Asthma

Michelle Rupp: Hello and welcome into this week’s edition of AFMC TV. We’re glad you’re joining us. Today we are talking about asthma, and we turn to one of the pros, Dr. Melissa Graham from Advanced Allergy and Asthma here in Little Rock. Hi Dr. Graham. Thanks for joining us.

Dr. Melissa Graham: Hi Michelle. Thanks for having me.

MR: So, when we talk about asthma, let me, let’s just kind of level set. And what causes asthma? Where does it begin?

MG: Well, there are many different causes. It’s kind of complicated but usually asthma begins in childhood. And so, asthma the true asthma, there are a lot of babies that get viruses that trigger an asthma type reaction. And those babies, a lot of times we call that transient wheezing or transient, old terms were reactive airway disease. Because after they have a virus that causes bronchiolitis and inflammation of the airways, they tend to wheeze or cough with future respiratory illnesses like other viruses. And then over time before they reach school age a lot of those outgrow that type of asthma. And so, we tend to try not to classify that as true asthma. And so, we say infantile or transient wheezing. But true asthma, some kids continue easing. And those are usually allergic kids that are developing their allergy and there’s a strong family history component with other allergic diseases such as hay fever or allergy in their nose with sneezing. Um A lot of those babies may also present with eczema or itchy flaky red skin. Atopic Dermatitis is another term. Um some of them might have food allergy. Um and then if they have eczema, or a food allergy like peanut allergy or milk or egg allergy, um then there’s about a 50% chance that they will end up having asthma by the time they’re school age. Um and so most kids who develop asthma will have had some symptoms of it by the time they’re five. And the family history of that is that if one of one parent has any of those illnesses or conditions that are allergic, the child has a 50% chance of having an allergic condition. And if a second parent or sibling to first degree relatives have any of the allergic diseases, then that increases your risk to 70%. And asthma just happens to be one of those. And so, there are about 25 million Americans who end up having the condition of asthma. And it ends up being the number one chronic condition of childhood. It’s it ends up being so common and then you can develop it as an adult as well. But if it’s an early young adult, then usually you were allergic as a child.

MR: Are there different types of asthma?

MG: Yes, there again, the broad categories of asthma. And we’ve learned a lot more over the years, to where we’ve divided it into further types, but overall, we used to say intrinsic and extrinsic asthma. Extrinsic was allergic asthma and then intrinsic was non allergic asthma. So those are still the two broad categories. And again, most kids too young adults have the allergic top and it’s rare for them to have non allergic or extrinsic, I mean intrinsic, non-allergic asthma. But in adults, about 50% of adults who develop asthma as an adult will have non allergic asthma. And so, but still, the main problem with asthma, what the condition is you get inflammation and swelling of the inside of your airway and then that causes narrowing. And it usually starts in the upper airway like your nose. Most people have, we’ve ended up calling it one airway one disease because the inflammation usually starts in your nose and then this the same lining of skin is the same in your nose and down your large airway, your trachea, and then it branches into your smaller airways. So, a lot of people think of that as two different conditions. But it’s actually one condition. And most people that have a flare of their asthma will have some upper airway nasal symptoms a few days before they start to have chest symptoms. And those symptoms will present as coughing is the very most common. A lot of people think of asthma is having a severe asthma attack and a lot of people; the majority of people may never have an asthma attack thankfully, but they will have short of breath, coughing. You could have wheezing or whistling noise that you may not hear. Usually don’t hear unless you have a stethoscope of a physician or the patient may hear some whistling noise as they’re trying to breathe their air out. And in the lungs, you also have muscles that twirl around your airways so there’s inflammation on the inside of your airways. The muscles around your airways also tighten. So, then that’s another reason that the airways will get constricted and smaller and it makes it harder to get air in and out.

MR: Let’s talk a little about exercise induced asthma. Is that is that such a thing?

MG: Yes, so there are different triggers for people’s asthma, and everybody has their own particular set of triggers. And so, I like to explain to people that there is a completely isolated condition called exercise induced asthma where you may only have symptoms in extreme cases of exercise when you’re really exerting yourself. And usually with the definition of exercise induced asthma is that you may be fine during your exercise but as during the cool down period um you will start to have some mucus production and a little bit of a cough and usually if you start to have some shortness of breath during exercise you can kind of continue through that and get through it and it doesn’t usually interfere much with your exercise activity but then you’ll notice that you’ll notice that cool down will cause you to have some symptoms. And the other thing that comes into play with exercise though and asthma is that if your asthma is not controlled exercise and exerting yourself will let you know that. So, activities that used to be able to do without any problem. If those start to cause you problems and you’re coughing or you’re short of breath tighten your chest and you can’t do those like you used to be able to do, then that should let you know that you need to tell your physician and hopefully it’s someone that you’re seeking specialty care for your asthma because there’s a lot better statistics and how you do long term if you’re seeing a specialist who has training in addition to their regular training after medical school, everyone who has an asthma specialist, either a pulmonologist or an allergy specialist has to do an additional fellowship to get special training in asthma. And so, if you’re seeing them and you have your correct diagnosis, you’re on the correct medications, then you will have better outcomes with your asthma. And so that’s a sign if you start having trouble with your exercise routine and you used not to get on a to get checked for your asthma to get things better controlled because the number one goal of asthma is to get a good diagnosis to get on the proper medication plan and we have asthma action plans that are given out to asthmatics so that they can adjust their plan if they start to have symptoms. And then they should be able to do everything that anyone else does without any symptoms. And I’d like to tell my young kids and older kids and adults that there are more Olympic athletes that when gold medals who have asthma than those who don’t because they usually developed in childhood and so they know how to manage their asthma and they’ve always taken care of it.

MR: Is there a cure for asthma?

MG: So, there’s really not a complete cure for asthma, but we have learned a lot over the years about allergy and asthma and especially allergic asthma. Most people, most Children develop asthma because of their allergy. So over 90% of kids who have asthma have allergy and if we can catch their allergy first before they even develop asthma, then there are good studies showing that we can prevent the development of asthma by using immunotherapy or allergy shots to treat their allergy. And once they don’t have allergy anymore, it decreases the chance of them developing asthma. And also, there are lots of good studies that are becoming longer and longer term studies where if you have asthma and you have allergy causing it. Then if we treat your allergy with allergy injections then as your allergies are cured from your allergy shots, then your asthma goes into remission and we’re able to wean you off your asthma medicines and then you can live years and years without any symptoms. There’s always a chance though in the right situation like if you’ve got a severe viral infection like the flu or perhaps covid that you if you’ve ever had asthma that’s been active um that it’s more likely to show up again in those situations. So, you always need to be aware that it may not be gone forever. But those are the steps that you can take to live your best life and to take care of your asthma and need to be aware of it. And then lately over probably you know up to 15 years ago probably, we’ve now developed injections for asthma that lots of people probably heard advertised on TV and that our monoclonal antibodies that are very specific. And we’re getting more and more specific with those. There is, most allergic asthma and most asthma in general, there are these white blood cells called neutrophils that are causing all the inflammation in the airway. And so lots of those monoclonal antibody drugs are specifically aimed at blocking the development of cinephiles. And so those have been very helpful and more severe asthma that steroid dependent. And then recently even more specific monoclonal antibody was developed as an injection that blocks all asthma. The more severe asthmatics that we’ve that have not been able to use those drugs that have more neutrophils that are also a white blood cell but usually found in bacterial infections, for those familiar with the different types of white blood cells. They just didn’t qualify even though probably the drugs might have helped them. But there’s a new medicine that just came out that will help even those patients because it works to step ahead. So, lots of exciting things are out now to help anyone with even the severest asthma. So, it’s been exciting over my last 20 something years in practice to be able to put those medications to work knowing where the asthma starts at the scientific level.

MR: That is great news for sure. Dr. Melissa Graham, thank you so much for joining us today.

MG: Of course. Thanks, and I’ll be happy to come back anytime. Thanks for having me.

MR: And thank you so much for joining us. We’ll see you back here next week for more AFMC TV.