Asthma In Adults

On April 6, 2018 CNN published an article about asthma in adults. It was called “Developing Severe Asthma in Adulthood”.

Asthma in adults occurs with a frequency of about 2.3 per 1000 people per year. This publication also noted that women suffer from this condition more often than men. For both sexes the occurrence of asthma in adults peaks at 35 years of age.

Symptoms of asthma

The triggering factors for asthma can be infections, allergies, or the condition can come on spontaneously. Coughing is one of the main symptoms. You may be breathless when walking stairs. You may feel weak or tired when exercising. After exercise you may be wheezing or coughing. If you measure your breathing capacity with a peak flow meter, the values are lower than normal. Cold air or irritants like cigarette smoke may trigger coughing or wheezing. In industrial workers the trigger for asthma can be noxious fumes.

Diagnosis of asthma


Your doctor likely will order a test, called spirometry. You are breathing into a tube with a connection to a spirometer. A technician will instruct you to breathe out to the max (maximal exhalation). Next you will have to breathe in as quickly as you can. These breathing activities translate into a breathing curve on the read-out of the spirometer. With asthma there is a certain degree of restriction of airflow due to spasms in the smaller bronchial tubes, called bronchioles. This will be obvious from the breathing pattern of the spirometry read-out.

Methacholine challenge test

When the spirometry test is normal or near normal, a Methacholine challenge test can be another diagnostic tool. If this produces an asthma attack, it is clear that the person does indeed have asthma.

Measuring nitric oxide in your breath

Our bodies normally produce nitric oxide, and a small amount of it appears in your breath. But if there is a large amount of it present in your breath, it indicates chronic inflammation in your airways, which can be one of the causes of asthma.

Other tests to rule out other related diseases

Your doctor may want to order sinus x-rays to rule out sinusitis or a chest X-ray to rule out pneumonia. If he suspects allergies a referral to an allergist sill be next. The specialist will do skin prick tests to see what you are reacting to.

Differential diagnosis of asthma and other diseases

When the physician is thinking about an asthma diagnosis, it will be necessary to exclude other diseases first. It is important to exclude a bronchial or lung infection as well as the presence of emphysema or chronic obstructive pulmonary disease (COPD). Clots in the pulmonary vasculature (pulmonary emboli) have to be ruled out. When there is a history of gastroesophageal reflux, tests should exclude that there is aspirated gastric contents into the lung. Another condition that could bring on wheezing is chronic congestive heart failure, where the heart fails to pump enough blood, and shortness of breath is a consequence. Tests are available to exclude all of these conditions.

Treatment of asthma in adults

Anti-inflammatory medication

As all patients with asthma have inflammation in the airways, it is important to use corticosteroid inhalers that will control this. These inhalers will control the swelling and mucous production in the lining of the bronchial tubes. With the daily use of these inhalers the airflow improves, the airways become less sensitive and the patient experiences fewer asthma episodes.


Bronchodilators are inhalers that will relax the muscle bands around the bronchial tubes. This allows the patient to breather easier. The mucous flows more freely and can be coughed up easier. There are short-acting and long-acting forms of bronchodilators. Your physician will instruct you which one to use.

Asthma In Adults

Asthma In Adults


Adult onset asthma is separate from asthma of childhood. Often the triggers are allergies or irritants, including industrial irritants. With a proper diagnosis and treatment adult asthmatics have a normal life expectancy. It is important to control the inflammation of the airways with anti-inflammatory corticosteroid inhalers. For acute asthma attacks a bronchodilator must be used right away to ensure normal airflow is restored. The patient learns how to modify the asthma therapy. As a result there are very few occasions where the patient would need treatment in a hospital. Most patients can treat an asthma attack quickly and they respond very well to the treatment. As a result adult asthmatics can lead active lives and have no physical limitations.

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Mold Allergies Often Overlooked

In a recent news story extensive mold infestation was found in a house that had oriented strand boards (OSB) instead of plywood walls. The house also was tightly sealed trapping moisture, which contributed to the extensive mold problem.

Mold problems have been around for centuries, but only in the past few decades allergists  have pointed out to their patients how important it is to prevent this from happening.

In the following I will review a few typical scenarios that can lead to mold accumulation.

1. Mold from airtight house construction

The homeowner described in the link above is not the only case in the world that has a mold problem. Energy efficient homes are popular because they save energy costs; homeowners often also respond to gas companies, electric utility companies and government incentives to convert to airtight home construction.

In the 1980’s the construction industry introduced the cheaper OSB products to replace the more expensive plywood for wall construction. This is often the problem with newer house construction. However, older homes are not immune to mold development.

2. Roof leaks in older homes

Older homes that were built in the 1970’s may have plywood walls and have a bit of airflow from poorer wall construction, which would prevent mold formation. But roofs are older and do not always get replaced right away when a leak is detected. It may even take some time in areas where there is less precipitation before it is picked up during a particularly heavy rainstorm. Water that enters from a leaky roof can form a puddle on top of the ceiling where mold softens the drywall material until a leak in the ceiling causes water to drip down onto the floor. The mold spores multiply particularly well in wall-to-wall carpeting, but OSB material is also a good growth opportunity for molds due to the mini air spaces between the glued wood pieces. Plywood with its several tight layers is much more resistant to water penetration and mold growth.

Mold Allergies Often Overlooked

Mold Allergies Often Overlooked

3. Mold growth after hurricanes

After hurricane Sandy images of “black mold” were frequently shown in the media. The problem is that after 48 hours anything that was in contact with water produces mold. However, often with disasters like hurricanes there are evacuation orders and you cannot return to your home for several days. There may be further delay because there is a waiting period for insurers to assess the amount of damage, before you can clean all surfaces affected by mold.

The end is result often that expensive mold sanitation is needed or the person ends up moving away and the house is levelled before a new house can be built.

4. Effects of molds

People with preexisting allergies and asthma are more susceptible to the effects of molds. It leads to itchy eyes, wheezing, coughing, and exacerbation of asthma.

Here is a brief overview what the CDC is stating about mold. This site also explains that you can recognize a mold problem because of a musty smell or foul stench in the air and because of the appearance (discoloration of ceilings or walls, water damage).

You can clean hard surfaces with bleach water. Bleach kills molds, but it may have to be cleaned several times within a few days to get rid of the last spores. Whatever cannot be sanitized in this way must be removed or replaced.

5. Health concerns regarding molds

Ref. 1 reviewed the public concern about the toxic effects of molds. It noted that with the Internet and the popular press having exaggerated some of the connections of symptoms with mold allergies, the term “mold madness” has been coined (Ref.2). Despite the paranoia in the general public about toxins from molds, there is only a small percentage of the population that is sensitive to molds where IgE antibodies and IgG antibodies against molds can be determined through blood tests. These individuals often are also allergic to other environmental allergens like grass pollen and dust mites. The asthmatic reactions in sensitive people are not as severe as what peanut traces would do to peanut sensitive patients, but skin testing and blood test screening for specific IgE and IgG antibodies do often confirm that sensitive people indeed can have specific mold allergies. In the vast majority of people these tests are negative and correlations between mold infestations and allergic reactions could not be verified (Ref.1).

6. Fixing mold damage and dealing with allergies

It follows from this that you should remove any visible molds and fix whatever the cause was for its appearance. Carefully disinfect the areas with diluted bleach water (the CDC recommends 1 cup of bleach per 1 gallon of water) several times. Make sure the areas are dry and not musty otherwise you  have  work on improving ventilation. If you are not one of these hypersensitive persons, there is nothing to worry further. However, if you are hypersensitive an allergist should examine you. Common indoor molds that cause the so-called “immediate type hyper reactivity” are due to the mold species Aspergillum and Penicillium. Most outdoor molds that can cause problems for sensitive people are due to Alternaria and Cladosporium species. The latter would be the ones found in carpets after a leaky roof has caused problems. When the allergist has found specific allergies to one or several of the mold species, allergy shots may be prescribed that would have to be given weekly to the sensitive person who was found to have environmentally induced asthma. Often it takes several years for these desensitization shots to stop the affected person from reacting  to molds. In some cases patients need to stay on these shots life-long.


The key with regard to mold allergies is to prevent mold growth by being vigilant about detecting early problems with leaky roofs, walls and cleaning up water damage right away. When there is a musty tell- tale smell, investigate right away and remedy the problem. For most people this is the end of the story. However, a small percentage of very sensitive people need to consult with an allergist who should investigate whether or not these people would benefit from allergy injections.

In some rare cases the affected person may have to relocate to another house that is free from molds.

More information about asthma: http://nethealthbook.com/lung-disease/asthma-introduction/


1.Shannon: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed. Copyright 2007 Saunders

2. Zacharisen MC, Fink JN: “Is indoor “mold madness” upon us?” Ann. Allergy Asthma Immun. 2005; 94:12-13.

Last edited Nov. 7, 2014


Vitamin D Deficiency Affects Asthma

New findings from an observational study point to the intake of vitamin D during pregnancy as a way to curb childhood asthma.
Dr. Carlos Camargo at Harvard Medical School and his colleagues followed more than 2000 pregnant women and their children, and data on 1,194 subjects over the span of three years are now available. Risk factors for asthma in the children at age 3 showed an inverse relationship with the women’s consumption of vitamin D. The lowest intake of vitamin D was 356 IU; the highest was at 724 IU.
The children of mothers who consumed the highest amount of vitamin D were half as likely to have wheezing in the first three years of life compared to those whose moms had the lowest vitamin D intake.

The children’s vitamin intake did not have any effects on the result, suggesting that it is within pregnancy vitamin D supplementation is of importance.

A study of investigators in London going back to 2005 reaffirms the fact, that vitamin D has a positive impact on respiratory health. Vitamin D was given to steroid-resistant asthmatics. Authors of the study suggested that the therapeutic response to glucocorticoids was increased in this group.

Vitamin D Deficiency Affects Asthma

Vitamin D Deficiency Affects Asthma

Further epidemiological investigations are needed to study the benefits of vitamin D as an inexpensive prenatal supplement to prevent childhood asthma.

More informaation on:

1. Asthma: http://nethealthbook.com/lung-disease/asthma-introduction/

2. Vitamin D3: http://nethealthbook.com/news/higher-vitamin-d-levels-associated-lower-risk-mortality/

Reference: The Medical Post, March 21, 2006, page 1 and 60

Last edited Oct. 31, 2014


Growth Factor In Breast Milk A Key In Protecting Infants From Asthma

It has been known for some time that breast milk plays a preventative role in infants. It transmits antibodies and protects from viral illnesses, but it also prevents the infant from developing asthma. Dr. Anne L. Wright, from the University of Arizona in Tucson, and colleagues published a study of 243 infants/mothers in the October issue of the Journal of Allergy and Clinical Immunology (J Allergy Clin Immunol 2003;112:723-728).

They measured cytokines and growth factors in breast milk and examined the infants paying particular attention to wheezing as a symptom of asthma. One of the cytokines, called transforming growth factor (TGF)-beta1, was inversely related to the amount of wheezing in the infants. In other words, the higher the level of this growth factor was in breast milk, the more protected from asthma the infant was. This was a highly significant correlation. After 3 months of being fed with breast milk with the highest level of TGF-beta1 the infants’ asthma rate was reduced by 78% compared to the rate of asthma found in infants fed only short-term with low level TGF-beta1 breast milk.

In their future research the investigators intend to investigate the effects of these breast milk cytokines on the cells, which form the lining of the airways, the immune system and the cells lining the gut in infants. There is already preliminary data to suggest cytokines play an important role in stabilizing these cells.

Growth Factor In Breast Milk A Key In Protecting Infants From Asthma

Breastfeeding prevents asthma

Here is a link to a chapter on asthma from the Net Health Book.

Last edited October 26, 2014


Asthma And Wheezing Influenced By Family Lifestyle (Swedish Study)

A new study from Sweden was published by Dr. Magnus Wickman and colleagues,from the Karolinska Hospital in Stockholm, in the medical journal Allergy 2003;58:730-731,742-747. The authors of this study were analyzing data of a prospective birth cohort study of 4089 children who were born in Sweden between 1994 and 1996.

The families were given health questionaires at the age of 2 months to assess whether the family was adhering to the allergy prevention guidelines (see below). Questionaires were again given at the age of 1 year and 2 years of these children. Specific questions were asked regarding environmental conditions in the house where the children lived. In the mid 1990’s allergy prevention guidelines were strongly recommended to the public in Sweden regarding the value of breast feeding, the avoidance of smoking inside the house in the presence of children, also that a house should be kept well ventilated and without dampness. All of these factors, as was stressed by the allergists in Sweden who organized the campaign, would protect the immune system from allergies against molds, dust mites as well as cigarette smoke and should reduce the rates of asthma.
Here are the results in tabular form.

Asthma And Wheezing Influenced By Family Lifestyle (Swedish Study)

Asthma And Wheezing Influenced By Family Lifestyle (Swedish Study)

As can be seen from this table, which is based on families without allergic parents, a two-fold drop of asthma and wheezing occured when the allergy prevention guidelines were followed in the house. With allergic parents the children had an even greater benefit as the reduction of asthma and wheezing was three-fold when compared to controls who did not follow the guidelines. This is one of the few studies, which shows conclusively that allergy prevention works!

Link to asthma chapter of Dr. Schilling’s Net Health Book: http://nethealthbook.com/lung-disease/asthma-introduction/

Swedish Family Lifestyle Study
Agreement with
allergy guidelines
% of asthma and wheezing at ages 1 and 2 of child:
Yes (all three measures followed) 6.8% 12.6%
No (one or none of measures followed) 17.9% 24.1%

Last edited October 26, 2014