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Managing Illnesses

Which Asthma Do I Have?

A young woman learning how to use an asthma inhaler
A young woman learning how to use an asthma inhaler
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Dr. Kenneth R. Chapman

Director – Asthma & Airway Centre,
University Health Network

If you’re struggling with asthma, you’re not alone. Studies confirm that asthma is becoming more common, and for those who have it, the disease is becoming more severe.

Scientists aren’t sure what’s caused this trend, but a favoured theory is that the body’s immune system has fewer infections to battle, leaving it free to misbehave and attack the lungs.

Different asthma treatments

Whatever the explanation, the increasing size of the asthma problem has prompted medical scientists to re-examine strategies for managing the disease. Effective inhaled treatments are becoming easier to take. Difficult-to-use spray inhalers have given way to simple and intuitive dry powder devices. Four-times-daily treatment has given way to twice-daily and, most recently, once-daily preventive treatment. Simple one-drug inhalers are being replaced by inhalers that deliver two medications at once, and soon we’ll be able to deliver three at once.

But despite our best efforts, some patients with severe asthma continue to suffer frequent episodes of cough, wheezing, and breathlessness when treatment is limited to inhalers alone. Such asthma can be disabling, with frequent visits to the doctor’s office, walk-in clinic, or emergency department, where the approach is to treat the crisis with steroid tablets such as prednisone. Day-to-day chores, family activities, and full-time employment become impossible. Yet for the busy family doctor, the patient seen between attacks appears perfectly well, and the frequency of asthma crises goes unrecognized. Even if the severity of the problem is detected, doctors tend to use a “one size fits all” approach to treatment — an approach that is failing our patients.

Even if the severity of the problem is detected, doctors tend to use a “one size fits all” approach to treatment — an approach that is failing our patients.

Finding an asthma solution fit for you

It’s becoming clear that not everyone’s asthma is the same. Some begins early in life, some begins late, and some is related to allergies, while many patients with the toughest-to-treat asthma have no allergies at all.

Studies have shown that there are several different patterns of asthma, and for each there is often a predominant chemical messenger or cell type responsible. One way to tackle this issue is to use biological therapies — injectable treatments that block the action of one important chemical or cellular pathway of importance. By reaching out beyond the lung to halt inflammatory signals, this approach can be highly effective. Selected asthma sufferers who have been disabled by cough and breathlessness for years can see their asthma melt away and their need for daily medicine and steroid treatments decrease dramatically.

Three biologic therapies are available in Canada now and more are expected over the next few years. If inhaled treatments have not controlled your asthma, and you have needed steroid tablets urgently two or more times in the past year, your asthma may benefit from biologic therapy. Whether the therapy is offered by one of the few highly specialized asthma centres, or you help evaluate such treatment in a clinical trial, biologic treatment for severe asthma is worth considering. As recommended recently by the venerable medical journal The Lancet, you can begin by asking your doctor, “Which asthma do I have?”

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