Asthma

Asthma is a chronic lung disease that affects 8% of Canadians based on 2014 census data. It typically presents in childhood but may be diagnosed in older adults as well. It is inflammation of the small airways of the lung that cause them to constrict and impair air from flowing out, at times causing a whistling noise from the chest called wheeze. In some patients, triggers of asthma attacks include cold air, exercise, environmental allergies, viral infections, pollutions and particulates from forest fires.  Asthma is diagnosed based on a history of episodes of breathing difficulties, chest tightness, wheeze, cough and breathing tests. Your doctor may order spirometry, lung function testing, or a methacholine challenge, or all of the above. Once the asthma is diagnosed, the treatment starts with avoidance of triggers, for example if an allergy to dust mite, animals, pollens or mold spores is identified, then suggestions for avoidance and decreased exposure are reviewed.

Treatment is determined based on frequency of symptoms and exacerbations as well as lung function. The main treatment is an inhaled steroid medication that helps decrease inflammation at baseline and allows the lungs to heal over time. It is important to take this medication regularly as prescribed. Another inhaled medicine is used to help relax the airways, for example Ventolin (salbutamol) is a common medication used. It acts right away but only lasts for 4-6 hours. Increased use of this medication means that the lung inflammation is not well controlled and a steroid medication is necessary. Ventolin should not be used on a daily basis and is only used as needed for occasional symptoms as it does not treat the underlying lung inflammation. At times, combination inhalers are prescribed that include both a steroid medication and a relaxer.

Inhaled steroids at low-medium doses do not have significant side-effects. Their proper use can prevent the need for steroid pills that are at times used during asthma exacerbations. The steroid pills are a significantly higher dose and come with side-effects such as weight gain, cataracts, osteoporosis, high blood pressure, diabetes. Inhaled steroids are much safer to take for long periods of time as they act on the lungs where the inflammation is and prevent exacerbations, thus reducing the need for oral steroids.

Dr. Ana-Maria Bosonea