Asthma & Allergies: Medications put patients in game

by Christopher Johnston

Originally printed in The Plain Dealer Health Supplement, May 20, 2003.
Reprinted with permission.

For the first half of her life, Wren Lorek's physical activities were controlled by her asthma and allergies. Four or five times a year, severe asthmatic flare-ups would put her into the hospital for several days. She loved sports, but couldn't continue to play them. That all changed in the second half of her life. Lorek's allergist, Ronald A. Strauss, M.D., helped her take control of her asthma and allergies with a combination of preventive medications, including steroid inhalers.

"When I was playing basketball in 7th grade, I could run up and down the court once or twice, then I'd be done," Lorek recalls. "But when I was 12 or 13, Dr. Strauss got me to the point where I could play competitively."

Lorek not only played basketball, volleyball and softball for Olmsted Falls High School, but went on to a successful basketball career at Muskingum College in New Concord, Ohio. Today, the 24-year-old first-grade teacher in Olmsted Falls is also the head coach of the girls basketball program at her old high school. She still runs two to three miles a day and participates in weight lifting and other fitness activities with her team. "Now I use a steroid inhaler 20 minutes before I run or play sports to open up all the airways," she says. "That has been a big quality-of-life improvement for me."

Dr. Strauss, who has maintained a special focus on asthmatics and sports throughout his 28-year practice, says he's seen a number of sedentary children blossom into good athletes once they realized their problem was asthma. "What's really exciting for me is to make a diagnosis of asthma, then see the patient using the correct medication to participate and at times excel in sports," says Strauss, head of the Cleveland Allergy & Asthma Center at Fairview Hospital Physicians' Center.

"I have a number of college athletes with chronic asthma playing at the varsity level. It's not like the old days when asthmatics couldn't participate in sports or other strenuous activities, because now we know how to treat it."

Lorek is just one of more than an estimated 17 million people in the United States who suffer from asthma, according to the Asthma and Allergy Foundation of America (AAFA). The AAFA also estimates that 60 million Americans have asthma or allergies, which costs the U.S. economy more than $20 billion annually in hospitalization, medical services and lost productivity at school and work.

As a disease, asthma blocks or constricts a person's airways, primarily the bronchial tubes which branch off from the trachea or windpipe and bring oxygen to the lungs. When a substance that triggers asthma in a particular individual comes in contact with the airways, the bronchial tissue becomes inflamed and the muscles on the outside of the airways tighten, causing them to narrow. Mucus enters the airways, which then become swollen, further narrowing the passages and hindering breathing. While these effects are usually temporary, they can cause shortness of breath and other breathing difficulties. In come cases they may be severe enough that the person requires medical attention to restore normal breathing.

For reasons that aren't yet completely understood, some people have more sensitive airways, and their asthma episodes are triggered by a variety of environmental stimuli. Each person's triggers are highly individual, but there are several common ones - including exercise, cold air or various allergens (such as grass, pollen, dust mites, mold, animal dander, cockroach debris and smoke) — as well as some types of viral infections. According to a patient brochure written by Dr. Strauss entitled "Modern Approach to Asthma," nonspecific stimuli such as weather changes, pollution, and emotions such as laughing and crying that can precipitate coughing and wheezing also can affect the bronchial tubes of asthmatics.

There are two basic levels of asthma. The first is mild or intermittent asthma, which requires a short-acting inhaler to relieve symptoms no more than two times a week or as needed. Anything more frequent is considered persistent asthma, which is subcategorized into mild, moderate or severe, based on symptom frequency and levels of lung function. Persistent asthma requires use of a "controller," an inhaled steroid taken on a regular basis to control the inflammation in the person's airways. In such cases, a short-acting inhaler often is used in conjunction with the controller.

David Lang, M.D., head of allergy immunology at the Cleveland Clinic, emphasizes that while there is no cure for asthma, it can be managed so that people can sleep through the night, not miss school or work, and participate in sports and other activities without requiring emergency care or hospitalization. "By taking proper measures to avoid the things they are allergic to and taking appropriate medication, people should be able to achieve the goals of asthma management," he says. "If they are not achieving these goals, something is wrong, and they should consider that unacceptable."

While this sounds like it should be easy to do, many people do not take proper steps to control their asthma. AAFA figures indicate that among children ages 5 to 17, asthma remains the leading cause of school absences from chronic illness.

Dr. Strauss cites several significant advances in medications over the past few years. One of the biggest breakthroughs, he believes, is the Advair diskus, which combines two different inhaler medications, eliminating the need to take four inhalations of one inhaler and six or eight inhalations of another inhaler. By using the Advair diskus, the person gets the equivalent of Flovent, an inhaled steroid or anti-inflammatory drug, and Serevent, a short-acting bronchial dilator, so the person can treat both aspects of the disease with one inhalation.

Another popular advance, Singulair, can be used for both asthma and allergies. Known as a leukotriene modifier, Singulair is a nonsteroid anti-inflammatory medication. The product needs to be taken only once a day.

Another much advertised allergy medication is Claritin. Once a prescription drug and now available over the counter, Claritin gained popularity because of its minimal side effects. Other drugs can cause either drowsiness or agitation, depending on the active ingredients. "While it's nice to have access to a medication without seeing a physician," Dr. Strauss warns, "the caveat is that some patients' care might not be optimal, because they're not treating the right problem. So if they're self-diagnosed and they think their problem is allergies and a chronic cough, but the cough is a manifestation of asthma, then Claritin won't really do anything."

The key lesson for people with asthma or allergies? Work with an allergist who can properly diagnose the specific problem and provide a course of treatment that will enable you to enjoy life without unnecessary limitations.

In general, it is quite good. In the majority of infants, asthma can be satisfactorily controlled, so that growth and development are normal. As your baby grows older, he should be able to have a normal lifestyle, including athletic participation, if his asthma is kept under control. The question frequently arises as to whether a child will "outgrow" asthma. Although it is true that in some children, the symptoms of asthma become milder with age, and may even seem to disappear completely, it is not possible to predict this for any individual child. It is never a good idea to postpone treatment in hopes that the problem will resolve itself. Asthma must be recognized and treated early if the best results are to be achieved.