[Allergy & Asthma Corner]

Recent national health statistics reflect a significant drop in the number of people dying from asthma over the past 5 years. That is the only good news. Hospital admissions and emergency department visits have not decreased. Furthermore, death rates in African-Americans and Puerto Rican based Hispanics have not gone down.

Well controlled asthma is a major goal of asthma management.

Well controlled asthma means:

1) You need your reliever inhaler less than three times per week during the day (exercise preventive puffs are not counted)

2) You have chest symptoms in the middle of the night or before planning to get up in the morning less than three times per month

3) You have no limitations due to asthma at work, home or school

4) Shortness of breath occurs less than three times per week

5) Your lung function is normal (by Peak Flow Rate or Pulmonary Function Test)

The most common reasons for failure to maintain or achieve good control of asthma that I have observed are:

1) Lack of an adequate daily controller medication (Flovent, Qvar, Pulmicort, Asmonex and others)

2) Lack of consistent use of a prescribed controller (many doses missed over time)

3) Poor inhaler technique:

a) Forgetting to completely empty the lungs (blow out) before inhaling the drug.

b) Not holding the inhaled medication in the lung long enough (should be at least 10 seconds)

c) Not shaking aerosol metered dose inhalers before using them

4) Failing to properly prime aerosol inhalers (each inhaler has its own priming information)

5) Not periodically cleaning the aerosol inhalers.

6) Lack of an established action plan reviewed by the asthma specialist

7) Unmet goals in reducing exposure to environmental allergens and irritants (pets, dust mite, tobacco exposure, fragrances etc.)

8) Additional medical problems that may worsen or complicate asthma which are either not identified or inadequately treated (sinus infections, gastric reflux “GERD”, allergic nasal problems, sleep apnea and anxiety and/or depression).

9) Poor understanding of asthma triggers and how to avoid them

10) Fear of asthma medications especially if expected to be used over months to years.

What can be done?

First, recognize that your asthma is not well controlled. Could one or more of the issues mentioned above be the reason? New asthma guidelines focus on how health providers should assess severity and control of asthma.

Board certified allergists are skilled in managing asthma. Are you seeing one?

If you are one of my patients and do not feel your asthma is well controlled call the office and arrange for a follow-up visit. If you cannot get an appointment within 1 month send me an email at: allergyqa@aol.com

Please review my postings on: Inhaler technique (Are You a Failure With Your Inhaler-March 1, 2007),

New HFA Inhalers: What You Should Know- Feb. 2, 2008 and Asthma Checklist- March

 25th, 2007 (also Asthma Control Test- March 2nd 2007)

Regarding: Common cold or allergy symptoms

Choose the one best answer-

1) Allergy symptoms tend to:

   a) Have a more abrupt onset and last for weeks

   b) Evolve over a few to several days then go away within a week

   c) Last for a just a few days

   d) Always go away by age 60

2) Allergy symptoms usually do not include:

   a) Runny nose, nasal congestion, itchy and watery eyes

   b) Fever, muscle aches and marked fatigue

   c) Sneezing and mild fatigue

3) Cold symptoms may be improved by:

   a) Antihistamines and nasal decongestants

   b) Rest and drinking plenty of fluids

   c) Some allergy nasal sprays prescribed by your doctor

   d) All the above

4) Cold symptoms and allergy symptoms:

   a) Respond well to allergy shots

   b) Are helped considerably by allergy environmental controls

   c) May precede a sinus infection and require antibiotics

   d) Are often equally responsive to allergy medications

5) There are well controlled studies (good scientific methods) that prove:

   a) Herbal teas and pills for colds are effective (e.g. Echinacea)

   b) Airborne is effective for the common cold

   c) A yeast free diet will reduce the risk of catching a cold

   d) None of the above

Answers in the Answer Widget

See my comments on drug ads aimed at the consumer:

www.healthcentral.com/allergy/c/3989/21139/docs-direct-drug/

Please leave a comment!

This is a question that is asked at least once weekly in my office. When children have lived with the diagnosis (of asthma) well past first grade, the answer is usually the same. Asthma is a genetic based disease which currently has no cure but can be well controlled in the majority of instances. Some young children are fortunate to have a remission period as they reach late adolescence. Many of those who experience a remission period have more asthma symptoms years later. Generally speaking, asthma is a life long disease.

But what about the younger child with wheezing in the first three years of life?

Actually a number of studies have followed children from infancy in order to analyze the natural course of the early wheezer. A study out of Tucson, Arizona (Tucson Children’s Respiratory Study) looked at 1,246 neonates over a 4 year period, and established three subclasses of wheezing children.

Transient Early Wheezing

About 60% were in this class (the largest class).

These children tended to have:

-Recurrent wheezing in the first year of life (sometimes very severe episodes)

-Typically chest symptoms were gone by 4 to six years of age

-Some major associations were: maternal smoking during pregnancy, poor lung function early on, male gender, day-care exposure, older siblings in the home and bottle propping in the baby bed or crib (thought to cause some reflux, especially after feedings)

Nonatopic Wheezing

About 20% of the children were in this category.

Their characteristics were:

-Premature birth was much more common

-A wheezing lower respiratory tract infection before one year of age was very common

-90% of these children had no further chest symptoms by school age (5)

-The majority had normal lung function at puberty

-Commonly effects children in developing countries and those in inner city areas of big cities in the U.S.

-RSV (Respiratory Syncytial Virus) was a common cause of the lower respiratory infection in these children

Atopic Wheezing

This group represented another 20% of the total studied.

These children represented the subset that more often went on to have asthma:

-Typically had a personal or family history of environmental allergic hypersensitivity

-Somewhat later episodes of intial wheezing compared to the other groups (first wheezing in 2nd or 3rd year of life)

-Reduced lung function at 6 years of age

-More common in the males, if either parent had asthma, if the child had allergic eczema, eosinophilia in infancy (measured in a routine CBC with differential- Total red and white blood count)

Bottom Line

Asthma is a disease which has many possible presentations (cough, wheeze, chest tightness, shortness of breath, chest pain). It represents interplay between genetics and environment. Young children, pre-school age, commonly wheeze. The likelihood that they will grow out of it is strongly associated with the presence or absence of allergic problems or family history of allergic airway problems. The child that from infancy on, has fewer wheezing episodes, no personal or family history of other allergic problems and good lung function at school age, has a good chance of not having asthma.

Tucson Study: Martinez f., Godfrey S. Epidemiology of wheezing in infants and young children. In: Martinez F, Godfrey S, eds. Wheezing Disorders in the Preschool: Pathophysiology and Management. London NY: Martin Dunitz 2003:1-19.