What is Asthma?
Asthma is a common lung disorder in which the inner lining of the small breathing tubes of the lungs, the bronchioles, becomes inflamed and swollen. At times this leads to spasms or narrowing of these tubes. This may cause wheezing, shortness of breath, and/or tightness in the chest. Cough, especially with exercise or in the middle of the night, is particularly common in asthma. In mild asthma, the only symptom may be cough. Wheezing may not occur, or may only be heard by your doctor listening with a stethoscope.
Who Develops Asthma?
Asthma may develop at any age, but most commonly does so in early childhood, or mid-adulthood. Most cases that occur in childhood improve greatly over time and with appropriate treatment. Many cases that occur in adulthood respond well to treatment, but remain chronic.
Approximately one person in ten has asthma. Many people with mild asthma may not even be aware they have it. The tendency in asthma is often inherited, and is often strongly related to allergies, particularly in childhood. The majority of children with asthma have allergies that cause or significantly aggravate their asthma.
What Causes Asthma?
As with many medical conditions, a combination of heredity and environment plays the biggest role in both causing and aggravating asthma. The most common triggers of asthma are allergies, respiratory infections, exercise, and cigarette smoke.
The allergens that most commonly trigger asthma are inhalants, such as house dust mites, pollens, molds, and animal danders. When the allergens are inhaled into the lungs, they directly provoke asthma by causing swelling of the lining of the bronchioles and mucus production. Asthma is indirectly worsened by allergies for two reasons: first, nasal congestion interferes with the normal filtering and humidification of inspired air; and second, the postnasal drainage from allergies aggravates the cough and wheeze associated with asthma.
Viral respiratory infections commonly cause asthma to flare temporarily, especially in young children, and account for some of the wintertime worsening seen in this age group. Smoldering sinus problems will worsen asthma as well.
Exercise, or any hyperventilation such that occurs with heavy laughing or emotional upset, will cause the bronchioles to tighten. This is because the asthmatic lung is overly sensitive to the sudden cooling and drying of the airway caused by rapid and deep breathing. For this reason, exercise in cooler weather often causes more trouble.
Cigarette smoking, both active and secondhand, is extremely harmful to patients with asthma. Smoke contains numerous toxic gases and particles that further irritate the already inflamed airway of the asthmatic. Cigarette smoking by asthmatics increases the severity of the asthma immediately, and further increases the likelihood of permanent lung damage.
How is Asthma Diagnosed?
Asthma is usually suspected when the characteristic symptoms occur, especially at nighttime, with exercise, with colds or with allergy flare-ups.
Definitive diagnosis and optimal treatment of each individual case requires not only periodic exams, but also measurements of lung function, starting by five or six years of age. This is done by measuring the amount and rate of air flow from your lungs. We often check to see how this changes after using an asthma inhaler. These results, along with your progress since your last visit, allow us to customize and update your treatment plan.
Since allergies are a common trigger in up to 85% of individuals with asthma, we will usually perform allergy testing as part of the initial evaluation in order to optimize your treatment. Chest x-rays, blood work, and other tests are rarely needed for the diagnosis and management of asthma, unless other medical problems are suspected.
How is Asthma Treated?
There are four general areas of asthma treatment. We will often recommend a combination of more than one, or even all, of these depending on your unique situation.
Avoidance of allergens and irritants: Depending on your history and the results of any allergy testing, we may recommend specific measures to reduce your exposure to the substances to which you are allergic. This will help reduce the amount of medication you need to control your asthma.
Treatment of underlying medical conditions: Chronic sinus problems, stomach acid reflux, obesity, and other conditions may cause or aggravate asthma. It is important that these problems be addressed in order to have ideal control of your asthma.
Medications: There are two basic categories of asthma medications- the first are bronchodilators, which temporarily relieve symptoms by relaxing constricted bronchial tubes. These are typically used only when needed. The second are anti-inflammatory medications, which prevent or heal the inflammation inside the bronchial tubes. These are generally used every day, even when you feel well.
Allergy immunotherapy: Allergy injections are the most effective long-term preventative strategy for allergy treatment. In the many cases of asthma where allergies are a significant trigger, injections help decrease asthma symptoms, reducing the amount of medications needed to control asthma.
Your Allergy Partners physician can help determine the cause of your asthma by combining a thorough medical history and physical examination with appropriate diagnostic testing. An allergist is an expert at managing asthma to ensure long-term health and well-being.