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Definition:   Asthma is a common long term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These episodes may occur a few times a day or a few times per week. Depending on the person they may become worse at night or with exercise.

Asthma is thought to be caused by a combination of genetic and environmental factors. Environmental factors include exposure to air pollution and allergens. Other potential triggers include medications such as aspirin and beta blockers. Diagnosis is usually based on the pattern of symptoms, response to therapy over time, and spirometry. Asthma is classified according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate. It may also be classified as atopic or non-atopic where atopy refers to a predisposition toward developing a type 1 hypersensitivity reaction…..CLICK & SEE 

There is no cure for asthma. Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by the use of inhaled corticosteroids. Long-acting beta agonists (LABA) or antileukotriene agents may be used in addition to inhaled corticosteroids if asthma symptoms remain uncontrolled. Treatment of rapidly worsening symptoms is usually with an inhaled short-acting beta-2 agonist such as salbutamol and corticosteroids taken by mouth. In very severe cases, interavenous corticosteroids, magnesium sulfate, and hospitalization may be required.
Asthma symptoms vary from person to person. One may have infrequent asthma attacks, has symptoms only at certain times — such as when exercising — or have symptoms all the time.

Asthma signs and symptoms include:

*Shortness of breath
*Chest tightness or pain
*Trouble sleeping caused by shortness of breath, coughing or wheezing
*A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
*Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
Signs that your asthma is probably worsening include:

*Asthma signs and symptoms that are more frequent and bothersome
*Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
*The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:

*Exercise-induced asthma, which may be worse when the air is cold and dry
*Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
*Allergy-induced asthma, triggered by particular allergens, such as pet dander, cockroaches or pollen.

Asthma is caused by a combination of complex and incompletely understood environmental and genetic interactions. These factors influence both its severity and its responsiveness to treatment. It is believed that the recent increased rates of asthma are due to changing epigenetics (heritable factors other than those related to the DNA sequence) and a changing living environment…..CLICK & SEE

Asthma triggers:

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

*Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
*Respiratory infections, such as the common cold
*Physical activity (exercise-induced asthma)
*Cold air
*Air pollutants and irritants, such as smoke
*Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)
*Strong emotions and stress
*Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine
*Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat.

While asthma is a well recognized condition, there is not one universal agreed upon definition. It is defined by the Global Initiative for Asthma as “a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment”.

There is currently no precise test with the diagnosis typically based on the pattern of symptoms and response to therapy over time. A diagnosis of asthma should be suspected if there is a history of: recurrent wheezing, coughing or difficulty breathing and these symptoms occur or worsen due to exercise, viral infections, allergens or air pollution.
Physical exam:

To rule out other possible conditions — such as a respiratory infection or chronic obstructive pulmonary disease (COPD) — your doctor will do a physical exam and ask you questions about your signs and symptoms and about any other health problems.

Tests to measure lung function

One may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:

*Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.

*Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.

Lung function tests often are done before and after taking a medication called a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it’s likely you have asthma.

Other additional tests:

Other tests to diagnose asthma include:

*Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.

*Nitric oxide test. This test, though not widely available, measures the amount of the gas, nitric oxide, that you have in your breath. When your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels.

*Imagingtest:   test:A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.

*Allergy testing. : This can be performed by a skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy.

*Sputum eosinophils. This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).

*Provocative testing for exercise and cold-induced asthma. In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.

Risk Factors:
A number of factors are thought to increase your chances of developing asthma. These include:

*Having a blood relative (such as a parent or sibling) with asthma
*Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
*Being overweight
*Being a smoker
*Exposure to secondhand smoke
*Exposure to exhaust fumes or other types of pollution
*Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

Asthma complications include:

*Signs and symptoms that interfere with sleep, work or recreational activities
*Sick days from work or school during asthma flare-ups
*Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
*Emergency room visits and hospitalizations for severe asthma attacks
*Side effects from long-term use of some medications used to stabilize severe asthma
*Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

While there is no cure for asthma, symptoms can typically be improved. A specific, customized plan for proactively monitoring and managing symptoms should be created. This plan should include the reduction of exposure to allergens, testing to assess the severity of symptoms, and the usage of medications. The treatment plan should be written down and advise adjustments to treatment according to changes in symptoms.

The most effective treatment for asthma is identifying triggers, such as cigarette smoke, pets, or aspirin, and eliminating exposure to them. If trigger avoidance is insufficient, the use of medication is recommended. Pharmaceutical drugs are selected based on, among other things, the severity of illness and the frequency of symptoms. Specific medications for asthma are broadly classified into fast-acting and long-acting categories.

Bronchodilators are recommended for short-term relief of symptoms. In those with occasional attacks, no other medication is needed. If mild persistent disease is present (more than two attacks a week), low-dose inhaled corticosteroids or alternatively, an oral leukotriene antagonist or a mast cell stabilizer is recommended. For those who have daily attacks, a higher dose of inhaled corticosteroids is used. In a moderate or severe exacerbation, oral corticosteroids are added to these treatments.

Lifestyle modification:
Avoidance of triggers is a key component of improving control and preventing attacks. The most common triggers include allergens, smoke (tobacco and other), air pollution, non selective beta-blockers, and sulfite-containing foods. Cigarette smoking and second-hand smoke (passive smoke) may reduce the effectiveness of medications such as corticosteroids. Laws that limit smoking decrease the number of people hospitalized for asthma. Dust mite control measures, including air filtration, chemicals to kill mites, vacuuming, mattress covers and others methods had no effect on asthma symptoms.[48] Overall, exercise is beneficial in people with stable asthma.

Medications used to treat asthma are divided into two g