Can You Outgrow Asthma? with Neha Solanki, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Imagine trying to take a breath and just not being able to pull the air you need into your lungs. It's a terrifying thought, and it's also a real worry for 300 million people around the world with asthma. So, here's a question, if you have the condition, is there a chance it might lessen with time or even go away? We're going to explore that topic today with pulmonologist Neha Solanki. She is one of the many trusted experts at Cleveland Clinic who pop into our weekly podcast to talk about our health. Now, let's take a look at asthma and whether there's anything you can do to loosen its grip on your breathing. Welcome back to the podcast, Dr. Solanki. Thanks for gifting us with some of your time again.

Dr. Neha Solanki:

Yes, thank you so much for having me.

John Horton:

So, in researching for today's topic ahead of our chat, I was absolutely blown away by the number of people - it was 300 million - who are dealing with asthma around the world. I get the sense that asthma is a much bigger issue than most of us suspect.

Dr. Neha Solanki:

Yes, it is, and so many people have it worldwide. We have so much asthma here in Ohio even. It affects children, it affects young adults, into our aging population, so it is definitely something that we see all the time that affects the ER, affects primary care, affects pulmonary care. A lot of people have it, and it is a bit of a burden on our healthcare system.

John Horton:

And that's why we're talking about what we're looking at today, which is what you can do to maybe minimize asthma or even if it's possible to outgrow it. So, when it comes to that, whether you can just get past it, does that happen or is it a little more complex than just a yes or no answer?

Dr. Neha Solanki:

Yes, I wish I could tell you, "Yes, it goes away when you turn X number of years of age," but that's not the case. Asthma is a disease of chronic inflammation in the airways, and a lot of times, it's driven by allergies. It can be driven by other things such as pollution, but the main driving force for most asthma is allergen exposure. If you continue having exposure to that allergen and you have a diagnosis of asthma, you will likely continue to have asthma.

We are talking now about asthma remission, and that is where people do go through what we call remission. So, they stop experiencing the symptoms of asthma, they don't have to use their inhalers as often, and this doesn't happen to everybody but there are a select group of people that do experience this as they grow older.

On the other hand, we have people who, as they get older, develop asthma, so it's something that we're looking into, something that is being actively researched, but it is not a one-size-fits-all.

John Horton:

So, it sounds like the whole remission concept with it, that's something that we're still learning a lot about? Because I remember seeing that a lot of kids will outgrow it, and I don't know if that's the right phrase or not, but it seems to lessen. Does that happen frequently with kids, or is it something that's hit or miss?

Dr. Neha Solanki:

We do see that a lot with the pediatric population. I do specifically adult asthma, but obviously, all adults were kids at some point. And so, they'll come in and they'll say, "I had really bad asthma as a child and then I grew out of it for many years, and then it came back." So, some people do grow out of it to grow right back into it, and then, some people grow out of it and never experience these symptoms again. The question becomes: Did they truly have asthma as a child? Did they have some sort of bronchitis? So, it's up for debate whether they ever fully outgrow asthma. It is something that can come and go over time.

John Horton:

And that's one of the big things. It seems like you see where even if you think that you're past it a little bit, it sounds like you're always at risk of it returning. Maybe something will set it off, or you have a certain trigger that will kickstart it up again.

Dr. Neha Solanki:

Yes. So, the people with asthma don't actively deal with their asthma every day, they have certain triggers. So cold weather is their trigger or perfume is their trigger, and once they experience those triggers, they have an asthma exacerbation. And that can be unpredictable. That can lead to an urgent care visit, a visit to the doctor or even sometimes, a visit to the emergency department. So even with somebody who has a mild form of asthma, the right trigger could still cause them to get very sick.

John Horton:

And does that happen out of the blue or is there a slow ramp-up?

Dr. Neha Solanki:

Generally, it can happen either way. Most people - if your trigger is perfume, you're going to start feeling that right away. If your trigger is cold, you'll feel that right away. With things such as allergies, such as cat dander, for instance, that person's asthma may need persistent exposure to the dander to develop that exacerbation. However, another person may have an acute exacerbation. So that's what makes asthma a little bit tricky - people aren't really textbook cases. Everybody's very unique, and everybody's experience with his or her own asthma is also very unique.

John Horton:

And you had mentioned that there are some people who will develop asthma later in life. Do we know why that happens or what all of a sudden makes it where you have trouble breathing like that?

Dr. Neha Solanki:

It's very puzzling. We don't know exactly why it happens, but we see it in our clinics. We see people who all of a sudden, they were exposed. Usually, there's an exposure, there's something that happens, something that they breathed in, they got sick with some illness that was going around in their family, and something about that exposure changes their immune system and they then develop persistent inflammation that goes on to be asthma. And this happens with a lot of chronic illnesses. You have a genetic predisposition and then, something else happens that pushes you over, and then you develop that chronic disease.

John Horton:

Yeah, so is there anything that people can do to manage asthma or keep the symptoms from returning with a vengeance?

Dr. Neha Solanki:

I think that you can control the things that are within your realm of control, and then there are certain things outside of your direct control that you can't really do very much about. So, what can you control? You can control your exposure. So, if you know have certain allergens, try to limit your exposure to that allergen if you can. If you're allergic to dogs, try to limit your exposure to dogs as much as possible, or at least see an allergy specialist or a pulmonary specialist if you have a pet that you're allergic to. That would be the first thing, avoidance. The second thing would be, if you have certain medications, if you're prescribed medications that you have been told to take, take those medications. But outside of avoidance and adherence to medications, there's not too much more that's within your control. Other things, though, could include don't smoke cigarettes, don't vape, don't smoke marijuana. Try to avoid going to campfires if you know that aggravates you. All of this is avoidance - falls under the umbrella of avoidance.

John Horton:

I thought I read somewhere, too, where they said sleeping positions might be able to help with asthma.

Dr. Neha Solanki:

What we know about sleep is that if you sleep on your side, it can help keep your airway open. So, if you're predisposed to something like sleep apnea, that positioning helps, but I don't think that the sleep positioning itself will help reduce risk of asthma. I think it can help you optimize the good sleep that you're getting if you sleep in a way that allows you to get good sleep, but it doesn't necessarily help you improve asthma control.

John Horton:

So, to go over them again, we're looking at avoiding the triggers. What are some of the main triggers? You had mentioned pet dander. What are some of the other biggies that might set things off for people?

Dr. Neha Solanki:

The first one always is pet dander. We have a patient who comes in, who has seven cats, and she has a cat allergy, and she has asthma because of all of the cats. That's going to be your first major trigger. Other triggers that we see often include dust, dust mites, and this can be triggered even if you wash your sheets daily, you're cleaning daily. You still can't see dust mites with your eyes, they're microscopic. And so, for that reason, we recommend using dust mite covers for your pillow, dust mite covers for your mattresses to try to mitigate the exposure to the dust mite.

Sometimes, when people go to hotels, their allergies and asthma act up a little bit more because you're sleeping in that bed and the bed can have dust mites. And so, for those people, I'd recommend trying to take an antihistamine with you if you're sleeping in a hotel. Those are your most common ones. We also see allergens such as pollen, trees, spring allergies - people often call it a ragweed allergy. Those are also common ones that we see. Those are all the allergic types of triggers. Then, you have non-allergic triggers that include air pollution, that include perfume, cold weather, exercise. And sometimes, someone's asthma is multifactorial, which means they have a little bit of cold-triggered, a little bit of fragrance-triggered, a little bit of allergen-triggered. Those people have multifactorial asthma.

John Horton:

It sounds like if you have asthma, it is one of those things that you have to manage your entire life and be cognizant of it, and make sure that you're avoiding those triggers and anything that could make it flare up?

Dr. Neha Solanki:

Yes, it is, and it's surprising the ways in which it can affect you. For instance, if you are somebody who wants to scuba dive, you have to consider your asthma in making that decision. Scuba diving is going to very, very deep waters, and in those depths, you're exposed to a lot of pressure pushing in on your lungs. If you have asthma, then you are more prone to having a fatal exacerbation, so you have to be checked out by a doctor who has to check your lung function testing, who has to make sure that you're breathing the way you should be breathing before you attempt scuba diving. That's an aspect that you wouldn't think you'd be affected by, but in fact, you are.

People who join the military have to be screened for asthma, and that's because if they have exacerbation while they're engaged in combat, that could be potentially disastrous. So that also is something that people don't often think about.

So, there are many ways in which it can affect your life, but I think for the most part, if people are, like you said, aware of what their triggers are, if they're smart about the decisions that they make regarding their asthma, they can be pretty controlled. Most people are pretty controlled with their asthma. There is a small percentage of people who, their lives are very affected by their very severe asthma, and they are very, very ill, but for the most part, people are able to manage it with or without medications and under their doctor's guidance.

John Horton:

Well, you've given us a fabulous game plan to follow, to keep asthma in check. Before we say our goodbyes, though, is there anything that we missed or anything else that you'd like to add?

Dr. Neha Solanki:

I think that asthma is an encouraging condition for me to treat because I think that people can get better and we see people get better and have fulfilling lives with minimal symptoms, and I think that's something to be optimistic about and something that we should be happy about. Asthma is something that we can take care of, and we can manage - and we can't say that about a lot of chronic illnesses.

John Horton:

Dr. Solanki, the perfect way to wrap things up. Thank you so much for being with us today and I look forward to having you back.

Dr. Neha Solanki:

No problem. Thank you.

John Horton:

Asthma is a potentially life-threatening condition that typically doesn't just disappear. And even if the condition does seem like it's gone, there's always a possibility it may return. That's why it's important to make lifestyle choices that can help keep it away. Until next time, be well.

Speaker 3:

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