Q:

1/10/2014
Is reactive airway disease same as Asthma?

A:

Thank you for your inquiry.

Unfortunately, I cannot give you a precise definition of reactive airways because such does not exist. Before attempting to define the term, however, since you mentioned it in the same context as asthma, it should be stated that the two terms are not synonymous.

Asthma can be considered a reactive airways disease, but the term "reactive airways disease" refers to many other conditions which have only been loosely defined.

Perhaps one way to approach the meaning of "reactive airways disease" is to refer to an article by two leading pulmonologists, Dr. John Fahy and Dr. Paul O'Byrne (1). The lead sentence in the title is "Reactive Airways Disease, a lazy term of uncertain meaning that should be abandoned." The first paragraph of this paper states:

"The terms “reactive airways” and “reactive airways disease” have crept into the clinical lexicon in recent years. They are being used as synonyms for asthma. The terms are widely used in case presentations involving outpatients and inpatients, and even patients in intensive care units. They are in particular commonly used in the pediatric setting. The problem is that “reactive airways” and “reactive airways disease” are highly nonspecific terms that have no clinical meaning. As such, we view these terms as unhelpful and potentially harmful, and we recommend that they not be used."

Having said this and introduced you to some of the strong sentiments against the use of this imprecise term, I will at least try and share with you some of the context in which this terminology is still employed.

Perhaps the most common use of the term "reactive airways" is employed in pediatrics. Its use is generated by the fact that wheezing is quite common in infants, and only about a third of those infants who wheeze ever develops true asthma. Thus, rather than refer to wheezing infants, who may never really be asthmatics, as having asthma (and thus labeling them with the disease), many physicians have employed the term "reactive airways" to refer to this group of children.

There is also a condition, usually related to occupational exposure to toxic inhalants, termed "reactive airways dysfunction syndrome" (2). In this syndrome, an individual develops lung damage which is manifested by coughing and shortness of breath, oftentimes with wheezing, after acute, high-dose exposures to toxic chemicals contained in vapors, fumes, or smoke. This condition mimics asthma but may often resolve, and is not synonymous with asthma per se (2).

In summary:
1. No, reactive airways disease is not the same as asthma.

2. Asthma is a form of reactive airways disease in that it exhibits hyperreactivity to substances like those mentioned above, but reactive airways disease as a phrase refers to other, less well-defined conditions.

Thank you again for your inquiry and we hope this response is helpful to you.

References:
1. M. O'BYRNE "“Reactive Airways Disease”", V. FAHY and PAUL JOHN American Journal of Respiratory and Critical Care Medicine, Vol. 163, No. 4 (2001), pp. 822-823.

2. S.M. Brooks, M.A. Weiss, I.L. Bernstein. "Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high level irritant exposures". Chest, Volume 88, 1985, 376-384.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology