Asthma has impacted the lives of millions of people for centuries. Many millions of research dollars have unlocked some of the mysteries of how and why the lungs make you cough, wheeze, short of breath or feel tight. Several medications have been developed to remedy this sometimes life-threatening disorder yet many people still suffer.
I think Dr. Paul Greenberger, an Allergy and Immunology Specialist at Northwestern University, Chicago (author of many research articles and head of the Allergy and Immunology Department and allergy training program) summed it up well in a recent article published in Allergy and Asthma Proceedings.
Dr. Greenberger elegantly summarizes the current state of thinking on asthma and how physicians should regard it as not just one disorder, but a syndrome.
The last several years of clinical research has revealed some very interesting facts about people who have difficult to control asthma. Many healthcare providers have scratched their heads as they try to understand why a particular patient isn't responding to one or more of the wondrous inhalers available for treatment of moderate to severe asthma.
Dr. Greenberger reminds the clinician the upper airway (nose and sinuses) should never be overlooked when providing asthma care. The nose and sinuses along with the lungs are considered a "unified airway". They are connected together by the larynx and trachea (structures in the throat). If you only focus treatment on the lungs, the allergic rhinitis (hay fever) or sinus infection may keep the asthma from fully responding to asthma medication.
Some people may cope with stuffy nose, sinus pressure and postnasal drip for months to years before finding out they have a longstanding infection of their sinuses. Often their asthma treatment has been intensified because of the failure to respond to low level asthma medications. But in many patients the asthma improves after the sinus infection is treated.
Dr. Greenberger recommends defining the impact of GERD (gastroesophageal reflux disease) on asthma. Research suggests that a high percentage of asthma patients are not well controlled on asthma medication alone because of GERD. Many people are unaware of it being a problem because they may not experience the classic symptoms of heartburn, indigestion, or backwash (the sensation of food or liquid coming back up the throat to the mouth after meals). Several studies have verified the relationship between GERD and asthma. GERD, untreated may mimic asthma, as well as cause asthma symptoms to worsen.
Here are the highlights of Dr. Greenberger's article:
- 1) Other specific disorders should be considered in situations of difficult to control asthma. These include: allergic rhinitis (allergy testing), chronic sinusitis (cat-scan of the sinuses), and GERD (consider treatment).
- 2) Allergy shots should be considered for people with hay fever and asthma because it directly manages the "unified airway".
- 3) Those with severe asthma who are frequently prescribed oral steroids or high dose inhaled steroids may benefit from Omalizumab injections. I have patients who have greatly benefitted from this treatment.
- 4) Dr. Greenberger also reviewed studies on environmental controls. He emphasized the importance of a comprehensive approach (do several things such as pet avoidance, remove carpet, get special encasements for bedding etc.).
Asthma may represent a combination of disorders for people that have more severe symptoms. Referral to an asthma specialist (board certified allergist or lung specialist) should be considered.
Has your asthma improved after getting treatment for a sinus or stomach problem?
Reference: Greenberger, Allergic rhinitis and asthma connection: Treatment implications, Allergy and Asthma Proceedings, Vol. 29, No. 6, Nov-Dec 2008