by Christopher Smith. M.D.
Asthma has traditionally been described as a reversible obstructive airway disease. The assumption was that after each asthma attack, the lungs returned to normal. Asthma experts now know, however, that if asthma sufferers fail to treat effectively the chronic airway inflammation that characterizes asthma, they will begin to develop scar tissue in their lungs. In the course of a year, a person with severe asthma can lose up to one percent of his or her lung function. It doesn’t sound like much until you consider that over several decades, you could permanently lose a significant amount of your lung function. This is called airway remodeling.
Asthma has three components: airway constriction due to muscle contraction around the airways; swelling of the lining of the airways due to chronic inflammation; and the accumulation of mucous in the airways. The first component—muscle constriction— occurs during an asthma attack and is treated with bronchodilators. These drugs, also known as rescue medicine, cause the muscles to relax and quickly restore a person’s ability to breathe more easily. The most common of these is albuterol, which is delivered by an aerosol inhaler.
The remaining components—inflammation of the airways and the production of mucous—are treated with preventive medicine. These medications (cromolyn, antileukotrienes, and inhaled steroids) typically take about a week to work. If you are relying on rescue medicine several times a week, your asthma is not under control and you need a preventive medicine. The only way to know if you are on the appropriate amount of preventive medication is a lung function test, interpreted by an asthma specialist.
Managing childhood asthma
Even when asthma symptoms are “tolerable,” children run the risk of losing lung function in the long run if they are left untreated. With the help of your allergist, the specific asthma triggers should be identified, preventive medications should be used when necessary, lung function should be tested periodically, and severe allergic triggers should be treated with allergy shots.
Asthma is the most common cause of chronic childhood illness, and is the number one reason children are admitted to the hospital. In the United States (and many other Western countries) there is twice as much asthma today as there was in 1980. While there are a number of theories about the rising incidence of asthma in Western countries, a leading theory relates to the impact of vaccines on the immune system.
Our immune systems have two types of lymphocytes (blood cells responsible for fighting disease): one type helps the body fight viral infections; the other responds to allergic reactions. Each of these two aspects of the immune system counter balances the other. Researchers hypothesize that in children who are well vaccinated against viral illnesses, they may not develop an adequate counterbalance to the allergic lymphocytes. In essence, the aspect of the immune system that fights viral infection is not getting stimulated, and the allergy-fighting arm is overactive. Studies have shown that allergy shots can restore this balance. Furthermore, medical experts agree that children must continue to be vaccinated, as this is just a theory that researchers are looking at as a possible explanation.
Allergists have demonstrated the importance of proper treatment early in life to increase the likelihood of a full, healthy, active adult life. While there is currently no cure, we do have the tools to manage asthma properly by working closely with patients, parents, and school nurses.
With proper medical management, children with asthma should be able to do everything their friends do, including racing around the playground, playing sports, and participating fully in gym class. If your child with asthma has difficulty being fully active or suffers frequent asthma attacks, this means the asthma is not well controlled. Your allergist can formulate a plan of treatment that can make all the difference in your child’s quality of life.
Dr. Smith is board certified in both pediatric medicine, and asthma, allergy, and immunology. He serves on the medical staff of Cayuga Medical Center and is in practice with Asthma and Allergy Associates, P.C.