by Stewart B. Segal, MD

ASTHMA:  THE NUMBERS ARE STAGGERING

One in fifteen people suffer from asthma.  The numbers are as follows:

• 22 million Americans suffer from asthma.
• 6 million of those are under the age of 18.
• 2 million emergency room visits yearly
• 10 million outpatient visits
• 500,000 hospitalizations
• 220,000 asthma related hospitalizations for children
• 14 million missed days of school
• 10 deaths a day

The numbers truly are staggering.  The government estimates that only fifty percent of asthmatics are properly treated.  There are large numbers of asthmatics who don’t even know they have asthma.  They come into the office complaining that they get a cold or bronchitis two to three times a year. 

So, what can we do?  The number one imperative is to make the diagnosis.  The diagnosis of asthma is made by taking a careful history and doing lung function testing.  Spirometry is a relatively inexpensive and harmless test that measures lung function.  Yes, it takes a maximum effort on the patient’s behalf; but, once accomplished, it is instrumental in both the diagnosis and future care of the asthmatic.

Asthma is a chronic disease and should be treated accordingly.  Once the diagnosis is confirmed, the patient and his doctor should develop an asthma action plan.  The plan should include instructions for the use of “controllers” (medication used to prevent an asthma attack), as well as instructions for the use of “rescue” medications used during an acute attack to restore normal breathing.  The plan should address future follow up visits and the need for future spirometry.  A well-controlled asthmatic should have a yearly physical and spirometry.

When you have asthma, feeling well does not necessarily mean being well.  In an early article entitled “My Stethoscope Lies”, I addressed the case of a young man who, despite feeling well, had a markedly abnormal spirometry.  His lung function had diminished at such a slow rate and over such a long time that he was not aware of what he had lost.  After treatment, his lung function returned to normal and his activity level markedly increased.

There is no such thing as a “little” asthma or “I used to have asthma”.  Asthma is often unpredictable.  A person who has not has an asthma attack in years can suddenly and, without reason, have a severe attack.  All asthmatics should have their rescue medication with them at all times!  Think of your rescue medication like your seatbelt.  Despite never having an automobile accident, a wise person puts on his seatbelt.  If your belt is not on at the time of a high speed, rear end collision, your chances of survival are diminished.  If you don’t have your rescue medication in your pocket during a sudden severe asthma attack, you may well be one of the ten people who die every day in the United States.  Just as automobile accidents are rare and random events, asthma attacks can be sudden, devastating random events. 

If you have asthma, please make sure you see your doctor at least yearly.  If you suspect that you may have asthma, see your doctor now.  Those yearly, recurrent coughs and colds may be more significant than you think!  Most of all, if you have any chronic disease, you should read and study everything you can about your condition.  Knowing your illness inside and out is crucial.  Knowledge really is power when it comes to medical issues.