Asthma is a common respiratory disease that affects children and adults. It is defined as “variable and recurring symptoms with reversible airway obstruction and bronchospasm.” What does this mean? Commonly, people with asthma report cough, chest tightness, wheezing and shortness of breath. These symptoms are caused by spasms of the bronchioles, the branches of the lungs. One of the defining characteristics of asthma is that these symptoms are reversible as long as we use the right therapies. For short term relief, we use albuterol and there are many therapies aimed at preventing bronchospasm from happening. One of the most common frustrations of asthma is that the disease is variable. One day you can feel great and the next day the symptoms can really slow you down.
Asthma is a common disease that can have a significant impact on quality of life. In Colorado, asthma statistics are a little lower than the national averages. But, it is still a common cause of expensive visits to the ER and hospitalizations as well as negative effects on quality of life. The most recent data in Colorado are from 2007. The data reveal that 6.6% of adults and 9.1% of children (age 1-14 years old) report having asthma. In the previous year, 20% of these children used an emergency room or urgent care for asthma exacerbations and 38% of them missed at least one day of school due to asthma. Among adults with asthma, 18% had difficulty sleeping and 19% were unable to work or carry on activities of daily living due to asthma in the past year. About 33% of adults with asthma had an exacerbation in the previous year.
There has been a Renaissance in the field of asthma therapies in the past few years and there is more to come.
Asthma costs grew from $53 billion to $56 billion between 2003 and 2007, about a 6% increase. The majority of asthma costs are caused by patients with poorly controlled asthma. About 5-10% of asthmatics with poor control, miss school or work, go to ER’s and Urgent Cares and require hospitalization are responsible for about 95% of the costs.
Treatments for asthma are legion. Albuterol is a medicine that relieves wheezing and shortness of breath within seconds or minutes of use. The much-needed relief only lasts for about 4-6 hours. It is a beta-agonist working on specific chemical receptors that line the airways making the muscles relax and allowing air back into the lungs. Albuterol has been used for more than 50 years and is very important for helping asthmatics.
About 30 years ago the inflammatory nature of asthma was highlighted. Scientists and patients continued to search for the cause of the chest tightness and the predisposition to the wheezing episodes. What they found were massive amounts of inflammatory cells in the lungs. These cells are very susceptible to steroid therapy, but the long term side effects of high dose oral steroids and steroid shots were not acceptable. So, the first “low-dose” steroid therapy was developed as an inhaled medicine. These medicines help reduce the variability of asthma by keeping inflammation under control. Next, inhaled steroids were combined with long acting albuterol. These medicines have highly publicized names like Advair, Symbicort, Dulera and newer versions like Breo. These are the trade names and are easier to remember than the chemical and generic names.
There is an oral, non-steroid medicine that helps some people with asthma. It is called montelukast or Singulair. It helps some people with mild asthma. However, patients with hard to control symptoms usually need a little more. Another class of medicine for asthma control is anticholinergics. One example is Spiriva. This medication can help with day-to- day asthma control by relieving bronchospasm and reducing mucous production. These two medicines are not steroids and have low side effect profiles.
In the past 3 years, multiple new medications have come to the market. The most interesting development for asthma therapy are therapies that are called “biologics.” These medicines go one step further than steroids when it comes to reducing inflammation. Where steroids stop many inflammatory markers, the new meds focus on interleukins (abbreviation “IL”) and immunoglobulins (abbreviation “Ig). Interleukins play a role by stimulating the bone marrow to produce inflammatory cells that can make certain types of an asthma flare up.
A specific immunoglobulin, IgE, remembers allergy triggers and can function to flare up asthma by stimulating inflammation. Currently, biological therapies blocking IgE and Interleukin 5 (IL-5) have been approved and are available. These medications have had a sensational impact on asthma, but most importantly they can help smooth out the variability of asthma and improve the quality of life for those with moderate to severe and uncontrolled asthma. There are many new biological therapies that are “in the pipeline.” Many of them will be available on the market over the next few years. There has been a Renaissance in the field of asthma therapies in the past few years and there is more to come.
Many people are interested in natural therapies for asthma. While there is limited scientific data regarding any specific herbal supplement, there are many natural options that can help. First, if asthma is triggered by allergies, then identification of those triggers with a board-certified allergist and developing a plan to avoid and treat those triggers could help control asthma symptoms. Second, avoid severe illnesses, get the flu vaccine and aggressively treat infections. Third, mounting evidence supports the role of regular cardiovascular exercise to help keep asthma and inflammation control. Fourth, practice breathing exercises such as are taught in yoga or tai chi class. For younger kids who do not enjoy exercise, they can participate in choir or wind instruments to train respiratory muscles.
Other helpful hints: never smoke – Any tobacco, any marijuana and no vaping for sure. Avoid all smokers, do not get overweight, eat a well-balanced diet with many fruits and veggies as well as the healthy fat found in fish and some nuts. You could work with a dietitian towards these goals.