The National Institutes of Health designated 1992 the Year of Asthma. What is asthma? How do you know if you have it? Can asthma start at any age? Can it be prevented or treated? Answering these and other questions can help raise our national awareness.
A Treatable Condition
Asthma is a treatable condition caused by both the spasm of the muscles surrounding the airways (bronchospasm) and by inflammation. Ten to 15 percent of Americans have asthma. Asthma can start at any age. It is not a problem that children will just “outgrow.” The symptoms must be recognized and treated appropriately. Adults can have their first episode at any time in their life. It often “starts” after a bad viral illness and may or may not be associated with allergies. Asthma without appropriate treatment can cause a dramatic change in lifestyle, for one may have to limit normal daily activities and reduce participation in physical activities (sports or exercise programs). Asthma may cause a decrease in performance at work or in school, an increased dependence on others and lower self-confidence.
Symptoms of Asthma
The symptoms of asthma are related to the obstruction of air flow in the lungs. This may result in shortness of breath at rest or with activity, wheezing, prolonged expiration (difficulty in getting air all the way out), coughing and chest “tightness.”
What does it feel like to have acute asthma? It is like breathing hard through a straw (or through the nose with the mouth closed) while running. The air passages are tight because of the airway muscle spasm, mucous obstruction and the swelling of the airway lining It is difficult to get the air out. Often sufferers limit their activities and lifestyle to avoid problems rather than seek medical care and appropriate medications.
Seventy eight percent of all children and adults with asthma have nighttime chest symptoms-coughing, chest tightness, difficulty breathing and wheezing. The symptoms are worse at night because of changes in normal body chemicals and the normal rhythm of the body. The airways are more sensitive and less stable. The treatment for coughing is not always cough medicine, but more appropriately may be asthma medications. Socalled “cough-variant asthma” needs to be treated, not with medications that suppress the cough reflex, but with medications called bronchodilators, which relax the airway muscles and improve air flow.
Exercise-induced asthma is very common. There were 70 participants in the 1984 Summer and Winter Olympics who had symptoms associated with exercise. Forty of these individuals won medals, including gold medals. Exerciseinduced asthma may be triggered by the drying of the airways, as well as by temperature changes within the airways (caused by any activity that increases breathing). Symptoms may begin during exercise and sometimes can be “run through.” Symptoms may also begin at the end of an exercise activity. Inhaled medications given before exercise can limit the symptoms. The inhaler may be used again during or at the end of exercise. The technique for using an inhaler is as important as having an inhaler available.
The medication should be inhaled slowly for three seconds and then held in the lungs for 10 seconds. This technique can seem to be a very difficult task during an acute episode of wheezing. A spacer (a device attached to the inhaler) is helpful to slow down the rapid spray provided by the gaspropelled inhaler and can significantly improve the delivery of the medication to the lungs. Without a spacer, the medication often ends up in the mouth or the back of the throat!
“Exercise” can include normal activities of daily life, such as climbing stairs, shopping, cleaning, playing with children or pets, as well as tennis, jogging and other routine activities. Using an inhaler before exercise is important so the physical conditioning period can be more productive. Better body conditioning means better oxygen delivery and longer endurance before the next “episode.”
Allergies and Asthma
Environmental factors can also trigger significant symptoms of chest tightness, coughing and wheezing, as well as nasal congestion, itchy eyes and itchy skin. Animal dander (skin flakes) from pets such as dogs, cats, hamsters, mice, etc., are a common cause of allergy. Keeping these pets out of the bedroom is especially helpful since at least onethird of the day is spent there. Another important environmental allergen is the house dust mite. Seventy to 80 percent of people with allergies are sensitive to the mite’s droppings. Smoking, a major irritant to the allergic and asthmatic patient, should not be allowed in the house.
Avoidance is the number one treatment in the care of asthma. Pollens cannot always be avoided, but allergy medications may be helpful. Many patients also benefit from allergy shots.
Asthma Associated with Infections
Another very common symptom of asthma is the cold that does not end or the cold that seems to progress to significant chest tightness. At all ages, wheezing or tightness can be triggered by viral infections. Common viral infections, not bacterial infections, cause the greatest problems. Influenza can cause significant illness in any age group, especially in patients with preexisting asthma or other chronic lung disease. (Flu shots are recommended for prevention.) Sinus infections can also trigger chest symptoms, without spreading to the lungs.
Asthma was once defined as “diffuse, reversible obstruction of the lungs,” and the emphasis of treatment was on medications to relax the muscles around the airways. This is only partial treatment, since we know that asthma involves inflammation of the airways as well as muscle spasm. Both have to be treated to control the symptoms. The medications used to open the airways include theophylline and a family of drugs (called beta-2 agents) that act like adrenalin. These agents are available as inhalers and oral medication. Inflammation of the airways must also be treated. By inhaling synthetic cortisone-like medications, it is possible to block the late reactions and chronic inflammation that often occur after an acute asthma attack. Cromolyn, another inhaled medication, works to reduce or prevent the immediate as well as delayed symptoms.
Inhaled medications (bronchodilators, corticosteroids and cromolyn) have fewer side effects than oral medications and can provide symptom relief and a return to normal daily activities (often including sports for school children as well as adults). Although asthma is treatable, the symptoms have to be recognized and an effort made to seek appropriate medical care. Throughout the world the death rate from asthma has increased significantly over the past few years, especially in the young (notably young black males) and the elderly. Some of the problems include delays in appropriate treatment, inadequate treatment or not continuing with care. Appropriate medications used with good technique, as well as individualized (written) treatment plans and follow-up, are essential.