Over the past year, the Santa Barbara area has suffered through several devastating environmental maladies, particularly the Thomas Fire. As a result, there has been a significant increase in asthma exacerbations among our population. As one can imagine, the poor air quality created by a prolonged fire burn could only worsen the respiratory problems of those suffering from asthma and other chronic lung diseases.

What is Asthma?  Asthma is a chronic disease affecting up to 35 million US citizens. It is characterized by inflammation of the lung airways with associated swelling, narrowing and mucous production. As a result, those affected have shortness of breath, chest tightness, cough and wheezing. The wheezing is most pronounced on expiration (when one breaths air out) and can very rapidly become fairly severe. Symptoms and frequency of flare-ups varies with each asthma sufferer. However, almost all asthma patients notice a substantial worsening of their symptoms during the late night hours.

What causes flare-ups?  There are a wide array of environmental factors that can help trigger an asthma episode. Seasonal pollens, molds, changes in temperature, smoke, pollution and food allergens are the most common instigators. Also, viral and bacterial respiratory infections often cause the lung linings and tubes to become inflamed leading to asthma symptoms. There are a number of asthmatic sufferers that have an intrinsic form that causes flare-ups without any known external stimulus or exposure to an allergen.

How is it Diagnosed?  Aside from taking a good lung and respiratory history, the Clinician will listen to a patient’s chest for signs of asthma. Common findings include audible wheezing, rapid breathing (tachypnea) and labored respiratory efforts. Performing a Chest X-Ray may be of benefit but the single most important diagnostic tool is office spirometry. This easy to perform test gives valuable information on the total maximum amount of air volume one can fully expire at a given time. Spirometry is a valuable tool for maintenance and follow-up care of asthmatic patients.

How is it treated?  Obviously avoiding factors that cause exacerbations is the most important element in caring for asthmatic patients. However, when one requires treatment both acutely and for long-term maintenance, there are now a number of great treatment options available. There are two categories of Inhalers utilized alone or in tandem for the treatment of asthma. The first group are Beta-Adrenergic Inhalers such as Albuterol (Ventolin, ProAire, etc.). These inhalers act by dilating and relaxing the smooth muscles of bronchial passageways. There are very short acting and are utilized mostly for mild symptoms and for exercise-induced asthma. For more severe symptoms and for maintenance care of persistent cases, we use Steroid Inhalers such as Fluticasone (Flonase). These last up to 12 hours and have become the critical in for long-term care of asthmatics patients. Combination Inhalers with both a long-acting Beta-Adrenergic and a Steroid have become the mainstay treatment for persistent asthma patients (e.g. Advair, Symbicort). Undoubtedly, the availability of these newer superior inhalation treatments has greatly improved the overall morbidity of asthmatic patients, as well as, decreasing emergency room visits and hospital admissions.

 

Article written by Eastside Clinic’s Lead physician, Neil Sullivan, M.D.