Aggressive Asthma Treatment Needed – to Prevent Airway Remodeling
- Sunday, September 20, 2009, 13:45
- Asthma
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- Andrew:
- There are many people who avoid taking medications when they don’t have active symptoms and feel that they are better off. I understand you experts now say that my not be necessarily true.
- Dr. Lanier:
- We used to think when people had asthma but weren’t wheezing, that they were okay, that asthma was just a problem of muscle spasm. We’ve learned differently through the years. What we’ve learned is that the body responds to swelling in the lungs, so-called inflammation – not infection, now, inflammation – by a process of scarring. So, basically what happens to people over a goodly period of time if they have asthma that’s poorly treated is they get the same sort of scarring that people do when they do bad things, like smoke. It’s not exactly the same place, but there is problems associated with people who have long-term asthma that’s not treated. We think that children especially need aggressive treatment in the first two or three years they have asthma in order not to let this process begin.
Now, the scarring has lots of names. I think the most genteel name for it is “remodeling,” but a lot of the women physicians have pointed out to us that remodeling to women is a good thing. You know? That the end product of remodeling is something better than they had before, and that’s certainly not the case with asthma. The remodeling process in asthma really is scarring, and that’s not a good thing.
And the way you prevent that is to control the asthma better, use medicines that don’t have inflammatory elements built into them like the older albuterol compounds, and you use inhaled corticosteroids, drugs that really reduce that swelling, and sometimes leukotriene modifiers. That makes a difference in some segment of children, and to the point that you can keep this swelling and inflammation down, and when you do that, kids can go into adult life with basically normal lungs.
All doctors have seen patients in their 40’s who have very poor lung function, and we always sort of thought maybe they were smoking and didn’t tell us. But now we’ve realized in retrospect that asthma can scar lungs, and people do lose lung function. And they lose it at an accelerated rate when the asthma is not under control. So, it’s really important to get proper treatment for asthma.
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