Blood Pressure Control

Asthma is a disease of the human respiratory system in which the airways narrow, often in response to a "trigger" such as exposure to an allergen, cold air, exercise, or emotional stress. This narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which are the hallmarks of asthma. Between episodes, most patients feel fine.

By Michelle Meadows - FDA

During the mid-1980s, Sandra Fusco-Walker's life was filled with sleepless nights, ruined vacations, emergency room visits, and her children's frequent school absences. Two of her three children--all under age 6 at the time--had asthma.

"I was always worried about when the next bad thing would happen," says the Kinnelon, N.J., resident. "But that was before we had a plan."

The "plan" was an asthma action plan that guided her on how to track her children's symptoms, monitor their breathing, and give them medication. "A plan tells you what to do and when," she says. "Without it, asthma is out of control, and that's when the disease wreaks havoc on your life."

Asthma causes the airways to be inflamed or swollen, and the surrounding muscles are tight. When people with asthma react to various triggers, such as dust, pollen or smoke, their airways become narrow, which causes labored breathing, wheezing, chest tightness, or coughing. About 15 million people in the United States have asthma and almost 5 million are children, according to the National Heart, Lung, and Blood Institute (NHLBI). Every year, asthma causes roughly 2 million emergency room visits, up to 500,000 hospitalizations, and 4,500 deaths.

Fusco-Walker says she learned to control asthma after she followed her doctor's advice and called a nonprofit organization called Allergy & Asthma Network Mothers of Asthmatics (AANMA). The woman who answered the phone was Nancy Sander, who founded the organization in 1985 after facing challenges in dealing with her own daughter's asthma. Fusco-Walker says, "Nancy assured me that I wasn't going crazy."

With support and advice from AANMA, Fusco-Walker learned to look for patterns in her children's illness. For example, her kids got sick every time they visited her mother, and her mother smoked. Her oldest daughter had an asthma attack when she visited their horse barn. Fusco-Walker also learned to spot early warning signs of trouble. "I noticed that one of my daughters rubbed her nose when breathing became difficult," she says. "If I saw her rubbing her nose, I knew to get the peak flow meter." A peak flow meter is a small tool that measures how fast air moves out of the airways. Fusco-Walker attributes the success of her asthma action plan to the regular use of a peak flow meter.

By the time Fusco-Walker's youngest child was diagnosed with asthma at age 5, her family had a much better understanding of the disease. Shannon, who is now 16, Jared, 19, and Morgan, 21, grew up learning how to use their asthma medicine. "They know when to use their inhalers, they know when they need refills, and they know when they need to take medication before doing an activity," she says. They also grew up participating in just about any activity they wanted to, including football, swimming, soccer, and snowboarding.

Experts say most people with asthma can live a normal, active life. What it takes is avoiding the triggers that make your asthma worse, keeping track of your symptoms, and sticking to an effective treatment regimen. Many people with asthma need short-term medicine for when they experience symptoms, and also long-term daily medicine that reduces inflammation in the airways and helps prevent asthma attacks.

"I'll hear people say they skipped their medication because they haven't been coughing that much," says Richard L. Wasserman, M.D., Ph.D., clinical associate professor of pediatrics at the University of Texas Southwestern Medical School. "But I tell them they probably wouldn't have coughed at all if they kept to the regimen." He says it's important to understand that asthma is a chronic inflammatory lung disease. "Like high blood pressure, asthma is there all the time even when there are no symptoms."

Accurate Diagnosis
The first step in controlling asthma is an accurate diagnosis. Fusco-Walker says doctors diagnosed her kids with all kinds of illnesses before she knew the problem was asthma. According to Kathleen Sheerin, M.D., an asthma specialist with the Atlanta Allergy and Asthma Clinic, this is a common problem, and both consumers and doctors play a role. "Some people are scared of the word 'asthma' because they only think of an emergency room scene on TV," she says. "I tell them there are a whole range of asthma symptoms, and the disease doesn't have to be scary if it's properly managed."

Sheerin says, "Doctors may call asthma other things like wheezy bronchitis or reactive airway disease." Asthma symptoms vary by individual, and the disease can look like other lung diseases. Also, asthma symptoms usually surface before age 6, but it can be difficult to establish a firm diagnosis in young children. "Babies up to age 2 or 3 may wheeze only when they get a cold, and we call them 'transient wheezers,'" Sheerin says. "For other kids, the wheezing continues as they grow." These children, often considered "persistent wheezers," have chronic asthma. (Also see "What Causes Asthma?")

"What we do is look for factors that make it more likely that a child's asthma will persist," Sheerin says. These factors include having a family history of asthma. Asthma is also more likely to persist if symptoms aren't only associated with a cold, but if there are also symptoms associated with other triggers such as smoke. People with asthma that persists also tend to experience wheezing that occurs at night, with exercise, or with seasonal changes. They also may have other allergic symptoms, such as allergic rhinitis or eczema, an itchy skin condition.

Sheerin participates in a state education program called Breathe Georgia, which uses the slogan "Call it what it is" to encourage doctors to accurately diagnose asthma. "You have to know that you have it in order to understand it and manage it," she says. "And an earlier diagnosis usually means better health outcomes."

The older someone is, the easier asthma is to diagnose. Doctors rely on a combination of a medical history, response to medications, and lung function tests. Such tests are generally hard to use in children under 6. One common lung function test, spirometry, involves inhaling and exhaling through a tube for several seconds. In some cases, allergy tests are performed to help determine asthma triggers.

Doctors determine whether asthma is intermittent (occurring from time to time), or persistent, defined as having symptoms at least twice a week during the day or twice a month during the night. Asthma that is considered persistent is further categorized as mild, moderate or severe. Fusco-Walker, who was diagnosed with mild asthma in her thirties, says these categories help doctors determine an appropriate treatment plan. "But remember that regardless of the type, you still have asthma and it is still a life-threatening illness," she says. "Some people hear the word 'mild' and think they don't have to worry about it. But they do."

Though asthma can't be cured, it typically can be treated, and scientists are currently studying whether untreated asthma causes a permanent change in the airways. As a natural part of aging, we begin losing lung function in our twenties. Untreated asthma might further accelerate that loss.

Common Triggers
Brian Thomas, 41, a book distributor in New York City, has childhood memories of vaporizers by the side of his bed. "I remember wheezing the night away, often with my mother sitting with me," he says. He noticed some relief from asthma symptoms when he went off to college in Syracuse, N.Y. But the symptoms returned whenever he came home to his childhood bedroom. The culprits were dust mites, tiny bugs that are too small to see. They live on mattresses, bed linens, carpet, and stuffed animals. When Thomas' parents removed the carpet from his room, his asthma symptoms improved considerably.

For more detailed information about Singulair and Asthma treatment, ask your health care provider.

Singulair(r) | Asthma Medication | Asthma Treatment