Three Things You May Not Know About Asthma

Updated on Jun 27, 2024 | Asthma, Your Health

If you or someone you know has asthma, then you probably know what it can be like when asthma causes that wheezing, chest tightness, and coughing.

In fact, more than 25 million people in the United States have asthma, and it is one of the most common and costly diseases, according to the Asthma and Allergy Foundation of America.

Asthma symptoms are caused by airway inflammation, airway swelling, accumulation of mucus, and constriction of airway muscle. Symptoms can be triggered by a variety of different things, including allergens like dust or pet dander, or can be developed in response to certain foods or exercise.

Linda Rogers, MD

Though this condition is widespread, many people may also have some misconceptions about asthma. Linda Rogers, MD, an Associate Professor in the Division of Pulmonary, Critical Care and Sleep Medicine, explains three things you may not know.

Asthma is not just a children’s disease

Although asthma and allergies are common in children, asthma can develop at any age. Some of the types of asthma that develop in adults are associated with sinus disease, including nasal polyps and late onset asthma in older people, and symptoms can present suddenly, seemingly out of nowhere, and are at times severe. Inhaled treatments can help keep symptoms in check and prevent flare-ups for those with asthma at all ages. For some people with asthma, there are new medicines given by injection if inhaled therapies are not keeping asthma under control.

Using albuterol alone as your only treatment for asthma may not be safe

Airway inflammation is an important driver of asthma symptoms. Albuterol is a medication delivered by an inhaler that helps to open airways when you have an asthma attack by relaxing the muscles. It is sold under brand names such as Ventolin, Proventil, and Proair. Albuterol does not treat inflammation and only provides quick relief without treating the underlying cause of asthma. Using albuterol alone has been linked to worsening airway inflammation, decreased sensitivity to albuterol for quick relief when it is most needed, and worsening of asthma over time. Instead of using albuterol alone, treatment with combination inhalers that have a medication to open the airways quickly (albuterol or formoterol) mixed together in one inhaler with a low dose anti-inflammatory inhaled steroid has been found to be a safer approach and is better at preventing flare-ups that land you in urgent care, the emergency room, or in the hospital. This is true for patients who may feel that they have mild asthma and only need treatment when they have symptoms. Some of these treatments can be used only when you have symptoms with better results than just albuterol alone.

Low dose inhaled steroids are safe and effective

Many patients with asthma are concerned about side effects from using inhaled steroids, and this concern leads them to use albuterol alone and to avoid inhaled steroids entirely. We now have almost 50 years of experience using inhaled steroids to treat asthma. Side effects that have been reported generally occur with high doses. When using low doses, inhaled steroids are extremely safe and better than albuterol alone at controlling symptoms and preventing flare-ups. New approaches that combine these medications in one inhaler with a quick relief medication (such as albuterol or formoterol) allow many patients with asthma to use these as needed for symptoms and get similar results to using daily medication while keeping the dose of inhaled steroids low.

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I Have Asthma. How Might COVID-19 Affect Me?

May 21, 2020 | Asthma, COVID-19, Your Health

Asthma is a very common respiratory condition in New York City—as well as other urban metropolitan areas—and is present in about 8 to 10 percent of the U.S. population. Because COVID-19 spreads through the respiratory system and attacks the lungs, those with asthma may be particularly concerned about contracting the virus. Linda Rogers, MD, Clinical Director at the Mount Sinai-National Jewish Health Institute, discusses what you need to know about COVID-19 if you have asthma.

Will I be at greater risk if I have asthma and COVID-19?

All of us who take care of patients with asthma have been concerned that having asthma may increase the risk of coronavirus or increase the risk of having a poor outcome from infection with coronavirus. Even under normal circumstances, asthma causes irregularities in immune response that may increase susceptibility to viral infection that can cause asthma to flare. There is also a subset of patients with asthma prone to wheezing and asthma flares when they develop viral respiratory infections. The coronavirus that causes COVID-19 is actually a distant relative of viruses that cause the common cold. These versions of coronavirus are normally in the community causing upper respiratory infections but unlike other viruses, such as respiratory syncytial virus (RSV) and rhinovirus, coronaviruses that cause the common cold are not among the more common viruses know to cause worsening asthma .

Generally, we’re seeing that asthma and allergies aren’t being found commonly in patients who are hospitalized with COVID-19 and who have died due to the virus. China and Italy have found very low rates of asthma in patients with a severe case of the virus and here in New York—out of thousands of patients who have died of COVID-19—the most common chronic illnesses that we find in patients who die of COVID-19 include high blood pressure, high cholesterol, diabetes, and heart disease.

How do I tell the difference between my asthma and COVID-19 symptoms?

Many of the symptoms of COVID-19 and asthma can overlap. Patients with the virus can have a dry cough and may become very short of breath—symptoms experienced by those with asthma. However, patients with asthma often find it difficult to exhale as opposed to those with COVID-19 who report difficulty taking a deep breath. So, the quality of shortness of breath may be different.

Additionally, patients with COVID-19 and those who have asthma might experience chest tightness. For patients with asthma, chest tightness should respond to quick relief medicine such as albuterol, whereas it’s less likely that the symptoms of COVID-19 would improve with albuterol. Moreover, with the virus you’re likely to have other symptoms apart from a cough, chest tightness, or shortness of breath. Often times, patients with COVID-19 will also have a fever, chills, fatigue, muscle aches, gastrointestinal symptoms, and alterations to taste and smell. Therefore, if you were to contract the virus, you would likely have symptoms other than cough, chest tightness or shortness of breath that would point in the direction of COVID-19 as opposed to your asthma.

What precautions can I take? Should I take my inhaler more often during this time?

If you are supposed to be taking daily medicine to prevent and control asthma symptoms, and you’re less than 100 percent perfect about doing that, now is a really good time to keep your asthma under control by taking your medicine regularly. However, there’s not really any benefit to taking extra doses of your quick relief medicine unless you are having symptoms for which you need relief.

Could my medication be weakening my immune system and put me at greater risk of contracting COVID-19?

Many or most patients with persistent asthma take inhaled medications to control their asthma that include inhaled corticosteroids. There has been some concern that inhaled corticosteroids may reduce immunity, but early data actually suggests the opposite. Based on some experiments done in the laboratory, the use of inhaled steroids may actually lower the presence of the ACE2 receptor—a protein present on many cells that is used by the virus to enter into the lungs and cause infection. While that is very preliminary data, it would suggest that the medicines are not harmful and actually could be protective.

Can my fear and anxiety about COVID-19 make my asthma worse?

This is a time of anxiety for all of us. It is a time where things are stressful and there is a lot of change. Stress is a driver of asthma symptoms and so it is necessary to manage our stress levels by getting enough sleep, eating well, and making sure we’re taking our asthma medication. Do all the things that you normally do to maintain your asthma and be sure to monitor your symptoms through journaling or with devices like a peak flow meter, which measures air flow from your lungs.

Although we need to be socially distancing, trying to spend time—at least remotely—with our friends and family can help reduce our stress levels. And, stay in touch with your health care provider through telemedicine. Reach out if your asthma worsens or you have symptoms that might reflect infection with COVID-19.

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Football Star Brings Inspiration to Young Patients

Updated on Jun 30, 2022 | Asthma, Featured, Patient Stories

2019 Heisman Trophy winner Joe Burrow met with pediatric patients, including Ryan Diaz.

Patients and families at the Child Life Zone at Mount Sinai Kravis Children’s Hospital received a special visit on Sunday, December 15, from Joe Burrow, just a day after he was named the 2019 Heisman Trophy winner. The Louisiana State University quarterback hosted a special trivia-themed episode on KidZone TV, answered questions, opened up about his personal life and adversity, and provided inspiration to patients and their families in an appearance made possible through the Companions in Courage Foundation.

Mr. Burrow also signed football keepsakes for the patients, much to the delight of one 13-year-old patient, Ryan Diaz, an aspiring football player himself. Ryan already has helped his Harlem Jets youth football team win two championships—no easy feat for this offensive guard and center who happens to have severe asthma.

“He has had asthma since he was a baby, and he has been in and out of the hospital,” recalled his mother, Christina Ortiz. “He would miss up to 18 days a year of school.” Added Ryan: “It was really hard. I would miss so many things because I couldn’t control my asthma. I struggled so much from something I didn’t cause.”

“We have many, many patients like Ryan with severe asthma,” said Alfin G. Vicencio, MD, Vice Chair for Clinical Affairs and Strategy, and Division Chief for Pediatric Pulmonology at Kravis Children’s Hospital, who started treating Ryan in September 2018. “He has multiple triggers, and it’s hard to isolate one thing, so what is your recourse, stay inside a bubble?”

Ryan Diaz with Alfin G. Vicencio, MD

Dr. Vicencio is primarily treating Ryan with an injection of omalizumab, a monoclonal antibody, every two weeks. “This medication targets very specific molecules that are important in the asthma-inflammation cascade,” said Dr. Vicencio. The treatment acts to decrease the number of sudden episodes of wheezing, shortness of breath, and trouble breathing in individuals whose symptoms are not controlled with inhaled steroids.

“Mount Sinai has a very active program for the diagnosis and treatment of children with severe asthma,” said Dr. Vicencio. “This includes some important research initiatives that are starting to identify new subtypes of asthma, some of which may be driven by unsuspected infections.”

Other components of the research program, he added, are starting to identify new genes in the airway that may contribute to severity. This is part of a collaborative project with Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, aimed at finding new therapeutic targets for patients with severe disease.

Following this protocol has allowed Ryan to keep active—except for when he was sidelined for two weeks in February with the flu and pneumonia. He is now able to resume his strenuous four-hour weekend football workouts and continue his participation in a dance and theater program.

Throughout it all, he has excelled in middle school, which has earned him an academic scholarship to Archbishop Stepinac High School in White Plains, New York, a football powerhouse.

“I just love football,” said Ryan, whose father, Juan Diaz, a registrar in Mount Sinai’s Institute for Advanced Medicine, played football for George Washington High School in New York City and has been a coach for the Harlem Jets since 2013. “It is a bond,” said Ryan.

Mr. Burrow is now certainly part of this bond, too. “It was really inspiring to speak with someone of that caliber,” said Ryan. “We talked about football, staying in school, and doing your best. One thing that made me proud—he signed my football jersey, and I gave him a signed Ryan Diaz #74 Harlem Jets hat, which he wore for the entire event.”

As for the football that Mr. Burrow signed, Ryan said he no longer has it. “We decided to give it to Dr. Vicencio because he has done so much for me. He let me lead a normal life. He really likes football, and I felt he really deserved that,” said Ryan. “I felt very, very touched,” said Dr. Vicencio. “I told Ryan that when he is in the National Football League, I will ask for one of these signed by him.”

Read more patient stories from Mount Sinai

Is Asthma Worse When You’re Pregnant?

Updated on Jun 30, 2022 | Asthma, OB/GYN, Your Health

 

Pregnancy can be a difficult time for many women, but especially for those with the added burden of asthma.

Asthma, a chronic disease of the airways of the lungs, is one of the most common medical problems that occurs during pregnancy. Sonali Bose, MD, a pulmonologist at the Mount Sinai – National Jewish Health Respiratory Institute, explains how asthma can affect both the mother and child, and what you can do about it.

Why is my asthma worse when I am pregnant?
Asthma control during pregnancy can be unpredictable. Asthma may get worse during pregnancy because of the effects of hormonal changes associated with pregnancy. Some experts have proposed that changes in the hormone progesterone can have effects on the mother’s airways, such as influencing airway inflammation or its sensitivity, but the exact mechanisms are still unclear.

Another major reason that asthma may get worse during pregnancy is that many pregnant women tend to stop or decrease their asthma medications because they are worried about how these medications may affect their unborn child, which in turn may cause the mothers to have worse control of their asthma.

What are the symptoms of asthma during pregnancy?
Women with asthma may have variable symptoms over the course of their pregnancy. Women with poorly controlled asthma may have more severe respiratory symptoms, such as wheeze, chest tightness, or cough. Some women may be more likely to have an asthma attack, either during the pregnancy or even after delivery.

Is asthma dangerous during pregnancy?
Asthma is a serious disease for all patients, not just pregnant women. However, asthma control can get worse with pregnancy. The detrimental effects of asthma not only affect the mother, but we are increasingly discovering their serious effects on the health and development of the unborn child.

Women with uncontrolled asthma during pregnancy have been reported to have more complications, such as preeclampsia, pregnancy-induced hypertension, and preterm labor. Uncontrolled asthma during pregnancy may lead to poor growth of the fetus and low birth weight. But we need better research studies to improve our understanding of exactly how asthma during pregnancy affects both the mother and child.

Can asthma be transferred from mother to child?
Asthma does run in families. Children of mothers with uncontrolled asthma (for example, those who have had an asthma attack during pregnancy) may have a higher risk of developing asthma and other allergic diseases and chest infections, or have lower lung function during childhood.

How is asthma treated during pregnancy?
The goal for treating asthma during pregnancy is similar to that for patients who are not pregnant: focus on improving asthma control. Inhaled corticosteroids are still the main way of helping control asthma during pregnancy and are effective in treating airway inflammation and preventing an exacerbation.  These inhalers appear to be safe in pregnancy, and any risks are thought to be outweighed by the benefits of achieving good asthma control.

However, if an exacerbation occurs, oral steroids may be needed to treat it. In addition, we advise that pregnant mothers try to avoid their known environmental triggers and follow universal precautions to avoid contracting a respiratory infection. It is important to optimize asthma control even before becoming pregnant, because it seems that women who have more severe asthma before getting pregnant may be more vulnerable to having problems during their pregnancy.

Make an appointment with Sonali Bose, MD
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