Asthma is a chronic lung condition that is characterized by inflammation and narrowing of the airways. It is commonly referred to as “Reactive Airway Disease” because patient’s airways overreact to different triggers. Triggers can include cold air, hot humid weather, upper respiratory infections, sinusitis, exercise, irritants such as cigarette smoke or strong smells, and allergies. Asthma can also be secondary to another underlying medical condition, such as Gastroesophageal Reflux (GERD), Adenoid Hypertrophy, Cystic Fibrosis, Alpha-1-Antitrypsin Deficiency, and Churg-Strauss Vasculitis to name a few. It is important to note that 80% of asthmatics have an underlying environmental allergy contributing to the asthma. Asthma classification is based on severity and consists of the following categories: Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent. Treatment is determined by the level of severity of the asthma.
Asthma symptoms include shortness of breath, chest tightness, chest pain, chest heaviness chest squeezing, wheezing, coughing, shortness of breath with activity and decreased endurance with sports. Patients do not need to present with all of these symptoms to have the diagnosis of asthma.
The diagnosis of Asthma is made based on the following: history, physical exam, spirometry and exhaled nitric oxide. Spirometry is a breathing test that evaluates the function of your lungs by measuring air flow. Fractional Exhaled Nitric Oxide (FENO), a relatively new test approved to help assess asthma control, measures the gas called Nitric Oxide in your breath, which is a marker of inflammation in the lungs. Both spirometry and exhaled nitric oxide are performed at Weiss Medical. If necessary, a Chest X-ray, Formal Pulmonary Function Tests and a Methacholine Challenge may also be obtained if the diagnosis of asthma is still in question despite extensive testing in the office.
Treatment of asthma is determined based on the frequency and severity of your symptoms. Treatment includes identifying and controlling triggers of your asthma. For example, if one is allergic to dust mites and has asthma, minimizing dust mite exposure via dust mite encasements and placement of an air purifier in the home should prove helpful. You should have a rescue inhaler which is used only if needed to temporarily relieve your asthma symptoms when they occur. The need for an everyday or maintenance anti-inflammatory medication depends on the severity of your asthma. Maintenance medications include inhaled corticosteroids, combination inhalers (inhaled corticosteroids with LABAs), Leukotriene antagonists and Anti-cholinergic inhalers. For patients with allergy-induced asthma who are not able to be taken off daily medications or remain poorly controlled despite the above medications, other treatment options include allergen immunotherapy (allergy shots) and the newer biologic agents as below. At Weiss Medical, treatment recommendations are based on Practice Parameters published by the American Academy of Allergy, Asthma and Immunology and fully discussed with the patients.
New Biologic Therapies
For patients with severe asthma who remain poorly controlled despite the above conventional treatments, other newer targeted treatment options are now available. These newer targeted therapies have been designed to more specifically target immunologic targets that drive severe asthma. These include omalizumab (Xolair), mepolizumab (Nucala) and benralizumab (Fasenra). Omalizumab (Xolair) is an injectable medication for asthma that is given once every 2-4 weeks for patients with Moderate to Severe Persistent Asthma with an allergic phenotype. For patients with severe asthma whose disease process is determined to be driven by a specific inflammatory cell type called the eosinophil, mepolizumab (Nucala) and benralizumab (Fasenra) are new treatment options. Mepolizumab (Nucala) is an injectable medication given every 4 weeks for Severe Persistent Asthma with an eosinophilic phenotype. Benralizumab (Fasenra) is an injectable medication given every 8 weeks for Severe Persistent Asthma with an eosinophilic phenotype.