Asthma is manageable with proper medications

Asthma is both misdiagnosed and underdiagnosed, both overtreated and undertreated. But the good news, says Dr. Loren Greenway, is that with proper medications the disease is manageable.

Greenway, director of pulmonary medicine at LDS Hospital, and Primary Children's Medical Center respiratory therapist Valerie Morgan-Wallace answered calls about asthma Saturday during the Deseret Morning News/Intermountain Healthcare Health Hotline.

Asthma symptoms can include shortness of breath, chest tightness, wheezing, a dry cough or simply a recurrent need to clear the throat. But those symptoms could also mean something else, including cardiac problems, polyps on the vocal cords, a virus or simply a "hyper-reactive" airway.

An accurate diagnosis requires a pulmonary function test, Greenway and Morgan-Wallace told callers. But some doctors "make the assumption that if there's wheezing, it's asthma," Greenway says.

"Ideally, you want a pulmonary function test before the patient is put on medication," Morgan-Wallace adds, "to see what kind of reversability (of decreased lung function) there is, if any." Ideally, she says, the test should be repeated every one to two years.

Some patients are put on asthma medications needlessly, Greenway says, which may add up to an over-medication with drugs like Advair, a combination of steroid and long-acting beta-agonist. Use of the drugs was questioned last week in a meta-analysis of 19 studies, published in the journal Annals of Internal Medicine. According to the analysis, the long-acting bronchodilator pose an increased risk of hospitalizations and death compared with placebos.

Several Hotline callers asked about the study. Greenway noted that the 4,000 to 5,000 asthma-related deaths the study said "may be" associated with Advair amount to a rate of .01 percent of the 3.5 million users of the drug.

People with occasional symptoms — when exposed to perfumes or cats, for example — may have hyper-reactive airway disease that may or may not lead to asthma as they get older or are exposed to more of the offending substance, Greenway explained.

Perfumes and room deodorizers can be a problem for people with allergies and/or asthma. One caller complained that she has had trouble finding a pediatrician for her child, who has severe asthma. Every pediatrician's office so far, she said, uses plug-in room deodorizers.

One caller wondered about exercise-induced asthma. If she exercises more than once a day, she asked, is it OK to use a short-acting bronchodilator inhaler each time? Morgan-Wallace told her to seek the advice of her physician but noted that she may need a longer-lasting medication that also decreases inflammation.

"If you use an inhaler all the time, to get through the day, it can get to the point where it doesn't work as effectively. And it's really the inflammation (of the airways) that needs to be addressed."

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