Asthma is a disorder that causes the airways of the lungs to swell and narrow making breathing more difficult. Inflammation and an increased production of mucus inside the bronchial tubes cause patients to have:
- shortness of breath
- chest tightness
Individuals with asthma can experience a combination of these chest symptoms or may only exhibit one of them. Chronic coughing may be the only obvious sign. Patients with only coughing are termed cough variant asthmatics. Asthma is typically a lifelong problem. While it can limit a person’s quality of life with proper management it can be well controlled. Proper measures may include avoidance of allergic triggers such as cat or dog allergens, use of prescribed inhalers and careful monitoring by a doctor. It is well known that asthma rates are on the rise. While asthma symptoms can begin at any age most children have their first symptoms by the time they are age 5.
The diagnosis of asthma is based on a combination of things such as the type and severity of your symptoms, whether or not you have allergies, and your familial history. Doctors also take into consideration smoke exposure, prematurity, and results of pulmonary function tests. There is a wide variation of how much it can affect an individual. Some people experience one or two episodes a year. Others are affected on a daily basis and for some people it can be a potentially life threatening disease requiring multiple ER visits and hospitalizations. Physicians have learned that it is best to identify and treat asthma early on in life in order to improve long term prognosis. Patients need to be taught to recognize early signs and symptoms of an asthma attack so implementation of rescue inhalers and steroid inhalers are begun. Early intervention helps to control and minimize the impact asthma has on one’s lifestyle.
Asthma triggers can be any one or a combination of several things such as:
- allergies to airborne pollen spores
- pet dander
- dust mite and cockroach exposure
- weather changes
- cold damp air or high humidity
- upper respiratory infections such as colds/sinus infections/bronchitis/pneumonia
- strong smells such as perfumes, cleaners and scented candles
- your emotions and stress
- medications like Aspirin and Motrin
- exposure to smoke (primary, secondary, or tertiary)
90% of asthmatics trigger with exercise. These patients are called exercise induced asthmatics, however asthma should not be used as an excuse not to exercise. All aerobic exercise helps to improve lung function. Singing and playing a musical instrument with your mouth will strengthen the lungs as well. The primary treatment for the majority of asthmatics is a two-fold treatment plan consisting of:
- the use of short acting bronchodilators (beta agonists) which help relieve airway constriction
- anti-inflammatory agents which help reduce inflammation in the lung
Bronchodilators such as Maxair, Proair, Proventil, Xopenex and Ventolin all relax the smooth muscles that surround the airways. They help open the lungs for about 4-6 hours. They are often referred to as “quick relief, fast acting or rescue medication” to be used when you are uncomfortable with your breathing. They can be given 10-15 minutes prior to exercise to prevent exercised induced asthma. All rescue inhalers (except Maxair) should be used with a spacer to maximize the amount of medication that reaches your lungs and to minimize side effects of medications like jitteriness or elevated heart rate. One should not rely on their rescue medication alone to treat a moderate to severe flare-up of their asthma or to control their asthma on a daily basis. If you are requiring rescue medication several times a day, a sick doctor’s visit is appropriate because your asthma is not under control. In very young children who are too young to use the correct breathing technique necessary for inhalers, nebulized medication can be used.
Anti-inflammatory agents or steroid inhalers help decrease inflammation. Some require you to use them with a spacer as well. Steroid agents such as Alvesco, Asmanex, Flovent, Pulmicort and Qvar help to decrease inflammation and are often referred to as “maintenance inhalers or controller medication”. Depending on the frequency of your symptoms you may be directed to use a maintenance inhaler daily (for persistent asthma) or episodically for flare-ups (for mild intermittent asthma). All steroid inhalers require good oral care after use so as to prevent thrush/yeast infection in your mouth.
Combination inhalers (ones which have both a long acting bronchodilator and a steroid agent) such as Advair, Dulera and Symbicort are used for patients with moderate to severe persistent asthma who experience frequent flares requiring systemic corticosteroid (Prednisone) bursts. These patients also need daily or frequent use of their rescue inhalers and often experience nocturnal awakening secondary to their asthma symptoms.
Many parents voice concern when being told their child needs a steroid inhaler. An important distinction is understanding that steroid inhalers for the lungs are corticosteroids as opposed to anabolic steroids that are abused by athletes to develop muscle bulk. Inhaled corticosteroids target the lung tissue specifically. There are minimal side effects and dosages are a fraction of what would be necessary if you or your child required oral Prednisone for a significant asthma flare-up. Side effects of frequent oral Prednisone/Medrol dose packs can be bone loss and stunted growth. The benefits of inhaled steroids for better asthma control far exceed their risks, and include:
- Reduced frequency of asthma attacks
- Decreased use of beta-agonist bronchodilators (quick relief or rescue inhalers)
- Improved lung function
- Reduced emergency room visits and hospitalizations for life-threatening asthma
Asthma often runs in families so it is not unusual to see siblings or parents with the same diagnosis. Approximately 80 percent of all asthma in children and half of all asthma in adults is caused by allergies according to the American College of Allergy, Asthma and Immunology. Studies have shown that patients who receive allergen immunotherapy (allergy shots) demonstrate significant improvement in symptom control for asthma. Allergy shots can minimize flare-ups of your asthma and thus your need for medication. This further reduces your out of pocket costs for healthcare. In children with allergic rhinitis, allergy shots help to prevent the onset of asthma.
Often allergists are asked if asthma can be outgrown. Some children improve or their asthma goes dormant and some children do not. For others, symptoms go away only to return a few years later. Many children with asthma never outgrow it. Persistent wheezing during early childhood, having a skin allergy such as atopic dermatitis or having allergic rhinitis are clues that your child may have asthma that’s likely to persist into adolescence and adulthood. Also, children with more severe asthma are less likely to outgrow it. For more information about asthma and treatment, the American Academy of Allergy Asthma and Immunology web-site provides extensive resources.