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Allergy & Asthma Advocate: Summer 2003
Understanding asthma Asthma affects more than 15 million people in the United States—and you may be one of those people. Understanding of the pathophysiology of asthma—or its causes, process and development—has evolved over the last decade. We now know that asthma is primarily a chronic inflammatory disease of the airways. This means that people with asthma have inflamed airways.
Asthma can be defined as reversible airway disease. Outstanding symptoms may be bronchospasm or wheezing, cough, increased mucous production and chronic inflammation leading to airway obstruction. It is a very complex disease with many causes. While some patients only cough and wheeze when they have an upper respiratory infection, others may wheeze when they exercise, hyperventilate or breathe cold air. Patients who have asthma attacks when taking aspirin or other nonsteroidal anti-inflammatory drugs (like ibuprofen) have an abnormal release of leukotrienes, the body’s asthma-producing chemicals. The most common form of asthma is triggered by inhaling an allergen. Thus someone with an allergy to cats may start to wheeze when walking into a home with a cat. The small amount of cat protein in the air will excite the allergy response even before the person knows there is a cat in the home. Likewise, exposure to plant pollens, dust mites, molds, latex, and other protein substances can evoke an asthma attack in susceptible individuals. Immunotherapy has been used to treat allergic rhinitis for almost a century. Charles Blackley first attempted desensitization on himself to treat his “hay fever” in 1873. By 1911 Dr. Leonard Noon had published a system of immunotherapy, or allergy shots. In addition, many allergists have used immunotherapy to treat asthma. However, there have been arguments over the effectiveness of this therapy in recent years. This disagreement has led to extensive studies to prove or disprove the therapy. Immunotherapy treatment can be highly effective when the major cause of asthma is an inhaled allergen that cannot be avoided. Treatment early in the course of the disease can prevent the development of more severe asthma. Your allergist/immunologist can help you by performing a detailed history and exam and by testing you to see if you have the type of asthma that might respond to allergy shots. There are many medications that can help asthma, but asthma relapses occur when people stop taking medication. Immunotherapy is the only therapy that can give permanent, long-lasting relief. 
Consequently, medications for asthma have been categorized into two general classes: long-term control to achieve and maintain control of asthma—fighting the primary inflammation—and quick-relief to treat intense symptoms and exacerbations (“attacks”)—assisting the lungs and bronchi during flare-ups. The purposes of these two types of medications differ. Successful management of asthma and its symptoms requires regular use of long-term control (preventive) medications with anti-inflammatory action, such as corticosteroids or cromolyn. These significantly control symptoms, lessening the frequency and/or intensity of asthma attacks. In contrast, medications such as inhaled beta-agonist bronchodilators (quick-relief) are intended to be used during asthma flare-ups to provide immediate assistance, and are not to be used regularly for asthma control. 
The reasons for not using optimal asthma medications are varied. Studies have shown that factors that can affect whether patients correctly use their medications include family support, a good physician/patient relationship, the patient’s understanding of the disease and treatment, and the medication’s effectiveness. If you are regularly using your quick-relief medication to control your asthma symptoms, it’s a warning sign that your asthma is not well-managed. Make sure to contact your physician if you regularly are experiencing intense asthma symptoms or attacks. A general goal of asthma management is to enable patients with asthma to live full, active and productive lives. Symptoms should be controlled so that they are minimal or absent. Achieving this goal requires that both the patient and physician take a proactive role in controlling the disease and preventing symptoms—rather than a reactive role in relieving observed acute symptoms. When used regularly, preventive (long-term control) asthma medications will help those with asthma control their disease. |
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