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Asthma is one of the most common chronic respiratory diseases affecting children
and adults in the United States. In fact, approximately
15% of the population is affected by asthma. Moreover,
mortality rates from this disease have been on
the rise since the 1970’s. Asthma is a frequent
cause of school and work absence, and accounts
for a significant number of physician office visits
each year. This is despite the availability of
newer and more potent medications to treat asthma.
Asthma is an inflammatory disease that affects
the airways (bronchi). The lining of these airways
typically becomes infiltrated with inflammatory
white blood cells such as eosinophils and mast
cells. These cells in turn secrete substances,
such as histamine and leukotrienes that are responsible
for the asthma response.
During an attack of asthma the lining of the
airways becomes swollen. In addition, the smooth
muscle fibers surrounding the airways contract
resulting in a reduction in the diameter of the
airways (bronchoconstriction). Mucous production
is also increased during an asthma attack. All
of the reactions together are responsible for
the symptoms commonly seen during an asthma attack.
Typical symptoms of asthma include breathlessness,
wheezing, chest tightness, and cough. Frequently
encountered triggers include dust, smoke, animal
dander, cold air, and fume exposure. Exercise
is also a common stimulus of asthma attacks (exercise-induced
asthma).
When a pulmonologist suspects that a patient
has asthma, they will inquire as to what symptoms
the patient has been experiencing, and how frequently
they occur. They will also ask whether any symptoms
of allergy, such as eczema, runny nose, itching
eyes, rash are present. A thorough physical exam
will also be performed looking especially for
wheezing or decreased breath sounds. A chest x-ray
will also routinely be taken. Most importantly,
a breathing test called a spirometry will be performed
to measure airway function. If the spirometry
is normal, and the pulmonologist still suspects
asthma, they may perform a more specialized test
called a methacholine challenge. Patients will
often be given a simple device called a peak flow
meter to measure their lung function at home.
The majority of medications used to treat asthma
are administered by some form of inhaler device
or by nebulizer. The current mainstays of asthma
therapy are the inhaled steroids. These are relatives
of prednisone and they work by directly reducing
airway inflammation. Albuterol is also frequently
prescribed and works by relaxing the muscles around
the airways. A newer class of asthma medications
is the leukotriene inhibitors, which are given
in pill form to reduce inflammation. With these
various medications, most asthmatics can lead
normal lives with minimal symptoms
If you suspect that you or a family member has
asthma, you should arrange for an appointment
with your pulmonologist or primary care physician.
Brian M. Legere M.D.
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