Asthma megaguide - causes, symptoms, diagnosis, prevention and complications

By 2025, a whopping 100 million people across the world will suffer from asthma. Here is a megaguide that explains everything about the disease.

It is estimated that by 2025, a whopping 100 million people across the world will suffer from asthma. Unfortunately, asthma is a condition for which there is no 'cure'. The only option is to accept the fact that you have to live with it and live fully! Understanding the condition can certainly help both the patient and the caregiver. Here is a megaguide that'll tell you everything you need to know about asthma.

Understanding asthma

Asthma is a condition where a person finds it difficult to breathe because the tubes that take air into the lungs swell up, making it difficult to breathe. This reaction is caused because the airway comes in contact with an asthma trigger (an allergen) that causes it to swell up.

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.

Read more about causes, symptoms, diagnosis and treatment of asthma.

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.

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.

Hormonal: In many women with asthma, the rise in progesterone and sharp decline in oestrogen just before menstruation increases the risk for asthma attacks by triggering bronchoconstriction. In case of men, low testosterone levels cause asthma because testosterone reduces the conversion of DHEAS (dehydroepiandrosterone sulfate) to DHEA. Decreased DHEA is believed to be the source of asthma.

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.
• begins suddenly
• comes in episodes with symptom-free periods in between
• worse at night or early in the morning
• may subside on its own
• gets worse when you breath 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 immidiately:

• 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

Read more..

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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 show an increase in the number of eosinophils. The level of a certain antibodies can be elevated.
• Chest X-ray 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 and methacholine challenge tests
• Spirometry - helpful in judging 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 total volume of air one can exhale after maximum breathing in.
• Forced Expiratory Volume in One Second, or FEV1- measures the volume of air one can exhale in the first second.
  • Methacholine challenge test commonly used in adults. Performed when your symptoms and spirometry do not convincingly diagnose asthma. Methacholine is an agent that, when inhaled, causes the airways to spasm (contract involuntarily) and narrow if asthma is present.
  • Allergy test- to identify any allergies that trigger asthma symptoms. Skin tests and blood tests help in detecting allergens.

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:

1. 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 anasthma 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.

• 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.E.g. Asmanex, Alvesco, Qvar AeroBid, Flovent, Pulmicort.For severe asthma (status asthmaticus), injections of drugs such as epinephrine and 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 Singulair and Accolate),Cromolyn sodium (Intal) or nedocromil sodium (Tilade), Omalizumab (Xolair), 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.

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.

What are the alternative treatments for Asthma?

Homeopathy

Homeopathy aims at strengthening your immune system so that gradually you will need decreased asthma medication and eventually you may not need any.Some of the popular remedies are:

• Pulsetila: for spasmodic symptoms. Anxiety, sudden wheezing, difficulty breathing and a feeling of suffocation, which worsens if you move.
• Ipecanum: for chronic asthma. It is used if you are older and the attacks occur during midnight, when you are awakened with soreness and pain in the chest and heat in the head which improves with warmth. Especially useful if you are anaemic.
• Antimonium tartaricum: presence of fine rattling or crackling sounds in the chest. Difficulty breathing and feeling of suffocation. Suitable for young children and the elderly.
• Natrum mur: for general symptoms including a worsening of asthma on exposure to mold and dampness. Wheezing and breathing difficulties aggravated by exertion. Loose bowels after each attack.
• Spongia tosta: for a barking cough and little mucus during an asthma attack.
• Pulsatilla: if wheezing starts after eating rich food or you get too warm. Tightness in the chest which worsens during the evening and at night. Relieved by fresh, cool air. Coughing brings up yellow-coloured mucus.
• Carbo vegitable: helpful in a tense, constricted feeling in the lower part of the chest, with pressure in the stomach. Asthma attack brought about by gastric disturbances. Overindulgence in sweets, spicy food, stimulants and alcohol.

Ayurveda

Some of the natural herbs used to cure asthma are Mullein, licorice, turmeric, thyme, black pepper, flax seed, antalkali ginger, clove, manna and myrrh. Massaging mustard oil with camphor over the chest loosens the mucus and helps in easy breathing during asthma attack. Inhaling steam with a few caraway seeds added to boiling water helps in dilation of bronchial passage. Honey is one of the most effective remedies used for treatment of asthma A few common medicines as suggested in Ayurveda are:

• A paste of Nagar and Bharangi in water
• Mixture of Shukti Bhasma, Trikuti Churna and Vasa Churna taken with honey
• Sitopaladi choorna
• Vasavleha
• Swaskuthar ras
• Panchakarma - before the onset of monsoon
• Rasayana Chikitsa during asthma attacks
• Kantakari Avalehya (semi solid preparation)
• Vasa Avalehya (semi solid preparation)
• Shitopaladi churnam (powdered preparation)
• Kanakasava (the fermented preparation)
• Agatsyaharitaki

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Managing asthma

Knowing what triggers the attacks and avoiding those triggers can certainly help in making the condition more bearable. Here are 10 triggers for asthma you should stay away from:

• Dust

Dust, due to its allergy-inducing properties, causes havoc for asthmatics. Therefore it's absolutely essential that very high levels of hygiene are maintained and that rooms are kept dust-free. This can be achieved by thoroughly vacuuming the entire room including every nook and cranny.

• Flowers

Pollen from flowers is a known trigger for asthma attacks and one will do well to avoid them. Growing plants indoors can be dangerous too, since they can be a source of mold which triggers asthma. To avoid the formation of molds, make sure not to overwater plants, keep them in a sunny place and remove dead parts as soon as they appear.

• Pets

Animal lovers are going to the find the going tough. Research suggests that contact with cats or dogs is extremely dangerous for asthmatics. Not to mention the fact that small pieces of fur, particles of hair, saliva and even skin are all known asthma triggers. Even if the pet is not physically around you, their fur/hair might be in your environment and may pose risks.

• Smoke and aromas in the kitchen

The smoke and aromas given off when cooking can be a major irritant to asthma sufferers so take steps to reduce such problems. If a proper exhaust fan or chimney is not available, then ensure there is an open window in the kitchen to help the cooking smells to escape outside.

• Smoking

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. Babies whose mothers smoked during pregnancy have worse lung function and increased risk of wheezing.

• Anti-inflammatory drugs

Certain prescription and over-the-counter drugs like aspirin and non-steroidal anti-inflammatory drugs (ibuprofen and beta blockers) may trigger asthma attacks. Whenever a doctor is prescribing you medicines, make sure you tell him/her that you suffer from asthma.

• Exercise

Exercise-induced asthma is a type of asthma triggered by vigorous or prolonged exercise or physical exertion. Narrowing of airway begins five to 20 minutes after exercise begins, making it difficult to catch your breath.

Normally, the air we take in is first warmed and moistened by the nasal passages. But during exercise people tend to breathe through their mouths thus inhaling colder and drier air. In exercise-induced asthma, the muscle bands around the airways are sensitive to these changes in temperature and humidity. They react by contracting, which narrows the airway. This results in symptoms of exercise-induced asthma.

• Extreme weather

Hot and humid weather or extremely cold weather causes asthma symptoms to flare-up. Even though weather is not in our control, asthmatic patients should ensure that they do not expose themselves to varying temperatures in a short time.

• Extreme emotional arousal

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.

• Food allergies

Some of the most common foods associated with allergic symptoms are eggs, cow's milk, peanuts, soy, wheat, fish, shrimp, etc. Food preservatives like sodium bisulfite, potassium bisulfite, sodium metabisulfite, potassium metabisulfite and sodium sulfite can also trigger asthma.

Besides avoiding these triggers, you should also do the following things to manage asthma.

Take regular medications. The control medications should be taken every day to maintain the airways. They prevent an attack of asthma. They maintain the normal diameter of the airways and control airway inflammation. Quit smoking. It can undo the effect of any medicine you are taking.

Monitor Lung Function regularly. Lung function usually decreases a couple of days prior to an asthma attack. A peak flow meter is a simple device to your lung function. It measures how quickly you can move air out of your lungs. It helps you see if an attack is coming and when medication is needed or other action needs to be taken. Peak flow values of 50% 80% of your best results are a sign of a moderate asthma attack. Values below 50% are a sign of a severe attack.

Read more about causes, symptoms, diagnosis and treatment of lung disease.

What should I do when I have an Asthma attack?

During an acute attack of Asthma:

• Take a puff from the inhaler. Always keep your inhaler with you.
• Open the windows of the room if you are in a warm and humid room.
• Loosen any tight clothing. Sit-up.
• If you do not feel any improvement, continue to take one puff of inhaler every minute for 3 to 5 minutes or until your symptoms improve
• If all the above steps fail, contact your doctor.

Read more..

1. What can I do to prevent my son from getting asthma attacks?

2. 8 steps to manage asthma in children better

3. Living with asthma, not an issue anymore

4. 10 asthma triggers you should avoid

5. A guide to exercising with asthma

6. Asthma: Self care and prevention

Complications

1.Decreased quality of life decreased ability to exercise and take part in other activities, fatigue, underperformance or absence from work, psychological problems including stress, anxiety and depression.

2.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 thelung and respiratory failure. In acute respiratory failure, the bronchial tubes are completely blocked. Oxygen level in the blood becomes dangerously low, or carbon dioxidelevel becomes dangerously high. Such patients have to beimmediately shifted on ventilators to avoid fatality.

3.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

4. Status asthmaticus (severe asthma attacks that do not respond to treatment).

You may also like to read:

• 8 steps to manage asthma in children better (Gallery)
• Asthma: All you need to know
• 10 asthma triggers you should avoid
• World Asthma Day 2013: 10 facts about asthma you should know
• Are you being overmedicated for asthma?
• Could your child's cough be a symptom of asthma?
• Natural remedies to relieve your child of the discomfort of asthma.
• All about asthma medication and treatment

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