Does living next to a freeway cause asthma?

In a recent article published in the Journal of Allergy and Clinical Immunology, researchers  found that children who lived in a neighborhood facing intersections with major highways or railroads were 40% to 70% more likely to develop asthma than children who lived in a neighborhood that did not face a major intersection or railroad.   Studies such as these suggesting a significant link between exposure to motor vehicle traffic and the risk of developing major chronic health problems in children such as asthma, has particular relevance for residents of Ahwatukee who believe that the proposed Loop 202 expansion around South Mountain is likely to bring their homes and children’s schools painfully close to one of the busiest truck traffic thoroughfares in the country.

ref. “The Influence of Neighborhood Environment on the Incidence of Childhood Asthma: A Propensity Score Approach”
Remarks by Juhn et al. (JACI April 2010 / Volume 125, No. 4)

Is Your Asthma Under Control: The Rules of Two

What Does Well Controlled Asthma Look Like?

Asthma is a long-term disease and although it cannot be cured, it can be controlled.  So what does well controlled asthma look like?
Some have suggested that it would include the following:

  1. Infrequent symptoms such as coughing and shortness of breath
  2. Minimal use of quick-relief medicines
  3. Normal lung function
  4. No night-time symptoms or symptoms associated with exercise.
  5. No severe asthma attacks that could result in a trip to the emergency room or being admitted to the hospital for treatment

The Two Faces of Asthma

Asthma has two parts: inflammation and bronchospasm.
Inflammation is present in the airways of asthmatics all the time, even when symptoms are quiet.  The inflamed airways are hypersensitive and easily irritated and will spasm with exposure to a variety of irritants such as cigarette smoke, cleaning fumes, air pollution, dust, exercises, and even cold viruses.  (In fact most asthma attacks are triggered by viral colds.)  We call the tightening and narrowing of the airways in asthma bronchospasm and it is the cause of most asthma symptoms including cough, chest tightness, and wheezing.

Asthma Inflammation

Although not all asthmatics are allergic, allergy is the primary cause of the inflammation found in children with asthma.  In Phoenix,  pollen and mold levels remain high much of the year. Other environmental factors such as the dry air and fine particulates (dust) and other elements of air pollution may contribute to airway inflammation.

So inflammation causes airway hypersensitivity which leads to bronchospasm which causes the symptoms of asthma.  In other words, if we are having a lot of asthma symptoms, that fact tells us that there is significant inflammation in the airways.

Two Types of Asthma Medications

Just like the two components of asthma, there are two broad categories of asthma medications:  anti-inflammatory medications and bronchodilators.   We call the anti-inflammatory medications “controllers” because they are used daily to keep inflammation under control which in turn will bring asthma symptoms under control.
Inhaled corticosteroids are the most effective anti-inflammatory medications. and are generally safe when taken as prescribed. They’re very different from the illegal anabolic steroids taken by some athletes. Inhaled corticosteroids aren’t habit-forming, even if you take them every day for many years.
Like many other medicines, inhaled corticosteroids can have side effects although most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risks of side effects.
Singulair (montelukast) is also used as a daily controller medication although it is not as effective as the inhaled corticosteroids.

Two Types of Bronchodilators

Short-Acting Bronchodilator (albuterol)

There are two types of bronchodilators: short acting and long-acting.  Both act to relax the muscles surrounding the airways.  The short acting bronchodilators are called “relievers” because they  are used as needed to relieve symptoms.   Long-acting bronchodilators (LABAS) are often used with inhaled steroids to reduce the dose of steroid needed to achieve control of symptoms.

One Size Does Not Fit All

Some patients with asthma have very mild and infrequent symptoms while others have continual symptoms or severe attacks requiring emergency treatment in a doctors office or hospital.    How do we know what medications are needed?
To answer this question, the NHLBI Expert Panel Report for the Diagnosis and Management of Asthma suggested dividing  asthma patients into four groups based on indicators of their asthma severity.  The categories ranged from mild to severe.   The first category, called mild persistent, included patients that had symptoms no more than than twice a week,  night-time symptoms no more than twice a month, and no more than one acute attack requiring oral steroids in a year.    For  this “mild intermittent’ group, use of an as needed rescue inhaler was needed.
For asthmatics with symptoms occurring more than twice a day, night-time symptoms occurring more than twice a month. and severe attack requiring emergency treatment or oral steroids more than twice a year, a daily controller medication is recommended, preferable an inhaled corticosteroid.
This  then is the  basis of the rules of two.

The Rules of Two:   If…..

  1. You have symptoms more than twice a day
  2. Night-time symptoms more than twice a month
  3. Severe asthma attacks requiring emergency treatment or oral steroids more than twice a year
  4. Uuse more than two canisters of a rescue medication in a year,

You should be taking two medications: a daily controller medication and an as-needed rescue medication

Vocal Cord Dysfunction

What is vocal cord dysfunction?

Vocal cord dysfunction is a condition caused by abnormal movement of the vocal cords.

Symptoms of vocal cord dysfunction include:

* Shortness of breath
* Intermittent hoarseness and/or wheezing
* Chronic cough and/or throat clearing
* Chest and/or throat tightness
* “Just having trouble getting air in.”

Unlike asthma, which is caused by contraction of airway muscles in the chest (bronchospasm) resulting from inflammation of the airways, the symptoms of vocal cord dysfunction is related to narrowing of the large airway in the neck. Although many patients with vocal cord dysfunction feel more symptoms in the neck and upper chest, the only symptom may be a sensation of not getting adequate air.

Because of the similar symptoms, many people with vocal cord dysfunction may be misdiagnosed with asthma and treated with asthma medications, often with poor results. If vocal cord dysfunction is still not diagnosed, oral steroids (used in other chronic lung diseases like severe asthma) may be prescribed. Significant side effects can develop with long-term use of these medicines. Additionally, a misdiagnosis can also lead to frequent emergency room visits and hospitalizations – even intubation.

Some people have both vocal cord dysfunction and asthma, which complicates both the diagnosis and the treatment.

What happens with vocal cord dysfunction?

To understand vocal cord dysfunction, it is helpful to understand how the vocal cords function. The vocal cords are located at the top of the windpipe (trachea). To produce the sounds of speech, the vocal chords tighten and partially block the airway. As exhaled air moves across the partially closed cords, they vibrate producing sound which is then shaped by our mouth and throat as speech. The vocal cords are relaxed during normal breathing, allowing air to easily pass through the trachea. However, with vocal cord dysfunction, the vocal cords close together, or constrict, during one or both parts of the breathing cycle, partially blocking the windpipe and creating a sensation of not getting enough air.

So what causes the vocal cords to tighten during normal breathing? In many, vocal cord dysfunction is a type of involuntary stress reaction. The vocal cords tighten when they are under pressure. This may be the case even though an individual does not feel particularly stressed or anxious. Vocal cord

dysfunction had recently been recognized a cause of exercise induced shortness of breath, particularly in children involved in school sports. A child, who has a strong internal drive to win or feels pressure from a coach or parents to do better, may exhibit vocal chord problems.

Diagnosing vocal cord dysfunction can be quite difficult because the symptoms are a lot like those of asthma including chronic cough, shortness of breath, difficulty inhaling enough air, chest tightness, throat tightness, hoarseness, and wheezing. In addition, symptoms of vocal cord dysfunction can be trigged by conditions that also trigger asthma symptoms, such as upper respiratory infections, gastroesophagel reflux (severe heartburn), fumes, odors, cigarette smoke, singing, emotional stress, and exercise. Because vocal cord dysfunction doesn’t respond to asthma treatment, however, it can cause frequent emergency room visits and hospitalizations.

Because the symptoms of vocal cord dysfunction mimic asthma, differentiating between the two can be a challenge. Often, the first clue is finding that symptoms do not respond to routine asthma medications. The most specific test for the disease is direct visualization of the vocal cords through laryngoscopy or bronchoscopy during an attack. Because the vocal cords may appear normal between attacks, a negative test may be misleading.

Treatments and Tips

Once a diagnosis of vocal chord dysfunction is made, specific treatment can be recommended. Speech therapy can be helpful to guide relaxed breathing and special exercises can help relax throat muscles and reduce the abnormal movement of vocal cords.
Because stress can worsen the symptoms of vocal chord dysfunction – and vocal chord dysfunction can increase levels of stress – many people with vocal chord dysfunction have found counseling to be an important part of their treatment. Counseling can help identify stresses and build coping skills that aid in minimizing the effects of vocal chord dysfunction on daily life.