Asthma is the most common chronic respiratory illness in the United States. It is also a condition for which there is sufficient evidence to support a standardized approach to treatment.
For most, this approach offers a chance at satisfactory control of symptoms and a reduction of any lifestyle limitations that may result from the condition.
For those most severely affected, new therapies are now available that offer the promise of improved control. Yet, despite the evidence base, available therapies and advances in treatment options, asthma continues to limit the daily health and well-being of many Americans, including children and adults.
Asthma is a chronic condition commonly resulting from inflammation in the small airways of the lungs. This produces a tendency toward bronchospasm, which is the involuntary constriction, or narrowing, of the lower airways, trapping air and restricting airflow. The inflammation of asthma is mediated by the immune system and can be related to physiologic processes similar to those underlying allergies.
Symptoms of asthma commonly include wheezing and cough. Wheezing refers to a typically high-pitched expiratory noise produced by turbulent airflow through constricted airways.
The restriction in airflow makes expiration more difficult and prolonged. This may be accompanied by a dry cough, although some asthma sufferers have a variant of asthma in which cough is the main symptom.
For those experiencing significant spasm in the airways, a sensation of chest tightness and breathing difficulty can accompany an asthma flare. While fortunately rare, severe airflow restriction may result in respiratory failure and even death. Both chronic asthma symptoms and asthma flares should be taken seriously.
Chronic airway inflammation associated with persistent forms of asthma can lead to permanent changes in the lower airway, known as airway remodeling. This process can lead to progression of disease symptoms.
There are many known triggers for asthma symptoms, and they vary in impact on individual sufferers. These can include exercise, cold air, viral illness, seasonal or perennial allergies, and acid reflux – just to name a few. Recognizing and avoiding triggers, to the extent possible, can be one effective way to reduce asthma symptoms.
The treatment of asthma is usually tailored to address both the airway spasm and the underlying inflammation. For those with the mildest forms of asthma, only symptomatic treatment may be necessary, although some guidelines are evolving to recognize the role of airway inflammation for all people with asthma.
There is consensus that those with persistent symptoms consisting of frequent wheeze, cough (especially nighttime cough) and measurable airway obstruction require daily treatment with anti-inflammatory medications for control of underlying airway inflammation.
This can both reduce symptoms and their lifestyle impact as well as prevent cumulative airway damage. For those with the severest forms of asthma that are not controlled with standard treatment, newer therapies are now available to address the immune system processes leading to airway inflammation.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.