Originally published in The Ottawa Citizen January 6, 2004
Original Title: A reader’s questions about asthma

From time to time I receive mail from readers asking about various medical conditions. One such letter contained numerous questions about asthma and lung disease that I wish to address in this column.

Can asthma lead to bronchitis or pneumonia?

Many people with a chronic cough are told they have chronic bronchitis. Often, what they probably have is asthma. If left untreated, asthma can cause the accumulation of mucus in the airways that can impair the lungs’ ability to clear out pneumonia-causing bacteria. Viral infections such as colds and flu can further impair this cleansing action. Well-controlled asthmatics have a minimal risk of developing pneumonia.

Can asthma leave for years and then return?

There can be periods of remission and relapse. Many children may experience severe asthmatic symptoms that gradually become less of a problem with age. Among the reasons for this are increases in lung size and airway diameter. This can reduce the risk of mucus plugging the airways. Allergies may become less severe or disappear. An environment that has fewer irritants and pollutants can reduce the frequency of asthma exacerbations. Relapses can occur without warning. Indeed, many people moving into Ottawa will report an increase in their asthma symptoms. The geographic characteristics of the Ottawa valley act as a reservoir for particulate matter and allergens.

Are there different kinds of asthma?

Yes. Each person may have specific asthma triggers. Some people will experience an attack when they exercise. Others may have completely normal lung function and require medications only when they develop a cold, flu or other infection. Allergies play a major role in asthma exacerbations for many others. Smoking can lead to the development of asthma and chronic lung disease. The treatment strategies may be different for each group.

Why are more people suffering from asthma?

This question perplexes many physicians. Various factors including maternal smoking, genetic factors, industrial pollutants and allergies contribute to the increased incidence of asthma. So far, there is no unified theory to explain the overall trend.

Does obesity make asthma worse?

Abdominal obesity can restrict the chest’s ability to expand with breathing efforts. It does not necessarily cause asthma but can hinder lung function, reducing the volume of air that fills the lungs.

Are there any lung-strengthening exercises an asthmatic can do to strengthen the lungs and get rid of asthma once and for all?

No. Asthma is a chronic disease that causes swelling and mucous secretions within the airways (bronchi) leading into and throughout the lung. It is not caused by any structural weakness within the respiratory system. Appropriate medical treatment can completely control asthma for most people.

Why can’t I take a brisk walk some mornings without coughing and wheezing, but I can walk later in the same day without any problems?

In mid to late spring, summer and early autumn, mornings are usually cooler than in the afternoon. For some asthmatics, abrupt temperature changes and rapid respiratory rates during exercise can trigger wheezing and shortness of breath. Bronchi naturally constrict (bronchoconstriction) when exposed to cold air.

Why do my symptoms leave when I stop and rest?

With cessation of exercise, breathing rates slow, reducing the stress on the airways.

How many people in Canada die each year because of lung disease?
Is it because they did not take their medication or because their medication failed?

Most deaths and misery associated with lung disease are caused by chronic obstructive pulmonary disease (COPD) and primary lung cancer. Both these smoking-related illnesses are preventable. In 1997, Health Canada reported COPD to be the fourth leading cause of death in men and seventh for women, killing 9,618 Canadians, and overall the fifth leading cause of death in Canada. The past 30 years has seen a 400-per-cent increase in COPD deaths. By 2020, it will be one of the leading causes of death in Canada.

An estimated 21,000 Canadians (12,000 men; 9,000 women) will have been diagnosed with lung cancer in 2003, and 18,800 will die from it. One in 11 men and one in 18 women will develop lung cancer during their lifetimes. One in 12 men and one in 20 women have a lifetime risk of dying from lung cancer.

Despite newer medication formulations and treatment protocols, asthma rates continue to climb. All asthmatics who use their bronchodilators (Ventolin and Airomir, Apo-Salvent and Berotec) more than two to three times a week have, by definition, unstable asthma. Many do not use the proper technique to inhale their medication.

It is frustrating for family and friends to bear witness to needless suffering. COPD and primary lung cancer can be prevented. Asthma can be controlled. Your doctor is available to help you.

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© Dr. Barry Dworkin 2004