Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
Asthma is one of the most common reasons for problems in the
lungs and is one of the diseases that we call reactive
airway disease. In asthma, the breathing tubes spasm, fill
with mucus and debris and they trap air. Asthmatics have a
characteristic wheeze. Asthma is treatable, but it can
kill.
Asthma can be caused by allergies, foreign bodies (peanuts
that go down the wrong "pipe" can cause wheezing), chemical
irritants, cold air, exercise, and of course for unknown
reasons, especially in the aged. Asthma is best diagnosed
through a battery of tests called pulmonary function
tests.
The cornerstone for treatment of asthma is to reduce the
inflammation so that the tubes don't get clogged. In the
acute setting, we often give a short course of steroids by
mouth, these potent drugs reduce inflammation but take up to
six hours to work. Therefore, giving steroids by mouth or
via a vein are basically equivalent.
In chronic asthma we give them through inhalations. They
have very few side effects this way. Even if you must take
oral steroids, if you take them for less than a week you do
not have to wean yourself off of them, but longer courses do
need a weaning period.
In acute asthma bronchodialators are used. These stop spasms
of the airways, but they should only be used when wheezing
is present or likely to occur. Ventolin is the most common
one and has outlasted all of the competitors. It is made by
our sponsor. Longer acting preparations are not for acute
attacks, and are used for likely attacks such as before
exercise or before going to sleep to help in the morning.
Severent is the most common one, again, made by our
sponsor.
A new drug that is extremely safe and works well is
Singulair (no, this is not made by our sponsor) but it
blocks inflammation as well by blocking the final pathway
for the creation of substances that cause inflammation.
Other drugs that have been used with varying success
including Helium, magnesium, water pills, and homeopathy.
The roles for all of these are still being worked out. There
is usually no role for antibiotics.
A similar disease in presentation but one that is a lot
harder to treat is COPD also known as emphysema. Here, the
lungs lose their elasticity, and become sagging bags that
easily clog up. These people have large barrel shaped chests
to compensate for this and frequently have shortness of
breath. Their hearts also have a hard time pushing blood
through these stiff lungs. This disease is almost always in
a smoker. Here there may be a role for antibiotics, and less
of a role for steroids. They don't do well.
We'll see more about these amazing organs next week. Write
me in care of the Yated.
