Twitchy airways…hyperreactive airways

I heard the best line by a doctor during a lecture. If you are “ticklish, you are ticklish”. The statement was made in reference to hyper-reactive airways. This had me thinking of what makes our airways twitchy?

Another name for asthma?

Did you know that “reactive airway disease” and “asthma” are used interchangeably but are not the same thing?

A precise definition for Reactive Airways  does not exist.1 Reactive Airways disease is a highly non specific term and may be used when asthma is suspected but not confirmed. This highlights that diagnosis of asthma in certain circumstances may be difficult to diagnosis. This is especially true in children where accurate children under the age of five, where tests to diagnosis are generally are not accurate.1

The greatest misuse of this term “reactive airway disease in correlation with asthma and confusion with asthma. This is seen in the pediatric population to describe symptoms of coughing, wheezing, or shortness of breath that may be triggered by infection.

The relationship between asthma and reactive airways

Asthma is often associated with “Reactive Airways” because asthma contains a component of “hyper-reactivity”. Airway hyperactivity means that the airways are hyper-reactive to specific stimuli for example methacholine, histamine, hypertonic saline, distilled water, exercise.2 So, what does this mean? This means that this form of hyperactivity has a broncho-constrictor response, at “doses” that normally would not produce a broncho-constrictor effect. Airway hyperactivity is said to include both sensitivities (the dose of agonist at which the FEV1 begins to fall) and airway hyper responsiveness (the slope of the dose–response curve thereafter).3 “Airway hyperactivity” is a highly specific term with a definite meaning, in contract to “airway reactivity”. It however is not a disease diagnosis but a term that identifies a physiological abnormality of the airway.

I have hyperactive airways (twitchy airways) confirmed by a methacholine challenge. While there is not a lot that can be done for twitchy airways, since airway epithelium is very difficult to alter and frankly, there is a lot that researchers are still figuring out. There is ongoing research that is looking at ways that airway epithelium may be modified. However, we are not quite at that stage, yet. From my own experience, bronchodilators can offer temporary solutions/relief. They have been helpful in keeping my hypper-reactive symptoms at bay. However, what I have found to be a key component is having good overall asthma control. This means avoiding triggers, keeping inflammation in check and staying on top of any changes.

I am hopefully that the development of some of the treatments which researchers are developing and may provide some hope that positive affects on airway hyper-reactivity may be seen. It is important to note that this has not yet been proven in a clinical trial but researchers are optimistic. Some patients, for whom smooth muscle constriction is a main component to their airway hyper-reactivity, may be evaluated for Bronchial Thermoplasty. I did go through the evaluation process for bronchial thermoplasty, however, it was identified that I would always need my anti-inflammtory therapy in conjunction and that I should wait to see if other therapies would be a better fit at this time. You never know, once I have my inflammation, situation under control it may be revisited.

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.
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