What is Asthma?
Asthma is a condition where the airways narrow and swell and produce extra mucus, which makes it hard to breathe and leads to shortness of breath and wheezing.
Signs or symptoms that you may have asthma:
- Wheezing or noisy breathing
- Chest tightness or pain
- Shortness of breath
- Trouble sleeping caused by shortness of breath, coughing or wheezing
- Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
Signs that your asthma is flaring up include:
- More frequent and bothersome signs and symptoms
- Increasing difficulty breathing
- The need to use your rescue inhaler more often
Each person with asthma may have a different trigger that may cause the signs and symptoms flare up in certain situations:
- Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste
- Respiratory infections, such as the common cold or flu
- Physical activity (exercise-induced asthma)
- Cold air
- Air pollutants and irritants, such as smoke
- Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve)
- Strong emotions and stress
- Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine
- Acid reflux disease or heartburn
How is Asthma diagnosed?
Asthma is primarily diagnosed using pulmonary function tests to determine how much air moves in and out as you breathe. These are performed in our office and include:
- Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
- Nitric oxide test. This test measures the amount of the gas, nitric oxide, that you have in your breath. When your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels.
Additional tests to diagnose asthma include:
- Methacholine challenge
- Imaging of the chest +/- sinuses
- Allergy Testing
- Sputum Eosinophils
- Provocative testing for exercise and cold-induced asthma
How is asthma treated?
Prevention and long-term control are key in stopping asthma attacks before they start. You will learn to recognize your triggers and avoid them. You will also need to keep track of your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol.
Asthma is treated with different types of medicines. The medicines can be inhalers, liquids, or pills. Your doctor will prescribe medicine based on how often you have symptoms and how serious your symptoms are. Asthma medicines work in 1 of 2 ways:
- Quick-relief medicines stop symptoms quickly – in 5 to 15 minutes. These will be prescribed to every patient with asthma, and should be carried with you at all times. They should be used whenever you have asthma symptoms.
- Long-term controller medicines control asthma and prevent future symptoms. People who get asthma symptoms more than 2 times a week need to use a controller medicine 1 or 2 times each day. These typically take longer to work, and this could sometimes take a few weeks. It’s important to continue using these medications, even if you feel they are not working.
- If you are symptoms remain uncontrolled despite maintenance inhaler therapy, a short course of oral steroids may be needed. In addition, some patients may qualify for the newer therapies that have become recently available. These include bronchial thermoplasty, or biologic therapies such as Fasenra, Nucala, Xolair or Dupixent. Ask your doctor if you may be eligible for any of these treatments.
What is an asthma action plan?
An asthma action plan is a list of instructions that tell you:
- Which medicines to use each day
- Which medicines to take if your symptoms get worse
- When to get help or seek medical attention
Work with your doctor to formulate a plan that is right for you.
While there's no way to prevent asthma, by working together, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.
- Follow your asthma action plan.
- Get vaccinated for influenza and pneumonia.
- Identify and avoid asthma triggers.
- Monitor your breathing.
- Your lung function may decrease before you notice any signs or symptoms, it’s recommended that you regularly measure and record your peak airflow with a home peak flow meter.
- Identify and treat attacks early.
- Take your medication as prescribed.
- Pay attention to increasing quick-relief inhaler use.
- If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn't under control. See your doctor about adjusting your treatment.
What is COPD?
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.
COPD cannot be cured, but its symptoms can be controlled. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.
COPD can be further characterized into two separate entities, Emphysema and Chronic Bronchitis. Emphysema can be diagnosed by either radiology, pulmonary function testing or on tissue biopsy. It is characterized by destruction of lung tissue at the smallest air sac level (alveoli). Chronic Bronchitis is characterized by inflammation of the lining of the bronchial tubes, and results in a daily cough and mucus production for at least 3 months a year in 2 consecutive years.
Common signs and symptoms of COPD may include:
- Shortness of breath, especially during exertion
- Chest tightness
- Excessive mucus production, especially early in the morning
- A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
- Blueness of the lips or fingernail beds, also known as cyanosis
- Frequent respiratory infections, including pneumonia
- Lack of energy
- Unintended weight loss (in later stages)
- Swelling in the ankles, feet or legs
People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days. These are typically treated with antibiotics and steroid pills.
Risk factors for COPD include:
- Exposure to tobacco smoke. This is by far the most common risk factor for developing COPD. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.
- People with asthma who smoke
- Occupational exposure to dusts and chemicals, including fumes, vapors and dusts
- Exposure to fumes from burning fuel, especially burning fuel for cooking and heating in poorly ventilated homes
- Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Talk to your doctor about getting tested this this.
How is COPD diagnosed?
• Pulmonary function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood.
Spirometry is the most common lung function test. During this test, you'll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs.
Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry.
• Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure.
• Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45.
What are the treatments?
There are 4 main types of treatment for COPD:
1. Medicines – There are a lot of medicines to treat COPD. Most commonly you will need inhalers to treat your COPD. There are two main types of inhalers. Every patient should have a rescue inhaler, most likely albuterol, which is only used when you are feeling short of breath. In addition, you may be started on maintenance inhalers that will be used on a daily basis in order to control your COPD and prevent future symptoms
2. Oxygen – If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options.
3. Pulmonary rehab – These programs generally combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program.
4. Surgery and endobronchial valves – Rarely, people with the emphysema type of severe COPD will need surgery. Surgery removes the most damaged parts of the lung. This surgery can reduce symptoms, but it does not always work. This can also be done bronchoscopically in which small “endobronchial valves” are placed in the damaged airways and thus allowing the healthier parts of the lung to work better
Will I need a lung transplant?
Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active. However, it's a major operation that has significant risks, such as organ rejection, and it's necessary to take lifelong immune-suppressing medications.
COPD can cause many complications, including:
- Respiratory infections
- An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections.
- Heart problems
- Lung cancer
- High blood pressure in lung arteries, also known as pulmonary hypertension
Smoking cessation is the most important way to prevent COPD. Quitting smoking will reduce your risk of developing COPD, as well as reducing the risk of worsening lung function. Talk to your physician about developing a smoking cessation plan.
Occupational exposure to chemical fumes and dust is another risk factor for COPD. If you work with this type of lung irritant, talk to your supervisor about the best ways to protect yourself, such as using respiratory protective equipment.