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ASTHMA
Asthma is a common lung disorder characterized by episodes of cough, wheeze and shortness of breath. Asthma is caused by inflammation of the lining of the small airways in the lungs (bronchioles) which leads to spasm or narrowing of these tubes. This spasm triggers asthma symptoms. Asthma may develop at any age, but most commonly presents in early childhood or mid-adulthood. Most cases that occur in childhood improve greatly over time and with appropriate treatment. Asthma that develops in adulthood typically responds well to treatment but is less likely to be outgrown.
Approximately one person in ten has asthma and 34.1 million Americans have been diagnosed with asthma. Asthma has a strong genetic component and often runs in families. Individuals with allergic conditions such as food allergies, eczema and hay fever are at increased risk for the development of asthma as are individuals who have immediate family members with asthma. For reasons that are not completely clear, the incidence of asthma and other allergic diseases has been steadily rising over the past several decades.
Asthma severity varies greatly from very mild to debilitating. Unfortunately, asthma can be fatal and over 4,000 Americans a year die from asthma. For the vast majority of asthmatics, however, asthma can be well controlled. As a chronic disease, asthma requires vigilance to maintain such control.

Symptoms
Common symptoms of asthma include one or more of the following:
 
• Coughing
• Wheezing
• Chest tightness
• Shortness of breath
• Decreased exercise tolerance 
  

Individuals with asthma may have one or more triggers for their asthma. Common asthma triggers include:
 
• Viral upper respiratory infections
• Environmental allergens such as pollens, dust, mold, and animal dander
• Irritants such as cigarette smoke, perfumes/cologne, and cleaning solvents
• Emotional stress such as laughing and crying
• Exercise
• Cold air/humid air
• Fluctuations in hormone levels such as seen in pregnancy or with menses
• Sinusitis
• Acid reflux
• Obstructive sleep apnea

Diagnosis
Asthma is usually suspected when the characteristic symptoms occur, especially at nighttime, with exercise, with colds or with allergy flare-ups. A favorable response to asthma medicines is suggestive as well. Definitive diagnosis and optimal treatment of each individual case requires not only periodic exams, but also measurement of lung function, starting by five or six years of age. This accomplished with spirometry which measures the amount and rate of air flow from the lungs. Often spirometry is performed before and after the use of a bronchodilator medication such as albuterol. This medication will cause a characteristic rise in air flow confirming asthma. Other tests such as a methacholine challenge or measurement of exhaled nitric oxide can also assist in the diagnosis of asthma. In a methacholine challenge, spirometry is performed before and after inhaling increasing doses of methacholine. In contrast to albuterol, methacholine will cause airflow to drop in asthmatics. Exhaled nitric oxide is a gas normally found in the breath, but increased amounts of this gas indicate asthmatic inflammation in the airways. Just as crucial as these tests, is an individual’s response to treatments and long term lung function trend. Since allergies are a common trigger in up to 85% of individuals with asthma, allergy skin testing is an integral part of the initial evaluation of asthma in order to optimize treatment. Chest x-rays, blood work and other tests are rarely needed for the diagnosis and management of asthma, unless other medical problems are suspected. Some examples of other medical conditions that can cause or aggravate asthma include chronic sinusitis, acid reflux and sleep apnea. If these conditions are suspected, further testing and treatment may be needed to optimize treatment and outcomes.

Treatment
Avoidance of allergens and irritants: Depending on the person’s history and the results of any allergy testing, specific measures to reduce exposure to the substances to which one is allergic is a vital part of asthma management. This will help reduce the amount of medications needed to control asthma.  
 
Treatment of underlying medical conditions: Chronic sinus problems, acid reflux (heartburn), obesity, and other conditions may cause or aggravate asthma. It is important that these problems be addressed in order to have ideal control of asthma. Since viral infections are common triggers of asthma, yearly flu vaccinations are recommended for patients with asthma.  
 
Medications: There are two basic categories of asthma medications- relievers and controllers. Relievers are commonly called rescue inhalers or bronchodilators, which temporarily relieve symptoms by relaxing constricted bronchiole tubes. These are typically used only when needed. Controllers are anti-inflammatory medications, which prevent or heal the inflammation inside the bronchiole tubes. These are generally used every day as a preventive medication.  Most patients with asthma will require a bronchodilator (ex. Albuterol or Xopenex) for occasional, as-needed, use. In patients with more persistent or chronic asthma, daily preventive therapy with an anti-inflammatory controller medication is necessary. Occasionally, patients with milder asthma will require anti-inflammatory therapy for short periods as with respiratory infections, or during their allergy season. Most patients, however, do best with year-round use of these preventive medications.  
 
Allergy Immunotherapy Injections: Allergy injections are the most effective long-term preventive strategy for the treatment of allergies. For many individuals, allergies are a significant trigger of asthma and aggressive control of their allergies can decrease the amount of asthma symptoms these individuals experience. Immunotherapy (allergy shots) help build up your immunity to the exact items to which you are allergic.  They can improve asthma directly by reducing the sensitivity of the lungs to inhaled air-borne allergens which can contribute to airway inflammation. They can indirectly improve asthma by reducing inflammation of the nasal and sinus passageways, thereby re-establishing the normal filtration and humidification of inspired air that is so important for lung health. Furthermore, control of environmental allergies can decrease the amount of infections, which are a major asthma trigger, one experiences.  The length of treatment depends on the nature and severity of the allergy.
 
Patients whose asthma symptoms interfere with work, school, recreation, or sleep and who are allergic to substances that are hard to avoid should seriously consider injections for long-term control.

How We Can Help
As the nation’s largest medical practice solely dedicated to the treatment of asthma and allergies, Allergy Partners provides you and your family with expert asthma care. Our physicians will combine an in depth medical history and physical examination with state of the art diagnostic testing to establish whether or not you indeed have asthma. We will also aggressively identify and treat underyling triggers or conditions so that your asthma can be better controlled with the least amount of medication necessary.

Interventions such as environmental allergen avoidance, immunotherapy, weight loss, and regular exercise can dramatically decrease the amount of symptoms individuals with asthma experience and reduce the amount of medication they require. Regular follow up in 3-4 month intervals is common to ensure that symptoms are under proper control and to adjust therapy as necessary.

At Allergy Partners, we recognize that no two people are the same and that optimum asthma care requires a comprehensive, personalized treatment plan. We look forward to working with you.

More Information:
For more information on this condition, please visit:

National Institutes of Health Asthma Guidelines
American Academy of Allergy, Asthma and Immunology
American Lung Association