Asthma is an extremely common problem in the United States. Along with problems like emphysema and bronchitis, more than fifteen million Americans are affected, that’s one in every fifteen people you know.
Asthma is probably even more common than is currently recognized because many physicians are reluctant to diagnose it. They fear the mere diagnosis will leave a stigma. Therefore, much of the “bronchitis” or “infectious wheezing” labels used by physicians may really represent asthma. It is important to recognize that asthma (or reactive airways disease) exists in a spectrum from very mild to severe. The great majority of asthma is easy to control……relax!!
The most common questions asked about asthma include:
1. What is asthma?
2. What causes asthma?
3. How safe is the treatment?
4. What about the long-term outlook for people with asthma? Do they really outgrow it?
You may have many more questions that are more specific to your own problems: get a pencil right now and write them down as you read this text.
What is Asthma?
In many people (especially children) asthma presents as only an annoying night cough. In others, chest tightness alone is felt after exercise or with laughter, but the majority of asthmatics feel and hear wheezing along with these symptoms.
To understand what is actually going on during an asthma attack, it may help to have some idea of what makes up the lung. The lungs are like a maze of tubes or branches getting smaller with each division (much like an upside down tree). These tubes divide into smaller tubes called bronchi and bronchioles. The very smallest of these tubes end blindly in small grape-like clusters of air sacs where the real work of breathing goes on.
In other problems such as emphysema, the air sacs are involved. In asthma, most of the difficulty is seen as a result of “jittery” muscles which encircle the long tubes, and with “hyperactive” mucus glands which are present in the inside of the lung tubes themselves.
When an asthmatic person is feeling well, his lungs are completely normal on x-ray and most laboratory studies. That is why asthma is considered “reversible” as opposed to problems like emphysema where the person’s lungs are never normal.
With asthma, two important events occur:
1. The “jittery” muscles encircling the lung tubes go into spasm causing the airways to narrow.
2. There is inflammation in the lungs much like a slight burn which can cause the mucus glands to secrete great quantities of mucus. If left untreated, this inflammation can cause permanent damage to the lungs, much like a scar.
Children with asthma may chest tightness and wheezing as a result of this muscle spasm, and may feel congestion as the mucus and inflammation builds up in the lungs.
Remember these two major problems: jittery lung muscles and inflammation, because we’ll discuss them again when we talk about basic treatment.
What Causes Asthma?
The exact cause of asthma is not known, but it is thought to have both genetic and environmental components.
No matter what the actual cause, it is probably much more important from the asthmatic’s viewpoint to know what activates or triggers asthma. As long as those things which trigger a person’s asthma can be recognized and avoided or treated, asthma need be only a minor problem. It is our goal as doctors to control your asthma so your asthma does not control you. Some times that means daily medications will be needed to control the inflammation.
An asthmatic may have many different triggers. Allergies, infections, laughing, and exercise are just a few. It is important to identify these unique triggers when possible.
Allergic substances such as pollen, animal dander, or mold spores may be taken directly into the lung producing an attack or causing lung inflammation. Special testing is often required to determine if you are allergic and if those allergies are contributing to asthma. In many cases, long-lasting protection is possible for unavoidable allergic exposures through allergy immunization otherwise known as allergy shots.
EXERCISE may be a major problem for asthmatics, especially if they are overweight, mouthbreathe, or work out in a cold climate. Soccer and basketball (if played on a higher level) may be difficult unless the athlete is premedicated in an expert manner. A well thought out program of physical fitness is indicated for all asthmatics: most doctors do not like to give excuses for physical education programs.
INFECTION may be the single most important trigger in producing the symptoms of an asthma attack, especially in small children. While almost any infection can be important, the upper respiratory viruses may be the most potent. Many parents note that with each “cold” they get the bonus of a prolonged asthma attack. This is one of the major reasons to always continue controller medications to prevent severe asthma attacks during times of infections, or with other triggers.
What About the Treatment?
Perhaps one of the most pressing concerns for any asthmatic, but particularly the parent of an asthmatic is, “What am I doing to my child (or myself) with all these drugs?” A legitimate concern for everyone dealing with asthma is the risk versus benefit of the medications. Fortunately, asthma medications are very safe.
Steroids: These medications are considered the back bone of asthma controller medications. Most commonly used as an inhaler, they also come in a liquid form for children to use in a nebulizer. These medications work very well in controlling the inflammation in the lungs that lead to the narrowing and inflammation of the airways. The word steroid seems to bring fear into most parents mind. However, these are not the dangerous steroids that are abused by athletes and others. In addition, when inhaled only very small doses are needed as they are directed right into the lung.
When taken in a tablet or liquid by mouth, steroids work very well but have the potential to affect the entire body. With longterm use of ORAL steroids there is significant risk for a lot of severe side effects. That is why “Targeted Topical Therapy” with an inhaler or nebulizer is recommended for daily use. Oral use should be only for short periods of time and should be limited to no more than once or twice a year. If needed more frequently then inhaled steroids should be started or increased to control your asthma.
Beta agents: while commonly thought of as the “asthma inhalers” these medications are used mostly for rescue during times of an asthma attack. These medications have no affect on inflammation but do open the lungs when there is airway narrowing. The side-effects of these medications may include increased heart rate, increased blood pressure, and tremors.
What About the Long-Term Outlook?
The long-term outlook for the great majority of asthmatics is very good. Asthma can usually be controlled once the medications are dosed properly and the asthmatic is more knowledgeable. It is crucial to continue all the controller medications as prescribed to prevent attacks. Asthma is compatible with professional sports, Olympic medals, and almost any profession. Asthma does not have to limit your horizons at all.
That being said, there still remains a huge burden of asthma in the United States. Each year up to 500,000 asthma patients visit the hospital. Over 4,000 asthma patients die each year from asthma attacks, which means about 11 people every day. So don’t underestimate asthma. The risk of hospitalization or even death is real. It is important to talk to your allergist and understand your treatment program, or that of your child. Most importantly stick to it, and don’t stop medicines without talking to your doctor first.
You may click on the following links to learn more about Asthma Relief, Allergic Rhinitis Relief, Sinus Problems, Eczema Relief and Food Allergies or access from the drop down menu under the “Allergy & Asthma Care” button. To schedule your personal appointment, call (949) 364-2900 today. You may also use our online Request an Appointment form to schedule a future appointment.