Breath Easy
You may have asthma, but it doesn’t have to have you.

For 23 million people, including 7 million children, daily living means living—and breathing—with asthma. But thanks to smart doctors and medications that are better than ever before, asthma is manageable. So you can have asthma, but it doesn’t have to have you.

What is asthma?

Our lungs are filled with branching tubes called airways. During an asthma “attack,” the airways spasm, swell, and produce extra mucus. This narrows the spaces in which air can move in and out of the lungs, and it becomes difficult for the asthmatic person to breathe. “The symptoms of an asthma attack can be mild or severe, depending on the patient, but usually include shortness of breath, wheezing, coughing, and sometimes even chest tightness,” explains pulmonologist Howard Blaustein, MD.

But asthma attacks don’t just happen at random; they occur in response to certain triggers, which can vary from patient to patient. It is estimated that 70 percent of asthma triggers are allergy-based, which means they come from things like seasonal allergies (also known as allergic rhinitis) and exposure to indoor allergens like dust or pet dander (especially from cats). Other common—but perhaps surprising—asthma triggers include acid reflux, stress (or other moments of intense emotion, like crying, yelling, or laughing), and seasonal changes. Anti-inflammatory drugs like aspirin can trigger an asthma attack, as can certain prescription drugs like beta blockers for heart disease and hypertension. Illnesses like the common cold, flu, bronchitis, or pneumonia can set off an attack. So can irritants like perfume, scented candles, cleaning fluids, cigarette smoke, air pollution, and smoke from kerosene heaters. Some people can’t handle sulfites found in red wine and beer. And many others have trouble during exercise, especially outdoors. This isn’t an excuse to avoid the gym, however—it just means you have to be more vigilant and diligent in managing your disease.

Diagnosing asthma

If you experience any of the classic hallmarks of asthma, including coughing (especially at night), wheezing, shortness of breath, or chest tightness, pain, or pressure, see your primary care doctor. He or she will first take a careful history, which should include information about smoking, allergies, and exposure to pollutants in your workplace, as well as information about family members with asthma. There are also several breathing tests your physician may perform. The most common is spirometry, which measures the amount and speed of the air you blow out, helping your doctor determine how efficiently your lungs are working. If you’re diagnosed with asthma, your doctor may suggest you see a pulmonologist, a specialist who can help you identify your particular triggers, manage your condition, and deal with any other issues (like allergies) that are causing your asthma to flare.

Why is asthma exploding?

“Asthma is on the rise worldwide,” reports Robert Sussman, MD, an attending pulmonologist at Overlook Hospital and co-director of the Clinical Research Center at Pulmonary and Allergy Associates in Summit. “While some asthma cases are genetically linked and poor air quality certainly doesn’t help, the most widely accepted explanation for the increased incidence of asthma is the Hygiene Hypothesis.” Sussman explains that after the Berlin Wall fell, scientists were fortunate enough to study a population of people who were extremely similar genetically, but vastly different socio-economically. They discovered that the incidence of asthma was higher in the wealthier, less marginalized West German population. Surprising? Not exactly … “For our immune systems to properly develop, they need to be exposed to a variety of things,” says Sussman. “So when babies are kept scrupulously clean and protected, their immune systems become overly reactive and they end up with chronic reactive conditions like asthma, eczema, and seasonal allergies.”

Experts now believe that millions of parents around the world are actually keeping their babies too clean (so much for all that hand sanitizer). That doesn’t mean you should allow your three-month-old to be hugged and kissed by every cold-ridden relative who comes to visit, but it does mean that parents can (and should) loosen their standards on simple everyday things, like a romp in that less-than-hygienic playground sandbox.

Living with asthma

Asthma is a chronic illness for which there is no cure. But with proper management, most asthmatics lead normal, healthy, active lives. Proper management means medication.

“Every asthma patient should have a rescue inhaler to dilate the airways during acute episodes,” says Blaustein, “and for some patients, this is all they need.” But for patients who turn to a rescue inhaler more than twice a week, daily maintenance therapies are prescribed. These include inhaled steroids or combination maintenance medications in addition to a rescue inhaler. For people with allergic asthma, there are pills that not only open the airways but also help ease allergies. There are also monthly injections that can be prescribed for the most stubborn cases of asthma, or in cases where there is a severe allergic component.

To be effective, asthma medications must be taken diligently and exactly as prescribed—and failure to do so can have dire consequences. “Despite the many ways we have to control asthma, it still causes 3,800 deaths each year,” warns Sussman. “Most of these fatal attacks are the result of patients not taking their meds regularly or stopping them altogether.” What’s more, asthma that is not properly managed can also lead to airway remodeling, a serious condition that happens when bronchial tubes become scarred from ongoing inflammation, often due to inadequate asthma treatment. As a result, less air is able to move through the airways. This in turn leads to a progressive and permanent decline in lung function, reducing a patient’s ability to perform daily activities.

But why would an asthmatic even think of discontinuing life-saving medications? Sometimes an asthmatic starts feeling better and they think they don’t need their meds anymore. “But asthma is chronic,” says Sussman, “and your daily regimen of medications should never be scaled back or stopped without the advice of a doctor.”

If you find yourself having an asthma attack that your rescue inhaler can’t ease, get medical attention as quickly as possible. “It’s important to see a doctor or go to the Emergency Room early during an asthma attack, since you can deteriorate very quickly,” says Blaustein. “Prompt medical attention can reduce the risk of hospitalization and even death.”

The future of asthma treatment

Research is ongoing to find better ways to manage asthma, and breakthroughs are sure to happen. “In the future I’d like to see medications that are not only more effective, but easier to take,” says Sussman. “For example, inhaled medications that require only one puff, once a day to control asthma.” Scientists are investigating the possibility of an asthma vaccine that would prevent the disease by stimulating the immune systems of babies, and are also evaluating treatments to modulate the immune systems of asthma sufferers to cure the condition. Although these goals are still far off from being realized, Sussman reports that a new treatment called bronchial thermoplasty recently received FDA approval. “This procedure involves inserting a bronchoscope with a radio frequency probe into a patient’s lungs and using controlled heating to actually prevent bronchospasm,” he says.

Taking control of your asthma

Besides taking your medication as directed, what can you do to minimize asthma symptoms? Sussman recommends these strategies.

• “Don’t smoke, and don’t smoke around your kids,” he says. Children of smokers are much more likely to develop asthma than kids of non-smokers.
  


• Learn what your particular triggers are and avoid them whenever possible. “If your asthma is exacerbated by dust, for example,” says Sussman, “then eliminate wall-to-wall carpeting from your home, invest in a vacuum with a HEPA filter, and cover your pillows and mattress with anti-allergen covers.”
  


• Stay healthy, especially if your asthma is triggered by colds. “Get a flu shot annually,” says Sussman, “and wash your hands diligently during cold and flu season.”

For a referral to a pulmonologist, call (866) 387-8104.