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 AERDMany 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 are the mainstay of asthma treatment and are sometimes combined with the long acting forms of rescue inhalers. If you don’t treat asthma properly though, you are at higher risk of dying. Sadly, New York Times reporter died in Syria, not by violence but from an asthma attack.   Most asthma deaths can be prevented by proper care and avoidance of triggers. Even for the severest asthma there are now potent but safe biologic drugs to control the condition. If someone is not responding to all treatment for asthma, it’s worth consider other causes.

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. It’s worth noting that doctors are taught in medical school “all that wheezes isn’t asthma.”

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