Asthma and Allergy Treatment

Asthma is a chronic inflammatory disease of the airways. This inflammation is associated with hyperactive airways. The airways are hyperactive in that they respond to a number of triggers (risk factors) that cause the airways to become inflamed and blocked by bronchocon striction. This results in the symptoms of asthma. Although the causes of asthma are not known with certainty, there are predisposing factors that make the individual susceptible to the disease. Atopy, the ability to produce allergic antibody (IgE) in response to environmental factors, is considered to be the strongest identifiable risk factor for the development of asthma. Studies have also shown that asthma occurs in families and is probably inherited along with the ability to develop allergic antibodies. The Division of Allergy staff is currently involved in a study to discover the genes that predispose people to develop allergy and asthma.

A careful history is necessary in order to identify each person's risk factors, such as allergens, respiratory infections, exercise, weather conditions, occupational agents and other pollutants. Once a person is sensitized to allergens, exposure to very small amounts of the allergen are able to cause an asthma exacerbation with major changes in the lungs. The patient's history helps to reveal contributing factors in the development of asthma, and skin tests with allergens are used to identify the specific triggers. Prick tests are the most commonly used diagnostic tests because of their simplicity, rapidity of performance, low cost and high sensitivity.

Once the allergens are identified, measures are taken to avoid exposure to these allergens. Avoidance or control of triggers can prevent exacerbation and reduce symptoms, as well as the need for additional medication. In addition, desensitization injections may be considered when avoiding allergens is not possible. Specifically, desensitization (immunotherapy) has been demonstrated to be effective for asthma caused by ragweed pollen, grass pollen, domestic mites, animal dander or mold allergy. Immunotherapy (desensitization) requires injections of the specific allergen with increasing doses over time. After a three-year course of treatment, the effect of treatment may last for several years. It is essential to also consider the risk factors in comparison to the benefits of this form of treatment. Specific measures are taken to reduce the risk. More than 56 percent of the patients who have asthma also have related allergies.

When not properly managed, asthma and related bronchospastic disorders -- activated by allergens, exercise, irritants such as cigarette smoke, cold air or weather changes, among others -- can lead to significant lifestyle limitations, and repeated emergency hospital visits and admissions, as well as absences from work and the classroom.

To develop a treatment plan tailored to each patient, specialists at the center -- who collaborate closely with the patient's primary-care physician -- assess the patient's overall health status as well as factors that contribute to asthma flares. Pulmonary physiologic testing through the center's Pulmonary Function Laboratory allows asthma specialists to determine the extent of airway over-reactivity among patients with asthma.

Gone are the days of focusing treatment on symptoms only. Focuses now include treating the cause of the symptoms and patient education. With this combined approach, in collaboration with the primary caregiver, the toxicity of treatment can be minimized.

Beta antagonists and theophylline, once the mainstays of asthma treatment, are slowly being replaced. These medications have high toxicity profiles and may be partially responsible for the increased mortality of severe asthma seen in recent studies. Inhaled corticosteroids with their low toxicity profile are eliminating the need for these other, more toxic, medications.

Perhaps the largest role health professionals now play in the treatment of asthma is educating the patient about disease monitoring and treatment decisions. Through home monitoring (using a peak flow meter), the need for office and emergency room visits may be decreased significantly. Small changes in the peak flow can identify flares in the disease at an early stage, and treatment can be started before symptoms occur. This approach also allows for identification of environmental factors that trigger bronchospasm. Avoidance techniques can then be applied to help decrease symptoms.

Efforts that combine an accurate assessment of the triggers causing asthma, monitored treatment, home monitoring and patient education have proven successful in stabilizing this condition in even the most difficult asthmatics.

Co-Directors
Peter Kaplan, M.D.
Antonio Zikos, D.O.

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