Outgrowing Asthma, Part II
In Part 1 of Outgrowing Asthma, I told you what it
means when some children appear to outgrow asthma
in their late teens. We know that inhaled steroids like
budesonide and fluticasone can reduce allergic
inflammation and the lung twitchiness that goes with
it. This raises the question of whether it’s beneficial
for adolescents who outgrow asthma to continue
taking inhaled steroids, even though they no longer
need the medication to control symptoms.
A recently published study from The Netherlands tried
to answer this question and found that 3 months of
fluticasone (an inhaled steroid found in Advair)
reduced methacholine sensitivity, a measure of airway
twitchiness. Fluticasone also lowered concentrations
of inflammatory products in the airways but didn’t
significantly improve pulmonary function tests. The
study didn’t examine long-term effects but earlier
studies in younger children have shown that the
effects of inhaled steroids are lost within 2 to 3
months after stopping treatment.
It’s important to remember that even oral steroids like
prednisone don’t entirely eliminate the airway
twitchiness that comes with asthma. The more we
learn about asthma, the more we recognize that it’s
not just about allergic reactions in the lungs of allergic
children. Genetic factors predispose children to lifelong
changes in their airway passages, which most likely
begin to occur before age 6. These airway alterations
make one prone to asthma and/or twitchy airways for
life, even if the signs and symptoms of asthma are
outgrown in adolescence. Current research on asthma
is attempting to explain what this means clinically.
Asthma in Teens & Adults
This topic provides information about asthma in teens
and adults. If you are looking for information about
asthma in children younger than 12, see the topic
Asthma in Children.
What is asthma?
Asthma is a long-term (chronic) disease of the
respiratory system. It causes inflammation in the
bronchial tubes, the airways that carry air to the
At times asthma blocks or narrows the airways,
making it difficult to breathe. This is known as an
acute asthma episode (also called an attack, flare-up,
or exacerbation). Acute asthma episodes can occur
rarely or frequently and be mild or severe. Generally,
you can take care of symptoms at home with an
asthma action plan, although a severe acute episode
may require emergency treatment and on rare
occasions can be fatal.
Even if you have few asthma episodes, the
inflammation is present and must be treated. If the
inflammation in the bronchial tubes is not controlled,
asthma could lead to permanent changes in the
tubes that impair your lung function.
Asthma often begins during childhood or the teen
years and may last throughout your life. It can
increase your risk of complications from lung and
airway infections, such as bronchitis and pneumonia.
What causes asthma?
The cause of asthma is unknown. A number of factors
combine to cause the inflammation that can lead to
and acute asthma episodes.
You may have inherited the tendency for asthma.
• In some people, the immune system releases cells
that cause inflammation in response to certain
substances (allergens) that cause allergic reactions.
Studies report that exposure to tobacco smoke or to
allergens such as dust mites, cockroaches, and animal
dander may influence asthma’s development. 1
Asthma is much more common in people with
allergies, though not all those with allergies develop
• Environmental factors may play a role in the
development of asthma. Some experts believe asthma
prevalence has increased because of what is known as
the hygiene hypothesis. According to this hypothesis,
children—especially in developed countries—have less
exposure to certain types of bacteria or infections. 2
As a result, children's immune systems may not
develop the type of cells needed to prevent asthma.
What are the symptoms of an acute asthma episode?
Symptoms of an asthma episode can be mild to severe
Rapid, shallow breathing or difficulty breathing.
Shortness of breath.
• Tiring quickly during exercise.
Your experience of asthma may range from having no
daily symptoms to having severe, daily symptoms. The
frequency of symptoms also may change.
Factors that can develop or worsen the symptoms of
• Having a cold or another type of respiratory illness,
one caused by a virus.
• Exercising (exercise-induced asthma), especially if
air is cold and dry.
Cigarette smoke and air pollution.
• Exposure to allergens, such as dust mites and
• Being around chemicals or other substances at work
• Expressions of strong emotion, such as laughing or
• Hormones, such as those involved in pregnancy and
• Medications, such as aspirin (aspirin-induced
Some people have symptoms that become worse at
night (nocturnal asthma).
How is asthma diagnosed?
No one test can definitively diagnose asthma. Most
health professionals rely on spirometry, your medical
history, a physical exam, and laboratory tests to make
Spirometry is the test most commonly used to
diagnose asthma. It measures how quickly you can
move air in and out of your lungs and how much air is
moved. The test helps your health professional decide
whether airflow is blocked because of inflamed
While taking your medical history, your health
professional will ask about your symptoms and when
they occur. A physical exam will not reveal signs of
asthma unless you are having symptoms. Your health
professional will listen to your chest for signs of
reduced airflow in the bronchial tubes and will look for
signs of sinus problems or allergies.
A chest X-ray may be done to see whether another
disease is causing your symptoms. Blood tests may
reveal evidence of allergies that could cause asthma
You will need routine checkups with your health
professional to monitor the condition and determine
How is asthma treated?
Asthma is treated by developing a management plan.
This consists of a daily treatment plan to prevent and
control airway inflammation and an action plan that
describes what to do during an acute asthma episode.
Medications play a primary role in asthma treatment,
especially inhaled corticosteroids and beta2-agonists.
Lifestyle changes such as avoiding allergens that
cause your asthma symptoms are also important.
Recognizing and treating asthma symptoms early may
prevent severe symptoms that might require an
emergency room visit or admission to the hospital.
What are asthma triggers?
An asthma trigger is a factor that can decrease lung
function and lead to sudden difficulty breathing (acute
asthma episode). When you are around a trigger, you
are at increased risk for an asthma episode. A severe
may mean you have to go to the hospital.
Some triggers are substances you may be allergic to
(allergens). Allergens cause the body's natural
defenses (immune system) to produce chemicals
called immunoglobulin E (IgE) antibodies. These
chemicals bind to allergens, causing inflammation of
the bronchial tubes. The allergen may also cause
House dust mites.
Other triggers can cause asthma symptoms without
the body's immune system. These include:
Cigarette smoke and air pollution.
• Viral infections, such as colds and flu, and sinus and
upper respiratory infections.
• Exercise. Many people with asthma have symptoms
Dry, cold air.
• Strong expressions of emotion, such as laughing or
Medications, such as aspirin.
• In adults, hormones, including those involved in
pregnancy and menstrual periods (just before or during
• Gastrointestinal reflux disease (GERD). Some
experts debate whether GERD makes asthma worse.
Studies have shown conflicting results as to whether
GERD triggers asthma. 1
by Franklin Adkinson, M.D.
Aug 26, 2005