Let’s Talk Asthma

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By Eunice Hoolihan, MD

5/18/2021

Background

Asthma is a chronic lung disease that affects 26 million Americans. Of those, 20 million are adults and 6 million are children. An estimated 1 in 12 people have asthma. This condition accounts for millions of school days missed a year and workday absences.

Asthma is defined as a chronic disease involving the airways of the lungs, called Bronchus and Bronchioles. In patients with asthma, these bronchial tubes become inflamed, and the muscle around them can tighten causing symptoms such as coughing, wheezing and shortness of breath.

Prevention

The cause of asthma is unknown. It is more common in families with a history of eczema, atopic dermatitis and asthma. Symptoms may be triggered by environmental factors such as smoking, second-hand smoke, allergens, pollutants and viruses.

 

When symptoms are triggered by exercise, it is called exercise-induced asthma, and there are medications that can be given to prevent these so you can continue working out.

 

If asthma is triggered by allergens, it is called allergic asthma. In this case, allergen avoidance and medications may prevent symptoms.

 

Asthma symptoms may also be triggered by inhaling fumes, gases and dust at work. This is called occupational asthma. Removing the person from their place of work may resolve symptoms.

 

Asthma symptoms may be triggered by viruses and respiratory infections. A patient with asthma should get a flu vaccine annually and pneumonia vaccine as indicated.

 

Finally, asthmatic patients should avoid smoking, second-hand smoke and exposure to cold air (by covering nose and mouth with a scarf).

 

Symptoms

Asthma symptoms include dry cough, wheezing, shortness of breath, chest tightness and chest pressure.

 

There are several conditions that may mimic asthma, such as foreign body aspiration, gastroesophageal reflux disease (GERD) and obesity. In children, cystic fibrosis, bronchiectasis and vocal cord dysfunction may cause wheezing. In adults, chronic obstructive pulmonary disease (COPD) and congestive heart failure may also cause similar symptoms.

 

The most accurate diagnosis test for asthma is spirometry, but your doctor may order some labs and chest X-ray to rule out other conditions.

 

Also, allergic and fractional exhaled nitric oxide (FENO) tests are useful in diagnosing and treating allergic asthma.

 

Treatment

When treating asthma, your medical provider will discuss with you:

  • Avoidance of triggers such as smoking, cold air, allergens, dust and fumes.
  • Treatment with medications, depending on the severity of your symptoms and your spirometry results.

Your provider will assess how severe your asthma is and inquire about daytime and nighttime symptoms and review your lung function test. Then, your treatment will be based on if your asthma symptoms are mild, moderate or severe, as well as intermittent or persistent.

 

Your provider may create a plan to assist you with how to treat your asthma exacerbations and when you need to be seen for treatment.

 

Asthma treatments include:

  • Rescue medication, called short-acting bronchodilators (short acting beta agonists, or SABA), to be used during asthma exacerbations only when you have symptoms. They come as inhalers or solutions for a nebulizer
  • Preventive medication, also called maintenance medication, to prevent asthma symptoms. This will not treat your symptoms of coughing and wheezing right away but will prevent them for happening. These medications include:
  1. Inhaled corticosteroids, inhaled long-acting beta-agonist and combos of both. Inhaled corticosteroids
    can be used with a nebulizer.
  2. Leukotriene modifiers come as chewables, tablets and granules and are especially helpful in allergic
    asthma.
  3. Methylxanthines, such as theophylline, come in liquid, tablets and capsules.
  4. Immunomodulators, known as omalizumab, for children over 12 years and adults, are a monthly or bimonthly injection. These are helpful for allergic asthma.
  5. Systemic steroids come in liquids, capsules or tablets.
  6. Cromolyn is to be used with a nebulizer.

 

Dr. Hoolihan is a Family Medicine Specialist for Nuvance Health who is bilingual in English and Spanish. She sees patients in Millbrook and now LaGrange. To visit, call (888) 525-HQMP (4767).

Eunice Hoolihan, MD

The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.