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.
JackWalsh:
I am 40yr old male.  I exercise regularly (still play sports) but at time when "at rest" feel I cant get a deep breath.  In particular this happens when in bed or even sleeping (have woken up in a panic feeling a struggle to get deep breaths).  Is this a symptom of asthma?
Sumita Khatri, MD:
shortness of breath can be very uncomfortable. the good news is that it seems that you are in shape. so, perhaps this could be asthma, as inability to take a deep breath in or breathlessness is a common complaint from my asthma patients. Only breathing tests, a clinical evaluation, can answer that. Sometimes, even a trial of asthma medication can answer that question.
Number_1Diva:
I am an extremely bad asthmatic, I have had both hips, and shoulders replaced because of steroid use.  Now I am finding it more and more difficult to get through the day without having symptoms.  I use oxygen at night.  I take Advair 500/50, oxygen at night and use ventolin.  I have had asthma since age four.  My asthma is severe.  As my symptoms are no longer controlled I am wondering is there any other drug that I have not heard of.
Sumita Khatri, MD:
Are your on steroids by mouth as well? There are some newer medications that can supplement what you are on. In addition, there is a new procedure called bronchial thermoplasty, which is a non-drug therapy performed under moderate sedation in 3 sessions. This has been FDA approved for severe asthma. The trick is that you have to be sick enough to qualify but well enough to tolerate the procedure.
Sumita Khatri, MD:
I suggest that you please be evaluated by a lung specialist, they can determine if you are a bronchial thermoplasty candidate.
stephanie1o:
I have had asthma since I was 2 yrs. old and I am now 53.  I have stopped taking asthma meds as don't seem to need them. Can asthma go away?
Sumita Khatri, MD:
WOW, that's great news. Childhood asthma can go away, usually in boys more than girls. Asthma can be intermittent, and people can find that it does not bother them for years. However a trigger like a cold or allergy can bring it on again. We all hope that our asthmatics can feel better enough to stop medications. Now that you know your asthma well, just be on the lookout for any new symptoms that pop up.
MedHelp:
Dr. Khatri will be right back.
MedHelp:
She had to take an emergency call.  We apologize about the delay.
Sumita Khatri, MD:
all clear, i'm back!
jimgina:
He's having trouble remembering when he went to the pulmonary specialist what all tests the had ran on him at that time. I know they said then he had pluerasy and chemical pnuemonia and seasonal asthma. Which a few yrs later on X-rays and now CT scans these calcified granulomas are showing and this relentless cough will just not give. He is coughing every breath to where he gets dizzy.
Sumita Khatri, MD:
how far do you live from Cleveland :)
Sumita Khatri, MD:
seriously, though, it seems that you should be re-evaluated by a lung doctor, sooner rather than later. asthma seems to be only part of the issue.
SoManyComplaints:
Whenever I do something strenuous, such as walking a flight of stairs,it seems as though I need to catch my breath pretty quickly. When I do, I stop, sit and take in a deep breath and let out a deep breath (as best I can) but I feel my heart and belly "flutter". There is no pain but kind of like an anxious feeling like I might not be able to get the breath in fast enough. I am able to get my breath and slow down my breathing to a normal rhythm within a few minutes. Is this some sort of anxiety attack or asthma?
Sumita Khatri, MD:
Hard to say. Having a lung condition that causes shortness of breath can certainly cause and worsen anxiety.
Sumita Khatri, MD:
Best plan would be to tease out what portion of your symptoms might be from a condition like asthma. When that comes under control, the panic will subside.
journey2motherhood:
I have cough variant asthma.  I haven't had a full blown attack in over 12 years, now I am just stuck with this cough.  I take singulair advair, occassionally, zrytec, nasal spray.  When its really bad I get a shot.  I am a 45 year old woman and nothing takes this cough away.  It's very hard to deal with - is there anything else I should be doing? Also I do see a pulminary specialist.
Sumita Khatri, MD:
Cough can be very annoying, I can understand your frustration.
Sumita Khatri, MD:
Does the treatment with the shot or zyrtec or nasal spray at least partially help the cough?
Jibs1:
My daughter had an anaphylactic reaction to nuts.  It sounded like stridor.  We thought when people say that their airways close that they have terrible asthma "attacks" with wheezing. Obviously we were wrong and it was more like croup.  What is the difference - why wheezing in some with allergic reaction and others tightening of throat with no wheeze?
Sumita Khatri, MD:
If the allergy causes an asthma flare, it will result in wheezing.
Sumita Khatri, MD:
However, closing up of the throat from an allergy decreases air entry into the lungs and for all the world can feel like asthma. This can cause wheezing of the 'upper airway' as well.
Sumita Khatri, MD:
The difference is whether there is swelling at the vocal cord/upper airway as was in your daughter's case or whether there is a lower airway (lung) systemic reaction that causes spasms of the bronchial tubes.  In an emergency, both can be treated similarly with the epi-pen and breathing treatments.
Sumita Khatri, MD:
Hope your daughter is doing better and this does not happen again.
journey2motherhood:
for a very short time, the shot will help about a few days.
Sumita Khatri, MD:
Then it seems that the anti-inflammatory treatment does work, though short term. Other factors that add to cough include sinus infections/inflammation, reflux (GERD), or even an underlying inflammation of the lungs outside of asthma. When cough is resistent to standard and consistent asthma medications, I start thinking of other things as well.
BCHHC:
Do you feel that certain foods can trigger asthma?
Sumita Khatri, MD:
Yes, especially if there is a known allergy. Allergy testing can be helpful to tease this out. Others have sensitivities to certain preservatives and wines, etc.
123jst:
I'm 50 and have had asthma since diagnosed at 6 months old.  I no longer have insurance and have not kept up with maintenance prescriptions.  I was finally convinced of how well maintenance medications worked and lived free of attacks for a couple of years.  I cannot afford the medications I was on and now live on my nebulizer - every day several times a day.  It's what keeps my lungs going.  My question is:  is this okay?  (I know it's not ideal; but it's that or die).
Sumita Khatri, MD:
I am so sorry that you are having to sacrifice your health.
Sumita Khatri, MD:
This is not at all OK, there are means for you to get the help you need. You DO need to be on controller medications and using only the nebulizer with albuterol is risky as one day it may not work as well anymore.
Sumita Khatri, MD:
Can you ask your doctor or your local health department to find a free clinic or federal/county healthcare center that may be able to help you? Pharmaceutical companies do have patient assistance programs, but a doctor/office has to refer you.