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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

bronchial 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

asthma 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

and may include:

• Wheezing.

• Coughing.

• Chest tightness.

• Rapid, shallow breathing or difficulty breathing.

• Sleep disturbance.

• 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

an episode include:

• Having a cold or another type of respiratory illness,

especially one caused by a virus.

• Exercising (exercise-induced asthma), especially if

the air is cold and dry.

• Cigarette smoke and air pollution.

• Exposure to allergens, such as dust mites and

animal dander.

• Being around chemicals or other substances at work

(occupational asthma).

• Expressions of strong emotion, such as laughing or

crying hard.

• Hormones, such as those involved in pregnancy and

menstrual periods.

• 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

the diagnosis.

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

bronchial tubes.

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

episode 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

asthma episodes.

Triggers may include:

• House dust mites.

• Cockroaches.

• Animal dander.

• Indoor mold.

• Pollen.

Other triggers can cause asthma symptoms without

affecting the body's immune system. These include:

• Cigarette smoke and air pollution.

• Viral infections, such as colds and flu, and sinus and

other upper respiratory infections.

• Exercise. Many people with asthma have symptoms

when they exercise.

• 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