Asthma 101: What You Need To Know

From: Jill Daniel   9 days 10 hours 34 minutes ago

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Q: What is Asthma?

A: Asthma is a chronic disease of the airway. It consists of bronchoconstriction (tightening or twitching of the lung muscles), inflammation (that’s where you get the mucous buildup), and obstruction (which is why you may wheeze). Over 30 million people in the US have been diagnosed with asthma, and this number is constantly increasing.

Q: What are the symptoms of this condition?

A: Symptoms include cough, wheezing, shortness of breath, decreased activities of daily living, etc. One of the most important symptoms to look for is coughing, especially at night.

Q: What causes/triggers this condition?

A: There are many triggers for asthma, including a cold or viral respiratory infection, allergies (such as pollen inhalation), cold air or liquid inhalation, and even laughter in some people. Of course you can have an asthma attack without an obvious trigger, which means that your ‘asthma genes’ are active during that particular time.

Q: What are traditional and non-traditional ways of treating asthma?

A: Traditional ways of treating asthma include inhaled medications, like albuterol to reduce the bronchoconstriction (or muscle twitching/tightening), corticosteroids (these are not the anabolic steroids used in bodybuilding, to reduce the inflammation, and then there are combination medications that work on both the lung muscles and the inflammation. There are also oral medications that work on inflammation like Singulair, and then anti-histamines if the person has allergic asthma. If symptoms are severe and the patient has allergies, there is even an anti-body to the ‘allergic’ antibody the immune system makes, and this can be taken once or twice a month. Of course, if the asthma is allergic, then allergy shots can help decrease symptoms or even cure them. Non-traditional ways to treat it include acupuncture or even chiropractic medicine. The only warning I give here is that the inflammation needs to be decreased, otherwise it may be like having a fire in the lungs, and only shutting the doors and windows on it. It is very important to maintain optimal control on symptoms.

Q: Is it possible to proactively prevent asthma?

A: Unfortunately preventing asthma is difficult, since we have genetic variations associated with asthma. And once the triggers are in place (pollution, tobacco smoke, viral colds, pollen or other allergens) there is little to do in preventing it, except for taking your inhaler medications as prescribed by your doctor. Allergy shots will only help with allergic asthma, and there’s more and more evidence that inflammation, whether it comes from pollution, obesity, and other diseases will worsen someone’s asthma overall.

Q: Who is at risk for this condition?

A: Anyone can be a t risk for asthma. Many of the asthma associated genes are being identified. Some of these asthma genes may stay fairly quiet, but certain environmental factors can help the genes express asthma. Examples are smoking, respiratory viruses, pollution and allergens.

Q: How does stress impact asthma?

A: Stress negatively impacts asthma. There are cytokines or molecules that send messages through the blood. If your body is under stress, the cytokines associated with stress help create a worse environment for your lungs.

Q: When is asthma most likely to develop?

A: Asthma usually develops on early in childhood. The confusing part is that a proportion of kids who wheeze early on in life may outgrow that wheeze. That is why we may not call a wheeze or cough asthma if it has happened once, or we may call it mild asthma. The emphasis now has shifted from labeling the asthma severity to see how well controlled it is. In other words the allergist's aim is for you not to have any asthma symptoms.

Q: How do you diagnose this condition, is it ever misdiagnosed?

A: Your doctor will take a good history of your symptoms (i.e. what makes you cough, how often, what time of day or season). He or she will observe your chest, then examine, tap on (percuss), and listen to your lungs. Finally a pulmonary function test (PFT) will help determine the flow of air while force breathing out and back in. A chest x-ray may be taken to make sure there's nothing wrong with the lungs. Asthma can be misdiagnosed as a viral cold and you can be given cough medication, when in fact you're doing nothing for the lung muscle constriction and the inflammation. Gastro-esophageal reflux disease (acid stomach or indigestion) can also cause one to wheeze and even cough. Simple treatment of reflux can stop the coughing and asthma symptoms. There are other conditions as well than can mimic asthma, an interesting one being vocal cord dysfunction. This is spasming of the vocal cords, and occurs more often in high achieving, anxious young women. Simply having them room temperature water in a glass (can even sip through a straw) while watching themselves in the mirror can help with this.

Q: What are the greatest new advances in treating asthma?

A: At UCLA we are actually looking at some of the genes responsible for asthma and figuring out where on the immunological map the defects and mis-signaling are. By getting more targeted therapy we are hoping to reduce side effects we can from broad scope medications like steroids that lead to liver disease, hair growth and blood sugar and blood pressure increases to name a few. Genetic differences actually affect how a patient will respond to one drug versus another. So there will come a day when we will prescribe a medication with certainty that it will work best in that particular individual.

Another important component of asthma that remains to be addressed is mucous production. There are experimental drugs that have shown decreased mucous production. If these work through the phases of clinical trials, they will greatly help manage and treat asthma. But we still have to clean up our environment, and change the course of the slow deterioration of everyone's lungs! So everyone needs to be proactive on the political scene and at home by decreasing emissions. Just because we don't see as much pollution does not mean our lungs are safer. If anything, things are worse than 20 years ago when you would get a burn in your throat from the thick diesel exhaust, and move away from the source. Now, you don't feel the finer particulates that are actually going further in your lungs. By the time you get the cough and asthma flare-up symptoms, it's too late and you have already inhaled quite a bit of this bad air.

Q: What are the latest stats or findings regarding this condition and women? Do the symptoms and treatment of asthma differ between men and women? Are men or women for susceptible to this asthma?

A: In childhood, boys are more likely to be diagnosed with asthma. But in adults, women are being diagnosed with asthma at a higher rate than men, they are having more emergency room and clinic visits, their hospital stays are up to 3 times longer, suggesting higher severity of asthma attacks. Some may argue that women seek health care more than men, but what's really worrisome is that the increase in asthma death rates is twice as high in women. Another interesting finding is that asthma attacks are worse during the perimenstrual period and during pregnancy in some studies. This is most likely due to hormonal effects.