Asthma is an eminently controllable illness. Indeed, for most sufferers, control is so effective that it amounts to a virtual cure. But asthma is not curable in the same way as, say, a bacterial pneumonia; it never entirely goes away. Also, no one cure would ever suffice. It is becoming increasingly clear that there many types of asthma–and they differ greatly in their presentation and genesis. For example, asthma that presents as a chronic cough, the “cough variant of asthma,” appears to be very different from the life-threatening variety, which results in extreme respiratory failure and sometimes death.
Nevertheless, the sine qua non of asthma–as we understand it today–is the increased sensitivity of the airways to many different agents. These agents include respiratory viruses (common cold virus), pollutants (ozone and cigarette smoke), airborne allergens (animal dander, pollens and molds) and exercise, especially in a cold and dry environment. These agents, called triggers, induce an inflammatory reaction in the airways that, in turn, results in the common symptoms of cough, wheezing, increased mucus production and shortness of breath. Successful control of asthma entails controlling the inflammation in the airways and reversing the symptoms before they get out of hand.
The greatest advances in controlling asthma may be the change in physicians’ attitudes toward using preventive medications, as well as attempts to make home rescue plans more aggressive and self-sufficient. The availability of selective and potent medications has made such changes possible. By avoiding known triggers in the environment, such as cigarette smoke, dust mites, roach antigens and dander from warm-blooded pets like cats and dogs, patients can help minimize airway inflammation. Also, newer, tighter and more energy-efficient homes, forced-air heating and wall-to-wall carpeting all contribute to higher levels of indoor triggers.