by Vejay Steede
Bermudians are no strangers to asthma. The condition, classified as a lung disease, has been present within these shores for centuries, and patients who live with it typically suffer from childhood right through to old age.
The presence of allergies in an asthma patient will often exacerbate the disease, making living with asthma even more miserable. Unfortunately, allergies and asthma often occur together.
According to the Mayo Clinic, “the same substances that trigger your hay fever symptoms, such as pollen, dust mites and pet dander, may also cause asthma signs and symptoms. In some people, skin or food allergies can cause asthma symptoms. This is called allergic asthma or allergy-induced asthma.”
Dr. James T. C. Li, M.D., Ph.D., a Mayo Clinic allergy specialist, breaks down the process by which an allergic reaction may cause asthma symptoms in patients:
“An allergic response occurs when immune system proteins (antibodies) mistakenly identify a harmless substance such as tree pollen, as an invader. In an attempt to protect your body from the substance, antibodies bind to the allergen.
“The chemicals released by your immune system lead to allergy signs and symptoms, such as nasal congestion, runny nose, itchy eyes or skin reactions. For some people, this same reaction also affects the lungs and airways, leading to asthma symptoms.”
Asthma and allergies look very similar and both can make the essential act of breathing far more onerous than you’d like it to be.
Local pediatrician extraordinaire, Dr. Sylvanus Nawab, MD, FAAP, asserts that “there are different subtypes of asthma, with most of the early onset types associated with allergic rhinitis and atopy in general.
“Allergies to cats, dust mites, and grass pollen, which is frequent in Bermuda, can also be associated with the onset of Asthma.”
“Others are also triggered by viruses, so keeping viral exposure low helps. Viral induced asthma, though transient, can make susceptible allergy induced asthmatics worse. There are treatments for allergies and asthma but they all have to be tailored to every patient’s needs.”
Reducing exposure to offending particles and viruses will help prevent and, or relieve asthma flare ups, but that often means limiting one’s quality of life quite a bit.
Nurse Jutta Harvey of the Allergy Clinic of Bermuda, speaking more broadly about asthma, added: “Asthma can be triggered by multiple factors. Exercise, infections like a cold, weather, or irritants such as vapours, sprays, powders, fragrances, and smoke.
Another trigger for asthma is allergies. One connection between asthma and allergies is that they are both inflammatory processes.
“In asthma, the inflammation is in the lining of the lower breathing tubes and the lungs. In allergies of the nose (rhinitis) the inflammation is in the nose and upper airways. The lining of the nose and lungs, called the mucous membrane, gets swollen, red, and twisted with production of extra mucous. The upper and lower airways are obviously connected, from the nose to the throat, down through the breathing tubes, trachea and bronchi, and the lungs. So, the pathway from the nose to the lungs is one long tube, lined with the same membrane; whatever affects the nose can also affect the lungs.”
Honing in on specific causes of allergy and asthma flare ups, nurse Harvey continued: “The most common allergic trigger for asthma is the components of dust, which are dust mites, cockroaches, pet dander, and mould. Another trigger may be pollen from grasses, trees or weeds. On occasion certain food allergies may trigger asthma.”
Unfortunately, Bermuda is teeming with all of the components of dust mentioned by Nurse Harvey above, so avoiding these often microscopic particles completely may be impossible at times, especially when you don’t even know they’re near.
Knowledge is key for controlling asthma and allergies. Nurse Harvey cites Open Airways and the Allergy Clinic of Bermuda, as well as some doctor’s offices as places where education on controlling asthma and allergies can be found, saying these places, “have qualified asthma educators that have the time and expertise to guide people in asthma care.”
The process of controlling asthma and allergies may not be so easy, however, and it will require considerable care and attention. Nurse Harvey outlines the process: “It is important to identify what triggers asthma by means of clinical observation, discussion, and, or allergy testing.
“Then, avoidance of offending allergic triggers, whether they be environmental or dietary. Some triggers are relatively obvious and easy to avoid. Others, such as mould are not so obvious and need a bigger effort to control. Assessing and repairing leaks, assuring adequate air exchange, and climate control, such as well-maintained air conditioners and dehumidifiers can help.
“Also, minimise airborne irritants. It is well understood that smoke exposure has a negative effect on health; but also, air fresheners, perfumes, and colognes – thought to be pleasant by some people – are dreadful triggers for people with asthma and allergies. Just as smoking is banned from certain spaces, the same consideration should be given to providing fragrance free areas.”
Treatments that do not involve simple avoidance of triggering particles are available for asthma and allergy sufferers. Nurse Harvey provides further advice on medications available for patients in Bermuda:
“Beyond environmental control, many people need medications to control their asthma. Historically, asthmatics have felt reliant on their blue pump as their rescue inhaler to open the lungs. However, the latest asthma guidelines indicate that equal, if not more, emphasis should be placed on the ongoing inflammatory part of asthma.
“The blue pump provides no relief from inflammation. One needs to have a combination inhaler that has anti-inflammatory properties, as well as opening up the lungs. The current recommendation is an inhaler called Symbicort, which requires a prescription. People who only have a blue pump should call their doctors office to review their medications.”
So, yes, asthma does go hand-in-hand with certain allergies; but both can be treated, and controlled, with vigilance and care. Breathing is not an option, so please, do all you can to learn how to best keep doing it.