Asthma affects 3-8% of the population, including nearly 5 million children. Physicians use words such as bronchial asthma, asthmatic bronchitis, and reactive airways disease to describe their patient's condition. The airways narrow and swell with mucus causing wheeze, cough, shortness of breath, and chest tightness. Symptoms occur as infrequently as a few times a year with a cold or as often as every day. Unlike other lung diseases such as emphysema, the airway obstruction in asthma is reversible with the use of medication, allowing most patients to have totally normal lung function when their asthma is properly treated.

Who gets asthma?

Asthma can develop at any time in one's life. In children and young adults, asthma is an allergic disease in greater than 90% of cases, often accompanied by other allergies such as hay fever, eczema, and food allergies. There is a strong hereditary component with offspring with one allergic parent having a 30-50% chance of having allergies and those with both parents being allergic having 60-80% likelihood of developing allergies. In people who develop asthma after age 40, allergies are not as often responsible for their disease (about half of these patients have allergies).

How do allergies cause asthma?

Inhaling airborne allergens (pollens, molds, animal dander, and dust contaminants) sets off a cascade of cellular events that produce narrowing (lung muscle spasm) and swelling (inflammation) of the bronchial tubes. An asthmatic with a positive skin test to ragweed, for example, will begin wheezing within 10 minutes of breathing ragweed pollen in the research laboratory. Nearly all allergic asthmatics will have nasal symptoms along with their asthma as the pollen heading for the lungs deposits on the nasal lining. Once the nose is swollen and congested it can no longer function as a filter, air conditioner, and humidifier for the lungs, making asthma worse. Other things that can trigger asthma symptoms besides allergens include viral infections, exercise, cold air, pollution, smoke, and laughing.

How is asthma diagnosed?

There is no single laboratory test for asthma like there is for other diseases. The physician must take into consideration the symptoms described by the patient, things that trigger symptoms, time of year they occur, previous response to therapy, environmental history, family history, and lung function testing. In the rare difficult to diagnose patient, a methacholine inhalation study may be helpful in detecting asthma.

What makes asthma worse?

This is the question that should be asked when asthma worsens. It is preferable to eliminate the cause of worsening asthma rather than add more medicines to control the breathing. Some of the common causes of increasing asthma include increased allergen exposure (e.g. new cat, cleaning dusty closet, pollen season), chronic sinus infection, viral infection, gastroesophageal reflux (regurgitation of stomach acid up the food pipe), and improper use of inhaled medicines.

Is there any warning of an asthma attack?

Asthma attacks can come on suddenly, but more often than not there are warning signs of worsening asthma. By properly recognizing these warnings you can adjust your medications according to an "action plan" provided by your doctor to ward off a serious attack. The common warning signs to be on the lookout for include:

1. increasing need of bronchodilator inhaler (Proventil, Ventolin, Maxair, Brethair),
2. inhaler effective for less than usual 6 hours,
3. waking up at night with cough, wheezing or chest tightness,
4. flu or upper respiratory infection,
5. fall in normal peak flow measurements.

If you are not sure as to the proper steps to take in response to these warnings, please call your doctor before it becomes too late.

What's new with asthma treatment?

One should always remember that asthma is a reversible process that should resolve with proper treatment. Avoidance of allergens discovered by careful skin testing is the first-line of therapy in all allergic diseases. Often avoidance is not enough and medicines are needed. Advances in pharmaceutical technology has provided us with most asthma drugs coming in a spray form, eliminating whole body exposure and subsequent side effects.

Medical treatment is directed towards the two mechanisms of asthma, narrowing and swelling:

1. bronchodilator medicines that relax lung muscle spasm- Ventolin, Proventil, Maxair, Brethair, Serevent, Volmax and theophyllines (Theodur, Uniphyl, Slo-bid, Theo-24), and
2. anti-inflammatory agents that clear excessive mucus in the bronchial tubes- inhaled steroids (Flovent, Pulmicort, Vanceril, Beclovent, Aerobid, and Azmacort), leukotriene modifying drugs (Accolate, Singulair and Zyflo),Intal and Tilade.

In addition, studies have shown allergy shots can be an effective therapy by "turning off" your sensitivity to allergens. Allergy shots control both the nasal and chest symptoms that are induced by airborne allergens. We have been conducting studies in our office with a future form of allergy shots which utilizes a humanized antibody that binds to your allergy antibodies. This should be available in a few years. For more severe asthma, oral steroids (prednisone, Medrol, Pediapred or Prelone) are sometimes needed. To prevent the adverse effects of oral steroids (weight gain, hair growth, cataracts and bone loss) courses of oral steroids should be given for less than one month in duration or, if needed for longer periods, below 10 mg a day. Fortunately, the inhaled form of steroids at standard prescribed doses do not lead to similar side effects.

The use of peak expiratory flow meters at home to measure changes in daily airflow puts the patient in charge of his asthma management. These meters can be thought of like a thermometer for tracking an infection, they measure the ups and downs of your asthma. As asthma worsens, a decline in peak flow will often precede symptoms and allow you to adjust your medication to prevent a major asthma flare. These simple and inexpensive home devices provide an objective measure for both you and the physician to monitor the roller coaster ride of asthma.