Asthma Impacts Many, But is Treatable

Asthma is one of the most common chronic respiratory conditions. It affects about 25 million Americans, including more than 4.6 million children. And while prevalence has remained steady, asthma still disproportionately affects certain demographics.

Almost 9% of adults and more than 6% of children in the U.S. have asthma, with more cases among women than men and more cases among Blacks and Hispanics than Whites, according to the U.S. Centers for Disease Control and Prevention.

Asthma continues to be a leading cause of hospitalizations and emergency department visits among both kids and adults. In 2021, for example, there were 1.6 million emergency department visits and 183,000 hospitalizations related to asthma. The respiratory condition also accounted for more than 7.9 million school days missed and 10.9 million missed work days among employed adults ages 18 years and older, according to the American Lung Association.

Thankfully, asthma deaths are rare. Still, the rates vary tremendously, with the highest incidence among the 65-years-and-older set and deaths among black asthma patients nearly four times more frequent than among whites.

“The good news is that asthma-related mortality has stabilized in the past 20 years,” says Trishul Siddharthan, M.D., FCCP, ATSF, a pulmonary and critical care specialist at the University of Miami Health System. “What has changed are the risk factors.”

Environmental triggers, such as air pollution, play a significant role in flare-ups.

Treatment has also improved in the past two decades, helping to limit flare-up incidents and improving the quality of life for many.

Therapy advances are particularly important for those individuals who suffer from the most severe asthma symptoms. About 5 to 10% of asthma patients fall into this category, though they make up about 30% of Dr. Siddharthan’s patients. (Having severe asthma means that the condition can be difficult to control even with high doses of inhaled corticosteroids and other medications. Individuals with severe asthma experience frequent chest tightness, shortness of breath and almost constant coughing, which can impact daily life.)

In most cases, inhalers (both reliever and long-term), as well as oral medication, can control asthma.

However, not everyone responds well to inhaled corticosteroids. This is where biologics — drugs made from living sources, such as human tissue or cells, bacteria and yeast — come in. Dr. Siddharthan uses this class of drugs for patients with Type 2 asthma, an autoimmune asthma in which eosinophils (a type of white blood cell) play a big part. Overactive eosinophils attack the lungs and airwaves, leading to inflammation, mucus, wheezing, coughing and shortness of breath.

Biologics address the underlying immune responses that cause airway inflammation.
– Trishul Siddharthan, M.D., FCCP, ATSF

How? They do this by blocking a protein that helps eosinophils grow and survive and by signaling to another protein receptor to destroy them. Therapy is relatively straightforward: an injection every other week for up to two months.

There are potential side effects to biologics, of course.

Biologics can cause allergic reactions as well as lower back pain or headaches in a small number of cases, Dr. Siddharthan adds. Nevertheless, “this is a disease-modifying therapy. [As a result], the lung function is remarkably improved.”

In certain severe asthma cases, some physicians also advise pulmonary rehabilitation. Typically used for another respiratory condition, chronic obstructive pulmonary disease (COPD), pulmonary rehab involves individualized exercise training, specific breathing exercises, and an education plan that covers asthma management, lifestyle changes, counseling and cognitive behavioral therapy. Rehab can take up to 12 weeks and require a commitment of two or three office visits a week.

Whatever the prescribed therapy, asthma treatment is essential.

“We should be more aggressive in treating asthma, especially severe asthma because we have several modalities that work,” says Dr. Siddharthan.” Also, if untreated or not treated properly, asthma can lead to permanent damage of the airwaves.”

Ana Veciana-Suárez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked for The Miami Herald, The Miami News, and The Palm Beach Post.

Tags: asthma triggers, difficulty breathing, lung function tests, people with asthma, uncontrolled asthma