Not all asthma reactions are alike: New discoveries yield more customized treatments

Margaret Co, MD, reviews new asthma discoveries yielding more precise treatment plans


For years, doctors thought all forms of asthma were created equal and treated all patients in essentially the same way.

That is changing.

In recent years, doctors have discovered that asthma, which affects about 8% of the U.S. population, can stem from different underlying causes, leading to a more customized treatment plan for individual patients, said Dr. Margaret Co, a board-certified allergist and immunologist at Bergen Medical Associates.

“Asthma is a disease of chronic inflammation affecting the airways in our lungs. We know now that there are different types of what we call ‘phenotypes’ of asthma, determined by the underlying inflammation, the way it presents and what triggers it. These include allergic asthma, non-allergic asthma, exercise-induced, aspirin-induced, severe asthma and others. Some phenotypes are more common in males than females or in children than adults and may even co-exist in the same patient,” Dr. Co explained. “Identifying a patient’s phenotype helps us better manage the disease.”

The most common phenotype is allergic asthma. “This is the type where environmental allergens trigger the immune system and cause asthma,” Dr. Co said. “We see this type of asthma in 40% to 50% of patients. In children, allergic asthma can account for up to 80% of cases.”

Allergic asthma also is one that is the most easily identified by its triggers and through tests. Pet dander, dust mites and cockroaches are the most common indoor allergen triggers. Seasonal pollen, another major trigger, can cause asthma in highly sensitive people, especially when pollen counts are very high, as they were recently this spring.

The best way to diagnose and manage allergic asthma is to visit a trained allergist, who will take a thorough medical history and conduct a variety of tests to determine which allergens most affect a patient. This includes office spirometry, which determines the extent of airway blockage and a FeNO or exhaled nitric oxide test that is usually elevated in allergic asthma and determines how much lung inflammation is present.

“With history and allergic testing, we can figure out if you have the allergic phenotype,” Dr. Co said.

“Once a diagnosis is reached, we can focus on how to avoid the allergens that trigger your asthma,” she said. A personalized treatment plan may include recommending certain changes in one’s environment when possible. For example, to combat dust mites which are present in every home, allergen-resistant covers for mattresses and pillows can help. Washing bedding in hot water and using a HEPA filter can also reduce allergic reactions.

Keeping windows closed on dry, windy days when pollen counts tend to be at the highest is another simple way to reduce allergic reactions.

“Together with allergen avoidance measures, medications may be prescribed to address the lung inflammation with asthma controller medications and to treat the symptoms with bronchodilators,” Dr. Co said. “There is no cure for asthma, but it can be managed very effectively in most cases.”

Medications for all types of asthma include inhaled corticosteroids, alone or combined with long-acting bronchodilators, leukotriene modifiers, anticholinergics, quick-relief or rescue bronchodilators and, for severe flare-ups, oral corticosteroids if needed.

If you have allergic asthma, some medications may work better for you than for those with other types of asthma. Also, additional medications such as antihistamines and nasal steroids may be prescribed to control your allergies.

Allergen immunotherapy (allergy shots) also may be recommended for more severe patients, especially if the allergen is not avoidable or for people who own pets and do not want to part with them. Allergy shots modify your disease over time, rather than just treating your symptoms.

“We give patients small doses of what they’re allergic to in order to train their immune system to develop tolerance to them,” Dr. Co said. For those who do not want to get shots, immunotherapy is now available in an oral tablet form. A tablet containing the allergen is placed under the tongue (sublingual) at home. This is a medication available by prescription only and would require an epinephrine auto-injector in case of a reaction.

The latest developments in therapies for asthma have been for allergic asthma. These are biologic therapies or “biologics” that reduce inflammation by precisely targeting the allergic response pathway.

“These treatments are monoclonal antibodies that block a certain area in the immune system that causes allergic asthma,” Dr. Co explained. A blood test and allergy test assist in determining which biologic is likely to be helpful. In more severe cases, biologics have been highly effective in preventing patients’ asthma from requiring ER visits, hospitalizations and oral steroids for flare-ups.

“Knowing if your asthma is allergic is essential for understanding your disease and managing it,” Dr. Co added. “Screening for allergies by a trained allergist will help diagnose your symptoms and determine the best treatment plan to manage your asthma.”

With offices in Emerson, Paramus, Ridgewood, Northvale and Montvale, Bergen Medical Associates offers specialized care in 12 divisions. The practice is founded on the principle of providing the highest quality care, tailored for each patient.

For more information, contact us today or call 201-967-8221.

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