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This time of year can be difficult for patients sensitive to environmental factors that can trigger symptoms related to asthma and allergies. Warmer weather means that common allergens in the air, such as pollen and mold, will flourish. Other allergens that can trigger asthma attacks include dust, animal dander, drugs, and food additives. Viral respiratory infections and physical exertion can also initiate asthmatic attacks. Allergies and asthma often occur together. Asthma is categorized as either allergic (extrinsic) or non-allergic (intrinsic). Allergic responses can lead to asthma symptoms when antibodies misidentify a typically harmless substance, such as pollen, as an invader. Antibodies bind to the allergen and the immune system releases chemicals that lead to allergy symptoms. For some patients, this same reaction also affects the lungs and airways, leading to asthma symptoms. The yearly trend has been for increased length of allergy seasons and higher pollen counts, so we can anticipate higher numbers of patients reporting symptoms this season as well.
Sometimes patients are not aware they have asthma because they may not have severe symptoms. Since asthma can become life-threatening, it is important to keep patients informed of typical symptoms. Common asthma symptoms include: coughing, especially at night, with exercise, or when laughing; difficulty breathing; tightness in the chest; and wheezing. Some patients have a chronic cough as the only symptom. Patients may experience symptoms most often in the night or morning, but they can occur at any time, especially if patients are exposed to substances that are triggers for them.
When treating patients, the best treatment strategy is prevention. Patients should be instructed to be aware of what situations prompt an attack, such as exposure to allergens, respiratory infections, and cold weather, and should be encouraged to avoid these situations. Beyond this, if a patient has asthma attacks that are severe, unpredictable, or occur more than twice a week, then the recommendation is for treatment with a long-term control medication. These preventive medications are taken daily to achieve and maintain control of asthma symptoms. A common and effective medication type for controlling asthma is inhaled corticosteroids. These anti-inflammatory medications can improve asthma control and normalize lung function. Other medications typically used for long-term control of asthma are long-acting beta-agonists (LABAs), cromolyn, theophylline, leukotriene modifiers, and immunomodulators. Quick-relief medications include short-acting beta-agonists (SABAs), which relax airway muscles to give rapid relief of symptoms and are to be used in patients only as needed, for symptomatic relief. Immunotherapy (allergy vaccinations) may provide patients relief from symptoms brought on by trigger allergens that cannot be avoided. Immunotherapy increases a patient’s tolerance to those trigger allergens. Allergy treatments include antihistamines, montelukast, immunomodulators, and oral corticosteroids. There are a few treatments that help both asthma and allergies, such as the leukotriene modifier, montelukast; immunotherapy; oral steroids; and anti-immunoglobulin E (IgE) therapy.
Prevention and control are primary goals for the protection of our patients' respiratory health. Unfortunately, the death rate and prevalence of asthma has increased significantly since the late 1970s. The impact is widespread, with estimates showing that approximately 26 million Americans have asthma and that the asthma mortality is near 4,000 deaths per year. Historical reports show that each year patients with asthma make approximately 13.9 million visits to doctors and 1.4 million visits to hospital outpatient departments, and that asthma is responsible for approximately 456,000 hospitalizations and 2.1 million emergency room visits. Any delay in administering appropriate drug therapy can lead to severe or even fatal asthma attacks. Patients should be reminded to never change or discontinue preventive medications, and to always keep an adequate supply available. It is important to work with patients to determine the best treatment to manage their symptoms, and also to continue regular consultations, since allergy and asthma symptoms can change over time.
PDR Network can be a useful resource for information on asthma and allergy drugs, as well as other drug types, offering alerts and specific product labeling. Keep current with information on products like those used to treat asthma and allergies by using PDR.net.
Salvatore Volpe, MD, FAAP, FACP, CHCQM
Chief Medical Officer