Are you having difficulty with recurrent cough?
Is your sleep disturbed by cough or breathlessness?
Is your ability to exercise or compete in sports limited by shortness of breath or the feeling of chest tightness?

The following few pages review asthma management. Education is a key component of good asthma control. Our care is only as good as the teaching we provide. If, after reviewing this information, you have any additional questions concerning your asthma care, please let us know at your next appointment or contact us sooner.

Asthma is an inflammatory condition of the lungs that leads to recurrent episodes of airway obstruction. Typical symptoms include wheezing, chest tightness, cough, or shortness of breath. Asthma affects 4.6% of the population or an estimated 11.5 million Americans. Asthma attacks are responsible for over 1.9 million emergency room visits and approximately 500,000 hospital admissions per year. The prevalence of asthma has increased 75% over the last 20 years. Unfortunately, the rate in younger children is increasing the most. Fortunately, with adequate recognition and proper treatment, the quality of life of asthma sufferers has improved.

The first step to getting asthma under control is proper diagnosis. There is no simple test to determine if you have asthma. The diagnosis is based on the recognition of symptoms that suggest narrowing of the airways or chest congestion. If you experience wheezing, chest tightness, cough or shortness of breath, you may have asthma. These symptoms sometimes can be confused with other conditions such as recurrent croup, bronchitis, or recurrent pneumonia. Reactive airway disease (RAD) is another common diagnosis given to young children with asthma. Children with RAD have a type of asthma triggered by upper respiratory tract infections (common colds). Another important step in the diagnosis of asthma is performing a simple breathing test that can detect ongoing airway obstruction. This test can be performed in adults and most children older than 4 years of age. You do not have to have evidence of airway obstruction on this test to have asthma but if detected it may alter how your doctor treats your asthma. Finally, it is important to consider several other medical conditions that may lead to cough, wheezing or chest tightness. Gastroesophageal reflux disease or heartburn, chronic sinus infection, heart disease, and swallowed foreign body all may cause asthma-like symptoms. Until these issues are detected and treated, your symptoms will likely persist.

The next step is to properly classify the severity of your asthma so an appropriate asthma treatment plan can be developed. At the most basic level, you can think of asthma symptoms as persistent or intermittent. Persistent symptoms would require daily treatment while intermittent asthma would only require treatment when symptoms flare. Patients with persistent symptoms have chest tightness, wheezing, chest congestion, or cough. These symptoms occur more frequently than two times per week during the day or more frequently than two times per month at night. If you have an easily inducible cough triggered by laughing, exertion, breathing cold air, or if exercise is limited by asthma symptoms, then your asthma may not be under good control. Persons are also thought to have persistent asthma if they have frequent asthma attacks or severe asthma attacks, even if they rarely have any symptoms at any other time. Another indication of poor asthma control is the frequent use of rescue inhalers (albuterol). Rescue inhalers should only be required for relief of symptoms during asthma flares. The last consideration for assessing severity is measuring lung function by a simple breathing test. If obstruction is detected by this test then this may indicate persistent asthma.

Once your asthma severity has been determined, a treatment plan will be recommended that is appropriate for your degree of symptoms. The following description is not intended to serve as specific recommendations for the reader. For persistent asthma, this management plan will include daily preventative treatment. Inhaled corticosteroids are the mainstay of preventative asthma therapy. Several different devices are available to deliver inhaled steroids. We will teach and review the proper techniques used with any device prior to prescribing it for your asthma. Another commonly used preventive medication blocks a mediator of allergic inflammation called leukotriene. This medication may be used as add on therapy to inhaled corticosteroids or alone in patients with good response. The next step of your asthma management plan provides instructions on how to treat the inevitable flare. Bronchodilators (albuterol) are delivered via inhalers or nebulizers for the quick relief of asthma symptoms. These can be safely administered at home every 4 hours. If symptoms require more frequent dosing of a bronchodilator then you should seek medical evaluation. Bronchodilators do not alter the course of an asthma flare. The second step of treating an asthma flare is to increase the dose of corticosteroid delivered to decrease the severity and duration of the attack. Typically we will advise you to initiate an inhaled steroid or double the dose of your current inhaled steroid. If you have severe symptoms or symptoms that have not improved, then oral steroids (prednisone or Orapred) may be prescribed for several days.

Asthma is not a static disease. The degree of symptoms can vary from flare to flare and patients may experience periods of more severe persistent symptoms. To maximize control of a disease with changing severity, symptoms should be monitored closely and the treatment plan should be adjusted to reflect the degree of severity. If we do not recognize deterioration in asthma control, we risk more severe asthma flares and patients can experience poor quality of life. During periodic follow-up visits we will ask questions to assess the degree of persistent symptoms and to determine the frequency and severity of asthma flares. Another important part of monitoring during your asthma follow-up visit is performance of a breathing test called spirometry (blowing out the candles). Through adequate treatment the normal lung function decline caused by asthma is preserved. Spirometry helps us to tract your lung function, and we use the results to make decisions regarding your asthma management plan. The patient is the most important part of successful monitoring. We rely on you to track symptoms and asthma flares. We will teach you during your routine asthma evaluations to look for symptoms of uncontrolled asthma. We may also ask you to periodically monitor peak flows with a simple device called a peak flow meter. This gives you and us a quantitative measurement of how your asthma is doing on a daily basis and can help you correlate symptoms with a measurement of lung performance.

We do not have a cure for asthma, nor do we know how to prevent it from occurring. We do know that different types of environmental triggers can contribute to airway inflammation and thus asthma. Triggers are grouped as either allergens or irritants. Not all asthma is caused by allergies but allergies do play an important role in many patients with persistent asthma. Any patient with persistent asthma should undergo allergy evaluation. If allergies are found, then avoidance measures can be undertaken which will make treatment more effective. In patients with asthma symptoms triggered by allergies, immunotherapy (allergy shots) alters how the body reacts to allergens, which can result in significant improvement is asthma control. Irritants such as cigarette smoke, air pollution, and chemicals can increase airway inflammation and make asthma more difficult to control. There is no specific test for airway irritants but avoidance of known triggers of asthma is recommended.