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What is asthma and how is it diagnosed?
Asthma is best defined as acute and chronic inflammation that causes the airways of the lungs to become narrowed or blocked, making it difficult to breathe. This is often a dynamic process that can come and go. People experience shortness of breath, which can be more evident with exercise. Other symptoms include coughing, chest tightness and wheezing. The diagnosis is based on a pulmonary function test to quantify the degree of airway obstruction. This testing often includes measuring whether there is improvement with bronchodilator therapy. If symptoms come and go, and there is a suspicion that a person has asthma despite normal pulmonary function testing, a provocation test is ordered. This involves giving the patient a medication, usually methacholine, which will provoke an asthmatic reaction in a person who has asthma.

What causes asthma?
There are many causes of asthma. The main causes are genetic and environmental. Often, asthma is related to allergies and sometimes can be linked to a history of eczema. Asthma can also happen after an upper or lower airway infection. Environmental irritants can also cause asthma by direct irritation of the airways or through an allergic reaction. Dust is a common environmental cause of asthma. Exposure to cold air can cause an asthma attack as well.

Can asthma be cured or just controlled?
Our goal in treatment is that every asthmatic is symptom free and has no respiratory limitations to leading a normal, active life. We also want to control underlying inflammation in the airways, which can lead to scarring and loss of lung function over time. Medications used in asthma can be divided into two major groups: controller medications that address inflammation and rescue medications that reverse airway obstruction. The ideal outcome is that symptoms are controlled so that patients need to use their rescue medications rarely. It is very important that patients understand these goals. This approach is endorsed by many professional organizations.

How do you know if you have asthma or a lung infection?
An infection is usually associated with a productive cough and fever. Asthma can be sudden or subtle in onset and is not usually associated with fever. It can cause a cough and be associated with wheezing, an airway noise that can sound like a whistling harmonica. Often the person having an asthma attack notices exercise limitation and has the feeling of being unable to catch his breath. Patients often tell me, "when I rest, it gets better." Their breathing becomes hard work.

Is there a connection between asthma and allergies?
There often is this connection. Allergic reactions trigger a cascade of events that can lead to inflammation in the lungs. A new class of drugs has recently become available that specifically targets this strong allergic response that is seen in some patients. These drugs are not appropriate for all asthmatics. We do blood tests to determine who might benefit from this class of medication.

Is there a common age group among patients who are diagnosed with asthma?
Anyone can be diagnosed with asthma any time in their lives. Frequently, asthma is diagnosed in childhood. In fact, the incidence of childhood asthma has risen dramatically over the last twenty years. Childhood asthma is more commonly related to allergies. In the older population, asthma can appear as a sign of acid reflux, or heartburn. Acid rises out of the stomach and washes down into the airway, causing an acid injury to the larynx and the lung.

Would you recommend a pneumonia vaccine for patients with asthma?
Absolutely. I also highly recommend getting an influenza vaccination annually. We work very hard to keep asthma patients free of upper and lower airway infections to try to prevent asthma attacks. It is important for patients to understand that the pneumonia vaccine covers only a certain class of pneumonia causing bacteria and that it does not prevent other causes of pneumonia. However, it does help to prevent the most common type of pneumonia. Both the pneumonia and influenza vaccines significantly help to decrease the potential for patients to acquire a lung infection.

Is there anything new and exciting in asthma treatment or research?
The future is in understanding and targeting genetic variations. This will help design more individualized treatments and target the important pathways that cause asthma. Until recently, we treated asthma patients with a broad brush because most medications were not particularly specific. About five years ago, a new class of medications, targeted toward a subgroup of allergic asthmatics, became available. We expect more targeted therapies to become available. This is very exciting. A targeted approach is much more successful and satisfying for the patient and physician, maximizing benefit and minimizing side effects and risk.

What is the single most important message you tell your asthma patients?
They can and should be symptom free and must not let asthma limit their lives. I ask them to work with me on controlling their disease. Asthma is not curable, but is certainly controllable. We must not allow asthma to control their lives.

Dr. Helena Jones is a board-certified specialist in pulmonology and critical care medicine. She practices with Northwest Respiratory Associates on the Northwest Hospital campus, 1560 N. 115th St., Suite G-10. For more information, call 206.368.1558 or visit nwhospital.org/pulmonary.