Looking for asthma facts?

ADVAIR is excited to bring you an insightful Q&A discussion with asthma specialist Dr. Paul Dorinsky.

A brief overview of Dr. Dorinsky's career

Dr. Dorinsky was formerly a Senior Director at the Respiratory Medicines Development Centre at GlaxoSmithKline.

He was trained in Pulmonary and Critical Care Medicine at Ohio State University, where he also spent 15 years as a distinguished faculty member. He was Director of the Medical Intensive Care Unit and an Associate Professor of Medicine at the Ohio State University Medical Center. He is a member of many professional organizations, including the American Thoracic Society and the American College of Chest Physicians (Fellow).

Dr. Dorinsky left Ohio State University in 1998 and until 2008, he did asthma clinical research at GlaxoSmithKline. He is also a practicing physician who sees patients regularly at the University of North Carolina. Dr. Dorinsky has published more than 20 articles on asthma.

Asthma questions answered by an asthma specialist

We asked Dr. Dorinsky these questions:

What is asthma?
How many people actually are diagnosed with asthma?
Is asthma a condition that stops and starts? Or is it something that is always there?
There are many myths surrounding asthma. One that we often hear is that it is possible to outgrow it. Is this true?
So, if people leave their asthma untreated, are there any long-term effects?
Is there a known cause of asthma?
Can you expand on some of the common triggers of asthma symptoms, and maybe some triggers that people are not aware of?
Are there any lifestyle changes that asthma patients can make to help them feel better more of the time?
Are there any dietary changes that an asthma patient can make?
Can you talk to us about the role of preventative medications in treating asthma?
What is ADVAIR and what are some of its benefits?
Why should somebody on ADVAIR continue to take it, even if this person is feeling fine and not having any asthma symptoms?
Can you talk about some of the reasons why people don't take their medications as prescribed by their doctors?
Are there any developments you can point to that have made a difference in the way asthma is being treated?

What is asthma?

Dr. Dorinsky: Asthma is a disease that affects the air passageways of the lungs. It is a disease with two main components—constriction, which is the narrowing of the airways caused by muscles tightening around them, and inflammation, which is swelling of the airways. Constriction and inflammation acting together cause difficulty in moving air in and out of the lungs.

How many people actually are diagnosed with asthma?

Dr. Dorinsky: The Centers for Disease Control and Prevention has estimated that 20 million people in the US currently have asthma. Not everybody who has asthma knows he or she has it, and not everybody who has asthma seeks treatment.

Is asthma a condition that stops and starts? Or is it something that is always there?

Dr. Dorinsky: One of the biggest misconceptions is that asthma is something that a person gets, and then it goes away. This is not true. The underlying parts of the disease, especially the inflammation, can be there, even in the absence of symptoms. It is important, therefore, to treat preventatively—to prevent symptoms from occurring in the first place, rather than waiting until symptoms become so bad that what could have been a minor problem becomes an emergency.

There are many myths surrounding asthma. One that we often hear is that it is possible to outgrow it. Is this true?

Dr. Dorinsky: That's a great question. There are definitely people who develop asthma during childhood and then have periods of time in their late childhood or early teens in which they don't have many, or any, symptoms. A lot of these people will, however, get symptoms of asthma again when they hit the age of 20 or so.

One of the most interesting things we're finding out about asthma is that some people who haven't had symptoms for several years can still have evidence of active inflammation in their airways.

So, if people leave their asthma untreated, are there any long-term effects?

Dr. Dorinsky: There are lots of problems that can take place if people don't treat their asthma. We now know, for example, that not treating asthma may lead to a long-term decline in lung function.

Is there a known cause of asthma?

Dr. Dorinsky: There is really no known cause of asthma. An important question that has been posed is, why don't we all have asthma? We are all exposed to lots of the same things – allergens in our environment, things like pollen, dust, mold, trees, grass, and a variety of other things – and yet, not all of us have problems.

There has been a lot of effort put forth trying to understand if there is a genetic or an inherited basis to this disease, and it definitely does run in some families. But at the present time, there has been no consistent genetic profile or hereditary profile identified in people who have it versus those who don't. A leading theory is that it's some combination of inherited risks for the disease, as well as interaction with allergens in our environment, that work together in leading to the development of the disease.

Can you expand on some of the common triggers of asthma symptoms, and maybe some triggers that people are not aware of?

Dr. Dorinsky: Yes, of course. There are a lot of known triggers for asthma. Some of the most common ones are things that people are exposed to every day, like dust in our homes, for example. There are triggers that most people are aware of, especially if they have any history of allergies. These triggers include ragweed, pet dander, and cockroaches. Triggers that people may not be as aware of are weather conditions such as high humidity, high temperatures, or very cold temperatures. All of these can be triggers for people with asthma. Infections such as the common cold and the flu can also trigger asthma symptoms. And then, finally, there is exercise, which can also be a trigger for asthma.

Are there any lifestyle changes that asthma patients can make to help them feel better more of the time?

Dr. Dorinsky: Yes, there definitely are. For example, people with dust allergies can reduce the dust in their homes by doing things as simple as changing sheets and bed linens weekly. Some air filters can be a big help in cutting down on dust in the home. It's hard to avoid being around pollen if you live in an area where it's very common. Appropriate treatment can play an important role in asthma management. In general, it's important to avoid exposure to strong fumes, cigarette smoke, and so forth. These can be irritants for people with asthma. The one that's often most difficult for patients with asthma is having in their home a beloved pet that may be triggering their asthma symptoms. Although there are some simple things that can be done to help deal with pet allergies, probably the most effective way is to not have the pet at all. Short of that, keeping your pet out of your bedroom or keeping it outside of the house can help cut down on some of the problems associated with pets.

Are there any dietary changes that an asthma patient can make?

Dr. Dorinsky: There is no specific dietary intervention that we know will help improve asthma. I think it's important to eat a well-balanced diet and make sure you are getting all the vitamins and minerals that any of us would need, as well as plenty of rest. I think that makes sense for everybody and will help anybody, including somebody who has asthma.

Can you talk to us about the role of preventative medications in treating asthma?

Dr. Dorinsky: The medications for asthma are generally divided into two classes. The one that most people with asthma are aware of is the rescue inhaler, or quick-relief inhaler, that they take when they get sudden symptoms or asthma attacks. And although it's critical that everybody who has asthma has access to a quick-relief inhaler, having to use it more than twice a week can be a sign that your asthma is not well controlled, and that you may need preventative medications, the other main class of asthma treatments. Preventative treatments help prevent asthma symptoms from occurring in the first place, but need to be taken regularly, every day, as directed by your physician.

What is ADVAIR and what are some of its benefits?

Dr. Dorinsky: There are a couple of things that we have learned about treating asthma in recent years. One is that, for many patients, optimal treatment requires that both main components (constriction and inflammation) of asthma be treated. The second thing is that patients often reach for their quick-relief medications instead of their preventative medications because they can feel the effects very quickly. ADVAIR is a preventative asthma product, and does not replace fast-acting inhalers for sudden symptoms and should be taken twice daily. One of the advantages of ADVAIR is that it contains both a medicine for the inflammation, an inhaled corticosteroid, as well as a medicine for the airway constriction, an inhaled bronchodilator. Unlike just taking a medicine for the inflammation, patients often notice the effects from the bronchodilator early — in the first hour or so. Maximum benefits may take a week or longer. And, very importantly, with ADVAIR, patients treat both main components of asthma, using a single device.

Why should somebody on ADVAIR continue to take it, even if this person is feeling fine and not having any asthma symptoms?

Dr. Dorinsky: I think that it's important for anybody who has asthma to take their medications as their doctor directs, not just when they are having symptoms. We also know that, with appropriate treatment, patients can achieve many or all of the goals of asthma treatment. In clinical trials, people using ADVAIR experienced significant improvement in lung function.

Achieving asthma treatment goals means that patients are able to engage in the activities that are important in their lives. These things are within the reach of most people with asthma.

Can you talk about some of the reasons why people don't take their medications as prescribed by their doctors?

Dr. Dorinsky: One of the reasons is that people who have asthma view it as something they get, not something that is always with them, even when they are not having symptoms. So, as soon as the symptoms go away, they may stop taking their preventative medications, not realizing that the underlying problems that are causing the symptoms in the first place require daily treatment.

Secondly, although there are plenty of effective medications, if people don't think they are helping, and thus don't take them, then they do absolutely no good. I think this is a big challenge with the preventative medications we have for asthma. One of the advantages of combining a long-acting bronchodilator and an inhaled corticosteroid together in ADVAIR is that patients are getting a treatment with two effective medications, and most patients can feel the benefits of treatment in the first hour or so. Maximum benefit may take a week or longer.

Are there any developments you can point to that have made a difference in the way asthma is being treated?

Dr. Dorinsky: I think that there are a couple of things that have been done. There's been a lot of effort on the part of people who care for patients with asthma to get the message out that asthma is a problem that can be controlled—that with good care, you can do most of the things that a person without asthma can do. I think patients who have diseases like asthma think that being impaired is a way of life and, therefore, they don't look for their lives to improve that much. We need to get the message out very clearly that managing asthma well can make a big difference. And that you don't have to have a life that's impaired. Asthma can be well controlled in the majority of patients.