Speaker 1: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilton.

Speaker 2: 0:21

David Hilton here. Today we're rolling with episode 12 of the podcast, and we're gonna talk about asthma with my friend and colleague, Dr. Josh Dorn. He is an allergist here at Hennepin Healthcare in downtown Minneapolis. Josh, welcome to the podcast.

Speaker 3: 0:34

Thank you so much for having me. Great to be here. Before we start, I also want to formally recognize you for your large promotion to be head of our large internal medicine department. So congratulations.

Speaker 2: 0:44

Thanks, Josh. Uh, uh, for listeners, I'm the chair of the Department of Medicine at Headpins, a new job. I have, I don't know if it's, uh, uh, congratulations or condolences are in order.

Speaker 3: 0:52

We're excited for you.

Speaker 2: 0:53

Thanks a lot. I appreciate it. I appreciate the support. Today we're gonna talk about asthma. What is asthma?

Speaker 3: 1:00

So asthma is a chronic lung condition and it involves inflammation of the airways, which get air to and from the lungs. Those airways become inflamed and that results in breathing difficulties and problems getting that air in and out of the lungs. We're, why

Speaker 2: 1:15

Are we talking to you about this? You're an allergist.

Speaker 3: 1:17

Great question. So there's a couple different specialties that might, uh, focus on asthma. One you may have heard of is pulmonology. Those are lung specialists. And, uh, we, an allergy also treat asthma. And so it kind of depends on the institution where you're at, who treats more severe asthma or some of the difficult asthma cases. But we really both do it and we kind of collaborate here, especially, we might take more of these severe asthma, which has more of an allergic focus, and they might take more asthma, which has maybe other conditions that also affect, uh, breathing, like C O P D and emphysema. Let me

Speaker 2: 1:49

Follow up on that then. What causes asthma? It's

Speaker 3: 1:52

A great question. Uh, we don't really know the answer fully. One problem with asthma is that it's really a syndrome. So it's really made up of probably many different smaller diseases with different underlying causes. And it, it's a combination of things you're exposed to in the environment. So we know of certain environmental exposures that affect the development of asthma, like certain viruses or air pollution, smoking, these sorts of things in combination with genetic factors that would put particular people at higher risk to develop it.

Speaker 2: 2:20

So we're all exposed to those things. I, I go outside, I'm exposed to cold weather, I'm exposed to the same pollutants as the person standing next to me. Why does one of us get asthma? And the other doesn't?

Speaker 3: 2:31

It comes down to the immune system and it being very complex. And so for the same reason, you know, some people might develop an allergy to a particular pollen or might develop eczema in response to certain things in the environment. Certain people's immune systems are more prone to respond in an allergic way or an inflammatory way to pollution or, uh, you know, other irritants. Uh, whereas other people's immune system might just treat it as the, something that's not significant.

Speaker 2: 2:57

So you said it's an in inflammation and, and your body is reacting to something. What is actually happening into, in the airways?

Speaker 3: 3:04

The airways are becoming inflamed, and when that happens, they become more narrow and they become inflamed because you get an immune response in the airways and this causes them to kind of swell up. If you think of somebody who has like eczema on the skin and their skin becomes inflamed, that same sort of process is going on in the airways and the tissues in the airways become inflamed. The muscles that control the airways can become kinda large and sort of hyperreactive, and those immune cells in the airways might secrete more mucus. And so all of this causes more narrow airways and that makes you not able to get air in and out as well as somebody else who doesn't have that.

Speaker 2: 3:41

So the person suffering from asthma, they're not moving air in and out. What symptoms might they experience? What does that feel like to the person who has it?

Speaker 3: 3:49

Yeah, the first thing, it, it, it feels bad. Like when you're not breathing well, it doesn't feel good. Yeah, it

Speaker 2: 3:54

Sounds like it freaked me out. It

Speaker 3: 3:55

Doesn't feel good. Um, the, the typical symptoms are cough, wheezing, shortness of breath and chest tightness. And uh, it's, it's highly variable. Some people have those symptoms all the time. Some people vary infrequently, but all of that can be asthma. What

Speaker 2: 4:11

Is wheezing? I think a lot of people know that, especially parents of like children who have it, you know, they, they've heard the term wheezing.

Speaker 3: 4:19

Yeah, wheezing is, what is it? Yeah, it is a high pitch noise, uh, that typically happens when you breathe out and it's a sign that there's a little bit of blockage, especially in the smaller airways of the lungs. Can

Speaker 2: 4:31

You give us a, are you good at doing impersonations? We'll

Speaker 3: 4:34

See.

Speaker 2: 4:35

Give us a wheeze. Not bad<laugh>. I'm looking, I'm looking at Dr. Do, he's over there with a big smile on his face. He's trying to do the wheezes

Speaker 3: 4:46

Fir. That was my first attempt. But, um, basically people with asthma, they can't especially get the air out of the lungs as efficiently as other people. They can't

Speaker 2: 4:53

Get the air out. Yeah.

Speaker 3: 4:54

Not in, in sometimes, but especially out. So there's obstruction, so it takes'em longer to get the air out than other people. And

Speaker 2: 5:02

Then the, the sound of that air moving slow makes that wheezing sound correct.

Speaker 3: 5:06

Like a musical high pitch sound. And

Speaker 2: 5:08

Some you said get cough, others get chest tightness. Uh, say more about the episodic nature of it. You said some people with asthma have it all the time. Others just sometimes. Can you say more about that?

Speaker 3: 5:19

Definitely, yeah. So many different diseases, if you have 50 patients with asthma, they can all have very different symptoms and patterns. Um, we, we kind of divide it up into persistent asthma and intermittent asthma. So persistent like it sounds, symptoms are typically present frequently, and that could be, you know, every day for people every week, but they don't really go away for a prolonged period of time. Other people might get intermittent asthma where certain times of year if they're allergic to a pollen, like a tree pollen, they get asthma symptoms. And if they're not around that, if they're not around a cat, then they don't get those symptoms. We're learning more and more that even these people with intermittent asthma can still really get severe flares in their asthma. So it, it doesn't always correlate to how mild or severe it is per se, but there's certain patterns people typically have that are different.

Speaker 2: 6:06

How common is asthma both in children and adults? Yeah,

Speaker 3: 6:09

Very common. So, and kids, I I believe it's the most common chronic, uh, illness in children probably affects around 10% of kids. There's a lot in the US a lot of kids, a lot of kids now, many of those can sometimes go away into adulthood. Doesn't always persist in the US as a whole. It's estimated that about 26 million people have asthma. Uh, so it's a lot of people, it's even still one of the most common chronic illnesses in adults. And might be around, depends on the population, but maybe around, uh, seven or 8% of adults.

Speaker 2: 6:39

Does that correlate with the same people who have allergies? In other words, you, you used the word eczema earlier, an allergic type of skin condition. Some people have nasal allergies, you know, environmental allergies, other have asthma. Uh, is there a correlation between the people who have those various conditions?

Speaker 3: 6:56

Uh, yes, definitely there is, there's both allergic and non-allergic asthma. But for somebody, asthma can be an allergic condition or it is an allergic condition in many. And if you have some of these other allergic conditions like eczema or allergies that affect the nose, you're at higher risk to develop asthma.

Speaker 2: 7:14

So 26 million people are living with asthma. It's probably not all of the same severity. And I want to delve into that a little bit. It can be a very serious condition, right?

Speaker 3: 7:24

Yes. So even, uh, death from asthma is a possibility. I think the last data from the CDC was 2019, and at that point it was estimated that about 10 people per day died of asthma. Now it's, it's still very rare and usually, you know, we're always focusing on how can we reduce people's risks to have a sort of a bad outcome like that. But, but it can be very serious. And then on the complete opposite end of the spectrum, it can be very, very mild too.

Speaker 2: 7:48

So is it equally common all over the, we're talking about the United States here or, or are there geographic differences?

Speaker 3: 7:55

Yeah, so, um, as far as the world goes, you're more likely to have asthma in more developed countries. Really?

Speaker 2: 8:01

Why? Probably

Speaker 3: 8:02

Do we know why? Well, all allergic conditions are like that and certain other inflammatory conditions are, and it has to do with what you're exposed to in the environment. If you live in like an urban area in the US where it's more common, you're exposed to different sort of irritants like air pollution, you might have less exposure to good bacteria. So the microbiome, which is the amount of, uh, bacteria or the bacteria that live on us and in us is distorted in asthma and other similar conditions where you don't have as many good bacteria. And that definitely plays a role in the development of asthma. And that that might be why compared to somebody growing up in a more rural area who has exposure, you know, on a farm for example, exposure to animals. It's a very different set of exposures that your immune system learns to respond to and is affected by when you're developing.

Speaker 2: 8:49

I think that's a fascinating point that what you're exposed to in your environment has a fairly direct link to this particular medical condition and probably quite a number of medical conditions as an allergist. Then, are you one of, are you a proponent of exposing your children to allergens and things in the

Speaker 3: 9:08

Environment? For a while there I was letting, uh, my oldest child be licked by her dog as much as possible. I think it's

Speaker 2: 9:13

A good idea. Does your kid eat dirt and all that too?

Speaker 3: 9:16

Well, my wife didn't like that, uh, but it was, uh, sort of tried a couple times, maybe<laugh>, I didn't fight it when you started to eat it, let's just say.

Speaker 2: 9:23

So are cases of asthma on the rise? Are people living with, with asthma on the rise in the us? So

Speaker 3: 9:28

Definitely over the past several decades, if not longer, asthma has been increasing. It's possible. There's been a little bit of leveling off maybe in the past seven or eight years, like since 2016 there's been, um, a reduction in the amount of asthma exacerbations in children. And so maybe we're treating it better. Maybe things like tobacco smoke exposure going down a little bit. It's hard to know, but it's possible. There's been a little bit of leveling off. We've seen that with some other things like food allergy too.

Speaker 2: 9:56

Are there things parents can do to reduce the risk of their child developing asthma?

Speaker 3: 10:02

We don't have any reliable preventative factors. Certainly many things are being studied, uh, including like many illnesses. Vitamin D has somewhat been implicated. Maybe, uh, maternal exposure to vitamin D during pregnancy or or after pregnancy may play a role in asthma development. But I think the combination of factors that lead to the development of asthma are a little bit too complex for us to be able to parse out for a a single preventative strategy at this point.

Speaker 2: 10:29

Let's talk about the severity and the stages and then I'm gonna ask you how is it diagnosed? So you said there's various stages per, you used the word persistent, you used the word mild. Um, talk to us about the, the, the stages.

Speaker 3: 10:40

Yeah. So stages are used basically to determine potentially what type of treatment someone would need or, or determined by what type of treatment they do need to control their asthma. But like we discussed, there's, we sort of divided up into intermittent and persistent, which is somewhat self-explanatory. And then within this persistent group we divided up into mild, moderate, and severe. How

Speaker 2: 11:04

Do you diagnose asthma?

Speaker 3: 11:05

The diagnosis is made based off of a combination of symptoms like we discussed the cough, weed, shortness of breath and chest tightness and breathing tests. Okay. So the symptoms have to occur in particular pattern and, and kind of behave like asthma. Sometimes people are more likely to have asthma symptoms during the night or early in the morning or with some of these exposures. We discussed, uh, irritants, uh, smoke, exercise allergens. And then the breathing tests include lung function tests where we actually test how well can people breathe air out of their lungs and into their lungs. And like I said, you can't breathe air, especially out as well with asthma. And there's another breathing test that's a little bit newer called exhaled nitric oxide, which actually tests for allergic inflammation in the lungs. Okay. And so some people really have black and white asthma. It's very clear do they have asthma, asthma or not? But there's also a lot of gray area. So we use this combination of factors to try to figure out if somebody has asthma. Sometimes if we're not quite sure, we might even put them on asthma treatment for a time and then retest the breathing test to see if that improved symptoms which would confirm the diagnosis. Even

Speaker 2: 12:08

In my clinic, my primary care practice, I'll get a patient comes in and they're wheezing. It's obvious I can hear it with my stethoscope. It's one of them actually, the things we can hear quite well with our stethoscope, can't we? But they don't all have asthma. There's other causes of reactive airways, if you will. So who should get those breathing tests? Is, is it just if you're not getting better on your inhaler, you should go get the breathing test? Or do you think that parents of children or adults for themselves, if you're having a wheezing thing, should they all get that breathing test?

Speaker 3: 12:38

Uh, so you know, generally most of our breathing tests would occur after on the age of five or six. So sometimes in very young kids there is breathing tests you can do, but they're not always the most helpful. And anybody who's having persistent respiratory symptoms should probably be evaluated, could be asthma or could be something else that can mimic asthma, all of which, uh, uh, would be beneficial to kind of figure out.

Speaker 2: 12:58

We're talking with Dr. Josh Dorn, an allergist here at Hennepin Healthcare in downtown Minneapolis. We're gonna take a quick break to catch our breath. We'll be right back.

Speaker 1: 13:08

You are listening to the Healthy Matters podcast with Dr. David Hedon. You got a question or comment for the doc? Email us at healthy matters hc m e d.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 13:31

And we're back talking to Dr. Josh Dorn about asthma. He is an allergist here at Hennepin Healthcare. So Josh, let's talk about treatments for asthma. Starting with the mild cases, what can be done? Yeah, so

Speaker 3: 13:42

For treatments I would kind of divide it into both, uh, medication treatments and non-medication treatments. Hmm. So for, for non-medication treatments, we're thinking about certain triggers for your asthma. If it is an allergen type of problem, then there's maybe certain things we can do to reduce exposure to that. Certainly tobacco, smoke exposure, things

Speaker 2: 14:00

Like that. So allergen is something in the environment?

Speaker 3: 14:03

Yeah, so allergens are usually proteins in the environment that can get into the airway and trigger this immune response, um, more significantly either in the nose or the lungs or or in the skin with eczema. And these are things like indoor things, dust, mold, animals, cockroach, even mice, and then outdoor things like pollens from trees, grasses, and weeds.

Speaker 2: 14:24

Those are proteins. Yes. And so then allergen then is a protein that your body's reacting to? That's right. So that's the first thing you do in looking at asthma treatment.

Speaker 3: 14:32

Yeah. That, that's one thing. So if you know, obviously most people would prefer to avoid something that's causing their symptoms rather than just take a medication to get rid of it, depending on to get

Speaker 2: 14:41

Rid of the cockroaches in

Speaker 3: 14:41

Your house. That's right. That's one thing. Sometimes we have to do that and it does help. Yeah. Yeah. The cockroaches are actually a pretty potent asthma trigger. And this might be some of the reason why you see high rates of asthma in certain populations that live more in like inner city urban areas.

Speaker 2: 14:54

That's fascinating. But I wanna bring up the picture. I have seen in every allergist office of what your home's supposed to look like, an Ikea store. It looks like something, there's no fabric, there's all a lot of hard edges on it. So how do people live their lives without having curtains, bedspreads, pillows, rugs? How do you make your house so that your, your child is less apt to get asthma or have a flareup?

Speaker 3: 15:16

Yeah, so a lot of our, you know, if there, if there is pests or animals triggering asthma, that's a little more straightforward, but they're

Speaker 2: 15:23

Never gonna get rid of their dog, Josh.

Speaker 3: 15:24

That's right. I tell, I tell people if if the allergist tells you to get rid of your dog, they just get rid of the allergist and find it. Yeah, that's what I would do.

Speaker 2: 15:30

I'd find it everyone. Yeah.

Speaker 3: 15:31

So the, the, the best data we have for environmental reduction in uh, allergic exposures is with dust mites, which are these little bugs that live in sort of the bed and the pillows, uh, in the carpet. You know, you can get special bed covers and pillowcase covers. You can get an air, a special type of air filter that will reduce your exposure to that. Hard floors are better than carpet and so there is some things you can do to reduce your exposure to that. But your point is well taken in that you usually, with many of these things, especially dust, you can't eliminate your exposure to that. You can reduce it somewhat. And so I I do tell people not to go too overboard because it's not gonna necessarily cure the asthma in every case. Yeah,

Speaker 2: 16:08

Yeah. Cuz we're talking about treatments of asthma here and I know we're gonna get into medications and inhalers, but the first thing you brought up is removing the allergen as part of the treatment and you're dangerously close to telling me I have to vacuum. You know, now you're talking crazy because you know, I'm not gonna vacuum. This

Speaker 3: 16:22

Isn't personal<laugh>,

Speaker 2: 16:24

But it is important to, to reduce your exposure to the things that are causing your asthma.

Speaker 3: 16:29

It, it can help. We have other things like allergen immunotherapy or allergy shots, which if the exposure is kind of too hard to get around, like pollens, people should be able to go outside. We can kind of reteach the immune system to not be overreactive to those things and make you more tolerant. And that can help with asthma as well. Exercise. So like our Academy of Allergy, just release guidance on the importance of exercise in asthma, which you think is a little counterintuitive cuz you, you think that people with asthma and might not be able to and if your asthma is poorly controlled, certainly you can't. But I usually tell people that if you can't do activities like that, it's sort of, it's my job to figure out how you can do those. And exercise regimens have been shown to improve some lung function and symptoms over time as well. You know, it's diet and exercise, right? So even diet, eating a healthier diet with lower inflammatory index. Um, things like omega-3 fatty acids with more fish oils and FRS fruits and vegetables also has a little bit of evidence in asthma. That's

Speaker 2: 17:22

So interesting because I tell people all the time, you should eat, eat like you live in the south of France on the Mediterranean diet and eat right. But I'm usually thinking cuz it's good for your heart. I don't often think that this could also be good for your lung function.

Speaker 3: 17:34

Asthma is also an inflammatory condition much like, you know, cardiovascular disease may be mm-hmm.<affirmative>, it doesn't just sit in the lungs by itself. So there is higher rates of cardiovascular disease in people with asthma. There's sort of this bidirectional relationship with asthma and even mental health disorders, uh, as they may share some, some underlying causes a little bit as well. And so obviously the lungs are what we focus on, but the lungs are in your body. Mm-hmm.

Speaker 2: 17:59

<affirmative>. Great points. Great points. Okay. What next in treatment? So

Speaker 3: 18:02

What, you know, what most people are familiar with are, are the asthma medications delivered by inhaler or nebulizer? Uh, the most common one being like albuterol. And what albuterol does is it sort of temporarily relaxes the muscles around the airways and allows those to open. That's really temporary. It doesn't really help with the underlying inflammation problem. That's really the issue in the airways. But albuterol is one treatment for fast relief of, of symptoms.

Speaker 2: 18:26

Is that what we mean by the rescue inhaler that some people talk about?

Speaker 3: 18:30

Yes, that's correct. So when people talk about a controller versus a rescue inhaler, so a controller inhaler is one you take every day to help prevent symptoms. A rescue inhaler is one that you take when you're having symptoms to quickly relieve them. We're, we're getting away from that maybe a little bit because it can be number one, a little bit confusing to people. I know you've seen in your clinic how many people come back, you give them two different inhalers, it's very difficult to keep straight which one you're supposed to use when. Okay. Exactly.

Speaker 2: 18:55

And I've had loads of people not using them as I intended.

Speaker 3: 18:58

Yes. And that, that's well supported by literature. The other common type of inhaler used uses one with anti-inflammatory medication and like a little bit of steroid inhaled steroid that's delivered to the airways. Those are traditionally taken every day to help prevent symptoms. And so when you know somebody gets a, a bad virus, which can also trigger asthma, uh, symptoms that you have a better control at baseline, which would help prevent more of a severe flare exacerbation asthma attack. Uh, what have you,

Speaker 2: 19:25

Are there adverse effects or side effects from taking, uh, in inhaling those two things, especially the steroid inhaling that every day? Is that

Speaker 3: 19:33

A problem? You know, there's no treatment we can do without potential side effects. So when people think of steroids, you know, the other common type of steroid people might think about is something like prednisone and that's a pill that affects the whole body. And sometimes for severe, uh, asthma flares we have to use that the inhaled steroids are much lower doses and delivered directly to the airway. And so there's a lower chance of those full body effects of steroids. And some people depends on how they break down the medication, but some people do have a little bit of a higher amount of exposure they get in their bodies to those inhaled steroids. But generally over time there's much smaller risk of these long-term steroid side effects. Those side effects potentially would be bone issues like osteoporosis, uh, higher sugars in the blood, so increased risk of diabetes, things like glaucoma that affects the eye. And then, you know, for the, for the steroid inhalers, actually what most people experience is sometimes just local side effects. So they, they breathe it in and some of it too much gets left in the throat and this can lead to horse voice or it can lead to uh, sort of a yeast, uh, candida thrush type infection in the, in the throat.

Speaker 2: 20:35

So you hear a lot about, on the TV news and stuff, you see somebody with asthma and they're running through a b filled tulip field and their asthma's all well controlled and they're advertising all these other inhalers. So beyond the basic albuterol and inhaled steroid, there's a lot of other options, aren't there? There

Speaker 3: 20:53

Are other options. Um, one of the kind of newer options that's more adopted in recent guidelines is actually using a similar inhaler that we commonly use with a steroid. It has another medication in it that's more of like a long-acting form of albuterol. Mm-hmm These were typically the controller medications where you would get that one for everyday use and then the albuterol for rescue use. But these inhalers now are sometimes used both as the controller and the rescue. So that's called smart therapy, single maintenance and reliever therapy. And that's adopted in more of our recent guidelines, which gives people just one inhaler they can use for everything and has been shown to reduce the risk of exacerbations and you may get less exposure to that steroid over time. Yeah, that

Speaker 2: 21:33

Really makes sense. If you add one inhaler that has two or three medications in them, and some of them do, many of them do, that might be easier for people to use. Um, rather than having the handful of different inhalers, that one's the blue one, one's the red one and which one do I use. Now when do people need the pills? Like you talked about prednisone. Sometimes we give patients a few days worth of a systemic or something that you swallow and inflammatory. When do, when do people need that? Yeah, what

Speaker 3: 21:59

You're referring to is, uh, what we would call, like there's different names for it. We call it an asthma exacerbation, but commonly people might say like asthma attack and this is a sudden worsening in symptoms where you're taking your inhalers or baseline medications and they're not working well enough. So you might take your albuterol and you're still having significant symptoms and this is what can lead you having to come to the hospital or becoming very sick from asthma. And so for those people, sometimes you would get a full body steroid and that's like prednisone. The most common way to do it is give it for five days. For people having one of those significant flares, sometimes they're given as injection.

Speaker 2: 22:33

What about all of the newer medications?

Speaker 3: 22:35

We have this newer class of medications called biologics, uh, and these are injection medications that sort of like replicate what your own immune system might do, but they're made to really target in a more specific way. Certain parts of the immune system that affect asthma. Oftentimes these are the more allergic parts of the immune system. So whereas prednisone really blanketly sort of shuts down or depresses the immune system for a time to reduce inflammation, these are much more targeted. And so they have many times great effects, uh, on symptoms and reducing those severe exacerbations, but they don't come with the same side effects as as the prednisone does. These

Speaker 2: 23:12

Are the ones, uh, listeners that you might be seeing on the TV

Speaker 3: 23:15

A lot. That's right. And, and you know, sometimes my patients are just as happy as the people in the commercial.

Speaker 2: 23:19

Are they really? Because they always are, you know, they always are. They're running through tulips with, you can see the pollen in the air and they're all just dancing through there and they're doing well. Those medications are effective, aren't they?

Speaker 3: 23:29

Very effective, very expensive. Uh, that's kind of the main downside, but you have to take'em as an injection usually somewhere between every two to eight weeks depending on the medication and really can help reduce your overall cumulative exposure to those steroids, which is a good, uh, sort of risk reduction, uh, uh, technique. Now. Now for those people, uh, who get to that point that's really called severe asthma, that's where you're, uh, you're, you're on a good amount of inhalers and you still have severe asthma. Not everyone has truly severe asthma, but for those that truly have that severe asthma, then those biologic medications have been very nice. Great

Speaker 2: 24:02

Information there. Let's shift now to the lifetime course of it. If, if my child has asthma or I'm an adult with asthma, can I expect it to get better with time or does it get worse?

Speaker 3: 24:12

Uh, as a blanket statement, a little bit hard to predict there. There's many different types of asthma. So you can have early preschool asthma, middle childhood asthma, adolescent asthma, early adult, middle adult, later adult and they can all kind of behave differently. So I guess we can take two examples. One would be like a younger childhood onset asthma who might have wheezing with viruses or sometimes in between viruses. The chances that they then go on to have asthma persistently into adulthood is probably less than 50%. So many of those do get better.

Speaker 2: 24:40

That's

Speaker 3: 24:40

Encouraging. Yeah, it is. Uh, you know, sometimes it'll go away for like 10 years and then it will come back in adulthood. But it, you know, I tell people like if they're worried about taking this daily medication, it doesn't mean it's forever. Like we just know that we have to do it right now and then things can get better. If you take another group of people, there's another type of asthma, which is very common to start in people's forties. More common in women and more common to have this certain type of allergic inflammation with eosinophils, a certain type of white blood cell. And those people, uh, if they get that type of asthma, that's a very persistent asthma that's unlikely to go away. It's a little bit harder to control. You're more likely to, to get those exacerbations or flares. So different types of asthma behave differently, but it's not necessarily forever.

Speaker 2: 25:20

It's interesting that it's a wide range of diseases or a wide range of presentations that we all call asthma. Think down the road with your crystal ball, do you think we'll get to a cure?

Speaker 3: 25:31

Yeah, I think as a blanket cure for all asthmas, that's hard to conceive right now just because there are so many different types and so you might need different sort of targets for each type. I think there are some like interesting studies going on. For example, if we talked about the microbiome earlier, like the bacteria which interact with your immune system. And so in some studies they've given a certain type of sort of broken down bacteria that can modify the immune system. So sort of getting more into that root cause on the level of the immune system might be the way that we could potentially target that in the future. Uh, but for right now we're a little bit far away from that I think. So

Speaker 2: 26:07

It does sound like our treatments are making substantial progress.

Speaker 3: 26:11

Our treatments are making substantial progress. I think the most exciting thing, you know, compared to maybe 20 or 30 years ago, everybody with asthma got the same treatments. Now we know because of these different types of asthma, we actually have more sometimes precision in how to treat these specific types. There's these things called treatable traits of asthma. So these will be specific features of someone's asthma maybe on their level of their immune system or other conditions they have where we can treat them in a very unique way to help them compared to somebody else who has a different type of asthma. So we're getting better at that.

Speaker 2: 26:41

Great news for people living with asthma. Dr. Josh Jordan, thanks for being with us today. Lots of great information for our listeners. Anything else you want to add?

Speaker 3: 26:48

Yeah, thanks again for having me here. Um, the only thing else I want to add is I'm involved in this very cool asthma camp for kids called Camp Superkids. I went to

Speaker 2: 26:56

It. Oh, we even have a graduate, uh, in our production team. That's right.

Speaker 3: 27:01

And look at him doing fantastic<laugh> further support for the, uh, for our camp. But it's super exciting. So it's at Camp i Hopi, which is a Y M C A camp, uh, in sort of west of the Twin Cities. So the camp is for kids with asthma ages seven to 16. It's a very cool camp because you get to do all the fun regular camp stuff with lake and activities, but also there's a little bit of a focus on asthma and camaraderie to be around other kids with asthma. It's fully staffed with medical providers of all types, uh, for the whole camp and it's really a great time. So I just wanted to mention that. How

Speaker 2: 27:32

Cool is that? So it sounds like we have a fan of the camp here on our production team. We will put a link to the camp in the show notes. So, uh, listeners, you're gonna want to check that out. Dr. Josh Jordan, it's been a great show. Thanks for being with me. Thank

Speaker 3: 27:44

You very much,

Speaker 2: 27:45

Listeners. I hope you've picked up some information as have I, and I hope you'll join us for our next show. In the meantime, be healthy and be well.

Speaker 1: 27:53

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden. To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. If you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan Camino and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.