MMS Physician Focus: June 2010
By Daniel G. Steinberg, M.D.
A report issued in April by the Asthma Regional Council (ARC) of
New England was clear and direct: New England has the highest rates
of asthma in the nation, with approximately one in ten residents
suffering from the condition.
The public health burden of asthma is approaching alarming
levels regionally and nationally. The Centers for Disease Control
estimates that nearly 24 million people of all ages are afflicted
with this chronic respiratory condition. Further, asthma is one of
the most common chronic allergic and respiratory conditions
impacting children. In Massachusetts alone, nearly 11 percent of
children in grades K-8 have asthma, according to the Massachusetts
Department of Public Health.
The reasons why New England has the highest rates of the disease
remain a question. Several theories exist, with the region's
housing, climate, seasonal changes, air pollution and other factors
possibly playing roles. One of ARC's most important
findings reported that the disease remains poorly controlled in
many patients. Almost two-thirds of adults and children reported
that they did not feel their asthma was well controlled.
The signs of asthma can vary between individuals and can present
differently in individuals at different times. Milder symptoms can
begin as chronic coughing, exercise limitation, wheezing or
shortness of breath. Symptoms can progress intermittently or on a
chronic basis to become associated with decreased productivity,
work absences or lost school days. If left untreated, asthma can
impair quality of life and lead to disability and even
death.
The underlying cause of the condition is inflammation or
irritation of the respiratory passages, which constricts the
airways, making it difficult to breathe. The causes of the disease
may not always be evident.
It appears that genetic factors can lead to a predisposition to
become asthmatic. Natural factors (pollen, dust mites, animals,
molds, other infections) and manmade environmental factors (tobacco
smoke, occupational triggers, chemicals, toxins, pollution) also
appear to be playing an increasingly important role. The
correlation between passive cigarette smoke exposure and asthma is
particularly strong, especially with regard to children. Research
has shown that children who live in homes with smokers have a 44
percent higher chance of developing asthma than those children who
do not live in homes with smokers.
One of the major challenges of treating asthma is that each
patient has a unique environmental history and a different genetic
makeup. For both physician and patient, the first step before any
therapeutic intervention is to pursue a thorough review of
potential triggers. Once this assessment is made, an asthmatic
patient and the physician together can develop a customized action
plan with strategies to manage the condition. These steps may
include avoidance of offending triggers (removing cigarette smoke,
mold, dust, or animals), medications, and in some cases,
desensitization (immunotherapy) to lower the patient's degree of
allergic reactivity.
Since several factors can contribute to poor control, patients
who have chronic respiratory symptoms for which the cause may be
unclear, may want to meet with an asthma specialist for an
assessment. This would include a thorough history, physical
examination and some simple tests to verify triggers and assess the
severity of the patient's condition. These findings will provide
the basis of a customized action plan that can be revisited over
time, adjusted seasonally, as a patient ages, or changes the home
or work environment.
For those patients interested in obtaining a customized action
plan to achieve better asthma control, an effective approach would
be described simply as this: get tested, get treated, and get
better. For more information, visit the American Academy of Asthma,
Allergy and Immunology at www.aaaai.org or the Massachusetts
Medical Society at www.physicianfocus.org
Daniel G. Steinberg, M.D. is a board-certified specialist in
Allergy/Immunology, Director of the Allergy & Asthma Center of
Massachusetts, and a Past President of the Massachusetts
Allergy & Asthma Society. Physician Focus is a public
service of the Massachusetts Medical Society. Readers should use
their own judgment when seeking medical care and consult with their
physician for treatment. Comments toPhysicianFocus@mms.org
.
