A leukotriene receptor antagonist used for chronic treatment of asthma in adults and children five years of age and older. Accolate is not a bronchodilator and should not be used as a rescue medication.
A hormone produced in response to stress by the adrenal glands, located on the surface of the kidneys. Adrenaline has widespread effects on the circulation, making the heart beat faster, narrowing blood vessels, and dilating the airways. Epinephrine given as an injection is used in the emergency room to treat anaphylaxsis, a potentially life-threatening allergic reaction. It is occasionally used to treat a severe asthma flare, because it can relax the airways.
albuterol (Proventil, Ventolin)
A medication used as a rescue inhaler to treat wheezing, shortness of breath, and troubled breathing caused by asthma and to prevent breathing problems during exercise. Albuterol belongs to a class of medications called beta 2-agonists, which work by relaxing and opening air passages in the lungs, making it easier to breathe.
A foreign substance such as pollen that the body interprets as a foreign invader and that can trigger an allergic reaction.
A doctor who diagnoses and manages asthma and allergy-related conditions. Allergists have specialty training in caring for patients with asthma.
Microscopic thin-walled air sacs where oxygen and carbon dioxide are exchanged, located at the end of the smallest airways in the lungs.
An abnormal and potentially life-threatening reaction to a particular allergen. It occurs when histamine and other potent chemicals are released from tissues and cause either local or widespread symptoms. The reaction may occur after an insect sting or as a reaction to a drug or a particular food. It can progress to anaphylactic shock, an extreme bodywide allergic reaction causing widespread swelling, constriction of the bronchioles, heart failure, circulatory collapse, and sometimes death.
A protein produced by a type of white blood cell called a lymphocyte that interacts with an antigen, or foreign protein. Bacteria, viruses and other microorganisms, pollens, dust mites, molds, and foods commonly contain many antigens. Normally, many types of antibodies are produced to protect the body. However, when the body forms large numbers of a particular type of antibody called IgE (Immunoglobulin E), allergic symptoms may develop when the patient is again exposed to the substance that caused the production of IgE antibodies.
A group of medicines that relax the muscles surrounding the airways. These drugs block acetylcholine, a chemical produced by the brain that causes airway muscles to constrict. These drugs are used by people with asthma as rescue medications, not as a daily maintenance treatment for persistent asthma. Anticholinergics include Atrovent (ipratropium bromide) and Spiriva (tiotropium bromide); Atrovent is available in metered-dose inhalers and in a liquid form for use in compressor-driven nebulizers. Spiriva is only available in handheld dry powder inhalers. When used as additional medication to treat asthma, these drugs work best when used with a short-acting beta 2-agonist inhaler.
A substance that can trigger an immune response, producing an antibody as part of the body’s defense against infection and disease. Many antigens are foreign proteins not found naturally in the body. An allergen is a special type of antigen, such as mold or pollen, that causes an allergic reaction.
Medicine that blocks the action of histamine, a chemical that is released by the body during an allergic reaction and that causes symptoms such as itching and swelling.
Medication that reduces inflammation, such as the swelling in the airway.
A type of asthma triggered by aspirin or NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen. This kind of asthma usually occurs in adults and is often accompanied by benign growths in the nose called nasal polyps or a chronically runny or stuffy nose. Aspirin-sensitive asthma may respond to leukotriene-modifying drugs.
asthma action plan
A list of specific instructions for a person with asthma, including what asthma medicines to take and what to do if peak-flow readings or asthma symptoms get worse. Asthma action plans are usually divided into zones, depending on seriousness of symptoms, from normal (green) to caution (yellow) to serious (red).
See ipratropium bromide.
A metered-dose inhaler (MDI) activated by the breath that does not require the breath-hand coordination of an aerosol MDI.
An anti-inflammatory corticosteroid used in a metered-dose inhaler by patients with asthma. It helps prevent inflammation of the lungs and hypersensitivity in the airways, but it is not effective in relieving inflammation during an asthma flare the way oral corticosteroids can. Side effects may include dry or irritated throat, hoarseness, coughing, bad taste in the mouth, headache, nausea, diarrhea, thirst, and fatigue. These symptoms may improve as the body adjusts to the medication. Trade names include Beclovent, Vanceril, and Qvar for asthmatic use; Beconase and Vancenase are prescribed for nasal inhalation.
beta-adrenergic agonist (B-adrenergic agonist)
See beta 2-agonist.
See beta 2-agonist.
beta 2-agonist (B 2-agonist)
A bronchodilator medicine that opens the airways of the lungs by relaxing muscles that have tightened around the airways. These medicines are available in both short-and long-acting forms and in both inhaled and oral forms. Side effects of beta 2-agonists include shaky feelings, overexcitement, and increased heart rate. Rarely, they may cause an upset stomach or sleeping problems. Oral forms of beta 2-agonists (Volmax) can have more side effects, because they are available in higher doses and are absorbed throughout the bloodstream to get to the lungs. Inhaled forms are deposited directly in the lungs and therefore have fewer side effects.
beta 2-agonist, long-acting
The long-acting forms of beta 2-agonists are used to provide control, not quick relief. They take longer to begin to work than short-acting beta 2-agonists, but their benefits last longer (up to 12 hours). Serevent and Foradil are the only inhaled, long-acting beta 2-agonists available and are used twice a day to maintain open airways for long-term control. They have also been shown to be helpful in treating exercise-induced asthma. Serevent and Foradil are available in dry powder inhaler (DPI) form. Serevent is also available in an MDI.
beta 2-agonist, short-acting
Short-acting beta 2-agonists administered by inhalation are used to relieve asthma symptoms within five minutes, increasing airflow and facilitating breathing for up to six hours. Short-acting beta 2-agonists include albuterol (Ventolin, Proventil, Accuneb), Alupent (metaproterinol), Combivent (combines a beta 2-agonist and an anticholinergic), Duoneb (combines a beta 2-agonist and an anticholinergic), Maxair, and Xopenex. They are available in inhaled, pill, liquid, and injectable forms; the inhaled form is available in metered-dose inhalers (MDIs), dry powder inhalers, and a liquid form. Nonprescription short-acting beta 2-agonist (epinephrine) is available as Primatene and Bronkaid. Long-acting forms include Serevent and Foradil; Advair combines Serevent and Flovent.
Inhaler that is similar to a metered-dose inhaler except that the beginning of inhalation triggers the release of the medication. Maxair (pirbuterol) is available in breath-actuated inhaler form.
The number of breaths a person takes each minute.
Lung sounds that can be heard through a stethoscope.
A system of tubes within the lungs that connects the lung to the trachea (windpipe).
The smallest branches of the airways in the lungs that connect to the air sacs (alveoli). If inhaled air cannot make it through the bronchiole to the air sacs because of asthma, the blood’s oxygen saturation level will drop.
A medication that opens the airways by relaxing the muscles constricting the airways during an asthma attack, improving airflow and breathing. Bronchodilators also help remove mucus from the lungs so that it can be coughed out. Common bronchodilators include Ventolin or Proventil (albuterol) and nonprescription Primatene (epinephrine). There are three main types of bronchodilator medications: beta 2-agonists (short- and long-acting forms), anticholinergics, and theophylline. Short-acting forms ease or stop asthma symptoms and are very helpful during an asthma attack. Long-acting forms help control asthma symptoms and prevent asthma attacks.
The tightening of the muscle bands that surround the airways, causing the airways to narrow.
A corticosteroid delivered by a turbuhaler and the first dry powder inhaled steroid approved by the U.S. Food and Drug Administration. The turbuhaler dispenses a measured dose of dry powder with each inhaled breath; no special timing is required.
A test done to determine whether a person’s bronchial tubes are hypersensitive. During the test, the subject breathes in air containing carefully controlled amounts of an aeorosolized substance known to cause bronchoconstriction, such as methacholine, histamine, or a known allergen. The bronchi of people with asthma respond to much smaller amounts of the substance; this test is often used to confirm a diagnosis of asthma if there is uncertainty.
A disease that can be treated and controlled but that cannot be cured. Asthma is a chronic disease.
chronic obstructive pulmonary disease (COPD)
A term for any long-standing condition that interferes with airflow in and out of the lungs; it is used most often to describe chronic bronchitis and emphysema. When persistent asthma develops into a chronic obstructive pulmonary disease, it typically indicates that the lungs have become irreversibly damaged and scarred from repeated, untreated asthma flares.
Hairlike structures that line the airways in the lungs, helping clear out the airways.
A metered-dose inhaler that combines both albuterol (Ventolin or Proventil) and ipratropium bromide (Atrovent). Albuterol acts immediately but has a shorter lifespan than ipratropium bromide. Combivent is more commonly prescribed for adults with chronic obstructive pulmonary disease.
A steroid hormone produced by the adrenal glands that can reduce swelling and inflammation. Synthetic corticosteroids enhance the body’s own production of these hormones, easing the swelling, inflammation, and mucus production that occur when lungs are irritated as a result of asthma. Oral corticosteroids are used for immediate short-term relief; they can be used to help treat stubborn, serious flares for about a week. Rarely, for patients with severe persistent asthma, oral corticosteorids may be used daily or on alternate days. Inhaled corticosteroids are used daily in persistent asthma to prevent asthma flares, but they will not stop a flare in progress.
cromolyn sodium (Intal)
A medication that prevents bronchospasm and inflammation. It is usually only effective for asthma that is triggered by allergens or exercise and is available both as a metered-dose inhaler and as a nebulizer solution.
Bits of cells shed from animal skin or hair that float through the air and settle on household surfaces. Pet dander is a major part of household dust and often causes allergic reactions and triggers allergic asthma.
Medication that shrinks swollen nasal passages to relieve swelling, congestion, and mucus secretion. It is available in both an oral form and a nonprescription nasal spray.
The major muscle of breathing, which contracts with each indrawn breath and relaxes with each exhale. It is attached to the lower ribs at each side and to the breastbone and the backbone at the front and back.
diskhaler (Flovent Rotadisk)
A type of dry powder inhaler with a round disk containing four doses of medication. To use, the patient punctures the pouch and inhales the drug through the mouthpiece.
The difference between the width of the airways in the lungs of asthma patients when measured 12 hours apart. Airways normally narrow and open naturally over a day in healthy individuals, but people with asthma experience a much greater variation. Typically, the larger the diurnal variation, the more unstable the person’s asthma. People with asthma can measure diurnal variation by taking morning and evening peak-flow readings.
dry-powder inhaler (DPI)
A small breath-activated handheld device for inhaling very fine dry powdered respiratory medicines into the lungs; it does not require an aerosol spray device. DPIs do not contain any of the propellants (CFCs) that are used in standard metered-dose inhalers (MDIs), which can be harmful to the environment. DPIs can be easier to use than MDIs, because the patient does not have to activate the inhaler and breathe in at the same time. DPIs also do not have as bad a taste and as unpleasant a texture as MDIs. Both quick-relief and long-term control asthma medicines can be given by DPI, including Advair Diskus, Asmanex Twisthaler, Ventolin Rotacap, Foradil Aerolizer, Flovent Diskhaler, Flovent Diskus, Flovent Rotadisk, Pulmicort Turbuhaler, and the Serevent Diskus.
Microscopic creatures that live in the dust in the home, especially when the air is humid. Dust mites can be found both in visible dust that might be found under the bed or behind the couch and in soft, hidden places such as pillows, mattresses, blankets, and stuffed animals. Many people with asthma are allergic to dust mites.
Shortness of breath.
Swelling caused by the collection of fluid within cells or tissues.
An acronym for enzyme-linked immuno-sorbent assay, an allergy test to detect allergens in the blood.
A type of white blood cell associated with the inflammation underlying asthma. People with asthma tend to have more eosinophils in their blood and an unusual number of eosinophils in the lungs.
Asthma that is triggered by exercise. Exercise is a very common trigger of symptoms, affecting between 70 and 80 percent of people with asthma.
An anti-inflammatory corticosteroid used in a metered-dose inhaler that helps prevent inflammation in the airways. It delivers a more potent drug with each puff than does beclomethasone, which is why in the past it was often prescribed for more severe cases of asthma.
fluticasone (Flonase, Flovent)
Inhaled corticosteroid also available in a nasal preparation for sinusitis and rhinitis. It is prescribed to ease allergic rhinitis symptoms that often trigger asthma flares.
The medical term for acid reflux, a disease that causes painful heartburn when acid from the stomach flows up into the throat. Acid reflux can trigger asthma and make it harder to treat. It happens mostly in people who are older and overweight, but it can happen in all kinds of people. People who have asthma get acid reflux more often than people without asthma, probably because of the pressure changes in the chest during asthmatics’ breathing. This high pressure can force liquid to travel the wrong way.
An allergy caused by pollens that affect the eyes and nose.
high-efficiency particulate (HEPA) filter
A type of filter on air cleaners that removes particles in the air by forcing them through screens containing microscopic pores. HEPA filters effectively remove 99.97 percent of all particulates (such as pollen and dust) that pass through the filter, returning purified air to the room.
A naturally occurring substance in the body that causes allergic reactions such as redness, itching, and swelling of the nose and eyes. This reaction also can occur in the skin, causing hives and swelling.
Chemicals released by endocrine glands and carried through the bloodstream to specific tissues, where they can produce either rapid or long-term effects.
Lack of oxygen in the blood and tissues. In people with asthma who have normal blood flow and blood pressure, a lowered oxygen saturation point can cause this condition. The brain is most critically affected by hypoxia.
IgE (immunoglobulin E)
The antibody produced in large amounts by people with allergic asthma and other allergic conditions. IgE can be measured in a blood sample to help diagnose whether a person is allergic, because people with allergies usually have high levels of IgE.
Proteins that are found in blood and in tissue fluids, also known as antibodies. Immunoglobulins are produced by cells of the immune system called B-lymphocytes; they bind to foreign antigens in the body. A particular type of immunoglobulin, IgE, plays a central role in allergies by binding to antigens (allergens) on the cell’s surfaces, thereby triggering an inflammatory reaction.
Swelling and irritation that in people with asthma affects the airways of the lungs. Inflammation is the body’s response to some kind of injury, a way of protecting itself and helping the injury heal. The purpose of the inflammation is to dilute and destroy whatever is causing the inflammation. In asthma, the linings of the airways become overreactive, inflamed, and so hypersensitive and twitchy that the slightest provocation triggers symptoms. Airway inflammation may always be present in a person with asthma, even if there are no symptoms. Many experts believe that if left untreated, this chronic inflammation can damage the airways and cause long-term loss of lung function.
Small, handheld canisters for delivering asthma medication into the airways, available in four types: CFC metered dose (MDIs), HFA MDIs, breath actuated, and dry powder.
See cromolyn sodium.
ipratropium bromide (Atrovent)
An inhaled bronchodilator available in both nebulizer solution and metered-dose inhaler form. Atrovent acts more slowly and is not typically used in back-to-back treatments the way albuterol can be. In critical situations, it may be combined with an albuterol dose administered by nebulizer; albuterol offers immediate relief, while Atrovent gives longer-lasting effects. Combivent combines the same two drugs in a metered-dose inhaler. Side effects with ipratropium bromide use may include dizziness, headache, nausea, dry mouth, cough, hoarseness, or blurred vision, although these symptoms may fade as the body adjusts to the drug.
Substances that bother the nose, throat, or airways when they are inhaled; irritants are not allergens. Examples of irritants in asthma include h2 chemicals, cigarette smoke, and perfume.
Chemical found naturally in the body. Increased amounts of these substances contribute to the swelling and the narrowing of air passages.
An oral class of nonsteroidal asthma drugs that block chemicals called leukotrienes in the airways, preventing or reducing inflammation of the airways. Antileukotrienes fall into one of two categories: inhibitors or antagonists (blockers). Leukotriene inhibitors known as zileuton (Zyflo) prevent leukotriene production; antagonists called montelukast (Singulair) or zafirlukast (Accolate) block the leukotriene receptors responsible for producing mucus and bronchoconstriction. By either preventing or halting the inflammatory reaction, antileukotrienes can potentially lower or eliminate the need for inhaled corticosteroids.
long-term control medicine
A medicine that must be taken every day to control asthma symptoms. It is not used for emergency relief during an asthma flare.
An older bronchodilator available only as a metered-dose inhaler, tablet, or syrup.
metered-dose inhaler (MDI)
A small aerosol device that, when pressed down from the top, releases a mist of medicine, which is then inhaled. Many asthma medicines are taken with an MDI. Less than 20 percent of the dose arrives in the lungs, and more than 80 percent, the larger particles that are too heavy to be inhaled, is left in the patient’s mouth. These particles are swallowed and absorbed by tissue and then travel throughout the rest of the body. Using a spacer device with an MDI lessens this effect, since the larger particles remain in the chamber instead of the mouth.
An antileukotriene that works by suppressing the effects of leukotrienes on their receptors in airway tissue. By preventing or halting the inflammatory reaction, antileukotrienes can lessen or eliminate the need for corticosteroids.
A material produced by glands in the airways, nose, and sinuses that is secreted as a protective lubricant.
A machine that creates fine droplets of medicine as an aerosol or mist that is then inhaled through a mouthpiece or mask. Nebulizers can be used to deliver bronchodilator medicines to open the airways, such as albuterol, as well as anti-inflammatory medicines. A nebulizer can be used instead of a metered-dose inhaler; because it transforms medicine into extremely fine particles, it increases the absorption rate by the lungs. Nebulizers are one of the most effective delivery techniques available for home use.
nedocromil sodium (Tilade)
A medication very similar to but longer-acting than cromolyn sodium, usually taken once or twice per day.
An anti-inflammatory medicine that is not a steroid.
A lightweight finger clamp device that monitors and reports the oxygen saturation of the blood. It is also known as an oximeter or pulse oximeter. Saturation levels should be in the high 90s.
The level of oxygen in the bloodstream, which is expressed as a percentage; the high 90s is considered to be an excellent reading.
peak expiratory flow rate (PEF)
How fast a person can breathe out. It is one of several tests that can determine how well your lungs are functioning.
A small handheld device that measures how fast air comes out of the lungs when a person exhales forcefully (the peak expiratory flow [PEF]). Measured in liters per minute (1pm), a person’s PEF might drop hours or even days before asthma symptoms appear. Readings from the meter can help a person with asthma recognize early changes that could indicate that the condition is worsening. A peak-flow meter also can help the patient figure out what substances or situations trigger symptoms and understand when symptoms require emergency care. Peak-flow readings also help a doctor decide when to add or reduce medicines.
personal best peak expiratory flow (PEF)
The highest peak-flow number a patient with asthma can achieve when symptoms are under good control. The personal best PEF is the number to which all other peak-flow readings should be compared. If the patient is still growing, the PEF rate is based on height; as the patient grows, the doctor will refigure the PEF about every six months or right after a growth spurt.
An infection of the lung caused by different types of germs, including bacteria, viruses, fungi, and parasites, in which the air sacs fill up with pus so that air is excluded and the lung becomes solid. Symptoms include fever, chills, cough, rapid breathing, grunting or wheezing breath sounds, labored breathing, vomiting, chest pain, abdominal pain, lethargy, loss of appetite, and bluish or gray color of the lips and fingernails. The extent of symptoms depends on how large an area of the lung is involved and how virulent the germs are.
An allergen that is released by grasses, weeds, and trees as a fine, powdery substance. Pollen is a common asthma trigger.
pollen and mold counts
A measure of the amount of allergens in the air usually reported for mold spores and grass, tree, and weed pollens. The count is reported as grains per cubic meter of air and is translated into absent, low, medium, or high.
An oral systemic corticosteroid that helps prevent inflammation by suppressing the immune response to triggers and stimuli. This powerful drug is typically prescribed only for a short time because it can cause severe side effects if used for long periods. Short-term treatments for 10 days or less are considered to be safe as long as they are not prescribed too often. These drugs include prednisone (Cortan, Deltasone, Prednicen-M, or Sterepred), prednisolone (Prelone, Pediapred, Delta-cortef), or methylprednisolone (Medrol and SoluMedrol).
A nonprescription bronchodilator that can be dangerous if abused, because it includes epinephrine.
A “wet” cough that often involves coughing up mucus.
pulmonary function tests
A test or series of tests that measure many aspects of lung function and capacity. They also may be called lung function tests.
A test in which a device that clips on the finger measures the oxygen level in the blood.
A rescue medicine that opens the airways right away to relieve symptoms of asthma. These medications are usually used only when symptoms have appeared.
An acronym for radioallergosorbent test, which identifies allergens in blood samples that can cause an allergic reaction.
See gastroesophageal reflux.
Short-term bronchodilators that provide immediate relief to the airways during an asthma flare. However, these drugs do not address the underlying inflammation causing the asthma attack.
Inflammation of the mucous membrane of the nose that may be caused by a viral infection or an allergic reaction. It is characterized by nasal congestion, runny nose, itching, and sneezing. Rhinitis often triggers flares in susceptible asthmatics.
A dry powder inhaler used with Rotacaps.
The World Health Organization’s preferred name for albuterol, a bronchodilator.
salmeterol inhaled (Serevent)
A long-acting bronchodilator that may be prescribed as a maintenance drug in combination with an inhaled corticosteroid, especially for people with asthma who need long-lasting effects. It may be used by students whose school systems restrict or prohibit the use of short-acting bronchodilator inhalers without a visit to the school nurse. Salmeterol does not stop an attack once it has started. Side effects include dry mouth and irritated throat, dizziness or lightheadedness, headache, heartburn, appetite loss, altered taste sensations, restlessness, anxiety, nervousness, trembling, and sweating.
See salmeterol inhaled.
An inflammation or infection in one or more sinuses (the hollow air spaces around the nose and eyes).
A chamber used with a metered-dose inhaler to help make the inhaler easier to use and to help deliver the medicine into the airways.
A basic lung function test that measures how fast and how much air can be inhaled and exhaled. The total volume of air a patient exhales is called the forced vital capacity (FVC). The spirometer also measures the volume of air you exhale in the first second (forced expiratory volume in one second, or FEV1).
Saliva mixed with mucus or phlegm, coughed up from the respiratory tract. Coughs that produce sputum are considered productive.
An extremely serious, life-threatening condition in which an asthma flare is not responding to treatment. This condition, which can be fatal, often requires hospitalization.
A common term often used with corticosteroids to describe medicine that reduces swelling and inflammation and is available in pill, syrup, injectable, and inhaled forms. It is also available as creams, ointments, and lotions for topical care of certain skin problems.
theophylline (Uniphyl, Theo-Dur, Slo-Bid, Theo-24)
A type of bronchodilator used as a long-term medicine to open airways, easing or preventing bronchospasm. This caffeine derivative is much less popular today than inhaled corticosteroids in the treatment of asthma. Available as a pill, liquid, or intravenous drug, it is used to treat difficult-to-control or severe asthma and must be taken daily. Side effects include nausea and/or vomiting, diarrhea, stomachache, headache, rapid or irregular heartbeat, muscle cramps, jittery or nervous feeling, and hyperactivity. Some medications, such as antibiotics containing erythromycin, seizure medicine, or ulcer medicine, can interfere with the way theophylline works. Some diseases and illnesses also can change how your body responds to theophylline. Theophylline’s potential side effects and its very thin margin between therapeutic dose and toxicity make it a less desirable choice for most patients.
See nedocromil sodium.
The main airway (windpipe) supplying both lungs.
A metered-dose inhaled corticosteroid.
Things that cause allergy and/or asthma symptoms to start or become worse.
A dry powder inhalation device used to deliver budesonide (Pulmicort). As the inhaler is rotated, the dry powder medication is released into a holding chamber from which the medicine is inhaled.
A machine that breathes for a patient when the person’s lungs can no longer inhale or exhale. A ventilator is typically the last resort when a patient is in severe status asthmaticus.