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House Calls / Dr. Michael Schwartz

Published 1:35 pm, Monday, February 25, 2013
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Asthma is a disease of the lungs. Although the most common symptoms are wheezing and shortness of breath, there are many atypical symptoms as well. A tickle in the throat, a cough or even tightness in the chest may indicate that someone has asthma. Currently, more than 20 million Americans suffer from asthma. Unfortunately, many don't even know that they have the disease.

Years ago, asthma was considered to be a disease of narrowing of the airways. It was often treated with quick-acting inhalers which would dilate or enlarge the size of the airway. After years of research, it was discovered that asthma is much more complex. Although the exact cause of asthma is still poorly understood, it appears that inflammation plays a major role in the disorder. Patients who are not properly diagnosed and treated can develop chronic scarring of the lungs. Ultimately this scarring leads to lung destruction.

Asthma attacks can be severe. Last year there were more than 200,000 hospital visits for asthma-related symptoms and more than 10 million doctor visits. Thousands of people die each year from the disease. Fortunately, asthma can be easily diagnosed and effectively treated.

Asthma is generally diagnosed using a breathing test called a spirometry. A patient is asked to blow into a device which measures air flow. When the flow is reduced, it often signifies the presence of the disease. Once detected, a physician administers an inhaled medication (a nebulizer) and then repeats the test. The results are then compared to determine the appropriate treatment. The test is quick and painless. Once confirmed, treatment can be initiated.

Asthma facts

Chronic asthma can cause daytime fatigue and nighttime insomnia.

Triggers include allergies, cold air, pollution, pet dander, molds, tobacco smoke, perfumes, chemical irritants and even exercise.

Certain medications including some blood pressure pills, aspirin and anti-inflammatories (e.g. Ibuprofen) can worsen symptoms.

There is no cure for asthma. However, avoiding known triggers and compliance with prescribed medications can significantly alter the progression of the disease.

Reflux disease (indigestion) can worsen asthma symptoms.

Treatment

Treatment options vary depending on the cause of the asthma. Inhalers are the mainstay of therapy. These include inhalers for immediate relief (e.g. Ventolin, Proventiland Proair) or inhalers for maintenance therapy which often include a steroid (e.g. Asmanex, Advair). "As a general rule of thumb, if you require your rescue inhaler more than two to three times a week, you probably should be on an anti-inflammatory inhaler on a regular basis. This is in an effort to prevent any long-term irreversible changes," said Dr. Joseph Sproviero of Fairfield County Allergy, Asthma and Immunology Associates in Norwalk.

Dr. Sproviero also emphasizes the importance of screening patients for asthma. "There are also the `poor perceivers' -- those individuals who don't complain of any symptoms but whose lung function is significantly diminished. Therefore it is important to do a breathing test on all asthmatics."

Antihistamines and other medications may be used to target the specific causes of the inflammatory response in the airways, thus reducing the frequency and severity of attacks.

Other options include allergy shots, which work to reduce the body's reaction to inhaled triggers.

Unfortunately, many asthma medications do have side effects. These include palpitations, feeling shaky and an increase in blood pressure.

Recommendations

Don't smoke; avoid smoky environments. Cigarette smoke is a leading cause of asthma symptoms.

Pets with fur tend to cause more problems than pets with hair. Thus, some animals seem to be more hypoallergenic than others. Avoidance is the key if you have pet allergies.

Cover your mattress and pillows with specially designed hypoallergenic covers. This will reduce your exposure to dust mites which can worsen symptoms.

Clean your home and office air ducts. These can harbor dust and mold. Replace your air filter twice a year.

Avoid going outside on cold days. Asthma symptoms may also worsen with high humidity or smog.

If you have exercise-induced asthma, a short-acting inhaler can be beneficial. Remember to take one puff about 30 minutes before exercise. Take a second puff about 10 to 15 minutes later. Separating your puffs is important. The first puff will open the upper airways, allowing the second puff to get to the lower airways.

Keep a diary of your asthma symptoms. Identifying the cause and then avoiding those triggers can significantly decrease the likelihood of future attacks. Peak flow meters can be very helpful. These are devices which measure the force of exhaled air. The patient blows into this device and then records a number. In an acute asthma attack, this value will decrease from normal, which can help identify if the asthma is the cause of one's symptoms.

Finally, learn the proper use of an inhaler. These devices can be tricky. If they are not used properly, they can cause worsening symptoms. Specially designed "spacers" can improve delivery of these drugs into the airways. Discuss this with your physician. You don't appreciate breathing until you can't. If you think you may have asthma, take a deep breath and see your doctor today.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, please visit his website at www.drmichaelbschwartz.com