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What is Asthma?
by Scott Nash, MD
April 2009
Asthma is a disease that affects the small airways of the lung. The main problem is constriction of the airways that causes shortness of breath, cough, and wheezing that is usually triggered by an exposure to an allergen, a virus, or other factors such as pollution or cold air. Also, people with asthma have an increased number of inflammatory cells that surround their airways. These inflammatory cells produce products that can cause constriction of the airways along with swelling of the airway and mucus production.
What are the symptoms of asthma?
The main symptoms of asthma include shortness of breath, persistent cough, and tightness in the chest. The symptoms become more noticeable during times of physical exertion such as walking up a flight of stairs. People with asthma tend to have a prolonged recovery time from upper respiratory infections and are often frequently diagnosed with pneumonia. People with asthma tend to have more problems during the night so if someone is waking up coughing in the middle of the night then it is likely asthma.
How is asthma diagnosed?
The best method for determining if a patient has asthma is to evaluate the response to an inhaled medication called Albuterol. Albuterol reverses the constriction in the airway caused by asthma. If a patient has asthma they will respond to Albuterol. If they do not have asthma then Albuterol will have no measurable effect on the airway. Testing can be done by measuring how much air a person can blow out forcefully. If a person can blow out more air after inhaling Albuterol, then that person is diagnosed with asthma.
What triggers asthma?
Usually people with asthma have multiple triggers for exacerbations of asthma. The most common trigger is an upper respiratory infection. Allergies also can cause problems for people with asthma but not everyone with allergies will have asthma. Common allergens include pets, pollen, and dust. Symptoms usually occur immediately after exposure. Cigarette smoke is an irritant to the airways and causes significant problems for asthmatics. People with asthma should not smoke and avoid second hand exposure to cigarette smoke. Pollution and cold air can also be problematic for people with asthma.
How is asthma treated?
Albuterol: Every person with asthma should have Albuterol. They should use this medication to relieve an acute onset of shortness of breath, persistent cough, and wheezing. Depending on how often a person needs to use Albuterol there are other medications that can help control asthma and will discussed by category.
Avoidance of triggers: Avoidance of known triggers is recommended but sometimes difficult. Something as simple as dust mite control measures can make a big difference in asthma symptoms. If a person with asthma currently smokes they should stop immediately. There are newer smoking cessation techniques and medication so a consultation with a physician can be helpful in quitting smoking.
Leukotriene modifiers: These medications work by inhibiting some of the products produced by the inflammatory cells of the airways. They are indicated for people who need to use Albuterol for a few times sporadically. They are also indicated for relief of allergy symptoms affecting the nose so they can be a good medication to treat both allergies and asthma.
Inhaled steroids: For people who need to use Albuterol more frequently the best medications are inhaled steroids. Inhaled steroids work by reducing and suppressing the inflammatory cells in the airway. It takes a few doses for the medication to work on the airway so there will not be any immediate relief felt after using the medication. They must be used daily in order for them to be effective and should not be used on an as needed basis. There is minimal, if any, absorption of the steroid into the body since most of the dose goes to the surface of the lung. Therefore concerns about side effects of steroids such as weight gain, hypertension, diabetes, and glaucoma do not apply to inhaled steroids. There can be some of the steroid that lands in the mouth while inhaling it and therefore patients should rinse their mouth after using inhaled steroids.
Combination therapy: Combination therapy means the use of an inhaled steroid and a long acting form of Albuterol in the same device. There are two brands on the market: Advair and Symbicort. These medication are best for people who have tried an inhaled steroid but are still having symptoms or someone who is using Albuterol a great deal and has been prescribed oral steroids or hospitalized for their asthma. They must also be used every day in order to have an effect. Both Advair and Symbicort could be dangerous in a certain portion of patients and that risk should be discussed with your physician.
Allergy shots: Allergy shots, also called allergen immunotherapy, can be used to reduce symptoms of asthma that are caused by exposure to allergens. For example, if tree pollen season cause an increase in asthma symptoms then allergy shots with tree pollen can reduce those symptoms. Allergy shots are safe and sometimes are a desirable alternative for people not wanting to take a lot of medication.
Omalizumab (Xolair): Omalizumab is also a treatment of asthma for people who have allergies. It is mainly for people who have severe asthma that is not controlled with inhaled steroids or the combination therapy described above. It is a medication that is injected either every two weeks or every four weeks.
Oral steroids: Oral steroids can control asthma symptoms but should be used sparingly. There are some cases of asthma that cannot be treated with any of the above medications and therefore oral steroids are needed. Oral steroids can also be used in short courses to get an acute exacerbation under control and this minimizes the long-term side effects. If a person’s asthma is managed well using the above medications then hopefully the need for oral steroids can be avoided.
Scott Nash, MD is owner of Nash Allergy & Asthma, 919.806.8500, nashallergy.com
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