Asthma & Allergies

Asthma is a disease of small and middle-sized airways.  It is characterized by spasm and inflammation of the bronchial tubes. Inflammation leads to outpouring of mucus and swelling of the lining of the bronchial tubes.  This causes shortness of breath, cough and wheezing.  Asthma can be mild to severe, and continuous or intermittent. 

Asthma is a hereditary condition that can be triggered by sinusitis, bronchitis, exercise, cold air, emotions, and/or allergies.  In a subset of cases, it can be triggered by antiinflammatory medications, such as aspirin. 

Approximately 90% of  children with asthma have allergies.  Many adults with asthma also have allergies. In both cases, treating the allergies can reduce the frequency and severity of asthmatic attacks.

Treatment of Asthma

Asthma is usually treated with medication to treat the inflammation and a bronchodilator for the muscle spasm.  The use of  an inhaled steroid combined with a long-acting bronchiodialator has been shown to be the most effective controller medicine for asthma.  Some medications such as Advair combine both in the convenience of a single inhaler.  In addition, most allergists will also prescribe a short acting bronchiodialtor as a rescue medicine.

Antiinflammatories usually consist of inhaled steroids.  Some people will also need the addition of a leukotriene inhibitor, such as Signulair or Accolate..  Other medications may be added as your doctor feels necessary.  For severe attacks, oral steroids may be prescribed.  

A new medication for asthma is Xolair. This is an antibody that is directed against the IGE antibody that causes allergies.  It binds the IGE Antibodies and prevents them from causing allergic reactions. It can be very helpful for patients with moderate to severe asthma but unfortunately is very expensive.

Antiinflammatory medicines  that are used for arthritis are not effective in asthma, and can precipitate an acute attack in some asthmatics.  For these patients, the leukotrienes inhibitors appear to be particularly effective.

Your doctor may want to give you a peak flow meter, a simple device that you can use to monitor your treatment progress at home.  Keeping track of your peak flow helps your doctor adjust your medication to maximize your treatment. 

Why an Allergist Should Be Part of Your Asthma Care Team

As you well know, asthma by itself is no piece of cake.  But allergies can make your asthma much worse. All children with asthma should be seen by an allergist.  If your allergist decides allergies are contributing to your or your child's asthma, you should be tested and treated with immunotherapy (allergy shots).