Q. Who is considered an
asthma specialist?
A. Allergists and pulmonologists are
considered the best trained and most
experienced physicians to care for
asthmatics. These physicians are
internists or pediatricians who have
done 2-3 years additional training in
allergy or pulmonology.
Q. Should every
asthmatic be seen by an
asthma specialist?
A.. In an ideal situation the answer
is yes but with up to 34 million
asthmatics in this country the
practical answer is that this may not
always be possible. Internists and
family practitioners provide a large proportion of this care, particularly
for patients with mild asthma. For these mild patients I
recommend at least a one-time consultation with an asthma
specialist to review the diagnosis and management and to ensure
proper treatment. Patients with moderate to severe bronchial
asthma require the regular care of an asthma specialist. These
individuals suffer more frequent asthmatic attacks and often
require emergency care. Despite advances in treatment, 3-4
thousand asthmatics still die of asthmatic attacks each year. I
know that every asthma specialist feels that each one of these
deaths is preventable.
Q. Does every asthmatic need to be tested
for allergies?
A. It is estimated that a little more than 50% of asthma is allergic
(also called extrinsic). Non-allergic (intrinsic) asthma is more
common in adults while the allergic form usually starts in
childhood. I feel that every person with asthma should have an
allergy evaluation. This information may be invaluable since it may
identify an asthma trigger such as a specific food that can be
avoided. If the results of the allergy testing are negative the
physician may then focus on reducing other common asthma
triggers such as cigarette smoke or infection.
Q. Is wheezing always an indication of asthma?
A. The old adage that “all that wheezes isn’t asthma” is still true.
A wheeze is a high pitched sound that comes from the air passages
of the lungs when the flow of air through them isn’t smooth. Unfortunately
patients who wheeze are often immediately labeled
asthmatic and are given an asthma spray without a correct
diagnosis. There are a number of illnesses that can mimic asthma.
In children aspiration of a foreign body may produce wheezing
due to a partial blockage of an airway. Elderly adults with
congestive heart failure may wheeze due to excess fluid in the
lungs producing narrowing of the airways. This is often called
“cardiac asthma”. Dysfunction of the voice box or larynx in which
the vocal cords move in the opposite direction that they are
supposed to may produce severe wheezing and be mistaken for
asthma. This entity is known as “laryngeal asthma”.
Q. How should asthma be diagnosed?
A. Although a patient’s history and physical exam may suggest a
diagnosis of asthma, a definite diagnosis requires the demonstration
of narrowed bronchial tubes that are opened by the administration
of a bronchodilator medication. This simple test is called
spirometry which requires a patient to exhale forcibly into a device
which measures air movement. The results taken before and after
the use of a short-acting bronchodilator are compared. A 15%
improvement after the use of the bronchodilator is the criteria for
the diagnosis of asthma.
Dr. Adams is a pulmonologist in private practice in New York City
and is the author of The Asthma Sourcebook, 3rd Edition
(McGraw-Hill). He hosts Doctor Radio on SiriusXM 81every
Tuesday from 6-8AM and 4-6PM .



