Barry Abrams, M.D.

Asthma, an inflammatory disease of the airways, affects an estimated 14 million Americans, with more than $6 billion spent on asthma treatment every year. Sufferers have increased mucus production, spasm, and swelling of the airways, which causes symptoms of wheezing, chest tightness, cough, and sputum production. During an asthma attack, airways narrow, making movement of air much more difficult. An acute attack is treated with a bronchodilator (inhaler) to relax the muscles and allow for easier breathing.

Bronchodilators, however, do not address underlying inflammation. Anti-inflammatory medications are used as maintenance therapy for persistent asthma, and help reduce acute asthma flares, improve airway function, and reduce the need for “rescue” medications such as Albuterol.

No one knows the cause of asthma, but it appears to be hereditary. Many people with asthma have a family member with the disease. There seems to be an inter-play between our environment and our genetics, but there is no clear link to a specific gene or chromosome.

Triggers of asthma symptoms, such as respiratory infections, reflux/heartburn, weather changes, exercise, pollutants, allergies, and sinus infections, must be addressed to ensure the disease is properly treated. Allergies have a very large impact on asthma control, and there is an overlap between asthma, allergies, and eczema (an allergic skin condition).

Children who grow up in homes where both parents smoke have an increased incidence of asthma as opposed to children who are not exposed. Avoidance of environmental factors such as exposure to cigarette smoke, dust, and other irritants is also very important in the treatment of asthma. If you smoke, please talk to your primary physician about methods of quitting.

Influenza is a major trigger for asthmatics. This aggressive and highly contagious respiratory infection can cause very severe symptoms. People with asthma should definitely get a flu shot in advance of flu season.

Asthma can be classified as occasional or persistent. Mild persistent patients have asthma symptoms a few days a week and more than two nights per month. Moderate persistent asthmatics experience symptoms daily, with problems more than one night per week. Severe persistent asthmatics have symptoms almost all the time. As persistent asthma worsens, maintenance treatment can include from one to three drugs.

Management strategy depends on the severity of the asthma, frequency of symptoms, and exposure to triggers. The most important maintenance drug is an inhaled corticosteroid or steroid. These drugs are delivered in tiny quantities directly to the lung. They work at the site of the inflammation, without causing system-wide symptoms. These drugs are very safe and effective in the ongoing treatment of persistent asthma. In addition to Albuterol, Salmeterol (Serevent) and Formoterol (Foradil) work very nicely in patients with moderate asthma when combined with an inhaled steroid.

Some people have problems with inflammatory substances the body makes naturally, called leukotrienes. Two classes of drugs, called anti-leukotrienes, can either inhibit or eliminate the effect they have on the airways. In patients with mild persistent asthma, the anti-leukotriene medications can be used alone as an anti-inflammatory. Anti-leukotrienes have produced good results in these patients and can be paired with inhaled steroids in patients with moderate affliction.

Asthma can occur at any age. Many people who develop asthma as adults are surprised because they believe it is a disease that only affects children. Children with asthma may seem to "outgrow" it, but the disease often returns later in life. Many times patients do not have symptoms for 1-2 years and think the disease is gone. Unfortunately patients throw out their inhalers or let them expire, only to find they may need them when they have a flare-up of symptoms. As a result, they have to seek medical treatment in Walk-In Care or the emergency room.

The goal of asthma treatment is simple: normal life and normal lungs. Education is the key, because an informed, educated patient is likely to have better control of their asthma and less need for emergency room visits or hospitalization.