triggers and become inflamed and clogged.
  • Breathing becomes harder and may hurt.
  • There may be coughing.
  • There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because:
    • Muscles that surround the airways tighten, and the inner lining of the airways swells and pushes inward.
    • Membranes that line the airways secrete extra mucus.
    • The mucus can form plugs that further block the air passages.
    • The rush of air through the narrowed airways produces the wheezing sounds.

    What are the risk factors for an asthma attack?

    Although anyone may have an asthma attack, it most commonly occurs in:

    • Children and adolescents between age 5 and 17
    • Females
    • People living in urban communities
    • Exposure to tobacco smoke

    Other factors include:

    • Family history of asthma
    • Personal medical history of allergies

    How is asthma diagnosed?

    To diagnose asthma and distinguish it from other lung disorders, doctors rely on a combination of medical history, physical examination, and laboratory tests, which may include:

    • Spirometry. A spirometer is a device used by your doctor that assesses lung function. Spirometry is the evaluation of lung function with a spirometer. The test is performed by blowing as hard as possible into a tube connected to a small machine (a spirometer) that measures the amount of air breathed out and in as well as the speed it is breathed out. This is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:
      • To determine how well the lungs receive, hold, and utilize air
      • To monitor a lung disease
      • To monitor the effectiveness of treatment
      • To determine the severity of a lung disease
      • To determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)

      What is the treatment for asthma?

      Specific treatment for asthma will be determined by your doctor based on:

      • Your age, overall health, and medical history
      • Your symptoms
      • Extent of the disease
      • Your tolerance for specific medications, procedures, or therapies
      • Expectations for the course of the disease
      • Your opinion or preference

      As of yet, there is no cure for asthma. However, it can often be controlled with prescription medications that may help to prevent or relieve symptoms, and by learning ways to manage episodes.

      How is asthma managed?

      People with asthma can learn to identify and avoid the things that trigger an episode. They can also educate themselves about medications and other asthma management strategies:

      • Asthma is a chronic disease. It has to be cared for all the time—not just when symptoms are present:
        • The four parts of continually managing asthma are:
          • Identify and minimize contact with asthma triggers.
          • Understand and take medications as prescribed.
          • Monitor asthma to recognize signs when it is getting worse.
          • Know what to do when asthma gets worse.

          Four components of asthma treatment

          1. The use of objective measures of lung function—spirometry, peak flow expiratory flow rate—to access the severity of asthma, and to monitor the course of treatment.
          2. The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airways.
          3. The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.
          4. Patient education that includes a partnership among the patient, family members, and the doctor.

          Basics

          • Occupational Asthma
          • Asthma and Exercise
          • Immunoglobulin A Deficiency
          • IgG Deficiencies
          • Granulomatosis with Polyangiitis

          Children’s Health

          • All About Asthma in Children

          Find a Doctor

          At Another Johns Hopkins Member Hospital:

          • Howard County General Hospital
          • Sibley Memorial Hospital
          • Suburban Hospital

          What Happens During an Asthma Attack?

          Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.

          Updated on February 17, 2022

          Sanja Jelic, MD is board-certified in pulmonary disease, sleep medicine, critical care medicine, and internal medicine. She is an assistant professor and attending physician at Columbia University College of Physicians and Surgeons in New York, NY .

          The immune system—or, more specifically, the abnormal response of the immune system—is at the heart of respiratory symptoms associated with asthma.

          When exposed to certain triggers, the immune system will overact and release chemicals into the bloodstream that cause the lungs to function abnormally.

          Young man using inhaler at gym

          Three features tend to characterize asthma attacks:

          • Tightening of muscles surrounding the air passages, known as bronchoconstriction, by which less air is able to enter the lungs
          • Excessive production of mucus, which clogs the air passages
          • Inflammation ​of the air passages as a result of the abnormal immune response

          These physiological actions lead to the wheezing, coughing, chest tightness, and shortness of breath experienced during an asthma attack.

          Causes of Bronchoconstriction

          The normal size of the air passages is regulated by the autonomic nervous system. This is the branch of the nervous system responsible for reflexes.

          The stimulation of nerve endings (by dust, cold air, or other asthma triggers) can instigate the release of a chemical known as acetylcholine.

          In persons with asthma, acetylcholine can act on cells in the smooth muscles of the lungs, causing bronchial spasms and the overproduction of mucus.

          Causes of Inflammation

          Inflammation is caused by a slightly different process. In people with normally functioning immune systems, the appearance of any foreign particle will be met by an antigen-presenting cell (APC).

          APCs are cells that the body uses to «check out» a particle and determine whether it is safe or not. In people with asthma, the APC will mistakenly identify the particle as a threat and immediately transform into a defensive cell called TH2.

          The role of TH2 is to signal the immune system to defend itself, which it does with inflammation. The consequence of lung inflammation in the absence of disease can be profound, leading to:

          • Enlargement of mucosal cells and the overproduction of mucus
          • Thickening of airway walls and the restriction of air flow
          • Hyperreactivity of the airway tissues, further triggering spasms

          If left untreated, ongoing attacks can lead to airway remodeling where progressive scarring of lung tissue leaves permanent, irreversible damage.

          Preventing Asthma Attacks

          While the best treatment for asthma is the avoidance of asthma triggers, this is not always possible or reasonable. Medications, therefore, are commonly prescribed to either manage symptoms or avert attacks.

          Among the currently available options:

          • Rescue medications provide fast relief of bronchial spasms and breathing restriction by relaxing the smooth muscles of the airways.
          • Inhaled and oral steroids prevent symptoms by tamping down the immune response and reducing inflammation.
          • Long-acting bronchodilators are used in combination with other drugs to provide better asthma control.
          • Anticholinergics are medications that provide relief by blocking acetylcholine receptors.

          Identifying both the triggers of an attack and the medications best able to stop them are steps to achieving durable control of asthma symptoms. Lifestyle interventions may help as well.

          Maintaining a healthy weight is important as obesity is associated with increased asthma severity and poor asthma control.

          Plus, regular exercise appears to have a protective effect, especially for exercise-induced asthma. Yoga is a great option, as it’s been shown to improve quality of life and reduce asthma symptoms.

          Finally, eating plenty of fruits and vegetables may help. Foods high in fiber and antioxidants have been associated with better asthma control, including airway reactivity and inflammation. The associations do not prove causal relationship. However, such plant-based diet may help with weight control, which may improve asthma symptoms control.

          5 Sources

          Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

          1. Bonser LR, Erle DJ. Airway mucus and asthma: The role of MUC5A and MUC5B. J Clin Med. 2017;6(12):112. doi:10.3390/jcm6120112
          2. Gosens R, Gross N. The mode of action of anticholinergics in asthma. Eur Respir J. 2018;52(4):1701247. doi:10.1183/13993003.01247-2017
          3. Gurram RK, Zhu J. Orchestration between ILC2s and Th2 cells in shaping type 2 immune responses. Cellular & Molecular Immunology. 2019;16(3):225-235. doi: 10.1038/s41423-019-0210-8
          4. Cleveland Clinic. Treating the inflammation of asthma.
          5. Stoodley I, Williams L, Thompson C, Scott H, Wood L. Evidence for lifestyle interventions in asthma. Breathe (Sheff). 2019;15(2):e50-e61. doi: 10.1183/20734735.0019-2019

          By Pat Bass, MD
          Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.

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          Occupational asthma

          Occupational asthma is a lung disorder in which substances found in the workplace cause the airways of the lungs to swell and narrow. This leads to attacks of wheezing, shortness of breath, chest tightness, and coughing.

          Causes

          Asthma is caused by inflammation (swelling) in the airways of the lungs. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways activate. This makes the airways narrower and reduces the amount of air that can pass through.

          In people who have sensitive airways, asthma symptoms can be triggered by breathing in substances called triggers.

          Many substances in the workplace can trigger asthma symptoms, leading to occupational asthma. The most common triggers are wood dust, grain dust, animal dander, fungi, or chemicals.

          The following workers are at higher risk:

          • Bakers
          • Detergent manufacturers
          • Drug manufacturers
          • Farmers
          • Grain elevator workers
          • Laboratory workers (especially those working with laboratory animals)
          • Metal workers
          • Millers
          • Plastics workers
          • Woodworkers

          Symptoms

          Symptoms are usually due to narrowing of the airways and tightening spasms of the muscles lining the airways. This reduces the amount of air that can pass through, which can lead to wheezing sounds.

          Symptoms usually occur shortly after you are exposed to the substance. They often improve or go away when you leave work. Some people may not have symptoms until 12 or more hours after being exposed to the trigger.

          Symptoms usually get worse toward the end of the work week and may go away on weekends or vacations.

          • Coughing
          • Shortness of breath
          • Tight feeling in the chest
          • Wheezing

          Exams and Tests

          The health care provider will perform a physical exam and ask about your medical history. The provider will listen to your lungs with a stethoscope to check for wheezing.

          Tests may be ordered to confirm the diagnosis:

          • Blood tests to look for antibodies to the suspected substance
          • Bronchial provocation test (test measuring reaction to possible triggers)
          • Chest x-ray
          • Complete blood count
          • Lung function tests
          • Peak expiratory flow rate

          Treatment

          Avoiding exposure to the substance that is causing your asthma is the best treatment.

          Measures may include:

          Changing jobs (though this may be difficult to do)

          Moving to a different location at the work site where there is less exposure to the substance. This may help, but over time, even a very small amount of the substance can trigger an asthma attack.

          Using a respiratory device to eliminate or reduce your exposure may help.

          Asthma medicines may help manage your symptoms.

          Your provider may prescribe:

          Asthma quick-relief medicines, called bronchodilators, to help relax the muscles of your airways
          Asthma control medicines that are taken every day to prevent symptoms

          Outlook (Prognosis)

          Occupational asthma may keep getting worse if you continue to be exposed to the substance that is causing the problem, even if medicines improve your symptoms. You may need to change jobs.

          Sometimes, symptoms may continue, even when the substance is removed.

          In general, the outcome for people with occupational asthma is good. However, symptoms may continue for years after you are no longer exposed in the workplace.

          When to Contact a Medical Professional

          Call your provider if you have symptoms of asthma.

          Talk to your provider about getting the flu and pneumococcal («pneumonia») vaccines.

          If you’ve been diagnosed with asthma, call your provider right away if you develop a cough, shortness of breath, fever, or other signs of a lung infection, especially if you think you have the flu. Since your lungs are already damaged, it’s very important to have the infection treated right away. This will prevent breathing problems from becoming severe, as well as further damage to your lungs.

          Alternative Names

          Asthma — occupational exposure; Irritant-induced reactive airways disease

          Images

          • SpirometrySpirometry
          • Respiratory systemRespiratory system

          References

          Lemière C, Martin JG. Occupational respiratory allergies. In: Rich RR, Fleisher TA, Shearer WT, Schroeder HW, Frew AJ, Weyand CM, eds. Clinical Immunology: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 49.

          Lemière C, Vandenplas O. Asthma in the workplace. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 100.

          Lemière C, Vandenplas O. Occupational allergy and asthma. In: Burks, AW, Holgate ST, O’Hehir RE, et al, eds. Middleton’s Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 56.

          Tarlo SM. Occupational lung disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 87.

          Review Date 4/17/2021

          Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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