Allergic Diseases, S.C. Steven H. Cohen, M.D.
Home Doctor First Visit Office Policies Medical Info Asthma Allergies Bronchodilators Stinging Insects Itch Cough Allergy Vaccine Therapy Mold Clinical Trials Contact Us FAQs Links	Asthma Asthma is not a single disease. It is a syndrome. The same symptom complex we call asthma may have many different causes. Clinically, asthma is a narrowing of the airways associated with increased muscle in the walls of the breathing tubes and increased amounts of sputum (frequently thick and hard to raise) in a soup of inflammatory secretions. For the most part, the initial symptom is difficulty breathing out, like blowing out through a straw. Normally, the large muscles of the chest wall and diaphragm are able to pull air into the lungs. Breathing out is usually a matter of relaxation of these muscles, thus allowing the air to flow out as the chest wall muscles loosen. In active asthma, however, the airways close down, trapping air and making it difficult to exhale. Patients have to work to force the air out of their lungs. When they can no longer do this, air gets trapped in the lungs, and the chest expands like a balloon, further restricting breathing and leading to the shortness of breath seen later in an asthma attack. At this point patients have trouble getting air in or out, and they are in serious trouble. Aggressive treatment may be needed in a doctor’s office, or perhaps more reasonably in an emergency room where more equipment is available to treat the serious event. Remember, not breathing is always a serious emergency- if you stop breathing, there is little left to worry about. Allergic Asthma One very common form of asthma is allergic or “extrinsic asthma”. This is the form of asthma seen in allergic individuals. Patients have excessive amount of a specific substance in their bodies called IgE which is directed against common things in the environment like trees, grasses, mold, ragweed, dogs, cats etc. which the person may be allergic to. When patients with this form of asthma are exposed to these allergens a reaction takes place between the IgE and the allergen. Other substances are released in the body in response to this allergic reaction. Release of these materials leads to the symptoms we see in people with hay fever and in people with asthma. In the chest, these substances cause the changes associated with asthma such as narrowed airways, increased secretions, and inflammation that appear immediately as well as later in an asthma attack. Treatment of Asthma The medications we use try to treat the symptoms of asthma. This is done by modifying or modulating the effects of the substances that are released in the body. Antihistamines, which are not primary medications for asthma, can still have a modifying effect on the symptoms. Steroids are anti-inflammatory and are felt by many to be the most effective medication to treat asthma. They may be in oral form for the most seriously ill patients, or in one of the many inhaled forms that are effective but are less likely to cause any systemic effect. Bronchodilators are available in short acting form to treat the emergent symptoms as well as long acting to act as a controller medication by modifying the fluctuations seen in asthma. The only forms of treatment available that are aimed at the underlying immunologic cause of the disease are Allergy Vaccine Injections (allergy shots) and Xolair, an anti-IgE medication which binds IgE in the patient and lessens the allergic reaction. Xolair is a new and costly medication that is generally saved for the most difficult asthma patients, especially those requiring oral steroid. This new treatment has been helpful in allowing many patients to decrease their steroid dose and, in some cases, discontinue it altogether. Allergy shots are individualized mixtures of allergy extracts given to each patient based on the results of their allergy evaluation. These injections suppress the production of IgE, thus decreasing allergy symptoms. Allergy injections are given on a weekly basis at first, later spacing out to every three to four weeks. The goal of treatment is the control of a patient’s symptoms for two consecutive seasons while using little or no medication other than the injections. The ultimate goal of asthma treatment is to provide care which normalizes the patient’s life style, improves the quality of life, and keeps him or her out of the hospital and the emergency room. That is the goal of the entire staff at Allergic Diseases SC. Exercise Induced Asthma The theory explaining exercise related asthma is that the cooling and drying of the airways from hyperventilation occurring during physical activity causes an irritant response which leads to the exercise induced asthma (EIA). People with exercise induced asthma are generally able to do the activity and complete the exercise. Five to ten minutes later, however, the bronchospasm begins and the symptoms become noticeable. These symptoms include wheezing, chest tightness, coughing, chest pain, shortness of breath and fatigue. Some people notice a decrease in EIA symptoms when they start taking anti-asthma medications and they are then able to be as active as they wish. Some people need to use additional bronchodilator or rescue medication before their activity to be able to tolerate the exercise. A warm-up period of activity before more intense exercise may lessen the chest tightness that ocurs after physical activity. A cool-down period which includes stretching and jogging after strenuous activity may prevent air in the lungs from changing rapidly from cold to warm, and, thus, may help prevent EIA symptoms. One of the goals of asthma treatment is to make people able to tolerate all the activity they want in order to enjoy their lifestyle. Make sure you tell your doctor if your wheezing or chest tightness becomes worse with physical activity or if these symptoms appear only with physical activity. How can I prevent Exercise Induced Asthma? Regular anti-asthma medications may help prevent the symptoms of Exercise Induced Asthma. Some people may need to use inhaled bronchodilators prior to their activity to prevent symptoms and be able to exercise without difficulty. The location of the activity, time of day of the activity and level of exertion can also be modified to help prevent symptoms from occurring. And, don't forget to include the warm-up and cool-down periods as part of your exercise routine.      11121 W. Oklahoma Avenue    West Allis, WI 53227    Tel: 414.545.1111