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What is asthma?

Asthma is a chronic (long-term) lung disease. It affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in your chest. When these symptoms get worse than usual, it is called an asthma attack or flare-up.

What causes asthma?

The exact cause of asthma is unknown. Genetics and your environment likely play a role in who gets asthma.

An asthma attack can happen when you are exposed to an asthma trigger. An asthma trigger is something that can set off or worsen your asthma symptoms. Different triggers can cause different types of asthma:

  • Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
    • Dust mites
    • Mold
    • Pets
    • Pollen from grass, trees, and weeds
    • Waste from pests such as cockroaches and mice
  • Nonallergic asthma is caused by triggers that are not allergens, such as
    • Breathing in cold air
    • Certain medicines
    • Household chemicals
    • Infections such as colds and the flu
    • Outdoor air pollution
    • Tobacco smoke
  • Occupational asthma is caused by breathing in chemicals or industrial dusts at work
  • Exercise-induced asthma happens during physical exercise, especially when the air is dry

Asthma triggers may be different for each person and can change over time.

Who is at risk for asthma?

Asthma affects people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:

  • Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
  • Being exposed to certain substances at work, such as chemical irritants or industrial dusts
  • Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if it's your mother.
  • Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
  • Having other diseases or conditions such as obesity and allergies
  • Often having viral respiratory infections as a young child
  • Sex. In children, asthma is more common in boys. In teens and adults, it is more common in women.
What are the symptoms of asthma?

The symptoms of asthma include:

  • Chest tightness
  • Coughing, especially at night or early morning
  • Shortness of breath
  • Wheezing, which causes a whistling sound when you breathe out

These symptoms can range from mild to severe. You may have them every day or only once in a while.

When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.

How is asthma diagnosed?

Your health care provider may use many tools to diagnose asthma:

  • Physical exam
  • Medical history
  • Lung function tests, including spirometry, to test how well your lungs work
  • Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
  • Peak expiratory flow (PEF) tests to measure how fast you can blow air out using maximum effort
  • Fractional exhaled nitric oxide (FeNO) tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
  • Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.
What are the treatments for asthma?

If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include:

  • Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
  • Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
  • Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.

If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.

Your provider may adjust your treatment until asthma symptoms are controlled.

Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway's ability to tighten and allows you to breathe more easily. The procedure has some risks, so it's important to discuss them with your provider.

Lung Diseases

When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to work and grow. During a normal day, you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in the U.S. have lung disease. If all types of lung disease are lumped together, it is the number three killer in the United States.

The term lung disease refers to many disorders affecting the lungs, such as asthma, COPD, infections like influenza, pneumonia and tuberculosis, lung cancer, and many other breathing problems. Some lung diseases can lead to respiratory failure.

Dept. of Health and Human Services Office on Women's Health

Alpha-1 Antitrypsin Deficiency

What is alpha-1 antitrypsin deficiency (AAT deficiency)?

Alpha-1 antitrypsin deficiency (AAT deficiency, or AATD) is an inherited condition that raises your risk for lung and liver disease. If you have this condition, your body doesn't make enough alpha-1 antitrypsin (AAT).

AAT is made by your liver. It helps protect your lungs from inflammation and irritating substances you might breathe in, such as smoke. If your liver doesn't make enough AAT, your lungs may be more easily damaged from smoking, pollution, or dust from the environment. This can lead to a serious lung condition called chronic obstructive pulmonary disease (COPD). AAT deficiency may also cause a liver disease called cirrhosis. This is more common in children who have AAT deficiency.

What causes alpha-1 antitrypsin deficiency (AAT deficiency)?

AAT deficiency is a genetic disorder. That means it's caused by changes in your genes, which may also be called gene variants or mutations.

Your genes carry information that controls what you look like and how your body works. AAT deficiency is caused by changes in the SERPINA1 gene, which carries instructions for making the AAT protein. These gene changes are inherited from your parents, so AAT deficiency tends to run in families:

  • If you have two mutated copies of the gene, it means you have a condition called AAT deficiency. People with this disorder have a higher risk of getting lung disease or liver damage before the age of 45.
  • If you have one mutated copy of the gene, you are a carrier of AAT deficiency. In these cases, this means you are at slightly higher risk of developing lung disease, especially if you have other risk factors, such as being a smoker. You could still pass the mutated gene on to your children.

There are a few gene changes that cause AAT deficiency. These gene changes can:

  • Decrease the amount of AAT protein your liver makes.
  • Prevent your liver from making any AAT.
  • Affect the shape of the AAT protein so that it can't move out of your liver to protect your lungs. Over time, AAT builds up in your liver and causes damage.
What are the symptoms of alpha-1 antitrypsin deficiency (AAT deficiency)?

Some people who have AAT deficiency do not have any symptoms. For those who do, symptoms usually appear in people between 20 and 50 years old. These symptoms may include:

  • Wheezing
  • Shortness of breath, especially after exercise
  • Chronic cough with phlegm (mucus)
  • Repeated respiratory infections such as colds and the flu
  • Chest pain
  • Fatigue
  • Faster-than-normal heartbeat when you stand up
  • Vision problems
  • Losing weight without trying

Some people who have AAT deficiency may have liver damage. Signs of liver damage include jaundice (a condition that causes your skin and eyes to turn yellow) and swelling in your legs.

Rarely, AAT deficiency can cause skin problems, such as painful lumps or patches.

How is alpha-1 antitrypsin deficiency (AAT deficiency) diagnosed?

Your health care provider may test you for AAT deficiency if you have:

  • Symptoms of AAT deficiency
  • A condition that could be related to AAT deficiency
  • Relatives who have AAT deficiency
  • Relatives who have a lung or liver disease that could be related to AAT deficiency

AAT deficiency in babies often affects the liver. Your baby may need AAT testing if he or she has signs of liver disease such as jaundice or abnormal liver enzyme tests.

A blood test can check the level of AAT protein in your blood. If the level is lower than normal, it is likely that you have AAT deficiency.

A genetic test is the most certain way to check for AAT deficiency and should be done to confirm the results of the blood test. There are two types of genetic tests:

  • A genotype test looks for the more common types of gene changes that can cause AAT deficiency.
  • A phenotype test checks for changes in the AAT protein that change how it would normally work.

If your lungs are affected, you may also have lung function tests to see how well your lungs are working.

What are the treatments for alpha-1 antitrypsin deficiency (AAT deficiency)?

There is no cure for AAT deficiency, but there are treatments to help with the symptoms and slow the lung damage it causes. Treatment options may include:

  • Inhaled medicines to help you breathe better.
  • Pulmonary rehabilitation.
  • Oxygen therapy.
  • Augmentation therapy, which is a lifelong treatment. It raises the levels of the AAT protein in your lungs, using ATT protein taken from the blood of donors. It helps slow down lung damage. It cannot prevent liver damage.
  • Lung surgery or a lung transplant, if your lungs are severely damaged.
  • Liver transplant, if your liver is severely damaged.

To help prevent or delay lung damage, it is important to quit smoking (if you smoke) and avoid secondhand smoke, dust, and air pollution. Ask your provider If you need to stop drinking alcohol.

Atrial Fibrillation

What is atrial fibrillation (AFib)?

Atrial fibrillation, also known as AFib or AF, is one of the most common types of arrhythmias. Arrhythmias are problems with the rate or rhythm of your heartbeat. They can cause your heart to beat too slowly, too fast, or in an irregular way.

If you have AFib, your heart beats irregularly and sometimes much faster than normal. Also, your heart's upper and lower chambers do not work together as they should. When this happens, the lower chambers do not fill completely or pump enough blood to your lungs and body. This can cause symptoms such as dizziness, fatigue, and a pounding heartbeat.

AFib may happen in brief episodes, or it may be a permanent condition. It's very important to treat it, since AFib can put you at risk for stroke and other heart conditions.

What causes atrial fibrillation (AFib)?

AFib is most often caused by changes to the heart's tissue or the electrical signaling that helps the heartbeat. These changes can happen due to different conditions and factors, such as high blood pressure, coronary artery disease, congenital heart defects, infections, and aging. Sometimes the cause is unknown.

Who is more likely to develop atrial fibrillation (AFib)?

Anyone can develop AFib, but there are certain things that raise your risk for it:

  • Aging. The risk of atrial fibrillation increases as you get older, especially when you are over age 65.
  • Family history and genetics. AFib can run in families. So can heart disease, which raises your risk of AFib.
  • Some lifestyle choices. Your risk is higher if you drink a lot of alcohol, use certain illegal drugs such as cocaine and methamphetamines, or smoke.
  • Having certain health conditions, such as:
    • High blood pressure
    • Diabetes
    • Heart failure
    • Heart valve diseases
    • Obesity
    • Hyperthyroidism
    • Chronic kidney disease
    • COPD and other lung diseases
    • Sleep apnea
  • Race. AFib is more common in people with European ancestry.
  • Recent surgery. You may be at risk of atrial fibrillation in the early days and weeks after surgery on your heart, lungs, or esophagus.
What are the symptoms of atrial fibrillation (AFib)?

Some people who have AFib don't have any symptoms and don't know they have it. If you do have symptoms, you may only notice them once in a while. Or you may have symptoms that are more frequent. And in some cases, the symptoms might be severe. If you have heart disease, you are more likely to notice your symptoms. And those symptoms could get worse if your heart disease gets worse.

The symptoms of AFib can include:

  • Extreme fatigue, which is the most common symptom
  • Heart palpitations (the feeling that your heart is skipping a beat, fluttering, pounding, or beating too hard or too fast)
  • Trouble breathing, especially when lying down or when exercising
  • Chest pain
  • Dizziness or fainting
  • Low blood pressure
What other problems can AFib cause?

If AFib is not treated, it can lead to serious health problems (complications) such as:

  • Stroke
  • Heart failure
  • Blood clots
  • Sudden cardiac arrest (SCA)
  • Cognitive impairment and dementia

To help prevent these problems, it's important to contact your health care provider if you are having symptoms. If you do have AFib, the sooner you are diagnosed and treated, the better.

How is atrial fibrillation (AFib) diagnosed?

To find out if you have AFib, your provider:

  • Will ask about your medical history, including your symptoms, lifestyle, and any other health conditions you may have
  • Will ask about your family history, to find out if you have relatives who have or had AFib
  • Will do a physical exam
  • May order blood tests
  • Will likely order heart tests, such as an electrocardiogram (also called an EKG or ECG) and echocardiogram
  • May ask you to wear a heart monitor device that records your heart's electrical activity
What are the treatments for atrial fibrillation (AFib)?

The treatments for AFib may include:

  • Blood thinner medicines that help prevent blood clots from forming.
  • Medicines to control your heart's rhythm and rate.
  • Following heart-healthy lifestyle changes, such as:
    • Following a heart-healthy eating plan that limits saturated fats, salt, and cholesterol. An example is the DASH eating plan.
    • Limiting or avoiding alcohol, because it can increase your heart rate.
    • Aiming for a healthy weight.
    • Getting regular physical activity.
    • Managing stress.
    • Quitting smoking.
  • Procedures such as:
    • Electrical cardioversion, which restores your heart rhythm using low-energy shocks to your heart.
    • Catheter ablation, which scars the tissue that is causing the arrhythmia. The scar tissue blocks the abnormal heart signals.
  • Surgeries such as:
    • Surgery to put in a pacemaker to help control the arrhythmia.
    • A Maze procedure, which creates scar tissue in a maze-like pattern in certain parts of the heart.
    • Left atrial appendage closure, a surgery on a small sac in the muscle wall of your left atrium (the upper left chamber of your heart). It helps prevent blood clots and can reduce your risk of stroke. This surgery is for people who are not able to take blood thinners.
Can atrial fibrillation (AFib) be prevented?

There are steps you can take to help lower your risk of atrial fibrillation, such as:

  • Making heart-healthy lifestyle changes:
    • Following a heart-healthy eating plan
    • Limiting or avoiding alcohol
    • Aiming for a healthy weight
    • Getting regular physical activity
    • Managing stress
    • Not smoking
  • Avoiding illegal drugs, such as cocaine and methamphetamines
  • Taking antiarrhythmic medicine (medicine to treat arrhythmia) if you are having heart surgery
  • Treating any health conditions that could raise your risk of AFib

NIH: National Heart, Lung, and Blood Institute


Coughing is a reflex that keeps your throat and airways clear. Although it can be annoying, coughing helps your body heal or protect itself. Coughs can be either acute or chronic. Acute coughs begin suddenly and usually last no more than 2 to 3 weeks. Acute coughs are the kind you most often get with a cold, flu, or acute bronchitis. Chronic coughs last longer than 2 to 3 weeks. Causes of chronic cough include:

  • Chronic bronchitis
  • Asthma
  • Allergies
  • COPD (chronic obstructive pulmonary disease)
  • GERD (gastroesophageal reflux disease)
  • Smoking
  • Throat disorders, such as croup in young children
  • Some medicines

Water can help ease your cough - whether you drink it or add it to the air with a steamy shower or vaporizer. If you have a cold or the flu, antihistamines may work better than non-prescription cough medicines. Children under four should not have cough medicine. For children over four, use caution and read labels carefully.

If you are thinking about hospice, palliative care, or home health, please do not hesitate to contact us. We will be happy to answer any questions and even visit your home for a free consultation.



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