Asthma Week

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General Information

Asthma Week

Asthma is a chronic inflammatory lung disease that is characterized by inflammation and narrowing of the airways. It is a very common disorder with more than 20 million people affected in the United States and 300 million people affected worldwide. Asthma has been on the rise since the 1980s, and the most recent data from the Centers for Disease Control indicate that it is prevalent in 7% of adults and 8.3% of children in the United States. Adult females are affected more than adult males, but male children are affected more than female children. Additionally, the disease is more common in African Americans and Puerto Ricans than the rest of the population.  Asthma is a significant health and economic burden, as each year it is responsible for approximately 9 million doctor visits, 2 million emergency department visits, $56 billion in health care expenses and four thousand deaths.

Patients with asthma have very sensitive airways that become inflamed, narrowed and blocked.  During an asthma attack, mucus clogs these inflamed airways and airway muscles tighten which further compounds the narrowing. These changes cause difficulty in airflow and air delivery to the alveoli in the lungs. The typical symptoms that patients experience during an asthma attack include shortness of breath, chest tightness, wheezing and coughing. It has been shown that the development of asthma is higher in those are genetically more ‘atopic’ (more predisposed to develop allergies), have occupational and environmental exposures. These patients have airways that are hyper-responsive to certain environmental exposures called triggers. Dust mites, tobacco smoke, viral infections, exposure to pets, mold and air pollution trigger asthma attacks. Some patients can also have increased symptoms during exercise, changes in weather or exposure to other known allergens.

The diagnosis of asthma can be made by a detailed history and physical examination. The presence of wheeze and coexistence of conditions like allergic rhinitis, polyps and atopic dermatitis suggest asthma. Spirometry is an essential diagnostic breathing test that documents airflow obstruction. A peak flow meter can be used at home to look for worsening airflow. Managing asthma involves reducing risk by identifying and avoiding triggers and reducing impairment by maintenance treatment. Drugs used include short and long acting bronchodilators, inhaled and oral corticosteroids, leukotriene antagonists, mast cell stabilizers and theophylline. A step up approach by gradually increasing treatment until control is achieved is used. Regular follow-up with the primary doctor and pulmonologist is essential. Medication use, adherence and technique, ways to control exposures and immunization are aspects of care that are reviewed at every visit.

Severe asthma requires high doses of inhaled steroids in addition to a second controller agent or oral steroids for more than 50% of the year to prevent uncontrolled symptoms. Conditions that are known to masquerade or contribute to asthma such as obesity, vocal cord dysfunction gastro-esophageal reflux and psychological factors are sought in these cases. These patients need close follow up an asthma specialist. Options for treatment include omalizumab ( anti-IgE antibody) for certain patients who have IgE dependent asthma, tiotropium (long acting muscarinic antagonist) and bronchial thermoplasty in very select patients. Asthma care requires an inclusive management strategy incorporating education of patients and families, close follow up and appropriate medical therapy to prevent progression and impairment.

Important Facts About Asthma

  1. More than 25 million children (1 in 11) and adults (1 in 12) live with asthma, making it one of the most common and costly diseases. 

  2. Each year, over 3,000 US asthma deaths occur. Low income and minority children bear the heaviest burden of asthma, including death.

  3. An estimated 50 million Americans suffer from all types of allergies (1 in 5 Americans) including indoor/outdoor, food & drug, latex, insect, skin and eye allergies.

  4. Allergy is the 5th leading chronic disease in the U.S. among all ages, and the 3rd most common chronic disease among children under 18 years old.