Asthma

What is asthma

Bronchial Asthma which is commonly known as Asthma is a chronic disease that inflames and narrows the lungs’ airways, making breathing difficult.

The inflammation of the airways causes the walls to become irritated and swollen, resulting in a decrease in airflow within the airways. Moreover, cells in the airways may also produce excessive amounts of mucus, which makes breathing even harder. There are different types of asthma that have varied intensities in severity.

However, with good management plans asthma can be controlled so that it doesn’t affect daily living activities.

What are the symptoms?

The most common symptoms of asthma are:

Wheezing (a whistling sound when breathing,particularly on expiration)
Breathlessness
Tight chest – Feeling as if a band is tightening around the chest
Coughing with or without mucus production

What causes asthma?

There are several causes of Asthma. However, allergies, respiratory infections, environmental conditions, and genetics can be considered the key factors that trigger the development of Asthma.

3.1 Allergies

Common allergens found in the environment are triggers for the development of allergic airway inflammation. Symptoms usually start with the upper airway and then cascade to involve the lower airways. There may be an associated history with eczema.

3.2 Respiratory Infections

Respiratory infections can cause severe symptoms of Asthma (asthma episode or attack).

Common respiratory infections include:

The common cold
- COVID-19 (the new coronavirus)
- The flu (influenza)
- Pneumonia
- Sinusitis
- Bronchitis
- Other viruses (such as parainfluenza, RSV, croup)

3.3 Environmental conditions

Environmental factors that predispose to asthma.

Environmental factors that predispose to asthma.
1. The existence of animal proteins (particularly cat and dog allergens), dust mites, cockroaches, fungi, and mould.
2. Cigarette smoking and Second hand Exposure to cigarette smoke is linked with an increased risk for developing asthma.
3. Pollution, sulfur dioxide, nitrogen oxide, ozone, cold temperatures, and high humidity are all known to trigger asthma in susceptible individuals.
Due to Environmental conditions, both Aaggravation of pPre -existing Asthma or the development of Irritant Asthma can occur.

3.4 Emotions

Strong emotions may trigger asthma symptoms or mimic asthma. Exposure to Stress, powerful emotions leading to laughter, grief, depression, panic attack link to development of Asthma.

3.5 Genetics

A person is more likely to develop asthma if they have a family history of the condition. This reflects that asthma can be genetic.

Tests to identify asthma

Asthma is often suspected from clinical history but it is important to obtain objective evidence of asthma when establishing the diagnosis.

FeNO test – Breathing into a machine that measures the level of nitric oxide in breath. An elevated level of Nitric Oxide in breath is a sign of eosinophilic inflammation in airways

Spirometry – Blowing into a machine that measures the rate that the patient can breathe out and how much air the lungs can hold. It may be normal or an obstructive pattern is often seen with significant bronchial dilatation (reversibility) after use of a inhaled bronchodilator.

Peak flow test – Blowing into a handheld device that measures the rate that the patient can breathe out.. This may be done over a course of a few times a day for a couple of weeks to identify if any changes take place.

Imaging – Bronchial wall thickening, hyperinflation, and focal atelectasis suggest asthma when they are present. However, chest radiographs can demonstrate completely normal findings.

Allergy testing – Although not diagnostic of asthma testing for sensitisation to common aeroallergens is helpful to identify triggers that exacerbate airway inflammation

Asthma treatments

There Is no cure for Asthma. However, there are many treatment options that help control airway inflammation and symptoms so that the person with asthma can lead a healthy and active life irrespective of the disease.

5.1 Inhalers

Inhaled bronchodilators – These medications are usually taken as inhalers where the medicine is Inhaled through the mouth and deposited into the lungs to help relax the airway smooth muscles. This results in opening up of the airways and allows more air to move in and out of lungs without turbulence, and helps to relieve breathlessness and chest tightness. Hence the rapid and short acting bronchodilators are often referred to as relievers. Long acting bronchodilators are often combined with inhaled corticosteroids.

Inhaled corticosteroids – These inhalers are the mainstay of asthma treatment and help reduce airway inflammation. They are referred to as preventative inhalers because the reduction in inflammation controls the disease drivers and prevents symptoms and asthma attacks.

5.2 Oral medication

Medications in the form of tablets may be used in addition to inhalers to control symptoms.

The most commonly used oral medication are:

Leukotriene receptor antagonists (LTRAs)
Theophyllines
Steroid tablets – This may only be recommended if other treatments are not making any significant corporation in controlling symptoms and in the management of acute asthma attacks

5.3 Injections

For individuals with severe asthma who are not responding to inhaled and oral medication may be candidates for treatment with biological therapy. These are monoclonal antibodies given by injection that control specific inflammatory pathways involved in the disease.

5.4 Therapies

Chest physiotherapy can help those with asthma and mucus secretion to clear their airways and improve quality of life. Other therapies are often used by people with asthma but there is little evidence of symptom relief. These include:

Acupuncture
Homeopathy
Dietary supplements