Asthma: Causes, Treatments & Cures
- Sunday, September 6, 2009, 22:57
- Asthma
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- Andrew:
- The world of asthma is changing, in terms of how we treat asthma, what our expectations should be related to symptoms, and even the potential of finding a cure.“What is exciting now is that physicians and researchers are thinking in a slightly different way. We’re not satisfied with only being able to control symptoms with medicines that we give today and if we stop make people become sick again because they need to be given all the time. We would like to have treatments in the future that can prevent the development of disease or that can cure the disease, and that is what is exciting about this moment in the development of research in asthma.” –Dr. Fernando Martinez
Joining us is Dr. Fernando Martinez, a world expert in asthma treatment and research of lung disease. He is director of the Respiratory Sciences Center at the University of Arizona.
- Andrew:
- Dr. Martinez, from your research do you now feel there is more than one type of asthma?
- Dr. Martinez:
- There are many different forms of asthma. That’s the first important thing to say, that the children who, and adults, who have difficulty breathing periodically that and then get a little bit better or get much better may have different causes for that. So, in terms of how we define asthma, we have become very broad in our definition.We consider that subjects have asthma when they have periodic difficulty to breathe and that they get better after certain treatments that are given to them. That is enough for us. Of course, this kind of disease has different courses in different individuals, and what we’re learning now is the different ways in which the disease develops in these different individuals.
- Andrew:
- Dr. Martinez, the cause of asthma, we used to look at it more simply, but now what’s your latest thinking about what causes that? Is it genetics? Is it environment? Is it a combination of both, and does it vary by individual?
- Dr. Martinez:
- The causes of asthma vary by individual. Certain individuals have asthma because they have a peculiar way in which they react to infection, mainly to viral infection. These individuals have usually a lot of problems very early in life, but then their problems tend to decrease and go away with puberty, to come back again later in life, especially if they smoke or if they have other risk factors for continued wheezing.Other individuals have asthma because they are allergic, because they have an alteration in the way in which their immune system, the defenses of the body, react to substances that usually should not produce any problems, called allergens. These individuals have a different form of disease, much more chronic, much more persistent, and that is associated with alterations in the way the lung grows. That’s why it’s so important to distinguish between the two types because the two types have different natural histories, as we say. They develop in different ways and have different ways in which they express at different ages.
- Andrew:
- Now, we also understand now that early treatment for an individual is so important to prevent airway remodeling and other factors that could be lifelong. So, what are you recommending now to parents, let’s say, where there’s some indication of a respiratory problem that could be one type or another of asthma?
- Dr. Martinez:
- Most cases of asthma – both those that are related to allergies and those that are related to an alteration in the response to viral infections – usually start in the first years of life, but there’s a difference between the two forms. Those that are more related to allergies are more associated with alterations in the way the lungs grow. And thus, we are trying very hard now to identify those children that are at a higher risk of having this latter form, more than those that have a form associated with viral infection that will go away with time.Both need to be treated in relation to the symptoms that occur at the time the doctor sees the child. But in the case of the one that is associated with more chronic symptoms, the atopy-related asthma, what we’re also trying to do is determining if by treating very early these forms we can prevent the alterations in the way that the lung grows that are associated with the disease.
- Andrew:
- Lifelong problems.
- Dr. Martinez:
- The lifelong problems. It’s a very important study [that was] very recently published in The New England Journal of Medicine, saying that if you treat them aggressively, after the age of six it may be too late because even in children who were aggressively treated with anti-inflammatory agents, they improved in their symptoms, but their lung function still remained low. They couldn’t recover from the losses of lung function that probably had already occurred by the age of six years. So, it’s important to have the doctor identify what kind of asthma your child may have and to treat aggressively those children who have a family history of asthma, eczema, that may increase the likelihood of them having this chronic form of disease.
- Andrew:
- From listening to your talk, the treatments that you’re looking into in the immunologic response varies by type of asthma but also by when a certain experimental medication or even existing medication might be given. It becomes increasingly complex. How is a parent who wants to get their child identified – do they have asthma, what type of asthma? – and get the proper treatment, where should they go for this sort of workup? It sounds like they need to go to a top researcher like you to have the benefit of long-term health for their child rather than a physician’s assistant – primary care – who may not be as knowledgeable.
- Dr. Martinez:
- Yes and no. It all depends on the severity of the disease. Parents have to use their common sense, and they usually do – believe me. If the child has very mild symptoms that can be treated just with bronchodilators, with albuterol or other bronchodilators, and the child seems to be very well during the whole summer period and has some wheezing during viral infections during the winter period, those children may be perfectly well treated by the general pediatrician or by the nurse practitioner or by the usual caregiver.My opinion, however, is the subjects who have a family history of asthma – for example, a parent with asthma – or have severe allergic symptoms such as severe atopic dermatitis, eczema, subjects who start having symptoms very early in life require nowadays the help of a person who is very much up to date in the ways in which we can prevent the development of the disease, both by decreasing certain exposures and by treating aggressively at the right time. The problem is that not every child who has asthma requires aggressive treatment.
So, it is important to distinguish between these different forms. The parents who have any doubts about the way in which things are going should consult with their caregivers and perhaps ask for a referral to a center where these more modern approaches are being developed. However, 50 [to] 60 percent of children who have asthma have rather mild symptoms, and they can be perfectly well treated by the general pediatrician or caregiver.
- Andrew:
- Dr. Martinez, there are more and more treatments for asthma, and there are experimental ones and final clinical trials to work on the immunological response that can be produced by allergens and asthma, etc. What guidance would you give to parents, and also adults, related to the complexity of the treatments and how they can begin? How excited are you about the available treatments and what’s in final research as far as helping people get control?
- Dr. Martinez:
- There are two aspects of the answer to this question. I think nowadays we have very good, very effective treatments to control symptoms in subjects who already have asthma. We have no treatments of any type that we know today that can cure asthma or prevent the development of the disease. So, from the point of view of the symptoms in subjects who already have them, we have good ways to control them. And it is important for people to understand that 99 percent of subjects with asthma today can lead a normal life.However, what is exciting now is that physicians and researchers are thinking in a slightly different way. We’re not satisfied with only being able to control symptoms with medicines that we give today and if we stop make people become sick again because they need to be given all the time. We would like to have treatments in the future that can prevent the development of disease, or that can cure the disease, and that is what is exciting about this moment in the development of research in asthma.
We don’t have those treatments any more, and all the ones we have are experimental. So, people who listen to the radio, or to the TV, or [read] in the newspapers about these new treatments have to understand that we’re at a very exciting time for researchers, but we don’t have yet any form of treatment that can cure or prevent the disease.
- Andrew:
- For someone with serious disease, does that argue then to enroll in a clinical trial, and are there clinical trials for children that would allow the use of these experimental medications?
- Dr. Martinez:
- There are many clinical trials going on for children nowadays. I’m involved in several of them. Certainly, they offer an enormous hope, but they cannot be applied to all children with asthma and should not be applied to children with asthma before we have done the adequately controlled studies.My great concern is that people hear about these trials and believe that the medicines we’re using in these trials have already been proven to be effective in the sense we are testing them for, and that is not the case. So, on the one hand, I’m excited about the new treatments that are available. On the other hand, I’m concerned that if people believe that they’re already proven to be effective, they may start using them at a time in which such a proof does not exist.
- Andrew:
- So, for our listeners, how would you wrap it up? You’re on the leading edge of science, and it’s become increasingly complex, both the doors you’re beginning to unlock – you don’t have all the answers. What hope would you give for people who are living with this disease or their children are that they can have a good quality of life?
- Dr. Martinez:
- I would like to tell them the following. First, as I said a minute ago, we have effective treatments. If there are symptoms, there’s no reason to have them. Go to your doctor or demand to get better care if you’re still having symptoms in spite of the treatments that you’re being given, because I can assure you 99 percent of persons with asthma can lead perfectly normal lives.On the other hand, I’m very excited that in the next 10 to 20 years we will crack this nut. We will understand what the causes of asthma are for the different forms of asthma, and we will be able to develop new treatments that will allow people who have the disease to say, “I can be cured” and will allow people at very high risk not to develop the disease. I think that the new leads that we’re getting into will offer us that hope.
- Andrew:
- So, when we hear of increasing incidence of asthma and also increasing death from asthma, that’s a real tragedy because there were medical answers to help those people.
- Dr. Martinez:
- That’s the most important thing that I would like to stress. There are answers for the treatment of asthma today that are effective and that are safe, and people should know that in the first place. The fact that we don’t have cures and we don’t have ways to prevent it does not have to justify that people who have the disease do not have a normal life.
- Andrew:
- Dr. Martinez, thank you very much for being with us on HealthTalk Interactive, you’ve provided us with an excellent understanding of the different kinds of asthma and how to take care of them, what patients should expect and how they can be advocates for their own care. Thank you.
- Dr. Martinez:
- Thank you very much.
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