What is asthma?
Asthma is a common chronic lung disease characterized by inflammation or swelling of the respiratory tract or bronchial lining in which airways constrict, become inflamed and produce excessive mucus. These episodes can be triggered by exposure to environmental stimulants such as allergens, tobacco smoke, cold or warm air, strong odors, pet dander or exercise. The most common triggers in childhood asthma are viral infections.
What are the symptoms of asthma?
The airway narrowing of asthma causes symptoms of wheezing, shortness of breath, chest tightness and labored breathing. Sometimes, an ongoing or off and on cough is the only symptom of asthma.
Many individuals think of asthma only in terms of episodes or attacks, but asthma is always present with or without symptoms. An asthmatic’s lungs have chronic low grade inflammation and with irritation the airway becomes narrowed. During an attack, the air passages narrow more and glands in the walls secrete excess mucus that traps air in the bronchial tubes, wheezing then becomes apparent. In severe cases, asthma can be deadly.
Who develops asthma?
If someone in your family has asthma, you are more likely to have it, but the underlying cause of asthma is due to various genetic and environmental factors present in individuals with asthma. Asthma can occur at any age. It is more common in children than in adults, and it is more common in boys than in girls. As adults, however, the sex difference disappears. More than 50% of current asthma cases in the US can be attributed or associated with allergic disease. The other cases however, are not associated with allergies and require further research to determine their causes.
How is the diagnosis of asthma made?
In many cases, a physician can diagnose asthma on the basis of a patient’s clinical history and physical examination. If a patient has eczema, allergic rhinitis or other allergic conditions, asthma is usually strongly suspected. The same is true if there is a family history of asthma. Measurement of airway function with pulmonary function tests, also called breathing tests, assists in making the diagnosis in most cases. This evaluation is possible in those five years of age and above and sometimes in those who are younger. The diagnosis of asthma in children however, is frequently based on an analysis of the patient’s medical history, the physical examination, and subsequent improvement with an inhaled bronchodilator medication. Measurement of reversibility of airway narrowing following inhaled bronchodilator medication may also be necessary in adults. Testing lung functions before and after exercise may be helpful to make the diagnosis in those with exercise induced asthma. Once the diagnosis is made, a patient can use a peak flow meter at home to monitor the severity of the disease.
A majority of children with asthma have identifiable allergy triggers. Approximately half of adults with asthma will have allergic problems. Allergy tests should be done to identify avoidable symptom triggers. Chest x-rays, CT scans, and evaluation for gastro esophageal reflux disease may also be necessary to further evaluate some patients with asthma
What can be done to prevent asthma?
Prevention is always the best strategy, and a person with asthma should avoid situations which prompt an attack, such as exposure to allergens or cold air.
If asthma attacks are occurring more than twice a week or are unpredictable or if symptoms occur on a daily basis, treatment with long-term controller medication is recommended. Taken daily these medications help an asthmatic achieve and maintain a symptom free lifestyle.
Since inflammation or swelling plays such a critical role in asthma, daily inhaled corticosteroids have become a mainstay of asthma treatment. Taken early and as directed, these medications can control and normalize lung function in many individuals. Taken as directed inhaled steroids are safe, well tolerated and are very effective in controlling asthma. It is important however, that a patient be monitored when on inhalable steroids for any possible side effects.
Other medications for the long term control of asthma are leukotriene receptor antagonists, long acting bronchodilators(beta agonists), long acting theophylline and oral steroids. Combination therapy of inhaled corticosteroids plus long acting beta 2 agonist may be indicated for asthma when inhaled steroids alone do not control the disease.
Anticholenergics are another inhaled type of medication that help in opening the airways. The medication tiotropium is used as maintenance therapy in asthma in combination with other inhalers.
A short acting bronchodilator (beta 2 agonist) should always be on hand for any patient with asthma. It can be life saving, and deaths have been attributed to lack of availability.
Immunotherapy may also be helpful for those individuals with allergic asthma. Immunotherapy increases a patient’s tolerance to the allergies, which cause the allergic asthma symptoms.
Traditional asthma treatments may not lead to complete control of symptoms if your asthma is severe. Biologics are injections or infusions shown to improve severe asthma. Blood tests are necessary to determine if these treatments are suitable for your particular kind of asthma. There are currently five biologic drugs approved by the Food and Drug Administration: reslizumab, mepolizumab, omalizumab, benralizumab, and dupilumab. These medications can be given at home or a medical facility. Your allergist is the best person to talk to about biologics. They will be able to determine which treatment is right for you and work with you to make sure the treatment is effective.
Outlook
Although asthma can’t be cured, with today’s knowledge and treatment most individuals with asthma can live normal, active and productive lives. For successful, comprehensive and personalized treatment, a board certified allergy, asthma and immunology specialist is the physician to consult. Since Allergists/Immunologists are trained in managing both asthma and allergies, they are able to manage all facets of asthma care.
The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.
An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.
A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.