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.
Make sure that your asthma is under good control
before you begin exercising. Refrain from exercise and consult your doctor if
your asthma is poorly controlled.
Warm up for at least 10 minutes prior to exercise.
This takes advantage of a "window of safety" which may last up to an hour,
often preventing exercise-induced asthma.
Avoid exercising in cold, dry air and on smoggy days.
Covering the mouth and nose with a scarf in cold weather can be helpful.
If asthma symptoms occur during exercise, stop
immediately and rest. Do not attempt to "run through" the symptoms. If your
breathing difficulty continues, use an inhaled bronchodilator.
Following completion of exercise, do "cool down"
exercises for 10 minutes to allow the bronchial tubes to re-warm slowly.
Preventative use of inhalers that contain cromolyn
sodium (Intal) or
bronchodilators, such as albuterol (Ventolin, Proventil), 15 to 20 minutes
before exercise is usually effective. Long-acting bronchodilators, such as
salmeterol (Serevent), should be taken 60 minutes before exercise. Recently,
the leukotriene modifiers, montelukast (Singulair) and zafirlukast
(Accolate), taken daily in pill form have been found to help prevent
exercise-induced asthma in some athletes.
Conditions that may worsen asthma
Gastroesophageal reflux disease (GERD)
GERD is a common condition caused by the regurgitation (reflux) or backwash
of stomach acid into the esophagus from the stomach. At times, the acid even may
regurgitate into the back of the throat and reach the lungs. GERD usually -- but
not always -- is associated with a burning discomfort under the breastbone, called
heartburn, which occurs mostly after meals or when lying down. In some patients,
the symptom of acid reflux is not heartburn. Instead, they experience coughing,
wheezing, hoarseness, or sore throat.
The presence of acid in the esophagus or the passage of acid into the lungs
(aspiration) may cause the bronchial tubes to constrict (bronchospasm), causing
wheezing and coughing that may not respond to medications for asthma.
Bronchospasm related to acid reflux tends to occur more frequently at night as a
result of lying down. Interestingly, GERD is common among patients with asthma.
Some doctors believe that asthma itself or asthma treatments in some way make
asthma patients more susceptible to acid reflux. For example, theophylline, an oral
medication occasionally used to treat asthma, may promote acid reflux by
relaxing the specialized muscles in the esophagus that normally tighten to
prevent regurgitation of acid.
In patients with nocturnal or difficult-to-control
asthma, treating acid reflux may help relieve coughing and wheezing. Treatment
of GERD involves elevating the head of the bed, losing weight, avoiding spicy
food, caffeine, alcohol, and cigarettes. Proton-pump inhibitors such as omeprazole (Prilosec), pantoprazole (Protonix),
rabeprazole (Aciphex), lansoprazole (Prevacid), and esomeprazole (Nexium) are potent inhibitors of production of acid in the
stomach and are effective treatments for asthma aggravated or caused by acid
reflux. Rarely, surgery is performed to prevent acid reflux for severe cases of
GERD that do not respond to medications.
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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