I was having an interesting conversation with a middle-aged asthma patient yesterday and it is one that I seem to have fairly often.  Since most of these articles come from exam room discussions I thought I would bring this one to you today. This patient was doing well; in fact, so well that he was only using his controller medication now and again when “he thought he needed it”. 

He went so far as to tell me he really had not been using it at all for several weeks.  Clearly, this was a teaching moment.  Patients with asthma have their disease because of a genetic predisposition.  None of the treatments or medications cures this problem.  The controller medications we use are designed to relieve symptoms, but also to prevent attacks. 

Asthma has a natural history with some patients doing well with little problems and others having significant difficulty despite all the therapies we have to offer.  Part of the problem is many patients feel their asthma is under good control because they have lived with it for a long time and have adapted to the symptoms. 

The subjective feelings do not match objective testing in most of these patients. We are trying to relieve symptoms, prevent acute attacks, and prevent permanent damage to the airways which could leave the patient with permanent, fixed and non-responsive airway narrowing.  Once this kind of damage is done there is really no way to return the airway function to normal.