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Asthma 101

Posted Aug 24 2008 1:49pm
ANNOUNCER: An estimated 25 million Americans have asthma. Some of those people experience occasional shortness of breath. But asthma can be more serious, and should never be ignored.

NANCY OSTROM, MD: Asthma is both a nuisance, for people that aren't breathing as well as they might be, and a very, very serious problem, in that it can cause death. There are approximately 5000 deaths a year from asthma. And the good news is most of these could be prevented.

ANNOUNCER: Asthma is the result of a several-stage process.

ELLEN CRAIN, MD: It usually is thought to involve three components: swelling of the airways, constriction of the muscles around the airways, and inflammation.

NANCY OSTROM, MD: There's a broad range of symptoms that people can experience with asthma, from having intermittent tightness or wheezing when they perhaps do heavy exercise and being perfectly normal in-between those periods to having daily wheezing, tightness of the chest, difficulty getting a good deep breath, even disruption of sleep with difficulty breathing at night.

ELLEN CRAIN, MD: A typical asthma attack usually begins with coughing, maybe some shortness of breath or feeling of tightness in the chest, and then goes on to more obvious evidence of real difficulty breathing.

NANCY OSTROM, MD: The causes of asthma are not entirely clear, but it does seem that there's generally a genetic predisposition. Once someone has a predisposition, the actual triggers of asthma are varied, but some of the common ones are cold air, exercise, infection, common viruses, irritants and allergies.

ANNOUNCER: Sometimes, avoiding the irritation is all that is necessary.

JAMES KEMP, MD: Asthma can be very easily managed by an environmental modification if the individual is only allergic to one or two substances where they can be eliminated or significantly minimized in the environment. I'll give you an example of that.

If the individual is allergic, let's say, to an animal that's indoors, taking that animal from the bedroom to the living room, or maybe, more ideally, to the kitchen or outdoors eliminates that stimulus for inflammation, and therefore inflammation will diminish and the asthma episodes should diminish.

ANNOUNCER: But often, avoiding asthma triggers is not possible. So in practice, asthma usually requires medical therapy.

NANCY OSTROM, MD: Anyone who has symptoms of asthma needs treatment. It's a matter of whether they need it intermittently or something of a more preventative nature.

ANNOUNCER: If it's to quell an attack, asthma medicine is called "reliever" medicine.

JAMES KEMP, MD: It's sort of like if you're prone to bleeding, you want to have a band-aid around, you know? If you're prone to wheezing, you want to have something around. These are generally what we call bronchodilators.

NANCY OSTROM, MD: When the asthma is persistent, however, treatment is needed to control both the underlying cause, the inflammation in the lining of the airways as well as the constriction of the airways.

JAMES KEMP, MD: Asthma is like a disorder in the lung, like people who have arthritis have a disorder in their joints. Their joints get hot, swollen, you know, painful. Similar things are going on with asthma in the lungs. So we use anti-inflammatory medicines or controller therapies.

There are several different categories of those, but the most effective and the most potent are the inhaled corticosteroids

ANNOUNCER: For people with persistent asthma, age five and above, federal guidelines call for the daily use of inhaled corticosteroids.

There are 7 steroid inhalers approved for the treatment of asthma: Aerobid, Azmacort, Flovent Rotadisk, Flovent, Pulmicort Respules, Pulmicort Turbuhaler and Q-VAR. Doctors find patients are often alarmed, although unnecessarily, about the use of steroids.

NANCY OSTROM, MD: If I ever say the word "steroid" in my office, I use the word "corticosteroid." People are scared of the word "steroid" because there are muscle-building steroids that can have serious side effects.

ANNOUNCER: Steroids used to fight asthma are of a different type, with much milder side effects. And the steroids taken by inhalation to treat persistent asthma are considered very safe. Especially in low doses.

NANCY OSTROM, MD: The good news is that the vast majority of patients who require treatment with inhaled corticosteroids do not require very, very high doses. And therefore are in a low- to moderate-dose category, where the risks of side effects are actually very minimal and the risk of good effects significantly outweigh the risks of side effects.

ANNOUNCER: While incidents of asthma appear to be on the rise across the United States, doctors say they have medicine to keep most cases under good control.

That means less chance of a serious attack. And a good likelihood that patients can go about everyday activities, even athletics, without any disabling shortness of breath.

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