Category: Asthma  


Asthma afflicts millions of Americans. It is a serious and occasionally fatal disease. Each year about 5,000 people die of asthma but this is usually a result of undertreatment or poor access to medical care. Asthma symptoms include wheezing, coughing, chest tightness or shortness of breath. Asthma triggers include allergies, upper respiratory infections, excessive humidity and temperature variations, smoking, exercise, pollutants, hormones (menstrual period or pregnancy), and rarely, medications or diet. The ubiquitous dust mite, which lives in bedding and carpeting is linked to the development of asthma but generally does not play a major role in established asthma.  Evaluating and treating sinusitis and acid reflux are very important but for different reasons. Sinus disease contributes to asthma severity with many of our sickest asthmatics having  nasal polyps and/or chronic sinusitis. Acid reflux, however, may mimic asthma and contribute to vocal cord problems which, unless properly recognized, can lead to overtreatment including excessive oral steroid use.

Since asthma is an inflammatory disease of the airways, the mainstay of therapy is anti-inflammatory medication. Fortunately, there are now a variety of asthma medications that enable most asthmatics to have an excellent quality of life. Most asthmatics are able to take inhaled “controller” asthma drugs which target the lungs and are generally considered safe. Proper inhaler use is very important for the success of asthma treatment. Some asthma patients take oral medications while some require multiple drugs to control their disease. Asthma is a chronic disease that waxes and wanes but with proper management is controllable.

Special Populations:

Asthma in Women

Asthma in Pregnancy

Asthma in the Elderly

Understanding Asthma:

Asthma is a disease of the bronchial tubes which transmit air from the larynx (windpipe) down to the lung. The walls of these tubes (bronchi) have involuntary, smooth muscles (as opposed to voluntary, skeletal muscle). When viewed in cross section, these bronchi look like pipes. Air flowing through normal pipes produces no abnormal sounds. However air passing through narrowed bronchi makes unusual wheezing or whistling sounds.

Lungs Before an Asthma Attack

It is the spasm of these muscles that gives the sensation of sudden asthmatic symptoms and this spasm is the only part of asthma treated by the rescue inhaler.  Gradual onset of asthma symptoms may be due to muscle spasm or due to excess mucous production, inflammation (white blood cells) or other swelling in the airway. Knowing what happens in the lungs is important for asthma patients since it leads to better understanding of the use of asthma medications.

Lungs During an Asthma Attack

Asthma Airway Muscle Spasm is usually quickly relieved with an asthma short acting reliever (or short acting bronchodilator). These medications are taken on an as needed basis. Symptoms are usually better within a few minutes but sometimes take longer. If recovery is not immediate then additional treatment will likely be necessary as per your doctor’s instructions. The diagram below demonstrates an asthma attack due only to muscle spasm and the response to brochodilator. Note that the lining of the airway is not thickened and that the airway has narrowed because of the muscle spasm.

Airway Muscle Spasm Response to Bronchodilator

Asthma with significant inflammation usually requires more than a quick reliever or bronchodilator. Anything beyond mild asthma (symptoms more than twice a week) should probably be treated with anti-inflammatory medications. These may take the form of tablets or inhalers (steroid or non-steroid) but whichever the case are almost always taken daily as part of an asthma management program.

Airway Inflammation Response to Steroid

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