Alicia Jacobs, MD, family medicine physician, is Vice Chair of Clinical Operations in Family Medicine at The University of Vermont Medical Center. She is also practices at Family Medicine Colchester.

What is asthma?

Asthma is a common disorder of the airways in the lungs.  It is a chronic health issue that can significantly affect the ability to breathe.  Symptoms of asthma can range from fatigue to cough to wheezing or tightness in the chest and may occur in the cold, with exercise, at night or all the time.  There are different levels of severity starting with intermittent asthma (often described as reactive airways) – this would include people who wheeze when they exercise, go out in the cold, or get a common viral cold.  Persistent asthmatics develop symptoms on a regular basis and severe asthmatics may require many medications to improve their breathing.  Leaving asthma untreated or uncontrolled is dangerous because it can lead to life threatening flares and decreases in lung function and capacity over time.

Who gets asthma?

Asthma is common and anyone can get it at any age.  Some conditions increase the likelihood of developing asthma including family history of asthma, seasonal or year-round allergies, other sinus disease, smoking and exposure to smoking.  Asthma can start at any time of life – for instance, children can get it (and perhaps even grow out of it) or adults can develop it later in life.

What causes asthma?

Two processes called bronchospasm and inflammation can occur in asthma.  Bronchospasm is the irritability of the airways (breathing tubes) themselves.  Allergens like pollen and irritants like smoke can get into the lungs and trigger the lining of the airways.  This can lead to a spasm and narrowing in the muscles in the airways.  This narrowing makes it difficult to exhale and sounds like whistling or wheezing.  When this wheezing happens frequently, it can lead to inflammation and swelling of the airways which limits breathing into and out of the lungs.  Inflamed airways can produce mucous and cause coughing.  Over time, this inflammation can cause irreversible lung damage leading to chronic difficulty with breathing and even shortened life span.

What kinds of medications are used to treat asthma?

Medical treatment is done primarily with inhalers of which there are two basic types.  Beta-agonists (like albuterol or levalbuterol) are called ‘rescue’ inhalers and relax the airways so that air will move in and out more easily.  Using a rescue inhaler for wheezing or cough more than twice a week qualifies as uncontrolled asthma.  Studies have shown that there is inflammation of the lung airways when symptoms requiring use of a rescue inhaler are more frequent than twice a week.  For this uncontrolled asthma, adding a steroid inhaler is recommended to decrease the inflammation, improve breathing and decrease long term damage to your lungs.  Moderate to severe asthma treatment can also include oral or nasal medications to help decrease severe symptoms, whether seasonal or year-round.  Many people with asthma also require allergy treatment.

Is it really necessary to use a spacer?

A spacer is absolutely essential to improving the delivery of inhaled medications into the lungs.  Since we have a right angle bend in our airway at the back of our throat, most of these medications can be deposited there if not administered correctly.  Using a spacer increases the amount of medication that makes it into the lungs by 50 percent. 

What else can I do to treat my asthma without the use of medication?

Perhaps the most important treatment includes ‘lifestyle modification’ which means reducing exposures to the things that trigger asthma.  The list of allergens or triggers is long and it is worth the effort to eliminate them.  Some of the common things to avoid are dust, pollen, pets, cigarette smoke, and air pollution such as car exhaust, wood smoke, and fragrances (perfume, lotions, fabric softener, hair products, and many more).

Are there other recommendations?

Since asthma is a chronic health condition and is present even when symptoms are not, it can increase susceptibility to lung infections.  For this reason, it is strongly recommended to receive a ‘pneumonia shot’ (pneumovax) and an annual flu shot.  Quitting smoking or eliminating smoking exposure is essential to improving asthma.  In addition, obesity can contribute to worsening control.  Maintaining a healthy weight is an essential part of treating and controlling asthma.

How do I know if I need further treatment?

If you have untreated or under-treated asthma, wheezing or cough, or if you have questions of how to self-manage your asthma, please make an appointment with your health care provider.  Determining whether your asthma is controlled can be difficult, especially if you need to use rescue inhalers before or after exercise.  You and your doctor can develop a home monitoring plan, figure out ways to keep your symptoms well controlled, and help make your home as safe as possible for your lungs.

What are we doing at the UVM Medical Center to improve treatment of this chronic disease?

At the UVM Medical Center, all of our primary care practices have become patient-centered medical homes focusing on chronic disease management.  Control of asthma can significantly impact individual patient daily wellness, lessen complications such as Emergency Department visits and hospitalizations, and overall decrease the cost and societal burden of this disease.  Currently, several disciplines in primary care – including Pediatrics, Family Medicine, Primary Care Internal Medicine as well as Pediatric and Adult Pulmonology – are researching how the use of our electronic health record can help us improve asthma management.

Alicia Jacobs, MD, family medicine physician, is Vice Chair of Clinical Operations in Family Medicine at The University of Vermont Medical Center. She is also practices at Family Medicine Colchester.

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