Asthma Christmas Wish List

The following was written by me and published at healthcentral.com/asthma on December 18, 2015.

Our Asthma Christmas Wish List

I recently participated in a brainstorming session with a group of respiratory therapists.  Our goal was to create a list of medicines asthmatics would like to find under the Christmas tree. That in mind, here’s our list of fake, or yet to be developed, asthma medicines.  This is our wish list we sent to Santa.

1. Probiotic Magic.  Probiotic is a fancy way of saying good, or healthy, bacteria that are essential for maintaining a healthy body.  Microflora is a fancy term for describing all the microbes inside our body, good and bad, such as parasites and bacteria.  The Microflora Hypothesis states that a normal balance of good and bad microflora inside our gut prevents an abnormal immune response that leads to asthma and allergies.  It also states that our modern diet, and antibiotic use, is killing off good microflora, leaving a microflora imbalance. A probiotic pill would, when swallowed, help the gut and immune system prevent allergic asthma.

2. Pig Vaccine.  The Hygiene Hypothesis states that our own cleanliness causes an abnormal immune response that leads to asthma. The idea is that, lacking certain “good bacteria” early in life when our immune systems are developing, it gets bored and starts attacking innocuous substances ingested or inhaled, leading to asthma and allergies.  This theory first came to light when it was observed that asthma rates were relatively low in underdeveloped countries. Studies actually showed asthma rates were lower among children who grew up on farms, particularly near pigs. A theory was postulated that animals, like pigs, carry the “good bacteria” our immune systems need to mature properly.  So our vaccine would involve a one time injection during the first month of life when the immune system is still developing, particularly in those infants shown to have an asthma gene.

3. Super Safe Steroid.  Systemic steroids are often used in emergency situations to end asthma attacks by reducing inflammation and swelling in asthmatic lungs.  Even though they make breathing easy, they cannot be taken long term due to some pretty awful side effects.  What we need is a synthetic version of this medicine that allows us to get the desired effects without the unwanted side effects. Ingesting a super safe steroid pill would prevent asthma symptoms.  A bonus is that it would also prevent other inflammatory diseases from flaring up, like arthritis.  So, along with better breathing, you’d also be pain free, too.  

4. Anti-Allergy Drops.  Three drops in the morning, placed gently on your tongue, would prevent your immune system from attacking innocuous substanceswithout causing drowsiness.  In other words, it would prevent allergies from happening sans side effects.  If we can prevent and control allergies, we can also prevent asthma attacks in those with allergic asthma.  This would allow those with allergic asthma to live normal lives, as they no longer would have to avoid their asthma triggers. No more avoiding dusty basements.  No more avoiding your aunt with all the dogs and cats.  Yes, you could just be a normal person for a change (aside from having to use the drops every day, but that’s an acceptable trade off).  

5. Fortnight Asthma Puffs.  This is an inhaler that is inhaled once every two weeks to prevent and control asthma. It’s a combination inhaler that contains both Probiotic Magic and Super Safe Steroid. It’s timed delayed action lasts two weeks, making it an ideal asthma medicine.  All you have to do is remember to mark your calendars, or download the Fortnight Asthma App for your iPhone which will remind you when your puffs are due.

Look, pharmaceuticals have come a long way to creating some great asthma medicines to help us live better lives.  Yet there is still some work to do, and this is where Santa comes in handy.  Here’s hoping Santa keeps us asthmatics in mind this Christmas season. Wishing you easing breathing this Holiday season!

You May Also Enjoy Reading

• Christmas Trees May Make You Sneezy And Wheezy
• Six Common Christmas Asthma Triggers
• Santa’s Elves Working On New Asthma Medicines

World Asthma Day

The following was originally published at healthcentral.com/asthma on May 4, 2015.  While it was published for last years event, it still applies today. 

World Asthma Day: You Can Control Your Asthma

World Asthma Day is May 5, 2015. This is an annual event sponsored by the Global Initiative for Asthma (GINA) since 1998. This is one day of the year specifically dedicated to improving asthma awareness and care throughout the world. This year’s theme is “You Can Control Your Asthma.”

Asthma, or asthma-like symptoms, were recorded in some of the earliest writings. The disease was relatively ignored by the medical profession, mainly because it was considered more of a nuisance (like a head cold) than a serious disease. So they ignored asthma in favor of diseases like tuberculosis and diptheria.

So now that those diseases are tackled, it’s our turn. Since the 1950s researchers have made great strides in asthma research. In the late 1980s and early 1990s, asthma guidelines were created -- such as GINA’ Guide to Asthma Management and Prevention and National Heart Blood and Lung Institute’s (NHLBI) Asthma Guidelines -- to arm doctors with the knowledge they need to help YOU control your asthma.

In 1998, the first World Asthma Day was sponsored by GINA. In 2003, GINA released the Global Burden of Asthma Report showing “the prevalence and impact of asthma around the world.” The theme for World Asthma Day 2004 was the “Burden of Asthma.” They just wanted to get the word out that, “Hey, our disease is important too. We would like some attention here.”

Yet despite all the progress made since then, all the evidence suggests that too many asthmatics continue to suffer; too many asthmatics continue to be victims of their disease and they don’t have to.

The American Academy of Allergy, Asthma and Immunology (AAAAI) estimates that about 300 million people worldwide have asthma, which is about 10 percent of the world’s population. Of these, about 53 percent have asthma attacks in a given year. So there are still many asthmatics who struggle with their disease.

So, as you can see, it’s a big deal that we get our own day, once a year, on the first Tuesday of May (National Asthma Month) to get the word out about our disease. And considering all those who continue to suffer from the effects of asthma, it’s only fitting that this year’s theme is “You Can Control Your Asthma.”

Most asthma experts now agree that most cases of asthma can be controlled by working with a doctor and creating an asthma action plan. This plan tells you what to do daily to control your asthma, and what action to take when you recognize asthma symptoms.

The goal of asthma control, as noted by GINA, is:

• No (or minimal) asthma symptoms
• No waking at night due to asthma
• Rare use of asthma rescue medicine
• Ability to do normal physical activity and exercise
• Normal lung function
• No (or infrequent) asthma attacks

These goals should be realistic for most asthmatics. For the 10 percent of asthmatics with severe asthma, the goal of asthma control might be satisfaction with your current qualify of life, or being able to do the things you love to do.

These guidelines arm physicians with the knowledge they need to help their asthma patients obtain and maintain good asthma control. No longer do asthmatics need to suffer as victims of their disease. Yet, as the evidence shows, many still do.

So, the goal of this year’s World Asthma Day is to get the word out to every asthmatic: You Can Control Your Asthma. To get started, check out my post “How to Obtain Good Control of Your Asthma.”

Further reading:

• What is Good Asthma Control?
• Asthma Action Plan Steps
• How to Obtain Good Control of Your Asthma
• GINA: World Asthma Day
• AAAAI: Asthma Statistics
• NHLBI: World Asthma Day and Asthma Awareness Month
• May is Asthma Awareness Month

Fetal Origins Hypothesis: Mother’s Environment May Cause COPD

Originally published at healthcentral.com/copd

Researchers are working overtime to learn what causes COPD. The Fetal Origins Hypothesis suggests it all begins in the uterus as the fetus adjusts to its environment. Such adjustments may predispose the fetus to chronic diseases like asthma and COPD later in life.  

During the 1950s and 1960s, physicians thought the placenta was a natural barrier that protected unborn babies from the mother’s environment; that it protected the fetus from anything bad ingested or inhaled; that it only allowed good substances, such as essential nutrients, to get to the fetus.

It was based on this old theory that caused physicians, or at least many of them, to remain indifferent to a mother’s nutritional status.  If anything, it was prefered they didn’t gain too much weight. Physicians also remained unconcerned about mothers having a few drinks or inhaling cigarette smoke. In fact, during the 1960s, about half of expectant mothers reported smoking cigarettes.

However, by the 1990s an abounding amount of evidence started to show that this theory was probably poppycock, that the placenta was not a natural barrier, and that anything the mother inhaled or ingested could have a major impact on the growth and development of the fetus, especially during the first trimester.  

In 1992, Dr. David J. Barker became the first person to seriously consider this new evidence. He postulated that undernourished infants tended to have small birth weights and were likely to have trouble with obesity later in life. This became known as Barker’s Hypothesis. This hypothesis was later expanded upon to include other chronic diseases, and is now referred to as the Fetal Origins Hypothesis.  

Barker believed inadequate nutrition programmed the fetus’s to develop metabolic changes that would predispose the unborn baby to chronic diseases later in life. Others suspected gene mutations leading to physiologic and metabolic changes that prevent the child from reaching a healthy birth weight.  

A good example here is COPD. The hypothesis suggest that changes made in utero as fetus’s attempt to adapt to their mother’s environments cause airway changes that prevent these children from obtaining peak lung function by early adulthood.  It is these children who are most likely to develop COPD when chronically exposed to harmful substances in the air.

Subsequent studies have linked small birth weights with decreased lung function and increased risk for respiratory symptoms (wheezing, shortness of breath) in childhood.  Other studies have small birth weights with the development of asthma later in life. It should also be understood here that researchers suspect up to 15 links between asthma and COPD.

There exist other interesting facets of this hypothesis. For instance, it suggests that the nine months in utero are the most critical in a person’s life.  It suggests that the mother’s environment may have a significant impact not just on the development of chronic diseases later in life, but also on a child’s future life, maybe even determining the child’s level of intelligence and future abilities.  

While it’s just one hypothesis, it seems to be well accepted by the scientific and medical communities. It shows the importance of ingesting a healthy diet and inhaling healthy air on the future health and abilities of unborn babies. Perhaps future research in this regard will lead to an end to diseases like asthma and COPD.

Here are my references and some further reading you may enjoy:

15 Links Between Asthma and COPD

Impact of Genes on COPD

Links Between Asthma and Genetics

NCBI:  Killing Me Softly: The Fetal Origins Hypothesis

NCBI: Early Life Influences on the Development of COPD

NCBI: Early Origins Or Chronic Pulmonary Disease

NCBI: The Fetal Origins of Adult Disease: A Narrative Review of the Epidemiological Literature

NCBI: Effects of Low Birth Weight on Childhood Asthma

Studying Asthma: You'll Be Impressed What Researchers Are Learning

Originally published at healtahcentral.com/asthma

Researchers are working overtime in their quest to find better treatment options for asthmatics. Here are some of the latest discoveries. We think you'll be impressed!

Key protein discovered.  Researchers at the University of Leipzig believe they found a “key molecule” responsible for allergic asthma. The molecule is called protein syndecan-4, and is found in the cell membrane of antigen presenting cells. The hope is further research in this regard will lead to better medicines or cures for allergies and asthma.  

Source:  Science Daily: Allergic Asthma: Key Molecule Identified

Root cause of asthma discovered. Using mouse models of asthma and human airway tissue, researchers at Cardiff University believe the calcium sensing receptor (CaSR) is the "potential root cause of asthma."  

It was already known that asthma triggers release chemicals that activate sensory neuro airways leading to airway twitchiness, inflammation, and narrowing. This leads to asthma symptoms such as wheezing, coughing, and shortness of breath. Missing was the link between triggers and inflammation. 

Activation of CaSR appears to be the missing link. They believe drugs already exist, called calcilytics, to manipulate CaSR proteins to reverse the asthma response. They believe this should prevent asthma symptoms, preventing the need for rescue inhalers. 

It appears the only thing standing in the way of this treatment option is funding for research. Once funding is locked down, researchers believe calcilitics may be an option for asthmatics in about five years. 

Sources: BBC News: Cardiff University scientists discover asthma's root cause andMedical Daily: Asthma Drug That Prevents Patients From Ever Having An Attack Could Be Five Years Away

Asthma cells move.  Epithelial cells are the cells lining airways. Normal epithelial cells “are pentagon-shaped and are jammed -- they hardly move at all.”  Up until now researchers believed asthmatic epithelial cells were the same.  However, the results of a study conducted at Harvard T.H. Chan School of Public Health show asthmatic epithelial cells are “unusually shaped and scramble around like there’s a fire drill going on.”  

Does the asthma process cause cells to become jammed, or does the jamming cause asthma? Hopefully, the quest to answer these questions will lead to better asthma wisdom and treatment. 

Source: Harvard Gazette: Asthma Cells Scramble Like ‘There’s a Fire Drill.’ (Check out this link to see asthma cells scramble)

Exercise key to good asthma control. Researchers in Montreal, Canada, studied 66 adults with poorly controlled asthma. They were divided into two groups: those who participated in supervised aerobic activities, and those who did not.

The results showed that those who exercised at least 30 minutes per day had better asthma control compared to those who failed to exercise. Dr. Salter might be smiling down upon us, as he was the first to recommend exercise to control asthma way back in 1860.

Source: Chest: Late-breaking study finds aerobic exercise significantly improved asthma control. 

Asthma controller medicine safe for baby. Most asthma experts teach that the risks of uncontrolled asthma on a fetus are far greater than the risks of the medicines used to treat and control asthma. A study released in July, 2015, seems to confirm that asthma controller medicines are safe for baby.

Source: AAAAI: Limited risk of congenital anomalies associated with inhaled asthma medication during pregnancy

Learning the impact of severe asthma. Severe asthma is a subtype of asthma that has been studied extensively in recent years. It’s a subtype of asthma that affects 5-15 percent of asthmatics.  It consists of airways that are chronically narrowed and less responsive to asthma controller medicines, like inhaled corticosteroids.

Results of a survey released in September showed the true impact of this disease on those who have it. Of 850 severe asthmatics in Europe surveyed, 25 percent reported symptoms on a daily basis, and 71 percent reported symptoms at least weekly. Likewise, 32 percent said it affected their social life, 23 percent said it affected their working life, 18 percent said it affected their family life, and 17 percent said it affected their sex life.

This spotlights the ongoing need to continue the quest to learn more about this asthma subtype. 

Sources: PR Newswire: New Survey Reveals True Impact of Severe Asthma on People's Lives

What can we take away from all this?  As an asthmatic myself, it’s neat to see that researchers are learning so much about our disease. If any of these can eliminate to carry rescue inhalers, that would be a major plus for asthmatics. We'll keep you posted as we learn more. In the meantime, the future for asthmatics looks bright.

You may also enjoy reading:

Links between asthma and genetics

What is allergic asthma?

What is the asthma syndrome?

What is severe asthma?

7 Reasons Childhood Asthma Seems To Go Away

Originally published at healthcentral.com/asthma

Many childhood asthmatics seem to get better with age.  Sometimes asthma attacks come less often, or are less severe.  In some cases asthma may seem to go away altogether, or to go into remission.  Here are seven reasons to explain this phenomenon.

1  Testosterone.  Asthma in boys often improves during teenage years. One theory for this suggests this may be due to an increase in testosterone levels. Testosterone (or one of its metabolites) may have an influence over the abnormal immune response that causes asthma.

2  Communication. Because you cannot see how other people feel, some parents have a hard time recognizing asthma in children. Making this worse, children are often poor communicators of how they feel.  As they grow older and mature, children become better communicators, and this makes asthma easier to both diagnose and treat.  

3  Medicine. For liability reasons, few studies are done to show the impact of asthma medications on children under the age of 12.  For this reason, some physicians are afraid to prescribe some medicines for children.  For instance, Advair helps many adults obtain optimal asthma control, although pediatricians may be hesitant to allow their patients to try it. Once children get older, this becomes less of a problem.

4  Compliance.  Let’s face it, it’s not easy to get children, especially smaller children, to take medicine. In fact, it’s hard to get kids to take medicine when they feel sick, let alone when they feel well.  Since asthma controller medicines must be taken every day, this may pose a problem for many childhood asthmatics.  As children mature, they learn the importance of taking their medicine the right way every day.

5.  Triggers.  Children are more likely to hang out in places where asthma triggers are most likely to be.  For instance, children play in musty basements, on dirty floors, in forests, in the weeds, etc. As children mature they are more likely to get away and stay away from their asthma triggers.

6.  Airways. Children tend to have smaller, more sensitive airways. This canmake them more brittle, or more likely to become obstructed. As children go through puberty their airways become larger and less sensitive to asthma triggers.  Surely asthma attacks may still occur, but they may tend to be less severe than during childhood.

7.  Sensitivity.  Asthmatic airways tend to be chronically inflamed, making them hypersensitive to asthma triggers.  Even a slight exposure a trigger (such as dust mites) may cause an asthma attack.  As lungs mature, this inflammation may lesson to such a degree that airways become less sensitive.  This may make asthma episodes so minor, or so non-existent, that asthma may appear to go into remission, or to go away altogether.

7.  Maturity.  As children mature they are better able to communicate how they feel, more likely to be compliant with their medicine, and to avoid their asthma triggers.  This alone may result in better asthma control.  As children mature they also become better capable of communicating with their asthma doctors, something that is essential to good asthma control.

It’s important to understandthat asthma never really goes away.  Even if it seems you no longer have it, you still do.  So it’s essential to continue seeing your asthma doctor at least once a year, and to never stop taking your asthma controller lmedicines without your doctor's approval. 

Further reading:

• What is Childhood Onset Asthma?
• Signs of Asthma in Infants
• How to Obtain Good Asthma Control
• Links Between Testosterone and Asthma
• 11 Asthma Myth Debunked

Learning Basic Lungsounds

The following was written by me and published at healthcentral.com/copd on January 25, 2016

Lungs 101: Learning Basic Lung Sounds

I have been listening to lung sounds for 20 years now, and every so often someone wants to know what I heard and what it means. That said, here is a pithy lesson on the five basic lung sounds and what they mean. 

First, however, a few definitions. 

Auscultation: The process of listening to lung sounds.  It can be done ear to chest, although most health professionals prefer to use a stethoscope. 

Stethoscope: It's a medical device used to auscultate (hear) lung and heart sounds.

Listening to lung sounds is an important part of assessing a patient. Based on what is heard can help a caregiver both diagnose and treat patients, and determine the progression of lung diseases over time. 

There are basically only five lung sounds.  You'd think that would make listening to them easy, but that's not always the case considering every patient is different. Regardless, here are the basic five and what they might mean.

1.  Clear.

This is a normal lung sound. It means the airways are open and air is easily moving through airways.

2.  Diminished.

This means that air movement is difficult to hear. It's quite common for COPD patients to develop diminished lung sounds, perticularly in the bases, or in the lower lobes. This is most commonly found when emphysema is present, as there is less lung tissue to move air. Of course it may also be due to a COPD flare-up where airways are obstructed by bronchospasm and increased secretions. This may indicate a need for a bronchodilator (like albuterol).

3.  Rhonchi. 

This is the sound of air moving through secretions.  It is a low-pitched, continuous sound that is best heard on expiration. Some describe it as coarse lung sounds, as it sounds coarse. Some say it sounds like snoring. It's usually lower than a wheeze because it's occurring in the larger airways.  It is also sometimes audible, and sometimes occurs with gurgling. Quite often rhonchi clears up with a good cough. Since this is common among COPD patients, we often teach methods to make a cough more effective.

4.  Wheeze. 

This is a high-pitched continuous sound heard on inspiration, expiration, or both. It's most commonly heard on expiration, though.  It is the sound of air moving past an obstruction in the airway. This can occur in the large airways or smaller airways.  An obstruction in the larger airways may produce an audible wheeze.  However, obstructions in the smaller airways, as what occurs with asthma and COPD, will cause a wheeze that can only be heard by auscultation.  Wheezing is a symptoms of bronchospasm, and may clear up after using a bronchodilator.

5.  Crackles. 

This is often described as a discontinuous sound, like the sound of velcro being torn apart. It usually needs a further qualification.

• Fine Inspiratory Crackles.  This is when the crackle is heard on inspiration. A cause might be the popping open of an air sac (alveoli) that had been collapsed. This is a common sound in the lung bases of people with COPD, and it can become a normal sound for them.  When crackles are heard in one lobe, this can be a sign of lobar pneumonia.
• Coarse Crackles (Rhales):  This is when crackles are heard on inspiration and expiration, and is the sound of air moving through fluid.  The fluid can be excessive secretions the patient is unable to cough up, or it could be pulmonary edema caused by heart failure. It means that the lungs are wet (the patient has wet lungs). Usually, but not always, this lung sound is heard on both sides of the lungs equally, as fluid is not prejudiced to one side of the lung. 

People with asthma should have clear lungmsounds when their asthma is controlled, and between asthma attacks. You can have clear lungs ounds with COPD too.  After using a bronchodilator, diminished lung sounds may become clear.

Or, sometimes, as airways open up, wheezing may occur. This we consider good, as it means air is moving better, and so wheezing can now be heard. So, you see, wheezing can be good, too. So auscultating before and after rescue medicine usage is one tool we have to determine if it's working (a peak flow meter is another such tool). Of course another tool is you, because you can just tell us that you feel better.

Pneumonia is a common complication of chronic bronchitis.  Fine inspiratory crackles can often be heard before pneumonia shows up on an x-ray, allowing your physician to start treating you early. As the pneumonia improves the crackles may go away. So, in this way, you can see how auscultating lung sounds can show how your illness is progressing over time.

Keep in mind that lung sounds are subjective, so every person may describe them somewhat different. Still, the basic principles are the same. It takes some practice to be able to hear and describe the different lung sounds. Nonetheless, I hope this post gives you a little better idea of what lung sounds are and what they mean. 

To hear the lung sounds described above you can check out practicalclinicalskills.com, "Auscultation Lesson." You can also check out UCLA's "Auscultation Assistant."

See More Helpful Articles

• Best Coughing Techniques For COPD
• What Is A Nebulizer?
• What Is Rescue Medicine
• What is a Peak Flow Meter?
• How Does Chronic Bronchitis Affect the Lungs?

Learning the Impact of Asthma on Women

Originally published at healthcentral.com/asthma

Evidence shows asthma treats women worse than men, and researchers believe this may be due to hormones responsible for the menstrual cycle, pregnancy, and menopause.  This has lead them to identify a new subtype of asthma called premenstrual or premenopausal asthma.  So, what is this, and what does it mean for women with asthma

First, check out these statistics from the American Lung Association.  

1. Boys are more likely to have asthma than girls until puberty, at which time women are more likely to have it than men until menopause.  Among children under 18, boys were 14 percent more likely to have it than girls.  Among adults 18 and over, females were 62 percent more likely to have asthma than men.
2. According to the American Lung Association, in 2011, women were 14 percent more likely to be diagnosed with asthma than men.  In the same year, 10.8 million males had asthma compared with 15.1 million females.
3. Women also have more asthma attacks than men.  In 2011, 5.1 million males had asthma attacks, while 8 million females had asthma attacks. This difference has been significant since 1999. Of the 3,388 people who died of asthma in 2009, 64 percent of these deaths occurred in women.

What is premenopausal asthma?  This is an asthma subtype that affects women during their reproductive years, or from puberty to menopause. Studies show about 40 percent of premenstrual women with asthma tend to have increasingly inflamed airways during or immediately following menstrual periods, making their airways hypersensitive to asthma triggers. Symptoms include increased coughing, wheezing, and shortness of breath. About 50 percent of hospital admissions for asthma in premenstrual women occurs during these times.

So, why does asthma impact women worse than men?  While the exact mechanisms are unknown, a common hypothesis is that three hormones may have an impact on the immune response responsible for asthma.   

1.  Testosterone. It’s often referred to as the male sex hormone that circulates in the bloodstream. It binds with receptors on targeted cells, and is responsible for the development of male sex organs. A rise in testosterone levels during adolescence is responsible for boys becoming men. It plays a role in the development of sperm cells, abdominal fat, and hair loss.

Levels decline gradually, about 1 percent per year, starting in the mid 30s, thereby remaining relatively stable throughout one’s lifetime. It’s also produced in women, although at significantly lower levels.

Researchers believe testosterone suppresses the immune response responsible for asthma and allergies. This may explain why asthma in boys is more likely to go into remission during teenage years than girls.  This may also explain why women seem to be at greater risk of more severe asthma attacks than men. To get a better understanding of the impact of testosterone on asthma you can read our post “Links Between Asthma and Testosterone.”

2.  Estrogen.  This refers to female sex hormones: estrone, estradiol, and estriol. It circulates in the bloodstream and binds with receptors on targeted cells, affecting the breasts, uterus, brain, bone, liver, heart, lungs, and other organs. Unlike testosterone levels in men, which are relatively stable, estrogen levels rise and fall during the menstrual cycle during reproductive years (before menopause).  They rise to help prepare the uterus and breasts for possible fertilization, and then fall sharply if the egg is not fertilized.

Researchers believe estrogen receptors are also present on key cells responsible for the asthma and allergic responses. So they suspect that it is for this reason women are more prone to developing asthma after puberty than their male counterparts. This may also explain why asthma symptoms are more likely during ovulation, menstruation and pregnancy. This may also help explain why women have it worse than men.  

Making matters worse, studies also show that postmenopausal women who receive estrogen replacement therapy also have an increased incidence of asthma.

3.  Progesterone.  This is a hormone that rises along with estrogen to prepare the body for possible fertilization during reproductive years. Like estrogen, progesterone levels drop sharply if the egg is not fertilized. Researchers believe progesterone acts as an airway dilator. So they suspect the sudden drop in progesterone following menstruation may create a withdrawal period where the airways of women may become increasingly inflamed and sensitive to asthma triggers. This may also explain worsening asthma symptoms immediately after menstruation.

There are other theories too.  Similar to severe asthmatics, premenopausal asthmatics may develop chronic airway changes. For instance, some research shows “impaired or altered” beta 2 adrenergic receptor “function and regulation” in females with asthma.” These are receptors that, when stimulated, cause airways to constrict, thus causing asthma symptoms.

What does this mean? It means that researchers are now working overtime to learn more about the impact of asthma on women. They know most female asthmatics respond well to traditional asthma medicines, although some continue to struggle with asthma control. Ideally, this will lead to improved treatment options and asthma guidelines tailored specifically for premenopausal asthmatics. The ultimate goal here is better asthma control for women.  

References and further reading:

What are Asthma Subtypes and Groups?

Links Between Asthma and Testosterone

What Are Your Asthma Triggers?

ALI: Trends in Asthma Morbidity and Mortality

NCBI: Premenstrual asthma: epidemiology, pathogenesis and treatment

NCBI: Estrogen Effects in Allergy and Asthma

Healthy Women: What is estrogen?

U.S. News: The Pill May Reduce Asthma Symptoms

PubMed: Menopausal Asthma: A New Biological Phenotype

Emergency Asthma, 1999, Barry E. Brenner, page 147

Asthma linked to chronic migraine

The following was written by me and published at healthcentral.com/asthma on January 29, 2016

Asthma (Possibly) Linked to Chronic Migraine

Evidence already links asthma with allergies, anxiety, gastrointestinal reflux, and insomnia. The latest research seems to suggest asthma may also be linked withchronic migraines (more than 15 migraine headaches in a year).

Researchers at the University of Cincinnati studied 4,500 individuals who suffered from occasional (less than 15 in a year) migraines. Participants were divided into two groups: those without asthma and those with asthma.  They were then asked to fill out questionnaires in 2008 and 2009.  

The results concluded that that only 2.5 percent of participants without asthma were diagnosed with new onset chronic migraine, while 5.5 percent of participants with asthma were diagnosed with new onset chronic migraine.  This means that asthmatics with occasional migraine were more than twice as likely to develop chronic migraine.

What to make of this data?  Asthma involves an overactive immune response where otherwise innocuous substances (asthma triggers) in the air are treated as enemies (like bacteria).  When inhaled, your immune system sets off a series of chemical reactions that includes the release of inflammatory markers that cause inflamed airways. This ultimately causes asthma and sets off asthma attacks.  

Researchers believe the link may have to do with the fact that both asthma, and some headaches, are caused by inflammation of smooth muscles. Asthma is caused by inflammation of smooth muscles wrapped around airways, and some headaches are caused by inflammation of smooth muscles wrapped around blood vessels.

Researchers now believe that the release of inflammatory markers may do more than just cause and trigger asthma. They suspect they may be the reason many asthmatics also suffer from anxiety.  This recent study has them now suspecting they may also lead to chronic migraine.

Interestingly, while other studies show depression may also lead to chronic migraine, this study suggests that individuals with asthma are at even greater risk than those with depression.  

Keep in mind this is just one study and one theory.  Research estimates that about 10 percent of individuals develop migraines, and only one percent develop chronic migraine. While this study may seem to indicate a link between asthma and chronic migraine, it does not prove anything as it is just one study.  While the theory that asthma-related inflammation may lead to migraine progression sounds like a valid theory, it is, in fact, just a theory.  Further studies will be needed to prove the link, and to show what the true cause and effect is.  

In the meantime.  Yes, some asthmatics (including myself) do suffer from episodic migraines, and some do suffer from chronic migraine.  It is strongly recommended that if you experience headaches you let your doctor know, as there are many safe and effective ways of treating headaches.  This may also be key to preventing the progression of episodic headaches to chronic migraine.  

See more from the other side: Progression to Chronic Migraine Impacted by Asthma

Further reading:

• The Times of India: Asthma May Lead To Never Ending Migraine
• Mayo Clinic: HeadachesWhat is the asthma syndrome?
• Asthma: More Than Just A Lung Disease

Asthma linked to heart disease

The following was written by me and published at healthcentral.com on January 19, 2016

Asthma (Possibly) Linked to Heart Disease

We now know that asthma isn't just a disease of the respiratory system, that it is a syndrome linked with the immune system, nervous system, and even the intestinal system.  The latest research now suggest a possible link between asthma and the cardiovascular system. 

The study was performed at Northwestern University and published in the December 8, 2015, issue of the Journal of Allergy & Clinical Immunology. It involved a survey of 13,275 children from all 50 states, and showed that those with allergic asthmatics were twice as likely to be diagnosed with high blood pressure and high cholesterol than those without asthma. 

It should be known here that most cases of asthma diagnosed in childhood (childhood onset asthma) also involve allergies.  It should also be known that about 75 percent of asthmatics overall also have allergies.  The asthma subtype involved here is sometimes called allergic asthma or eosinophilic asthma. 

 

It should also be known that both high blood pressure and high cholesterol, (particularly the bad kind of cholesterol), is linked with heart disease.  High blood pressure results from arteries that are constricted, and this causes the heart to work hard to push blood through them. This can cause strain on the heart.

 

The bad kind of cholesterol are called low density lipoproteins (LDL). According to the American Heart Association, it contributes to the buildup of plaque inside arterial walls that can make the arteries less flexible or hard. This is a condition called atherosclerosis.  It makes the arteries increasingly narrow, leading to high blood pressure.  Clots may form and block arteries, leading to a heart attack or stroke.

 

What's the connection?

We must keep in mind this is only one study, so ongoing studies will need to be performed to confirm the link.  Likewise, researchers are unsure of the cause or effect of the link. 

 

However, one theory is that asthma is an inflammatory disease, and that inflammatory markers may cause more than just asthma. Evidence already suggests inflammatory markers may cause anxiety in some asthmatics. Some evidence even suggests inflammatory markers may cause migraine headaches in some asthmatics that lead to chronic migraine.  Researchers guess that the same inflammatory markers may also lead to heart disease.

 

The study also showed that asthma occured in 14 percent, exzema occured in 12 percent, and allergies in 16.6 percent.  All of these are associated with higher rates of obesity, which may also be a contributing factor leading to the link between allergies and heart disease.  Asthmatics may also be more sedentary than non-asthmatics, and this may also contribute to heart disease.

 

So you can see that further studies will be needed to confirm the link, and to confirm cause and effect.

 

Regardless, this might be reason enough to suggest that the path to heart disease may begin early in life among those with allergic asthma. This should encourage physicians to screen all asthmatic patients to make sure they do not have high blood pressure or high cholesterol. If these are diagnosed, they can easily be prevented and controlled, thus lowering the risk of heart disease later in life.

 

See More Helpful Articles

• Science News: Children with common allergies have twice heart attack risk
• Asthma: More Than Just A Lung Disease
• AMA: Good -vs- Bad Cholesterol

Exercise Proven to Improve Asthma Control

The following was written by me and published at healthcentral.com/asthma on January 4, 2016.

9 Ways Exercise Improves Asthma Control

If you have asthma, you should be exercising on a regular basis. The evidence of the benefits of exercising is abounding, and even shows that regular exercise can help you obtain and maintain good asthma control. If you already do it, great! If you don't, here's nine reasons to begin your exercise program today, especially if you have asthma.

This is because exercise...

1.  Makes your heart and lungs stronger.  Exercising builds up muscle strength. Your heart is a muscle, so when you exercise, you are, in essence, making it a stronger pump. The Mayo Clinic explains that this makes it easier for it to pump blood through your lungs and body, making you feel less winded. This also increases oxygen and nutrients to the various tissues of your body to help your cardiovascular system work more efficiently.

2.  Boosts your energy. Even though you may feel fatigue today, forcing yourself to exercise everyday should give you more energy in the long term. One recent study performed at the University of Georgia showed that low-intensity exercise boosted energy by 20 percent and reduced fatigue by 60 percent.  The theory is that regular exercise makes your cardiovascular system more efficient at pumping nutrients and oxygen to the various tissues of your body, in turn giving you more energy every day.

3.  Boosts your immune system.  Keep in mind here that respiratory viral infections (or your common colds) are the most common cause of asthma attacks. Having a strong immune response is perhaps the best way of fending off nasty viruses, and making colds less severe when you do get them.

4. Helps you lose weight.  Exercising alone probably will not cause you to lose weight.  However, when coupled with a healthy diet, exercising can help you lose weight.  For one thing, it causes you to burn calories.  Fitness expert John Hussman explains that a pound of pure muscle burns up to 50 calories a day, so if you gain ten pounds of muscle that's an extra 500 calories your body would be burning even when you're just sitting around. He said, "The more lean muscle you have, the easier it is to burn fat." So exercising does help you lose weight, and losing weight helps you gain better asthma control.

5.   Curb obesity and therefore asthma.  Studies actually link obesity with asthma. One theory is that adipose tissue (fat tissue) releases a hormone called leptin, which in turn causes inflammation in asthmatic lungs. While all asthmatics have leptin, it's levels are higher in obese asthmatics. So losing weight, and maintaining a healthy weight, should help you obtain better asthma control.

6.  High fat foods trigger asthma. When eating healthy you should be avoiding high fat foods, and this alone may improve your asthma.  One theory suggests that asthmatic immune systems recognize saturated fat as an enemy, and sets off a series of chemical reactions to rid it from the body. Inflammatory markers released during the process causes asthma and asthma symptoms. This basically means that saturated fat is an asthma trigger that should be avoided to obtainbetter asthma control.

7.  Makes you healthier overall. Exercise increases the production of high-density lipoprotein (HDL), which is the good cholesterol. This keeps your blood flowing smoothly and protects against high blood pressure, heart disease, stroke, depression, some cancers, arthritis, and falls. When you consider that a recent study found a link between heart disease and asthma, this benefit is all the more impressive.

8. Makes you happier. It is a proven fact that asthma is often linked with anxiety and depression even when your asthma is well controlled. Exercise stimulates the brain to release a chemical called endorphins. They act like analgesics such as morphine to diminish the perception of pain, causing a sedative effect, reducing stress, warding off anxiety, warding off depression, boosting self esteem, and improving sleep. This is why people sense a feeling of euphoria after running.

9. Increases your memory. It stimulates the brain to release a chemical brain-derived neurotrophic factor (BDNF) that rewrites memory circuits so your memory becomes better. So if you are a student, or simply trying to figure out how all these new complex asthma medicines work, this is a HUGE incentive to exercise. In fact, some experts recommend children immediately exercise when they get home from school, and then sit down to do their homework. Supposedly this facilitates learning.

Start your exercise program today. Look, Hippocrates recommended a healthy diet and exercise to maintain good health as long ago as 400 B.C. Lacking better remedies, this was the advice of many physicians over the years to help asthmatics, including a young Teddy Roosevelt. Today we have many studies that have confirmed these benefits, even explaining why. Again, if you already exercise, wonderful! If you don't, there's no better time than right now to get active, get fit, and breathe better. 

You may also enjoy reading:

• 14 Tips To Exercising With Asthma
• Does Obesity Cause Asthma?
• 6 Steps to Better Asthma Control
• Links Between Asthma and Anxiety
• Top 10 Asthma Medicines

How I conquered exercise induced bronchospasm

The following was written by me and published at healthcentral.com/asthma on January 11, 2016

How I Conquered Exercise Induced Asthma

To say I never exercised as a kid is not telling the whole truth.  A more accurate statement would be to say that I rarely exercised when my asthma was acting up.  And considering I had brittle asthma as a child, there were many times I was unable to exercise with it.  Now I exercise every day, so what changed?

Essentially, I conquered exercise induced asthma (EIA), or what is now referred to as exercise induced bronchospasm (EIB). Here are five reasons I credit for helping me conquer EIB.

1.  Brittle asthma.  During teenage years airways increase in scope and size with the rest of your body.  So my airways are now bigger and less brittle.  Now, this does not mean they are less sensitive.  It just means when my airways spasm, there is more room than there once was. So now, when I'm exposed to a potential asthma trigger, it doesn't close off my airways the way it once did. 

2.  Better medicine.  The medicines available today are much better than when I was a kid.  For instance, most modern inhaled corticosteroids are stronger and last longer than previous ones. The same is true of bronchodilators.  Not only that, combination medicines make it so you can take all your inhalers in one or two puffs once or twice a day. 

3.  Better compliance.  Better medicines have resulted in better compliance.  Or, worded another way, the fact that most modern medicines only need to be taken once or twice a day has made it easy to stay compliant with a medicine regime.  Basically, I take my medicine when I brush my teeth.  Puff and then brush.  This is a far easier routine than 8 puffs, 8 times a day of Azmacort, or three time of remembering to take my theophylline pill at 6 a.m., 2 p.m. and 10 p.m. 

4.  Better wisdom.  Back in the 1970s it was known that inhaled corticosteroids worked to control asthma.  However, doctors were still concerned about the side effects.  So, as I was being discharged from yet another hospital admission for asthma, my doctor would write the following: "Have this boy take his Vancerin inhaler for a week or two until he feels better, then stop it."  You see, one of the reasons I had such poor asthma control was because I wasn't taking the medicine meant to prevent it.  Thankfully, later studies showed that not only do inhaled corticosteroids work, they are very safe.

5.  Doctors.  Back in the 1980s regional physicians were left to learn about asthma on their own, and were often left with incomplete wisdom.  This was why I had to be shipped to Denver in 1985 so that I could learn how to gain control of my asthma.  Today, asthma guidelines, and the Internet, make it so regional doctors are kept up to date on the latest asthma wisdom in order to best help asthmatics like me.

Bottom Line.  Even as recently as 1997 I was forced to get a medical excuse to get out of a college gym class.  Just since that time I have tackled my EIB to the point that I can now exercise whenever I want. This is amazing in that it shows how far asthma wisdom has improved just in my short lifetime. 

You May Also Enjoy Reading:

• What is Exercise Induced Bronchospasm
• EIA Troubles Many, Even Olympians
• My Extended Stay for Asthma
• RT Cave Facebook Page
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What is Severe Asthma (Asthma/COPD Overlap Syndrome)

The following was written by me and published at healthcentral.com/asthma on November 4, 2015.

What is Severe Asthma? 

Researchers have learned that 5-10 percent of asthmatics do not respond well to traditional asthma medications, making their asthma difficult to control.  In order to better help these asthmatics, researchers now categorize them under a specialasthma subtype called Severe Asthma. So, what is severe asthma, and what does it mean if you have it?

What is it?  Sally Wenzel, professor of medicine at the University of Pittsburgh, defines severe asthma as “patients who require high dose inhaled glucocorticoid (GC), or continuous or near continuous oral GC treatment to maintain asthma control or who never achieve control despite that treatment.”  It was defined as an asthma subtype less than 15 years ago.

What is it not?  Severe asthma must not be confused with other causes of difficult to treat asthma, including:

• Asthma exacerbated by uncontrolled asthma triggers (You have allergic asthma and have attacks when exposed to molds)
• Asthma that is poorly controlled due to nonadherence (You do not take your medicines)
• Disorders that mimic asthma (you have sinus infections)
• Asthma exacerbated by comorbid conditions (you have asthma and allergies, or asthma and GERD; controlling one means controlling the other)

 What does a diagnosis of severe asthma mean? It means that you have:

• Chronic Airway Inflammation.  This makes airways hypersensitive to asthma triggers, exposure to which causes the smooth muscles that wrap around them to spasm. This narrows or obstructs the airways. A second response is increased sputum production, further obstructing airways.  This causes asthma symptoms like wheezing and shortness of breath. This response is completely reversible, and can be prevented and treated with typical asthma medications.  This is seen in all asthmatics.

• Airway Remodelling.  This is also referred to as airway scarring.  It’s associated with a permanent thickening of the walls lining airways, particularly smaller airways. This makes them chronically narrowed or chronically obstructed. The cause of this remains a mystery, although some speculate it has to do with asthma left untreated long-term, or too many severe asthma attacks. It makes you feel short of breath even on a good asthma day. This response is irreversible, and there is at present no treatment.  This is similar to what happens in COPD, and is only present in severe asthmatics.

These two components together act as a "double whammy," making asthma difficult to control.  This probably means you also have: 

Air trapping.  Air can get past chronically narrowed airways but has a hard time getting back out.  This causes air to become trapped inside your lungs.

Airflow limitation.  This is best observed by a prolonged expiration. Sometimes it may seem you can exhale forever and never get all the air out. You can't generate enough flow to blow out a candle. 

Fewer treatment options.  No medicine treats airway remodelling. You respondpoorly to traditional asthma medications, like inhaled corticosteroids. However, a new treatment called bronchial thermoplasty does show promise.

More frequent and severe asthma attacks. Their airways are increasingly brittle and narrow making them increasingly prone to more severe attacks compared to those with typical asthma.   

Lots of doctor appointments. They'll need to see doctors who specialize in this type of asthma.  They are also prone to more frequent and unscheduled doctor visits compared to those with typical asthma. 

Lots of fees.  While they consist of only 5-10 percent of asthmatics, they consume up to half the cost of asthma in both the U.S. and Europe.

Unanswered questions.  So, why is it that only 5-10 percent of asthmatics develop severe asthma? Researchers are working overtime to answer this question and to create special guidelines and medicinal options to help them achieve optimal control of their disease.  

Here is some of what is presently understood. Researchers believe the immune response that occurs in severe asthmatics is different than what occurs in traditional asthmatics. For instance, immune cells (called CD4-T cells) secrete different inflammatory proteins (particularly interferon gamma) than the same cells in traditional asthmatics. This makes their airways hypersensitive in such a way that does not respond to corticosteroids.

So what does this mean?  It signifies hope for better treatment options. Researchers also discovered that mice that lacked the interferon gamma protein may develop traditional asthma but not Severe Asthma.  Using computer models, they compared gamma protein with asthma genes, and learned that as interferon gamma levels rose, a protein called leukocyte protease inhibitor (SLPI) dropped. They later learned that boosting SLPI levels reduced airway hyperreactivity in animal models.

Other names.  There is no consensus on what to call this asthma subtype. Some refer to it as Severe Asthma, while others as Therapy Resistant Asthma or Asthma COPD Overlap Syndrome.

The Burden.  The true impact of severe asthma on people's lives was revealed in a survey released in September, 2015.  Of 850 severe asthmatics surveyed, 25% reported daily symptoms, and 71% reported weekly symptoms. Likewise, 32% said it affected their social life, 23% said it affected their working life, 18% said it affected their family life, and 17% said it affected their sex life.

Conclusion.  A proper diagnosisan may lead your doctor to the best treatment options to helping you obtain ideal control of your disease. Ongoing research should equal better breathing in the near future for all asthmatics.

Related Links and References:

• Two types of asthma: typical and atypical
• What are asthma subtypes?
• What is double whammy asthma?
• What is bronchial thermoplasty?
• PR News Wire: New study shows the true impact of severe asthma on people’s lives
• Eureka Alert: Severe asthma fails to respond to mainstay asthma treatment
• Up To Date: Treatment of severe asthma in adolescents and adults
• Up To Date: Evaluation of severe asthma in adolescents and adults
• “Difficult to Treat Asthma,” 2011, edited by S.E. Wenzell and K.F. Chung
• PR Newswire: New Survey Reveals True Impact of Severe Asthma on People's Lives
• RT Cave Facebook Page
• RT Cave on Twitter