Health Chats
Asthma: Diagnosis and Treatments
Friday Aug 26, 2011, 01:00PM - 02:00PM (EST)
Sumita Khatri, MDBlank
Physician
Cleveland Clinic
Pulmonary, Allergy and Critical Care Medicine, Cleveland, OH
Asthma is a common chronic disease that affects the airways of the lungs and ultimately results in the inflammation of the air passages, making it very difficult to breath. It affects about 5 to 10 percent of children in the United States and is the most common chronic condition of childhood. Asthma symptoms can begin at any age from infancy through adulthood and although the rate of prevalence is increasing, the death rate from asthma is on the decline.<br><br> A person with asthma has very sensitive airways that react to a variety of external factors, or "triggers." These triggers cause the airways to tighten and become inflamed and blocked with mucus, resulting in difficulty breathing. An acute asthma attack can begin immediately after exposure to a trigger or several hours or days later. Some people are affected by numerous triggers; others may not be able to identify any. Recognizing and avoiding triggers, when possible, is an important way to control asthma. While it can be controlled, asthma cannot be cured. It is not normal to have frequent symptoms, trouble sleeping, or trouble completing tasks. Appropriate asthma care will prevent symptoms and visits to the emergency room and hospital. However, asthma can also be life threatening, especially when serious cases are not effectively managed by use of an inhaler or medication. <br><br> Take this opportunity to learn more about asthma, including diagnosis and treatment for severe asthma, and have your questions answered by Dr. Sumita Khatri from Cleveland Clinic.
MedHelp:
Hi Everyone! Welcome to the Asthma Health Chat. We'll be getting started soon but in the meantime, feel free to submit your questions.
MedHelp:
Welcome Dr. Khatri and thank you for taking the time to answer questions today.
Sumita Khatri, MD:
It's my pleasure to be here, hope I can be helpful in some way!
kristine24:
Hello, my mother, a 66 year old woman, is experiencing nonproductive and itchy cough at night and I wonder if it is asthma. Since it is only her cough without wheezing, and clear lung sounds can it be asthma? Also, she sometimes have congested nose at night and often clears her throat after she coughs. Thanks for helping me.
Sumita Khatri, MD:
Asthma can often present with only a cough. Wheezing is common but not necessary. If there are symptoms like chest tightness it makes it more likely to be asthma.
Sumita Khatri, MD:
That being said, upper airway irritation from allergies either on its own (rhinitis/sinusitis) or by making asthma worse can give this picture. Best to be seen and consider breathing tests to further evaluate.
FAASGmom2:
Thanks for doing this chat!  I am a Mom to a highly allergic 10yr old daughter.  Why does Singulair work for some and not all people?  We add it to her regime of meds during pollen season and it helps her asthma and her allergies a lot.
Sumita Khatri, MD:
Singulair works to interrupt a pathway of inflammation related to 'leukotrienes'. Certain types of asthma have more leukotriene related irritation. For instance, exercise or cold-induced asthma. However, some people with allergies and sinus problems do well with adding Singulair as well.
Sumita Khatri, MD:
The challenge is to find the right regimen for each individual because asthma is a spectrum of a condition, not just one disease. Therefore partnering with a caregiver that tailors the regimen for the individual is key.
Sumita Khatri, MD:
Sounds like you are doing that with your doctor and you've found the right combination of 'just enough but not too much'. That's what I try to do with my patients.
uteman:
I am 58 years old and began developing  tightness when trying to take a deep breath approximately 10 years ago.  This is intermittent and I notice it occurs when I have developed a sinus or throat infection. I saw a pulmonologist and had pulmonary function tests. These came back normal. Yet, the doc prescribed Ventolin prn and gave me a dx of asthma. Would this be your dx? Also, I have had allergies all of my life but have never had any lung issues. Thanks
Sumita Khatri, MD:
Asthma is condition with symptoms that can be in episodes that are intermittent or persistent. Sounds like in your case, it is more intermittent. Often asthmatics DO have normal pulmonary function tests, and we are left to make a clinical diagnosis. This is what may be possible in your case. However, to avoid being on medications long-term, you can pursue further testing with a diagnostic test called a 'methacholine challenge test'.
Sumita Khatri, MD:
The important point, though, is that if you need ventolin frequently, you should be on a controller medication.
tda76:
Hi I have been having trouble finishing a sentence without running out of breath and if I do anything physical or around someone who smokes I cant get in enough air could this be from asthma?
Sumita Khatri, MD:
Yes, this sounds very suspicious for asthma. Please go see your regular doctor for initial evaluation and then a specialist (pulmonary or allergy) if you need further management.
Maljo:
I have taken advair, symbicort, and now dulera. All three make me lose my voice. I'm a singer and teacher and need to be able to have a clear strong voice. Any recommendations on inhalers? I still need to be able to breathe as well.
Sumita Khatri, MD:
Hoarseness can be a side effect of inhaled steroids. Usually this can be curtailed by using a spacer and rinsing your mouth after use. Reviewing the asthma inhaler technique with an asthma nurse or educator may be helpful.
uteman:
Thanks for your response. Would the methacholine challenge test give a more definitive dx? What does it entail?
Sumita Khatri, MD:
It is a test with serial inhalations of a chemical called methacholine followed by serial breathing tests. It simulates an 'asthma flare' without the actual asthma flaring up. This can help determine whether you should, in fact, be on regular asthma meds.
BoldStac:
I notice that every time I eat something hot or sweet, drink milk or something creamy, get excited like happy or if the weather is to hot or cold I get these clicks in my chest and can hear them as well. It feels as though my lungs close, stick and cut off my air supply. I get this strong urge to cough and try to clear my throat like theres mucus trapped and won't move. What can this mean?
Sumita Khatri, MD:
It means that you are very observant and likely have many triggers that may be worsening asthma, if you have it. Inflammation from asthma can increase mucus production, and you seem to have a mucus-y response. Getting breathing tests would be helpful, as even some minimal asthma medications may help you feel better quickly.
mzrichee:
Can you explain what happens during an asthma attack?
Sumita Khatri, MD:
Each person can be different. But usually, it starts with coughing and chest tightness, wheezing, inability to catch one's breath. It can then get worse and worse and in some cases can be life threatening. Reducing severity and frequency of attacks, and stopping attacks altogether is how asthma is managed.
Jibs1:
What is asthma caused by?  What are ways to prevent developing asthma?
Sumita Khatri, MD:
This is a very big question. There are many theories, but ultimately asthma experts believe that there is an inherent genetic component as well as a large environmental component.
Sumita Khatri, MD:
Asthma researchers are still trying to get the answers to this questions, as clearly, it is a condition that affects many with symptoms, lost productivity, and absenteeism.
Sumita Khatri, MD:
Unfortunately, we do not know enough yet to decipher how to PREVENT asthma. We are left with controlling asthma so that one's ability to be productive and symptom free is the main goal of therapy and management.
susanmacG:
I have had asthma since I was 3 yrs old, I'm now 60.  I take Advair daily and ventolin as needed.  Is there anything better that I can take that would NOT be a steroid? thanks, Susan
Sumita Khatri, MD:
It would depend on how you are right now. Do you feel that your asthma is stable, getting a bit better, or still causing you problems? Based on our medical guidelines, we have to use the least medication necessary to keep your asthma symptoms stable. Maybe there is room to decrease your medications? However, only your doctor would be able to answer that.
Sumita Khatri, MD:
But, in short, anti-inflammatory medications such as inhaled steroids, are the mainstay of treatment.
jimgina:
Hi Dr. Khatri, thank you for taking your time in helping us. My husband has had a persistant severe cough for aproximate 4 months even with a Z-pack and albuterol nothing seems to help. We've even used otc Robitussen Dm to suppress the cough and he has used Advair and Tessalon pearls in the past, but nothing seems to help. The doctor has taken an x-ray and CT scan both showed a calcified granuloma in the right lower lobe of the lung. This has shown on previous x-rays over the past couple of yrs, but no one has ordered any further testing except for the CT. Now his RBC has dropped to 186 and has to start taking VIT B-12 inj QWK until we can get his levels up. Any suggestions will be greatly appreciated. We do not know where to go from here. He has to get some relief.
Sumita Khatri, MD:
Has he had breathing tests performed yet?