Childhood asthma and allergies: Frequently asked questions

Miles Weinberger, MD
Professor of Pediatrics
Allergy, Immunology, and Pulmonary 

For people with asthma, it is important for them to be aware of the high expectations that should be anticipated from appropriate control of asthma. If they are having symptoms that interfere with sleep or activity, cause urgent care requirements or hospitalization, or having side effects from medication, they should discuss this with their doctor and consider seeking an additional medical opinion from an asthma specialist if they are not already seeing one.

First, I want to talk about what asthma is, what is likely to happen if you have asthma, and what can be done about it. Asthma is extremely common. In fact, it is the most common cause of hospitalization of children, the major cause of missed school, and a major cause of visits to emergency rooms. There is a paradox regarding the management of asthma. Better medication than ever is available and there is greater potential to manage asthma effectively then ever before. But the statistics tell us the outcome overall is not improving. There is a great contrast in the outcome of asthma when treated in selected specialty programs as a general outcome in the community. My perception of the problem with asthma today is that it is a problem of health care delivery. Essentially appropriate medical decisions are either not made by the physician or not carried out by the patient.

What is it in pollen that activates such severe allergies?

Pollen has various proteins on its surface structure to which people make allergic type antibodies.

Is it common for people with allergies to suffer allergy-induced asthma? I get it from allergic reaction to animals, but not from sports or running.

Yes. You can get asthma from allergies. That is quite common.

Can you explain what happens to the lungs that causes this problem?

When an airborne allergen is inhaled and gets down into the lungs of someone who has the airway sensitivity that we call asthma, it sets up an allergic reaction on the surface of the airway that results in the release of various chemical substances that causes constriction of muscle around the airway and also inflammation with swelling of the lining of the airway and secretion of mucous.

What are the best inhalers and can a primary care physician prescribe them or does it need to be done by a specialist?

A primary care physician can prescribe anything that a specialist can prescribe. The only difference is that a specialist may know more about the various alternatives. With regard to what are the best inhalers, this requires information about what the inhaler is used for. There are inhalers used as an acute intervention measure to relieve symptoms when they are present, and there are different medications in inhalers that are used in maintenance medication to decrease the frequency of symptoms and prevent the need for the intervention measures as much as possible. To answer the question, I would want to know which type of medication, intervention or maintenance, the questioner is asking about.

Does the environment play a large role in asthma? Does all the smog increase numbers of patients, or is it not related?

The environment plays a role in asthma for many patients, but this may vary considerably from one patient to another. Some patients with asthma have allergies to environmental factors that cause a major problem in their asthma, and others do not. Non-allergic factors that make asthma worse include exposure to cigarette smoke and, in some patients, strong odors or irritating fumes. The information on smog is not absolutely clear. It probably increases asthma for at least some if not many patients. But some of the same environmental factors that cause smog such as an inversion layer, not only increases smog, but also keeps airborne allergens close to the ground, and that increases their concentration in the air.

How do I deal with this season and these allergies?

That is not a question I can readily answer in this format. That would require ideally an allergy evaluation and prescriptions of appropriate medication. A competent allergist can identify the allergic factors that are causing a problem and should be able to prescribe medication or recommendations that will provide control of your symptoms.

What can be done to "cure" asthma? Or can one expect to live with it and treat it?

There is no known cure for asthma. However, asthma should almost always be manageable. Manageable meaning it should meet specific criteria control. Control of asthma means the absence of urgent visits to the doctor or emergency rooms or the hospital; the absence of symptoms that interfere with sleep or activity including athletics; the lack of need for intervention measures with an inhaler broncodilator; use of oral corticosteroids within defined limits; the absence of any side effects from medication; and the lack of need of routine medication more often than twice daily.

How does asthma develop in children?

Children who develop asthma have inherited a genetic predisposition to have the disease. The genetics of asthma are complex and not fully understood. There is also a relationship between the genetics and the environment that influences the development of asthma although the nature of this interaction is not well understood.

What are the pros and cons of inhaled steroids?

The major pros of inhaled steroids are its effectiveness and relative safety in usual doses as a maintenance medication for controlling chronic asthma. The con of inhaled steroids is that it does not consistently control all chronic asthma at usual doses, and there are some potential adverse effects that can occur at higher doses. Also, as effective as inhaled corticosteroids are, they do not reliably prevent acute exacerbations from viral respiratory infections (common colds) which are the major triggers for asthma that result in urgent care requirements and hospitalization, especially in children.