May you never take one single breath for granted, a line from Lee Ann Womacks award-winning country/pop crossover hit, may well be the motto for the 12 to 15 million Americans coping with asthma.

A chronic lung disease that mainly affects the airways in one of three ways airway inflammation, spasm of the muscles surrounding the airway (reversible bronchiospasm and airway hyperactivity (irritability) asthma makes breathing difficult and performing routine daily activities a challenge.

Fortunately, medical professionals today are improving asthma sufferers quality of life through a combination of prescription medications, patient education and the use of peak flow meters to monitor asthma at home in order to manage the disease more effectively.

What happens during an asthma attack?

During normal breathing, air is taken in through the nose and passed through the windpipe and into the bronchial tubes in the lungs. At the ends of these tubes are small air sacs called alveoli that transfer oxygen to the blood and also help eliminate toxins such as carbon dioxide. During normal breathing, the small bands of muscle surrounding the airways are relaxed, allowing air to flow easily.

However, when an asthma attack occurs, the small bands of muscle surrounding the airways go into a spasm and squeeze the airway and/or become inflamed, restricting air flow and inhibiting breathing, explains Dr. John D. Cosachov, DO, who practices at Central New York Asthma & Allergy Consultants, in Auburn, and is board certified in allergy, immunology and internal medicine.

As a result, a person suffering from an asthma attack may experience shortness of breath, coughing, tightening of the chest and wheezing. Other symptoms of an asthma attack may include very rapid breathing, retractions of the neck and chest muscles causing tightness, difficulty talking, feelings of panic or anxiety and a pale, sweaty face.

According to a review by the American College of Allergy, Asthma & Immunology, asthma is an illness with many variations in cause and severity. Not every asthma sufferer will experience the same symptoms.

Treating asthma

Mild asthma attacks, in which only some of the airways are closed, are most common. However, these attacks can escalate quickly, making immediate treatment to control airway inflammation necessary in order to prevent more severe attacks.

Severe asthma attacks are less common but last longer and require the prescribed use of a quick-relief medication, such as Albuterol or Levalbuterol, and possibly the use of inhaled corticosteroids, such as Azmacort, Flovent and QVAR, among others, Cosachov explained.

Today, the current thrust of asthma treatment is controlling airway inflammation in order to prevent irreversible destruction. The most effective treatments for asthma are those that are preventive, such as doctor-prescribed anti-inflammatories or inhaled corticosteroids, the doctor advises.

If inflammation is present in the airways over a long period of time, changes in the structure of the airway occur, he explained. This leads to loss of lung function over time and irreversible obstruction of the airway.

More and more medical evidence suggests that anti-inflammatory medications, particularly corticosteroids, prevent this from occurring if their use is started early on, according to the National Asthma Education and Prevention Program, NAEPP, Guidelines for the Diagnosis and Management of Asthma, June 2002.

Research points to

effective medications

Although long-term control medications such as leukotriene antagonists, cromolyn, nedocrimil and theophylline have anti-inflammatory properties, recent studies indicate that they are not as effective at preventing airway inflammation as inhaled corticosteroids, the NAEPP report states. In fact, the most recent guidelines from the National Heart, Lung and Blood Institute now recommend inhaled corticosteroids as first line therapy for the control of asthma inflammation.

Unlike oral corticosteroids, which can produce serious side effects if taken frequently over a long period of time, inhaled corticosteroids do not produce significant problems, according to studies looking at their possible long-term side effects.

When used by the inhaled route, the doses of corticosteroids required are much, much smaller, Cosachov explained.

By inhaling the medications, they are delivered to the affected area directly and, as a result, the side effects are minimal, he said.

Taming the triggers

The inflammation and irritation of the airways that characterize asthma may be triggered by a variety of environmental and emotional factors.

Common asthma triggers may include, but are not limited to, colds, pollens and mold spores, animal dander, smoke and pollution, changes in temperature and humidity, exercise and anxiety. People can best control their asthma by identifying the triggers present at the onset of their asthma symptoms and avoiding them.

Such triggers could include allergens, Cosachov explained. Therefore, identifying a patients allergies is important because doing so, and then addressing the allergy issue, may reduce inflammation and decrease the need for using anti-inflammatory medications.

Additionally, appropriate immunotherapy, which reduces the degree of a persons allergies and subsequent severity of the disease, can help maintain or improve the control of the patients asthma, according to the American College of Allergy, Asthma & Immunology.

In summary, current asthma treatments combine reducing airway inflammation through the avoidance of known allergens and irritants, with medications and immunotherapy that reduces airway irritability and bronchiospasm and may decrease the likelihood that long-term airway damage will occur.