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HOUSE CALL WITH DR. SANJAY GUPTA
An In-Depth Look into the Reality of Asthma
Aired May 7, 2005 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
TONY HARRIS, CNN ANCHOR: ...al Jazeera TV aired video showing an Australian engineer apparently pleading for his life as insurgents pointed rifles at him. Al Jazeera said captors demanded that Australia begin withdrawing its troops from Iraq within 72 hours.
A report this morning that North Korea may be preparing a nuclear weapons test. A Pentagon official has said satellite images show a suspected test site. The hole dug at the site is apparently consistent with preparations for an underground test. North Korea claims it has nuclear weapons, but that's never been confirmed.
President Bush is in Latvia today, the first stop on a trip through Europe that will test his skills of diplomacy. He is celebrating the end of World War II, but his visit to the Baltic states is causing some friction in Moscow.
I'm Tony Harris in Atlanta. HOUSECALL begins right now.
SANJAY GUPTA, HOST: Good morning, welcome to HOUSECALL. I'm Dr. Sanjay Gupta. Today, we're talking about asthma, a disease that leaves millions of people in this country literally gasping for air. It's not just inconvenient, it can be deadly.
Christy Feig has all the details.
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: First, like many patients, it's often made worse by allergies.
KATHLEEN SHEERIN, DR., ALLERGIST: 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 who miss days of work. 40 percent of people are waking up at night. And 50 percent of people who have asthma altered 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.
GUPTA: All right, Christy, thanks.
If you're wondering whether you might have asthma, here are some warning signs. 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 were all reasons to go see your doctor and find out whether you have asthma.
Helping us answer all your questions this morning is Dr. Sumita Khatri, asthma specialist at the Emory Clinic here in Atlanta.
First of all, welcome.
SUMITA KHATRI, ASTHMA SPECIALIST: Thank you.
GUPTA: Thanks for making time. Listen, as Christy mentioned in her piece, asthma appears to be on the rise. Is it more pollution? Is it people spending inside surrounded by allergens? What is it?
KHATRI: It's a lot of those things, actually. We know that there's an epidemiological association of increased asthma in more industrialized countries. Why that is, we're not sure. It could be due to increased pollution. It could be due to increased exposure to allergens. Also, it could be due to over prescription of antibiotics.
Finally, pollution is the most important thing that they're noticing is associated with asthma.
GUPTA: And obviously, that's sort of talking about society as a whole. What about individual triggers? We've got a lot of questions about what can trigger asthma in an individual.
KHATRI: Mm-hmm. Each person has different triggers. That's why treating asthma is an art as well as a science. You should know what causes your asthma. You should pay attention to the triggers. Known and common triggers include cigarette smoke, dust mites, pollen, other pollutants such as high ozone season. Also high emotional state, such as stress, anxiety or extreme happiness can trigger asthma. So you just have to pay attention to what causes your asthma.
GUPTA: If you're happy, you wheeze. KHATRI: Yes, well...
GUPTA: You know, it's important. You yourself have asthma and pointed out that while you were pregnant, your symptoms actually got better.
GUPTA: Really interesting.
GUPTA: Well, the good news as well, is if you're suffering from asthma, controlling it is getting easier. Treatment options range from long-term medications that you take every day to quick relief inhalers in cases of an attack.
And a recent study calls into question whether those long-term drugs are even needed if you have mild asthma. And that brings us to our first question. This comes from Jennifer in New York, who writes this.
"My 9-year-old son was diagnosed with asthma last October and has had no 'flare-ups' since. Does this new study warrant review how much asthma medication children who have mild tendencies toward asthma are receiving?"
So doctor, should this study change the way that doctors are prescribing these medications, the way patients should take them?
KHATRI: Actually, there is not enough data from this study alone to change clinical practice. If you ask me does it change my management of my patients with asthma? No, it does not.
First of all, this is a very coached group of 225 adult asthmatic patients who know what their triggers are and how to avoid them. And also, this is not in children. So it's not really translatable to her son. Also, you know, basically, this is a decision that needs to be made between her and her son's physician.
GUPTA: And we're going to talk specifically about the amount and types of medications. But let me ask you about allergy shots. A lot of people talk about allergy shots actually being used to try and combat their symptoms of asthma. Anything to that?
KHATRI: Actually, there have been some studies that have shown that treating allergies with allergy shots may decrease the incidence of asthma farther down the line. So if a child has bad allergies, being seen by an allergist and being evaluated for allergy immunotherapy or allergy shots is a good idea.
GUPTA: Definitely a link between the two. And we talked about that before on this program as well.
Let's keep going here with questions. A lot of people worrying about staying on their medications for so long as well. Kelly in Maryland is one of them. She writes this. "I've been on steroids to control my asthma for eight years. What are the long-term affects of being on these drugs for so long?" And presumably, she's going to be on them for the rest of her life? Steroids for asthma. How long?
KHATRI: Any time you have a chronic illness, you have to weigh the risk versus benefit of treatment. And essentially, the risk of not treating asthma is way worse than the risks of being on treatment.
And I guess I would ask whether she's on oral steroids or if she's on inhaled steroids. Inhaled steroids generally have a lot fewer side effects systemically than oral steroids. And it does protect you from having asthma symptoms and missed days from work and having more symptoms from your asthma. And oral steroids, if you can avoid being on them, and your doctor can get away without using them, you're much better off.
GUPTA: The inhaled steroids, you can be on for the rest of your life, though?
KHATRI: You can, as long as the doctor is managing your asthma with the least possible dose of asthma medication.
GUPTA: Are most who take asthma drugs, any asthma drugs, counting steroids and other ones as well, going to be on it for the rest their life?
KHATRI: It depends. That's the thing about asthma. You have -- it's a changing picture. For instance, if somebody's doing well during winter season and does poorly during summer season, you basically upgrade their therapy or step up their therapy when they're doing poorly. And then once they're stable for about three months or so, it's safe to step down their therapy again.
GUPTA: OK, all right. We're talking with Dr. Sumita Khatri, about asthma.
Coming up on HOUSECALL, kids and asthma. What do you need to be looking for? Stay tuned.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: When I cough, it's -- really hard -- like that - I should be taking my medicine.
(END VIDEO CLIP)
UNIDENTIFIED FEMALE: Struggling for air, how can you help your children catch their breath? Plus, is it possible to outgrow asthma? Our expert answers your questions, when HOUSECALL returns.
First, today's quiz. Which is the 2005 asthma capital of the U.S.? Washington, D.C.? Fresno, California? Or Knoxville, Tennessee? That answer, coming up.
(COMMERCIAL BREAK) UNIDENTIFIED FEMALE: Checking our quiz, we asked, which is the 2005 asthma capital of the U.S.? Washington, D.C.? Fresno, California? Or Knoxville, Tennessee?
According to the Asthma and Allergy Foundation of America, Knoxville, Tennessee tops the list of cities you might not want to live in if you suffer from asthma.
GUPTA: And our guest here says it might be the mountains there trapping all that ozone.
We're talking about controlling your asthma with Dr. Sumita Khatri, an asthma specialist here in Atlanta. We've been talking about triggers. And from our quiz, it certainly seems that living in certain areas may not help.
Jimmy in New York has a question about that. "Is there a relationship about where I'm living geographically and my asthma? Obviously, there's places that are worse than others, but what's the relationship there?"
KHATRI: Basically, we've noticed that there are more visits to the emergency room in areas that are more polluted. So Atlanta, Los Angeles, these are areas where you'd have more asthma visits to the ER. So pollution and smog contribute to the problem.
Finally, if you have lung disease at all, living at high altitudes may cause your asthma to be worse. Even though Denver is generally cleaner, you might have more trouble with your asthma there.
GUPTA: And it's worth pointing out that our asthma specialist here got the quiz answer correct as well.
Now while location is important, so is your age. Almost half of all Americans suffering from asthma are under the age of 18. Christy Feig is back to take a look at what makes them so susceptible.
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Eight-year-old Kirsten Solomon suffers from asthma, a condition that causes her breathing passages to become inflamed and makes breathing difficult. For years when this happened, her grandmother thought it was just a bad cold. She never thought it might be asthma.
DOROTHY DAVIS, KIRSTEN'S GRANDMOTHER: The cough would last for some time anywhere from two to five days, straight, constantly coughing.
FEIG: Now diagnosed, Kirsten is on medication and uses an inhaler to help her breathe. She says living with asthma is hard, but she's learning how to manage it.
KIRSTEN SOLOMON: I cough and stuff. And when I'm really hard, like that, I should be taking my medicine. FEIG: Experts say since asthma is the most chronic disease in young people, parents should be on the lookout for symptoms in their children.
STEPHEN TEACH, DR., CHILDREN'S NAT'L MEDICAL CTR.: They include cough, wheezing, breathing heavily, pain in the chest, flaring of the nostrils, rapid breathing.
FEIG: Asthma can be triggered by exercise or environmental factors that are often worse in big cities.
TEACH: Things like pollen, air pollution, indoor poor air quality due to cigarette smoke, dust, cockroaches and that kind of thing.
FEIG: That's why children like Kirsten who live in urban areas are more likely to suffer from asthma than those who live outside cities. Although it is seldom fatal, asthma in children results in nearly 3 million doctors' visits and 200,000 hospitalizations each year.
If left untreated or undertreated, it can result in death. In Washington, I'm Christy Feig.
GUPTA: All right, Christy, thanks again. We received lots of questions from worried parents out there like Miriam from New Jersey who asked this question. What can you do to find out if your child has asthma? Are there tests? And, doctor, I'd ask you, when should a child be coming to see an asthma specialist?
KHATRI: Well, if the parent is noticing those symptoms that the previous doctor mentioned, for instance, wheezing, persistence of a chest cold longer than 10 days, shortness of breath, cough, especially at night, these are things that should make a parent wonder whether a patient has, or their child has asthma or not.
And then for the definitive idea, go see an asthma specialist or even your general pediatrician. And they can take the clinical story and do possibly further testing to see whether or not this, you know, child has asthma.
GUPTA: And what they're trying to figure out during this testing is what the lung capacity is? Is that right?
KHATRI: Yes, not so much the lung capacity, but actually how reactive the patient is to stimulants.
KHATRI: And how quickly a patient can breathe out over time.
GUPTA: Is it different for adults versus children?
KHATRI: Asthma generally pathophysiologically is about the same. Basically, it's a lot of airway reactivity and a lot of inflammation. What triggers them and what causes them may be a little different, but severity is generally the same if it's untreated.
GUPTA: OK. We sent out our roving cameras out on this topic, to try and get a few more questions. Let's take a listen to this one.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: If you have asthma as a child, is it possible to not have asthma as an adult? Can you grow out of it?
(END VIDEO CLIP)
GUPTA: And I got to tell you, that's probably one of the most common questions we get. Because you hear about asthma a lot in children, but not as much in adults. Do people grow out of it?
KHATRI: There have been longitudinal studies that I've looked at. The fact that about 25 to 30 percent of children who wheeze do have recurrent wheeze as a young adult or an adult. And risk factors for that include being allergic to house dust, being around passive tobacco smoke, smoking and then being a woman also kind of increases your risk of having recurrent asthma as an adult.
GUPTA: OK, lots of good advice, lots of good tips as well. We've got a lot more to cover still. So don't go away.
UNIDENTIFIED FEMALE: Does working out leave you gasping for air? We'll give you some tips on staying active and breathing easy this summer.
Plus, could losing weight help your asthma? Find out, after the break.
First, check out this week's medical headlines in "The Pulse".
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Former President Bill Clinton, Arkansas Governor Mike Huckabee and the American Heart Association have teamed up to tackle childhood obesity. The alliance will focus on slowing the increasing rate of obesity and encouraging healthier lifestyles for young people.
Nearly 16 percent of the nation's children and teens are overweight.
And a new study raises questions about the benefits of acupuncture for the treatment of migraine headaches. The German study published in the Journal of the American Medical Association found that acupuncture reduced migraines compared to receiving no treatment, but true acupuncture treatment is not more effective than fake acupuncture in reducing migraine headaches.
But other studies have shown acupuncture can be effective in reducing various types of pain. Christy Feig, CNN.
GUPTA: All right, we're back with HOUSECALL. Asthma can be a frustrating disease, causing someone to cut back on physical activity or perhaps even become depressed. But asthma doesn't have to limit you.
Our guest, asthma specialist, Dr. Sumita Khatri, is helping us get control of asthma. And you know, lots of questions coming in on this topic. But once you've been diagnosed with asthma, are there things you can do to try and prevent another attack?
KHATRI: I think the two most important things are to have a good relationship with your physician, so you can ask questions. You can sort of decide what's good and what's bad about your asthma.
And the second thing is to be educated. What about my asthma makes me feel bad? What are the triggers that make me feel about?
KHATRI: And the important thing to do might be - for instance, to do peak flow monitoring. For instance, if you're noticing that, you know, in the morning when you wake up, your shortness of breath is worse or your wheezing or your chest is tight, it's a good idea to do a peak flow.
GUPTA: What is this?
KHATRI: Now this is a commonly used peak flow meter. And what it does is it measures how quickly you can breathe out a full breath, and how much breath you can breathe out over a short period of time.
KHATRI: And if you're having an asthma attack, you can't breathe out very much. And it has a numerical value for how much you are able to breathe out. And you can monitor that over time.
So let's say you went over, you know, your Aunt Christy's house and she had a cat. And later on that evening, you weren't feeling well. And you could check your peak flow. And then you have some more idea of, well, you know, I didn't realize that this chest tightness was asthma, for instance. And another thing you can you do is be compliant with your medications.
KHATRI: Take the controlled or medications regularly, not when you just think you need it. That's a job for your doctor and you to work out together. And technique, proper technique in using medications also key. For instance, the rescue inhalers or any other inhalers that have the propellant in it, using a spacer actually enhances delivery to the lungs and actually decreases side effects, because you absorb less into your gut.
So you shake it. You take off the cap. You press and then you inhale. And you hold it for 10 seconds.
GUPTA: That's the spacer there.
KHATRI: That's the spacer. That's the inhaler.
GUPTA: All right.
KHATRI: And then there are other preparations and medications that come as a dry powder form, which you click, and there's actually a counter for how many more doses you have left. And you take a rapid inhalation in, as opposed to a slow deep one in.
KHATRI: And this is all very important. That's why doctors really need to take a lot of time with their patients to go over proper techniques. So...
GUPTA: Yes, the peak flow meter's pretty interesting. To actually have one of these in your home maybe to test and see if you're having symptoms. Good advice.
Let's keep going with some of the e-mails here. Another question coming in on how patients can deal with their asthma. Same topic here. Jennifer in New Jersey asking this. "Is weight an issue with asthma? If someone is overweight by 20 or 30 pounds and loses that weight, will their asthma get any better?" What do you say?
KHATRI: Well, actually, we've shown that in some patients who've lost weight drastically, that their asthma gets worse. About -- in a study of patients who underwent rapid weight loss, about 40 percent were able to get off their asthma medications altogether.
Why is that? That's not entirely clear. Is it due to the inflammation in the body? Is it due to the restriction of the weight? Is it due to the fact that you're now having a healthier lifestyle? We're not sure. But definitely, one of the key things that we try and counsel our patients is to try and lose weight.
GUPTA: Maybe a combination of all of those things as well.
GUPTA: Let's keep going here. We've said that exercise is a common trigger. I fall into this category. Even many non asthmatic patients, up to 13 percent of the population experience asthma associated with exercise.
And Jack from Iowa had a question about this. "When running, how do I know when to keep pushing in order to get myself in shape and when to stop and give my lungs a rest?"
This is an important topic, because a lot of people obviously are going to have some shortness of breath in their exercising. How do they know when it's crossed that threshold and moved into asthma?
KHATRI: Well, I would say that just, sort of, if you exercise regularly, and you're noticing no improvement in your exercise time, then there's probably a barrier that you're not able to cross, just with conditioning alone.
And then what you can do is again, note how soon you get this symptoms. Talk to your doctor. Maybe get a peak flow. And do peak flows before and during exercise.
And then, last thing your doctor may try to do some testing, or give you an asthma medication, like a quick reliever, like that short- acting beta agonin.
KHATRI: And you can take that 10 to 30 minutes before exercising. If your exercise tolerance improves, that can tell you that you have exercise induced asthma.
GUPTA: All right. And Jack, you can run with one of these as well. Maybe that would work for you.
Looking for more treatment options? Stay where you are. We've got some alternatives, coming up.
UNIDENTIFIED FEMALE: Sick of pills? Drug costs getting out of control? Our expert gives us some options to breathe a little easier.
Plus -- it's a HOUSECALL Mother's Day salute. Keeping our moms healthy by getting them the test they need.
GUPTA: Welcome back to HOUSECALL. Well, we couldn't let the show go by without wishing all the moms out there a very happy mother's day. And so our bod squad looks at which tests are must- haves for all of those women in our lives.
HOLLY FIRFIR, CNN CORRESPONDENT (voice-over): Health experts are urging women to start getting proactive with their health. That means getting check-ups regularly.
Start with monthly self-breast exams to check for any irregularities. Beginning around age 40, doctors recommend a yearly mammogram, earlier if there's a family history of breast cancer. Monitoring your blood pressure and cholesterol regularly can help reduce risk of strokes and major heart problems later in life.
STUART SEIDES, DR., CARDIOLOGIST: Hardened vascular disease is the biggest killer of women in this country, just like it is the biggest killer of men.
FIRFIR: Gynecologists recommend getting regular pap smears. It's the best test for cervical cancer. Plus, doctors advise women to get bone density scans to determine their risk of bone fracture from osteoporosis.
DAVID DOWNING, OB/GYN: Basically, an x-ray would - tells you how dense the bones are.
FIRFIR: What else can women do to stay healthy? Doctors advise a balanced diet, regular exercise, avoid smoking and limit alcohol.
Holly Firfer, CNN.
GUPTA: All right, mom, I hope you're listening. Thanks, Holly.
We're talking with asthma specialist, Dr. Sumita Khatri. Doctor, we've got time for one more question. This comes from Dar in South Dakota, who writes this. "Is there any kind of natural remedy use for asthma?" A lot of patients ask me about this, doctor. They don't want to take the medications. What sort of natural remedies are there?
KHATRI: There's no proven natural remedy for asthma. There are people trying to find this out, however. But I guess the best advice I can give you is to have a well-balanced diet with adequate fruits and vegetables, and have a healthy lifestyle with adequate exercise. That's the short and quick answer.
GUPTA: Lots of good advice today. We appreciate it. Unfortunately, we're out of time this morning. Dr. Sumitra Khatri, thank you for all your time.
KHATRI: You're welcome.
GUPTA: All your great advice as well. Everyone at home, thank you. Make sure to watch next week when we take an inside look at big city forensic crime solving. You're not going to want to miss the show. That's next weekend at 8:30 in the morning.
Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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