Asthma

Asthma remains one of the most common, chronic non-communicable disease affecting children and adults. Typical symptoms of asthma include wheezing, shortness of breath, coughing, chest tightness and air hunger. Major pulmonary manifestations should be reversed with inhaling a short acting bronchodilator such as albuterol. Spirometry testing of the amount of air forcibly exhaled in one second should improve by more than 12% or 200ml within 15 minutes after inhaling albuterol.

In America, the minority population appears at greater risk than Caucasians yet the incidence in whites still exceeds 7.5%. Family clustering seems likely. Among children the attack rate in boys exceeds that in girls. A switch in sex incidence occurs during puberty with the rate among adult women surpassing that in men. Asthma appears much less common in developing nations than in more affluent countries.

Asthma attacks vary in severity and tend to be more frequent in the early morning and late evening. A change in season may precipitate attacks; the same occurs with exercise especially in cold air or with exposure to chlorine from swimming pools. A variety of triggers may lead to asthma attacks. These include viral upper respiratory infections, bacterial sinusitis, exposure to cigarette smoke or atmospheric pollutants. Occupational exposure remains a common inciting factor.

Childhood asthma is often associated with eczema and allergic rhinitis. Symptoms often persist into the adult years. Obesity, obstructive sleep apnea and GERD or gastroesophageal reflux disease may be associated with asthma.

Many with asthma suffer from hyperresponsive airways. Exposure to pollens, dander, pollutants and viruses may lead to constriction of smooth muscle lining the airways with consequent narrowing of the respiratory passageways. Inflammation of the airways is another major issue that leads to further restriction of the bronchial tree often worsened by production of mucus. All of this increases the work of breathing.

Attacks may spontaneously disappear or require albuterol. Persistent asthma should be additionally treated with inhaled corticosteroids as the primary drug. Some need additional bronchodilators often referred to as LABA or LAMA. Only when these agents fail should injectable biologic agents be considered. The monthly cash cost for these highly advertised biologics ranges between $2000-$5000.