Asthma is a chronic inflammatory disease of the airways found in individuals of any age. Asthma may be chronic, ongoing, and quite severe or may be mild enough to only affect patients at certain times or certain situations. Symptoms often include wheezing, coughing, chest tightness, and shortness of breath. Some patients may have a combination of these symptoms while others may have only one or two. Some people may have very few, if any, symptoms but markedly abnormal lung functions.
Inflammation of the Lungs
Inflammatory changes in the lung airways result in obstruction or narrowing of the airways that is often considered to be reversible. This means that when the patient is doing well, these changes are not present. At other times, inflammatory changes may be present continuously. In the asthmatic patient’s airway, the lining of the tube is inflamed, swollen, and contains a thick mucus discharge. Muscles surrounding the airway tighten and contribute to the narrowing of the airways. These changes block airflow causing difficulty breathing.
Inflamed airways are more susceptible to irritants, allergens, and infections which may result in an asthma attack. Many factors may trigger an asthma attack. Allergic triggers include pollen, mold, dust, animal danders and, in some cases, certain foods. Non-allergic triggers include exercise, smoke, viral infections, strong odors, air pollution, chemical exposures, and cold air. Emotions such as laughing or crying as well as changes in weather and temperature can trigger asthma attacks. An individual may have many triggers for asthma symptoms. If we can eliminate or control those triggers, asthma symptoms will be reduced. In some patients, aspirin or other drugs may trigger asthma symptoms. Sulfiting agents that are preservatives found in wine, beer, some salads, and other prepared foods, as well as in some medications, may also cause symptoms in certain patients. An asthmatic patient should never be exposed to tobacco smoke, a major trigger factor.
Other Asthmatic Symptoms
Not all patients with asthma experience wheezing. For many, coughing may be the major symptom. The cough may occur at any time including night, during or after exercise, with laughter or with crying, and following cold air exposure or temperature change. In many cases of asthma, there may be lasting changes in the appearance of the bronchial wall related to inflammation, which is known as airway remodeling.
For some patients, asthma symptoms may occur for very brief periods. For others, symptoms may occur daily for an entire lifetime. For some patients, symptoms may occur for a few months and appear to be gone only to reappear years later. About 50% of the children who begin wheezing before the age of seven will have no symptoms of asthma by the time they reach early adulthood. Many children do not experience any significant long-term physical effects from asthma if it is well-controlled. It is impossible to predict who will experience a remission of asthma and for how long.
Asthma is a disease of the bronchial tubes in the lungs and it is never truly “outgrown” even though symptoms are not present. Generally, patients with milder asthma or infrequent attacks most often experience a remission to some degree.
There is no clear cure for asthma; however, there are a variety of treatments and medications that are useful to control the disease. It has been estimated that between five and eight percent of the population in the United States has asthma or an asthma-like problem. In most patients, asthma symptoms seem to develop following viral upper respiratory infections. Reducing the number of these infections is possible through hygiene control with measures such as washing hands frequently, avoiding contact with sick children, and avoiding sharing food or drink. Yearly influenza immunizations are almost always recommended. In many situations, asthma cannot be prevented from occurring. Reducing the number of infections reduces the frequency and severity of the asthma. Avoidance of tobacco smoke, both personally and passively, is vital in reducing asthma symptoms.
Controlling Your Environment
Environmental factors such as smoke, contact with a cat or other animals, or some chemical exposures at work may sometimes trigger or aggravate symptoms. In those patients who are exposed to such triggers, avoidance is the best way to control symptoms. There are a number of methods used to control asthma symptoms.Environmental control measures both at home and at work are essential. Pets should be kept out of the sleeping area of the home and ventilation should be improved at the workplace.
In most cases, there are varieties of helpful medications which can reduce symptoms greatly. Under the direction of your doctor, some of the medications may be taken intermittently or as needed but others must be taken regularly. In many cases, allergic factors such as pollens, dust and molds cannot be avoided and in these situations, allergen injection treatment offers additional benefit. A Board Certified allergist is in a unique position to guide the asthmatic patient regarding proper diagnosis and treatment. In many allergic patients, the use of immunotherapy or allergy shots can prevent asthma.
Living with Asthma
With careful medical control, asthma is an illness which often has a good outcome. Many patients, particularly children, will have an excellent result from regular use of medication, allergen avoidance and, when indicated, allergen injection treatment. Older adults sometimes experience more problems; however, there are many medications available which can control the illness to the point that almost all daily activities are well tolerated. Working with an asthma professional can provide a major level of improvement in symptom control and normalization of activities.