Asthma

What is Asthma?

Asthma is an inflammatory lung disease affecting the bronchial tubes (airways), interfering with the normal movement of air in and out of our lungs. If you picture the airways as conduits or pipes, inflammation in the walls of these pipes causes the walls to get thicker. As the walls thicken, there is less open space in the middle of the pipe (called the lumen) for air to pass through. To make matters worse, small muscles that surround our airways like little elastic bands become overly reactive due to the inflammation. Triggers like cold air, pollution, allergens, and even exercise can cause these muscles to clamp down, a phenomenon known as “bronchospasm”, squeezing the airways and further narrowing the central airspace. When this happens, the result can be a sudden sensation that breathing itself requires extra work. This may be accompanied by a sense that one’s chest feels “tight”, and breathing may produce audible wheezing sounds. One of the hallmarks of asthma is that this sudden obstruction of airflow is reversible: removing the trigger, remaining calm, and using an appropriate rapidly acting medication to relax the airway muscles (known as a bronchodilator) can result in return to normal easy breathing.

Untreated Asthma

Along with these acute attacks that can punctuate the breathing of someone with asthma, this chronic condition has a more insidious side. The presence of inflammation in the airways, if left unchecked, affects more than just the airway muscles. It causes the mucous secreting glands to go into overdrive, producing excessive amounts of mucous which can make breathing feel “wet” or “phlegmy”. With time, the mucous glands also become larger and more numerous, further increasing their production capacity. Other changes in the airway walls physically alter the architecture of the pipe system. This process, referred to as “remodeling,” if left unchecked can gradually erode the capacity of the lungs to move air in and out. These changes, unfortunately, are irreversible.

Allergies and Asthma

No matter how often you experience asthma symptoms, if you or members of your family have allergies, it is quite possible that your asthma may be set off by exposure to environmental triggers like pollens, dust, or pet dander. A comprehensive approach to managing your asthma should include an evaluation for allergies, and a physician-guided plan to anticipate and reduce your exposure to any environmental trigger to which you are allergic. Believe it or not, there are often simple, easy to implement measures we can take to reduce our exposures, even to seemingly ubiquitous allergens like pollens. The gold standard for determining if you have allergies is the allergy skin test. It’s a highly sensitive test that is easy to undergo in your allergist’s office and provides an answer in 15 minutes.

Asthma on the Rise

The number of people with asthma in the U.S. has been increasing for several decades, with more than 20.5 million Americans estimated to be affected in 2007. If you believe you are experiencing symptoms of asthma, you are not alone. But most importantly, you are not powerless. Don’t ignore your symptoms. Let your doctor know what you are experiencing, and get your lungs checked out. For many with asthma, appropriate simple management can result in near elimination of symptoms while protecting from long-term deleterious effects down the line.

The Good News

If you have asthma, the good news is that there are a variety of easy-to-use medications available that aim to prevent the long term remodeling associated with uncontrolled asthma, while at the same time greatly reducing the likelihood of a serious acute attack. These medications, termed “controllers” because they control the inflammation of asthma, come in oral (tablet) and inhaled (pump, nebulized) forms. You may not need a controller if you have very infrequent asthma symptoms. On the other hand, if you have breathing symptoms more than once or twice in a week, you would benefit from consulting your physician and giving serious consideration to starting a daily controller regimen. This has the dual advantage of reducing the frequency of attacks of bronchospasm, making everyday life more comfortable, and protecting your lungs against the long-term damage associated with inflammatory remodeling.

For more information about asthma, visit the American Lung Association.

For a customizable view of the asthma treatment options available to you, take a look at the  American Lung Association’s “Asthma Profiler Tool.” It’s free, easy to use, and provides expert advice without commercial bias.