If you’re wheezing, it might be asthma — not allergies

Spring often is accompanied by the sound of sneezing. If wheezing joins that sneeze, it may not be just allergies — it may be asthma. The past three decades have witnessed a rise in asthma and allergies worldwide.

Asthma is a chronic lung disease that narrows the airways (bronchi) when exposed to stimuli such as pollens, dust mites, animal dander, smoke, cold air and exercise.

During an asthma attack, the smooth (involuntary) muscles of the airways constrict. The tissues lining the bronchial tubes swell from inflammation and secrete extra mucus, which further narrows the diameter making it harder to breathe. Severe asthma attacks can be life threatening.

According to the National Institutes of Health, asthma affects more than 25 million people in the United States, including about 7 million children. Asthma is the No. 1 admitting diagnosis to any children’s hospital in the United States. The Centers for Disease Control states that one out of 12 people have asthma.

No one catches asthma or is born with asthma — the cause is unknown. A combination of genetic and environmental factors makes a person more vulnerable to the condition. Childhood asthma is usually diagnosed by age 5. A family history of asthma, allergies or having a mother who smoked while pregnant increase a child’s chances of developing the disease. For adults, being overweight, smoking and having an allergic condition puts people at higher risk for asthma.

Do we outgrow childhood asthma?

The 2010 Annual Report Nevada Behavioral Risk Factor Surveillance System, reports that 14.5 percent of Nevada adults have asthma, which is higher than the national rate of 13.8 percent.

Does this statistic reflect a return of childhood asthma or is this adult-onset asthma?

Dr. Mary Beth Hogan, University of Nevada School of Medicine professor and board certified specialist in allergy and immunology, treats both children and adults on a daily basis.

“The disease is so variable,” Hogan said. “You can be quiescent (not active, or causing symptoms) for a long period of time and then you get the right trigger and it starts up again. My gut instinct, because I’m treating both pediatric and adult asthmatics, it’s probably a mix of both,” said Hogan. “That’s why this understanding of having an adult epidemic is so confusing.”

She theorizes that some adults might never have been diagnosed with asthma in childhood or it may be brand-new cases of adult-onset asthma.

“There are not enough studies out there to answer that question clearly,” Hogan said. The studies do not answer the question of whether a specific individual has outgrown asthma or whether they will have it again, she noted.

“We can say you have some prognosticative indicators that say you might have adult asthma, but we cannot predict for any individual what is really coming their way,” she added.

Recent studies suggest there are more than 50 genes capable of contributing to a person developing asthma. Environmental exposure to a multitude of triggers during a lifetime further complicates predicting if a person will become asthmatic.

“It’s hard to say when (as a child or an adult) you are going to have your environmental interaction with your gene set,” Hogan said.

Local native Erin Breen, 59, director of UNLV’s Safe Community Partnership program, never experienced allergies or asthma growing up in Las Vegas. She remembers it wasn’t until she turned 28 years old that allergies hit her “like a ton of bricks.” Breen was a professional singer at the time and the symptoms presented like one continuous common cold that severely affected her career.

She saw an allergist and submitted to scratch tests and sera, which did nothing to alleviate her symptoms. When she became pregnant at age 33, she stopped using all medications and her symptoms went away for the next four to five years. Eventually, though, the allergies came back, this time with a vengeance.

“I remember it vividly,” Breen said. She was pushing a cart full of back-to-school bike safety display items at the Boulevard Mall when all of a sudden she couldn’t breathe.

For more than 17 years, she sought help from several ear, nose and throat specialists when she was sick. Breen’s symptoms persisted with only temporary sporadic relief.

In December 2013, she landed in the emergency room.

“I literally couldn’t breathe. I thought this is it — I’m dying,” Breen recalled. Her lung capacity was down to 70 percent. “The E.R. doc said, ‘You have to take care of what’s causing this,’ so the next day I wound up looking for an allergy doctor.”

Breen now sees David Tottori, a board-certified allergy and immunology specialist physician. He changed and adjusted her medications and for the first time she was shown how to properly use an inhaler.

“Not one doctor or pharmacist had ever shown me the right way to use one,” she said.

“It’s like a different world to me now,” added Breen, who now faithfully follows her doctor’s instructions to the letter.

Current asthma research is focused on the approximately 5 percent, or 1.25 million, moderate-to-severe asthmatics who have persistent symptoms that cause them to miss work or school or end up in the emergency room and require hospitalization.

Because asthma presents itself in so many ways, receiving a diagnosis can be a struggle and treatment options vary. Environmental triggers and patient compliance contribute to the complexity of the disease.

“Asthma is one of the few fields that the care is individualized to the patient,” Hogan said.

That is what makes it so messy for the patient and the physician, she added.

“A lot of patients do very well with their asthma because the physician has managed to figure out how to treat you, the individual,” she said.