Your Doctor Discussion Guide: Allergic Asthma
If you experience wheezing, shortness of breath, or coughing attacks that don't seem to quit, you may be one of the millions of Americans who have allergic asthma.
Although there is essentially no difference in symptoms between allergic asthma and other types of asthma, they do have different triggers. For example, asthmaa condition in which the lungs are hypersensitive and swell and tighten in response to triggerscan be caused by things like cold temperature, exercise, or weather.
Allergic asthma, on the other hand, is triggered by an underlying allergywhether it's pollen, pets, mold, dust, or something else. About 60% of asthma cases are allergic asthma.
Allergic asthma is both treatable and controllable so one of the best things you can do is sit down and have a heart-to-heart with your doctor. Download these 10 questions you should ask your doctor about allergic asthma before you go, and read why you should ask them below.
How do I know I have allergic asthma and not another type of asthma?
Your doctor will probably start by asking you if there are any kinds of patterns to your asthma attacks. Do they happen after you've come into contact with cats, dogs, or birds? Do you get them only at a certain time of the year? Or when you're outside?
"This gives us clues that (a person) could have an allergic cause for their asthma," says Karim Dhanani, MD, an allergist with Scott & White Healthcare in Round Rock, Texas.
The common triggers for allergic asthma are cat dander, pollen (especially white-oak pollen), and mold.
Is there a test for allergic asthma?
Keeping an allergy diary may help clarify your trouble spots, but the only way to know for sure if you have this type of asthma is to get an allergy test. There are several different types of tests you can get.
A skin-prick test, which involves putting a small amount of a potential allergen under your skin to see if there's a reaction, is the easiest, simplest and fastest. If the result is positive, you'll see some swelling around the prick site within 20 minutes. That means you can leave the doctor's office with answers.
A blood test can also yield good results, but takes a little more time.
How do I figure out my triggers?
If you do have allergic asthma and your body detects an allergen, it produces an antibody specific to that allergen called Immunoglobulin I (IgE). This causes inflammation in the airway and makes it harder to breathe.
"Basically what happens is when a ragweed protein comes in contact with a ragweed antibody. (which is) already in your bloodstream... an allergic reaction (is) set off," explains Dr. Dhanani.
Avoiding your triggers is always a good idea and this may not be as hard as you think. For example, dust mites are microscopic organisms that thrive in your mattresses, pillows, carpets, drapes, cloth couches. "They love humidity and they love warmth, which our bodies provide," says Dr. Dhanani.
Putting special protective covers on mattresses and pillows erects a barrier between you and the mites. "That can dramatically decrease symptoms of asthma," says Dr. Dhanani.
Washing all bedding (including blankets) in hot-water temperatures of 130-140 degrees Fahrenheit each week will actually kill dust mites.
Are there changes I can make in my home to reduce the chances of an asthma attack?
Other tips include using synthetic bedding rather than down or wool; replacing carpets with bare floors; cleaning surfaces with a wet mop or rag rather than a dry one; using a dehumidifier; and using a vacuum cleaner with a HEPA filter.
If you can't bear to part with a beloved pet even if it triggers your asthma, the first thing you should do is avoid sleeping with your pet.
"If you don't want to get rid of it, I at least advise (patients) to keep the (pet) outside the bedroom and close the door," says Dr. Dhanani. A lot of times people sleep in the same bed as their pets. "They're literally breathing in cat allergen all night long so no wonder they are symptomatic," Dr. Dhanani says.
If pets aren't a trigger, mold might be. Molds like the damp, so a dehumidifier will help control this, as will eliminating any leaks in pipes or faucets.
For cockroaches (another major trigger), keep your house clean of crumbs, don't eat in the bedroom, and be diligent about washing the kitchen. You might also try traps and check the house for any places that might be providing access.
It's usually impossible to completely eradicate every trace of a trigger, but medications are very effective in keeping symptoms under control.
Next Page: Will I have to use an inhaler? [ pagebreak ]
Will I have to use an inhaler?
For mild cases of allergic asthma, a bronchodilator such as albuterol may be enough of a treatment, says Dr. Dhanani.
These come in the form of a small inhaler you can carry in a purse or pocket. They work by opening the muscles of your airway and you use them as needed to manage symptoms.
But if you use bronchodilators too oftenyour doctor will be able to tell you what the guidelines arethen you need to bump up your treatment plan.
"If you start overusing albuterol, it's a sign things are not controlled," says Dr. Dhanani.
What are the other treatments?
If this happens, your doctor might put you on an inhaled corticosteroid. These also come in the form of portable inhalers and work by decreasing inflammation. Generally your doctor will tell you how often to use them, usually not more than once or twice a day.
What if the standard treatments don't work?
If your asthma still isn't controlled, the next step would be a combination of an inhaled steroid and a long-acting bronchodilator. Unlike products such as albuterol, long-acting bronchodilators are formulated to keep the lungs dilated for a longer period of time, perhaps 12 hours or more.
"You can get quite significant relief from that," said Dr. Dhanani.
With any drug, it's best to find the lowest effective dose.
"The goal is getting down to the lowest dose possible for control and do no more and no less than that," Dr. Dhanani said. "You don't want to keep having asthma exacerbations because over time it leads to deterioration in lung function but at the same time you don't want to overtreat people and give them doses which are unnecessarily high."
How often will I need to see the doctor?
Regardless of your treatment, your doctor will initially want to see you fairly often, perhaps at three-month intervals. If your condition is stabilized, you can go longer between visits.
What are allergy shots and will they work for me?
Allergy shots are also an option for people with allergic asthma. The purpose of the shots is to desensitize you to an allergen by giving you trace amounts of it.
"You're injecting (the allergen) in higher and higher doses hoping to change the immune system to accept it as normal," explains Dr. Dhanani.
The downside is convenience (you have to keeping going to your doctor's office to get the shots) and there can occasionally be severe anaphylactic reactions to the allergen.
Will my asthma ever go away?
The upside is that sometimes allergy shots can be discontinued without asthma symptoms returning. "You can gain long-term control and a lot of times (the patient) can come off medication entirely or go to a low dosage," says Dr. Dhanani.
An alternative to allergy shots is a treatment called sublingual therapy. This works on the same principle as a shot but instead of injecting the allergen, drops are placed under your tongue.
One analysis conducted by researchers at Johns Hopkins in Baltimore found that this type of therapy did improve symptoms in a large proportion of patients. It's also much more convenient than shots.
Unfortunately, the therapy is not yet approved in the U.S., although some doctors do offer it to patients "off label." And Dr. Dhanani thinks it will eventually be approved here."There's quite a bit of data that it is pretty effective," he says. "It's just a matter of time."