Asthma tends to be regarded as a condition of the young, particularly children, and indeed, it is very much more common in children, as we have seen. But there are some patients who develop asthma for the first time in their later years, often to their great irritation. The symptoms in the older patient are identical to those found in the younger patient with asthma except that breathlessness, especially on exertion, is quite common.

Asthma is a chronic condition marked by periodic attacks of wheezing and difficulty of breathing, especially in expelling air. It is a lung disease that causes obstruction of the airways. During an asthma attack, spasms in the muscles surrounding the bronchi (small airways in the lungs) constrict, impending the outward passage of air. Sufferers often describe this plight as “starving for air.”

The spasms that characterize the acute attack are not the cause of disorders, but a result of chronic inflammation and hypersensitivity of the airways to certain stimuli. An attack may be triggered if a susceptible individual is exposed to an allergen or irritants.

Most asthma is triggered by an allergy to such substances as pollen; skin particles of cats and dogs; mites in house dust; some foodstuffs such as eggs and milk, chemicals; drugs, environmental pollutants; feathers; food additives; fumes; molds and tobacco smoke, but any kind of allergen can precipitate asthma attack in a susceptible individual.

Other things that can cause asthma attacks includes adrenal disorders, anxiety, changes in temperature, strenuous exercise; extremes of dryness or humidity, fear, laughing, low blood sugar, and stress. Attacks can also be caused by infections (especially of the respiratory tract) and some type of medications. Some attacks start for no apparent reason.

What are the symptoms?

The four main symptoms of asthma include:

Wheeze -- with or without breathlessness, wheeze may occur in response to a trigger or for no obvious reason.

Cough -- A phlegm producing or a dry cough may be signs of asthma.

Breathlessness -- often associated with wheeze and cough, but may also occur alone.

Chest tightness -- Although often a symptom of asthma, chest tightness may be mistaken for a heart problem in older people.

In severe cases, breathing becomes so difficult that it may cause sweating, an increased pulse rate, and severe anxiety. In very severe attacks the face and lips may turn blue because of the diminishing supply of oxygen in the body.

How is asthma diagnosed?

The trouble with these symptoms is that they occur in many other types of lung or heart conditions. A careful history of what the symptoms are, what sets them on, how long they last, how bad they are and whether there are any recognizable patterns of symptoms, is essential for a physician to arrive at a diagnosis.

Although listening to the chest is part of any examination, very often in asthma it doesn’t help the doctor a great deal. The absence of wheezing does not mean that asthma isn’t the diagnosis.

Conversely, all that wheezes is not asthma -- making the diagnosis of asthma is quite difficult.

What are the risks?

Asthma is a fairly common condition in school-age children. Most children outgrow it, and no more than 2 or 3 percent of the adult population has asthma. A succession of severe asthma attacks can be very disabling. Each year, several thousand people die during attack. However, many of these people are older and have other illnesses too. Today, because many treatments have been developed, there is little risk of lasting disability or death for people who take their asthma seriously and consult a physician about it.

What is the treatment?

Self-help: Because asthma is often cause by an external irritant -- a substance to which you have developed a sensitivity -- your first step in controlling the disease is to try to identify the irritant that bothers you. Once you have identified an allergen, the best treatment is to avoid exposure to the substance.

Professional help: Once the diagnosis of asthma has been made, much can be done for the patient. In the past few years, the methods for treating asthma have improved enormously with the introduction of new drugs, which can be taken as pills, liquid, or inhalants. Inhalation has the advantage of bringing the drug directly to the site of the obstruction in the lungs. Some people with asthma have learned to use home nebulizers; these devices mix the drug with a fine mist of water vapor, which is the ideal form for inhalation deep into the lungs.

If no pill, liquid, or inhalant succeeds in relieving the symptoms of a severe case of asthma, a bronchodilator drug may be injected into the blood stream.

Lastly, if your asthma attacks are caused by pollen or some inhaled dust, it may be possible to desensitize your lungs to the responsible allergen with a series of injections.