Asthma is a chronic inflammatory lung disease that affects 17 million Americans, 5 million of which are school age children. Asthma may be mild or severe, but always characterized by coughing, breathlessness, wheezing, or exercise intolerance. Ninety percent of children and 50% of adults have associated allergies (immune sensitivity) to environmental or food proteins which can trigger or worsen asthma. This definition is extremely important to understand because vigilant medical treatment and avoidance of triggers are essential to the long term control of asthma and clinical remission. Other factors that can trigger asthma are:
- Allergens (dust mites, cat dander, pollen, peanuts)
- Irritants (substances that do not trigger allergies, but hone the less induce asthma ie smoke, perfume, pollution)
- Viral infections (colds, flu)
- Cold air
- Exercise (strenuous aerobic activity)
- Gastroesophageal reflux disease (heartburn)
- Medications (Aspirin, Motrin)
- Emotional Anxiety (stress for an exam, audition, 9/11)
For most patients, asthma becomes most severe in the colder months when the lungs are exposed to extreme changes in temperature, cold and flu viruses, and forced dry air heating in homes and office buildings. We often call the months between October and April the "Asthma Season". Of course seasonal spring time allergies can trigger asthma. The treatment of asthma is tailored to meet the specific needs of each patient. No two patients are the same, but the goals set out by The National Asthma Education and Prevention Program, National Institutes of Health 1997 are the same:
- Prevent chronic and troublesome symptoms
- Maintain normal pulmonary function
- Maintain normal activity levels; including exercise
- Prevent attacks, hospitalizations and emergency room visits, after diagnosis
- Meet patients and families expectations of and satisfaction with asthma care.
To reach these goals patients and families need to work closely with experts in this disease such as an Allergist Immunologist. Every patient experiencing the symptoms of asthma should have the following done:
- Careful history to determine severity and triggers of asthma
- Skin testing to identify known and unknown allergic triggers
- Spirometry - airflow assessment to judge severity of asthma and response to treatment
- Additional studies to consider alternate diagnosis ie: vocal cord paralysis, emphysema, cystic fibrosis.
In the beginning of this article, we described asthma as a chronic inflammatory disease. This requires daily use of anti-inflammatory medications often used in inhalation form. Unfortunately, the idea of regular medication raises the eyebrow of many patients for fear of "addiction" or "reliance" on medication to breathe. The fear becomes even more powerful if the medication is a topical corticosteroid (steroid.) This fear is unjustified. Studies have shown that aggressive use of topical (inhaled) steroids when patients are young often time leads to remission and eventual discontinuation of therapy. Remember, inhaled steroids should not be confused with performance enhancing androgenic steroids often abused by athletes to run faster or increase power. Inhaled steroids have been shown to be the most effective medication to control asthma and protect lung function. Prescribed doses show no long-term affect on growth, bones, and eyes. It is unfortunate to see middle age patients who spent years being treated with quick relief inhalers (Beta Sprays) only to end with poor lung function. This is often irreversible. Quick relief medications (Albuterol, Proventil, Maxair) should be used only prior to exercise and for acute symptoms only. Using quick relief medication more than 2 times a week outside of exercise is too much. Overuse of this medication is a tip to call your doctor.
Remember, the key to good asthma control and quality of life is working closely with your doctor and understanding that asthma can easily be treated. Never stop your medication without speaking to your physician, even if you feel great. Continue to remain informed and not fearful.