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Asthma: Causes, Symptoms, Treatments (podcast)

Scripps expert discusses asthma triggers and medications

Dr. Steven Zhao discusses asthma in San Diego Health podcast.

Dr. Steven Zhao, Pulmonology, Scripps Clinic

Scripps expert discusses asthma triggers and medications

If you’ve been experiencing shortness of breath, coughing or wheezing, and tightness in the chest, you may have asthma.


The common condition (it affects about one in 12 people) causes the airways in the lungs to constrict and swell when exposed to certain environmental triggers, such as smoke, pollution, electronic cigarettes, animal dander, pollen and perfumes.


Though about 75 percent of cases are diagnosed during childhood, asthma can also develop in adults.

 

In this episode of San Diego Health, host Susan Taylor and guest, Steven Zhao, MD, a pulmonologist and critical care specialist at Scripps Clinic Torrey Pines and Scripps Clinic Anderson Medical Pavilion in La Jolla, discuss the types of asthma, their symptoms and treatment options.


Dr. Zhao also explains that while symptoms can overlap with those from a variety of other conditions, certain combinations can point towards an asthma diagnosis. 

Listen to the episode on the causes and treatments for asthma

Listen to the episode on the causes and treatments for asthma

Podcast highlights

What is asthma? (0:50)

Asthma is a pretty common lung condition that involves primarily the airways of the lungs. The airways are these little tubes that bring air from their environment around you down to the lung tissue where gas exchange happens.


Asthma fundamentally is a problem with three sort of domains.


  • Number one, there is inflammation in the airways.
  • Number two, that inflammation can lead to what we call bronchospasm or narrowing of these airways.
  • Number three, there is an increase in sensitivity to environmental triggers that can bring on these episodes of airway, inflammation and narrowing.


All these together can lead you to the typical symptoms of coughing, of wheezing, a fullness of breath or chest tightness.

 

Who is most at risk for asthma? (1:35)

Asthma is a pretty common condition. Something like one in 12 Americans have asthma. It’s very likely that somebody in their family or among their friends has this problem. It can affect all kinds of people, people who are young with no other medical problems or people who are at increased risk due to a history of smoking or being overweight or just having exposure to things in the environment that can trigger their asthma.

 

Some of the most common things are environmental triggers, such as smoke, which can come from cigarette smoking, but also from vapors and electronic cigarettes. People in more urban settings have more smog and pollution in the air.


Other common triggers for asthma include pollen and seasonal environmental allergies, such as animal dander, grass or tree pollen. Strong smells or perfumes can be triggers to set off asthma.

Is asthma genetic? (2:35)

It is something that often times can run in families. It doesn’t necessarily mean that you will have it if someone in your family has it, but it does increase the likelihood.

When are most people diagnosed with asthma? (2:50)

The vast majority of asthma cases get diagnosed early in childhood, often manifesting or associated with recurrent episodes of respiratory tract infections, frequent episodes of bronchitis, things like that.


About three quarters of the time, it is diagnosed in childhood. With that said, that leaves 25 percent, which is the number of people who get diagnosed later in life. It can often present with the same sort of symptoms.


Whether you’re young or old, the challenge in diagnosing sometimes becomes a little bit more difficult for people who are adults because they often have more other potential causes for feeling short of breath or coughing.

What are symptoms of asthma? (3:33)

The diagnosis of asthma can be a little bit tricky. There are often many other things, lung conditions, heart conditions, or diseases in general that can cause these symptoms.


Some of the more typical hallmarks of asthma are coughing, wheezing and shortness of breath. But there are also a couple other clues that can point towards asthma as a diagnosis.


Typically, asthma is more sporadic in the sense that you might have asthma symptoms one day and be feeling totally fine the very next day. Often, they can be triggered by environmental smoke or pollen or other things that can trigger allergies or strong smells.

What are common triggers for asthma? (4:25)

There are a lot of potential triggers for asthma, which helps us differentiate the different types of asthma.


There is the sort of general run-of-the mill asthma or allergic asthma where people’s lungs are set off by something in the environment, such as pollen. There is also what we call occupational induced asthma, where something about a person’s work environment can be affecting their lungs and causing them to have asthma symptoms, particularly at work.


There is also exercise-induced asthma where people can have no symptoms normally, but when they try to exercise, particularly in cold air, that can be enough to trigger bronchospasm.


Lastly, there is a category of asthma called aspirin-exacerbated asthma, where people can have a sensitivity to medications, such as aspirin or ibuprofen.

What kind of work environment can lead to asthma? (5:20)

There is a wide spectrum of things that can bring out asthma. Being exposed to things like chemicals, fumes, manufacturing can certainly set off asthma. But at the same time, I have some patients whose trigger is just the smell of something in their work environment, a strong flower or a co-worker who wears a strong perfume. These are all things that can bring out asthma.

How do you treat asthma? (6:00)

Asthma fundamentally is a problem of airways inflammation and narrowing of the airways, bronchospasm. The goals with asthma are to reduce airway inflammation and to relax the muscles in the airway to help reduce that narrowing and help reduce those symptoms of coughing, wheezing and shortness of breath.


The main medications for asthma involve inhalers. Inhalers are simple devices that are used to deliver a medication through your mouth and into your lungs.


There are different brands and different types of inhalers that all work to do the same thing.


You might see different people have different kinds of inhalers that look different, but their job is all the same, which is to give you a dose of medication that you breathe into your lungs.


The specific inhaler may have different combinations of medications, but the overarching goal is to reduce inflammation and open up the airways in your lungs.

How do you prevent an asthma attack? (7:13)

The best way to treat asthma is to avoid the triggers. It’s really important for patients who have asthma to be very aware of what things can set their lungs off.


Whether it’s something seasonal, whether it’s a certain kind of environment or weather or something in their workplace, it’s really important to know what those things are and try to avoid them as much as possible.


Beyond that, it’s really important to stay on the inhalers that your doctor recommends. There are a number of different kinds of inhalers, and some inhalers are meant to be used purely on an as needed basis when you develop symptoms.


But many other inhalers need to be taken on a daily basis for them to have effect. The best way to prevent having a flare up or an exacerbation of your asthma is to make sure you’re using the medications that are going to help your lungs.

If you have symptoms, when should you see your doctor? (8:05)

Anybody who has ongoing symptoms of shortness of breath or wheezing or coughing, should be checking in with their doctor to see what the underlying cause is and get started on the right treatment.


For somebody with a confirmed diagnosis of asthma, they should get checked out, depending on how severe their symptoms are, anywhere from once every couple of months to a couple of times a year. It really just depends on how they’re feeling and how effective their medications are. We want to make sure that we’re matching the patient with the right medications.

What happens if asthma is not under control? (8:44)

There are a number of potentially serious consequences of not having your asthma adequately treated.


In the short term, people can experience what we call flares or exacerbations of their asthma, where their symptoms can dramatically worsen over the span of a few hours to a few days. In those cases, they can have quite a lot of trouble with their breathing, and they often need to be treated in an urgent care or emergency room setting to expedite their treatment and get them out of intensive care they might require.


Over the long term, asthma can cause some long term damage to the airways. The airways are little tubes that connect your lung tissue to your throat and to the surrounding world. Over time, that narrowing and bronchospasm and inflammation, can cause permanently narrowed airways that can affect the way you breathe on an ongoing basis. So it’s important to get treated.

When should you see a specialist for asthma treatment? (9:43)

Depending on the situation, often times the primary care physician is very comfortable managing patients with asthma. Sometimes when it gets to be a little bit more complex or they’re having a little bit more trouble controlling their symptoms, it’s a good idea for a patient to see a specialist, whether it’s a lung specialist or an allergy specialist. These are all specialists that have expertise in dealing with asthma.

Watch the video on treatments for asthma

Watch the San Diego Health video with host Susan Taylor and Dr. Zhao discussing the symptoms and treatments for asthma.