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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Author:

Alan Szeftel, MD

Alan Szeftel, MD

Dr. Szeftel received his Medical Degree from the University of Cape Town Medical School in South Africa. His clinical training was at Groote Schuur Hospital. He completed his Internal Medicine residency at Brigham & Women's Hospital and Harvard University. He is board certified in Internal Medicine, Pulmonary Diseases, Critical Care and Allergy and Immunology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Myths, facts, and statistics about asthma
• What is asthma?
• From the past to the present
• The scope of the problem
• Normal bronchial tubes
• How does asthma affect breathing?
• The importance of inflammation
• Which triggers cause an asthma attack?
• The many faces of asthma
• Types: allergic (extrinsic) and nonallergic (intrinsic) asthma
• Typical asthma symptoms and signs
• Acute asthma attack
• What medications are used in the treatment of asthma?
• Asthma At A Glance
• Asthma FAQs
• Patient Comments: Asthma - Symptoms
• Patient Comments: Asthma - Effective Treatments
• Find a local Asthma & Allergy Specialist in your town
• Asthma Index

Asthma causes a narrowing of the breathing airways, which interferes with the normal movement of air in and out of the lungs. Asthma involves only the bronchial tubes and does not affect the air sacs or the lung tissue. The narrowing that occurs in asthma is caused by three major factors: inflammation, bronchospasm, and hyperreactivity.

Inflammation

The first and most important factor causing narrowing of the bronchial tubes is inflammation. The bronchial tubes become red, irritated, and swollen. This inflammation increases the thickness of the wall of the bronchial tubes and thus results in a smaller passageway for air to flow through. The inflammation occurs in response to an allergen or irritant and results from the action of chemical mediators (histamine, leukotrienes, and others). The inflamed tissues produce an excess amount of "sticky" mucus into the tubes. The mucus can clump together and form "plugs" that can clog the smaller airways. Specialized allergy and inflammation cells (eosinophils and white blood cells), which accumulate at the site, cause tissue damage. These damaged cells are shed into the airways, thereby contributing to the narrowing.

Bronchospasm

The muscles around the bronchial tubes tighten during an attack of asthma. This muscle constriction of the airways is called bronchospasm. Bronchospasm causes the airway to narrow further. Chemical mediators and nerves in the bronchial tubes cause the muscles to constrict. Bronchospasm can occur in all humans and can be brought on by inhaling cold or dry air.

Hyperreactivity (hypersensitivity)

In patients with asthma, the chronically inflamed and constricted airways become highly sensitive, or reactive, to triggers such as allergens, irritants, and infections. Exposure to these triggers may result in progressively more inflammation and narrowing.

The combination of these three factors results in difficulty with breathing out, or exhaling. As a result, the air needs to be forcefully exhaled to overcome the narrowing, thereby causing the typical "wheezing" sound. People with asthma also frequently "cough" in an attempt to expel the thick mucus plugs. Reducing the flow of air may result in less oxygen passing into the bloodstream, and if very severe, carbon dioxide may dangerously accumulate in the blood.