Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
"All that wheezes is not asthma." Other medical
conditions can mimic asthma and make the correct diagnosis of asthma more difficult.
Cardiac asthma
Cardiac asthma usually occurs in elderly people who have
wheezing and shortness of breath that are due to heart failure. When the heart is too weak to
pump blood effectively, fluid will accumulate in the lungs. Fluid in the lungs
causes shortness of breath and wheezing. A chest
X-ray can be
helpful in diagnosing heart failure by demonstrating an enlarged heart (usually
a sign of heart failure) along with fluid in the tissues of the lung. Treatment
of heart failure involves using diuretics (water pills) to rid the lungs of excess fluid
and medications to help the heart muscle pump more effectively. When the heart
failure has been adequately controlled, the wheezing will cease. Some people may
suffer from asthma and heart failure simultaneously. These patients require
treatment for both conditions.
Other bronchial conditions
Acute bronchitis. Acute
bronchitis is an infection, usually viral or bacterial, of the bronchi, the
larger airways or breathing tubes. The symptoms
of acute bronchitis include fever, cough, yellow or green sputum, and, sometimes,
wheezing. This combination of coughing and wheezing is sometimes referred to as
"asthmatic bronchitis" or post-viral bronchial hyperreactivity
of the airways. Acute bronchitis is generally treated with antibiotics and/or
antiinflammatory medications such as corticosteroids. The coughing and wheezing
usually subside within a few weeks. Some patients with asthma can produce green mucus that may not reflect an ongoing infection but the consequence of airway inflammation or allergic response.
Chronic bronchitis. Chronic
bronchitis usually is defined as a daily cough with production of sputum for
three months for two years in a row. The most common cause of chronic bronchitis
is cigarette smoking. With chronic bronchitis, there is longstanding inflammation
and swelling of the inner lining of the airways, and the inflammation and swelling
cause narrowing of the airways. The inflammation also stimulates production of
mucous within the airways that becomes the sputum produced by coughing.
Infections of the airways with viruses or bacteria are common among individuals with chronic bronchitis. Infections
further aggravate the inflammation and narrowing of the airways, worsening the
symptoms of shortness of breath, coughing, and wheezing. Treatments include
antibiotics, quitting cigarette smoking, bronchodilators to expand the airways,
and corticosteroids to reduce the inflammation.
Emphysema. Emphysema is a disease where there is permanent destruction
of the walls of the air sacs (alveoli) and the small
airways (bronchioles). The destruction of the alveolar walls reduces the elasticity of the lung. Loss of
elasticity leads to the collapse of the bronchioles, obstructing airflow out of
the alveoli. Air becomes permanently "trapped" in the alveoli. Air trapped in
the alveoli cannot be exchanged for room air, and this reduces the ability of
the lung to get rid of carbon dioxide and take in oxygen. Emphysema is most
often caused by years of cigarette smoking; however, a genetic disease, alpha-1
antitrypsin deficiency, also causes emphysema.
The combination of chronic bronchitis and emphysema is
called chronic obstructive
pulmonary disease (COPD). The major symptom of emphysema is shortness of
breath. Patients with emphysema also may wheeze if they also suffer from chronic
bronchitis and/or asthma. Treatment of these latter patients begins with smoking
cessation and the use of inhalers to deliver bronchodilators and corticosteroids
to the lungs. Antibiotics, oxygen, and surgery in the advanced
stages of these diseases also can be helpful.
Bronchiectasis.
Bronchiectasis is a chronic condition in which the bronchial tubes (larger
airways) are damaged by repeated bronchial infections. The major symptom of
bronchiectasis is a persistent cough with thick and usually green mucus. Bronchiectasis is treated with bronchodilators, antibiotics, and
corticosteroids when flare-ups occur.
Cystic fibrosis is an inherited condition in which the affected patients can
produce thick mucus that plugs the bronchial tubes. The plugging of the
bronchial tubes causes repeated bouts of bronchitis and pneumonia, leading to
the development of bronchiectasis.
Localized bronchial
obstruction. Wheezing and coughing can be symptoms
of a localized obstruction of the airways (the bronchial tubes or trachea). The
wheezing represents the sound of air rushing around the blockage, and the
coughing is the body's effort to clear the blockage. The most common causes of
localized airway obstruction are foreign bodies such as accidentally inhaled
peanuts, bronchial tumors, and the narrowing of the trachea that occurs after a
tracheostomy. The
wheezing and coughing due to a localized obstruction will not respond to
medications for asthma. The treatment is to relieve the obstruction.
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Corticosteroid drugs such as prednisone and prednisolone are commonly used to treat asthma, allergic reactions, RA, and IBD. Steroids such as these do have serious drawbacks such as steroid withdrawal symptoms such as: fatigue, weakness, decreased appetite, weight loss, nausea, vomiting, abdominal pain, and diarrhea. Speak with your healthcare provider prior to tapering off steroid medications.
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Biologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the day.
Exercise-induced asthma is asthma triggered by vigorous exercise. Symptoms include coughing, shortness of breath, chest tightness, wheezing, and fatigue while exercising. Preventing exercise-induced asthma attacks involves using inhaled medicines before exercising, performing warm-up exercises and cooling down afterward, avoiding exercising outdoors when pollen counts are high, restricting exercise when you have a viral infection, and wearing a mask over your nose and mouth when exercising in cold weather.
Secondhand smoke can cause illness and disease in nonsmokers. Some of these conditions include lung cancer, heart disease, respiratory illnesses such as asthma, SIDS, bronchitis, and pneumonia. Learn how you can protect yourself and your family from secondhand smoke exposure in the home environment and workplace.
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