Asthma is a lung condition that causes airways to narrow and stimulates mucus production. Breathing becomes difficult. Symptoms include wheezing, coughing and shortness of breath.
Dr. Amy Mehta discusses triggers and treatment of asthma.
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Asthma, What You Need to Know
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Learn more about our physicians at www.dignityhealth.org/ourdoctors.
Amy Mehta, MD
Amy Mehta, MD is a pulmonologist in Bakersfield, CA and has been practicing for 5 years. She graduated from Boston Univ Sch Of Med in 2007 and specializes in pulmonary disease, critical care medicine, and more.Learn more about our physicians at www.dignityhealth.org/ourdoctors.
Transcription:
Asthma, What You Need to Know
Bill Klaproth (Host): For some people asthma is a minor nuisance. For others, it can be a life-threatening condition as it makes breathing difficult and can cause coughing, wheezing, and shortness of breath. Here to talk with us about asthma and what you need to know is Dr. Amy Mehta a pulmonary and critical care physician at Dignity Health. Dr. Mehta, thank you for your time. So, let’s start here, what is asthma?
Amy Mehta, MD (Guest): So, asthma basically is a disease which causes three main things. It can cause a lot of inflammation of your airways and then that makes you start coughing and you produce a lot of mucus in your airways secondary to the inflammation. You also get wheezing so that means your airways are constricting down because of all the inflammation. It’s prevalent a lot. You hear about it a lot in kids and adolescents and you can – it can go into remission but then it can come back when you are an adult too. So, a lot of patients will have it when they are younger, and they will grow out of it and if they have ever been exposed to smoking or they smoke themselves; there is a high chance that they can get it back when they are older. Also, there is a prevalence of patients over the age of 65 developing asthma too. And so, they get the same symptoms of having shortness of breath or coughing or wheezing or chest tightness and not everybody has to present with all the symptoms. I have seen patients that just present with chest tightness when they try to do any exercise, or they are walking, or some patients just present with a cough that just does not go away. So, there can be lots of different presentations of asthma.
Bill: So, it sounds like asthma isn’t necessarily hereditary, it sounds like it’s more lifestyle or environmental. Is that right? I mean are there certain environmental or lifestyle choices that bring asthma on?
Dr. Mehta: There definitely is, but it can also be a mixture of genetics and the environment. And sometimes it’s just one of the other, but a lot of times, it’s both. So, for genetics, some people have a higher likelihood of developing asthma because they present – they just produce a lot more antibodies when they are exposed to certain environmental factors. But there are also, things that you can be exposed to in the environment that can make you more prone to asthma also. So, that includes if you smoke yourself, if you have been exposed to secondhand smoke and also air quality. So, being exposed to pollution, exhaust fumes and especially for the adults being exposed to anything in your occupation such as different chemicals like any cleaning materials, things you are exposed to in hair dressing, manufacturing or farming are exposed to a lot of different pesticides which can sometimes cause asthma also. And another one is being overweight can also cause asthma or worsen asthma too. And being overweight also makes you more predisposed to getting heartburn which can also cause asthma type symptoms as well.
Bill: Right, so what are the common symptoms and when is it time to see the doctor?
Dr. Mehta: So, if you are having a hard time breathing, just doing exercising or even doing simple activities in your house and showering or making the bed, vacuuming, things that you used to be able to do and now you are noticing having a hard time breathing, if you are getting a lot of chest tightness, if you are noticing that you are wheezing or coughing a lot more; those are times that you need to go see your doctor and to get worked up for why you are having such a hard time breathing.
Bill: So, this sounds like it almost mirrors a heart attack when you are talking about shortness of breath and chest pain. Is that right?
Dr. Mehta: It can sometimes. A lot of times, I see patients that come in to either the ER or they go to their primary care doctor and they are complaining of chest pain and that they are having a hard time breathing and they go see the cardiologist first and they will get worked up there because it’s sometimes hard to tell the difference between the two. And then once their heart gets checked out and they know they are okay then they get referred to a pulmonary doctor and then we can kind of work them up for other reasons why they have shortness of breath such as asthma. So, it is a little bit difficult to dissect sometimes which one is which because they can both present with similar symptoms.
Bill: And it sounds like maybe allergies too. If somebody has allergies they may have some shortness of breath or tightening of the chest or coughing and wheezing, so is that a possibility too? So, how do you eventually diagnose this as asthma as like you say, someone could present with the symptoms, you kind of have to figure out what it is? How do you diagnose that it is asthma?
Dr. Mehta: Well, most of it is from history. So, when you kind of talk to the patient, you ask them what symptoms do you have – what are you doing when you have these symptoms. So, a lot of people say well I exercise, when I try to walk a little bit, I have a hard time breathing, I get this chest tightness and a lot of it is – fortunately asthma is also related to having allergies too so, people that have a lot of allergies, they are sometime more at risk of getting asthma too along with their allergies. So, that can kind of give you a clue too. And then the other tests that we usually do in the office is something called spirometry which is a breathing test where they breath into a tube and we can figure out what their lung function is and then we give them a medication called albuterol which helps open up your airways so it makes it easier to breathe and if you have a pretty – if it opens up your airways to a significant degree we can kind of diagnose asthma based on that. There’s another test which is also a breathing test that we can do in the office called a methacholine challenge test. It’s not always necessary but sometimes when it’s a little – when you are on the fence about exactly what it is you can do this methacholine challenge test to see which makes you inhale a material which can induce asthma and that can confirm the diagnosis too.
Bill: And Dr. Mehta, let’s turn to treatment now. How do you treat someone with asthma?
Dr. Mehta: Well, there are a couple of different things that we look for. One is education. So, you want to make sure that you – so some people know what their triggers are for asthma whether it be cold air, smoking, dust mites, or cockroaches, or animal dander so if you have asthma and you know there is a cat or a dog around you that provokes your asthma; the best thing is to avoid any cats or dogs. Make sure they do not sleep in your bed also. Another thing is some people think that their triggers are perfumes or colognes, that’s another thing to avoid which sometimes can be difficult. And also, infections can usually trigger asthma too so make sure you wash your hands a lot and make sure you get a yearly flu shot. Other things are cleaning products so try to wear a mask if you can if you have to clean and try to avoid strong chemicals too. The other thing is knowing what your symptoms are of asthma and making sure you attack it early on before it gets worse so that you don’t have to end up in the hospital so if your triggers are – or if your symptoms are mainly that you start coughing, you notice that your chest tightness, make sure you call your doctor right away so you can get the appropriate treatment before you start getting worse. But the main treatment for it is inhalers. So, there are lots of different inhalers for asthma and the type of inhaler you are on will vary based on the severity of your asthma. So, if your asthma just comes on with exercise or when you are going to exert yourself in any way; you can always take an inhaler just right before you do exercise and that can help with your symptoms. If it’s a daily thing where you all day everyday you have symptoms of being short of breath there is more inhalers that are kind of daily inhalers to take everyday to maintain your asthma just like you take medications to control your blood pressure and diabetes every day if you take medications for those. Another I was going to say is make sure if you smoke, do not smoke because that can worsen your asthma and to make sure you are up to date on all your vaccinations.
Bill: So, those triggers are really important. You were just mentioning those animals, all the pet dander, cleaning products, smoking, even exercise induced asthma. So, be careful of those triggers, right, that’s really important to know about those. And long-term, Dr. Mehta, what is the outlook for asthma sufferers?
Dr. Mehta: Most of the time, most asthma patients do very well. Usually it is pretty well-controlled with just inhalers and avoiding any triggers for it. But sometimes especially if you have long-term asthma, it can begin to kind of look more like a chronic disease where it can cause chronic damage to your lungs. But there are a lot of newer medications that are out there now for asthma so it’s not just inhalers. Sometimes we can’t control it with inhalers and there is also prednisone that we can use which is a steroid or an anti-inflammatory. It has a lot of side effects associated with it. So, there are some newer medications which are injectable medications that help with mainly patients with asthma related to allergies and it attacks kind of the inflammatory process associated with it and a lot of people can feel a lot better from it, but there are shots that you have to get once or twice a month and you may have to get them for the rest of your life too. But it really can help with the quality of life that you are having and even get your life back if your asthma is very severe. There’s also another procedure that’s been around for a maybe around ten years. It’s something called bronchothermoplasty which is done mainly in centers throughout California but basically it involves doing a bronchoscopy which is a camera that they put down your – through your mouth and take a look at your airways. What happens in asthma is that your muscles can – the muscle of your airways can get really bigger because they have been inflamed for so long. So, they go in and apply heat to those – to the airways to help decrease the size of them so they don’t get so inflamed which can help also decrease your exacerbation risk. So, those are some newer things that are out for asthma and I’m sure they are going to – there is a lot more new medications that are being produced kind of attacking the cell that causes all the inflammation of asthma.
Bill: So good to hear of these advancements Dr. Mehta and thank you so much for your time today. for more information on asthma treatment and management please visit dignityhealth.org/bakersfield, that’s dignityhealth.org/bakersfield. This is Hello Healthy a Dignity Health Podcast. I’m Bill Klaproth. Thanks for listening.
Asthma, What You Need to Know
Bill Klaproth (Host): For some people asthma is a minor nuisance. For others, it can be a life-threatening condition as it makes breathing difficult and can cause coughing, wheezing, and shortness of breath. Here to talk with us about asthma and what you need to know is Dr. Amy Mehta a pulmonary and critical care physician at Dignity Health. Dr. Mehta, thank you for your time. So, let’s start here, what is asthma?
Amy Mehta, MD (Guest): So, asthma basically is a disease which causes three main things. It can cause a lot of inflammation of your airways and then that makes you start coughing and you produce a lot of mucus in your airways secondary to the inflammation. You also get wheezing so that means your airways are constricting down because of all the inflammation. It’s prevalent a lot. You hear about it a lot in kids and adolescents and you can – it can go into remission but then it can come back when you are an adult too. So, a lot of patients will have it when they are younger, and they will grow out of it and if they have ever been exposed to smoking or they smoke themselves; there is a high chance that they can get it back when they are older. Also, there is a prevalence of patients over the age of 65 developing asthma too. And so, they get the same symptoms of having shortness of breath or coughing or wheezing or chest tightness and not everybody has to present with all the symptoms. I have seen patients that just present with chest tightness when they try to do any exercise, or they are walking, or some patients just present with a cough that just does not go away. So, there can be lots of different presentations of asthma.
Bill: So, it sounds like asthma isn’t necessarily hereditary, it sounds like it’s more lifestyle or environmental. Is that right? I mean are there certain environmental or lifestyle choices that bring asthma on?
Dr. Mehta: There definitely is, but it can also be a mixture of genetics and the environment. And sometimes it’s just one of the other, but a lot of times, it’s both. So, for genetics, some people have a higher likelihood of developing asthma because they present – they just produce a lot more antibodies when they are exposed to certain environmental factors. But there are also, things that you can be exposed to in the environment that can make you more prone to asthma also. So, that includes if you smoke yourself, if you have been exposed to secondhand smoke and also air quality. So, being exposed to pollution, exhaust fumes and especially for the adults being exposed to anything in your occupation such as different chemicals like any cleaning materials, things you are exposed to in hair dressing, manufacturing or farming are exposed to a lot of different pesticides which can sometimes cause asthma also. And another one is being overweight can also cause asthma or worsen asthma too. And being overweight also makes you more predisposed to getting heartburn which can also cause asthma type symptoms as well.
Bill: Right, so what are the common symptoms and when is it time to see the doctor?
Dr. Mehta: So, if you are having a hard time breathing, just doing exercising or even doing simple activities in your house and showering or making the bed, vacuuming, things that you used to be able to do and now you are noticing having a hard time breathing, if you are getting a lot of chest tightness, if you are noticing that you are wheezing or coughing a lot more; those are times that you need to go see your doctor and to get worked up for why you are having such a hard time breathing.
Bill: So, this sounds like it almost mirrors a heart attack when you are talking about shortness of breath and chest pain. Is that right?
Dr. Mehta: It can sometimes. A lot of times, I see patients that come in to either the ER or they go to their primary care doctor and they are complaining of chest pain and that they are having a hard time breathing and they go see the cardiologist first and they will get worked up there because it’s sometimes hard to tell the difference between the two. And then once their heart gets checked out and they know they are okay then they get referred to a pulmonary doctor and then we can kind of work them up for other reasons why they have shortness of breath such as asthma. So, it is a little bit difficult to dissect sometimes which one is which because they can both present with similar symptoms.
Bill: And it sounds like maybe allergies too. If somebody has allergies they may have some shortness of breath or tightening of the chest or coughing and wheezing, so is that a possibility too? So, how do you eventually diagnose this as asthma as like you say, someone could present with the symptoms, you kind of have to figure out what it is? How do you diagnose that it is asthma?
Dr. Mehta: Well, most of it is from history. So, when you kind of talk to the patient, you ask them what symptoms do you have – what are you doing when you have these symptoms. So, a lot of people say well I exercise, when I try to walk a little bit, I have a hard time breathing, I get this chest tightness and a lot of it is – fortunately asthma is also related to having allergies too so, people that have a lot of allergies, they are sometime more at risk of getting asthma too along with their allergies. So, that can kind of give you a clue too. And then the other tests that we usually do in the office is something called spirometry which is a breathing test where they breath into a tube and we can figure out what their lung function is and then we give them a medication called albuterol which helps open up your airways so it makes it easier to breathe and if you have a pretty – if it opens up your airways to a significant degree we can kind of diagnose asthma based on that. There’s another test which is also a breathing test that we can do in the office called a methacholine challenge test. It’s not always necessary but sometimes when it’s a little – when you are on the fence about exactly what it is you can do this methacholine challenge test to see which makes you inhale a material which can induce asthma and that can confirm the diagnosis too.
Bill: And Dr. Mehta, let’s turn to treatment now. How do you treat someone with asthma?
Dr. Mehta: Well, there are a couple of different things that we look for. One is education. So, you want to make sure that you – so some people know what their triggers are for asthma whether it be cold air, smoking, dust mites, or cockroaches, or animal dander so if you have asthma and you know there is a cat or a dog around you that provokes your asthma; the best thing is to avoid any cats or dogs. Make sure they do not sleep in your bed also. Another thing is some people think that their triggers are perfumes or colognes, that’s another thing to avoid which sometimes can be difficult. And also, infections can usually trigger asthma too so make sure you wash your hands a lot and make sure you get a yearly flu shot. Other things are cleaning products so try to wear a mask if you can if you have to clean and try to avoid strong chemicals too. The other thing is knowing what your symptoms are of asthma and making sure you attack it early on before it gets worse so that you don’t have to end up in the hospital so if your triggers are – or if your symptoms are mainly that you start coughing, you notice that your chest tightness, make sure you call your doctor right away so you can get the appropriate treatment before you start getting worse. But the main treatment for it is inhalers. So, there are lots of different inhalers for asthma and the type of inhaler you are on will vary based on the severity of your asthma. So, if your asthma just comes on with exercise or when you are going to exert yourself in any way; you can always take an inhaler just right before you do exercise and that can help with your symptoms. If it’s a daily thing where you all day everyday you have symptoms of being short of breath there is more inhalers that are kind of daily inhalers to take everyday to maintain your asthma just like you take medications to control your blood pressure and diabetes every day if you take medications for those. Another I was going to say is make sure if you smoke, do not smoke because that can worsen your asthma and to make sure you are up to date on all your vaccinations.
Bill: So, those triggers are really important. You were just mentioning those animals, all the pet dander, cleaning products, smoking, even exercise induced asthma. So, be careful of those triggers, right, that’s really important to know about those. And long-term, Dr. Mehta, what is the outlook for asthma sufferers?
Dr. Mehta: Most of the time, most asthma patients do very well. Usually it is pretty well-controlled with just inhalers and avoiding any triggers for it. But sometimes especially if you have long-term asthma, it can begin to kind of look more like a chronic disease where it can cause chronic damage to your lungs. But there are a lot of newer medications that are out there now for asthma so it’s not just inhalers. Sometimes we can’t control it with inhalers and there is also prednisone that we can use which is a steroid or an anti-inflammatory. It has a lot of side effects associated with it. So, there are some newer medications which are injectable medications that help with mainly patients with asthma related to allergies and it attacks kind of the inflammatory process associated with it and a lot of people can feel a lot better from it, but there are shots that you have to get once or twice a month and you may have to get them for the rest of your life too. But it really can help with the quality of life that you are having and even get your life back if your asthma is very severe. There’s also another procedure that’s been around for a maybe around ten years. It’s something called bronchothermoplasty which is done mainly in centers throughout California but basically it involves doing a bronchoscopy which is a camera that they put down your – through your mouth and take a look at your airways. What happens in asthma is that your muscles can – the muscle of your airways can get really bigger because they have been inflamed for so long. So, they go in and apply heat to those – to the airways to help decrease the size of them so they don’t get so inflamed which can help also decrease your exacerbation risk. So, those are some newer things that are out for asthma and I’m sure they are going to – there is a lot more new medications that are being produced kind of attacking the cell that causes all the inflammation of asthma.
Bill: So good to hear of these advancements Dr. Mehta and thank you so much for your time today. for more information on asthma treatment and management please visit dignityhealth.org/bakersfield, that’s dignityhealth.org/bakersfield. This is Hello Healthy a Dignity Health Podcast. I’m Bill Klaproth. Thanks for listening.