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Asthma

What is Asthma?

It is a respiratory condition which mainly affects the airways causing them to narrow down. This makes breathing difficult and causes shortness of breath. Patients with severe asthma may even have trouble talking. The airways also produce extra mucus which leads to a whistling sound (wheezing) while breathing. 

Asthma is common among all age groups; children, adults and elderly. There is no cure for asthma and effective management lies in preventing and relieving the symptoms.

 

Symptoms

  • Shortness of breath

  • Chest tightness

  • Chest pain, especially while coughing

  • Easily gets tired (fatigue)

  • Wheezing (whistling sound) while breathing out (common in children)

  • Difficulty sleeping due to coughing, shortness of breath and wheezing

  • Coughing or wheezing attacks are worse when you catch cold or flu

Causes and triggers

  • Respiratory tract infections such as sinusitis 

  • Allergens such as pollens, molds, dust and dust mites

  • Pet danger (hair and skin shed by pets e.g., cats, dogs etc)

  • Strong odours from perfumes, paints or cleaning solutions

  • Air pollution

  • Tobacco smoke

  • Chemical fumes

  • Exercises

  • Cold air or changes in the weather conditions (temperature or humidity)

  • Gastroesophageal reflux disease (GERD is stomach acid regurgitating into the food pipe)

  • Emotional stress such as anxiety, sadness etc

  • Medicines such as NSAIDS (non-steroidal anti-inflammatory drugs such as ibuprofen), aspirin (blood thinning medicine) etc

  • Consuming food items that contain sulfite (food preservatives) such as certain pickles, bottled lemon juices, beer and wine

 

 

 

Risk factors

The following factors increase the risk of developing asthma

  • Family history (parent, sibling or any blood relative with asthma)

  • Exposure to various triggers during childhood 

  • Boys are more likely to develop asthma in comparison to girls

  • Having allergic condition, such as eczema (itchy inflammation of skin) also known as atopic dermatitis (young children with atopic dermatitis tend to develop asthma later in life) 

  • Having underlying lung infections such as pneumonia or bronchitis

  • Obesity/ being overweight

  • Smoking cigarettes or cigars

  • Exposure to secondhand smoke

  • Exposure to exhaust fumes/gases 

  • Occupational hazard such as exposure to chemicals used in farming or manufacturing

Types of asthma

  1. Mild intermittent asthma: mild symptoms less than 2 times a week. Night-time symptoms are less than twice a month. Can be manged with fewer medications.

  2. Mild persistent asthma: symptoms occur 3 to 6 times a week. Night-time symptoms are around 3 to 4 times a month. Asthma attacks may affect normal daily activities.

  3. Moderate persistent asthma: asthma symptoms occur daily. Night-time symptoms occur around 5 or more times a month. Symptoms affect normal daily activities and lifestyle modifications are required.

  4. Severe persistent asthma: asthma symptoms occur daily and quite often. Symptoms affect normal daily activities and sleep. Activity restriction is required.

Diagnosis

Your doctor may ask you to undergo any of the following tests to diagnose the type and severity of asthma.

Spirometry: it is a simple breathing test which measures the amount of air inhaled and exhaled by an individual.

Exhaled nitric oxide test: You will be asked to breathe into a tube that is connected to a machine. This machine measures the amount of nitric oxide in your breath. The levels of nitric oxide are higher if your airways are inflamed.

Chest X ray: this provides an image of the airways and the lungs. A chest x ray is helpful in identifying any structural abnormalities which may be causing airway obstruction.

Chest CT (computerized tomography): this is helpful in identifying any soft tissue abnormalities of the airways. It is very easy to diagnose chest infections on a CT scan.

Allergy tests: this can be either a blood or skin test. It is helpful in exactly pinpointing which allergen triggers an asthma attack.

Sputum test: this test looks for presence of red blood cells and/or white blood cells(eosinophils) in the sputum. Healthy sputum contains less than 1% eosinophils, if the count is higher, then probably you are suffering from asthma.

Also, presence of bacteria or any other micro-organism in the sputum that is causing lung infection also increases the risk of developing asthma.

 

Treatment 

There is no definite cure for asthma. Symptomatic management with the help of inhalers and oral medicines is the treatment of choice. Your doctor will prescribe right medications depending on the type of asthma, severity of symptoms, age and allergens causing it. 

Your doctor will closely work with you and create an asthma action plan. He/she may ask you to track your symptoms and create your own list of triggers. The type, frequency and duration of the medicines will be altered depending on your progress. It is important to follow your doctor’s advice if you want to adequately control your asthma. 

What is an asthma attack?

It is an episode of severe breathlessness which occurs due to marked constriction of the airway muscles (bronchospasm). Thick and more viscous mucus is produced which lines the inner walls of the airways making breathing very difficult. The condition is life threatening if not promptly treated. Other symptoms of an asthma attack include:

  • Severe wheezing while breathing 

  • Severe coughing that won't stop

  • Rapid and shallow breathing

  • Pale and sweaty face

  • Bluish discoloration of lips and fingernails

  • Marked chest pain 

  • Severe chest tightness or sense of pressure

  • Tightness of neck muscles (retractions)

  • Difficulty talking

  • Associated feelings of anxiety 

The symptoms of an asthma attack can quickly worsen. It is important to immediately use an inhaler (bronchodilator) to ease breathing. If the patient is not responding to inhaler and symptoms continue to get worse, the patient should be rushed to emergency department without losing any time. 

 

Lifestyle modifications and home remedies

  • Use an air conditioner: this will reduce the number of pollens, dust particles and dust mites in the indoor air.

  • Cleaning up your space: regularly clean your house, especially vacuum clean your bedroom pillows, mattresses and blankets to get rid of any allergens, bed bugs, dust mites etc.

  • Avoid having indoor plants: these will increase the level of indoor humidity and create a damp environment for molds to grow rapidly.

  • Reduce pet danger (dried skin or hairs): avoid pets with fur or feathers. Don’t allow the pet on your bed or in your personal space. If you have a pet, regularly get it groomed and clean the surroundings more frequently.

  • Avoid exposure to cold air or air pollutants: wear a face mask to cover your nose and mouth when outdoors to avoid inhaling any smoke or allergens.

  • Maintain a healthy body weight: asthma symptoms are worse and difficult to manage in obese patients 

  • Breathing exercises: will help in managing episodes of breathlessness

  • Pace your activities: don’t exert yourself and take breaks/rest periods between your daily activities

  • Natural remedies: consuming ginger, garlic, omega-3 oils (present in fish and flax seeds), herbal teas etc. may help in managing asthma symptoms.

  • Alternate medicines: yoga, acupuncture, meditation etc. may also be effective in managing breathing difficulties.

  • Get those allergy shots: overtime allergy shots will reduce your immune system response to specific allergens. Shots are usually given over a period of few months to few years.

  • Vaccination: get vaccinated for COVID-19, flu, pneumonia, shingles, or whooping cough (pertussis). This lowers the risk of developing these conditions as well as asthma.

 

Complications 

If asthma is not effectively and timely managed, it can lead to serious medical complications over the period of time. These include-

  • Pneumonia 

  • Loss of pregnancy

  • Preterm delivery 

  • Permanent narrowing of bronchial tubes 

  • Lung collapse

  • Respiratory failure

Types of Asthma

Bronchial Asthma is the most common type of Asthma, which affects the bronchi in the lungs. Other Asthma includes childhood asthma and adult-onset asthma. In adult-onset asthma, symptoms will not appear until at least age 20.

Other specific types of Asthma are the following:

1. Allergic Asthma (extrinsic Asthma)

Allergens are the cause of this common type of Asthma. Allergic Asthma is quite often seasonal because it goes hand-in-hand with seasonal allergies.

These might include:

  • pet dander from animals like dogs, cats and rodents
  • food
  • mould
  • pollen
  • dust

2. Nonallergic Asthma (intrinsic Asthma)

Irritants in the air but not related to particular allergies trigger this type of Asthma. These are:

  • burning wood
  • cigarette smoke
  • cold air
  • air pollution
  • viral illnesses
  • air fresheners
  • household cleaning products
  • perfumes

3. Occupational Asthma

Occupational Asthma is caused by working in dangerous environmental conditions. These include:

  • dust
  • dyes
  • gases and fumes
  • industrial chemicals
  • animal proteins
  • rubber latex

4. Exercise-induced bronchoconstriction (EIB)

Exercise-induced bronchoconstriction (EIB) affects people within a few minutes of starting strenuous exercise.

5. Aspirin-induced Asthma

Aspirin-induced Asthma (AIA) is caused due to the intake of aspirin or another NSAID (a nonsteroidal anti-inflammatory drug), such as naproxen (Aleve) or ibuprofen (Advil).

6. Nocturnal Asthma

In this type of Asthma, symptoms develop at night.

Triggers that are thought to bring on symptoms are:

  • heartburn
  • pet dander
  • dust mites

7. Cough-variant Asthma (CVA)

A persistent, dry cough characterizes Cough-variant Asthma (CVA). If not treated quickly, it can lead to full-blown asthma flares that include the other more common symptoms.

Diagnosis

The doctor will conduct a variety of tests to determine if the symptoms are the result of Asthma.

The following tests can help diagnose Asthma:

  • Health history: The doctor may examine your family history to check for any genetic connection.
  • Physical exam: The doctor will check your breathing with a stethoscope and look for signs of an allergic reaction.
  • Breathing tests: The doctor may recommend Pulmonary function tests (PFTs) that measure airflow into and out of your lungs.

Treatment

Treatments for Asthma comprise of three primary categories:

  1. Breathing exercises
  2. Quick-acting treatments
  3. Long-term asthma control medications

Your doctor will determine and plan your treatment based on:

  • the type of Asthma you have
  • your age
  • your triggers

1. Breathing exercises

Breathing exercises will help you get more air into and out of your lungs. This will help you expand and increase lung capacity and cut down on severe asthma symptoms.

2. Quick-relief asthma treatments

These medications are prescribed by the doctor in the event of asthma symptoms or an attack. These medicines will provide you with quick relief and help you breathe again.

  • Bronchodilators: Bronchodilators helps the tightened muscles around your airwaves to relax within minutes. They can be used as an inhaler (rescue) or nebulizer.
  • First aid asthma treatment: If someone is having an asthma attack, make them sit upright and support them in using their rescue inhaler or nebulizer. If symptoms linger for more than 20 minutes, and the second round of medication doesn’t bring relief, seek emergency medical attention.

3. Long-term asthma control medications

Long-term asthma control medications include the following:

  • Anti-inflammatories: These are used along with corticosteroids, an inhaler, and other anti-inflammatory drugs to reduce swelling and mucus production in your airwaves, making it easier to breathe.
  • Long-acting bronchodilators: These are used in combination with anti-inflammatory asthma medications.
  • Anticholinergics: These medications will help stop your muscles from tightening around your airwaves.
  • Biologic therapy drugs: To treat people with severe Asthma, these new, injectable medications are used.
  • Bronchial thermoplasty: To treat severe Asthma, this treatment is utilized by placing an electrode to heat the airwaves inside the lungs. This helps to reduce the size of the muscle and prevent it from tightening.

 

Prevention

The following strategies are included to hamper asthma attacks:

  • Avoid Triggers: You should steer clear of chemicals, smells, or products that have caused breathing problems in the past.
  • Reduce exposure to allergens: Any allergens that you have identified which triggers your Asthma should be avoided.
  • Getting allergy shots: Depending on the type of Asthma, your doctor may recommend allergen immunotherapy. This is a type of treatment that may help alter your immune system. With the injection of routine shots, your body will become less sensitive to any triggers you encounter.
  • Taking preventive medication: Your doctor may prescribe medication for you, and it could also be used in addition to the one you use in case of an emergency.

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