Asthma
Asthma

Roughly 34 million Americans - more than one in ten people -- suffer from asthma.

Asthma is a chronic inflammatory disease of the airways that thickens the walls of both large and small air passages, reducing the size of those passages and making it hard to breathe. Asthma can be intermittent (twice a week or less) or continuous; it can range from a single isolated episode to a constant complaint that is severely debilitating.


Symptoms

Typical asthma reactions including wheezing (that ranges from easily audible to levels that can only be heard through a stethoscope), which is often accompanied by a persistent, dry cough; tightness in the chest; and labored breathing.

Asthma begins with an inflammatory reaction that reduces the size of air passages, along with a reactive broncho-spastic component that contracts the muscles surrounding the passages and further restricts airflow. Once inflamed, bronchial passages are more susceptible to irritants such as cleansers or perfumes, which can compound the sufferer's symptoms. In severe cases, air passages can also become plugged with mucus and these asthma attacks can turn deadly if left untreated. Over 4000 people die from asthma-related causes yearly in this country.

Asthma can be diagnosed by symptoms and/or objective lung function measurement. Bronchial biopsies can also provide evidence of inflamed air passages but are only used in unusual cases.

Causes

Many occupational and environmental factors can trigger asthma attacks, including:

  • allergens,
  • exercise,
  • air quality,
  • industrial chemicals,
  • viruses,
  • and even changes in the weather

In young children the most common trigger is viruses. Fortunately, this form of asthma is usually outgrown.

80% of asthma in older children between four and twelve, and 50% of adult asthma is caused by inhaled allergens. These allergens may include animals, pollens, molds or dust mites. What triggers the other 50% of adults hasn't been definitively determined, although genetics and repeated exposure to irritants seem to be integral to the process.

Allergic reactions are mediated by specialized white blood cells called mast cells which are found mainly in the skin, eyes, nose, bronchial tubes and gut. People susceptible to allergic reactions produce special "IgE" antibodies that connect to high-affinity receptor sites on the surface of mast cells and capture allergens. Which allergens the IgE antibodies capture depend on the sensitivities of the individual and the potential to make IgE to a given allergen is inherited.

Treatment

Since allergic reactions of the hay-fever type frequently progress into asthma, especially in young children, European studies have indicated that treating allergies early can reduce progression into asthma by as much as 50%.

We treat asthma three ways: avoidance, medication and desensitization. Each builds on the previous treatments.

AVOIDANCE:

With allergic asthma, effective treatment often begins simply by identifying and avoiding specific allergens. Removing carpeting to combat a dust mite allergy or making sure the family pet is a non-allergenic breed are examples of trigger avoidance.

MEDICATION:

Asthma medications consist of "relievers" and "controllers."

Relievers, also known as bronchodilators, provide quick relief by opposing the contraction of the muscles surrounding air passages. For intermittent asthma sufferers, the occasional use of a reliever may be all that is required for successful treatment.

For persistent asthmatics, anti-inflammatory drugs, either inhaled or taken orally, are needed to reduce the swelling within bronchial passages. Currently, the most effective anti-inflammatory drugs for asthma are inhaled steroids. Their therapeutic effects are not immediate, however. Some patients neglect their regular use, overusing bronchodialators instead as they look for immediate relief - but consistent use of controllers is critical to successful treatment, even if the asthma is "persistent" for only a month or two each year.

DESENSITIZATION:

The third tier of treatment is desensitization. This is the only truly disease-modifying therapy and is usually reserved for those who suffer year-round allergies or a significantly impaired quality of life. Desensitization is a three-year program of subcutaneous injections of vaccines made from specific allergens which gradually progress in strength and decrease in frequency from weekly to monthly.

By introducing the allergens through a different route and on a different schedule than ordinary exposure, the production of IgE in response to exposure is actually reduced. This method results in long-term disease modification for about 85% of the asthmatics who try it.

The doctors of AIRCare MD can develop a program for you that should help you to control and improve your life with asthma.