Asthma Update -- Paul Enright, MD. -- 11/25/02

By Paul Enright
WebMD Live Events Transcript

Asthma is on the rise in the U.S. What are the reasons behind the increase in childhood asthma rates? What are known triggers? What's the latest research? We asked these and other questions about prevention and treatment when WebMD's own asthma expert, Paul Enright, MD, joined us on WebMD Live.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Today's guest is WebMD 's asthma expert, Paul Enright, MD. Let's get to some member questions:

Member: My nephew is only 7 months old and he has asthma. He gets attacks at least every week. What is the best treatment for it? There is asthma in his mother's family.

Enright: The best treatment for infants is very similar to that for adults. Inhaled bronchodilators such as albuterol given by nebulizer and inhaled corticosteroids are popular these days. The good news is that over one half of children with asthma-like symptoms below age 2 do not have asthma by the time they start school (elementary school -- age 6).

Moderator: Can you address any genetic link as inferred by the member's question?

Enright: The risk of asthma in children is much higher when one or both parents have asthma or allergies. There is one medical test that can be done to assess the asthma risk in children under age 2, that is the blood IgE level.

Member: Are exercise-induced bronchial spasms the same thing as asthma? If so, will my child have this condition for the rest of her life? Is this also due to being overweight?

Enright: Exercise-induced bronchospasm happens to most people with asthma. It is usually easily prevented with appropriate medication.

About one-third of children with EIB or asthma grow out of it by their teen years. Obesity is associated with asthma, and weight loss and exercise in a person with asthma who is overweight can improve asthma control.

Member: My son's asthma only flares when he exercises in cold weather. Why is that?

Enright: Exercise in cold weather is a strong stimulus for EIB because of the drying of airways. Again, most EIB can be prevented by using albuterol or other asthma medications a half-hour prior to exercise. Walking or mild exercise in cold weather is less likely to cause EIB if a sweater or scarf is placed around the mouth and the nose. It recaptures some of the moisture and heat exhaled.

Member: Dr. Enright, thank you for answering my questions on the asthma message board. I take Advair twice daily and albuterol five days per week for exercise. I am concerned about long-term effects of these medications. Should I be concerned? I am referring to the effects of the bronchodilators, the pounding heart, elevated blood pressure, etc.

Enright: I appreciate your many insightful comments on the message board each week. There are no known long-term side effects of inhaled bronchodilators -- only short-term effects with which you are familiar, such as pounding heart, headache, and nervousness. If these side effects are bothersome, you may try alternate medications to prevent EIB such as Singulair, or even Cromolyn.

Member: My 17-year-old daughter is taking the medication Singulair to control her asthma. She began treatment with this drug three years ago and it has been a godsend. My question is, is it safe for her to continue this daily medication indefinitely? Are there any known side effects from long-term usage of this drug?

Enright: There have been no long-term adverse side effects reported from daily use of Singulair. It is an excellent asthma controller medication for about one-third of those who try it. Unfortunately, one-third of patients with asthma have no benefit from Singulair. And good or bad or lack of response cannot be predicted without trying the medication.

Moderator: What are the primary categories of asthma medications?

Enright: The two primary categories of asthma medications are controllers, which reduce airway inflammation, and relievers, which are bronchodilators that quickly open up the airways. It is important that if an asthma reliever or rescue medication is needed more than two times per week that a daily asthma control medication is indicated. The asthma controller medications can be subdivided into inhaled corticosteroids such as Flovent and Leukotriene; antagonists, such as Singulair; and a few people still take Theophylline pills or Cromolyn inhalers as asthma-controller drugs.

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