Asthma

Asthma is a disease of the lungs that can affect all age groups and is a serious and often life threatening disease. There are approximately 30 million asthmatics in the US, with increasing incidence every year. Asthma is a major health problem. Every day in America 28,000 people miss work, 36,000 children do not attend school, 5,000 people go to the ER for asthma attacks, and 1,400 people are hospitalized due to asthma. At least 11 Americans die from asthma every day.

What is asthma?

Asthma is an inflammatory disease of the lungs. This inflammation causes irritation, mucus, and clogging of the airways, which leads to asthma symptoms: coughing, wheezing, chest tightness, chest pain, and shortness of breath. This inflammation of the lungs is similar to what happens to the skin on your knee when you scrape it; specifically, the small airways of the lungs becoming very red and swollen, very sensitive and filled with mucus. Most patients with asthma have this type of inflammation in their lungs all the time. This explains why it takes more than a few days to resolve an asthma attack, possibly even months, as the inflammation from an attack takes time to resolve, like a large scrape on the knee.

Who gets asthma?

Anyone can get asthma. This disease affects all age groups, races, sexes and economic classes. There is a genetic predisposition to develop asthma and with exposure to environmental triggers, like viruses, air pollution, allergens, tobacco smoke, and chemicals, asthma can develop. Patients with allergies frequently have asthma. It is especially common in children as 70% of childhood asthmatics will have nasal allergies. Patients who have had eczema, an allergic skin condition, have a higher risk of developing asthma throughout their lives.

What are asthma symptoms?

While coughing with or without mucus, wheezing, chest pain, chest tightness, and shortness of breath are common symptoms, not everyone’s asthma symptoms present in the same way. A cough that occurs in the middle of the night, with exposure to cold air or strong odors like cigarette smoke might be contributed to asthma. Coughing or chest tightness that occurs after laughing or talking loud may also be a sign of asthma. A lingering cough or chest congestion after the cold has resolved, can result from asthma. For both adults and children, asthma can occur during and after exercise with symptoms that include shortness of breath, cough, chest tightness, wheezing or poor endurance. It estimated that about 50% of allergy sufferers experience exercise induced asthma symptoms.

Are there long term consequences to asthma?

Besides causing acute attacks, there can be long term health consequences to having asthma. Studies have shown that untreated asthma in both adults and children affects their quality of life. Asthma may keep some people from participating in sports and may interfere with day to day life causing absences from work and school and frequent doctor visits. When asthma is left untreated it can also lead to irreversible lung damage in both adults and children. Children with untreated asthma may not grow as tall and may have "stunted lungs."

How is asthma evaluated?

A thorough history and physical are important to develop an understanding of a patient's asthma. Other medical conditions can contribute to the onset and severity of asthma. In adults, some medications can cause or worsen asthma. A good history will help to uncover triggers that cause asthma. Likewise a thorough physical exam is important. Breathing tests such as spirometry and exhaled nitrous oxide can be helpful diagnosing asthma and evaluating asthma treatments. Radiographic studies of the lungs may be helpful. Allergy tests may be useful to identify allergy triggers.

How is asthma treated?

There are three main ways to treat asthma: identify triggers that need to be avoided, asthma medication, and allergy desensitization.

Asthma treatment begins with identifying triggers that set off asthma symptoms. These triggers include allergies, other diseases or conditions that can exacerbate asthma, medications and environmental factors at home, school or work that contribute to the severity of the disease. By eliminating or reducing these triggers, asthma symptoms and severity can be reduced.

Asthma medication can include oral medication, inhalers and injectable medications. These medications function as either relievers, which relieve asthma symptoms for a few hours, or controllers, which prevent asthma inflammation and asthma attacks. Relievers are used as needed, but controller medications are required to be taken on a daily and long term basis. The majority of asthma patients will need to have both of these medications to control their symptoms. Our office will develop an individualized Asthma Action Plan for patients to help them understand how and when to use their medications.

Allergy desensitization can be very helpful to reduce allergy triggers for asthma patients. Allergy testing and a thorough history will help to identify candidates for this procedure, which is utilized along with appropriate medications for control of asthma.

Do corticosteroid inhalers for asthma damage your body?

One of the mainstays of asthma therapy is "steroid" inhalers. These are not the same type of steroids used by body builders, but are drugs that have been shown to be very effective anti-inflammatory drugs. Using corticosteroids as pills, liquids or shots requires a much higher dose of medication than topical corticosteroid inhalers.

There have been studies to suggest that frequent use of oral corticosteroids can have side effects like weight gain, elevated blood pressure, elevated blood sugar, glaucoma, depressed immune system, and osteoporosis. Generally oral corticosteroids, like prednisone, are used to treat acute asthma attacks and to prevent more severe attacks. Using oral corticosteroids is a sign that your asthma is not well controlled.

Topical corticosteroid inhalers deliver medication directly to the airways and the amount the rest of the body receives is very small. In children, the use of corticosteroid inhalers has been associated with a slight reduction in growth velocity, but they eventually achieve their expected adult height even when using the corticosteroid inhalers on a regular basis. Another way to consider the use of corticosteroid inhalers is to realize that a five day course of an oral corticosteroid is much more corticosteroid than over a year's worth of daily "steroid" inhaler.

Can asthmatics exercise?

Yes, in fact, exercise in both adults and children with asthma is encouraged. Exercise is an important part of asthma management along with taking appropriate medications. In children, exercise has been shown to reduce asthmatic severity by helping to prevent obesity and to expand lung capacity. To reiterate, exercise should be encourage when asthma symptoms are under control.