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	Asthma
	Asthma is largely hereditary, tending to strike each generation of a family, and possibly occurring in more than one member of the family. In children, asthma may be diagnosed at age 3 or younger. In infants, asthma may be the aftermath of flu, a cold, or virus infection. Bronchiolitis (a viral inflammation of the small airways that occurs in young children during the cold months) is sometimes followed by asthma, and the symptoms of asthma resemble those of the viral infection. Although wheezing represents the hallmark of asthma, this breathing problem can also be caused by other respiratory disorders, so most physicians do not diagnose asthma until they carefully examine a child and note more than two asthma episodes. For many, asthma fades over time. About half of all children with asthma lose all symptoms as they enter their middle teens. Many evidence improvement once they reach age 6 or so, when the airways normally widen. Although asthma is rarely fatal, it can be disruptive. For although it can be controlled through medication and other means, it cannot be cured.
	Definition
	The word asthma is derived from a Greek word meaning "breathlessness" or "panting," both of which accurately describe an asthma attack. The sense of breathlessness during an asthma episode results from a hyperactive response of the breathing tubes: The bronchial tubes narrow due to muscle spasms in the bronchioles and swelling of the bronchial tissues, mucus clogs the smaller tubes, and stale air is trapped in the struggling lungs. Asthma episodes range from mild or severe, lasting anywhere from a few minutes to a few days. When the episode is over, breathing usually returns to normal.
	Cause
	Asthma episodes can be triggered by a variety of factors, most notably allergens, infections, environmental pollutants, and nonspecific stimuli such as exercise and emotional states. Between 50 and 70 percent of adults with asthma suffer from allergies. In children under 3 years of age, viral infections are likely to be the most common trigger. After 3 years, allergies also begin to play an increasing role as a trigger. After 20 years of age, occupational exposure to toxic substances and allergens also can be important triggers for asthma. Common allergens associated with asthmatic responses are: Foods: nuts, peanuts, chocolate, eggs, citrus fruits, milk Plants or plant products: pollens, grasses, mold spores Animal or insect materials: dust mites, animal danders, feathers, canine or feline saliva Infections usually viral are often the initiating event for asthma, and almost always aggravate the condition in patients with preexisting asthma. The most common infectious forerunners of asthma are influenza, colds, upper respiratory infections and bronchitis. Numerous environmental pollutants and common chemical agents have also been linked to asthma episodes. Airborne chemicals can irritate the sensitive tissues of the respiratory tract and make the airways hypersensitive to subsequent exposures. Exposure to airborne irritants can worsen asthma, or cause asthma to develop in "normal" individuals. It is believed that occupational exposure to chemicals and contaminants causes up to 15 percent of adult-onset asthma inmen. Environmental risk factors include tobacco smoke, toluene, and sulfur dioxides (sulfites). Many chemicals commonly found in the home have been known to trigger asthma attacks. Persons with a history of asthma should avoid inhaling fumes from any household cleaning product, and should wear a mask when working with any chemical substance. Common household chemicals that have been associated with asthmatic responses include: Paints and pain thinner, Hairspray, Chlorine bleach, Spray starch, Room deodorizers, Spray furniture polish, Cleaning solvents, Perfumes. In some individuals, chemicals in foods particularly sulfites can prompt severe, potentially fatal asthmatic episodes. Sulfite-sensitive persons should wear a medical alert bracelet at all times and carry both a bronchodilator inhaler and injectable epinephrine. Asthma episodes can also be triggered or worsened by nonspecific stimuli, particularly exercise and exposure to cold, dry air. Exercise-induced asthma is fairly common in children and adolescents and usually begins within 6 to 10 minutes of the start of exercise, or shortly after exercise is completed. Emotional factors can intensify asthma episodes excitement, sadness, worry, laughing too hard, crying, coughing, and anger have been associated with asthma responses.
	Treatment
	Treatment of asthma begins with identification and avoidance of known triggers when possible. A clear understanding of the pathogenesis, namely the underlying airway inflammation, increased mucus production, and bronchoconstriction, leads the patient to accept a long term plan to prevent or suppress inflammation as well as to promote to bronchodiation with acute therapy using a bronchodilator. For very mild asthma, use of bronchodilators as necessary may be sufficient. For asthma of moderate or greater severity, a daily or continuous regimen is necessary. Treatment of an acute asthma attack is critical. The goal is to alleviate the airway obstruction by reducing airway inflammation, mucus secretion, and bronchial muscle constriction that block the airways and restore normal breathing. If left untreated, an asthma attack can lead to hyperinflation of the lungs and trapping of used air within the bronchial sacs. The lack of adequate ventilation with fresh air can lead to a potentially fatal deficiency of oxygen in the body's tissues as well as retention of carbon dioxide with severe acidosis. For this reason, acute asthma episodes should be taken very seriously and treated immediately. In general, the following steps should be taken. Inhalation or injection of a bronchodilating drug. Although some over-the-counter medications may help alleviate a mild asthma episode, most of these medications are of little use against acute attacks and cause unpleasant side effects such as nervousness, tremors, or heart palpitations. If inhaled bronchodilators fail to have an effect, the person should be rushed to an emergency care facility for further treatment. If the person suffers from oxygen deprivation (becomes blue around the lips, fingers, or toes), warm humidified oxygen should be administered. For children suffering an asthmatic attack, the Lung Association suggests these steps: Reassure the child by the tone of voice, and by acting calm and self-confident. Give medication prescribed by the physician for the start of an episode. Give liquids to prevent dehydration (the amount necessary varies from patient to patient). Let the child do his favorite relaxation exercises. Try to determine what triggered the episode and remove it or the child from the area. Decide whether the physician needs to be called, or whether the episode is under control.
	Prevention
	The first step in preventing asthma episodes is determining the factor(s) that trigger the asthmatic response. Allergy testing can identify many environmental allergens, and food challenge techniques can be used to identify foods that less commonly prompt an asthmatic reaction. Once identified, causative factors should be avoided as much as possible. Immunotherapy (allergy shots) can also be initiated to desensitize allergic individuals who do not respond to the usual therapy. Drug treatment for asthma can be directed at either acutely relieving the symptom of airflow obstruction (using bronchodilator medications) or at preventing the underlying process that leads to obstruction (administering, cromolyn, nedocromil, and corticosteroids). In addition to medication, many asthma sufferers respond well to behavioural and psychological interventions such as: - Relaxation exercises - Airway-clearing exercises
	Home Remedies and Alternative Therapies
	Some alternative therapies may be useful adjuncts to conventional treatment of asthma, but caution is needed in using them. For example, herbal remedies may contain the very substances that trigger allergic asthma. So-called anti-asthma diets often eliminate entire food groups, resulting in possible nutritional deficiencies. The naturally occurring stimulants found in coffee and tea may provide some relief to some asthma sufferers, presumably because the body can convert caffeine to theophylline. But these stimulants should not be considered a substitute for needed asthma medications. Many people with asthma can benefit from medically supervised exercise conditioning, but again, caution is needed because exercise is a common asthma trigger. Patients should be taught how to use preventive medications prior to exercise, and also helped to select appropriate activities. In general, endurance activities such as long-distance running should be avoided. Using a stationary cycle or swimming in an appropriate environment are generally good choices. Meditation, yoga, deep breathing and other relaxation therapies may help counter stress; although it plays a lesser role in asthma than was previously thought, stress may be a factor in some asthma attacks. Before engaging in any alternative therapy, inform your primary-care physician, who can alert you to possible hazards.
	Male/Female Differences
	Many more boys than girls suffer asthma, although the reasons for this phenomenon have not been explained. The Asthmatic Child in School and the Community Parents of children with asthma should inform the child's teacher of the condition, what triggers it, and what needs to be done for the child in case of an episode. A child's friends should also be told. They can be very supportive, and their knowledge helps the child feel more accepted. Children, with their physicians' approval, can participate in many sports and activities, typically those that are not carried out in dusty or pollen-laden areas, and which enable the child brief rest periods. For example, cheerleading and bicycling are all appropriate activities; swimming is considered especially good exercise for children with asthma. Before engaging in strenuous physical activity, children should perform warm-up exercises to prepare their bodies for activity. Children with asthma should not be excused from chores or school responsibilities. Those who suffer breathing problems during vigorous exercise generally are able to prevent wheezing by taking medication just before the activity. Indeed several well-known individuals with asthma have won Olympic gold medals. With appropriate care and use of inhalers, children and adults with asthma should be able to engage in normal physical activity, and this should always be a goal of therapy.