We often talk about asthma but it is rarely defined. People think of asthma as coughing, wheezing and breathing difficulty. Often it is portrayed in the movies as having a sudden attack of breathing difficulty associated with anxiety. The Hollywood portrayal of asthma is probably not correct most of the time. For most people asthma tends to be much more of a chronic condition with the potential for a cute flares or exacerbations.

If we look at asthma in its simplest form, asthma is inflammation of the breathing tubes in the lungs. The breathing tubes that make up the airways in the lungs, especially the medium but also the small breathing tubes tend to be the primary locations involved with asthma. The breathing tubes are lined with mucous membranes like the lining inside of the nose and sinuses. In asthma, just like in allergies of the nose, there is inflammation involving these mucous membranes. That inflammation leads to increased mucus production, thickening of the membranes, thickening of the underlying structures and tightening of the muscles that surround the breathing tubes. The end result of this is a narrowed airway to breathe through, and of course more difficulty breathing. The wheeze that occurs with asthma is caused by whistling of resonance of airways as air passes through the narrowed breathing tubes. What surprises a lot of people is that many people with asthma don’t wheeze. Instead many patients with asthma have more trouble with coughing or, especially in adults, breathing tightness. The breathing tightness can be mistaken for fatigue and poor exercise tolerance.
Most people with asthma use a medication called albuterol. Albuterol temporarily provides relaxation of muscles that surround the breathing tubes to allow the breathing tubes to temporarily open. This temporarily makes it easier to breathe. However, albuterol does not do anything for the underlying inflammation that causes asthma. Most commonly inhaled steroid medications are used to treat the inflammation that underlies asthma. These inhaled steroid medications are safe because the doses are very low. Inhaled steroids medications can be used safely lifelong. These steroid medications as the mainstay of asthma management.

Another treatment of asthma is to address underlying allergies. Most people with asthma have allergic causes the trigger the asthma. These causes need to be discovered. Then environmental control can be undertaken to minimize the impact these triggers have on asthma. Another treatment option for allergic asthma is allergy shots otherwise known as allergen immunotherapy. The goal of immunotherapy for allergies and asthma is to make the immune system less allergic or less reactive to normal things in the environment. The outcomes of allergen immunotherapy for many people are: reduced need for medicine, decreased symptoms and, most importantly, improvement in the quality of life. This benefit is not just seen in nasal/eye allergy, patients with allergic asthma can benefit greatly from treatment with allergen immunotherapy.


For questions we recommend that you talk to your primary care provider or to an allergist.