What is Asthma?
Asthma occurs when the linings of airways become inflamed and swollen and muscle spasms constrict airflow to the lungs. An "asthma attack" is characterized by labored or restricted breathing, a tight feeling in the chest, coughing and wheezing. The condition can develop quickly and may vary in severity from mild discomfort to life-threatening attacks. Sometimes, a chronic cough is the only symptom. Asthma can occur at any age and is more common in children than adults. Heredity plays a role, but becomes less important when asthma begins in adults. Although the exact cause remains unknown, many treatment options are available to reduce the chronic inflammation and improve symptoms.
What happens in an asthma attack?
People generally think of asthma in terms of episodes or attacks. Actually, the asthmatic condition is always present, but symptoms may be dormant until "triggered" by an allergen, respiratory infection or cold weather. Other triggers may include aspirin, environmental irritants, and physical exertion, especially prolonged running or cycling. Common allergen triggers are dust mites, pollens, molds and animal danders. Food allergy is a very uncommon asthma trigger. Because of asthma's chronic, low-grade inflammation and irritation of the bronchial tube lining, airways can become "twitchy". During an asthma attack, the muscles that surround the bronchial tubes contract, narrowing the air passages. With worsening asthma, inflammation of the lining of the airways increases and produces swelling and further reduction of airway size. In addition, mucus glands in the lining of the air passages secrete excess mucus that accumulates in the already narrowed air passages. Air is trapped behind the narrowed bronchial tubes and there is a decrease in the oxygen available to the body. The end result is that breathing, especially exhaling, becomes extremely noisy and difficult.
What should be done during the attack?
People with asthma should have an action plan for dealing with an acute attack. In general, it is important to stay calm and take prescribed medications. Quick-relief medications, including, rapid-onset inhaled beta2-agonist bronchodilators, such as albuterol, are used to treat asthma attacks and are taken on an as-needed bases. They relieve symptoms rapidly by relaxing the muscles surrounding the airways, helping to open the bronchial tubes. More severe attacks may require systemic corticosteroids to reduce airway mucus and swelling.
What about longer-term treatment?
Prevention is always the best treatment. A person with asthma should know what situations prompt an attack, such as exposure to allergens, respiratory infections and cold weather, and to avoid these situations whenever possible. If asthma attacks are severe, unpredictable or flare up more than twice a week, then treatment with a long-term control medication is recommended. Long-term medications are preventive, taken daily and can achieve and maintain control of the asthma symptoms. Because inflammation of the lungs and airways plays a critical role in asthma, the most effective medications for long-term control have anti-inflammatory effects. Various forms of anti-inflammatory medications are available and should be discussed with a physician. One of the most effective anti-inflammatory medications for controlling asthma is inhaled corticosteroids. Taken regularly, as directed, these medications can improve asthma control, normalize lung function, and possibly prevent irreversible injury to lung airways. Other, less potent anti-inflammatory medications include cromolyn, nedocromil, and montelukast. For more severe asthma, other medications such as long-acting inhaled bronchodilators (beta agonists), long-acting theophylline or montelukast may be added to inhaled corticosteroids. For people with allergic asthma, immunotherapy, or allergy vaccinations may offer relief from symptoms prompted by allergens that act as triggers and cannot be avoided. Immunotherapy increases a patient's tolerance to the allergens that trigger asthma symptoms.
When should a person see an allergist?
If an individual is having difficulty breathing or is coughing and wheezing, an allergist can help determine the cause of the condition and provide treatment that controls or eliminates the symptoms. Individuals should see an allergist if, breathing difficulties are interfering with daily activities, breathing problems are decreasing the quality of life, or shortness of breath, wheezing or coughing especially at night or after exercise. An allergist is a physician who specializes in the diagnosis and treatment of asthma and allergies. We have additional years of fellowship training and have passed Board Certification examinations.
Although no cure exists for asthma, effective treatments are available. We learn more about asthma every year and newer, more effective drugs are developed. As a result, most people with asthma live normal, productive lives. Research is continuing, and the outlook is bright. For personalized information about asthma please contact our office for a consultation.