Texas Allergy Experts
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New thinking about Asthma


There are some totally new ways of thinking about asthma in the last five years. Research projects that Texas Allergy Experts have participated in have resulted in the approval of medications like Advair, Symbicort, Dulera, Singulair, albuterol and the new monoclonal antibody for severe asthma called Xolair. We are very active in cutting edge research. This is a time of great discovery and huge innovations. In the past we've grouped all forms of asthma together and treated them basically the same. Now we are looking at subgroups of asthma like allergic asthma, aspirin driven asthma, exercise-induced asthma, nonallergic asthma, and asthma which responds to medications produced for specific chemicals produced in the lymphocytes of the immune system. While these are incredible discoveries, the basics remain the same.  The sixty second video below says it well. 

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DEFINITIONS:

 

ASTHMA:

an intermittent lung disorder characterized as shortness of breath in otherwise healthy, normal people manifested as wheezing, chest tightness, or cough which responds rapidly to anti- asthmatic medications.

 

BRONCHITIS: An infectious condition of the lungs often accompanied by a cough productive of green, yellow, or brown mucus. While bronchitis may complicate asthma, they are separate processes.

 

REACTIVE AIRWAYS

DISEASE: synonymous with the term asthma, RAD is a more descriptive term indicating that the lung tubes are ..jittery" and apt to go into spasm.

 

TIGHTNESS: a sensation of constriction or pressure in the chest felt by most asthmatics during an attack.

 

WHEEZE: a musical sound usually produced by an asthmatic during exhalation or talking. The sound is made by air turbulence bronchial tubes where muscle spasm has produced narrowing.

 

WHAT CAUSES ASTHMA?

The exact cause of asthma is not known, but it is thought to have its basis in an imbalance of lung chemicals. The tendency to have asthma is definitely hereditary, but the problem may skip generations. Therefore, the bronchitis or “consumption” that one of your grandparents had may actually have been asthma. Remember that until the middle nineteen forties, asthma was mistakenly thought to be a purely psychological problem. No one wanted this diagnosis.


No matter what the actual cause, it is probably much more important from the asthmatic's viewpoint to know what activates or triggers this usually dormant process. In some respects asthma may be compared to a gun. It is there all the time, but unless it is activated, it is harmless. As long as those things which trigger a person's asthma can be recognized and avoided or treated, asthma need be only a minor problem. Knowing the triggers and recognizing the patterns of asthma are extremely important concepts in developing a medical program which will head off problems before they reach major proportions.

An asthmatic may have many triggers which produce enough physical stress to induce wheezing. If wheezing follows a seasonal pattern, allergy may be involved. This is particularly evident when the person's nose is completely blocked off forcing him to breathe through the mouth. Allergic substances such as pollen or mold spores may be taken directly into the lung producing an attack. Special testing may be required, and special medications needed. It is sometimes easy to avoid certain allergic causes of asthma once they are identified.  In many cases, long-lasting protection is possible for unavoidable allergic exposures through allergy immunization.  Foods may also be a problem because of allergy or because they may contain certain chemical additives or preservatives.


EXERCISE may be a major problem for asthmatics, especially if they are overweight, mouth breathe, or work out in a cold climate.  While almost any form of vigorous exercise can produce bronchospasm, sustained running seems to be the most common factor in recognizing a sport which may produce difficult competition. Soccer and basketball (if played on a higher level) may be difficult unless the athlete is premeditated in an expert manner. Baseball and swimming, and even football rarely produce problems. A well thought out program of physical fitness is indicated for all asthmatics: most doctors do not like to give excuses for physical education programs.


EMOTION can play a role in asthma, but it is important to point out that asthma is not a psychological problem unless it is very poorly managed. If small, children repetitively associate asthma attacks with pain, sleep deprivation, panic, and exhaustion, emotion may eventually become a primary trigger. Properly managed away from the hospital emergency room, emotion is not usually a major stress. It is important to point out, however, that the stress of emotions which produce asthma attacks may be either positive or negative.

Positive emotions such as anticipation of Christmas or birthdays may be as potent a stress as a negative event like a bad report card or an encounter with the boss.


 INFECTION may be the single most important trigger in producing the symptoms of asthma, especially in small children. While almost any infection can be important, the upper respiratory viruses may be the most potent. Many parents note that with each “cold” they get the bonus of asthma. Some “cold” medicines may complicate the asthma: check with your doctor (aspirin may be particularly bad). The best treatment for asthma is that which is started early. If, for example, it has been your experience that wheezing occurs one or two days after a “cold” has begun, the time to start the medicine ( even if no wheezing is apparent) is on the first day. Don't wait for wheezing to begin. Head it off. Prepare by giving the prescribed medicine and as we'll discuss later, lots and lots of fluids.

 

WHAT ABOUT THE TREATMENT?

Perhaps one of the most pressing concerns for any asthmatic, but particularly the parents of asthmatics is, “What am I doing to my child (or myself) with all these drugs?” A legitimate concern for everyone dealing with asthma is the risk/benefit ratio of the medications. Fortunately, the safety margin for most asthmatic drugs is wide.

 

Beta agents: while commonly thought of as the rescue  “asthma inhalers” these medications may be taken orally, by injection, or by their most familiar route: inhalation. The side-effects of these medications may include increased heart rate, increased blood pressure, and tremors. These medications have abuse potential and must be monitored carefully. Beta medications are particularly helpful in preventing exercise-induced asthma. Trade names include Ventolin, Proventil, and ProAir to mention a few.

Steroids: We use them by inalation to reduce the potential side effects which are mostly in the growth area. We have great long term studies on the effects of inhaling steroids. They are looked upon as the most potent of anti-asthma drugs and are generally considered to have POTENTIAL side-effects including cataract formation, ulcer production and growth suppression. Steroids have a definite use in some asthmatics, particularly the more severely affected person. This medication isalways given under the careful scrutiny of a trained physician. More information about this and all the other medications will be found in the section,  


Theophylline: not used currently

Cromolyn: not used currently

 

Perhaps the one most overlooked treatment for asthma involves the aggressive use of water.  While the drugs will often calm the jittery muscles in asthma, nothing exceptwater (and plenty of it) will thin the thick mucus associated with asthma and allow it to be moved along. It is hard to tell any asthmatics exactly how much water to drink during an attack. Looking at the urine is a more accurate way to determine hydration. We've all had the experience of working hard in the summer without enough fluids. The urine is always dark yellow. If the urine of a person experiencing asthma is dark-yellow, cloudy, more liquids are indicated regardless of how much fluid has already been consumed. When the urine is clear, you can feel a little more relaxed. How one takes the fluid is of little importance except that caffeine-containing drinks and milk are probably not the best choice. It is hard to overemphasize the importance of enough fluids in asthma. One of the most common denominators for asthmatics who visit the emergency room or who are hospitalized is dehydration. It is particularly tragic since it is almost always preventable.

 

WHAT ABOUT THE LONG-TERM OUTLOOK?

The long-term outlook for the great majority of asthmatics is very good, although “outgrowing” asthma is a rare phenomenon. The asthmatic adult who has “outgrown” asthma may find an unpleasant surprise if he or she chooses the wrong profession (veterinary medicine, coal mining, or spray painting to mention a few) or picks up a dumb habit like smoking. Doctors all over the country are used to seeing a different set of asthmatics every few years, indicating that this process does usually get better, but that is not quite the same thing as “outgrowing” this hereditary process.

Asthma can usually be controlled once the medications are dosed properly and the asthmatic is more knowledgeable.  Asthma is compatible with professional sports, Olympic medals, and almost any profession.  Asthma does not have to limit your horizons at all.

 

A FINAL WORD

Before you do more in-depth reading on the avoidance techniques, drugs and immunotherapy associated with asthma, take a break.  Remember to write down your questions as you read, learn to expect answers from your physician and keep that “positive mental attitude”.