Eleven-year-old Tommy sat on the exam table showing no obvious distress. He answered my questions concisely. Yes, he had been a little short of breath the last couple of days, but not too bad. A closer look revealed he was breathing a little fast and eyeing his pulse oximetry (oxygen) level, I noted it was several percentage points lower than ideal. His parents hadn’t been too concerned but wanted to be sure he was doing OK. Placing the stethoscope on his chest I was impressed by how little air movement I was hearing — mostly just long high-pitched wheezes.
We gave Tommy a nebulizer breathing treatment but his pulse ox and air movement barely improved. In the end, he had to be taken to Children’s Hospital and it took a couple days of intense treatment to turn him around. Sometimes asthma can be tricky that way. An asthmatic may get so used to their shortness of breath that they barely recognize it as serious. And they may reduce their activity, and even the amount of talking they do, to accommodate their marginal breathing.
So, what is asthma? It is a common chronic airway disease characterized by periods of reversible airflow tightness (asthma attacks). At these times, airflow is obstructed by inflammation and swelling in the airways along with contraction of the small muscles surrounding the airways that causes them to constrict.
There are a host of possible triggers for asthma attacks. Sixty percent of asthma has an allergy trigger. Other exposures include exercise, viral infections, pollutants (especially cigarette smoke), emotional stress, exposure to cold, sinusitis, gastroesophageal reflux (GERD), and aspirin and other medication sensitivities.
Asthma affects 5-10% of the population or an estimated 25 million persons, including 7 million children. Fortunately, about half of all children diagnosed with asthma have a decrease or disappearance of symptoms by early adulthood. There are approximately a half million hospitalizations yearly from asthma and it is the number one chronic cause of missed school days. Unfortunately, the incidence of asthma has been steadily increasing in the U.S. over the last decade for reasons which are not clear. Despite this, the death rate from asthma has been declining, though slowly, with about 3,300 deaths per year currently.
There are a host of treatments available for asthma. The key is to not let the readily available treatments lull us into not taking asthma as seriously or responding to it as promptly as we should. The earlier we recognize and jump on an asthma flare-up the better.
What kind of treatments are we talking about?
• Treating the triggers such as underlying sinus infections
• Aggressively treating allergy, possibly with allergy shots (immunotherapy)
• Using maintenance asthma meds daily (if needed) to keep the need for rescue inhaler use down to no more than two times per week
• Pre-treating with an asthma med prior to exercise if you have exercise-induced asthma
• Not smoking, and avoiding second hand smoke and other inhaled irritants as much as possible
If a flare-up occurs, get in to see your doctor as soon as possible so that you have a plan
in place to nip the problem in the bud. This can often keep you out of the Emergency Department and hospital, or at least direct you there if it is necessary. Aggressive treatment can usually allow an asthmatic to participate fully in sports and other exertional activities. Don’t buy into the myth that aggressive treatment will somehow weaken your lungs — it’s just the opposite. So, if you wrestle with asthma, go after it early and vigorously so you can still enjoy these beautiful spring months here in East Tennessee.