Image for increased asthma article For 6-year-old Sydney W., the winters in New England can be long. With the cold weather setting off her asthma , she sometimes spends recess inside while the other kids go out to play. Sydney may be the only child in her classroom with such severe asthma, but her situation is all too common in schools across the US.

The number of people with asthma in the US. has increased throughout the 1980s and 1990s and shows no sign of abating. In fact, according to the American Lung Association, in 2001, over 6 million American children and close to 14 million American adults suffered from asthma. And while Sydney’s asthma may only cause her to miss recess, many other children are more severely affected. Nationwide, children with asthma account for over 10 million school absence days every year. Asthma has become a huge public health issue, costing the US an estimated $14 billion per year.

What Is Asthma?

Asthma is a condition characterized by inflammation of the airways in your lungs. That inflammation is similar to the redness and swelling seen when you cut your skin, but in asthma it occurs inside the body. As the inflammation worsens, your airways become narrower and less air passes through to your lungs. It’s kind of like a clogged garden hose that only allows a trickle of water through, but in this case, it’s air that can’t get through. The inflammation also makes your airways more sensitive to irritation, so they tend to spasm and constrict more easily.

Symptoms of asthma may range from difficulty breathing to coughing, wheezing, or chest tightness and chest pain.

“It’s hard to get a deep breath,” explains Risha Nathan, a 24-year-old who was first diagnosed with asthma at age 11. “It’s also hard to get a breath out.”

For many people, their asthma has certain triggers. For Sydney, it’s cold weather. For Nathan, exercise causes symptoms to appear. Other common triggers include pollutants like tobacco smoke and smog, or allergens like dust mites, cockroaches, or cat dander. Catching a cold or a viral infection may also induce asthma attacks in many people. For some people, stress or certain medications such as aspirin may spark problems.

Why Is the Rate of Asthma Increasing?

Why more and more people seem to be suffering from asthma is not well understood. Some doctors blame the increase on what is sometimes called the “hygiene hypothesis.” This hypothesis suggests that because personal and public hygiene have improved in recent years, children suffer from fewer infectious diseases during early childhood. As the immune system develops, our bodies respond to allergens and pollutants rather than bacteria and viruses. The result is an immune system permanently biased toward allergic responses and subsequently, an increased incidence of asthma—particularly in people who have family histories of asthma and allergies.

How Is Asthma Treated?

Doctors treat asthma as a chronic (lasting over a long period of time) disease. Like hypertension or diabetes , the underlying condition is always present, even when a patient is not experiencing symptoms.

The National Heart, Lung, and Blood Institute (NHLBI) recommends quick-relief medications along with long-term anti-inflammatory treatments for most people with asthma. Quick-relief medications, such as albuterol inhalers, open up the airways quickly, but are short-acting and do not reduce the inflammation that persists long after an acute attack. Some long-term control medications, such as corticosteroid inhalers, reduce the underlying inflammation responsible for prolonged and recurring symptoms. Other long-acting medications (eg, salmeterol) do not have an effect on inflammation, and for maximum safety and benefit, must be combined with an inhaled corticosteroid.

For patients who experience asthma symptoms more than twice a week during the day, or more than twice a month at night, the NHLBI recommends taking long-term anti-inflammatory medications every day whether they have symptoms or not. Once patients improve, their doctor may allow them to reduce their level of medication.

What Else Can I Do?

Medications are only one approach to controlling asthma. You may also reduce your asthma symptoms by reducing your exposure to asthma triggers. General recommendations include:

  • Keep pets, food, and smoke out of your bedroom.
  • Cover your mattress and pillow with a dust-proof cover.
  • Wash sheets, blankets, and pillows weekly in hot water (>130ºF).
  • Try to have someone else vacuum for you or wear a dust mask while vacuuming. If possible, use a vacuum cleaner with high efficiency (HEPA) filters, which may reduce the amount of dust recirculated into the air by the vacuuming process.
  • Avoid strong odors, perfumes, paints, and smoke.
  • Get a flu shot every year.

Awareness of workplace exposures to a variety of industrial compounds known to cause lung disorders could also reduce asthma attacks for some employees. Many persons with asthma do not realize that workplace exposures can be responsible for some of the symptoms. The good news is that public health organizations are trying to reduce asthma triggers in our environment. Efforts to reduce chemicals in the air like nitrogen oxides and wood or tobacco smoke may potentially help many people with asthma.

In sum, asthma is a chronic disease with symptoms that can vary throughout your lifetime. Encountering a new trigger, getting sick, or even changing an exercise routine may set off symptoms in someone who was previously doing well. Like other chronic diseases, the best way to manage asthma is to learn about your condition, communicate with your physician, and enlist support from family and friends.