What is Asthma?
Asthma is a lung disease affecting the small airways. You can think the lungs as an inverted tree and as the air is transported down, the branches get smaller. In asthma, the smallest branches are narrowed by two processes: inflammation and muscle spasm. This results in at least 1 of the 4 main symptoms of asthma: wheezing, coughing, chest tightness and shortness of breath. The treatment of asthma targets these 2 main causes. For the mildest asthmatics, the airway muscle relaxers alone are sufficient (these are also known as bronchodilators or rescue inhalers). Most asthma patients, however, require a daily or machinate medication which is usually an inhaled steroid (which despite the term steroid, is quite safe).
An Inside Look At Asthma
What Triggers Asthma?
The ubiquitous dust mite, which lives in bedding and carpeting is linked to the development of asthma early in life but usually does not play a major role in established asthma. Sinus problems are linked to more severe asthma—especially nasal polyps and/or chronic sinusitis. A frequently severe form of asthma with nasal polyps and aspirin allergy is termed AERD. Many things can trigger asthma attacks including pollens, molds, animal dander and dust mites), colds or sinus infections, cold air, smoking, exercise and pollutants.
Certain asthma populations require a special approach:
Asthmatic women
Asthma in overweight people
Elderly ashthmatics
Cold air causes narrowing of the airways in some asthmatics due to drying of the airway and thickening of mucous. The effect of cold air on asthmatics, especially exercising asthmatics, is dose-dependent. The colder the air, the more dramatic the impact on asthma. This poses a challenge for elite athletes. Even otherwise mild asthmatics may be so severely affected that no medical regimen adequately controls symptoms. An alternative is to protect the airway from drying by use of a heat-exchange device which uses the warmth and moisture of exhaled air to condition inspired air. This has been shown in clinical trials (Beuther and Martin) to significantly reduce asthma symptoms, even more so than a bronchodilator.
How Do You Treat Asthma?
Rescue medications that dilate the airway relieve the acute problem for a short period of time but are not a long term solution. Inhaled steroids (which are very safe) are the mainstay of asthma treatment and are sometimes combined with long acting bronchodilators. For severe asthma, targeterd injectible biologic drugs can be life-changing (and life-saving). Take you asthma seriously. People still die of this disease such as a reporter who died in Syria, not by violence but from an asthma attack. These days virtuall all asthma deaths can be prevented by proper care.
It Looks Like Asthma, But Sometimes It’s Not
Evaluating and treating sinusitis and acid reflux are very important but for different reasons. Another problem linked to more severe asthma is acid reflux, which can also mimic asthma and contribute to vocal cord problems which, unless properly recognized, can lead to asthma overtreatment including excessive oral steroid use. Every doctor is taught that “all that wheezes isn’t asthma.” Remember that if you’re not any better with good asthma therapy.