Asthma: Inflammation of the airways

There are over 15 million asthma sufferers in the U.S. The incidence of this disease has risen four-fold in the last two decades. This time of the year can be hard for individuals with asthma and other chronic respiratory problems due to the heat, high humidity, and environmental irritants.

Normal breathing or “respiration” is for the purpose of getting oxygen into the body and removing carbon dioxide from the body. This process depends on an unobstructed flow of air through the bronchial tubes, into the lungs, and then back out again. In asthma, this flow of air is impeded, and breathing is restricted.  

There are two major components to the respiratory condition of asthma. The first is inflammation of the lining of the bronchial tubes. The second is constriction of the bronchial tubes in response to irritants and other stimuli, such as pollens, animal dander, smoke, exercise, and temperature changes. Both inflammation and constriction in the bronchial tubes reduce the size of the opening through which air can move. When acute constriction occurs, it is called an asthma attack.

Because air is moving through smaller than normal passageways in an asthma attack, wheezing will occur.  Wheezing is the cardinal sign and symptom of asthma. Coughing can also occur. In severe asthma attacks, individuals are working harder to breathe and may use other chest muscles in an attempt to get more air. This is called accessory muscle use.  Retractions can be seen when the breast bone pulls inward as the individual attempts to draw in each breath.     

Children are more likely to develop asthma if there is a family history of asthma, if they have allergies (food or environmental), or if their mother smokes during pregnancy. Those that develop asthma at an age less than five years old are more likely to have chronic lung problems later in life. Some children will “outgrow” their asthma due partly to the fact that, as they age, their bronchial tubes become larger and less susceptible to severe constriction.

Asthma severity is divided into four classifications. The first group is intermittent asthma. These individuals have symptoms one or two days per week. Symptoms easily respond to inhaled bronchodilators (albuterol), so-called “rescue” medicines.  Some individuals will have exercise-induced asthma, meaning an attack is triggered only with physical exertion.

The second group is mild persistent asthma. These people have symptoms most days of the week. They usually require daily medicines to prevent worsening of symptoms and rescue medicines in case of attacks. The third group is moderate persistent asthma. They have daily symptoms that require daily medicines as well. And the final group is severe persistent asthma. These individuals have almost constant symptoms, which requires daily anti-inflammatory medicines and bronchodilators, and may require more potent medicines such as steroid pills.  

Asthmatics can track their condition by using a peak flow meter. This is a small plastic, hand-held device that can monitor the “openness” of their airways.  If they see a decline, they can take precautions and adjust their medicines to prevent an attack. With more severe drops, they can consult their physician. Asthmatics can be at greater risk for complications when they develop acute respiratory infections. They should always be followed closely by their primary physician.

Thousands of individuals will die each year from asthma. Like most health conditions, the key is controlling the disease through active patient involvement. This means being aware of their current breathing status and taking their medications as prescribed.

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.

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