February 9, 2018

A lot of people who have asthma might not even realize it, and uncontrolled asthma can cause permanent damage.


Many adults deal with the discomfort of asthma, while not even realizing that it is asthma that is affecting them. Allergist and immunologist John Fahrenholz, M.D., of the Vanderbilt Asthma, Sinus and Allergy Program, talked to us to help us better understand asthma.


Question: What is asthma?

Answer: Asthma is an inflammatory disorder of the airways. Inflammation in the lungs — most commonly driven by allergies — causes the airways of the lungs to collapse little bits at a time, and so periodically people will have the symptoms of shortness of breath and wheezing.


Question: Are there certain seasons that make asthma more common?

Answer: Fall is an active time with respiratory viruses and the dominant allergens that are around: ragweed, in particular, and mold. But it depends somewhat on your allergic profile. There are people who will have more trouble in the spring or summer, or if viral infections are a big part of it, then sometimes late fall and even winter. It’s definitely a year-round process disease, but fall is an active season.


Question: What can trigger an asthma attack?

Answer: The main triggers are viral infections, in terms of causing flare-ups, and then allergic triggers for those who are allergic. Many people will have trouble with exercise triggering asthma symptoms.


Question: What are the long-term effects of asthma on the lungs?

Answer: Asthma can actually cause damage to your lungs, and often, people don’t think about that. We’re not sure exactly who is more prone to have that damage, but it seems that those who have more severe asthma are more affected. Uncontrolled inflammation can cause a process that we call remodeling, in which permanent damage, fibrosis, decreases lung function. It can cause long-term problems.


Question: How many people are walking around with asthma that they aren’t treating? Is that a big problem?

Answer: A lot of people who have asthma might not recognize it, depending on how severe it is. Sometimes, we see people who grew up having pretty bad asthma that gets better during their teenage years, so as adults, their symptoms don’t seem that bad compared to when they were kids. There are groups of people who just don’t really feel like it’s a problem anymore, or maybe they haven’t been diagnosed. They think it’s related to being out of shape or other problems that just aren’t recognized as persistent asthma.


Question: What are the signs and symptoms of asthma?

Answer: Generally, having periods of time when you’re having more trouble breathing and your activities are limited, particularly exercise. People will have a tendency to wake up and feel tightness in the chest. Not everybody wheezes; sometimes it’s a chronic cough. We’ll see many people who have cough-variant asthma, and periodically, they will get into bouts and fits of coughing that are suggestive of asthma. Again, not everybody wheezes. Cough is a pretty common symptom, and then sometimes just having shortness of breath during exercise, or right after exercise, could be a big problem.


Question: What about long-term management of asthma?

Answer: The key distinction is between intermittent asthma or persistent asthma. Persistent asthma is defined by having symptoms more than twice a week, apart from exercise, where you have this wheezing or feeling short of breath and need an albuterol inhaler. Medicines like albuterol are designed to help open the airways so that we can breathe easier. For people who need that frequently, that implies a more persistent, profound or severe inflammation that requires anti-inflammatory treatment. One of the key treatments that we use would be anti-inflammatory inhaled steroids to try to control symptoms, along with many others.


Question: What is the treatment for asthma?

Answer: We have an approach that takes into account the entire airway. Many people will have sinus problems that trigger asthma symptoms. If you have chronic active sinus disease, it’s very hard to have asthma well-controlled. If your allergies aren’t well-controlled in terms of allergic rhinitis, that’s something that impacts asthma.

We have specialists across the gamut in terms of airways with our ear, nose and throat rhinology specialty surgeons. We have allergists and pulmonologists, or lung doctors, who are a part of our program. That really allows us to do a comprehensive evaluation. We start by looking at symptoms and taking a good history about what’s been happening with the patient.

Key testing would be looking at lung function for this reversible obstruction that is seen in persistent asthma; if your lung function is impaired with asthma, the good news is it gets better. With the albuterol treatment, we see lung function improve.

Need help?

Call 615-936-2727 for an appointment with the Vanderbilt Asthma, Sinus and Allergy Program for an evaluation and the most up-to-date treatment recommendations.