I believe I started this blog backwards.
When Asthma Mom went live last fall, I had no clear plan but assumed the world didn’t need another comprehensive asthma website. Then my traffic numbers started creeping up and I started getting some emails from regular readers and some of those emails included questions.
Then I started getting more. And my traffic stats revealed the most popular Asthma Mom posts are, apparently, the ones about how asthma works and what treatment can entail — the exact information I figured readers wanted from the larger medical sites.
Huh.
People are the same across racial, economic, geographic, and age lines, aren’t we? All of us like our health information to feel personal and specific, and above all we need to know other people understand us and what we’re experiencing. I’m only one woman writing about one very personal and frustrating experience with a child’s asthma, but I’m discovering it’s that very specificity that appeals.
So I’m going all the way back to the beginning to tackle the most basic question, the one factor we all have in common:
What is asthma?
Over three frightening and often solitary years passed between my daughter’s original diagnosis at age two and the point of stable, consistent control at age five. Plenty of factors delayed good control, including her moderate to severe symptoms themselves, but my lack of clear understanding in the beginning didn’t help. No one ever said to me,
This is asthma.
These things tend to set it off.
This is how you treat it.
These are some things to keep in mind.
AG’s diagnosis went more like this:
Um, your daughter has asthma. Fill this prescription for a nebulizer, and give her an albuterol treatment whenever she’s breathing too fast.
I’m only exaggerating a tiny bit here, and I truly never grasped the complexity and seriousness of my daughter’s condition until I had a clear picture of how her lungs worked and how they were supposed to work. When I finally educated myself, advocacy for her health and good control of her symptoms followed.
This is my asthma explanation. The progression of a flare looks like a list in my head, so that’s how I explain it to friends and family. Maybe it will make sense to you, too, although I’ve included some medical links below if you prefer the more technical breakdown.
This is Normal Breathing
1. You breathe air in.
2. Air heads down your windpipe into the right and left bronchial tubes, or the tubes that connect the windpipe to the lungs.
3. While the air travels through these clear and open airways, mucus traps dirt, bacteria, and other stuff you don’t want in your lungs.
4. Finally, the air passes through tinier bronchioles at the end of the airways, inside the lungs. (see photo) And at the very end of the bronchioles, alveoli are tiny sacs that grab oxygen out and pass it into the blood and exchange carbon dioxide in return (the exhale).
(An actual pair of plasticized lungs. All those tiny branchlike structures are bronchioles.)
This is Breathing with Asthma
1. You have inflamed and swollen airways all the time. No one knows why, although there are some risk factors.
2. Swelling narrows the airways and makes them more sensitive.
3. You breathe in, and various triggers like allergens or airborne irritants make those inflamed bronchial tubes start spasming and producing more mucus than they should. This is an asthma flare.
4. Since swelling already narrowed the airways, the extra mucus and spasms don’t help.
5. You therefore cannot exhale as much air as you need to.
6. The “dead air” stays trapped in the bottom of your lungs, forcing you to breathe shallowly with just the top of your lungs. You cannot take deep breaths without intervention, and that’s where the inhaler comes in.
If you say asthma, most people will free-associate the word wheeze, and that’s the whistling sound air can make as it tries to travel through narrow, spasming airways during a flare. But wheezing, is not the number-one asthma symptom. Coughing is. Many asthmatics–including my daughter–never wheeze at all, but they will cough and cough and cough without stopping as their lungs try to force the air out.
Treatment for most asthmatics means taking preventative medicines to keep the inflammation down so that flares are less frequent and less severe, avoiding triggers for the same reason, and using an emergency inhaler for any flares that do occur.
These are the basics, and asthma treatment involves more variables than the above sentence can cover. It will, in fact, take many more posts over the next several weeks (months?) if you’re interested.
More Information
What is Asthma? (National Jewish)
Childhood Asthma: An Overview (American Lung Association)
Adult Onset of Asthma (Asthma and Allergy Foundation of America)
You so totally rock! What a fab explanation and one that I wished I’d gotten.
The only thing I would add is what my doc told me recently. When the airways are swollen and inflamed, the turbulence of your regular volume of air on intake through smaller tubes irritates the already irritated airways and your asthma worsens exponentially. He says this is where most people end up either on prednisone (me!) or in the hospital because breathing treatment lose their effectivness and systemic steroids, either oral or IV become the go-to treatment with breathing treatments in conjuction.
Here’s something else that rocks. . . . the online health community.
See, we are very familiar with the way a severe enough flare can escalate into oral steroids, but I always thought it was only because massive inflammation means albuterol can’t reach the right places.
It’s been 7 years now and I’ve never had a dr. tell me this. Fascinating. I will edit accordingly.
Thanks.
You go girls!
I have gotten better explanations on this website than I have gotten from any Dr. that is for sure!! I am so thrilled to have found you all and in turn I am now able to educate other moms that I run into on a daily basis. I dont want them to go through what I went through……..I want the learning curve to be shorter for them and pay it forward!! 
Do you know even as a nurse, I completely associated asthma with wheezing (two yrs. ago). And I would bring my dd (9 at the time) in to the peds. again and again, only to be told her chronic cough was allergies……then finally (after 4 months) was given a consult to Respiratory……and even though they gave me some info…….it was almost identical to what Amy said “here’s an inhaler….take this twice a day…..take this one if peak gets worse than this……” off I went…..
This is one AWESOME site and I am so thankful to have found you
. Asthma doesnt have to be so scarey and confusing to the newly diagnosed …….you go girl!!!! 
Hey there,
Speaking of nurses and the coughing symptom…..once, when AG was little and before I knew her massive coughing fits were actually asthma flares, I had an ER nurse tell me, “Well a nebulizer treatment isn’t going to stop her coughing!”
As we NOW know, the neb. treatment will absolutely stop her coughing if it is asthma causing the coughing, as it usually is!
I guess part of the problem is that a GP or a nurse without a resp. specialization won’t know everything about asthma, of course–but I wonder why, if millions—literally, MILLIONS–of U.S. children have asthma and it causes a large portion of school absences, there is so much misconception surrounding it, even in the medical field.
Anyway, thanks!
It’s odd…
My doc is Internal Medicine, but he did a big chunk of training in respiritory medicine back in Wisconson before he headed west. There have been improvements in meds since then, but he has a lot of first hand experience treating asthmatics and a good understanding of lungs and symptoms. Although he has sent me to specialists when he wanted a second opinion. It is however a world of difference in seeing other Internal Medicine folks in his practice. They have not a clue… “I don’t hear you wheezing”. Well, do you hear me coughing? I end up telling them how to prescribe for me. Which is why I followed him when he moved his practice 30 miles. Goodness knows how long it would have taken for a diagnoses if I’d had any other doctor….
And then my worst fear, that I might not be credible with another doctor because I lack that classic wheeze most of the time.
Great informative post. I couldn’t have worded it better myself. I think if doctors did a better job of educating their patients, and parents of kids, there would be fewer asthma attacks on a yearly basis, and fewer trips to the hospital. As I talk to some of my patients, I’m amazed at how little some of them know about it. Of course as an asthmatic myself, that’s one of my favorite things to do as an RT: educate asthmatics.
AG sure would have experienced fewer flares, no question. We didn’t even know coughing was a major symptom until 2 years AFTER her diagnosis–so keep on with the educating. It’s sorely needed.
Thanks so much for this post! I have had the same problems trying to understand what’s going on in my daughter’s lungs, and the docs never take the time to explain it. Leave it to a Mom to make things easy to understand!