by C. Michael Bowman, Ph.D., M.D.

A quick primer on asthma.

Q: What happens during an asthma attack?

In your lungs, two tubes with lots of branches transport and deposit air. These airways are mostly made of muscle, but this muscle is different from that in your arms or legs. It doesn’t follow your wishes; it acts on its own. And it’s extra irritable in people with asthma.

When asthmatic airways get irritated, muscles that wrap around them spasm, kind of like a leg cramp. This doesn’t hurt, but it closes down the size of the breathing passage. (Think of trying to drink a milkshake through a pinched straw.) The airway walls thicken, and the passages get congested with mucus and fluid. All of this leads to wheezing, coughing or chest tightness (“I can’t catch my breath”).

Each asthmatic has particular triggers that set off the airways, ranging from cigarette smoke to viral infections to allergies to acid reflux to emotions.

Q: What causes asthma?

We don’t yet know what causes asthma in everyone, but we think that genes, exposure to specific irritants, and possibly allergies, and certain viral infections in the first year of life can lead to it.

There are things you can do to lessen your child’s chance of developing asthma—most importantly keeping them away from cigarette smoke. Children of smokers have twice the risk of asthma that children of nonsmokers have.

Avoiding viral infections in early life (RSV, bronchiolitis and cold viruses are important) may make asthma less likely. That means keeping children (including brothers and sisters) who are sick away from your new baby. It means not taking the baby to places with lots of people (stores, church, parties) during the cold and flu season.

That said, we aren’t really sure yet whether these infections actually cause asthma or are simply more likely in people who are going to get asthma anyway.

Q: How do you treat asthma?

Though asthma is not curable, it’s certainly treatable. That’s crucial because untreated asthma can lead to permanent lung damage or, less commonly, death.

The most important treatment goal is control. This requires taking so-called controller medicines every day. These decrease how irritable the airways are when they come into contact with a trigger.

Then, if you need them, rescue medicines relax the muscles during an attack, opening the airways.

If you have asthma, you should have a written action plan—specific instructions on what to do, what medicines to take and whom to call if you get sick. Time is important, so don’t wait to see if it gets better. Start acting right away.

C. MICHAEL BOWMAN,  Ph.D., M.D., is a professor of pediatrics at the Medical University of South Carolina and a board-certified pediatric pulmonologist with the MUSC Children’s Hospital.

Last updated and/or approved: March 2010. Original article appeared in summer 2007 former print magazine. Bio current as of summer 2007.

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