Asthma is a chronic respiratory disease of the airways affecting more than 18 million adults and children in the US, and genetics are often a major factor. Asthma is variable, and patients are often categorized as either intermittent or persistent, and either mild, moderate or severe.
Symptoms most often seen include cough, wheeze, shortness of breath, and chest tightness.
Causes of asthma episodes
Though there is currently no cure for asthma, a board certified allergist/immunologist can help define a patient’s “triggers” and then formulate a treatment plan that meets the needs of the individual patient. Common “triggers” include allergies, upper respiratory infection, exercise, tobacco smoke exposure, and environmental or work place irritants. Properly managed asthma can allow asthmatics to live a normal and active lifestyle. If left untreated, asthmatics are at risk for reduced lung function, absenteeism from work or school, need for emergency care or hospitalization, and some attacks can result in severe morbidity or even death.
Diagnosis of asthma
Diagnosis of asthma is based on medical history, exam, and testing which may include pulmonary function testing, and imaging such as chest x-rays. Asthma patients have a 70-80% chance of having allergic rhinitis. So, allergy testing for co-existing allergic disease is often a major component of the evaluation of potential asthma patients.
Some medical problems can cause similar symptoms or can masquerade as asthma.
GERD or gastro-esophageal reflux disease, VCD or vocal cord dysfunction, medication side effects (ACE inhibitor induced cough), and other forms of COPD or chronic obstructive pulmonary disease are examples of other disease states that can present like asthma.
Treatment of asthma
Asthma treatment begins with avoidance of allergic “triggers” and environmental control where appropriate. Medical treatment centers around 2 major types of medicines:
- Rescue or reliever medicines provide fast relief of acute symptoms within minutes. They work by reducing muscle spasm or bronchospasm in the airways. Examples include albuterol or lev-albuterol. Rescue medications may be delivered by metered dose inhaler or nebulizer, and can be used every 4-6 hours as needed.
- Maintenance or controller medications are treatments which act to prevent future asthma symptoms. Preventative therapies help to control inflammation in the lungs, and subsequently decrease the chance of having future asthma problems. Inhaled steroids are the most commonly used maintenance medicines. They also can be delivered via inhaler or nebulizer. Common examples include Flovent, Qvar, Asmanex, Aerospan, Alvesco, Pulmicort, and Arnuity.
Asthma remissions
There is no known cure for asthma, and it is a lifelong chronic illness which can improve or worsen without any real warning or obvious pattern. Patients do not usually “outgrow” their asthma, but rather can have remissions or periods of time where they have few or no symptoms. Asthma can be unpredictable, and can require regular follow-up appointments with an asthma specialist to help evaluate an individual patient’s asthma, and make appropriate adjustments in the treatment plan.