Asthma Can Strike at Any Age

Vol. 20 •Issue 6 • Page 28
Asthma Can Strike at Any Age

Born and raised in sunny San Diego, Calif., Kini Schoop doesn’t remember ever having any sort of breathing problems growing up. All that changed a couple of years ago when she moved from the West Coast to the East Coast.

“I moved to New York City in 1999,” she explained. “My first symptoms included a cough that seemed to never go away. In time, my symptoms became more and more severe.”

Finding she wasn’t getting any better, Schoop eventually decided to see a pulmonologist.

“The pulmonologist diagnosed asthma and put me on some medications,” she said.

In an article titled “The Incidence of Asthma in Young Adults,” published in the June 2005 issue of CHEST, Simon F. Thomsen wrote: “There is a continuing high incidence of asthma past childhood that is most pronounced among female subjects. Increasing levels of BMI are associated with a greater likelihood of developing asthma for both sexes. A substantial portion of cases of adult asthma is preceded by upper airway allergic symptoms and or eczema, thus indicating a shared pathogenesis.”

Studies have shown that over the years, repetitive inflammatory events like those associated with asthma can cause irreversible structural and functional changes in the airways. This process is called remodeling. Unfortunately, the remodeled airways are persistently narrow and can cause chronic asthma.

Searching for Clues

Researchers are now looking at a number of factors that can cause a person to develop asthma after formally having no signs of pulmonary disease in their younger years.

“Asthma is a very common disease that affects 20 to 30 million Americans,” said Eric J. Schenkel, MD, clinical assistant professor of medicine at Drexel University’s School of Medicine in Philadelphia. “Asthma can come on at any time and is often underdiagnosed. Asthma manifests itself in adults with allergies, occupational hazards and after a respiratory infection.”

The roles that certain medical conditions play in asthma are still being studied. However, there are a couple of diseases researchers have found that may lead to adult onset of asthma.

“A lot of asthma is triggered by allergies,” said J. Michael Fuller, MD, medical director of the Greenville Memorial Hospital Lung Center in Greenville, S.C. “Some adults who have allergies develop more sensitive airways over time and this leads to asthma.”

Researchers are looking at the potential that potent immune factors like interleukins may be linked to a number of processes possibly involved in remodeling, including overgrowth of cells in the smooth muscles that line the airways and scaring in the airways.

GERD and Asthma

Other medical conditions, which may contribute to adult onset asthma, are respiratory infection, gastroesophageal reflux disease and—in some cases—hormonal changes.

“There are a lot of adults who will develop adult onset asthma after a viral infection,” said Fuller. “Persistent cough and wheezing symptoms can be signs of a number of things. However, when it goes on for several weeks or months, it’s time to see a doctor.”

Researchers have found that at least half of asthmatic patients also have gastroesophageal reflux disease (GERD), a condition that causes heartburn.

Researchers have two theories about the link between GERD and asthma in adults. The first is that acid leaking from the lower esophagus stimulates the vagus nerves, which run through the gastrointestinal tract. These stimulated nerves, in turn, trigger the nearby airways in the lung to constrict, causing asthma symptoms.

In the second, it is believed acid backup that reaches the mouth may be inhaled into the airways, triggering a reaction in the airways to cause asthma symptoms.

Hormones and Asthma

Researchers have found that hormones or changes in hormone levels may likewise play a role in the severity of asthma in women. Studies have shown that 30 percent to 40 percent of women with asthma experience severe fluctuations during their menstrual cycle.

Theoretically, oral contraceptives should help women with asthma by leveling out hormonal changes, some doctors say, but so far the contraceptives do not appear to have much effect. There have been a small number of reports of oral contraceptives exacerbating asthma symptoms in fact.

Regardless of the reason for the onset of asthma during adulthood, the treatment of asthma is the same: bronchodilators and steroids do keep air passages open and the patient breathing freely.

“Inhaled steroids are the cornerstone of treatment,” explained Schenkel. “The basic problem with asthma is airway inflammation. Inhaled steroids prevent inflammation and control airway sensitivity.”

It’s important to see a pulmonary specialist to assure asthma has been properly diagnosed so treatment can begin. “Proper diagnosis occurs through pulmonary function tests and chest X-rays,” he explained. “Patients should also learn about asthma triggers and how the disease manifests itself.”

Kini Schoop now admits she wasn’t the best respiratory patient when first diagnosed with asthma. “In the beginning I didn’t understand why I needed to take all those medications, and that caused me to have problems. But now I do. I’m taking my medications as prescribed and I feel so much better.”

Marc Willis is a Pennsylvania television reporter.