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HOUSE CALL WITH DR. SANJAY GUPTA

Asthma Chronic Problem Faced by Millions

Aired June 26, 2004 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


BETTY NGUYEN, CNN ANCHOR: President Bush is wrapping up a meeting with European leaders in Ireland. The president and Irish prime minister, Bertie Ahern, will meet with reporters at 8:45 Eastern this morning, and CNN is planning live coverage so stay here.
Round three of the six nation talks on North Korea's nuclear weapons program has ended in Beijing. There have been an agree -- there has been an agreement to meet again by the end of September. Sources say North Korea is offering to give up its nuclear program in exchange for fuel aid, an end to U.S. economic sanctions and removal from the American list of nations that sponsor terrorism.

The first tests of an animal carcass from Mad Cow Disease are considered inconclusive. The Agriculture Department will now send tissue samples to a lab in Iowa for further tests. Officials say the animal was never in the food supply.

We now have HOUSE CALL with Dr. Sanjay Gupta, and that begins right now.

DR. SANJAY GUPTA, HOST: Good morning. Welcome to HOUSE CALL.

We're talking about asthma today. Twenty million Americans suffer from it. Nine million of them are children. And this chronic disease is not just inconvenient; it can be deadly at times.

Christy Feig has the details.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT: Wendy Gregory was diagnosed with asthma at age 13. Because of it, each year of high school, she missed about 60 days of school.

WENDY GREGORY, ASTHMA SUFFERER: It's like somebody's trying to smother you but there's no one there. You can feel your lungs actually physically get tighter and smaller, and it's hard to both inhale and exhale.

FEIG: Hers, like many patients, is often made worse by allergies.

DR. KATHLEEN SHEERIN, ALLERGY ASTHMA FOUNDATION OF AMERICA: It can be dogs, cats, dust mites and, of course, in the spring, pollen.

FEIG: With asthma, treatment is imperative but it can take time to tailor it for each patient. SHEERIN: Twenty-five percent of people will miss days of work. Forty percent of people are waking up at night and 50 percent of people who have asthma alter their activity level because of their asthma.

FEIG: And it can be even worse.

SHEERIN: We have millions of hospitalizations, emergency room visits each year, and, unfortunately, we have, in this country, almost 5,000 unnecessary deaths each year.

FEIG: In the last 20 years, new diagnoses have more than doubled. Doctors have several theories about why this is. But they aren't yet certain.

Christy Feig, CNN, Washington.

(END VIDEOTAPE)

GUPTA: Christy Feig, thank you.

If you're wondering if you at home might be suffering from asthma, here are some warning signs. If you have increased shortness of breath or your sleep is disturbed by coughing or shortness of breath. You may also experience tightness in your chest or wheezing. These are all reasons to go see your doctor and find out if you, in fact, have asthma.

And controlling that asthma is getting easier. Lots of treatment options out there, ranging from long term control drugs to quick relief inhalers in case of an attack.

Plus, with 60 percent of all asthma caused by allergies, allergy shots or injection of a new drug called Xolair can calm your immune system's reaction to allergic asthma triggers.

Here to help us answer all of your questions about living with asthma is Dr. Linda Guydon. She's a board certified immunologist and asthma specialist here in Atlanta.

Welcome.

DR. LINDA GUYDON, IMMUNOLOGIST: Thank you so much.

GUPTA: Thanks for your time. First of all, very basically, what is asthma?

GUYDON: Asthma is a disease of the airway. It's a chronic inflammatory disease of the airway where the airways tighten, squeeze down, and are inflamed with mucus, and patients feel those symptoms of tightness and shortness of breath and wheeze.

GUPTA: That can be a very terrible feeling, shortness of breath. Springtime now, is it a busy time for you?

GUYDON: Well, it is because of the pollen counts in Atlanta. They're quite high, and allergy sufferers do indeed suffer.

GUPTA: Lots of e-mails coming in on this. These are questions you answer all the time. Let's see if we can get through some of them.

Sarah in Alabama writing, "Can the consumption of specific foods, such as dairy products, make asthma sufferers worse? And how much does stress affect asthma symptoms?"

First of all, certain foods?

GUYDON: Well, certain foods. If you are allergic to a food, one of the manifestations of being allergic is wheezing and tightness in the chest. There are other symptoms, as well.

Some feel that certain foods, particularly dairy products, induce mucous production and for certain asthmatics seems to aggravate their asthma.

GUPTA: Also, what about stress?

GUYDON: Stress is a major factor. I think it's really been an underestimated trigger. In the inner city, in the urban settings, people are starting to study that, because stress manifests itself in various ways.

GUPTA: People think of that when someone gets particularly stressed out, they have a harder time breathing.

GUYDON: Absolutely.

GUPTA: They could be having an asthma attack?

GUYDON: Indeed.

GUPTA: We talked a little bit about the drugs used to treat asthma. Two new studies call into question the safety of a commonly prescribed asthma medication called beta-agonists. That's a general name.

One study reports daily doses of the drug may increase your heart attack risk, and the other study finds your lungs can build up a resistance to these drugs, possibly putting you at risk of a more severe asthma attack.

Lots of questions coming in about this. Beta-agonists are a pretty common drug. Eric from California writing, "I've just read an article stating that beta-agonists may increase the risk of fatal asthma attacks and heart failure. Which drugs classify as beta- agonists, and should I stop using them? Are there better options?"

Doctor, first let's start with what are the beta-agonists? There's long-term and there's short-term sort of drugs, right?

GUYDON: Indeed. The long-term beta-agonists are those that last about 12 hours. The short-term beta-agonists are those that are used for rescue, relief of symptoms acutely.

GUPTA: Sounds pretty concerning, these studies. I mean, should people stop taking these medications?

GUYDON: No. I think you, first of all, have to look at your individual situation. Never stop your medication without consulting your physician first.

GUPTA: So the heart failure and the buildup of tolerance, is that something that -- this is what you do. Are you concerned about that?

GUYDON: Well, I am concerned about that if I see that a patient is having to overuse their beta-agonists. I think that's really the take take-home.

Overuse of the beta-agonists has well described as reason to down regulate the beta-receptor. And therefore, you develop tolerance. But the point is overuse.

And if there is overuse the question is why. That's a red flag. Their asthma is not under control and, therefore, other medications are needed to control their asthma.

GUPTA: Take as directed, good point.

Another e-mail question. Al in California wants to know, "Can someone build up a tolerance for Albuterol, requiring higher doses? I used to get by with smaller doses of the drug in a pocket inhaler, but now that is not effective."

What do you say to him?

GUYDON: The very same issue. Albuterol is a beta-agonist. Overuse of it absolutely can cause tolerance, but the take home is again, why are they overusing it? And if they are overusing it, it indicates that their asthma is not controlled.

GUPTA: OK. Good point. And they should probably be seeing you at that point?

GUYDON: Absolutely.

GUPTA: Lots of e-mails coming in. Tons of them, in fact. One of the most common was about possible side effects of taking any of these drugs long-term. Should people be worried about that?

You take -- you hear about a lot of kids who have asthma. They take drugs for a short period of time. If you have to take it long term, years and years, is that a concern for you?

GUYDON: I think the important thing is you have to recognize why they are provided. They are the only method of actually reversing bronchial constriction acutely, so long-term is relative.

Long-term use with multiple inhalations daily, yes, that is of concern. But if you are using your inhaler less than two times a week, that's of no concern.

GUPTA: We're talking to Dr. Linda Guydon. Good advice there. We've got a lot more to talk about on this topic, including exercise and asthma. Don't go away.

ANNOUNCER: Does exercise leave you gasping for air? You may have exercise-induced asthma. We'll give you some tips on staying activity and breathing free this summer.

And later...

UNIDENTIFIED MALE: If you had asthma as a child, will you eventually grow out of it, or is it possible that you'll grow out of it as an adult?

ANNOUNCER: We'll have the answer but, first, take this week's "Daily Dose" quiz. True or false: secondhand smoke may cause asthma in children.

The answer when we come back.

(COMMERCIAL BREAK)

ANNOUNCER: Checking the "Daily Dose" quiz. We asked true or false: second smoke may cause asthma in children. The answer is true. According to the National Academy of Sciences, evidence suggests secondhand smoke may be a cause of asthma in preschool children.

GUPTA: As you just heard, secondhand smoke can put you at risk for asthma. Other possible risk factors include living in an urban area, if you work with chemicals that can aggravate your lungs or also if your parents have asthma or you're obese. All those are risk factors.

We're talking with Linda Guydon. She's an allergist and an asthma specialist.

Doctor, we sent out our cameras. There was lots of questions. We sent out our cameras to try to pick up a few. Take a listen.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: What's the correlation between asthma and allergies and can one spawn the other?

(END VIDEO CLIP)

GUPTA: Common question.

GUYDON: Absolutely. Actually, allergies are the underlying problem. Being allergic predisposes you to several complications. Asthma happens to be one of them.

GUPTA: Lots of connections between the two in terms of controlling your allergies and subsequently controlling your asthma?

GUYDON: Absolutely. In fact, the basis of control is to control your allergies and, therefore, you control your asthma.

GUPTA: Let's keep on topic here a little bit. Let's get to Kay now in Wisconsin, who writes, "I've heard that having a dog in the house reduces the chances of developing asthma. Is that true? If it is, would a dog reduce the severity of asthma for someone who already has asthma?"

First of all, Kay, you're right. There was a study out just last year that showed infants exposed to dogs and cats were half as likely to have easily irritated airways, which is a risk factor for asthma.

What about the dogs, though? Dogs actually in the household for adults reduce the risk or the severity?

GUYDON: That study was actually looking at the exposure in the first year of life. The question beyond that, the answer is not so straightforward, and not all studies actually concur with that study. If you're already sensitized the dog it's absolutely going to aggravate your asthma.

GUPTA: Is this because a lot of people are allergic to dogs and therefore, exposing them early in life makes them less allergic later? Or what's...

GUYDON: Well, the thought that perhaps the exposure early in life may down regulate or desensitize, so that you don't become sensitized. It's really not entirely clear, because not all studies concur that having that exposure is protective. And remember, that study actually looked at exposure in the first year of life.

GUPTA: Really that first year. So adults, even older children may not get the benefit?

GUYDON: Absolutely.

GUPTA: Let's keep on topic. Another question now. Lisa from Virginia asking, "Are there methods, medicines or devices that can help someone who suffers from exercise-induced asthma to incorporate running into their lifestyle without triggering an attack."

I know you have mild exercise-induced asthma, as well.

GUYDON: Yes, I do.

GUPTA: So personally and professionally, what do you say?

GUYDON: It's very easy to control. It kind of relates back to that short acting beta-agonist question we talked about earlier. But they are the mainstay of therapy and are designed to be given about 20 to 30 minutes prior to the exercise, and they work very well.

GUPTA: How do you know if you need to do that, though? Everyone gets a little bit of shortness of breath when they're running. How do you know when you need to start taking the medication?

GUYDON: It's generally pretty easy to tell. You're fairly winded. You may be winded during exercise but classically, the windedness occurs following the cessation of exercise.

GUPTA: I was going to say, because I certainly get winded during exercise. Most people do.

I've got time for one more question. Let's go again to our roving camera.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: What could people do to prevent the onset of asthma attacks, living in a polluted city environment?

(END VIDEO CLIP)

GUPTA: And you know, Doctor, studies have shown that ozone and pollution can cause asthma. So what do you do about that? I mean, you live with it. What can you do to prevent it?

GUYDON: Exactly. It's very hard to, of course, totally eliminate being exposed to it, but you can, if necessary, wearing a mask. You can avoid being outside for long periods.

GUPTA: It looks kind of silly, though, right?

GUYDON: It does look pretty silly, but if you're desperate, you'll do it. Certainly, prolonged exposure outdoors will decrease the risk of having asthma.

And then, of course, if you are asthmatic and your asthma is triggered by pollution, this is where medication becomes important, because they control the inflammation subsequent to the pollution exposure.

GUPTA: So you can prevent this.

GUYDON: You can.

GUPTA: Sometimes it requires medications.

Good advice, Dr. Linda Guydon. Coming up on HOUSE CALL, can you outgrow your asthma? We'll get you that answer right after the break.

(BEGIN VIDEO CLIP)

HOLLY FIRFER, CNN MEDICAL CORRESPONDENT (voice-over): From a camp with kids with asthma...

EMILY HAWKINS, CAMPER, CAMP BREATHE EASY: You get to be around people who have the same thing as you.

FIRFER: ... to your own backyard. We'll give you hints to keep your kids breathing easy this summer.

But, first, here's a tip from our health conscious Bod Squad.

With terms like downward facing dog, you'd think this was designed just for man's best friend. No, you're not seeing things. The quest for physical enlightenment has gone to the dogs, literally.

Helping forge this human dog yoga bond is Crunch Fitness, whose free doggie and me sessions, called "Ruff Yoga," are popping up at locations across the country.

Pioneered by Susie Teitelman, doggie yoga evolved from Teitelman's love for the art and her adorable pooch, Coley (ph).

SUZI TEITELMAN, YOGA DIRECTOR: It's a traditional vinyasha (ph) class. We flow through poses. We "ohm." We sing to the dogs. We use them as props. You help them, they help you. And we just experience yoga together.

FIRFER: Moving through poses like Sun Salute and Reverse Warrior, Ruff Yoga offers a unique opportunity for dog lovers to spend quality time with their pooches and for canines to get rid of unwanted stress.

Holly Firfer, CNN, Atlanta.

(END VIDEO CLIP)

GUPTA: Welcome back to HOUSE CALL.

Nearly 50 percent of asthma sufferers are children, and summer can spell trouble for them with lots of running and games outdoors. But one summer camp is hoping to keep kids playing and educating them at the same time.

Holly Firfer

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Welcome to Camp Breathe Easy, where the campers are swinging from trees.

The water is perfect...

UNIDENTIFIED FEMALE: Kick, kick!

FIRFER: ... and the kids have asthma.

DR. LOU GOHL, PEDIATRIC PULMONOLOGIST: And that's one of the values with a camp like this where everybody has the problem. Everybody is taking medicine. You're not singled out. You're not different. You fit in with everybody who's here.

HAWKINS, CAMPER: I think it's fun. And it's just like you get to be around people who have the same thing as you.

CHANDA MOHLEY, CAMP BREATHE EASY DIRECTOR: The goal of camp is to promote self-confident and to teach children with asthma that they can do anything that children without asthma can do.

FIRFER: Asthma is the leading serious chronic illness among children, and if not managed properly, it can be life threatening. It's estimated nine million kids in the U.S. have asthma, a number that has steadily risen over the years.

GOHL: Nobody knows exactly why the incidence of asthma is rising. There are a number of things can be attributed to: air pollution, tobacco smoke exposure, genetics -- there may be a chance in the genetic pattern. Some have concerns for sick building syndrome.

FIRFER: What is known and what is taught in Camp Breathe Easy is how to avoid asthma triggers, such animal dander, dust mites, pollen, mold and cigarette smoke.

COURTNEY MONTOYA, CAMPER: The most important thing I like is when they teach you about asthma. Then you know how to prevent it and how to take control.

FIRFER: And they learn the importance of taking medications and watching for asthma signals.

Holly Firfer, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: That looks pretty fun, actually. Camp Breathe Easy is one of the largest asthma camps in the country, run by the American Lung Association.

To learn more about asthma camps in your area, log on to www.LungUsa.org.

We're talking with Dr. Linda Guydon. She's an asthma specialist. She's also a certified immunologist.

Kids and asthma, are the symptoms the same in children as they are in adults when they have asthma?

GUYDON: It can be somewhat different. Cough is often a symptom that a child will have, and they may not have enough of an ability to actually wheeze.

GUPTA: Let's get to another e-mail question here, as well. Lizzie in Virginia writing, "I've heard that children can outgrow asthma. My daughter is 3 years old and, while her asthma episodes are less frequent and more mild, they still occur. Is there any hope that she may still grow out of her asthma?"

We get a lot of questions like Lizzie's. Kids -- It seems like a lot more kids have asthma than adults.

GUYDON: Yes, indeed, it is more common in children. And kids can, quote/unquote, outgrow asthma. In reality, there's a rule of thought that you can never really outgrow it; it goes into remission.

But there's a group in Tucson that actually looked at that. And within the first six years of life, those kids that had wheezed during their first three years, 66 -- 60 percent of them were not wheezing by 6 years of age. GUPTA: And there are adults who never had asthma as a child and develop it later in life. Can they also outgrow their asthma?

GUYDON: Probably not entirely. You can develop asthma at any time in your life. You can be 60 years of age and develop asthma. It's controllable, but yet it really does not go away.

There are actually biopsy studies that show that even though you may be in clinical remission, there is still inflammation in the lungs.

GUPTA: You know, 30 to 40 percent of your practice is children. What sort of things -- For people listening, what sort of things make you want to give a child medication for their symptoms?

GUYDON: I think you really have to look at the fact that children want to play. They need to lead active lives. Asthma can really change a child's life. And it's important to recognize that that does not have to happen.

We can control asthma. And so children that are coughing, children that don't play, children that are inhibited because they don't feel well...

GUPTA: Interfering with their life?

GUYDON: Absolutely.

GUPTA: We got an e-mail sort of along those lines. This is Teresa from Colorado. She's asking, "My 2-year-old daughter has just been diagnosed with asthma. Are there any lifestyle changes I need to make for her? Should I make sure she doesn't run around? Is she OK with everyday activities as long as she's not wheezing and complaining?"

This is probably a debate for a lot of parents. What -- Do you sort of keep them housebound or what do you do?

GUYDON: No, you really don't want to diminish exercise. In fact, exercise is good for asthma. What you want to do is get them on the right regiment so you can control the asthma and they can just lead normal lives as children.

GUPTA: We're talking with Dr. Linda Guydon, getting lots of good advice. But we're not done yet. When we come back, we'll check out some of this week's medical headlines, from mammograms to smoking. Stay tuned for that.

ANNOUNCER: Coming up, a new study shows it's never too late to kick a bad habit.

Plus we'll give you web sites that can help you find your asthma triggers and an outline for an asthma action plan. That's straight ahead.

(COMMERCIAL BREAK) FEIG (voice-over): Smoking cigarettes cuts an average of ten years off a person's life, according to a new study published in the "British Medical Journal."

The study found that quitting at any age reduces the risk of dying from smoking related diseases. If smokers quit by the age of 30, research suggests they can avoid nearly all risk of premature death. Even at 50 years old, kicking the habit can cut your risk of death in half.

And a new study in the journal "Cancer" found women over 40 are not getting their getting their recommended annual mammogram. The study found only one in 20 women consistently got a yearly test over a 10-year period, even though the screening can considerably reduce the risk of death from breast cancer.

Christy Feig, CNN.

(END VIDEO CLIP)

GUPTA: That's your latest medical news. Also to get the latest asthma news, click on to the web site of American Academy of Allergy, Asthma and Immunology. That at four "A's" and an "I" dot org.

Along with the news, there's a checklist to help you decide if you may have allergic asthma.

Also, try health.nih.gov. There you're going to find the resources of the National Institutes of Health at your disposal.

We also like the National Heart, Lung and Blood Institute fact sheet that included an asthma action plan and a checklist of possible triggers that you can track and bring to your doctor.

And we're talking with our doctor, Dr. Linda Guydon. Really interesting show today.

What's a final thought you'd like to leave with our viewers?

GUYDON: I think everyone should know that if you have asthma or you suspect that you have asthma or you know someone with asthma, see a specialist. Be appropriately diagnosed and treated, because there are so many wonderful treatment modalities available so that you can lead a normal life. It's quite realistic.

GUPTA: See someone like you. That can be the message, absolutely.

That's all the time we have for today. Thank you so much.

Before you head home, head out for the 4th of July next weekend, tune in for show that could potentially save your life: preventing skin cancer. E-mail us your questions at HouseCall@CNN.com. That's next weekend on HOUSE CALL.

Remember this is the place where you can ask the experts all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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