Signs and symptoms
Common signs and symptoms of asthma include:
Coughing, usually worse at night or early in the morning.
Wheezing
Chest tightness
Shortness of breath
Asthma rates are rising in the United States, growing by 4.3 million people between 2001 and 2009, including a 50 percent increase among black children, according to a recent study by the Centers for Disease Control and Prevention.
Although the CDC stopped short of identifying a cause for the increase, local allergists have plenty of theories, ranging from environmental conditions to sedentary lifestyles.
“It might be a consequence of changes in diet and nutrition,” said Dr. Arturo Bonnin of the Allergy & Asthma Centre of Dayton.
“Some people with asthma have lower levels of Vitamin A, B, E and Zinc. They don’t eat enough fruits and vegetables. Obesity appears (to be a factor as well). Fat tissue produces a substance called lipokines, which promotes inflammation of the airways.”
One theory posits that the increase is due to improved diagnoses, meaning that perhaps what we’re seeing is not so much a technical increase in asthma cases but a more accurate measure of the people who were already suffering from it.
“Access to care is better than it has been in the past,” said Dr. William Parker of Allergy & Asthma Associates, which has several Dayton-area locations. “And physicians are more aware that asthma can be (represented by) a wide spectrum of symptoms, that it’s not just wheezing, but can be a chronic cough.”
Parker continued: “It could be something that’s unique to our area as well. We’ve received some notoriety for being the allergy capital of the country. More accurate diagnoses is one theory, poor air quality is another.”
Dayton ranked seventh this year on the Asthma and Allergy Foundation of America’s annual list of the 100 worst cities with spring allergies. In October, the foundation named Dayton as the No. 1 fall allergy capital in the country.
A diagnosis example
One example of an asthma sufferer who fell through the cracks for a long time was Kettering resident Eileen Maloney, who was diagnosed with mild asthma and allergies 3½ years ago at the age of 45.
“I always had sinus infections, twice a year, spring and fall,” she said. “One time, it was so bad I had to have a cortisone shot, which made me dehydrated, and I ended up in the hospital. One time, I walked into Dorothy Lane Market and I couldn’t breathe. I went into the pharmacy and said, ‘Give me something quick.’ Well, they can’t give you something quick. So I got some Benadryl and drank lots of water, and basically tried to calm myself down, because when you can’t breathe, it’s scary.”
To Maloney’s surprise, after her family practitioner recommended allergy testing, she was diagnosed with allergies and mild asthma, requiring a low-steroid inhaler.
“There was fear of the unknown,” she said.
“Questions like, do I need a nebulizer? Can I still ‘play outside?’ Even the doctor doesn’t want to tell you, or they want to tell you it’s just temporary. It’s lifelong and you have to put it on your insurance when you apply for life insurance and other things, just like diabetes and high-blood pressure, and other things that make you high-risk.”
Challenges in diagnosis, treatment
One challenge with identifying and treating asthma patients is a perceived stigma surrounding asthma, making people reluctant to get treated.
“(If there’s a problem), it’s usually in getting people to come in. There’s some denial, sometimes with parents (with asthmatic kids). They don’t want to see their kids get labeled,” Dr. Parker said.
This is potentially alarming, as local allergists say they believe asthma is underrated as a potential killer, despite the popular image of a sufferer simply taking a hit from a pocket inhaler when they get out of breath, and everything’s fine afterwards.
“Even though it’s a controllable disease, tragedies occur on a regular basis,” Dr. Parker said. “Just because we don’t know anyone who has died from asthma, we think it’s never happened. And so people deny or delay their treatment.”
Recommendations for asthma patients
Earlier diagnosis is always preferred, so those who suspect they have asthma should consult their physician.
“The earlier you’re diagnosed, the more likely it is because of allergies, which can improve over time,” Dr. Bonnin said. “People diagnosed later as adults are more likely to be non-allergic, and that’s more difficult to control. People diagnosed under 30 are 90 percent likely to have allergy-related asthma. After 30, that number drops to 65 percent.”
Depending on the seriousness of the asthma, patients may have to take medication every day or treat their symptoms as they occur after discovering their triggers.
“Triggers can be air pollution, cigarette smoke, allergies, changes in weather, particularly during those periods when it’s most erratic, like in March-April or October-November,” Dr. Parker said.
Although asthma is always present, the symptoms can come and go, Dr. Bonnin explained.
“They should always have their controller and use it. They should avoid outside exposure on summer days when there’s a lot of ozone in the air, and they should avoid cold air in the winter. If they play sports, they should warm up slowly and cool down slowly,” he said.
The good news is that asthma sufferers can potentially be as active as non-sufferers. Eileen Maloney still takes three daily medications: Singulair (a pill), an Asmanex inhaler, and a Nasonex nasal spray. Yet she bikes and swims regularly, has run two half-marathons and is currently training for a triathlon event in Chicago.
“I also have eye drops and an emergency inhaler as needed,” she said.
“I keep (the inhaler) in my purse at all times, and in my belt when I go running. But I haven’t needed it for over a year, and I recently had my dosage cut in half. I’m in a much better place.”
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