What is Asthma?
Celeste Heckman, MD
Strasburg Family Health Center
"Reprinted From Lancaster County Woman Newspaper."
The word Asthma originates from a Greek work meaning panting. Essentially, asthma is the inability to breathe properly. Asthma is a chronic condition where the airways undergo certain changes when stimulated by allergens, viruses, or environmental triggers. Two processes characterize asthma. The first is bronchoconstriction or narrowing of the airways and inflammation. Over the course of years, recurrent asthma can cause irreversible structural and functional changes in the airways, a process called remodeling.
What causes asthma? There are many factors that may contribute to the development of asthma. Asthma is highly associated with allergies. Genetic factors also play a role. About one-third of all persons with asthma share this condition with a member of their immediate family. Also, a family history of seasonal allergies or eczema is a risk factor for developing asthma. Respiratory infections, chronic sinusitis, exposure to cold air, exercise, exposure to irritants such as smoking, strong aerosols, and fumes, may also be triggers for asthma. It is important to mention that gastro esophageal reflux disease or heartburn may also play a role in some people with asthma. This is a condition where acid leaks up the esophagus from the stomach and triggers a reaction in the airways that can cause asthma symptoms.
The classic symptoms of asthma include wheezing when breathing out, shortness of breath, coughing, chest tightness, neck muscles tighten, rapid heart rate, and sweating. However, some people, especially children, may only have coughing gas their symptom of asthma. Initially, the cough may be a dry, hacking cough but can later develop into a cough that produces a thick stringy mucous. After an initial attack, inflammation persists for days to weeks. The inflammation may be asymptomatic but treating it will prevent a relapse of asthma.
The diagnosis of Asthma should be considered if there is a history of recurrent bronchitis or pneumonia, periodic attacks of shortness of breath or wheezing with exercise. It is important to identify if there are any triggers for these events, which may include seasonal allergies, exercise, respiratory infection, exposure to cold air. Certain tests including a chest X-ray, blood counts, and lung testing are useful in making the diagnosis of asthma. Allergy testing may also be recommended.
Avoiding allergens, following appropriate drug treatments, and home monitoring are key elements in preventing dangerous asthma attacks and hospitalization. A combination of medications is important and effective for both treating and preventing asthma attacks. In addition, good communication between the physician and patient is a key factor in a successful management program.
When treating asthma, it is important to understand the difference between treating symptoms and controlling the disease. Medications for asthma are placed into two categories:
“Rescue Medicines”—drugs used to relieve the acute symptoms of asthma. Generally, these are bronchodilators. They relax the muscle surrounding the airways and help to open the airways. Examples would be Albuterol, Proventil, Maxair, and Xopenex. None of these agents have any effect on the disease process itself. They are only useful for treating symptoms. Oral steroids are also used as rescue medications for asthma attacks.
“Preventative or maintenance medications”—drugs used to control long-term persistent inflammation and prevent lung injury. Patients with persistent asthma require medications to control inflammation. These are people who are using their rescue medicines more than twice a week and may have asthma attacks that affect their daily activity. The standard agents for maintenance treatments are inhaled corticosteroids. Others include leukotriene antagonists like Singulair, cromolyn (Intal) and long acting bronchodilators. These are less effective than inhaled steroids but may be used in addition to inhaled steroids.
It is important to monitor the symptoms of asthma. This can be done with a home device called a peak flow meter. Medications can be adjusted accordingly; those who use home monitoring tend to have fewer hospitalizations and a better quality of life than those who rely on doctors or emergency room visits only when symptoms arise do. If you are exhibiting signs of asthma or have been diagnosed with asthma, you should follow up with your family physician to further discuss your symptoms and your treatment plan. Also, as a reminder as flu season is approaching, it is recommended that those diagnosed with asthma should have an annual flu vaccine and a pneumonia vaccine.