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New Symptoms, a Sign of Disease Progression

This has been a week of discoveries. I had been having some new symptoms that I just could not seem to shake. I am currently investigating what may be a root cause. It has been determined that my asthma is maybe progressing. Say what? I was nervous that my good streak of at least mostly stable disease was changing? How can this be possible? It seemed like it took me forever to get me to this point of stability.

My disease is considered to be mostly lung based, however, a recent diagnosis of nasal polyps seems to be shifting the tide to asthma with chronic rhinosinusitis with nasal polyps CRSsNP). This has been associated with poorer asthma control.3 The current plan is to get a handle on the polyps and see if sinus surgery may be helpful and a reevaluation of lung function to see if there are other progressions that have also occurred. This had me considering, how did I get here?

The progression of asthma

It is considered that asthma progression in adulthood is measured by a loss of lung function. 1 While there have been a couple of studies that have primarily focused on the loss of lung function as criteria for disease progression, there are thoughts that this theory may be inconclusive. Researchers are still working on exact causes and processes. With the rise in precision medicine, this theory will expand and be more definitive. In general, it is thought that during severe exacerbations, airway remodeling accelerates and results in a decrease in lung function. While there has been significant focus on a loss of lung function, it may not be the only player. Identifying patients that may be at the greatest risk for loss of lung function over time poses clinical challenges.2

What about the role of exacerbations in disease progression?

Acute exacerbations contribute to disease progression through the possible impact of airway structural changes. These changes may contribute to airway and peripheral lung remodeling, or alveolar wall changes and loss of elastic recoil.3

Researchers are currently looking at defining the biological mechanisms of exacerbations. With the mechanism we can identify what may lead to changes, hopefully, the development of treatments will follow.

Have you gone through disease progression? I would love to hear about your experiences.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Rasmussen, F., Taylor, D.R., Flannery, E.M., Cowan, J.O., Greene, J.M., Herbison, G.P. et al. Risk factors for airway remodeling in asthma manifested by a low post-bronchodilator FEV1/vital capacity ratio: a longitudinal population study from childhood to adulthood. Am J Respir Crit Care Med. 2002;165: 1480–1488
  2. Clinical assessment of asthma progression in children and adultsSpahn, Joseph D. et al.Journal of Allergy and Clinical Immunology , Volume 121 , Issue 3 , 548 - 5573. https://www.atsjournals.org/doi/full/10.1513/pats.2306026
  3. https://www.aaaai.org/global/latest-research-summaries/New-Research-from-JACI-In-Practice/nasal-polyp-asthma

Comments

  • Camouflage
    8 months ago

    Did not realize that asthma would not be reversible. Dx. at age 5, now in late 60’s, 50% of lung function is lost to remodeling. Always thought I could get through it with the battery of meds. What happens next?

  • Leon Lebowitz, RRT moderator
    8 months ago

    Hi Camouflage and thanks for your post. While we cannot provide medical advice or diagnostics over the internet (for your own safety), your concern certainly warrants a reply. Based on your inquiry as to ‘what happens next’, I would suggest you take this up in detail with your prescribing physician. And please do check back with us to let us know how you’re doing. All the best, Leon (site moderator)

  • zues3221
    8 months ago

    wow 73 years that is a long time to have asthma

  • zues3221
    8 months ago

    what is asthma?

  • Lyn Harper, RRT moderator
    8 months ago

    Hi zues3221 – Here’s an article about the basics of asthma. It does a great job of describing what asthma is and the different types of asthma.
    https://asthma.net/basics/
    If you suspect that you have it, I highly recommend you make an appointment with your doctor to be checked out. Keep track of the symptoms you find suspicious and tell your doctor about them.
    Please let us know what you find out.
    – Lyn (site moderator)

  • TracyLee
    9 months ago

    /anjaba, It would be great if you would be willing to describe your successful techniques in the Stories section of this website.

  • zues3221
    8 months ago

    asthma is A condition in which a person’s airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe.

  • Leon Lebowitz, RRT moderator
    8 months ago

    Hi zues and thanks for your post(s). I see in this post you were able to answer your own question (further above) as to ‘what is asthma?’
    If you haven’t already, please note that my colleague, Lyn, has also provided an answer (and some guidance) as to what asthma is and about seeing a physician if you think you may have the condition. Have you seen her reply as yet?
    Leon (site moderator)

  • krishwaecosse
    9 months ago

    Does everyone’s asthma get progressively worse over time?

    I know mine has, though slowly over time.
    I was on low dose ics until a few years ago, and now on a high dose. This proves to be fairly successful most of the time with pred helping with bigger flares.

  • zues3221
    8 months ago

    what is asthma i might have asthma i don’t know much about asthma

  • Leon Lebowitz, RRT moderator
    9 months ago

    Hi krishwaecosse and thanks for your post. I most certainly have heard from patients whose asthma has progressed over time, Frequently, that can be the case until they’ve gained more control through appropriate treatment plans and medication regimens. Based on your comment, that seems to be the case for you as well. Glad to hear you’ve been doing well. Leon (site moderator)

  • zues3221
    8 months ago

    hi leon,
    i might have asthma i don’t know can you tell me somethings about asthma?

  • anjaba
    9 months ago

    My asthma has improved over my 73 years. I became a respiratory therapist to overcome my asthma and it worked. I am a master at avoiding my triggers and keeping my lungs clear of secretions. Asthma does not have to get worse.

  • Leon Lebowitz, RRT moderator
    9 months ago

    Hi anjaba – wow! 73 years of asthma experience and all getting better throughout those years! That’s quite the accomplishment. Over the years I’ve known many, many therapists who have gravitated towards the profession because of their asthma as well. Keep up the good work! Leon (site moderator)

  • ckratina
    9 months ago

    I had mild to moderate asthma from youth till about 2 years ago. Then at 42 I had multiple exacerbations treated with high dose oral steroids with little to no relief. Tried xolair with no success then fasenra. After 6 months able to function with fewer exacerbations with short duration of symptoms. Life changing drug for me. Not sure why the sudden changes. Glad to feel somewhat normal again. It was taking over my daily life before being placed on fasenra.

  • TracyLee
    9 months ago

    Dia, I am glad that the doctors identified something that might be fixable — the polyps.

    For “it is thought that during severe exacerbations, airway remodeling accelerates and results in a decrease in lung function.” How is “severe exacerbation” defined? Is severe an exacerbation that does not improve with a bronchioldataor?

    I spend the first hour of each morning coughing up mucus that collects in my lungs over night, and usually a few more coughing sessions during the day. My pulmonogist has not replied when I asked him whether this indicates enough airway inflammation to risk airway structure changes, so I am left wondering about this.

  • zues3221
    8 months ago

    what is asthma?

  • Shellzoo
    9 months ago

    I am fairly new to an asthma diagnosis but at one appointment last year, it was hinted that my provider suspects I have actually had asthma much longer and have some progression. My latest spirometry result is up to 79 after being on Spiriva Respimat along with my controller inhaler but my provider did not seem very impressed with that result which left me feeling a little deflated. Still, I know that much of the work to breathing well and maintaining my lung function falls into my hands. Since that appointment I got an app to track my asthma. I now have a record of my compliance to treatment and my rescue inhaler use. I can always now look all the way back to childhood and recognize I most likely had mild asthma. I now am left wondering if my denial and lack of recognizing asthma early on lead to where I am now. By the way, I also have had chronic sinusitis and nasal issues for what seems like forever. I look forward to reading more from you regarding this. I know my provider has said a happy nose is important for a happy airway.

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