Asthma

Overview

Asthma is a long-term condition that affects respiratory airways. This disease most often begins in childhood, but it can start at any age. 

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Asthma is a condition affecting the breathing of the patient due to the irritation in the small tubes or airways carrying air in and out of lungs. These airways are called bronchi. 

Asthma symptoms occur when bronchi get inflamed (swollen), become narrower and thus reducing the air flow to the lungs.  Additionally, increased amount of mucous secretions (sticky phlegm) and chest muscle stiffness further make breathing more difficult.

It is believed that asthma patients have more sensitive airways that get irritated when patient is exposed to asthma triggers Allergies and hypersensitivities are typically to blame for this condition, as well as any associated complications/ exacerbations.  

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Asthma triggers are substances in air or a state of condition which induce asthma symptoms.  Asthma triggers varies from person to person.  One person may have many triggers of asthma. Commonly asthma symptoms are triggered due to exposure to house dust mites, animal fur, pollen, tobacco smoke, certain chemicals fumes and even exercise, cold air and chest infections

In some people asthma symptoms are triggered due to exposure to certain chemicals/ substances at workplace e.g. chemicals in paints, fumes and gases, latex use in the making of gloves etc.  This type of asthma is referred as Occupational Asthma.

Signs and Symptoms

The severity of asthma varies from person to person and can include:

  • Shortness of breath
  • Wheezing and coughing attacks especially at night time
  • Chest pain or tightness
  • Whistling sound when exhaling
  • Trouble in sleeping due to excessive coughing

The symptoms may get worse with certain situations, such as:

  • When exposed to allergies
  • With exercise
  • With exposure to occupational dust, gases or chemical fumes
Causes and Risk Factors

Exactly what causes asthma is unknown. 

Most doctors believe that a combination of genetic and environmental factors are at play.  There are many triggers that can stimulate asthma symptoms that all people with asthma need to be aware of and these include:

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  • Allergic substances in air we breath (house dust mites, molds, animal fur etc)
  • Physical activity (exercise-related asthma)
  • Smoke and other air pollutants
  • Stress and strong emotions

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  • Gastro esophageal reflux disease (GERD) or acid reflux disease
  • Infections of the respiratory system e.g. common cold
  • Cold weather or cold air
  • Certain medications, such as aspirin, naproxen, beta blockers and ibuprofen
  • Preservatives and sulfites
  • The menstrual cycle

 

Asthma Attacks

Usually severe asthma attack develops from 6 – 48 hours.  The patient feels more wheezing coughing, breathlessness, tightening of chest and the routine inhalers do not relieve the symptoms.  In case of severe asthma attack, the patient should contact the doctor immediately.

Below are some risk factors that may increase chances of developing asthma:

  • Family history of asthma (a blood relative has asthma)
  • Being a smoker
  • Pollution or exhaust fume exposure
  • Being overweight
  • Having an allergic condition
  • Being exposed to occupational irritants (paints, chemical fumes etc)

 

Diagnosis and Testing

After a complete physical examination and making note of the patient’s symptoms and medical history, the doctor will perform pulmonary function testing to see how air is moving out during breathing.  Common tests include:

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  • Peak flow: This test looks at how hard a person is able to breath out.  When the readings are lower than what is considered to be normal, this can indicate a worsening of asthma and that the lungs are not working as well as they should.
  •  Spirometry:  This test looks at bronchial tube narrowing by testing the ability to exhale after taking a deep breath.  It seeks to find out how fast a person is able to breath out and how much they can breath out.

Doctors may recommend additional testing in the diagnosis of asthma and to get an idea of how progressed it is and these may include:

  • Methacholine challenge: This is a medication that is known to trigger asthma and cause mild airway constriction.  If a person has asthma, they will react, aiding in a diagnosis.
  •  Imaging tests: Doctors may do CT scans and chest X-rays to look for structural abnormalities in the sinuses and lungs.
  •  Sputum eosinophils: This test looks at eosinophils (a type of white blood cell) in a mix of sputum and saliva that is coughed up.
  •   Nitric oxide test: This test looks at how much nitric oxide is in the breath to measure airway inflammation.
  •  Allergy testing: This can be done to see if a specific allergy is triggering asthma.
Treatment

Primarily, asthma treatment will include avoiding substances that trigger asthma symptoms and taking medicines as per doctor’ instructions.

Asthma is a chronic (long-term) condition, but there are a wide range of treatments that can help to reduce symptoms and control the disease.  Asthma does not impact the quality of life of the patient as such, provided that the proper medications are used. Medications are a common factor in asthma maintenance and there are many different types.  It is said in medicine that even the worst case of asthma is treatable.  Long-term medications are usually taken everyday to control this condition and they may include:

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  • Inhalers – containing a drug called corticosteroids to reduce inflammation
  • Combination inhalers  – that usually combine a corticosteroid and a long-acting beta agonist
  • Leukotriene modifiers can help to alleviate the symptoms of asthma for as long as 24 hours
  • Long-acting beta agonists work to open the airways

Rescue medications may include:

  • Short-acting beta agonists to rapidly lessen symptoms by dilating the airways
  • Corticosteroids can be given via IV and orally to reduce  airway inflammation
  • Ipratropium works to relax the airway immediately

Doctors may also recommend medications and therapies to keep allergies under control for those whose asthma is triggered by specific allergens.  Allergy medications and allergy shots are commonly prescribed in this case and the type prescribed ultimately depends on the patient.

Possible Complications

Asthma is a serious condition and when it is under-treated or left untreated, complications can occur, including:

  • Flare-ups causing missed school and work days
  • Inability to participate in recreational activities
  • Severe asthma attacks
  • Medication side effects
  • Permanent bronchial tube narrowing
Living with

Most people with asthma are able to live a full life with some lifestyle modifications and maintaining the conditions of your environment:

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  • Be careful of the cold
  •  Keep your home clean: Make sure to keep your home and furniture dust free.  Clean your bedding and curtains regularly
  •  Prevent mold spores: Make sure to avoid damp (moist) area in the home to prevent fungus or mold growth
  •  Maintain a healthy weight: Being overweight can worsen asthma symptoms
  •  Control GERD and heartburn: Talk to your doctor about the best medication to keep these under control
  •  Exercise regularly: This helps to strengthen your lungs and heart.
  • Reduce pet exposure: If you are allergic to animals, make sure to clean regularly and have all pets groomed.

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