Top Doctors: Understanding and treating asthma

Across Long Island's verdant lawns and wooded fields, even adults who've never had asthma can succumb to breathing difficulties.

"There's so much vegetation from oak trees and flowers and grass and pine trees," noted Dr. Lawrence Walser, a pulmonologist in Riverhead.

Because pollen can irritate the lungs and trigger symptoms, Walser sees a lot of people who move to the island for work or to retire and start to develop nasal symptoms or asthma in mid- to-late adulthood.

Asthma is a chronic condition that causes the bronchial tubes, which carry air to the lungs, to become narrowed and inflamed. The muscles around these tubes, or airways, tighten, and cells in the airways produce extra mucus, reducing air flow to the lungs.

SYMPTOMS

Not everyone with asthma develops the same symptoms, but common symptoms include:

coughing

wheezing

chest tightness

shortness of breath

RISK FACTORS

More than 22 million Americans are known to have asthma, including 6 million children, according to the U.S. National Heart, Lung and Blood Institute.

It tends to run in families and often occurs in people who have allergies, reports the American Lung Association. The risk is also greater among people who had respiratory infections as an infant or young child that resulted in lung damage and people who have been exposed to certain irritants in the environment.

Dr. Ian Newmark, a pulmonologist in Syosset and chief of the division of critical care medicine at Plainview Hospital, part of the North Shore-Long Island Jewish Health System, said that most people have either allergic asthma, triggered by irritants such as cats, dust, mold or pollen, or nonallergic asthma, set off by changes in weather, respiratory infections or tobacco smoke.

CURRENT THINKING

Today, asthma is managed much like high blood pressure or other chronic diseases. The goal is to keep symptoms from exacerbating.

"In the last five years, everybody who treats asthma regularly is convinced that you need maintenance therapy - regular, everyday treatment, whereas for many years they just treated the symptoms," Walser explained.

A typical maintenance regimen consists of daily use of inhaled corticosteroids, which reduce inflammation in the airways.

And though inhaled steroids are the standard of care for long-term control of asthma, many people wrongly believe that, if they go on these medicines, they'll become addicted or gain weight, Newmark said. "They don't realize inhaled steroids work primarily on the airways and are not absorbed all that much into the system," he said.

The key to successful asthma management is knowing your asthma triggers and sticking with your medication regimen, he added. "I think people who are very compliant are much less likely to have severe attacks, are much less likely to end up in the hospital and certainly much less likely to have life-threatening attacks of asthma," Newmark said.

THE LONG ISLAND SCENE

In his practice, Newmark said, he sees a number of firefighters with severe and persistent asthma symptoms, most of whom had not experienced respiratory symptoms before their exposure on Sept. 11, 2001.

These firefighters have a unique "reactive airways disease syndrome" because of toxic exposure to chemicals, he said, and "many firemen wind up on permanent disability, permanent medication usage from their exposure at the World Trade Center site."