Asthma: Are We Missing Something?

I have been asked quite often, “What is asthma?” Asthma is a disease of the airway. It is characterized by inflammatory hyper-responsiveness with clinical manifestation of shortness of breath and wheezing. It is also sometimes associated with coughing and feelings of chest tightness. Asthma has become one of the fastest growing causes of medical disability and morbidity for all ages but especially for the young in industrialized countries.

Asthma may manifest as an acute attack or chronic exacerbations. The attacks are often triggered by:

1) exposure to irritants such as smoke, pollen, and cold air
2) allergens such as dust, mold, animal dander, air pollution, and petrochemical products 3) bronchial or sinus infection.

Acid reflux, viral infection, congestive heart failure, foreign bodies and drug reaction are also common conditions associated with recurrent asthma. However, there is a large portion of people suffering from no obvious triggering agents or infections. These individuals are not responding to conventional therapy.

Standard treatment for asthma typically consists of bronchodilators such as albuterol and corticosteroids in the forms of oral, nasal or intravenous preparations. There are many other forms of medications for asthma including cromolyn sodium, leukotriene antagonists like Singulair, theophylline and the new generation of long acting bronchodilators. Despite aggressive usage of multiple medications for the management of asthma, more than 15 million Americans are suffering. Over 5000 people die from severe asthma attacks every year. The total medical costs related to asthma are estimated at over 14 billion dollars. The overall rate of asthma and the resulting financial burden have been rising for the last 30 years. Are doctors missing something?

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