Asthma is an inflammatory condition of the breathing tubes (airways) of the lungs. It is usually (but not always) associated with allergy. In fact, the same type of inflammation that happens in the mucous membranes in the nose and sinuses with “hay fever” type allergies also occurs in the airways, leading to inflammatory changes of the mucous membranes (including increased mucous production). This inflammatory process also leads to tightening of bands of muscle that surround the airways, causing the further narrowing of the airways.
This combination of inflammation, increased mucous production and airway narrowing (bronchoconstriction) leads to the symptoms people recognize as part of asthma: breathing tightness, cough and wheeze. Not everyone with asthma wheezes. People can have different symptoms with asthma at different times. Often, infants and young children with asthma exhibit cough, without obvious wheezing or other breathing problem. In the child with asthma, cough will often occur in episodes (rather than just a solitary cough). The cough may continue to the point of gagging or even vomiting. Nighttime cough is very common in people with asthma (children and adults). Other symptoms, including breathing tightness, are also often worse at night. In infants and toddlers, there may be difficulty with cough (or other asthma symptoms) when laughing hard or crying.
Asthma often worsens with exposure to environmental allergens (both indoor and outdoor allergens). Respiratory infections, including something as simple as the common cold virus, will also frequently result in increasing trouble with asthma. This means that not only will asthma flare during a persons allergy season, but some of the more severe exacerbation will happen during cold and flu season.
Other triggers for asthma include irritants such as cold/dry air, exercise, chemicals (including household cleaning products), cigarette smoke, wood smoke and perfume. Different irritants will trigger symptoms in different people. Fortunately, if asthma is well-controlled, these same irritants tend to be less problematic.
Because asthma can interfere with exercise, children with asthma may experience difficulty keeping up with their peers on the playground or on sports teams. They may try to rest more than their peers during play or exercise. Often, both children and adults with exercise-induced asthma will limit exercise or activity in order to avoid breathing difficulty. This avoidance of exercise or activity may occur without an individual being consciously aware that they are doing so. Fortunately, with appropriate treatment, most people can participate in sports, exercise and other physical activities without limitation due to asthma.
The ultimate goal of asthma treatment is to improve our patients’ quality of life. Treatment depends on the severity and frequency of symptoms. Typically, an individual will need an inhaler for rapid relief of breathing symptoms if they occur. These medications are called rescue inhalers and typically contain a medication called albuterol that works by temporarily relaxing and opening the breathing tubes in the lungs. Treatment may also include a daily asthma medication, called a controller medication. Controller medications help to prevent escalation of symptoms. Most, but not all, controller medications are inhaled steroids that decrease inflammation in the breathing tubes in the lungs. If there is a severe flare of asthma, a short course of a systemic steroid (usually a steroid pill) may be necessary to bring symptoms the asthma back under control. Fortunately, with modern therapy, long-term need for systemic steroid medication is rare. Individuals with severe asthma that is not completely controlled with typical daily medications do sometimes need treatment with injectable “biological” medications that alter the inflammatory or immune system in ways to help overcome asthma. These biological medications are very expensive, but in individuals with severe asthma, insurance coverage (and sometimes additional grants to help with medication copays) is usually possible.
While it is a chronic condition affecting people of all ages and all groups, asthma is readily treatable in the vast majority of individuals to a point where it does not need to limit or impair an individuals quality of life. Contact us if you or a family member has concerns or questions regarding asthma.