Transcription:
Triggers for Asthma in Young Children

Intro: At Bryan Health, we care for patients, educate tomorrow's healthcare providers, motivate our community with fitness and health programs and collaborate to continually improve how we serve others. That's why we are proud to present another Bryan Health podcast.

Caitlin Whyte: Welcome to the Bryan Health podcast. I'm Caitlyn Whyte. And today we are discussing asthma symptoms and triggers with Dr. Robert Szalewski, an allergist and immunologist with Allergy, Asthma and Immunology Associates. To start off doctor, what is asthma and what causes it?

Robert Szalewski, MD: So asthma is a common condition, unfortunately, that affects millions of people worldwide. It's most commonly diagnosed in children as well. The global initiative for asthma defines asthma as a heterogeneous disease, usually characterized by chronic inflammation, defined by the history of respiratory symptoms, such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity together with what they call variable expiratory airflow limitation.

So in more simple terms, it is basically a chronic inflammation of the airways. So when individuals with asthma are exposed to a certain trigger, their lungs become more inflamed and irritated. And in addition, the muscles around the airways can get very tight because they are contracting too much. So when this occurs, it makes it harder for air to move in and out of the lungs and air ends up getting trapped in the lungs or you get some obstruction. And this results in the symptoms, such as shortness of breath, chest tightness, wheeze and cough.

And there are a lot of different mechanisms that can contribute to asthma. In general, many of the same cells that contribute to allergies, so various immune cells and antibodies like IgE also contribute to airway inflammation and asthma. In addition, hereditary causes also play a role because you're more likely to develop asthma if other family members have asthma.

Caitlin Whyte: And what are some common symptoms?

Robert Szalewski, MD: So most commonly, asthma symptoms include shortness of breath, chest tightness, wheezing, and cough. And again, these symptoms tend to develop after exposure to a certain trigger, which results in the muscles around the airways contracting too much and causing obstruction of airflow. These symptoms most often are reversible with medications, such as steroid inhalers to help decrease inflammation in the airways and also inhalers like albuterol to help open the airways.

Symptoms are usually the same in children and adults, and so it is important to make an appointment with a provider if you do notice your child is experiencing symptoms such as constant coughing or coughing that is worse with infections or cold air or exercise. Your child has shortness of breath or they're wheezing, or they're stopping to catch their breath when they're playing or exercising more so than usual, or they're having trouble sleeping at night because they're coughing or they're wheezing.

An allergist can help make the diagnosis of asthma by using breathing tests such as spirometry and exhaled nitric oxide. And they can also help identify potential triggers by doing allergy testing.

Caitlin Whyte: And that leads me into my next question, what triggers asthma?

Robert Szalewski, MD: So asthma can be triggered by many different factors. Typical environmental triggers include various allergens, so pollens, things like ragweed that cause hay fever, for instance, dust mites in people's homes, animal dander, so people around cats or dogs or other animals, various molds can trigger it. In addition, irritants like air pollution can contribute, cigarette smoke. Some people have their asthma triggered by respiratory tract infections, whether it be viral or bacterial. Some people have asthma triggered by exercise, even changes in temperature and humidity. Some people also have a condition called aspirin-exacerbated respiratory disease, where their asthma symptoms are triggered by taking medications like aspirin.

And now in the working population, there are some studies that have shown 10 to 25% of cases of new-onset asthma in adults are due to exposures in the workplace, which is called occupational asthma. And there are many different chemicals that can contribute to occupational asthma, various things like people who work in the metal industry, people who work with dyes or flowers or other types of chemicals like that.

Caitlin Whyte: So if we have asthma, how do we manage it? Is it at all curable?

Robert Szalewski, MD: So asthma is not curable, but it can be managed very appropriately and effectively. Things like continuing to use your medications that are prescribed by your doctor, like steroid inhalers to decrease inflammation in the lungs, using your short-acting inhaler like albuterol to help open your airways if you need it. Really identifying your triggers, whether that be an allergen that you're exposed to in the environment or some sort of irritation or exercise or the things that I'd mentioned previously really can help kind of decrease the burden that asthma has on you.

Now, there are some newer therapies called biologic therapies, which are injectable medications that people can take that really target very specific immune cells in the body that help improve asthma symptoms.

Caitlin Whyte: Are asthma and eczema at all related?

Robert Szalewski, MD: In short, yes, they are. So one of the biggest risk factors for developing asthma is if you have other, what we would call atopic conditions such as eczema or seasonal allergies. Now there's something that we as allergists called the atopic march, which is essentially the progression from eczema that starts in infancy to asthma and seasonal allergies later on in childhood. There may be a connection between eczema and asthma in regards to very specific genes like the skin protein gene that's mutated in eczema, the filaggrin gene. But other studies have shown that kids with eczema that are found to be sensitized, meaning they have specific antibodies that are IgE antibodies to an allergen, whether it's a food allergen or something in the environment, are much more likely to develop asthma later on in childhood.

So it's important for these kids to be evaluated by an allergist to help identify if there are any allergic triggers that are present that would make it more likely for these kids to develop asthma later on, so that way we can initiate appropriate treatment and help keep things under control.

Caitlin Whyte: That's so interesting. I would've never linked those two because they seem so different just on the surface.

Robert Szalewski, MD: Yup, they do. But there are a lot of different factors that can contribute from a genetic and an environmental standpoint.

Caitlin Whyte: Well, doctor, is there anything else you want our listeners with asthma to know?

Robert Szalewski, MD: I think the most important thing is continuing to take the medications appropriately. And consistently, the most important thing would be making sure your asthma stays under control. We wouldn't want you to end up in the hospital or worse, especially given this time of year with flu season and the pandemic and other viral infections that trigger a lot of people's asthma.

Caitlin Whyte: And that wraps up this episode of Bryan Health podcast. Head on over to our website at bryanhealth.org for more information, and to get connected with one of our providers.

Please remember to subscribe, rate and review this podcast and all the other Bryan Health podcasts. I'm Caitlin Whyte. Stay well.