Massachusetts Medical Society's Physician Focus

July 2010



  • Asthma is a chronic disease of the lungs that affects breathing; it can impair quality of life and lead to disability or even death.

  • The New England states have the highest rates of asthma in the nation, with one in ten adults and children suffering from the condition.

  • Nearly 24 million people in the U.S. and more than 2 million in New England have asthma.

  • Asthma is one of the most common long-term conditions of children. In Massachusetts, nearly 11 percent of children in grades K-8 have asthma.

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The chronic respiratory condition of asthma affects some 24 million people in the U.S., and its incidence is especially high in New England. A study by the Asthma Regional Council of New England has found that the New England states have the highest rates of asthma in the country: this disease affects almost one in ten residents in the six-state region.

In Massachusetts, 10 percent of children have the condition, and its incidence is growing among adults: from 2000 through 2007, the number of adults with asthma jumped 16 percent, according to the Massachusetts Department of Public Health.

Asthma can take a variety of presentations,” says Daniel Steinberg, M.D., director of the Allergy & Asthma Center of Massachusetts. “They can be quite subtle, such as coughing, wheezing, or shortness of breath. Or the disease can be more flagrant in terms of debilitating symptoms, to the point of making a person not be functional, resulting in lost work or lost school days.”

Dr. Steinberg, a specialist in asthma and allergies and a past president of the Massachusetts Asthma and Allergy Society, explained the basics of this chronic lung condition, how it’s diagnosed, and how it’s treated in the July edition of the Massachusetts Medical Society’s Physician Focus with host Bruce Karlin, M.D., a primary care physician.

The medical conditions that create asthma can be quite varied, Dr. Steinberg says, but the underlying condition is an inflammation or irritation of the respiratory passages. This inflammation or irritation shrinks the breathing passages, making it more difficult to breath. The condition can range from mild to moderate to severe.

One cause of the disease can be genetic – the genes inherited from your parents may give some people a predisposition to asthma (as well as other conditions). Another source is your environment, or, as Dr. Steinberg says, “what you encounter as you move through life.”

A variety of “triggers” – natural or manmade - can set off asthmatic conditions. Housing, carpeting, exposures to animal danders, cigarette smoke, pollen, air pollution, or mold could be the culprits. In some cases, occupational triggers, such as chemicals or dust, could be to blame. “Every day,” Dr. Steinberg says, “we are at war with microbial and immunologic challenges that present in everyday life.” Asthma, he says, can be a “continuation of an irritation that goes on every day of your life.”

Who is susceptible to asthma? Dr. Steinberg says different people may react in different ways to similar triggers; some people have lower thresholds than others. Differentiating between patients is “the art of managing different patients with different levels of the disease.”

The first step, he says “is to get a patient to the front door, to understand that he or she is having potentially an asthmatic symptom. And that can be a difficult thing to understand.”

It’s important to know what the causes may be. “Each patient has a different, unique environmental history, a different genetic makeup,” he says. “When patients start to understand their triggers, that’s the first step to diagnostic and therapeutic intervention.”

For both the physician and patient, “The ‘Eureka moment’ is in discovering the trigger,” he said. “Once you know what caused it, you can develop some concrete strategies in terms of avoidance, medications, or even desensitization. You can develop a customized asthma action plan.”

Dr. Steinberg’s has some good advice for all patients with asthma, especially those patients who may be experiencing symptoms, but may not know they have the condition. The most important thing is for patients to understand that the signs and symptoms of the disease may be somewhat subtle and not always clear. The patient should then sit down with a trained professional to undergo tests and translate those findings into a concrete action plan. He puts it concisely: “Get tested, get treated, get better.”

MMS/Richard Gulla

American Academy of Allergy, Asthma and Immunology

Mass. Department of Public Health

Asthma Regional Council of New England

Asthma and Allergy Foundation of America

Allergy and Asthma Network/Mothers of Asthmatics

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"Asthma" PSA

From left: Bruce Karlin, M.D., Daniel Steinberg, M.D.
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