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URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000141.htm

Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness
of breath, chest tightness, and coughing.

See also: Pediatric asthma

 

Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles
surrounding the airways become tight and the lining of the air passages swell. This reduces the
amount of air that can pass by, and can lead to wheezing sounds.

Most people with asthma have wheezing attacks separated by symptom-free periods. Some
patients have long-term shortness of breath with episodes of increased shortness of breath. In
others, a cough may be the main symptom. Asthma attacks can last minutes to days and can
become dangerous if the airflow becomes severely restricted.

In sensitive individuals, asthma symptoms can be triggered by breathing in allergy-causing

substances (called allergens or triggers).

Common asthma triggers include:

—Y Animals (pet hair or dander)

—Y Gust
—Y Changes in weather (most often cold weather)
—Y Chemicals in the air or in food
—Y ^ ercise
—Y Mold
—Y Pollen
—Y Respiratory infections, such as the common cold
—Y Strong emotions (stress)
—Y Tobacco smoke

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIGs) provoke asthma in some
patients.

Many people with asthma have an individual or family history of allergies, such as hay fever
(allergic rhinitis) or eczema. Others have no history of allergies.

 



—Y Cough with or without sputum (phlegm) production

—Y Pulling in of the skin between the ribs when breathing (intercostal retractions)
 —Y Shortness of breath that gets worse with e ercise or activity
—Y Wheezing
„Y Comes in episodes
„Y May be worse at night or in early morning
„Y May go away on its own
„Y Ñets better when using drugs that open the airways (bronchodilators)
„Y Ñets worse when breathing in cold air
„Y Ñets worse with e ercise
„Y Ñets worse with heartburn (reflu )
„Y Usually begins suddenly

^mergency symptoms:

—Y èluish color to the lips and face

—Y Gecreased level of alertness such as severe drowsiness or confusion, during an asthma
attack
—Y ^ treme difficulty breathing
—Y Rapid pulse
—Y Severe an iety due to shortness of breath
—Y Sweating

Additional symptoms that may be associated with this disease:

—Y Abnormal breathing pattern --breathing out takes more than twice as long as breathing in
—Y èreathing temporarily stops
—Y Chest pain
—Y Nasal flaring
—Y Tightness in the chest

^   

Allergy testing may be helpful in identifying allergens in people with persistent asthma.
Common allergens include pet dander, dust mites, cockroach allergens, molds, and pollens.
Common respiratory irritants include tobacco smoke, pollution, and fumes from burning wood or
gas.

The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard.
However, lung sounds are usually normal between asthma episodes.

Tests may include:

—Y Arterial blood gas

—Y èlood tests to measure eosinophil count (a type of white blood cell) and Ig^ (a type of
immune system protein called an immunoglobulin)
—Y Chest -ray
—Y Lung function tests
 —Y Peak flow measurements




The goal of treatment is to avoid the substances that trigger your symptoms and to control airway
inflammation. You and your doctor should work together as a team to develop and carry out a
plan for eliminating asthma triggers and monitoring symptoms.

There are two basic kinds of medication for the treatment of asthma:

—Y Long-acting medications to prevent attacks

—Y -uick-relief medications for use during attacks

Long-term control medications are used on a regular basis to prevent attacks, not to treat them.
Such medicines include:

—Y Inhaled corticosteroids (such as Azmacort, Vanceril, Aeroèid, Flovent) prevent

inflammation
—Y Leukotriene inhibitors (such as Singulair and Accolate)
—Y Long-acting bronchodilators (such as Serevent) help open airways
—Y Omilizumab (Xolair), which blocks a pathway that the immune system uses to trigger
asthma symptoms
—Y Cromolyn sodium (Intal) or nedocromil sodium (Tilade)
—Y Aminophylline or theophylline (not used as frequently as in the past)
—Y Sometimes a single medication that combines steroids and bronchodilators are used
(Advair, Symbicort)

-uick relief, or rescue, medications are used to relieve symptoms during an attack. These
include:

—Y Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, Xopene , and others

—Y Corticosteroids, such as methylprednisolone, may be given directly into a vein
(intravenously), during a severe attack, along with other inhaled medications

People with mild asthma (infrequent attacks) may use quick relief medication as needed. Those
with persistent asthma should take control medications on a regular basis to prevent symptoms.
A severe asthma attack requires a check up by a doctor and, possibly, a hospital stay, o ygen,
and medications through a vein (IV).

A peak flow meter is a simple device to measure how quickly you can move air out of your
lungs. It can help you see if an attack is coming, sometimes even before any symptoms appear.
Peak flow measurements can help show when medication is needed, or other action needs to be
taken. Peak flow values of 50-80% of a specific person's best results are a sign of a moderate
asthma attack, while values below 50% are a sign of a severe attack.





The stress caused by illness can often be helped by joining a support group, where members
share common e periences and problems.

See: Asthma and allergy - support group

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There is no cure for asthma, although symptoms sometimes improve over time. With proper self
management and medical treatment, most people with asthma can lead normal lives.



 



The complications of asthma can be severe. Some include:

—Y Geath
—Y Gecreased ability to e ercise and take part in other activities
—Y Lack of sleep due to nighttime symptoms
—Y Permanent changes in the function of the lungs
—Y Persistent cough
—Y Trouble breathing that requires breathing assistance (ventilator)

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Call for an appointment with your health care provider if asthma symptoms develop.

Call your health care provider or go to the emergency room if:

—Y An asthma attack requires more medication than recommended

—Y Symptoms get worse or do not improve with treatment
—Y You have shortness of breath while talking
—Y Your peak flow measurement is 50-80% of your personal best

Ño to the emergency room if:

—Y Growsiness or confusion develops

—Y There is severe shortness of breath at rest
—Y The peak flow measurement is less than 50% of your personal best
—Y You have severe chest pain





Asthma symptoms can be substantially reduced by avoiding known triggers and substances that
irritate the airways.
èedding can be covered with "allergy proof" casings to reduce e posure to dust mites. Removing
carpets from bedrooms and vacuuming regularly is also helpful. Getergents and cleaning
materials in the home should be unscented.

Keeping humidity levels low and fi ing leaks can reduce growth of organisms such as mold.
Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the
possibility of cockroaches, which can trigger asthma attacks in some people.

If a person is allergic to an animal that cannot be removed from the home, the animal should be
kept out of the patient's bedroom. Filtering material can be placed over the heating outlets to trap
animal dander.

^liminating tobacco smoke from the home is the single most important thing a family can do to
help a child with asthma. Smoking outside the house is not enough. Family members and visitors
who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma
symptoms.

Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes,
as much as possible.

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èronchial asthma; ^ ercise-induced asthma

Y Y
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Typhoid fever is an acute illness associated with fever caused by the 



 bacteria. It
can also be caused by 


  
, a related bacterium that usually causes a less severe
illness. The bacteria are deposited in water or food by a human carrier and are then spread to
other people in the area.

The incidence of typhoid fever in the United States has markedly decreased since the early
1900s. Today, less than 500 cases are reported annually in the United States, mostly in people
who recently have traveled to endemic areas. This is in comparison to the 1920s, when over
35,000 cases were reported in the U.S. This improvement is the result of improved
environmental sanitation. Me ico and South America are the most common areas for U.S.
citizens to contract typhoid fever. India, Pakistan, and ^gypt are also known high-risk areas for
developing this disease. Worldwide, typhoid fever affects more than 13 million people annually,
with over 500,000 patients dying of the disease.

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Typhoid fever is contracted by the ingestion of the bacteria in contaminated food or water.
Patients with acute illness can contaminate the surrounding water supply through stool, which
contains a high concentration of the bacteria. Contamination of the water supply can, in turn,
taint the food supply. About 3%-5% of patients become carriers of the bacteria after the acute
illness. Some patients suffer a very mild illness that goes unrecognized. These patients can
become long-term carriers of the bacteria. The bacteria multiplies in the gallbladder, bile ducts,
or liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewage.
These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid
fever for many years.

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After the ingestion of contaminated food or water, the 


bacteria invade the small
intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in
the liver, spleen, and bone marrow. The bacteria then multiply in the cells of these organs and
reenter the bloodstream. Patients develop symptoms, including fever, when the organism reenters
the bloodstream. èacteria invade the gallbladder, biliary system, and the lymphatic tissue of the
bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be
identified for diagnosis in cultures from the stool tested in the laboratory. Stool cultures are
sensitive in the early and late stages of the disease but often need to be supplemented with blood
cultures to make the definite diagnosis.

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The incubation period is usually one to two weeks, and the duration of the illness is about four to
si weeks. The patient e periences

—Y poor appetite,
 —Y headaches,
—Y generalized aches and pains,
—Y fever,
—Y lethargy, and
—Y diarrhea.

People with typhoid fever usually have a sustained fever as high as 103 to 104 degrees
Fahrenheit (39 to 40 degrees Celsius).

Chest congestion develops in many patients, and abdominal pain and discomfort are common.
The fever becomes constant. Improvement occurs in the third and fourth week in those without
complications. About 10% of patients have recurrent symptoms (relapse) after feeling better for
one to two weeks. Relapses are actually more common in individuals treated with antibiotics.

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Typhoid fever is treated with antibiotics which kill the 


bacteria. Prior to the use of
antibiotics, the fatality rate was 20%. Geath occurred from overwhelming infection, pneumonia,
intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has
been reduced to 1%-2%. With appropriate antibiotic therapy, there is usually improvement
within one to two days and recovery within seven to 10 days.

Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the
original drug of choice for many years. èecause of rare serious side effects, chloramphenicol has
been replaced by other effective antibiotics. The choice of antibiotics needs to be guided by
identifying the geographic region where the organism was acquired and the results of cultures
once available. (Certain strains from South America show a significant resistance to some
antibiotics.) If relapses occur, patients are retreated with antibiotics.

The carrier state, which occurs in 3%-5% of those infected, can be treated with prolonged
antibiotics. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier
state.

For those traveling to high-risk areas, vaccines are now available.

Typhoid Fever At A Glance

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