Erie County Medical Society

September 8th, 2017

Asthma and You

Asthma and You

Asthma is a common chronic disease that affects 26 million people in the United States. Adult-onset asthma, in people over 40, is more frequent among women.

On the other hand, asthmatic children, of whom there are seven million in the US, are almost twice as likely to be boys. Moreover, asthma is a common cause of hospitalization of children in the US. Fortunately, about half of children diagnosed with asthma will have a decrease or disappearance of symptoms by early adulthood.

What Is Asthma

Asthma is a disease in which the airways become inflamed, episodically obstructed, and hyper-responsive to stimuli. These processes are at least partially reversible. However, after long duration there may be some permanent changes in the airways.

Asthma Symptoms

Asthma symptoms include wheezing, coughing, shortness of breath, and chest tightness. These symptoms may occur acutely (suddenly and briefly), sub-acutely (less suddenly and of longer duration), or chronically (slowly and of prolonged duration).

Asthma Triggers

Asthma symptom flare-ups may occur in conjunction with exposure to environmental allergens, environmental irritants, viruses, cold air, exercise, gastroesophageal reflux disease (GERD), smoke, paint fumes, nitrous oxide, ozone, or emotional factors. Other triggering factors may be aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and sulfites.

Environmental allergens closely associated with asthma flare-ups include household dust mites, dog and cat allergens, fungi, and cockroach allergens.

Aspirin sensitivity accompanies asthma in 5-10% of patients in their 20s and 30s. Exposure to a single aspirin or NSAID tablet can provoke an asthma attack in these individuals.

Asthma patients are three times more likely than others to have GERD. Gastric acid in the distal esophagus provokes airway reactivity. One fourth of these patients do not realize that they have gastric reflux. Two thirds of these patients have a favorable response of their asthma when treated for GERD.

Asthma symptoms are somewhat more likely to occur between 4:00 and 6:00 AM due to the normal cyclical variations in body cortisol.

Exercise Induced Asthma

Exercise induced asthma is an asthmatic response to exercise, especially to that occurring in cold dry air. As many as half of those so affected, have asthmatic responses under no conditions other than exercise. This type response occurs more often in children and young adults than in older people.

Asthma and Wheezing

Wheezing does not always mean asthma. Other diseases causing wheezing are COPD, heart failure, cystic fibrosis, foreign bodies in the airway, sarcoid, upper respiratory tract infection, and vocal cord dysfunction.

Conversely, asthma does not always exhibit wheezing. Mildly afflicted asthmatics may not wheeze. On the other hand, since wheezing is caused by turbulence of air in the airway, severely afflicted asthmatics may not be able to move sufficient air to wheeze.

Avoid Environmental Exposures

• The most effective way to deal with an asthma attack is not to have one. Helpful steps for asthmatics to follow are the following:           

•           Avoid both first-hand and second-hand exposures to tobacco smoke.     
•           Clean and dust regularly.

          Wear a facemask while vacuuming.

          Use impervious covers on mattresses and pillows.

          Limit upholstered furniture and window blinds.

          Put clothing away in closets and drawers.

          Wash soft toys often or periodically put them in the freezer.

          Do not allow animals in the bedroom

          Place filtering material over heating and cooling duct vents.

          Wash cats and dogs often.

          Never leave food uncovered.

          Store firewood outdoors.

          Stay inside midday when pollen counts are highest.

          Wear a facemask while gardening.

          Control GERD and sinusitis.

          If possible, exercise indoors in a warm, humid environment rather than outdoors in a cold, dry environment.

          When exercising outdoors, wear a facemask to warm and humidify the inhaled air.

          Avoid foods high in sulfites if sulfite sensitivity exists.

          Avoid aspirin or NSAIDs if sensitive to these.

          If obese, lose 5-10% of body weight to improve asthma control.

Medical Treatment

Numerous medical treatments for asthma are available. The medications include short-acting treatments to treat exacerbations and long-acting treatments to reduce the frequency of exacerbations. They include medications of various strengths commensurate with the degree of severity of the asthma. The medications also include drugs of several different families to act together in their primary effect to treat the asthma but with different secondary effects to reduce the side effect impact of the medications.

Your doctor has many choices to help you deal with asthma. Close coordination with your doctor will enable you to exercise the optimum control over your asthma.

References

Harding, S., Guzzo, M., & Richter, J. (2000). The Prevalence of Gastroesophageal Reflux in Asthma Patients without Reflux Symptoms. American Journal of Respiratory and Critical Care Medicine,162(1), 34-39. doi:10.1164/ajrccm.162.1.9907072

Morris, M. J., MD. (2017, August 17). Asthma - Medscape. Retrieved September 08, 2017, from http://emedicine.medscape.com/article/296301-overview

Thomas Falasca, DO