Asthma that begins during childhood is called child-onset asthma. This type of asthma happens because a child becomes sensitized to common allergens in the environment – most likely due to genetic reasons. The child is atopic – a genetically determined state of hypersensitivity to environmental allergens.
Allergens are any substances that the body will treat as a foreign body, triggering an immune response. These vary widely between individuals and often include animal proteins, fungi, pollen, house-dust mites and some kind of dust. The airway cells are sensitive to particular materials making an asthmatic response more likely if the child is exposed to a certain amount of an allergen.
This term is used when a person develops asthma after reaching 20 years of age. Adult-onset asthma affects women more than men, and it is also much less common than child-onset asthma.
It can also be triggered by some allergic material or an allergy. It is estimated that up to perhaps 50% of adult-onset asthmas are linked to allergies. However, a substantial proportion of adult-onset asthma does not seem to be triggered by exposure to allergen(s); this is called non-allergic adult-onset asthma. This non-allergic type of adult onset asthma is also known as intrinsic asthma. Exposure to a particle or chemical in certain plastics, metals, medications, or wood dust can also be a cause of adult-onset asthma.
Asthma without allergies
People may also have asthma not triggered by allergies. Usually an upper respiratory infection (cold, flu, and rhinovirus) sets off their asthma. As soon as cold or flu symptoms appear patients are typically prescribed a short course of inhaled corticosteroids for 10-14 days.
Pescatore has patients eliminate known allergies, any food sensitivities and eat a clean diet of low glycemic index protein, fruits, vegetables and nuts to see if this makes a difference. “Anybody who has asthma has an inflammatory condition,” says Pescatore. “If you decrease inflammation in the body, you decrease your body’s need to ‘act out’ so to speak. When there is less inflammation around there is less need for your bronchials to constrict and your mast cells to activate and all of the things that occur during an asthma attack.”
Aspirin Exacerbated Respiratory Disease (AERD)
This type is triggered by aspirin. Patients may have nasal polyps, rhinitis, sneezing and a runny nose, and a history of aspirin sensitivity. When they take aspirin, they develop sneezing and a stuffy nose, which leads to wheezing and difficulty breathing. “If this type of asthma is severe enough, we actually recommend aspirin desensitization. The body is desensitized with incremental doses of aspirin usually done in a hospital setting,” says Lee. Once people tolerate the full dose of aspirin they take a daily maintenance dose, which has been shown to help with polyps, allergies and asthma.
If you cough, wheeze or feel out of breath during or after exercise, you could be suffering from exercise-induced asthma. Obviously, your level of fitness is also a factor – a person who is unfit and runs fast for ten minutes is going to be out of breath. However, if your coughing, wheezing or panting does not make sense, this could be an indication of exercise-induced asthma.
As with other types of asthma, a person with exercise-induced asthma will experience difficulty in getting air in and out of the lungs because of inflammation of the bronchial tubes (airways) and extra mucus.
Some people only experience asthma symptoms during physical exertion. The good news is that with proper treatment, a person who suffers from exercise-induced asthma does not have to limit his/her athletic goals. With proper asthma management, one can exercise as much as desired. Mark Spitz won nine swimming gold medals during the 1972 Olympics and he suffered from exercise-induced asthma.
Eighty percent of people with other types of asthma may have symptoms during exercise, but many people with exercise-induced asthma never have symptoms while they are not physically exerting themselves.
Cough variant is asthma that is characterized by a dry hacking cough. It can occur while awake or asleep and affect both adults and children. Patients usually respond well to inhaled corticosteroids. Vitamin D has also been shown to improve asthma. Studies show there is less incidence of asthma in the south, which may be related to people having less sun exposure and lower vitamin D levels in northern climates.
Occupational asthma occurs when something on the job sets off an asthma attack. Irritant induced asthma is usually from smoke or inhaled irritants like chlorine. It’s not related to an allergy; the irritant is inhaled and triggers an attack.
In occupations that deal with chemicals like paint or lab animals like rats or mice, patients may also be allergic to their trigger. They must find out exactly what sets off their symptoms and try to avoid it. If you can’t get away from your trigger, you may have to use a corticosteroid inhaler to ease symptoms. Pescatore also likes vitamin A, which has been shown to help get rid of the mucus in the respiratory tract, which can be an irritant.
He also likes Pycnogenol. The pine tree bark extract is an anti-inflammatory andantioxidant that clinical research shows helps to open the bronchial tubes and reduces asthma symptoms.
While corticosteroids and bronchodilators are often necessary in the treatment of asthma, there are many things that can help ease symptoms and prevent the various types of asthma attacks including learning your triggers, finding out what you’re allergic to, discovering food sensitivities, trying vitamins and herbal supplements, as well as lifestyle changes such as eating a healthier diet, removing shoes indoors and using a home air filter.
Nocturnal asthma occurs between midnight and 8 AM. It is triggered by allergens in the home such as dust and pet dander or is caused by sinus conditions. Nocturnal or nighttime asthma may occur without any daytime symptoms recognized by the patient. The patient may have wheezing or short breath when lying down and may not notice these symptoms until awoken by them in the middle of the night – usually between 2 and 4 AM.
Nocturnal asthma may occur only once in a while or frequently during the week. Nighttime symptoms may also be a common problem in those with daytime asthma as well. However, when there are no daytime symptoms to suggest asthma is an underlying cause of the nighttime cough, this type of asthma will be more difficult to recognize – usually delaying proper therapy. The causes of this phenomenon are unknown, although many possibilities are under investigation.
Steroid-Resistant Asthma (Severe Asthma)
While the majority of patients respond to regular inhaled glucocorticoid (steroid) therapy, some are steroid resistant. Airway inflammation and immune activation play an important role in chronic asthma. Current guidelines of asthma therapy have therefore focused on the use of anti-inflammatory therapy, particularly inhaled glucocorticoids (GCs). By reducing airway inflammation and immune activation, glucocorticoids are used to treat asthma. However, patients with steroid resistant asthma have higher levels of immune activation in their airways than do patients with steroid sensitive (SS) asthma.
Furthermore, glucocorticoids do not reduce the eosinophilia (high concentration of eosinophil granulocytes in the blood) or T cell activation found in steroid resistant asthmatics. This persistent immune activation is associated with high levels of the immune system molecules IL-2 (interleukin 2), IL-4 and IL-5 in the airways of these patients.