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Asthma is a chronic lung disease characterized by symptoms of recurrent cough, wheezing, and difficulty breathing (short of breath).   It can be as threatening as Dorothy’s “lions, and tigers and bears” in The Wizard of Oz.  24 million Americans have this disorder.  This disease is the most common disease of childhood affecting nearly 7 million children.  It is a common cause of trips to the physician’s offices and emergency departments.  It is also a common cause of admission to the hospital.   

Still, this disorder is not understood by patients and therefore not appropriately treated.  Asthma is really a disease of inflammation.  Certain triggers create an increase in mucus production in the airways (bronchial tubes). These triggers can be anything from dusts, pollens, and perfumes to infections.  Certain medications like aspirin or antibiotics, cold, stress or even exercise can cause an asthma attack. This mucus overload obstructs airflow and leads to spasm of the muscle that surrounds those airways.  The muscle spasm narrows the airways even further. Thereby decreasing the flow of oxygen into the lung tissue for its transport into the bloodstream.  As a result patients feel anxiety and panic because they aren’t “getting enough air”.  They turn blue, can lose consciousness and can die from asphyxia. This still happens every year in the United States.

One of the reasons I am writing this note is due to the misunderstanding of patients regarding the treatment of asthma.  Most persons affected by this disorder (or anyone having an episode of shortness of breath) may have used a variety of medications to relieve their symptoms associated with this disease. Since this is a disease of inflammation and spasm of muscle around the bronchial tubes the mainstays of therapy are drugs aimed at stopping one or both of the processes.  

Acute exacerbations of asthma are treated primarily with medications that relieve the spasm of muscle around the bronchial tubes.  These are classified as bronchodilator medications and are primarily sold as albuterol (Proventil or Ventolin) and metaproterenol (Alupent).  

Unfortunately bronchodilator medications do not reduce the preceding and persistent inflammation the goes on inside the lung tubes (which is the primary underlying problem with asthma).  To remedy this issue the most commonly selected agents are corticosteroid inhalers like fluticasone (Flovent) or mometasone (Asmanex) or other types of inhalers that reduce inflammation such as cromolyn (Intal) or nedocromil (Tilade) or an oral agent such as montelukast (Singulair).  

Therefore, in those people with persistent symptoms of wheezing, coughing and difficulty breathing it is absolutely necessary to be consistent with the use of the medication that they are taking for reduction of inflammation.  The most common agents used are corticosteroid inhalers such as Flovent, Asmanex, Pulmicort, and several others.  Doing this will greatly decrease the severity of symptoms in turn decreasing the need for office visits and hospital visits due to exacerbations.   The National Asthma Education and Prevention Program has specific guidelines about what medications should be used and how often.  Talk to your doctor about a treatment protocol for yourself or your family member if you don’t have a plan for asthma treatment.  

And once you have a plan, please be consistent using your steroid inhaler or other anti-inflammatory medication or inhaler.  Believe me, you’ll breathe easier!!


Dr. Steve Fuller
Family Practice