Related topics: •  Asthma Center •  Inhaler Update •  What are the Symptoms of Asthma?

"How we view asthma has changed over the last five to ten years," says Dr. Carolyn Lopez of Cook County Hospital in Chicago. "We used to think it was just an airway disease and that all physicians needed to do was provide local relief. But we've come to understand that asthma is really an inflammatory disease. And that's the key to controlling it."

In the past, researchers thought the main culprit in an asthma attack was the tightening of the tiny smooth muscles that surround the bronchial tubes. In asthmatics these muscles constrict when provoked by allergens like pollen, dust, mold, or animal dander, or by other triggers such as colds, smoke, cold air, exercise, or stress. It turns out, though, that this reaction is only part of the problem. When an asthmatic's lungs are exposed to an irritant or other triggers, the insides of the airways also become inflamed. And it's this mechanism, researchers now agree, that keeps the airways partly blocked with swelling and mucus. Inflamed airways are supersensitive to allergens, exercise, or other stimuli, which squeeze the already constricted airways even more, setting off acute symptoms like shortness of breath, wheezing, tightness in the chest, and coughing, particularly at night and early in the morning.

With this new understanding has come new standards for asthma treatment. In 1997 the National Institutes of Health issued revised guidelines, which had a potent message for doctors and patients dealing with the message: Go after it with gusto. The more aggressively asthma is treated, the less damage it's likely to do and the easier it will be to control. The current consensus on care reflects that message, calling for initial high doses of anti-inflammatory drugs to arrest both acute symptoms and underlying inflammation, then a gradual move to lesser doses.

Although not new, corticosteroids have emerged as the cornerstone of this approach. The NIH standards review revised guidelines for prescribing the drugs. Doctors are now advised to prescribe daily doses of inhaled steroids to patients whose symptoms flare up more than twice a week. For long-term use, inhaled steroids are generally preferred over their oral counterparts because they have fewer lasting side effects. Once asthma is well controlled, inhaled steroid doses may be able to be reduced gradually every two to three months until patients reach the lowest dose needed to maintain control -- although if you have severe persistent asthma you may need a course of oral steroids.

New evidence also suggests that inhaled corticosteroids do not, as previously thought, stunt growth in children by one centimeter a year. There are other risks, however: a higher risk of glaucoma and cataracts and lower bone density. If you're on high doses of inhaled corticosteroids, experts suggest taking vitamin D and a calcium supplement to counter any bone loss and having an eye exam every six months.

Anti-inflammatory medications, of course, aren't the only drugs in the arsenal. If you have asthma, you'll also need a fast-acting muscle relaxant, like albuterol, that works within minutes. But since these short-acting drugs don't battle inflammation, they're only considered a first-line therapy in people with mild and intermittent asthma. Leukotriene modifers, which blocks a messenger chemical that signals airway muscles to suck in like a straw, may help with inflammation that steroids don't seem to curb.

A caution: One leukotriene modifier, Accolate, has recently been linked to liver damage in several women. Although the medication seems to be well-tolerated by most users, the manufacturer has warned patients taking Accolate to report symptoms like nausea, vomiting, fever, and weakness to their physician immediately. Researchers at the University of California at San Francisco medical school have also called for all patients taking Accolate -- especially women -- to get regular blood tests to check for elevated liver enzymes.

Sometimes effective treatments come in unlikely packages. Complementary therapies shouldn't be dismissed as long as they aren't harmful, says Dr. Barbara Yawn, a family physician who conducts asthma research in Rochester, Minnesota. Some promising findings have come out of a recent study that found improved peak airflow and other lung functions among asthmatic children who received a nightly massage from their parents for one month. The therapy did more than improve breathing, says lead investigator Tiffany Field, a psychologist and director of the Touch Research Institute at the University of Miami. "The children were less anxious," she says. "And parents felt like they were doing something constructive."

-- Sarah Henry is an award-winning health writer specializing in parenting and social issues. She was a staff writer for the Center for Investigative Reporting for more than a decade, and has also reported on health issues for Hippocrates, Time Inc. Health, the Washington Post, the Los Angeles Times Magazine, and for television programs such as "60 Minutes" and PBS's "Health Quarterly."

References

First published January 23, 2001
Last updated September 10, 2007
Copyright © 2001 Consumer Health Interactive

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