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respiratory

Asthma Defined
Viruses and weather changes play a significant role as asthma triggers Viruses and weather changes play a significant role as asthma triggers
Asthma is one of the most common diseases affecting over 30 million Americans. It may start in patients as young as one year of age or it may wait until they are 50. Asthma is a disease characterized by wheezing although many children may present with just a cough.

What is asthma?
Asthma may be defined as a reversible obstructive lung disease (unlike emphysema, which is generally non-reversible). With asthma, the lung tissues become inflamed causing them to be hyper-responsive to environmental factors such as allergens (pollens, molds, pet dander, and/or dust mites). Viruses and weather changes play a significant role as asthma triggers. Patients with asthma may experience symptoms all of their lives or the symptoms may be sporadic. Genetics play an important role in determining the age of onset and the severity.

Who gets asthma?
Infants are known to wheeze, particularly in the winter months when they get a common virus called RSV (respiratory syncitial virus). This condition is not asthma, but the RSV may “sensitize” these children to develop asthma at a later age. If there is a strong family history of allergic disease with or without asthma, many of these children may start their asthma symptoms (wheezing and coughing) by age one. Some physicians are reluctant to use the word “asthma” and instead use the diagnosis of “reactive airways disease.” I am sorry to say that this is just a play on words, for reactive airways disease IS asthma! In children, adolescents, and young adults asthma is frequently associated with allergy. Many adults may get asthma at a later age, such as 50, and it is usually not associated with allergy. As women get older, menopause may trigger the onset of non-allergic asthma.

As women get older, menopause may trigger the onset of non-allergic asthma How do we diagnose asthma?
As with any disease, history taking is most important. A history of allergy or asthma in the family is an indicator. Of course, the patients’ history of seasonal or year-round coughing and/or wheezing is significant. Coughing or shortness of breath with exercise, nighttime awakenings with coughing are also significant clues. The best test for determining asthma is the lung function test. Children under the age of four generally have a hard time performing this test and the diagnosis must rely on family history and physical examination. However, by age four most patients are able to perform lung functions testing. These tests will determine lung volumes and possible obstructions. Then, an aerosol treatment may be given with a lung dilator and the test performed again to determine if reversibility is present. We must be aware of other diseases that might present with similar symptoms. Patients may wheeze or cough as presenting symptoms of GERD (gastro-esophageal reflux disease = acid reflux), sinusitis, aspirin sensitivity, heart disease, and chronic bronchitis. Certain medications such as beta-blockers (used for blood pressure control or heart disease) can cause or worsen wheezing.

How do we treat asthma?
Treatment guidelines have been published by the NIH (National Institute of Health) and are generally followed by most physicians. Medications are generally chosen depending upon the level of severity. Currently, there are four levels: (mild intermittent, mild persistent, moderate persistent and severe persistent). When symptoms occur more than once weekly, or awaken you every week or so, you are generally considered to be in the mild persistent category. Therefore, it is recommended that you be started on a daily inhaled steroid. Even children as young as age one who are diagnosed with asthma should be taking an aerosolized steroid daily. Recent studies have shown that children, who are not started on inhaled steroids early, may suffer from decreased lung functions as they get older. As patients progress up the scale of severity, further medications are added such as long-acting lung dilators (i.e. Serevent), Singulair, Theophylline and even systemic steroids. Many parents may be reticent to start their children on inhaled steroids, but recent evidence has shown that children reach their full adult height as long as dosages for their ages are followed.

The following is a list of medications used for asthma: Steroids (Flovent, Asmanex, Pulmicort, Q-var), Long-acting lung dilator + steroid (Advair, Symbicort), Short-acting lung dilators (Proventil, Ventolin, Pro-air, Xopenex), Long-acting lung dilators (Serevent, Foradil) should only be used in combination with an inhaled steroid. Non-steroids (Singulair, Intal, Tilade, Theophylline, Zyflo, Accolate).

The good news
Asthma treatment has come a long way since the 1970’s and 1980’s. Asthma deaths have decreased over the past year due to the advent of the newer combination medications. If you feel you or your child may have asthma, seek out an asthma specialist. Allergists are at the forefront in diagnosis and treatment of asthmatic diseases. In addition, don’t let anyone fool you. Children may not “outgrow” their asthma, and it is never too early to see a specialist.

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"Asthma Defined"
   authored by:
ALLERGY
Thom F. Rosenberg, M.D., a graduate of The Chicago Medical. Pediatric internship and residency @ The Childrens' Hospital of Pittsburgh. Allergy & Immunology Fellowship @ The University of Pittsburgh Hospitals and The Childrens' Hospital of Pittsburgh...



COPD... cigarette sm...

Asthma Defined