Your Doctor & Asthma Educator | Frequently Asked Questions
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General Questions About Asthma
Asthma is defined as “a chronic inflammatory disease of the airways” and is characterized by reversible airway obstruction. Irreversible airway obstruction may develop due to the alterations in airway structure that occur with airway remodeling. Airway remodeling is an ongoing process in reaction to inflammation as the body activates a process in an attempt to repair the lungs in response to persistent inflammation. This leads to permanent structural and functional changes. Much as a skin wound leads to scar tissue formation (this has a different structure from surrounding skin); airway remodelling results in different airway characteristics. The cells (epithelial) that line the airway are damaged and the basement membrane underneath the epithelial cells becomes thicker. More blood vessels are formed and the amount of smooth muscle surrounding the airway increases. The airways loose elasticity, the walls thicken, and excess muscle results in bronchoconstriction and long term loss of lung function, a worsening of asthma and the development of fixed airflow limitation.
Airway remodelling may be, at least somewhat, reversible and preventable. The number of asthma exacerbations/loss of control episodes has been associated with greater decline in lung function and a higher risk of airway remodeling. Treatments for asthma may play a significant role by reducing asthma exacerbations resulting in preventing the decline in lung function and airway remodeling. It is extremely important for you to learn how and why your medications work.
The current treatment of asthma is aimed toward decreasing airway inflammation, reducing symptoms, and improving lung function. The use of controller/anti-inflammatory medications reduces the inflammatory process associated with asthma and thus results in less remodelling. A return toward normal airway structure has been found when proper and regular anti-inflammatory treatment is followed. You can find more information about Controllers here.
That said, the overall incidence of asthma has been increasing. While researchers do not know exactly why, they do have several theories.
One theory suggests that more people develop asthma today because we spend more time indoors than people used to. Indoor air can contain a number of asthma triggers, such as smoke, dust mites and pet allergens. Additionally, in response to the oil crisis of the 1970s, modern homes are more tightly sealed than older homes. This means that indoor air doesn’t circulate with outdoor air the way it did in older, better-ventilated homes. As a result, people inside are exposed to greater amounts of indoor air and the triggers it may contain.
Other theories attempting to explain why asthma is on the rise include the suggestion that outdoor air pollution has a significant effect on asthma. There is also the possibility that because children today experience fewer infections, they are somehow more susceptible to developing asthma.
There are several factors that may contribute to your experiencing more asthma symptoms at night:
- The circadian rhythm causes certain natural hormones (similar to those in certain asthma medications) to be at lower levels at night. These lower hormone levels reduce the diameter of the airways slightly and may make it more likely that you experience asthma symptoms at night.
- You could be inhaling dust mite allergens from your pillows, blankets and mattress while you sleep.
- When you lie down, the distribution of gravity on your chest can put extra pressure on your lungs.
If you experience nighttime symptoms, it means your asthma is not being properly controlled. Discuss these nighttime symptoms with your doctor. You may also want to bring a copy of the How Much is Too Much? quiz to your next doctor’s appointment. The quiz can help you find out how well you’re managing your asthma symptoms.
All asthma is characterized by long-term inflammation, an increase in mucous, and “twitchy” airways. However, asthma has been called by different names according to when and how it develops. These names include:
- Bronchial asthma
- Childhood asthma
- Adult-onset asthma
- Occupational asthma
- Allergic asthma
- Non-allergic asthma
- Mild asthma
- Moderate asthma
- Severe asthma
- Intermittent asthma
- Persistent asthma
- Silent asthma
- Fragile asthma
- Coughing asthma
- Viral-induced asthma
What’s more, children with another allergic disorder may be more likely to develop asthma as well. In cases like these, exposure to common asthma triggers should be minimized as much as possible. Under no circumstances should a child (or anyone else for that matter) be exposed to secondhand smoke. Known causes of occupational asthma should also be avoided.
Questions About Asthma, Allergies and Symptom Triggers
An example of an allergic reaction of the skin is called eczema, an itchy rash commonly found in the creases of the arms, legs and neck.
An allergic reaction in the nose is called rhinitis or hay fever. Common symptoms of allergic rhinitis are itchy, runny nose, stuffiness, sneezing, ear blockage and watery eyes.
In the lungs, an allergic reaction manifests itself as asthma. Although allergens are common asthma triggers, many experience asthma symptoms with non-allergic triggers such as smoke, cold air or exercise.
If you’re told you can’t eat certain foods, it’s important to make sure you’re getting the nutrients you need from other, non-allergic products. Ask your doctor or a dietitian how you can control your asthma symptoms and still enjoy a healthy, balanced diet.
Questions About Medication and Asthma
Most asthma medication is generally safe to take during pregnancy but, as always, you should be taking the lowest amount of medication that controls your asthma. Discuss any concerns with your doctor – he or she can explain the risks and benefits in greater detail. Keep in mind that when you’re pregnant, it’s more important than ever to avoid your personal asthma triggers as well as any source of tobacco smoke.
Medication is an important part of controlling asthma. If asthma is not well-controlled, it can lead to serious consequences, including:
- A decrease in your overall quality of life (trouble sleeping, the inability to enjoy regular exercise, time missed from school or work)
- A greater chance of experiencing a severe, life-threatening asthma attack (every year, about 500 Canadians die from asthma)
- Long-term, uncontrolled airway inflammation that can lead to permanent damage of the lungs
Mild asthma is sometimes classified as “mild intermittent,” meaning that symptoms are mild and occasional, and “mild persistent,” meaning the symptoms are mild but occur regularly. Of these two types, “mild persistent” is more likely to require a low dose of daily anti-inflammatory medication.
Here’s what The Canadian Asthma Consensus Report, 1999, a supplement to The Canadian Medical Association Journal 1999; 161 (11 Suppl) has to say on the subject: “There is no objective evidence of any benefit, apart from placebo effect, from the more frequently used unconventional therapies such as acupuncture, chiropractic, homeopathy, naturopathy, osteopathy and herbal remedies.”
If you do decide to try an alternative therapy, tell your physician first, and make sure you continue to take your controller medication as directed. Bear in mind that, in addition to the fact that alternative therapies have not been properly tested, they also haven’t been tested for side effects. Most herbs do not have to be tested for benefits or side effects because they’re classified as food products. And remember, just because something is called “natural” doesn’t mean that it’s healthy. Cyanide, uranium and viruses are all perfectly “natural.”