Will Rogers Institute : Research & Health

Asthma is the narrowing of the airways in the lungs due to a combination of smooth muscle activity narrowing the airways and mucus or other kinds of secretions filling the airways and blocking the opening.

What are common triggers that cause asthma?

The most common is idiopathic; you can have an attack in the absence of an extrinsic (external) trigger. We don't understand why this happens. It could be related to infections, anxiety and other intrinsic (internal) factors. Intrinsic asthma is more common in adults. The usual extrinsic triggers, especially in childhood asthma, are allergens, exercise, cold air and air pollution.

New treatments for asthma?

The number of people in the United States with asthma ranges in the tens of millions. Because it is so prevalent, drug companies are interested in developing new treatments.

There are three classes of drugs that are most commonly used to treat asthma. The most popular includes the beta-adrenergic agonists. These drugs are usually taken by inhalation. These medications are extremely effective acutely in treating asthma attacks when they are occurring, although some patients exhibit a gradual resistance to drugs when used frequently. And the drugs can have some side effects, although usually minor, such as rapid heart rate.

The current mainstays in treating asthma are steroid inhalant drugs. Most asthma doctors recommend maintenance with an inhaled steroid in patients whose asthma is active, with beta-adrenergic agonists used for acute flairs.

In cases where the asthma gets severe, oral steroids are usually the drug of choice at a relatively high ddose for short period of time.

Research in asthma medication continues intensively at the current time.

A group of drugs, currently under active investigation at this time is leukotriene antagonists. Leukotrienes are a class of instrinsic body chemicals produced by most cells. There is reason to believe that they cause the airways smooth muscle to be activated. There is some hope that they will have a major positive effect on relaxing the airway muscles and thereby opening the airways. These drugs are in a final trial and may become part of the treatment of asthma in the near future.

Does the medical industry have a theory to why asthma is on the rise?

We seem to be identifying more patients with significant asthma as the years go by. It is hard to be sure whether that is better reporting due to a better health care delivery system in the United States or if it's due to an actual increase in incidence caused by other factors such as increased air pollution or increased crowding in inner cities.

It is also clear that deaths from asthma especially in inner cities has been increasing in recent years, although it is relatively low as a cause of death in the United States. Nevertheless, when an asthma death occurs it is u sually in a patient that is otherwise healthy and frequently young, so that those deaths become especially troubling to all of us. Public health advocates are paying a great deal of attention to this "epidemic" and hopefully will lead us to appropriate approaches to the problem.

Is there anything people can do to "asthma proof" their homes or schools?

Yes. Intrinsic asthma is harder to deal with, because it involves factors that can't be controlled. However, extrinsic asthma can be approached by trying to reduce the potential causes. For example, allergens can be present to trigger asthma in cat lovers. Cat dander is a very prominent allergen, therefore, a cat lover should think very sriously about having a cat in the home. There are allergen free pillows, allergen clearing devices to keep the air in your home freer of allergens, etc. Exercising or cold air can trigger asthma and each individual patient should consult with his or her physician. Stay indoors on heavy air polluted days if asthma acts up and remain in air-conditioned spaces if possible.

What can I do if someone is having an asthma attack?

The best thing a person can do is to remain calm and make sure appropriate medical attention is taken and medication is used properly. The asthma attack can be very serious if not treated properly. Patients normally treat themselves appropriately when having an asthma attack and will usually get themselves to an emergency room, but excessive delay can be dangerous.

What is tuberculosis?

Tuberculosis is a disease of humans caused by an organism named Mycobacterium tuberculosis. It is one of the major killers of humans worldwide primarily because of the unavailability of modern drugs in most non-western countries. Ordinarily, a bacillus finding a home in the lungs of the patient causes tuberculosis. It is a very slow growing organism and therefore tuberculosis is a chronic disease in which the lung is gradually destroyed by the bacillus.

One of the reasons that it is so difficult to treat TB is due to the fact that it is so slow growing. Generally speaking, antibiotics take advantage of the rapid growth of bacteria in that they interfere with the formation of the bacterial wall such that the daughter cells cannot survive in the presence of the antibiotic. But because TB grows so slowly, the ordinary antibiotics are ineffective against it. Nevertheless, effective medication appeared in the 1950's and today we have effective medications that will treat the great majority of cases to a complete cure when the drugs are taken properly.

What are the symptoms associated with TB?

The symptoms are variable. Primarily with TB the most common presentation in the western world is cough, fever, drenching sweats at night, and weight loss. Occasionally there will be sputum production with some blood in it and the patient may feel weak and fatigued as a result of the infection.

How is tuberculosis contracted?

Tuberculosis is ordinarily contracted through the air. An infected patient that coughs microscopic droplets of mucus or sputum frequently will be able to transmit the organism into another person through the inhalation route. The organism when introduced into a susceptible individual will take root in the lung. Many people who are infected do not necessarily develop symptoms. The body contains the infection without requiring antibiotics or the patient even knowing they were infected. Nevertheless, in some patients the infection goes onto a full-blown case of tuberculosis.

How is one tested for tuberculosis?

There is a very simple screening test for TB. It is called a PPD skin test. It is painless and involves a minor injection just under the skin usually on the arm. The results are read two days later. If there is significant swelling at the sight, it implies that the patient, at least in the past, has been infected with the TB organisms; it does not mean that they have active tuberculosis. If the test is positive, especially newly positive, the next step is to have a chest x-ray. If the x-ray is clear, active pulmonary tuberculosis is not present. If the chest x-ray is abnormal, however, the presence of tuberculosis organisms needs to be confirmed by special laboratory tests and cultures of the patient's airway secretions.

What is the difference between emphysema and chronic bronchitis?

Both of those diseases are frequently lumped together under the terminology COPD (chronic obstructive pulmonary disease). The reason for that is that the symptoms are frequently the same. The symptoms are shortness of breath and exercise limitation sometimes accompanied by a cough with sputum production and/or weight loss. However, the two diseases are quite different pathologically.

Emphysema is a disease that involves destruction of lung tissue. We don't know for sure why that destruction takes place, but we believe that it is an imbalance between the enzymes proteases that are in the lung to protect the lung against foreign invaders such as bacteria, and the defense mechanisms of the lung which have enzymes antiproteases in them that prevent the proteases from attacking lung tissue.

If there is an imbalance between the proteases and antiproteases, the proteases then can attack lung tissue itself, in addition to protecting the lung against bacterium. Over the years, that breakdown of lung tissue can gradually result in emphysema. The reason we believe the imbalance may be caused by cigarette smoking is that there is evidence that protease production in the lung, usually by white blood cells (which are the protectors of the lung), is increased in cigarette smokers, thereby helping to cause an imbalance that leads to destruction of lung tissue over time.

Chronic bronchitis is a different disease in that it doesn't involve destruction of lung tissue but rather inflammation of the airways. The airways become inflamed, for reasons that aren't quite clear, attracting white blood cells and secreting inflammatory enzymes that cause the airways to be clogged with mucus, narrow or become inflamed and badly injured, sometimes leading to lung cancer. In chronic bronchitis the disease is particularly patchy, but the end result is that the patient has a problem getting air in and out of the lung, especially out, and leaves the same symptoms as though lung tissue is being destroyed as in emphysema.

What is the response of the diseases to the discontinuation of cigarette smoking?

The response is also a little bit different. In chronic bronchitis smoking cessation leads to a decrease in the inflammation of the lungs and there can actually be a recovery of lung function. With emphysema, however, cessation does not restore lung tissue, which does not grow back; however, it does greatly decrease the rate at which lung tissue degrades because it naturally degrades as we age anyway.

I have been smoking for over 20 years. Will it make a difference if I quit now?

Yes, as stated above, with emphysema it greatly slows down the rate of progression, and with chronic bronchitis the inflammation can be relieved and there can be an improvement of lung function, decrease of cough and sputum and a general feeling of well being.

The most ominous consequence of cigarette smoking that we all worry about is lung cancer, or bronchogenic carcinoma, which we know is associated with cigarette smoking.

We think it occurs due to chronic inflammation of the cells that line the airways, which eventually mutate and become cancerous. Lung cancer is a very serious cancer in the sense that the five-year survival of all lung cancer victims is in the vicinity of five percent. Nevertheless, it is one of the cancers that have been relatively resistant to treatment over the last fifty years. The cessation of cigarette smoking does decrease the increased incidence of lung cancer over time. The data suggest that once you stop smoking for ten years, your risk of lung cancer decreases to near the same level as the risk of lung cancer in patients who never smoked. In the intervening time there is a gradual decrease in your excess risk of lung cancer that begins immediately after ceasing.

What is sleep apnea?

An extraordinarily large fraction of the population of the world has a problem with sleep. The most common problem is called sleep apnea. The official definition of sleep apnea is related to the number of times an individual doesn't breathe for ten seconds or more during sleep. The condition is very prominent in men as they get older.

Sleep apnea has not yet been proven absolutely to cause other diseases such as cardiac arrhythmia or hypertension, although the suspicion is strong that they are associated with sleep apnea conditions.

However the most problematic aspect of sleep apnea is the daytime drowsiness that occurs, because usually patients that have sleep apnea do not sleep restfully. Because they stop breathing during sleep, they frequently wake up on a regular basis, not knowing why, and perhaps not even noticing it. They then fall back to sleep until the next episode occurs. As a result, they are hyper-somnolent in the daytime. The danger and risk that occurs as a result of that is automobile accidents and other accidents due to sleepiness. Many of us believe that is a public health risk that needs to be taken seriously and perhaps is as important as drunk driving. Fortunately a lot of attention has been paid to sleep apnea these days, and there are relatively simple and curative treatments for patients who are diagnosed with this condition. Our advice would be to consult your physician and discuss the issue of sleep apnea, especially if you have been told you are snoring excessively, and if you notice you are sleeping chronically during the daytime.

Where can I go, that is near me, for help or the latest information on pulmonary diseases and disorders?

We recommend contacting doctors at your local university or medical school. These institutions have cutting edge technology and resources for numerous medical conditions, including rare diseases and specialized fields.

What is SARS?

(SARS) has been reported to in China (Guangdong Province), Hong Kong, and Hanoi, Viet Nam. The cause of SARS (severe acute respiratory syndrome) appears to be a virus related to the measles and mumps viruses.

Early manifestations among patients with SARS have included influenza-like symptoms such as fever, muscle aches, headache, sore throat, dry cough, shortness of breath, or difficulty breathing. In some cases these symptoms are followed by hypoxia, pneumonia, and occasionally acute respiratory distress requiring mechanical ventilation and death. Laboratory findings may include low platelet and white blood counts.

If you feel that you may have contracted this illness you should promptly contact your physician.

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