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Topic of the Month: January 2007: Asthma Facts
In this Topic of the Month, you will learn the answers to:
- What is asthma?
- How do I know if I have asthma, what are the symptoms?
- What are asthma triggers?
- Are there different types of asthma?
- How can I manage my asthma?
- What kind of physician should I see to treat my asthma?
- What do asthma treatments include?
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What is asthma?
Asthma is a chronic lung disease that affects more than 17 million Americans. Asthma is characterized by inflammation of the airways with intermittent bronchospasm. Bronchospasm (narrowing of the bronchial tubes) is caused by the inflammation of the muscles surrounding the air passageways. The inflammation makes the airways smaller and therefore making it more difficult for air to move in and out of the lung. In some cases, your breathing may be so labored that an asthma attack becomes life-threatening.
How do I know if I have asthma, what are the symptoms?
Inflammation from asthma makes the airways smaller and therefore makes it more difficult for air to move in and out of the lung. This creates the following symptoms:
- Cough
- Chest tightness
- Shortness of breath
- Wheezing
Asthma symptoms are often worse in the morning and late at night. In between asthmatic episodes symptoms have been known to disappear or improve but that does not mean the asthma has gone away. Asthma can be present in a silent manner.
What are asthma triggers?
Symptoms can be brought on by a variety of triggers such as:
Every person has their own triggers. If you have asthma you can minimize your symptoms by avoiding the factors that trigger your symptoms, and by working with your physician to develop an effective management and treatment plan.
Are there different types of asthma?
While asthma itself is one disease there are different classifications of asthma that help to pinpoint what is causing your asthma attacks:
- Allergic asthma – Caused by airway inflammation when exposed to allergens
- Exercised-induced asthma – Airways narrow when triggered by vigorous activity
- Cough-variant asthma – A chronic, persistent cough without shortness of breath
- Occupational asthma – Related to working in a particular occupational environment. Symptoms are more severe while at work during the exposure.
 How can I manage my asthma?
Asthma is a chronic disease and it requires continuous management and appropriate treatment. According to the National Guidelines for the Diagnosis and Management of Asthma (National Asthma Education and Prevention Program, National Institutes of Health, 1997), asthma treatment has four main components:
- The use of objective measure of lung function (such as peak flow meters and spirometers) to assess the severity of asthma and to monitor the course of treatment
- Environmental control measures to avoid or eliminate factors that trigger asthma symptoms or flare-ups
- Medication therapy for long-term management to reverse and prevent airway inflammation as well as therapy to manage asthma flare-ups
- Patient education to foster a partnership between the patients, his or her family, and the physician and other health care providers
According to the Guidelines, there are six general goals for the effective management of asthma:
- Prevent chronic and troublesome symptoms
- Maintain (near) "normal" breathing
- Maintain normal activity levels, including exercise
- Prevent recurrent asthma flare-ups, and minimize the need for emergency room visits or hospitalizations
- Provide optimal medication therapy with no or minimal adverse effects
- Meet patients' and families' expectations of satisfactory asthma care
Each person with asthma has her/his specific goals. Share these so your physician can focus on helping you attain them. Chances are once your specific goals are met, the general goals listed above will also be met.
You and your physician can work together on these goals to ensure that your asthma is well-managed. Having asthma should not stop you from participating in normal activities.
What kind of physician should I see to treat my asthma?
Allergists/immunologists are the best-qualified medical professionals trained to manage the prevention, diagnosis and treatment of allergies and asthma. If you have asthma related symptoms click here to find an allergist in your area.
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
- Need to confirm the diagnosis of asthma
- Have asthma and see their symptoms get worse after a new pet has been introduced into the home
- Have a history of seasonal or persistent asthma, to evaluate their sensitivity to inhaled allergens and provide instructions regarding avoidance measures
- Need education on asthma and guidance in techniques for self-management
- Need for daily asthma reliever medications
- Are not using medications as prescribed, and this is limiting their ability to control their asthma
What is a board certified Allergist/Immunologist?
What do asthma treatments include?
Asthma management includes using proper medications to prevent and control asthma symptoms and to reduce airway inflammation. Asthma medications are thus categorized into two general classes, quick-relief and long-term control medications. Quick-relief medications that are used to provide temporary relief of symptoms include:
- Bronchodilators, generally used as "rescue medications," open up the bronchial tubes so that more air can flow through. Bronchodilators include beta-agonists and anticholinergics, and come in inhaled, tablet, liquid or injectable forms.
- Corticosteroids are administered for short-term use orally or by injection to speed up the resolution of airway inflammation.
Long-term control medications are taken daily to control the airway inflammation in persistent asthma. This class includes:
- Inhaled corticosteroids are the most effective long-term therapy available for persistent asthma. They are generally well tolerated and safe at recommended dosages.
- Cromolyn or Nedocromil stop the development of inflammation in the lungs, as well as help to prevent it. Response to these two are less predictable than the response to inhaled corticosteroids. These medications are very safe.
- Leukotriene modifiers fight potent chemicals called leukotrienes (lu-ko-try-eens), which contribute to the airway inflammation. They are generally safe, but lack the ability to control inflammation to the same degree as inhaled corticosteroids.
- Inhaled long-acting beta 2-agonists exert effects for 8-12 hours and are long-acting and beneficial when added to inhaled corticosteroids.
- Methylxanthines provide mild to moderate dilation of the airways and may have a mild anti-inflammatory effect. Theophylline is the most frequently used methylxanthine.
- Omalizumab was approved in 2003 as a new class of therapy, known as anti-IgE, for patients with moderate to severe persistent allergic asthma. IgE is an antibody that we all have and it is responsible for causing allergic problems in some people. It may reduce allergic reactions by causing free IgE to disappear from the body so that the IgE cannot attach to allergens such as dust mites, mold, animal dander and pollen.
Combination therapy, with the addition of a long-acting beta2-agonist to low-to-medium doses of inhaled corticosteroids, results in improvement in asthma control. Adding a leukotriene modifier or theophylline to inhaled corticosteroids may also improve asthma control but the evidence is not as substantial.
Make sure you follow your physician's instruction on the appropriate use and dosage of your prescribed medications.
The better informed you are about your asthma triggers and management, the less asthma symptoms will interfere with your activities. It is important to avoid your triggers, work with your physician on a management plan and take appropriate medications as prescribed. Together, you and your allergist/immunologist can work to ensure that asthma does not interfere with your optimal quality of life.
Additional Resources:
This topic was reviewed on 1/1/2007 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor
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