Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital
Perhaps you will decide not to read this column since it concerns a respiratory disease that may not affect you. But this disease, asthma, is not just a disease of young people. Many elderly people suffer from this disease which develops only when they became older.
Asthma is a disease of the airways. Bronchi, the airways of the lungs, begin to spasm and become swollen and filled with mucus and other debris. The person feels short of breath and begins to wheeze. About 15 million Americans are affected, and it affects men more than women.
Causes of asthma are many. Commonly asthma is a result of an allergic problem, but other causes are a reaction to cold weather, some upper respiratory tract infections (common especially in babies), exercise, air pollution and fumes in the workplace (including the home where the problem is cleaning fluids such as ammonia). Smoking by an adult around a child is a risk for the child developing asthma. Some medicines can precipitate asthma: for example aspirin in some individuals.
For years, treatment of asthma didn't change, but lately exciting new drugs have changed the face of the disease. In the past, acute treatment was simply with inhalation therapies that stopped the spasm. About 15 years ago we discovered that reducing the swelling with drugs called steroids was critical in the management of asthma. Many people do not like the feelings they get when they take steroids, which can cause water retention and weight gain. Because they can have chronic effects on the body, we try to avoid using steroid pills for long periods of time. However, steroids that come in the form of an inhaler are poorly absorbed into the rest of body, so they can be used for long term, and are the cornerstone of therapy. Theophylline, another commonly used drug adds little and can be dangerous.
Recently, extremely safe drugs called Leukotriene Esterase Inhibitors have come on the market (you can remember it as: Leukotriene Esterase Inhibitors, Best Medicine Asthma No Medical Deficits, which spells "Leibman M.D.") and newer ones are on the way that all work by blocking the creation of the material in the body that causes the spasm.
Asthma can still kill. A similar disease called COPD or emphysema is seen in smokers, and responds much more poorly to treatment. People with brittle asthma or COPD with acute attacks should be watched carefully and brought to the emergency room when bad attacks occur.
In general, acute attacks do not need x rays, or blood tests. Peak flow measurement, where one blows into a tube as hard as he can is a useful measure. Antibiotics are usually not necessary. In a child, an aspirated foreign body such as a peanut should be considered with a sudden attack. A person with a severe allergic reaction who never had asthma before and is now wheezing and swelling up is a real serious medical emergency.
Asthma should not be a debilitating disease to a youngster. With proper use of medications, asthmatics live normal lives. Write me in care of the Yated.
Mazel Tov on Dr. Leibman's appointment to the Executive Board of the Israeli Association of Emergency Medicine.
