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Asthma is an ancient Greek word meaning "panting or short-drawn breath." It is the most troublesome of the respiratory diseases. The asthma patient gets frequent attacks of breathlessness in between normal breaths.

Patients suffering from asthma appear to be gasping for breath. Actually, they have more trouble exhaling than inhaling because the air passages of the small bronchi become clogged and constricted with mucus, thus making it difficult for the patient to breathe out. All asthmatics have more difficulty at night, especially during sleep.

The onset of asthma is either gradual or abrupt. Sudden onsets are often preceded by a spell of coughing which may be associated with itching of the chin, the back of the neck or chest. When the onset is gradual, the attack is usually brought on by a respiratory infection. A severe attack causes an increase in heartbeat and respiratory rates and the patient feels restless and fatigued.

There may be coughing, tightness in the chest, profuse sweating, vomiting, abdominal pain, especially if coughing is severe. Foggy weather aggravates the symptoms.

An asthmatic attack begins when the bronchial tubes in the lungs become constricted. The tubes having become narrow, the inhaled air becomes trapped in the tiny air sacs at the end of the tubes, making the release of breath difficult. The wheezing sound identified with asthma is produced by the air being pushed through the narrowed bronchi.

By Edwin A Bronsky, MD: Asthma symptoms were once thought to arise solely from spasms of the bronchial tubes (airways). But in the 1980s, experts began to recognize bronchial tube inflammation as the basic underlying problem. Inflammation is part of the immune system's response to injury or harmful foreign substances that enter the body. Inflammation is caused by the arrival of blood cells and other immune system sentries into the area involved. In people with allergies, this defense system reacts against normally benign substances like pollen from weeds and trees.

Is asthma an "allergic" condition? Not always, but certain allergens (any substance that can spur an allergic reaction) are common triggers of asthma symptoms. These include dust mites, cockroaches, molds, and pollens.
With asthma, the allergen triggers an unwanted inflammatory reaction in the airways. Certain immune cells release chemicals called mediators that attack the allergen and, along the way, set off asthma symptoms.

During this defensive act, some damage and changes occur in the tissues of the bronchial tubes, which can cause them to become easily irritated, or "hyper-responsive." In this state, the lungs become excessively "twitchy" and may react (or overreact) to previously non-stimulating irritants, such as cold weather, pollution, dry air, and chemical odors.

This entire process is possibly reversible if caught early and addressed with preventive measures. If left untreated these changes in the lungs and airways can lead to long-term, irreversible damage. Numerous scientific studies have shown that avoidance of specific allergens will result in less severe asthma symptoms and less medicine.

Do Hormonal Cycles Affect Asthma?
Do we know why estrogen and progesterone may improve lung function?
Asthma is characterized by inflammation and narrowing of the airways. This inflammation may occur as a result of a hyperimmunity. So the immune system might be overly revved up. Progesterone has been shown to suppress the immune system and so in that sense it's protective or helpful. It may reduce the increased inflammation that's occurring.

Additionally, both progesterone and estrogen have been found to reduce constriction of the airways and relax the bronchial smooth muscle in the airways. Progesterone is responsible for relaxing uterine smooth muscle—that's its natural function, and it's been found to impart these effects throughout the whole body—so it also works to relax the muscles in the airways.

Who may experience worsening asthma symptoms?
Premenstrual women may notice a worsening of asthma symptoms just before and during the menstrual cycle. This is the time when estrogen and progesterone are at their lowest levels and it's also the time at which they really drop. So certainly women could see if they notice a pattern in asthma related to the menstrual cycle. This could be something they could discuss with their doctor at that time.

Another time to look for changes would be as women move through and into their menopausal period because at this time estrogen, and progesterone also rapidly decline.
What is the percentage of women with asthma who have worsening symptoms during their periods?
The majority of the data suggests about a third of the women, but the range is really about a third to a half of women who are specifically asked if they experience worsening of asthma.

Why is this relationship between lung function and hormones important?
Understanding that in a subset of women, asthma may worsen during times of low hormonal levels, we may be able to better predict who is at risk for more frequent asthma attacks, and when. In some women, there may be treatment suggestions that could be made based on this information. I don't think at this time we could make any recommendations. But if women discuss these patterns with their doctor, they may find benefit from using oral contraceptives to smooth out the fluctuations in hormonal levels. And there may be therapeutic strategies that could be developed in the future, which takes advantage of this relationship.

Asthma and Pregnancy By: Qanta Ahmed, MD
As a doctor who specializes in asthma, it is not often that I see pregnant women in my office, but I do see them from time to time. While I worry about all my patients, pregnant women have special needs that makes caring for them both challenging and gratifying. Remember, we are not just looking after you, but also your awaited baby.

You must go see your doctor when you are pregnant. This is probably the most important thing you can do for your new child. If you have asthma, your doctor visits become even more important.

Asthma's Changing Patterns: Pregnant women with asthma are not necessarily 'high risk' patients. In fact, asthma can follow a curious pattern in pregnant patients. One-third of women experience no change in their asthma during pregnancy, one-third actually notice an improvement when they are pregnant, and one-third may experience a flare-up of their asthma during this time. Since there is no index to predict which way a patient will react, it is necessary to closely follow every pregnant asthma patient.

Most people are well aware of the myriad changes a body goes through during pregnancy - even the lungs go through interesting and intelligent alterations to adapt to the developing baby. In fact, one of the most confounding aspects of taking care of a pregnant patient is that it is normal for her to be short of breath. This makes it difficult to discern a 'normal' breathlessness from a problem that requires medication.

The Pregnant Body
A woman's body adjusts gradually as the pregnancy develops. Since a pregnant patient is carrying more weight, the lungs need to accommodate for the additional work of breathing caused by the weight gain. A pregnant woman breathes a little faster than normal, which is perfectly healthy. The body is raising what is called the minute ventilation (the amount of breathing you do in a minute).

As the belly grows, it alters the shape of the bottom part of the chest. The chest is separated from the belly by a swathe of muscle called the diaphragm, which is a vital muscle that helps you to breathe. As the belly gains in girth, it pushes upwards against the diaphragm, preventing deep breaths and consequently increasing the respiratory rate. To make the chest a little bigger, the ribs splay outwards like bucket handles, letting the patient breath a little deeper.

Now the most important thing you can do for your baby is to avoid cigarette smoke. When you smoke, your baby suffocates - even inhaled second-hand smoke can be very harmful. You need to keep cigarettes away from your developing child. A mother who smokes is more likely to give birth to a child with low birth weight and is more likely to have a child with a respiratory diseases, such as asthma. And if one of the parents, either mother or father, has asthma, the risk of having a child with this condition multiplies.

What if I need a cesarean section?
Many children today are delivered by c-section, for all sorts of reasons. A cesarean section should be thought of as any other operation. For you to do well, you need to be in the best shape possible. This includes controlling your asthma. There is a little rule that is taught to doctors in training - never send a wheezing patient to the operating room.

After the Child is Born
Remember, just because you have asthma does not mean that your baby will too - in fact, it's more likely that they will not. You should be able to use your usual medications now that the baby is born, but always check with your doctor. Not only is it safe for the baby to breast-feed; Breast-feeding is also beneficial to your newborn baby's immune system. As your body recovers from the pregnancy and all the changes that happened in the lungs and chest normalize, your breathing will return to normal.