Online Health Chat with Lamia Ibrahim, MD & Rachel Taliercio, DO

Wednesday, August 16, 2017


Description

At Cleveland Clinic Asthma Center, we offer the most advanced diagnostic testing and innovative treatments for adults and children with asthma. Within Cleveland Clinic Respiratory Institute, the Asthma Center brings together physicians from allergy and immunology, pulmonary and critical care, and sports medicine (for asthma in elite athletes). For those with asthma and co-existing conditions, such as sinusitis, gastroesophageal reflux, vocal cord dysfunction, cataracts, glaucoma or osteoporosis, we also coordinate your care with specialists in gastroenterology, ophthalmology, otolaryngology, osteoporosis and metabolic bone disease, and speech therapy.

Asthma is one of the most common chronic diseases in the world, becoming more prevalent and more severe in recent years. Asthma causes the airways of the lungs (bronchial tubes) to narrow, the lining of the airways to swell and the cells that line the airways to produce more mucus. These changes make breathing difficult and cause symptoms, such as cough, shortness of breath, wheezing, chest tightness and excess mucus production.

Asthma symptoms are not the same for everyone. They can even change from episode to episode in the same person. Also, you may have only one symptom of asthma, such as cough, but another person may have all the symptoms of asthma. It is important to know all the symptoms of asthma and to be aware that your asthma can present in any of these ways at any time. Symptoms include coughing, especially at night; shortness of breath; wheezing; and chest tightness, pain, or pressure.


About the Speakers

Lamia Ibrahim, MD, attended Ain Shams University Faculty of Medicine in Cairo, Egypt and completed her residency in internal medicine at the Illinois Masonic Medical Center. She completed fellowships in pulmonary critical care and sleep medicine at University Hospitals, and was appointed to the Cleveland Clinic staff in 2013.

Rachel Taliercio, DO, completed medical school at New York College of Osteopathic Medicine, and completed her internship and residency at Cleveland Clinic, where she was appointed to the staff in 2012. Her specialty interests include, asthma, bronchitis, COPD, cough, emphysema, end stage lung cancer, lung cancer, pneumonia and pulmonary disease.


Let’s Chat About Asthma


Asthma ABCs

Susan5467: Can you develop asthma later in life, even if you’ve never experienced symptoms when younger?

Rachel_Taliercio,_DO.: Yes. You can develop asthma as an adult. This is called adult-onset asthma and can even happen much later in life.

Martymoose44: Can asthma cause permanent damage to the lungs?

Lamia_Ibrahim,_MD.: Asthma is reversible obstruction in the airways of the lungs. Certain medications can help reverse this obstruction. If severe asthma is left untreated for many years, it can lead to permanent damage in the lungs. Asthma attacks can heal by forming scar tissue in the airways, which can lead to irreversible damage. The obstruction then becomes permanent.


Determining Diagnosis

Burt&Ernie: I typically have a cough every morning and a lot of mucus build up. I fight the mucus and cough throughout the day until about 1 p.m. Could this be asthma? How would one get tested for asthma?

Rachel_Taliercio,_DO.: Yes, this could be asthma. Getting more information about your symptoms and health history will be important. It will also be important to get breathing tests done. This is called spirometry.

curious124: I have a chronic cough that I'm afraid might be linked to asthma. What type of specialists or treatments are available to help diagnosis whether this is asthma or something more serious?

Rachel_Taliercio,_DO.: Asthma can be a cause of chronic cough. Breathing tests can often help support the diagnosis of asthma. Specialty chronic cough clinics typically involve pulmonologists (lung specialists) and ENT physicians (Ear, nose and throat specialists).

DrTerri: I am interested in having someone re-evaluate my asthma. I have had it all my life and been able to control it. Now, at age 59, I am having more issues controlling it. I have noticed an inability to train for my next half-marathon due to more persistent constriction. I’ve been evaluating food sensitivity, which seems to have some impact. How do I select the right type of specialist for my type of condition? I see a number that seem to deal with more end stage and elderly issues. Who is best for an older, overweight, semi-athlete?

Rachel_Taliercio,_DO.: I am sorry to hear your asthma has been more difficult to control. I would recommend you start by seeing an asthma specialist. In our Asthma Center, we work with adults of all ages and see many different types of athletes. See the appointment information at the end of the chat.

BigPicture: My FEV1 readings are stable but well below average. My pulmonologist thinks there may have been some structural change in my lungs that has caused this reduced capacity. Are there any diagnostic tests that could be performed to determine the underlying cause(s) of this diminished capacity? Are structural changes in the lungs ever reversible? Thank you.

Lamia_Ibrahim,_MD.: I am sorry to hear your readings are below average. This is a difficult question to answer in a few sentences in a web chat without the actual testing results, but I will try. Asthma can lead to irreversible damage in the airways, but FEV1 readings alone are not always the only diagnostic factor. So, yes, there is other testing that can and should be done to determine if the damage is irreversible or if there are other underlying conditions that may be contributing. You may have already had these tests done and, therefore, your pulmonologist gave you this diagnosis. Without all your information at hand, I cannot say what other testing should be done. In our Asthma Center, we do extensive testing to make sure the changes are irreversible and true.

BigPicture: Follow-up: What tests do you perform to determine if the damage is irreversible? Thank you.

Lamia_Ibrahim,_MD.: We typically use a combination of tests over time, which include breathing tests and imaging. Initial testing includes confirming that your symptoms are from asthma. As I mentioned earlier, it is very difficult to give you an exact answer without seeing your records. If you would like a second opinion, our Asthma Center does offer virtual visits where you could present your records for further evaluation. See the message below regarding virtual visits.


Thinking Treatments

Prizeless12: Why are there so many different types of inhalers? Which one would you recommend?

Rachel_Taliercio,_DO.: There are several different classes of inhalers. Some contain steroids and some contain short- or long-acting airway dilators. Inhalers can also have two different types of medications in one. These are combination inhalers. The type of inhaler prescribed varies based on what condition is being treated.

MoMtoBE1985: I am pregnant and my asthma seems to be getting worse. Is there anything I can do? I have followed my action plan the same way for many years and have been in the green zone. Since I found out I was pregnant, I have been falling more into the yellow zone with chest tightness and shortness of breath.

Rachel_Taliercio,_DO.: Unfortunately, asthma can get worse during pregnancy. It may be necessary to start a daily medication (if you are not already on one), add another medication or increase the dose of existing medications. Please make sure to discuss your symptoms with your doctor. There are many ways to help you feel better.

MOrk&MinDi: What are your thoughts on using Chinese herbal therapy as a complimentary treatment?

Lamia_Ibrahim,_MD.: There is no medical-based evidence to suggest the use of herbals is beneficial; rather, there have not been formal studies looking into it. I would recommend discussing with your physician which herbals you are considering using, and he or she may be able to research information on that.

Betty1004: What type of inhalers should I consider when first diagnosed with asthma?

Rachel_Taliercio,_DO.: It will depend on whether or not you have daily symptoms of asthma and if you need to use your rescue inhaler on a regular basis. Your doctor can determine the severity level of your asthma (mild, moderate, severe) and then discuss medication options with you.


Talking Triggers

Samson4: Does stress trigger asthma?

Rachel_Taliercio,_DO.: Yes. Stress can definitely trigger asthma. It is important to know your triggers in order to help manage asthma symptoms.

lemonyyellow: My daughter has been diagnosed with exercise-induced asthma. Is that the same thing as "real" asthma?

Lamia_Ibrahim,_MD.: Asthma is the reversible obstruction of the airways in the lungs, which means during the attacks the person has difficulty blowing air out of the lungs. Asthma has many different causes and triggers. Exercise-induced asthma means that the obstruction occurs in response to exercise, so the trigger is exercise. The difference between exercise-induced asthma and typical asthma is that there is only one trigger, exercise, and when the person is not exercising they have no symptoms. Rarely, exercise-induced asthma can become typical asthma with other triggers, so that is something you should be mindful of with your daughter.


Life with Asthma

1st Grader: My son (recently diagnosed with asthma) is starting school next week, and I am nervous he will have trouble with his asthma. What are some things I can do to better prepare him for "asthma attacks"?

Rachel_Taliercio,_DO.: It will be important for your son to have an asthma action plan. This will help him know when and what medications to use if he is having asthma symptoms. The school nurse can review the plan and will be able to help. If he is on a daily medication for asthma, it will be important for him to take it every day as prescribed. Please make sure he has his rescue medication either with him or in the school office. It is also important to know his triggers, such as allergies, as avoiding known triggers when possible will help keep asthma under control.

winon: How do I slow the advancement of what I think is a minor case of COPD? Does it have to get worse as I age? I am 56 and quit smoking 43 years ago when I developed asthma after years of exposure to smoke in the home and cats and dogs. Since I left MN and moved to the southwest desert, I haven't had a cold or flu in more than 18 months. However, twice in the last six months I needed to use an inhaler because of overexposure to bleach, and exposure to cats and cigarette smoke. I walk 15 to 20 miles a week, hike regularly and play pickleball. What else should I be doing to prevent disease progression?

Rachel_Taliercio,_DO.: Congratulations on quitting smoking! This is the best thing you can do for your lung health. I also want to commend your commitment to staying active and exercising regularly. It is encouraging to hear that you have not had a chest cold in over a year. Exposure to strong odors and irritants such as smoke is a common cause of difficulty breathing, both in COPD and asthma. COPD is diagnosed by breathing tests. Please schedule a visit to see your doctor and get routine lung function testing (spirometry).

Rachel_Taliercio,_DO. and Lamia_Ibrahim,_MD.: Thank you for joining us today!


Closing

That is all the time we have for questions today. Thank you, Dr. Ibrahim and Dr. Taliercio, for taking time to educate us about Asthma.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at my.clevelandclinic.org.


For Appointments

To make an appointment today with one of our asthma specialists. Call the Asthma Center at 216.444.0582 or toll-free 800.223.2273, ext. 40582, or learn more on our website at clevelandclinic.org/Asthma.


More Information

About Cleveland Clinic

At Cleveland Clinic's Respiratory Institute, we provide world-class patient care by combining our strengths in clinical expertise, research and education. Serving nearly 90,000 patients annually, the Respiratory Institute’s unsurpassed expertise and experience attracts patients from all over the world who seek a definitive diagnosis and leading-edge treatment, often for a rare or complex lung disorder. With more than 100 pulmonologists, allergists/immunologists and critical care specialists, the Respiratory Institute diagnoses and treats a wide range of lung, allergy and breathing-related conditions.

At Cleveland Clinic Asthma Center, we offer the most advanced diagnostic testing and innovative treatments for adults and children with asthma. Within Cleveland Clinic Respiratory Institute, the Asthma Center brings together physicians from allergy and immunology, pulmonary and critical care, and sports medicine (for asthma in elite athletes). For those with asthma and co-existing conditions, such as sinusitis, gastroesophageal reflux, vocal cord dysfunction, cataracts, glaucoma or osteoporosis, we also coordinate your care with specialists in gastroenterology, ophthalmology, otolaryngology, osteoporosis and metabolic bone disease, and speech therapy. Our integrated approach to patient care provides you with state-of-the-art diagnostic and treatment services and opportunities to try new medications and therapies through clinical trials.

Services

We offer a full range of clinical services including:

  • Comprehensive consultation services and ongoing care for refractory asthma (poorly-controlled asthma)
  • Occupational and environmental asthma evaluation
  • Bronchoprovocation testing with methacholine and exercise
  • Testing for suspected sensitivity to foods, food additives, aspirin and allergens
  • Specialized testing to determine how well your asthma is being controlled
  • Treatment for asthma, including new and innovative therapies from injections to procedures
  • Treatment and direction for coexisting conditions that complicate asthma control
  • Initial management plans for newly diagnosed asthma cases and continued care when needed
  • Comprehensive patient education

Cleveland Clinic Health Information

Cleveland Clinic Treatment Guide

Clinical Trials

  • Asthma Research & Clinical Trials
    The Asthma Center is a forerunner in developing new treatments through clinical trials and conducting translational research that supports and enhances patient care.
  • For additional information about clinical trials, visit ClinicalTrials.gov.

Your Health

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A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic My Consult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.

Virtual Visit Information

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This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2017. The Cleveland Clinic Foundation. All rights reserved.