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Breathing uneasily

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Many people do not consider asthma to be a serious disease, but in some cases it can be life-threatening. During my nearly two decades as a primary-care physician in private practice, I treated hundreds of patients with asthma.

Many people have asthma as children and seem to "grow out" of their disease. Others have lifelong symptoms. It always worried me when I saw a young person with no history of asthma as a child who developed severe symptoms later in life. This generally represents a serious form of asthma that can be hard to control.

I was once asked to consult on an 18-year-old woman who had been left brain-injured after a severe asthma attack. Her distraught parents wanted me to treat her aggressively to help her recover. There was no magic that could be done. She had widespread ischemic cerebral vascular damage and did not survive. This lovely young woman had her life ended much too soon by this common respiratory disease. This tragedy possibly could have been avoided by better treatment earlier.

Asthma is a major public health problem in Hawaii. Its prevalence among HMSA’s 685,000 members is 8.9 percent. More than a third of that group is under age 19; asthma is the most common chronic condition among children in our islands. Last year, 657 HMSA members, mostly children, were rushed to local emergency rooms because they could not breathe due to extreme wheezing, chest tightness or uncontrollable coughing.

Asthma has a genetic basis and tends to run in families. Asthma symptoms are caused by allergens or irritants that are inhaled into the airways (bronchial tubes) that move air from the nose and throat to the lungs. As the airways become inflamed and irritated, the muscles of the bronchial walls tighten. During an asthma attack the airways narrow, produce large amounts of mucous, and might even close. This can cause symptoms that range from minor wheezing, chest tightness and shortness of breath to life-threatening respiratory failure.


Pay attention to your asthma triggers. If you live with a smoker, lay down the rules about not smoking in your presence. If you are a smoker, seek help for quitting.

Consider buying a dehumidifier, if needed, to reduce the humidity level in the air. Humid air can cause mold and mildew to grow inside your home.

Work closely with your family physician, allergist or pulmonologist to develop an action plan, watch your symptoms and manage your medications.

Take your medications as prescribed. Since asthma is an intermittently symptomatic disease, it is easy to skip your medicine when you are feeling well.

About 90 percent to 95 percent of asthma cases can be controlled with adequate medication and by identifying and removing the "triggers" that bring on an attack. But the remaining asthmatic population suffers from a more severe form of the disease that responds poorly to treatment. People who have severe asthma are likely to have more attacks and are at greater risk of a fatal attack. It is especially important for these people to work closely with their doctor to manage the disease.

The guidelines for specific anti-asthma medicines vary for different age groups and depend on severity of symptoms.

Most people with asthma have a mild form and are treated with bronchodilators. These medications open up constricted bronchial tubes and help clear mucus from lungs. If you have mild asthma with only occasional wheezing, a short-acting bronchodilator from an asthma inhaler is often prescribed. This "rescue" medication can relieve symptoms within minutes and lasts two to four hours. This might be the only treatment people with mild asthma need.

Use of a short-acting bronchodilator more than twice a week can be a sign of unstable asthma that needs more aggressive treatment. These patients, who have moderate to severe asthma, might need a controller medication as well. A controller medicine works over time to help reduce airway inflammation. Anti-inflammatory medications are usually steroids given by inhaler and used once or twice daily.

For the majority of people with asthma, the "rescue" inhaler and long-acting anti-inflammatory medication will keep the disease under control. But for those with the most severe form of the illness, a long-acting bronchodilator might be needed.

These long-acting sympathomimetics are powerful drugs and should be used only by patients with severe asthma that cannot be controlled by anti-inflammatory medications alone. Unnecessary and overuse of long-acting agents can lead to respiratory failure. Studies show that too many people use both an inhaled steroid type of medication and a long-acting bronchodilator, and this can cause problems. Work with your physician to see whether a steroid drug alone is enough or whether you truly need both of these medications.

Asthma management also requires avoiding your triggers, which commonly include cockroach droppings, outdoor pollen, animal dander, and mold and dust mites. (One speck of dust can contain 40,000 dust mites.) Other triggers include exposure to cold air, respiratory viruses and firsthand and secondhand tobacco smoke. According to a three-year study of 2,000 children on the Big Island by pulmonary and internal medicine physician Elizabeth K. Tam, exposure to tobacco smoke is a cause of asthma, not just a trigger.

There is no cure for asthma, but it can be managed with the right treatment.

On the Net:
» American Lung Association of Hawaii (537-5966 on Oahu):
» Hawaii Department of Health:


John Berthiaume, M.D., is an HMSA vice president and medical director. He practiced medicine at Straub Clinic in Aiea before joining HMSA in 1999. HMSA’s "Health Scene" appears on the second Tuesday of every month in the Star-Advertiser.


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