Gemma’s comment: Emergencies can be scary. During a vacation at a popular seaside resort in the northeast, I was caught on the beach as a squall came up, blowing sand in my face and mouth. Because my children were playing happily, I delayed leaving the beach, and by the time I did, I was gasping [...]

Immunoglobulins are protein molecules that circulate in the bloodstream. They are part of the body’s immune response to a stimulus perceived as foreign, such as bacteria, parasites, or allergens. There are five classes of immunoglobulins, named G, A, M, E, and D, and abbreviated: IgG, IgA, IgM, IgE, and IgD. Each class has its own [...]

How can I find out whether or not I have allergies? If I do have allergies in addition to my asthma, what types of treatment are available? A strong link between asthma and allergy has been recognized for a long time and both diagnoses frequently co-exist, as explained in Question 9. Many people believe that [...]

Referral to an asthma specialist is advised under two general circumstances: the “tricky” diagnosis, and the need for expert evaluation or treatment. When to Consult an Asthma Specialist To establish the diagnosis If your “asthma” symptoms and signs are not typical of asthma, you should obtain a referral to an asthma specialist. If you require [...]

What makes a doctor an asthma specialist and how can I find out if my physician is a specialist in asthma care? An asthma specialist is a physician who has a special interest in treating patients with asthma and who has completed postdoctoral training either in adult or pediatric lung diseases (pulmonary medicine) or in [...]

Well-controlled, stable, treated asthma does not affect the lungs’ ability to extract needed oxygen from the air we breathe. Severe exacerbations of asthma, however, have the potential to significantly interfere with the lungs’ capacity to obtain oxygen from the air around us and send it into the body. When ongoing inflammation, bronchospasm, and mucus accumulation [...]

The fundamental goal of asthma therapy is the control of all symptoms, which in turn leads to normalization of lung function and prevention of exacerbations and hospitalizations and allows for an active, healthy lifestyle. Once control is established, ongoing, successful treatment may include daily prescription medication, such as inhaled bronchodilators and anti-inflammatory medicines, a regular [...]

Gemma’s comment: My daughter and I seem to be especially sensitive to certain foods, like soy and nuts. My daughter feels that if she has a cold, the skin of some foods (e.g., peaches and eggplant) makes her throat close up. I, too, have had such symptoms, but I think that food sensitivities, which are [...]

Perhaps the biggest asthma myth circulating today is summed up in the phrase no symptoms means no asthma. Wrong! The correct concept is “no symptoms means I still have asthma; I feel fine because my asthma is well controlled.” Two distinct clinical scenarios apply when asthma symptoms become imperceptible and you feel fine. Either your [...]

The National Asthma Education and Prevention Pro-gram’s  EPR-3 emphasizes patient education and the forging of an ongoing active partnership between the patient and the treating healthcare provider in order to ensure optimal asthma treatment. The clinician has, without question, a continuing responsibility to educate every patient about their own asthma and to teach what constitutes [...]

Gemma’s comment: I worked for many years in a large public building, which was often described as a “sick” building, in part because of its faulty ventilating system. I often noticed breathing problems, especially when water in the radiators leaked, leaving the industrial carpeting on my office floor damp and probably moldy. Although the building [...]

The first report of what is now called the asthmatic triad appeared in 1922 in La Presse Médicale, a French medical journal. The authors of the report, Widal, Abrami, and Lermoyez, described an association between sensitivity to aspirin—introduced commercially by the Bayer Company by 1899—and the occurrence of nasal polyps and asthma. In the late [...]

Exercise-induced asthma is an outdated phrase that makes little sense to an asthma specialist and that is confusing to boot! Exercise is a universal and common asthma trigger that is a cause of asthma symptoms when asthma is not optimally controlled. Any individual with inadequately controlled asthma will invariably experience variable cough, wheezing, and breathlessness [...]

Cough-variant asthma is a type of asthma in which cough is the dominant and sometimes only symptom. A person with cough-variant asthma experiences dry, generally nonproductive cough without wheezing or breathlessness. The cough in that situation is considered to be a wheeze equivalent. The cough in cough-variant asthma may be provoked by triggers such as [...]

Yes, several alternative classifications have recently been developed. They all acknowledge the fact that NAEPP classifications have been extremely useful in guiding asthma care and treatment over the years and have been widely used by practicing physicians in daily patient care. In May 2006, a task force sponsored by the National Heart, Lung, and Blood [...]

Once asthma is diagnosed, the next step is to determine its severity in order to guide therapy. The NAEPP’s third  Expert Panel Report (EPR-3) bases its classification of asthma on the frequency of asthma symptoms, the frequency of nighttime awakenings from asthma, how often a short-acting inhaled β2 (SABA) bronchodilator is required for symptom relief, [...]

The National Asthma Education and Prevention Pro-gram, or NAEPP, was founded in March 1989 to address the growing problem of asthma in the United States. Although much was understood about asthma itself, treatment and outcomes were clearly suboptimal, especially when viewed from a national perspective. The NAEPP’s primary goal is to improve asthma care in [...]

Bronchoscopy is a lung procedure that allows the physician to look directly into the bronchi and to obtain samples or biopsies of any abnormalities found in the bronchial tree. Bronchoscopy is said to be diagnostic when it is carried out to assist physicians in investigating a lung abnormality. A bronchoscopy is therapeutic when performed to [...]

When a physician needs information on how efficiently a patient’s lungs are functioning, an arterial blood gas (ABG) can provide the answer. The ABG is a blood test. Performance of a routine blood test requires blood taken from a vein, often from the area near the elbow crease. For an ABG test, however, blood is [...]

A methacholine challenge test is a diagnostic test used in the evaluation of suspected asthma when reversibility is not demonstrated on initial spirometry. The methacholine challenge is also used for research purposes to study airway hyperreactivity. It is one type of a class of specialized tests called bronchoprovocation tests. Cold-air exercise tests are another example [...]