HOW does untreated asthma cause lung/airway damage?

[giraffescantdanceallnight]

Have read in various places that if asthma is not well controlled then it can cause damage to airways.

So if hypothetically someone might be coughing/wheezing having a flare up but for whatever reason don't have access to or don't use meds or seek treatment...once the cough/wheeze stops will this have caused damage to their lungs?

Have read that this is the case but not HOW or WHY or any actual research on it. Can anyone help?

And if this is the case then does it need to be made more common knowledge?

Not sure where you are coming from in terms of background knowledge of physiology etc but this information is certainly out there and the whole idea of asthma nurses, specialist clinics etc is to manage the fact that its not just flare ups and short episodes, its lifelong chronic disease. Over time the inflammation that causes acute attacks can lead to airway remodelling, changes in the epithelial tissues lining the small airways, muscle changes making the airways permanently narrowed. This is why its important to identify and avoid triggers, and if you are symptomatic enough to need a steroid inhaler its suggested you use it regularly, to suppress the inflammation leading to these changes.

Just because its news to you doesn't mean its news to everyone else, its a big area of discussion and research, not fully understood, and there are certainly many people across the world working on the mechanisms behind chronic changes in asthma and trying to minimize them. I should state that I am not involved in any such research or clinical work.

That last paragraph seems really churlish of me- good on you for taking an interest and trying to find out more. A good and reliable place to start might be the British Thoracic Society www.brit-thoracic.org.uk - you will see patient info/links to all sorts of lung conditions. Asthma UK is another site you might find useful.

I used to work in asthma research....but researching the fine detail not the whole picture.

I think

Imagine your airways as a soft squidgy rubber band like tube.
Now you get an infection/inflammation.
During this there are lots of ways that the delicate cells of your airway can be damaged. There are lots of chemicals flying about which are designed to get all the fighting equipment up and running.
But these chemicals can cause a range of effects and the combination of these chemicals and any bacteria can damage the airways in the short term.
But thats ok...the body can repair it....except the repair isn't quite the same. It is scar tissue.
A bit of scar tissue in an otherwise healthy lung isn't a big problem but in a person with repetitive lung injury (eg an asthmatic) the scar tissue builds up.
So now instead of soft squidgy flexibke airways they are scarred and less springy. Also the scar tissue isnt the same as 'proper' lung tissue. Its thicker, and the oxygen can't pass across it so easily, so essentially the area of the lung which is useful for absorbing oxygen is reduced...making the lungs need to work harder, making things that much more critical during the next exacerbation.

I hope that makes some sense.

Two very good explanations there. Just to re-iterate, it's not one untreated episode that causes long-term damage, it's repeated episodes over a long period of time. Hence the emphasis on good long-term control.

I'd be worried if anyone with asthma wasn't aware of this. Whoever is managing their asthma clearly needs to work on their patient education skills!

thanks for this thread

i think i have asthma after chest infection last year. i see i should be taking it a bit more seriously!

maybe i should actually get and use an inhaler then

You need to see a GP or expert in asthma before jumping to a conclusion you may have it.

not treating the inflammation of the airways can lead to scarring.
which means that the airways then are not as flexible anymore and can't adjust to changes in air pressure, can't easily widen for easier breathing

edwina explains it so much better...
which is why it is soooo important to keep up with the medicines.
in case you can't get to the gp for a new prescription of your steroid treatment you could get a steroid nasal spray at the chemists.

merci make an appointment with your gp (or athma nurse if they have one). I usually use my reliever (blue inhaler) in case of an attack or constricted breathing. and steroid nasal spray through hayfever season (one of my triggers). other asthmatics might need long acting stepid inhalers (brown inhaler).

"Just because its news to you doesn't mean its news to everyone else"

I really don't think it is common knowledge - I don't mean among Drs I mean among asthmatics. I constantly hear people say "Oh I should probably take my inhaler" or "Oh yes I always forget to take it" I am not sure they KNOW that it is not just the issue at the time but potentially causing long term problems.

And actually as a severe brittle asthmatic who has regular hospital admissions and attends resp clinic and difficult asthma clinic then I have never been told that either. Been told it's importnt to have good control so as don't end up having serious attacks etc. But no one has ever actually said that it is important to treat the wheezing/cough/tightness right away as can be causing damage.

I am on

4 x a day 250 flixotide
4x a day 250 seretide
1x a day spiriva
1x a day 10mg montelukast
cetirezine

regular predniselone 40mg a day courses
regular doxycycline courses

So I do know the importance of keeping on top of it but am not sure it is common knowledge other than "because you might have a worse attack" the aspect of it permanently damaging your airways and leading to worse conditions when older is not imo well known.

Sorry to hijack your thread giraffe but I wondered if anyone knew if anything would show up on a chest x-ray if you had asthma?

No a chest x ray shouldn't show up asthma.

You are on Flixotide AND Seretide? Then you are taking Fluticasone (the steroid in Flixotide and Seretide) far too much You need to be either on Flixotide and (a separate inhaler) Serevent, or Seretide only, two puffs twice daily. Spireva is a long acting bronch-dilator normally used in irreversible airway narrowing, (as a result of airway remodelling from not taking preventer puffers( ie steroid puffer) or smoking related irriversible airway damage commonly known as COPD.

Sorry posted too early. As a severe brittle asthmatic I would still be querying the dosage as usually you would use tow DIFFERENT steroids and would also be wanting bone density scans to ensure I was not suffering the side effects of lots of steroids. Are you seen in a tertiary centre? ie A large specialist teaching hosptial for this?

Yes am on flixotide and seretide - am on that as been told it is about equivalent of taking a low dose of pred. And is to try to prevent the very very frequent high doses of pred I have.

Yes been told that spiriva is not licensed for asthma but it works for me.

Yes seen in a very large hospital that has a specialist CF unit and my resp consultant is very well known. People from hours away come to be treated here as their local hosps not specialist enough.

candy no won't show up on xray but can do tests like spirometery