Asthma

About Asthma

asthma

Asthma is a disease of the airways which causes difficulty in breathing. It is caused by inflammation of the air passages that make them narrow. Symptoms of narrowing airways include whistling noise with breathing, shortness of breath, chest tightness and coughing. There can be several triggers or factors that can aggravate the symptoms of asthma. Common factors include dust, mites, pollen, smoke, pollution, weather changes, cold & cough and respiratory infections. Asthma can be broadly categorised into two categories – specific and non-specific. Specific asthma is caused by breathing in allergens or irritants while non-specific asthma is caused by exercise, weather or genetic predisposition. The exact cause of asthma is not known but it is seen in families having a history of asthma. Asthma cannot be cured, but it can be managed well with a number of treatment options aimed at relieving the symptoms and preventing the occurrence of severe asthma attacks. Here's what Dr Navneet Sood, Consultant, Pulmonary & Critical Care Medicine, Jaypee Hospital, Noida has to say about causes, symptoms, and treatment of asthma.

Types

There are two types of asthma, depending on the type of trigger – extrinsic and intrinsic asthma.

Extrinsic asthma is an immune response to an external allergen such as pollen, animal dander, dust etc.

Intrinsic asthma is caused due to inhaling certain chemical agents such as cigarette smoke, paint vapours, etc. In some cases it may also be worsened by a chest infection, stress, laughter etc. Some drugs like aspirin and other NSAIDs are also known to cause asthma attacks.

Causes

Asthma is caused due to inflammation in the airways. During an asthma attack, the muscles surrounding the airways become tight and the lining of the air passages become swollen. This reduces the amount of air that can pass by. Here are some useful tips to prevent asthma you should be aware of.

Asthma triggers can be broadly categorized into:

1. Specific (Allergens and Irritants): In sensitive people, asthma symptoms is triggered by breathing in allergy-causing substances like:

Airborne irritants: Any substances you breathe in can become an allergen. These might include traffic fumes, animal dander (from dogs and cats), house dust mites, pollen, mold, industrial fumes (especially those containing sulphur dioxide), household chemicals (air fresheners and aerosols), perfumed cosmetics, scented flowers, etc.

Respiratory infections: Viral or bacterial respiratory infections that trigger asthma attack are common cold, flu, bronchitis and sinus infections. They are a common cause of asthma especially in children.

Food and food additives: Some of the most common foods associated with allergic symptoms are eggs, Cow’s milk, Peanuts, Soy, Wheat, Fish, Shrimp, etc. Food preservatives Sulfite additives like sodium bisulfite, potassium bisulfite, sodium metabisulfite, potassium metabisulfite and sodium sulfite can also trigger asthma.

Tobacco smoke: Cigarette smoke contains different chemicals and gases that can irritate the lungs. Smoking increases your chance of getting asthma. Symptoms such as coughing and wheezing become worse when you smoke with asthma. Babies whose mothers smoked during pregnancy have worse lung function and increased risk of wheezing.

Heart burn: Severe heartburn, known as gastroesophageal reflux disease (GERD) and asthma often go hand-in-hand. The stomach acids reflux into the esophagus because the valve between the esophagus and stomach does not function properly. If the acid reaches into the airways, the irritation and inflammation can trigger an asthma attack.

Drugs: Certain prescription and over-the-counter drugs like aspirin and non-steroidal anti-inflammatory drugs (ibuprofen and beta blockers) may trigger asthma attacks.

Alcohol: alcohol can cause asthma to worsen. One possible reason could be that alcohol causes various degrees of acid reflux. Another reason is sensitivity to sulfites used mostly in wines and beers that can increase symptoms in people with asthma.

2. Non-specific: Emotional Stress: extreme emotions such as anxiety, anger and fear induce stress which in turn changes heart-rate and breathing patterns. There is rapid, shallow breathing causing constriction of airways and this consequently leads to an asthmatic attack.

Exercise-induced – asthma triggered by exercise or physical exertion.
Extreme weather – Hot and humid weather or extremely cold weather causes asthma symptoms to flare-up.
Genetic predisposition – family history of allergies. Genetic tendency for asthma leads to susceptibility to be affected by external or internal trigger factors.

Symptoms

Most people with asthma have attacks separated by symptom-free periods. You may not have any asthma attack symptoms for weeks to months. Symptoms include:

Cough with or without sputum (phlegm) production
Chest tightness – pulling in of the skin between the ribs when breathing
Breathlessness
Wheezing – a musical, whistling or hissing sound with breathing.
comes in episodes usually with seasonal variation with symptom-free periods in between
worse at night or early in the morning
may subside on its own
gets worse when you breathe in cold air
gets worse with exercise and heartburn
gets better with drugs that open the airways

If you or anyone you know experiences the symptoms below, it is best to visit a doctor immediately:

Bluish colour of the lips and face
Decreased level of alertness, such as severe drowsiness or confusion
Rapid pulse
Severe anxiety due to shortness of breath
Sweating
Other symptoms that may occur are abnormal breathing pattern, stopped breathing and chest pain

Diagnosis

Asthma is diagnosed based on the patient’s medical history, physical examination and laboratory test results. Your doctor will take a detailed medical history and ask you about your asthma symptoms and allergy triggers. Your doctor may use one or more of the following asthma tests to diagnose asthma, to assess your breathing and to monitor the effectiveness of asthma treatment:

Blood and Sputum analysis – It shows an increase in the number of eosinophils. The level of certain antibodies can be elevated.
Chest X-ray – This may show abnormality in the airway.
Arterial blood gas analysis – shows decreased oxygen concentration in blood.
Lung function testing – The two most common pulmonary function tests for asthma are spirometry.
Spirometry – It is helpful in judging the severity of airway obstruction. It measures how much air you can breathe in and out and how fast you can blow air out. Some of the common values looked at are:
Forced Vital Capacity or FVC – It is the total volume of air one can exhale after maximum breathing in.
Forced Expiratory Volume in One Second, or FEV1– It measures the volume of air one can exhale in the first second.

Treatment

The aim of asthma treatment is to avoid the substances that trigger your symptoms and control airway inflammation. There are two basic kinds of medication for treating asthma:

Control drugs – to prevent attacks. They control your symptoms. You must take them every day for them to work. They are administered orally or by inhalation. The most common and effective way to deliver asthma drugs to the lungs are asthma Inhalers. Metered-dose inhalers (MDI) and dry powder inhaler (Rotacaps) are the most widely used method. Have a warm drink or water after using MDI to get rid of unpleasant aftertaste of the medicine. Combination asthma inhalers contain two different medications: an inhaled steroid and a long-acting bronchodilator. They are popular due to their convenience. The medications last for at least 12 hours. If it is difficult to use small inhalers, your doctor may prescribe an asthma nebulizer, a breathing machine. The nebulizer changes asthma medications from a liquid to a mist which is more easily inhaled into the lungs. The asthma nebulizer with a mask is typically used for infants, small children and elderly adults. You may also like to read specific articles on management of asthma in children

Steroids and Other Anti-Inflammatory Drugs: the most important treatment for most people with asthma, particularly the inhaled steroids. They prevent asthma attacks by reducing swelling and mucus production in the airways which cause the airways to be less sensitive and less likely to react to asthma triggers. For severe asthma (status asthmaticus), injections of drugs such as prednisone are often necessary. Prednisone is the most potent and effective anti-inflammatory asthma medication available.
Long-acting bronchodilators – often combined with inhaled steroids for long-term control of asthma symptoms or when you have asthma symptoms daily despite treatment with a daily inhaled steroid alone. Long-acting bronchodilators are never used alone for long-term therapy.
Other control drugs that may be used are Leukotriene inhibitors (such as Cromolyn sodium, Omalizumab, Aminophylline or theophylline (rarely used anymore).

2. Quick-relief drugs: These drugs are mainly used during an emergency. They are normally prescribed by a pulmonologist and the patient is told how to use them in case the need arises.

Short-acting bronchodilator inhalers are used to quickly relieve the cough, wheeze, chest tightness, and shortness of breath caused by asthma. Bronchodilators relieve the symptoms of asthma by dilating or widen the bronchial tubes. They should not be used regularly for in the treatment of asthma. The most commonly used short-acting bronchodilator is albuterol. Here’s every you need to know about drugs for asthma.

A severe asthma attack (status asthmaticus) may not respond quickly to routine treatment with asthma inhalers.

Continuous use of an asthma nebulizer and injections of drugs such as epinephrine and prednisone for asthma are often necessary.
Other therapies may include terbutaline injections, magnesium sulfate (induces smooth muscle relaxation of the airways) and leukotriene inhibitors, which are anti-inflammatory drugs.
During a severe asthma attack that does not respond to asthma drugs, a mechanical ventilator may be needed to assist the lungs and respiratory muscles. A facemask is applied or a breathing tube is inserted in the nose or mouth for this asthma treatment. These breathing aids are temporary and are removed once the attack has subsided and the lungs have recovered sufficiently to resume the work of breathing on their own.
A short hospital stay in an intensive care unit may be necessary with an acute attack.

Please do note that all of the above mentioned drugs require a prescription from your asthma doctor.

Also read about home remedies for asthma.

Diet Tips

Here are dietary guidelines by nutritionist, Priya Kathpal to deal with asthma:

Go for probiotics
Eat ginger
Load up on omega-3 fatty acids
Stick to a low-salt diet
Eat magnesium-rich foods
Sprinkle rosemary leaves on foods
Replace vegetable oils with olive oil
Ditch the dairy
Don’t eat raw foods
Limit omega-6 intake
Avoid food additives

Here is detailed information on diet tips for asthmatics.

Complications

The complications fo asthma include –

Decreased quality of life – It signifies the decreased ability to exercise and take part in other activities, fatigue, underperformance or absence from work, psychological problems including stress, anxiety and depression.
Respiratory complications – Asthma can lead to a number of serious respiratory complications, like pneumonia (infection of the lungs), a collapse of part or all of the lung and respiratory failure. In acute respiratory failure, the bronchial tubes are completely blocked. Oxygen level in the blood becomes dangerously low, or carbon dioxide level becomes dangerously high. Such patients have to be immediately shifted on ventilators to avoid fatality.
Pregnancy – In pregnant women asthma complications may include early labour, hypertension, gestational diabetes and haemorrhage. Asthma also puts their babies at risk of lower birth weight and breathing disorders
Status asthmaticus (severe asthma attacks that do not respond to treatment).

The content has been verified by Dr Navneet Sood, Consultant, Pulmonary & Critical Care Medicine, Jaypee Hospital, Noida.

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