Asthma is a condition in which one’s airways constrict, swell, and produce mucus, a trifecta of sorts which results in less air moving from the outside world into the lungs. This can lead to a decrease in oxygen exchange with the waste product, carbon dioxide. As such, breathing—and thereby, adequate oxygenation—is compromised. Thought to be triggered by environmental factors in genetically predisposed individuals, the exact cause is unknown.
Genetic (inherited) hypersensitivity + exposure to environmental triggers -> ASTHMA
A common occurrence is a wheezing sound during exhalation. Naturally, having the flu or a cold worsens any asthmatic situations and can even mimic asthma. Mostly harmless but bothersome, in severe cases asthma can lead to death.
In childhood, more males have asthma than females, but by age 20 it evens out; after 40, more females have it.
What causes asthma?
Some people get it, some don’t.
That’s the genetics at play and there’s not much that can be done about that. Along with inherited hypersensitivities that haunt particular persons in their genes, an exaggerated and hypersensitive immune system affects the airway in response to triggering environmental stimuli; this is the conventional answer as to what causes it. Therefore, prevention by eliminating one’s environmental “triggers” is something a person with asthma can do.
This hypersensitivity is part of an immunity response, and a particular antibody, IgE, is usually elevated with asthma. But this is not so much a cause as a finding. Also elevated are certain white blood cells, called eosinophils, active in allergic reactions and which can be identified in saliva and mucus.
How can asthma be avoided?
Because of the genetic connection, the disease itself cannot be avoided. But eliminating indoor irritants can help prevent asthma attacks:
- House dust, which carries mites, is a principal trigger in children.
- Mold, particularly Alternaria mold, is important in the asthma that comes later, after childhood.
- Cockroaches. These, favorites of nobody, are a major trigger, especially in the inner city. It is found commonly in bedroom dust, which includes their droppings.
- Animal triggers, but this is a double edged sword. Whether they are triggers or not depends on when they are introduced into one’s life. Although triggering attacks in older children, the earlier in life children are exposed to cat and dog allergens, the less likely they are to develop asthma. Take a bow, Fido! The same goes for early childhood farm animal exposure.
Can asthma be tested for?
A thorough history, including family history, along with documentation of the signs and symptoms above, may be all that is needed to diagnose asthma. However, it is important to avoid misdiagnosing asthma as another pulmonary disease or as an upper respiratory infections, like flu. Sometimes an X-ray can rule out other problems that can result in wheezing. Pulmonary function tests can document the condition of the lungs and airways.
What would put someone at increased risk for asthma?
- Having a close relative with asthma (parents or siblings)
- Having another allergic condition, such as eczema or hay fever
- Smoking and second-hand smoke
- Exposure to pollution, exhaust fumes, or chemicals used in pesticides, hair care, or industrial manufacturing
What kinds of complications can happen?
Most of the complications are secondary, interfering with the activities of daily living, such as missed work days, avoiding normal recreational activities, time wasted in emergency rooms are with medical care, and complications from the asthma medications, which can sometimes trigger attacks themselves or mask worsening disease.
One particular complication is life threatening. Rarely an asthmatic attack can be so severe that no emergency treatments will break the attack. Called status asthmaticus, this deadly condition often requires the mechanical support of a ventilator and admission to an ICU.
In typical asthma, what are the treatments used?
- Eliminating exposure to triggers—household and environmental
- Long-term medications.
- Inhaled corticosteroids (anti-inflammatory) such as fluticasone (Flonase, Flovent); budesonide (Pulmicort Flexhaler and Rhinocort); flunisolide; ciclesonide, beclomethasone ; mometasone (Nasonex); fluticasone.
- Long-acting beta agonists. Beta receptors in the airways, when activated, will dilate them, allowing more air to pass with each breath. Inhaled medications such as salmeterol (Serevent); formoterol. Since these themselves may actually trigger asthma, they should be taken with an inhaled corticosteroid.
- Leukotriene modifiers. Oral medications can provide a maintenance therapy. Taken daily. Montelukast (Singulair); zafirlukast (Accolate); zileuton (Zyflo). These have rarely caused psychological reactions, so any mental or emotional changes should prompt reporting to the prescribing doctor.
- Combination inhalers, which contain a beta-against + a corticosteroid. Fluticasone-salmeterol (Advair Diskus); budesonide-formoterol (Dulera-Zenhale).
- Short-term (or “rescue”) medications
- Short-acting beta agonists. Albuterol (ProAir, Ventolin); levalbuterol (Xopenex).
- Ipratropium (Atrovent), a bronchodilator
- Oral or intravenous corticosteroids (prednisone and methylprednisolone). These can cause long-term side effects, so they are used only in the “short-term” medications category.
- Allergy medications if asthma is triggered by allergies. Allergy shots or omalizumab (Xolair), which alter one’s immune system.
- Decreasing the amount of smooth muscle in the airways. This is a radical approach that uses heat to destroy the amount of muscle that causes the constriction of the airway.
How long will treatment take?
This is a difficult question, because it really depends on whether someone has asthma in childhood, develops it later in life, how severe it is, how frequent attacks occur, and whether one responds to the typical medical remedies. For example, a childhood asthma may simply be outgrown by adolescence, treatment limited to just managing and minimizing symptoms.
An individualized plan should be written out, preferably on a flow sheet that will outline the steps to take, from simplest to most involved, for an attack that isn’t immediately stopped.
Asthma is like a bad hand at poker. One cannot help how the cards are dealt, but one can proactively and reactively respond to the way the hand plays out.
- Weiss ST, Gold DR. Gender differences in asthma. Pediatr Pulmonol 1995; 19:153.
- Toelle BG, Peat JK, Salome CM, et al. Toward a definition of asthma for epidemiology. Am Rev Respir Dis 1992; 146:633.
- Burrows B, Martinez FD, Halonen M, et al. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med 1989; 320:271.
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