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Difficult-to-Treat Asthma (DTA) article in the Annuls of Thoracic Medicine

This is an article from the Jan-Mar 2011 edition of the Annuls of Thoracic Medicine.  It makes several interesting points about asthma.  I hadn't heard the term "DTA" Difficult-to-Treat Asthma before but it is appropriate!  

In the first paragraph - 

" . . . Nongenuine causes can be further divided into three categories: (1) misdiagnosis where the problem is not bronchial asthma to start with, but another respiratory system pathology that is not appropriately addressed, e.g. bronchiectasis, endo-bronchial tumors, and vocal cord dysfunction,[] (2) comorbidity that worsen bronchial asthma and making it difficult to manage, e.g. chronic sinusitis, gastro-esophageal disease, sleep apnea syndrome, and congestive heart failure . . . "

 

Another paragraph from the article - 

"Asthmatic patients with persistent symptoms despite adequate maintenance therapy should be systematically evaluated to identify factors contributing to the poor control and then adopt a targeted intervention scheme.[,] This includes a through history to identify precipitating factors, home or work allergens, compliance with medications, nature of their illness, and any other relevant issues. A complete physical examination for the chest and the rest of the body is to be done to explore other comorbidities such as the presence of signs of bronchiectasis, interstitial lung disease, CHF, and joint disease. Laboratory tests include complete blood count, serum levels of IgE, schistosoma serology, screening for liver and kidney diseases, and other inflammatory biomarkers if relevant and available.[] Radiological tests include chest radiography, computerized chest, and sinuses scans. Other investigations are requested according to the clinical situation and differential diagnosis.[]"

 

I wasn't sure exactly what "comorbitity" is so I found this definition on the Merriam-Webster online dictionary –

Definition of comorbid

existing simultaneously with and usually independently of another medical condition
 
 
I was thinking that it meant another medical condition that would affect a person's asthma but it looks like it means another medical condition that does NOT usually affect a person's asthma.  Are they just trying to find out if a patient has other medical conditions?  To what end are the extra tests if the other condition does not usually interact with asthma?  Is it in case it IS interacting with the asthma?
 
Thoughts?  Thanks!!
 
( As I was typing all this I think I may have answered my own questions, but I am sure some of you will have more knowledge in this area than I do!!  Thanks!  )
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Comments 9

  • Melissa G

    This is very interesting. I need to take some time later to really give it more thought and I will get back to you. 

  • LK

    Melissa,  You do have a lot going on right now!    No rush! 

  • Pljohns

    Really good article-I’ve been reading a lot of new asthma articles and apparently now, they are subcaterizing asthma into different geanomes-can’t remember what some of them are but I do remember that there is a lot of research on people that are nonresponsive to normal treatment with high eosinophils-@Shea. I thought about you.  Seems like everything that is coming out is for that type of asthma-wish that was me, but it’s not.

  • K8sMom2002
    LK posted:

     I was thinking that it meant another medical condition that would affect a person's asthma but it looks like it means another medical condition that does NOT usually affect a person's asthma.  Are they just trying to find out if a patient has other medical conditions?  To what end are the extra tests if the other condition does not usually interact with asthma?  Is it in case it IS interacting with the asthma? 

    Hey, Lisa, interesting article! Could you talk to your doc about this to get a perspective of how this meshes with your own situation?

    My take on co-morbidities is that it often falls under the "tipping point" scenario. One without the other might be okay, but together, they make things more difficult.

    My DD is a good example of that. 

    When she was very small, she had a history of horrid daily nosebleeds that lasted for 30-45 minutes at a time, and were very difficult to stop. She also had repeat episodes of asthma flares and bronchitis and severe environmental allergies. And she broke out in hives and had severe GI issues whenever she ate corn.

    On the surface, you wouldn't think any of these were connected. 

    First we found out that she had a rare PAIR of bleeding disorders. That was the cause of her nosebleeds. 

    As I tracked her nosebleeds in a symptom log, I noticed that they were worse at times of the year that environmental allergies were worse. But they were better at times that her doctors expected them to be worse (in the winter). That confused her docs, and they suggested we see an allergist.

    An allergist diagnosed her as having a corn allergy, and we pulled corn. No more hives … and no more nosebleeds. 

    Her allergist and hem/onc say that what happened was that one disorder made the other worse. Her corn allergy led to lesions or sores in her mucous membranes, and her bleeding disorder made it where those lesions couldn't heal. 

    With asthma, anything that "triggers" an asthma flare can keep things stirred up and make it more difficult to control. Doctors try to help patients find those triggers and manage them so that patients can be on the lowest possible doses of medication.

    Other co-morbidities can work in a similar way. Diabetes can affect your heart, your eyes, your circulation and the way your body heals. And if you're dealing with CHF (chronic heart failure), you may not be able to exercise, so you may be more at risk for developing diabetes.

    Often times, the same risk factors that lead to one illness like diabetes – obesity, less-than-great nutrition and exercise — can also lead to things like an increased risk of heart attack, stroke and cancer.

    I like to thing of it as tag-team wrestling against us — we're often battling more than one opponent, but our odds of success go way up if we can take out one of the tag-team.

    Thanks for sharing the article!

  • LK

    Cynthia,  I truly appreciate all this!  I find it quite fascinating trying to figure out what's what.  Kind of like a puzzle, I guess.  

    I plan to ask my pulmo at the next visit.  

    What a great way to put it!! –

    "I like to thing of it as tag-team wrestling against us — we're often battling more than one opponent, but our odds of success go way up if we can take out one of the tag-team."

    How terrifying when your DD had those nose bleeds!  My heart goes out to you!  That must've taken quite a bit of detective work on your part to keep track of all the occurrences of physical problems and foods and seasonal changes.  I imagine it took a few years to get a handle on the majority of symptoms.  I commend you on doing such a thorough job to get it all figured out!!  Wow!  

  • K8sMom2002

    Lisa, all the credit goes to our very smart doctors. I've learned that everyone's health picture is different, so it's important that we talk with our doctors and really communicate what's going on. 

  • LK

    Cynthia,  I thought of a corollary to your analogy  - 

    K8sMom2002 posted:

    I like to thing of it as tag-team wrestling against us — we're often battling more than one opponent, but our odds of success go way up if we can take out one of the tag-team.

    One "tag team" may be asthma and all our other medical challenges, but on the other hand we have a "tag team" of our own; mainly ourselves, our doctors and any other helpful people in our lives – especially folks on these forums!  

  • Shea

    I love the "tag team" metaphor fir both sides of the equation: we are fighting with and against trying to find some sort of balance. I think allergists and doctors can do a lot to help us in our detective work– but they cannot do it all. 

    K8Smom, you have to give yourself credit for the detective eork you did and the experts you appriached to identify the corn allergy– what a huge relief it is to know a trigger! But then… There is the avoidance part and that part can be tough. I think you are doing an amazing job of that. 

    I am trying to figure out sone of my son's issues– I know environmental allergens but he is having "itchiness" after eating certain foods so I have been eliminating different things to see what in the world it is. It is either something in his soy-free mayonnaise or in the lettuce mixure…. I have narrowed it down to that. So we are getting closer. It may be a seasonal Oral Food Allergy or the beginning stages of an allergy but reactions have been very small. He has some allergy test scheduled too but they are more general tests so I will need some detective work too.

  • K8sMom2002
    LK posted:

    Cynthia,  I thought of a corollary to your analogy  - 

    K8sMom2002 posted:

    I like to thing of it as tag-team wrestling against us — we're often battling more than one opponent, but our odds of success go way up if we can take out one of the tag-team.

    One "tag team" may be asthma and all our other medical challenges, but on the other hand we have a "tag team" of our own; mainly ourselves, our doctors and any other helpful people in our lives – especially folks on these forums!  

    Lisa, I LOVE it! We DO have a tag team! 

    Shea, good luck on tracking down the cause of the itchies! Glad you have an allergist's appointment coming up. Hopefully that will help solve the mystery.