Take Control of Asthma Before Asthma Controls You 

By Dr. Sanjeev Jain, MD, PhD

Columbia Asthma & Allergy Clinic

Ste. 101, 3400 SE 196^th AVE

Camas, WA 98607

(360) 834-6700
 

Asthma is one of the most common chronic illnesses that afflict children, teenagers, and adults. The incidence of asthma is rising rapidly; between 1980 to 1995 the prevalence of asthma increased by 67%.  It is estimated that presently nearly eighteen million Americans including five million children suffer from this condition.  Asthma results in approximately half a million hospital admissions and more than five thousand deaths in America each year.  Asthma is the leading cause of absenteeism from school, with more than 10 million school days missed annually.  The yearly financial cost in the United States from asthma exceeds twelve billion dollars.  These statistics are particularly disturbing because asthma is a very treatable disease, and most individuals suffering from asthma can lead normal productive lives by receiving proper medical care and understanding the causes of their asthma.
 

Asthma is caused by inflammation of airways in the lungs which results in swelling of the airways, mucus production, and obstruction to air flow in the lungs.  When examined with a microscope, the airway inflammation in asthma is “allergic,” meaning it is similar in appearance to the inflammation in the nose of individuals suffering from hay fever.  In nearly 90% of children and 60% of adults who have asthma, we can identify the biologic agents or “allergens” which are causing the inflammation of their airways.  Inflammation makes airways twitchy such that they become narrow in response to many “irritants” or triggers.me of the common allergens that cause inflammation of the airways are dust mites, cat and dog dander, mold, pests, and pollen from trees, grasses, and weeds.   Additional triggers for asthma are smoke, dust, pollutants, exercise, cold air, viral infection, and other irritants.  When exposed to a trigger, an asthmatic can have an asthma attack, resulting in wheezing, coughing, chest tightness, or shortness of breath.  In between asthma attacks, some asthmatics may have no symptoms and no activity restrictions.  Others with mild disease or good physical conditioning may have symptoms only during strenuous physical exertion.  Some individuals with severe asthma have difficulty breathing even when resting.

How to Control Asthma

The most important goal in treating asthma is to reduce the frequency and severity of asthma attacks.  If and when an asthma attack occurs, our goal is to make it as mild and as brief as possible.  The first step in achieving these goals is to identify which allergens are causing the inflammation in the airways.  Allergists make this determination either by observing the reaction to suspected allergens applied on the skin, or by using a blood test.  Once the allergens are identified, an individualized plan for reducing exposure to these allergens is developed.  If avoiding allergens is not sufficient or the asthma is more severe, medications are used to reduce the airway inflammation.  These medications are called controller medications and they are not designed to treat an asthma attack.  They need to be used regularly to reduce the frequency and severity of asthma attacks.  Many of these controller medications contain steroids which reduce inflammation.  Steroids, when used long term in the form of pills have many potential adverse effects.  For this reason inhaled steroids are often used since they have very few and relatively mild adverse effects even when used regularly for years.

Many allergists have also studied the effectiveness of immunotherapy or allergy shots for the treatment of asthma.  Most of these studies have showed significant benefit in reducing allergic sensitivity of asthma sufferers and thus improving their symptoms and reducing their need for medications.  However, some asthmatics with severe or prolonged disease may not benefit from allergy shots.  Recent studies have shown that allergy shots significantly reduce the risk of developing asthma in allergic children.

Individuals who have an asthma attack need another class of medications called rescue medications.  They include inhaled bronchodilators such as albuterol which rapidly open up the airways.  Rescue medications provide immediate relief while controller medications take days to weeks to start working.  For this reason some asthmatics tend to over-use rescue medications instead of using controller medications regularly.  This is not a good practice since it leads to inadequate treatment of the underlying disease, and also because bronchodilators may loose their effectiveness if used excessively.  Our goal is to bring asthma under sufficient control so that rescue medications are not needed more than twice per week.

The obstruction in the airways that exists in asthma is at least partially reversible.  However, in some individuals with years of continuous airway inflammation, permanent scarring of the airway lining may occur.  For this reason it is very important to control this inflammation through avoidance of allergens and through medications if necessary.  If an asthmatic is a smoker, permanent scarring of the airway lining is much more likely.  It is therefore essential for asthmatics to stop smoking.  As stated above, smoke is also a potent trigger for asthma attacks.

In summary, all asthma sufferers can find significant relief through avoidance of triggers for their asthma, and proper medical care.  Most asthmatics can live a normal and productive life in spite of their illness.  Studies have shown that receiving medical care from an allergist leads to much better outcomes in terms of asthma control.

Dr. Sanjeev Jain MD, PhD is an allergy, asthma, and immunology specialist who practices at Columbia Asthma & Allergy Clinic, located in Camas at the border of Southeast Vancouver, near QFC on SE 192^nd Avenue. The clinic address is 3400 SE 196^th AVE, Suite 101, and the phone number is (360)834-6700. Dr. Jain is dedicated to providing highest quality medical care to allergy and asthma sufferers in a warm and comfortable community-based clinic. He has won numerous awards, and has been included in the Guide to America’s Top Physicians.

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