Asthma is a disease of the small airways in the lungs that become over-reactive to a number of triggers. (Asthma has been described as “twitchy lungs.”) This can cause obstruction leading to cough, shortness of breath, chest tightness, and wheezing. Any new onset of wheezing should be evaluated by a physician as there are other causes, including cardiac problems. Over 1 in 20 Americans have been diagnosed with asthma. The prevalence of asthma has increased 61%, and death 31%, since 1980.

Multiple environmental factors contribute to asthma attacks. They include respiratory infections (bronchitis,sinusitis, and pneumonia), breathing in cold air, drinking cold liquids, humidity, dust, allergies especially to cats or other animals, GERD, emotional stress, ingesting sulfites added to food, and of course smoking and other inhaled irritants. Air pollution is certainly linked to asthma, but in spite of public misconceptions, because of clean air laws in the United States, the important types of gas and particulate pollution have been reduced 50 to 80% from 1970 to 2006.

Dietary factors have been neglected. Many studies using elimination diets have shown various food items can precipitate an asthma attack. Cow’s milk and dairy foods in general has been shown to be the worst offender. Peanut allergy has been well publicized but is far less common, and there is a long list of foods that affect some people occasionally. Beer, wine, and liquor contains histamine, the chemical that sets off allergy symptoms, and studies have verified this connection. Wine and beer also contain sulfites. Bologna, some hot dogs and other prepared meats also contain sulfites, and I remember the patient years ago who got a severe asthma attack every time he ate a bologna sandwich. A high fat diet fuels the inflammatory component of asthma. Vitamin D has been shown to lessen inflammation in asthma and enables steroids to work better. It has been shown that asthma medications lower vitamin D levels, therefore making the asthma worse. (2/3rds of us have vitamin D insufficiency if it hasn’t been diagnosed and treated).

Treatment usually starts with inhaled bronchodilators such as Albuteral on an as needed basis. This is an adrenaline type of drug and side effects include rapid heart rate and palpitations. Steroids (prednisone) are the most powerful dilators of bronchial tubes known, given either orally or by inhalation. Chronic oral steroids have well known side effects, but your doctor may prescribe frequently a 5 day course of Medrol dospak (a steroid) that does wonders for an asthma flare-up without the long term side effects. Inhaled steroids (sometimes given chronically in severe cases) also are very effective with a lower incidence of side effects. Intal by inhalation is an anti-inflammatory sometimes prescribed especially for children. Singulaire is a leukotrien antagonist (leukotriens are inflammatory white cells) and is a potent drug for lessening symptoms of allergies and asthma. Long acting Albuteral type inhalers are also useful, some in combination with inhaled steroids.

Even though most asthma should be able to be controlled or even cured, the statistics remain sobering. Elimination diets are often effective but under recommended. Any asthmatic can try it themselves by eliminating one class of common foods for several weeks, and see the results. Eliminate any obvious triggers, and dairy is the first class of foods that should be tried.

Why should the incidence and death rate from asthma be so much higher just since 1980? Smoking and air pollution are decreased. But changing diets more likely to worsen asthma and lower vitamin D levels now compared to 30 years ago are the most likely explanations.