Getting asthma under control

The focus has shifted to managing asthma all the time so that everyday activities need not be curtailed.

By LAURAN NEERGAARD, Associated Press
Published May 8, 2007

WASHINGTON - Only one in five children with asthma has the disease under good control, sobering findings that are helping to fuel a shift in care.

The change: a stronger focus on day-to-day symptoms, not just the bad attacks, so that the 20.5-million Americans who have asthma can breathe easier without limiting their activities.

Federal guidelines due this summer are expected to urge doctors to closely monitor whether treatment is truly controlling everyday symptoms and improving quality of life - and to adjust therapy until it does.

A campaign is under way to teach patients to recognize they need better help and to assist them in conveying that to a doctor. If the doctor is happy that you've had no flare-ups but doesn't know you had to quit playing soccer to do it, you're not achieving good control.

Too often, physicians don't realize how severe symptoms are, says Dr. Jill Halterman, a pediatric asthma specialist at the University of Rochester. With children, their own parents may underestimate symptoms.

It's more complicated than denial: Wheezing while running, or waking up coughing have been routine for years, but people may not know to complain.

Says Halterman, "The goal (is) for the child to have no symptoms and no limitations on activities."

That's the goal for adults, too, as specialists shift from asthma's severity as the chief treatment guide to this broader goal of asthma control, says Dr. Allan Luskin of the University of Wisconsin in Madison.

"They can live normal lives, but it takes work" to do so, Luskin says.

Asthma is a chronic lung disease caused by inflammation inside airways that in turn makes them super-sensitive, narrowing in response to irritants that wouldn't bother a healthy lung. The result: recurring episodes of wheezing, coughing, chest tightness and difficulty breathing.

Attacks can be triggered by numerous things - breathing someone else's cigarette smoke, exercise, cold air, stress, viruses - but roughly 60 percent are triggered by allergens.

There is no cure, but there are effective daily medications that reduce inflammation and prevent flare-ups. Yet asthma still kills more than 4, 000 people a year.