Asthma

When a person has asthma, the airways in his or her lungs become blocked and swollen. The airways grow extra sensitive to particles in the air. This makes it hard to breathe and causes coughing or wheezing.

People with HIV infection often have asthma that isn’t recognized by their doctors. People with HIV are more vulnerable to the bad effects of smoking. They may be at higher risk of developing lung-related disorders such as emphysema. All of these things can make asthma worse.

Symptoms

Symptoms of asthma can vary widely from person to person. Even in the same person, the symptoms may be worse sometimes than others.

The first signs of an attack are wheezing, coughing or being short of breath. The coughing usually doesn’t produce mucus. A person having an asthma attack may feel tightness or pressure in the chest. It may be difficult to breathe.

During a serious attack, a person may have a rapid heartbeat and breathing rate. This happens as the body struggles to make up for the lack of oxygen in the lungs. During severe attacks, a person may not be able to speak. He or she may prefer to sit upright or lean forward. They may feel anxious and appear to be fighting for air.

At this point, carbon dioxide builds up in the blood. This may cause a person to become confused or lethargic. The lungs may start to fill up with mucus. The wheezing may appear to go away. This is a sign of a serious breathing problem that can be life threatening.

An attack of asthma can be set off by a variety of things:

• Crying, screaming or laughing
• Dust or other allergens 
• Exercising 
• Fumes such as chemical fumes or air pollution

Causes

A number of things can cause asthma, including:

• Swelling (inflammation) of the linings of the airways
• Spasms of the muscles that line the airways
• Injury
• An increase in the mucus made by the linings of the airways

In most people with asthma, the airways close up quickly when they are stimulated. It is not known why this happens. It may be due to changes that happen in the lungs. Cells in the airways may peel away. This may cause a person to lose the factors that help relax the squeezing of the muscles of the airways. The lining of the airways may get thicker. Sometimes allergic reactions cause the airways to swell up or produce more mucus. 

Risk Factors

More black people die from asthma than white people.  

Prevention

It is important to avoid anything that may trigger an attack. These include animal danders, dust, airborne molds, pollens and cockroaches. Foods that contain sulfites, such as red wine, beer or shrimp should be avoided if they tend to set off an attack. People with HIV may be more sensitive to these irritants than others.

It may be necessary to cover mattresses and box springs with a zippered covering to control triggers. Removing carpets and keeping the temperature and humidity controlled may also help prevent attacks.

A person with asthma should not smoke. Smoking by itself irritates the air passages. It also reduces the amount of oxygen in the blood and damages the lungs.

Diagnosis

The signs of asthma can be like those of other lung diseases and heart failure. A doctor will ask about the symptoms and do a physical examination. The doctor may also ask about other families members and whether they have allergies or lung conditions. He or she may also do some or all of the following tests:

• A blood test. This can be used to check how much of various gases are in the blood. A blood test will also measure how much acid is in the blood.
• Allergy tests to see how sensitive the person is to cigarette smoke or allergens from the environment.
• Chest X-ray. This will show whether there is air trapped inside the chest. In children with asthma, the middle part of their right lung may be collapsed.
• Exercise testing on a treadmill or a bicycle. People with asthma may have problems breathing after starting to exercise.
• Looking at the sputum. In a person with asthma, the sputum may be sticky, rubbery and whitish. If there is an infection, the sputum may be yellowish.
• Lung function tests. This check to see how blocked the passages is. They also monitor how the lungs react to allergens and irritants. These tests may be repeated over time to see how well a person with asthma is doing. Sometimes they are done before and after a person is given a spray to open up his or her airways.
• Measuring whether an equal amount of air is entering the lungs and leaving the lungs. People who have asthma often take in a different amount of air than they breathe out.
  

Treatment

There is no cure for asthma. Whether a person with asthma has HIV or not, the treatment is the same.

Treatment focuses on preventing the symptoms, keeping the lungs working as well as possible and avoiding asthma attacks that can lead to going to the hospital.

Several types of drugs can be used to treat asthma. Different drugs act on different asthma-related problems. Some relax the muscles; some reduce swelling and some block allergic reactions. Most asthma drugs, including inhalers, don’t have side effects when used with anti-HIV drugs.

During an attack, a person may be able to use a spray (given in an inhaler) that opens up the airways. In serious cases, a person may need to go to the hospital and have drugs that are given through a vein (intravenously). Sometimes, a person may need to be given oxygen to help them breathe and relax.

People who have HIV are prone to getting lung infections. It’s important that these be treated as early as possible to avoid complications with asthma.
 
It is important that person with asthma and his or her family and friends learn as much as possible about the disease. Knowing what triggers an attack, what to do to prevent an attack from getting worse and what drugs to take when are important. The more a person knows about asthma, the better.