Myths and Facts: Asthma

Chances are, everyone knows someone who has asthma. In fact, asthma is so common that most don’t believe it’s a serious illness. But it is. More than 25 million people in the U.S. have asthma, seven million of whom are children,¹ and an estimated 300 million people worldwide have asthma.² Every day, 30,000 Americans suffer an asthma attack, and each year, asthma accounts for 25 percent (two million) of all emergency room visits in the U.S. The annual national cost of asthma is estimated to be nearly $18 billion.³ Unfortunately, asthma results in death for some — deaths that could be avoidable if the facts were understood about this potentially lethal illness.

Separating Myth from Fact

MYTH: Asthma mainly affects adults.

FACT: Asthma can affect people at any age. It is more common among adult women than adult men, but it is more common among male children than female children.Asthma is the most common serious chronic disease among children and the No. 1 reason children miss school, accounting for more than 14 million total missed days of school.³

MYTH: Asthma is not a life-threatening illness.

FACT: According to the Asthma and Allergy Foundation of America, there are approximately 4,000 deaths due to asthma each year in the U.S.⁴ And, African-American women are three times more likely to be both hospitalized and die from asthma.

“Asthma mortality has been increasing in recent years,” said Donald R. Elton, MD, FCCP, at Lexington Pulmonary and Critical Care, Lexington, S.C. “Various experts have debated why this is so, but several facts are apparent from the available data. First, most patients who die of asthma do not die in the hospital. Most do not die suddenly and have frequently been in the midst of an exacerbation for several days.”⁵

MYTH: Asthma is all in people’s heads.

FACT: It was once believed that asthma was caused by an emotional problem. But while emotional triggers such as stress can cause flare-ups of asthma, asthma is not a psychological condition; it is a chronic (long-term) lung disease that inflames and narrows the airways. It causes recurring periods of wheezing (a whistling sound during breathing), chest tightness, shortness of breath, and coughing that often occurs at night or early in the morning.²

MYTH: Asthma is the same in all people.

FACT: Advances in understanding asthma have led experts to define specific types of the disease, including exercise-induced asthma, cough-variant asthma, occupational asthma and nighttime (nocturnal) asthma. Exercise-induced asthma is triggered by exercise or physical exertion. With this type of asthma, airway narrowing peaks five to 20 minutes after exercise begins, making it difficult to catch one’s breath. Symptoms can include wheezing and coughing, and an asthma inhaler (bronchodilator) before exercise may be needed. With cough-variant asthma, coughing is the predominant symptom, usually triggered by respiratory infections and exercise. This type of asthma is vastly underdiagnosed and undertreated. Occupational asthma results from workplace triggers. Some common jobs associated with this type of asthma include animal breeders, farmers, hairdressers, nurses, painters and woodworkers. Most people with occupational asthma suffer from a runny nose and congestion or eye irritation; they also may have a cough instead of the typical asthma wheezing. Nocturnal asthma results in symptoms that are more pronounced during sleep because asthma is powerfully influenced by the sleep-wake cycle (circadian rhythms).These symptoms of wheezing, coughing and troubled breathing can be dangerous; most deaths related to asthma occur at night.

Individuals also differ in the severity of their asthma. In those with mild intermittent asthma, symptoms occur less than twice a week, and there are rare exacerbation or asthma attacks and infrequent nighttime asthma symptoms. Those with mild persistent asthma have symptoms more than twice a week, but less than once a day. In these people, asthma attacks affect activity, and nighttime symptoms occur more than twice a month. Moderate persistent asthma results in symptoms that occur daily, nighttime symptoms that occur more than once a week and asthma attacks that affect activity and that may last several days, requiring quick-acting asthma medication to control symptoms. Last, people with severe persistent asthma have symptoms that occur day and night, have limited activity and frequent attacks.⁶

Understanding which type of asthma an individual has is key to getting the right treatment. It’s also possible that an individual does not have asthma, but rather another illness that has the same symptoms as asthma. For instance, cardiac asthma is a form of heart failure in which the symptoms mimic some of the symptoms of regular asthma. Vocal cord dysfunction also mimics asthma symptoms.⁷

MYTH: Asthma is caused by one’s environment.

FACT: It is unknown exactly what causes asthma, but researchers believe it is caused by both genetic and environmental factors, including an inherited tendency to develop allergies (atopy), parents who have asthma, certain respiratory infections during childhood, or contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing.⁸

It’s common for allergies and asthma to go hand in hand. Allergic rhinitis (hay fever), which causes inflammation of the inside lining of the nose, is the most common chronic allergic disease, causing a constant runny nose, ongoing sneezing, swollen nasal passages, excess mucus, weepy eyes, a scratchy throat and, sometimes, a cough due to the constant postnasal drip.⁷

An individual whose parents don’t have asthma has a 6 percent chance of having asthma. If one parent has asthma, that person has a 30 percent chance of having asthma, and if both parents have asthma, that person has a 70 percent chance of having asthma.⁶ If atopy runs in the family, exposure to irritants such as tobacco smoke might make the airways more reactive to substances in the air.⁸

There also is the hygiene hypothesis. Researchers believe that the Western lifestyle that emphasizes hygiene and sanitation has resulted in younger children no longer being exposed to the same types of environments and infections as they were in the past. Therefore, the way in which young children’s immune systems develop during early childhood may increase their risk for atopy and asthma, especially in children who have close family members with one or both of these conditions. However, this hypothesis has yet to be proved.⁸

MYTH: Asthma doesn’t need to be diagnosed with tests.

FACT: It’s important to confirm that an individual does in fact have asthma and if there are other co-existing conditions such as allergies, gastroesophageal reflux disease (GERD) or sinusitis so that a doctor can prescribe the proper medications to help manage the asthma and to prevent attacks. Asthma can be diagnosed with lung function tests, tests for allergies, blood tests and tests that measure levels of immunoglobulin E, a key antibody that is released during an allergic reaction.

The two most common lung function tests are spirometry and methacholine challenge tests. Spirometry is a simple breathing tests that measures how much and how fast a person can blow air out of his or her lungs to determine the amount of airway obstruction. The methacholine challenge test is performed if symptoms or the spirometry test doesn’t establish an asthma diagnosis.

A chest X-ray can show whether or not something other than asthma such as bronchitis or a broken bone is causing symptoms. Other specific tests can determine whether a person has GERD, which can worsen asthma symptoms, or sinusitis, which can make asthma harder to treat and control.⁹

MYTH: People with asthma should avoid exercise.

FACT: Exercise can actually help people with asthma. The key is to begin an exercise program carefully and to discuss the program with the person’s physician. Asthma symptoms often can be prevented by taking medications prior to exercising.¹⁰ The best forms of exercise for people with asthma are swimming and sports with stop-and-go activity such as baseball, football and short-term track and field rather than sports that have a lot of ongoing activity such as soccer, basketball, field hockey or long-distance running. Walking, leisure biking and hiking are also good sporting activities. And, warm-ups and cooldowns may prevent or lessen symptoms.²

Children should especially be encouraged to exercise. They can play, take gym class and play sports, but they also may need to take medication before they play.¹¹

MYTH: Medicine should be taken for asthma only when there are symptoms.

FACT: The best way to control asthma is with carefully planned treatments. The goal is to put people in control of their asthma rather than letting the asthma control them. Asthma medication is divided into two categories. Quick-relief asthma medication treats acute asthma symptoms. Controller asthma medication attempts to prevent asthma symptoms. Controller asthma medication should not be stopped when individuals feel well. When individuals are feeling well and are not experiencing symptoms or breathing problems, it is because the medicine is working. On the other hand, quick-relief medication should not be used when individuals feel well; it should be used only as needed when there are symptoms, problems breathing or as pretreatment before exercise.¹¹

Which medicines are prescribed depends upon a person’s age, symptoms, asthma triggers and what works best to keep the asthma under control. There are five types of long-term control medications. Inhaled corticosteroids typically take several days to weeks before they reach their maximum benefit and have a relatively low risk of side effects. Leukotriene modifiers are oral medications that relieve asthma symptoms for up to 24 hours and, in rare instances, they have been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Long-acting beta agonists are inhaled medications that are intended to be taken only in combination with an inhaled corticosteroid. Research shows they may increase the risk of a severe asthma attack, and they are not to be used for an acute asthma attack. Combination inhalers contain a long-acting beta agonist along with a corticosteroid, and they also may increase the risk of a severe asthma attack. Theophylline is a daily pill that relaxes the muscles around the airways to help keep the airways open. However, it is not prescribed as often as in the past.

There are three quick-relief medications. Short-acting beta agonists can be taken using a portable, handheld inhaler or a nebulizer to rapidly ease symptoms during an asthma attack. Ipratropium (Atrovent) acts quickly to relax the airways, making it easier to breathe.And, oral and intravenous corticosteroids, which include prednisone and methylprednisolone, relieve airway inflammation caused by severe asthma. However, because these corticosteroids can cause serious side effects when used long-term, they are used only on a short-term basis.¹²

MYTH: Medicines for asthma can be addictive.

FACT: Because people with asthma are dependent upon their medications to stay well and to stop attacks, many fear they will become addicted to them. However, there is no evidence of the development of addiction to asthma medications. Patients with severe asthma may become “steroid dependent” for control of their disease, but that does not represent an addiction to medication. And, in the case of systemic corticosteroids, the management of reduction and withdrawal of these agents must be closely supervised due to possible adrenal insufficiency.¹³

MYTH: Alternative and complementary approaches are better for treating asthma.

FACT: The verdict is still out on whether complementary or alternative approaches to treating asthma really work and are safe. Some studies suggest that symptoms may improve with acupuncture. While there’s no clear evidence as of yet, it is a relatively low-risk alternative treatment. A number of studies also have shown that people’s asthma symptoms have improved with breathing exercises. And, some clinics and researchers offer breathing technique instructions as part of asthma treatment. Two breathing techniques used are Buteyko and pranayama (yoga breathing).

Herbalremedies,which have been used forthousands of years to treat lung disorders, have shown promise in research. These include butterbur, dried ivy, ginkgo extract, tylophora indica, French maritime pine bark extract (Pycnogenol), Indian frankincense (Boswellia serrata) and choline. When using herbal remedies, certain combinations of herbs may be more effective than taking one alone, and certain concerns should be considered, including the quality and dose, side effects (which can range from minor to severe) and drug interactions.

There also are some vitamins and supplements that show promise. These include antioxidants such as vitamin C, vitamin A and magnesium to boost the immune system, omega-3 fatty acids to reduce inflammation, and vitamin D.

Other treatments that either show no evidence of relieving asthma symptoms or that experts discourage include homeopathy (using very small doses of substances that cause symptoms), inspiratory muscle training, massage and chiropractic treatment, and relaxation therapy.¹⁴

MYTH: In some people, asthma will eventually go away.

FACT: People who have asthma have asthma; they cannot grow out of it. In 50 percent of children with asthma, the condition may become inactive in the teenage years. But the symptoms may recur at any time in adulthood.⁶

MYTH: Asthma is curable.

FACT: There is no cure for asthma. Even moving to a new location won’t cure asthma as some people believe. After relocating, people will become sensitized to the new environment and the asthma symptoms will return with the same or even greater intensity. However, asthma can be controlled with good medical care.⁶

Dispelling the Myths Now

With the number of asthma cases on the rise, there is continued investment in a search for a cure. While many experts agree that a cure is unlikely, some also predict that the disease will afflict only a small number of people in 10 to 20 years due to significant improvements in the currently used treatments.¹⁵ For now, however, the best way for asthma sufferers to live free from the effects of the disease is to be armed with the knowledge of how to prevent and manage it.