San Diego Allergy, Asthma & Immunology Consultants, Inc
Bernard A. Feigenbaum, M.D. FACP, FAAAAI
Asthma is an inflammatory disease. The inflammation is usually caused by allergies. The keys to asthma treatment are monitoring lung function, avoiding triggers that cause asthma attacks and controlling inflammation.
MONITORING LUNG FUNCTION
This is best done with pulmonary function tests (PFT’s.) These tests are extremely accurate and measure the flow of air in and out of the lungs over time. Asthma causes obstruction in the airways and prevents air from leaving the lungs quickly. This is what causes wheezing. Dr. Feigenbaum can “see” the wheezing on the PFT’s and determine the severity of the obstruction. Many people with asthma can blow out a normal amount of air, but this is only half of the picture. What really matters with asthma is how quickly you can blow the air out. We may ask you to take a treatment in the office with albuterol, a bronchodilator. This medication can quickly reverse any obstruction in the airways. By doing a breathing test before and after, we can see whether there is reversible obstruction. Reversible obstruction of more than 12-15% is one of the most diagnostic signs of asthma.
Most people with asthma know that they have “triggers” which make their asthma worse. Common triggers are cats, dust mites, cold air, exercise, and viral infections. The chest of someone without asthma is usually not bothered by cold air, exercise or a viral infection, so there is obviously something special about an asthmatic’s lungs. This usually has something to do with substances to which you are allergic (allergens) and inflammation. If you could completely avoid every allergen that causes your asthma, your asthma would likely improve markedly.
GOALS OF TREATMENT
The goals of treatment are normal exercise tolerance, undisturbed sleep, and use of the least medicine with the least adverse effects. If exercise makes you wheeze, the proper treatment is not avoidance of exercise, but treatment of the asthma, so that you can exercise. There are many Olympic athletes with asthma. A proper combination of allergen avoidance, medications, and patient education usually allows a person with asthma to live a normal life.
Feigenbaum BA, Stevenson DD, Simon RA. Respiratory Succinate Sensitivity That Does Not Cross-react In An Aspirin Sensitive Asthmatic. Ann Allergy, 1994; 72:94.
Feigenbaum BA, Simon RA, Stevenson DD. Aspirin Intolerance. (Letter) Ann Allergy, 1994; 73:455-56.
Feigenbaum BA, Stevenson DD, Simon RA. Lack of Cross-Sensitivity To IV Hydrocortisone in Aspirin-Sensitive Subjects With Asthma. J Allergy Clin Immunol 1994; 93:242.
Feigenbaum BA, Stevenson DD, Simon RA. Hydrocortisone Sodium Succinate Does Not Cross-react With Aspirin in Aspirin Sensitive Asthmatics. J Allergy Clin Immunol 1995; 96:545-8.
Feigenbaum BA. Insect-sting challenges-all risk and no benefit? (Letter) J Allergy Clin Immunol 1995; 96:704-705.
Feigenbaum BA, Simon RA. Remission of Steroid Dependent Asthma Following Fundoplication for Asymptomatic Reflux. J Allergy Clin Immunol, 1995; 95:202.
Feigenbaum BA, Simon RA. A Case of Vocal Cord Dysfunction Mimicking Asthma. Ann Allergy, 1995; 74:92.
Feigenbaum, BA. Self-reported, doctor-diagnosed 'asthma' is not necessarily asthma; 78.9% of these 'asthma' cases were atopic. (Correspondence) J Allergy Clin Immunol 2008;121:1291.
Feigenbaum BA. Fractional exhaled nitric oxide in subjects with atopic asthma: Correct Definitions of the Terms Atopy and Asthma. (Correspondence) Ann Allergy Asthma Immunol 2008; 101; 110.
2008 “Allergy & Immunology: What’s New?” NYU Division of General Internal Medicine Grand Rounds
2011 “Asthma”, Medicine Grand Rounds, Mount Vernon Hospital.
2011 “Effective Asthma Treatment”, Medicine Grand Rounds, Queens Hospital-Mt Sinai.