What is asthma exactly? Asthma is an umbrella term for a chronic respiratory disease caused by a constriction of the muscles surrounding the airway and inflammation of the lining of the airway. Symptoms may include wheezing, coughing, and shortness of breath. If an asthma attack becomes so bad that the airways are blocked, you may have to go to ER to get help restoring your breathing. In fact, asthma causes nearly 2 million ER visits each year. While childhood asthma is most common, women are more likely than men to get adult-onset asthma. In fact, only 50% of women with asthma are diagnosed by age 24 compared with 50% of boys who are diagnosed before they’re 15. How is asthma different from allergies? While both conditions can make it tough to breathe, allergies occur when your immune system overreacts to typically harmless things, such as pollen or dust mites or cat dander. “Most of the time asthma attacks are triggered by allergies, but there are some people who have asthma without allergies,” says William Calhoun, MD, asthma expert and professor in the department of internal medicine at the University of Texas Medical Branch. What causes asthma in the first place? Experts aren’t exactly sure what causes asthma. Many believe the disease has a variety of different roots–ranging from allergies to genetics. “Causes are probably a combination of genetics and environmental factors,” says Neil Minikes, MD, FAAAAI, an allergist/immunologist at the Allergy and Asthma Center of Northern New Jersey and assistant clinical professor of pediatrics at Columbia University College of Physicians and Surgeons. If someone has a genetic predisposition for developing asthma but is not exposed to environmental triggers such as allergens, viral infections, and smoke, they are less likely to develop the condition. “For example, in a study of several thousand sets of twins, environmental influences such as hay fever, eczema, smoking, and exposure to secondhand smoke in childhood were risk factors for asthma,” Minikes says. What causes allergies? Experts believe, as with asthma, allergies are caused by a combination of genetics and environmental factors. Genetics. Interleukin-4 is one of the key proteins that play an essential role in allergic reactions. It increases production of the IgE antibody, which is what makes you sick. Scientists theorize that high occurrences of a gene that promotes interleukin-4 production may be the reason why African-Americans have higher rates of allergies and asthma. Environment. The hygiene hypothesis states that our over-sanitized Western lifestyle keeps our immune systems confused, off balance, and unable to distinguish friend from foe. Researchers believe that much of this imbalance begins in infancy. Increasing evidence shows that a baby’s immature immune system can’t develop properly unless it’s exposed to such things as the bacteria found in fermented foods. “You want the right stimulus down in your gut when you’re an infant,” says Harold Nelson, MD, senior staff physician at the National Jewish Medical and Research Center in Denver. Early exposure to antibiotics, however, seems to create the wrong stimulus by disrupting the balance of friendly and unfriendly bacteria. The result is an increased risk of allergy. What are the symptoms and triggers of asthma? Most people experience coughing, wheezing, shortness of breath, and/or chest tightness. Asthma attacks can be sparked by secondhand smoke, dust mites, mold, cockroaches, warm-blooded pets (such as dogs and cats), and the nitrogen dioxide emissions from gas and oil heaters and woodstoves. One often overlooked trigger: the menstrual cycle. “Up to 30% of women experience worsening of asthma symptoms around the time of their period,” says Lynda M. Cristiano, MD, a specialist in women’s lung health at Brigham and Women’s Hospital in Boston and coauthor of The Harvard Medical School Guide to Taking Control of Asthma. The phenomenon is called perimenstrual asthma and is thought to be associated with monthly shifts in hormone levels. “It’s unclear how hormones affect the airway, but they could be behind the fact that after puberty, more women than men are hospitalized for asthma, and that some hormonal states like pregnancy can affect asthma severity.” So what are common allergy symptoms and triggers? Allergies strike when your immune system acts like a drama queen, over-responding to things in the environment such as cat dander, dust, or pollen. Your body starts fighting them as if they were bacteria or viruses by releasing a substance called histamine, which you can blame for telltale allergy symptoms like a runny nose; uncontrollable sneezing; itchy, watery eyes; and congestion. What are the best tests for detecting allergies and asthma? For a diagnosis and treatment plan, you should see an allergist or pulmonologist (lung specialist). For asthma, you can get a pulmonary function test. To measure your airflow, you blow into a device called a spirometer. Then a reading is taken. If asthma is suspected, you are given a bronchodilator and are then tested again. If your airflow improves, it’s a good indication that asthma is present. The most common allergy tests are: Skin Tests Drops of suspected allergens are either placed onto or injected into your skin. If you’re allergic to the substance, a round wheel or flare will form on your skin after 15 to 20 minutes. Blood Tests These tests measure either the total amount of immunoglobulin E, or IgE, in your bloodstream or the IgE that’s specific to certain allergens, such as ragweed pollen. When IgE comes in contact with an allergen, it releases chemicals such as histamine, prostaglandins, and leukotrienes. These chemicals cause the symptoms of allergies. Patch Tests A piece of blotting paper is soaked with the suspected allergen, then it is taped to your skin for 24 to 48 hours. If a rash develops on the site, it’s a sign of eczema, or an inflamed skin reaction that’s a sign of allergies. Provocation Tests Performed only if specific allergy testing is not available, these tests require you to inhale or swallow a very small amount of the suspected allergen so that your reaction to it can be observed. Because of the risk of serious reactions, these tests must be done only under a doctor’s supervision. What are the best treatments for asthma? “There’s no one-size-fits-all treatment because triggers and severity vary from person to person,” says James L. Sublett, MD, chair of the Indoor Environments Committee for the American College of Allergy, Asthma and Immunology (ACAAI). One part of treating asthma calls for pinpointing your particular triggers and avoiding them. It’s best to have an allergist do skin testing to identify exactly what your allergic sensitivities are so that you can make lifestyle changes to help manage your symptoms. There’s also research showing that adding certain nutrients to your diet, such as disease-fighting antioxidants found in produce or vitamin D, may offer some protection for your lungs against the inflammation that aggravates asthma symptoms, says Dr. Minikes. Your doctor will usually prescribe two types of meds to help keep symptoms under control. The first are called bronchodilators, or relievers, that act fast to relax the muscles around your airways when you’re having an attack so that you can breathe more easily. The second are anti-inflammatories, or controllers, that need to be taken regularly in order to reduce swelling and mucus in the lungs’ lining to help prevent attacks from happening in the first place. What are the best treatments for allergies? Two types of over-the-counter medication attack allergy symptoms. Antihistamines relieve sneezing, itching, and runny nose. And decongestants help unclog a stuffed-up nose. Some medicines combine both; read the label to find out what you need. The big drawback of most antihistamines is that they can make you drowsy. If your only symptom is a stuffy nose, just take a decongestant, but if you need an antihistamine, try a non-drowsy antihistamine such as Allegra® or Claritin®. If you’re unhappy with the effectiveness of one antihistamine, try different brands until you find one that works. If your allergies seem to resist every trick, you may need allergy shots. Doctors can inject you with small quantities of what you’re allergic to, helping your body build immunity to the allergen. This is usually a last resort, since you may need from 6 months to a year of weekly shots plus another shot each month for up to 5 years. What is chronic obstructive pulmonary disease (COPD)? COPD is an umbrella term used to describe treatable but irreversible lung conditions such as emphysema and chronic bronchitis. Over 13 million people in the U.S. are diagnosed with COPD, and an estimated 12 million people have it and just don’t know it. COPD’s symptoms, which include shortness of breath and a persistent cough with or without mucous, gradually get worse over time, so it’s easy to mistake them for something else. You may think shortness of breath is just a sign that you’re out of shape or the result of yet another candle on your birthday cake. A chronic cough that doesn’t go away may be pegged as allergies or asthma and treated with OTC meds. “These symptoms should be treated early before it gets to the point where you can’t breathe,” says Byron Thomashow MD, chairman of the board of the COPD Foundation and a clinical professor of medicine at Columbia University Medical Center. To discover if your symptoms might be COPD, ask yourself: How does my breathing compare to a year ago? Can I still do the same activities? Can I do what I want to do? How can I prevent COPD? While being a smoker is the biggest risk factor for COPD, just because you’ve never taken a puff doesn’t mean you’re not in danger. Both women and children have smaller lungs, and that means airways are narrower so it takes less inflammation to restrict them. This also makes them more prone to damage from secondhand smoke. Besides steering clear of smoke, the best way to prevent the disease is to live a healthy lifestyle. “Our lungs are assaulted with toxins every second we breathe, so it’s important to live healthfully,” says Norman Edelman, MD, chief medical officer for the American Lung Association and a professor of medicine at the State University of New York at Stony Brook. “Eat leafy greens and other colorful fruits and vegetables daily because they’re full of antioxidants to protect lungs.” Fit in at least 30 minutes of cardio workouts, such as walking, as often as you can. “Exercise helps keep your heart pumping efficiently, so it takes less oxygen to, say, climb one flight of stairs and lessens the burden on your lungs.” Where can I go to find out more? Asthma and Allergy Foundation of America American Academy of Allergy Asthma & Immunology Mayo Clinic
