What Does Asthma Mean?
Many people think asthma and wheezing are the same thing. Actually, wheezing is only one sign of asthma, and many other things besides asthma can cause wheezing. Because of this confusion, the term asthma is being replaced with a more accurate description: Reactive Airway Disease (RAD). Those with RAD (5% and growing in the U.S.) have bronchial (lung) passages that are more sensitive to irritation than normal. This hypersensitivity leads to inflammation (redness and swelling) in the tiny airways deep in the lungs. The inflammation in turn causes excess mucus production, and tightening of airway muscles that wind around the bronchial tubes like laces. The combination of swelling, mucus, and muscle tightening all cause narrowing of the airways. Wheezing (whistling and labored breathing) usually results, but a dry cough is sometimes the only sign. Click on the figure to see what happens in an asthma attack.

Nobody knows exactly why some people have RAD. Many times it is inherited, and is often associated with allergies (especially in children). Asthma can develop at any time, but is more common in young children. When it starts in childhood it usually improves with age. But with adult onset asthma, aging often worsens the problem. Asthma has also become more common in this country, again for unknown reasons.

What Causes an Asthma Attack?
The diagram at the right shows the chain of events in asthma or RAD that lead to a classic asthma attack. As you can see, there must be a triggering factor causing airway inflammation to begin the process. In children, allergies frequently act as asthma triggers. Cigarette smoke, weather changes, and emotional stress also bring on wheezing, but probably the most common trigger is a simple cold or other respiratory infection. For some unknown reason, the lung airways in asthmatics become inflamed very quickly with colds, even if the virus stays in the head.

Exercise induced asthma is just plain old asthma with exercise as the trigger. Cold, dry air is worse for exercise asthma; warm, moist air causes fewer problems.

Heartburn (reflux esophagitis) also leads to asthma attacks. This often occurs at night, when laying flat allows acid to seep back into the swallowing tube and throat. If the acid leaks into your breathing passages, choking and wheezing result. If your asthma attacks don’t seem to be caused by colds, allergens, or other respiratory irritation, consider reflux.

Over-the-counter treatment for asthma is controversial. The FDA has stated that OTC inhalers and tablets to relieve the wheezing symptoms should only be used by patients if their doctor is aware of their condition and has okayed the use and frequency of the over-the-counter drugs.

OTC inhalers and tablets are useful for treatment of wheezing only. As discussed in basics, the wheezing is a result rather than the underlying cause in asthma. Only prescription medications work against airway inflammation at the root of all asthma attacks. It seems then that self-treatment of asthma with OTC medications should occur only in unusual circumstances --- for temporary treatment of wheezing only if your doctor has approved it. In actuality, these OTC products are often used when an asthmatic patient’s prescription inhaler is empty and the patient desires temporary relief until the prescription can be refilled or further medical care sought. Since asthma is often much worse at night, lack of available physician care also leads to OTC self-treatment.

All OTC asthma medications are bronchodilators --- that is, they relax tight airway muscles to widen your breathing passages. They come in two forms:

Epinephrine aerosol inhaler. Inhaled epinephrine (adrenaline) can give relief from wheezing in minutes. Unfortunately, this effect only lasts for a couple of hours. This should only be considered a temporary replacement for prescription inhalers.

Ephedrine tablets. This stimulant drug is longer acting (2-4 hours) than inhaled epinephrine, but may take 30-60 minutes to take full effect.