Surprise Attacks

Dr. Malcolm Blumenthal, director of the asthma and allergy program at the University of Minnesota, says researchers have identified genes that seem to cause asthma. Scientists believe that, eventually, they’ll be able to use genetics to identify people at high risk of developing the disease and to treat it. But Blumenthal is not optimistic about a short timeline for genetic therapies. “I used to say it would be 10 years; now I don’t know,” he says. “I think we’re going slow on that now because of the many genes involved.”

Complicating the picture is an ever-growing list of identified “triggers,” the substances that spark asthma attacks. Besides allergens, they include smoking or secondhand smoke; respiratory infections; exercise; cold air; medications, including aspirin and other nonsteroidal anti-inflammatory drugs; air pollutants; chemical fumes; sulfites used as preservatives in food and wine; sinusitis; and gastroesophageal reflux disease, a condition in which stomach acids back up into the esophagus.

Under Attack

Wheezing and gasping for breath are the best-known symptoms of asthma, so people tend to overlook others, like coughing or chest tightness. Before her children were diagnosed with asthma, Johnson’s two youngest would get a cold or allergy attack that progressed to coughing throughout the night. “They would wake up coughing badly and have to sit up and kind of catch their breath,” Johnson says. “I would be afraid they would stop breathing. It was very scary.”

Along with frequent nighttime coughing, losing your breath easily and feeling very tired or weak when exercising can be early signs of an asthma attack. If untreated, a mild attack can escalate to severe wheezing, coughing that won’t stop, very rapid breathing, and difficulty talking. Real danger signs are a bluish cast to the lips or fingernails, indicating a lack of oxygen, and a sudden disappearance of the wheezing, which means the lungs are so constricted that there is no air coming out to make sound.

“Failure to recognize the symptoms is a problem,” says Dr. Cherie Zachary at Minnesota Allergy and Asthma Consultants in Burnsville.

Severe attacks kill more than 4,000 people who have asthma every year.

Develop a Plan

Asthma has no cure, and without treatment symptoms generally get worse. Limiting exposure to triggers, such as cold air, can help prevent attacks, but most people with asthma need to take medication to hold attacks at bay. These fall into two categories: anti-inflammatories for attack prevention and bronchodilators for attack recovery.

Anti-inflammatories reduce swelling and mucus production in the airways, making them less sensitive to asthma triggers. Corticosteroids delivered directly to the lungs through an inhaler are the most effective and safe for long-term asthma control, and are generally taken daily. Natural corticosteroids are hormones produced by the adrenal glands; the synthetic versions used for asthma are marketed under the names Flovent, Azmacort, and Qvar, to name a few.