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Advanced Therapies, Education Improve Adult Asthma Treatment

By Matthew Sharpe, MD, Pulmonary and Critical Care

Many people believe asthma is a chronic disease that begins in childhood. While it's true that asthma is more frequently diagnosed in children, many outgrow the condition with proper treatment and time. However, the frequency of adult asthma diagnoses continues to rise among different phenotypes and age groups – often presenting in an individual's 30s and 40s and even into the 70s.

With adult asthma, symptoms can be intermittent or mild enough to go undetected until an allergic reaction or viral infection, such as bronchitis, triggers a noticeable wheezing or cough. In females, we recognize an adult asthma phenotype associated with obesity. This would imply a relationship between hormonal changes and increased inflammation that comes with significant weight gain and the development of asthma later in life. Similarly, we've seen aggravated asthma symptoms during pregnancy, indicating another connection to female hormonal shifts.

Diagnosing adult asthma

Asthma diagnoses can be difficult given the similarity of symptoms to those of other diseases and conditions. The most telling symptoms are a cough, high-pitched wheeze with exhalation, shortness of breath or chest tightness, typically brought on by a trigger – such as an allergen or viral infection in the lung, a chemical exposure or heavy perfumes. These symptoms indicate bronchoconstriction and increased airway resistance.

Physicians should ask patients about nocturnal symptoms – a nighttime cough or wheezing when the person is asleep. This often-overlooked evaluation is important, as it may point to critical asthma markers associated with lung function.

Spirometry testing provides perhaps our most useful measure of obstruction or abnormal pulmonary function. This objective assessment can point to a decisive diagnosis of asthma. Our research tells us as many as ⅓ of individuals experience misdiagnosis, usually because they've not had spirometry testing or had inaccurate interpretation of its results.

Treatment, advanced therapies and patient response

Adult asthma can present in varying degrees of severity, and how an adult patient responds to treatment can be just as varied. At The University of Kansas Health System, we see many adults who experienced minor asthma symptoms as a child, and therefore received less aggressive treatment. Many kids who spend time in outdoor activities, including sports and physical education, may run out of breath sooner, developing a cough or other symptoms. Often this is chalked up to being out of shape or unconditioned while the true culprit of asthma goes undiagnosed. This speaks to the need for greater asthma education among school nurses, trainers, coaches and student athletes themselves.

The good news is that at almost any stage of life, asthma can be easily treated and controlled. Inhaled corticosteroids become a first line of treatment and generally produce very effective results in the majority of cases. However, in a smaller percentage of adult patients, we find more severe, persistent symptoms, requiring alternative medications or a more specialized approach.

For patients with severe, persistent eosinophilic asthma (allergic reaction), we've tapped biologic agents such as IL-5 inhibitors – medications injected on a monthly basis. The IL-5 inhibitors reduce the production of inflammatory eosinophil cells released from bone marrow during an allergic reaction, and as a result, minimize the severity of asthma symptoms. The resulting outcomes include a reduction in ER or hospital visits by 50%, measurable improvement in lung function and, in many cases, a tapering off of the inhaled steroids and oral medication use.

As with many common diseases today, ongoing research based on phenotypes is providing more tailored treatment options in asthma disease management. At The University of Kansas Health System, we offer an innovative procedure called bronchial thermoplasty in which we insert a scope into the patient's lung – into the smallest component of the airway – to release thermal energy. Many severe asthmatics who've received optimal, guideline-based asthma treatments over their lives still suffer from chronic inflammation not controlled by standard therapies. The bronchial thermoplasty procedure reduces the airway muscle's tendency to constrict when airways become inflamed and promotes easier breathing.

We've seen this procedure prove beneficial in lessening exacerbation of severe asthma symptoms in these individuals, including reducing ER visits and improving quality of life. As with any medical treatment, it doesn't work for everyone, but for many, it can be life-changing.

Our ultimate goal is to streamline therapy for asthma patients. We need to ensure that everyone recognizes the basics of adult asthma and how to diagnose it correctly. This will increase our ability to monitor and treat even the most remote patients and provide us with data we need to drive better care.

To refer a patient to The University of Kansas Health System or consult with a physician in any specialty, call 913-588-5862 or toll-free 877-588-5862.

Dr. Sharpe is a pulmonary and critical care specialist at The University of Kansas Health System. He is co-founder and director of the KU Asthma Center at the University of Kansas Medical Center. His research includes health-related outcomes, exercise-induced bronchoconstriction in college athletes, quality of life in asthma and telehealth asthma education.

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