Question

Asthma - All About It!

Dr.Radhika A (Md) · Accepted Answer

Asthma
The word "asthma" originates from the Greek word, sthma that means, "panting. Asthma is a medical condition in which the airways swells and produces extra mucus that can make breathing difficult. Because of the inflammation and the extra mucus, it can trigger shortness of breath and wheeze or coughing.

Documented as early as Ancient Egypt, Asthma can be either a minor nuisance or life-threatening. In asthma, the inside walls of the airways get inflamed so that lesser air can pass through them from and to the lungs making breathing a difficult exercise. This swelling can also make the airways really sensitive and increase a person s susceptibility to allergic reactions.

Asthma has been on the rise significantly since the 1960s and now according to WHO estimate, around 300 million people suffer from asthma worldwide. In fact Asthma is one of the most common chronic childhood illness.

Symptoms of Asthma-
The symptoms of asthma vary. But what most people with asthma have in common is the extreme airway sensitivity because of triggered airway inflammation. Some people have frequent asthma attacks, some people experience asthma only during certain times, some people have it all the time and some people only experience it infrequently.

Common asthma signs and symptoms include:
- Wheezing or coughing

- Shallow breathing

- Breathlessness

- Chest pain

- Throat infection

- Faster heart rate

- Trouble in sleeping

- Difficulty in speaking

Types of Asthma-
Normally people suffering from an asthma attack tend to have a whistling or wheezing sound when exhaling. There are different types of asthma. Some of the most common types of asthma are:

1. Exercise-induced asthma
Also called exercise-induced bronchoconstriction, this type of asthma is induced by strenuous exercises and can cause symptoms like coughing, wheezing, shortness or breath and other symptoms. These symptoms may worsen when the air is dry and cold and usually get triggered during or after an exercise.

2. Occupational asthma
As the name suggests, occupational asthma is triggered by breathing in certain chemical fumes, dust, gases, or other kinds of exposure to allergens at the workplace.

3. Allergy-induced asthma
Allergy-induced asthma is the most common type of asthma, which is triggered by common airborne allergens like pollen, mold spores, dust mites, or particles of skin.

What Are Causes of Asthma?
Although the causes are not particularly clear and anyone can get asthma at any age, it is more common childhood ailment. The studies are still underway to prove a clear asthma cause but according to the researches this disease is believed to be caused by a blend of genetic and environmental factors. Genomics, which is the study of how a person s genes interrelate with environmental factors, may be the key to understanding why certain people are more prone to asthma than others.

Asthma Triggers-
Asthma triggers can differ from person to person and the key is to know what irritants trigger your asthma to ensure minimized exposure to it. Some generic asthma signs and symptoms can include:

- Cold air

- Exercise and other physical activities

- Common cold and other respiratory infections

- Stress

- Airborne substances like pollen, mold spores, pet dander, cockroach waste, dust mites, etc.

- Airborne substances, such as pollen, dust mites, mold spores, pet dander

- Certain chemicals and air pollutants (smoke)

- Certain preservatives (added to food and beverages)

- Gastroesophageal reflux disease (GERD)

- Certain medicines like aspirin, ibuprofen, etc.

Risk factors-
There are several risk factors that can increase your chances of developing asthma including:

- Genetics. Having a family especially a blood relative suffering from asthma

- Having other allergic condition (hay fever)

- Smoking

- Exposure to secondary smoking

- Obesity (people who are overweight are at a greater risk of developing asthma)

- Exposure to increasing amount of smoke or other pollutants

- Occupational triggers

- Stress and anxiety

Diagnosis of Asthma-
Even though it is a common childhood disease, it doesn t mean, as an adult one cannot develop it. If a person is feeling any of the symptoms whether a child or an adult, it is always a good idea to get checked to know for sure if you have asthma. Asthma symptoms can come and go since it is a variable disease.

It is also important to not do self-diagnosis, as some symptoms, which may look like asthma triggers, may not be actually asthma-like persistent cough caused by other diseases like certain heart diseases and chronic obstructive pulmonary disease (COPD).

Effective diagnosis of Asthma depends upon its classification. There are four different classifications of Asthma:

Classification of Asthma
- Mild intermittent It is a mild case of asthma if the symptoms last only for up to two days a week, symptoms flaring up mainly at night and asthma lasting not more than two nights in a month.

- Mild persistent Mild persistent asthma is when the symptoms can occur twice in a week but not more than one episode per day.

- Moderate persistent This happens when a person experiences symptoms once a day and in excess of one night a week.

- Severe persistent - Symptoms can last throughout the day and frequently at night on most days.

Diagnosis of Asthma
1. Physical test
The doctor would want to rule out other possible condition through a physical exam to get to know the signs and symptoms.

Some lung function tests can help in determining how the lung in functioning in a person.

2. Spirometry
One of the most common pulmonary function tests, spirometry measures lung function by checking the amount of air a person can inhale and exhale after deep breaths.

3. Peak flow
The peak expiratory flow is a pulmonary device that can measure the maximum speed one can breathe out. If the readings are low, it may be a sign that the person s lungs are not working properly and could be a potential sign of asthma.

These tests can be done with a medicine called as bronchodilator (albuterol) to check if the lung functions better with the medication. If the test gets better after the use of bronchodilator, then it is highly likely for a person to suffer from asthma

Additional tests and Diagnosis For Asthma
Other tests that may be required to diagnose asthma include:

1. Methacholine challenge-
Methacholine is considered an asthma trigger and so when it is inhaled it can cause mild constriction of the airways. Most people who have asthma are likely to react to methacholine. Doctor could use this test to determine whether you have asthma.

2. Imaging tests-
Certain imaging tests like x-rays and CT scan can help in identifying certain abnormalities that might be causing breathing issues.

3. Allergy testing-
Most allergy tests can help in identifying allergy to triggers like pollen, dust, etc.

4. Sputum eosinophils-
This test can help in identifying the while blood cells in the mucus to see if asthma is present or not.

5. Nitric oxide test-
For people whose airways are inflamed, they may have higher nitric oxide level than normal which may be able to help in identifying whether the person is suffering from asthma or not.

7. Provocative testing for exercise and cold-induced asthma-
As the name suggests, in this a person is made to perform vigorous physical activities in a controlled environment to check for the triggers.

Treatment of Asthma-
Although there is no known cure available for asthma and it is generally a life-long condition, treatment can control asthma symptoms so a person can lead a normal life. Also when it comes to asthma, there is no one-size fit all treatment methodology. The idea is to understand the triggers that worsen your symptoms, taking steps to avoid them and taking the medication on time to keep asthma in check.

1. Inhalers
Inhalers are medical devices, which are used for supplying medication into the body through the lungs. There are three types of inhalers. These are:

- Reliever Inhalers: These inhalers are used for the purpose of relieving symptoms at the time of asthma attack. Normally reliever inhalers don t have many side effects, in some people they may increase heart beat and induce shaking.

- Preventive Inhalers: True to their name, this types of inhalers are used to stop the symptoms from developing.

- Combination Inhalers: If either of these kinds of inhalers doesn t work for a person, they would need an inhaler that would both relieve the attack and prevent it from happening again.

2. Tablets -
If inhalers don t work to control the symptoms, one may also use tablets.

Leukotriene receptor antagonists (LTRAs)
LTRAs are the oral tablets prescribed for asthma and are also available in syrup and powder forms. It can be taken every day without many side effects. However, some people may experience some side effects including headaches and stomach pain.

Theophylline
If LTRAs tablets cannot be prescribed for some reasons or is not working, doctors may also prescribe Theophylline. It should be taken every day.

Steroid tablets-
Steroid tablets are given to give relief from an asthma attack. Long-term usage of steroid tablets for is not recommended unless a person is suffering from severe asthma and if inhalers aren t handy controlling the symptoms. Some possible side effects of using steroid tablets for long-term are mood swings, fragile bones, high blood pressure, etc.

Other treatments for Asthma
Other treatments like surgery or injections may be required in case other treatments don t work for a person.

Injections
For certain people with severe asthma, some injections like omalizumab, mepolizumab, or reslizumab may be able control the symptoms. For some severe asthma patients, injections are prescribed every few weeks in order to control the symptoms. However, these injections should be taken only under the prescription from an asthma specialist, as these injections may are not advisable for every asthma patient.

Surgery
For some people for whom treatments like inhalers, tablets, and injections don t work or in certain cases cannot be administered, a surgical procedure called bronchial thermoplasty can be used. In this treatment, a flexible thin tube is passed down the throat into the lungs and heat is used to warm up muscles surrounding the air controlling nerves to stop causing asthma-like symptoms.

However, this process is fairly new and so much research has not been done on its long-term relief.

Complementary therapies
There are many complementary therapies that can help ease the symptoms, prevent asthma from happening, and help strengthen the lungs and the airway muscles. However, before incorporating any of these therapies in your lifestyle, it is always best to check with your asthma specialist first. These therapies include

Certain breathing exercises including yoga
- Alternative medicines like homeopathy, chiropractic, and Ayurveda

- Dietary supplements

- Acupuncture

- Certain traditional Chinese medicine

- Ionizers

Common Myths About Asthma
Myth #1: Asthma is a psychological disease

One of the biggest beliefs that many people have is that asthma is psychological and thus they don t believe in getting medical help. Since asthma affects the airways it is to be noted that is not psychological as it causes the immune system and the lungs to behave erratically when it comes to certain triggers.

Myth #2: Asthma medications lose their effectiveness over time

Asthma meds don t lose their effectiveness over time and can be used for long-term if the right doses are taken as directed.

Myth #3: People with asthma should avoid physical activity

Although strenuous exercises can sometimes induce asthma, simple exercises can keep a person fit and healthy and help them lead a normal life.

Myth #4: You can outgrow asthma

Some asthma symptoms may improve over time. People also learn how to deal with asthma better as they age since they know what triggers it and what doesn t. However, there is no outgrowing asthma because it is a lifelong condition.

Myth #5: Asthma Is Easy to Control

Asthma can be easy or difficult to control depends on the kind of asthma a person is suffering from and the triggers. Although even in mild form of asthma, the treatment is required to give the necessary relief to a person to reduce flares and maintain proper lung functions.

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