Asthma is one of the major noncommunicable diseases that affects millions across the world including children. This condition, which affects your airways, is triggered when inhaled substances provoke allergic reactions. Asthma can be controlled by medications and avoiding triggers.
What is Asthma?
Asthma is a lung disorder that affects your airways and causes difficulty in breathing. It is triggered by inflammation of the air passages which makes them narrow. Symptoms of narrowing airways include whistling noisy 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 change, cold & cough and respiratory infections. Asthma can be broadly classified into two categories – specific and non-specific. Specific asthma hits you when you breathe 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 with a history of the condition. 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 attacks. Here's what Dr Navneet Sood, Consultant, Pulmonary & Critical Care Medicine, Jaypee Hospital, Noida has to say about the types, causes, symptoms, and treatment of asthma.
Types of Asthma
Broadly speaking, there are two types of asthma, based on the nature of trigger behind it: Extrinsic asthma and intrinsic asthma.
Extrinsic asthma: It is an immune response to an external allergen such as pollen, animal dander, dust, etc.
Intrinsic asthma: It occurs when you inhale certain chemical agents such as cigarette smoke, paint vapours, etc. In some cases, it may also be worsened by a chest infection, stress, and even loud bouts of laughter. Some drugs like aspirin and other NSAIDs are also known to cause asthma attacks.
Most people with asthma experience symptoms intermittently. The time gap between asthma flare-ups could be weeks or months. The symptoms generally worsen in the night or early in the morning. Other factors that can worsen asthma manifestations are breathing in cold air, strenuous physical exercise and heartburn. The tell-tale signs of this condition include
- Cough with or without sputum (phlegm) production
- Chest tightness: Pulling in of the skin between the ribs when breathing
- Wheezing: A musical, whistling or hissing sound with breathing.
Apart from these, there are other manifestations of this condition which demand immediate addressal by the doctor
- 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
What Causes Asthma?
During an episode of 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. Though doctors haven’t been able to identify a specific cause behind asthma, specific triggers have been spotted. Asthma triggers can be broadly categorized into Specific and Non-Specific Trigger
SPECIFIC TRIGGERS: When we say specific triggers, we talk about allergens, irritants, conditions like heartburn and more.
- Airborne irritants: Any substance 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 an asthma attack are common cold, flu, bronchitis and sinus infections. They are a common cause of asthma, especially in children.
- Certain foods 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, especially sulphite additives can also be potential triggers behind an asthma flare-up. They include sodium bisulphite, potassium bisulphite, sodium metabisulphite, potassium metabisulfite and sodium sulphite.
- 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. Newborns can have poor lung function and an increased risk of wheezing if their moms smoke during pregnancy.
- Heart burn: Severe heartburn, known as gastroesophageal reflux disease (GERD), and asthma often go hand-in-hand. Your stomach acids reflux into the oesophagus when the valve between this organ and the stomach does not function properly. If the acid reaches your 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 symptoms to worsen. One possible reason could be that alcohol causes acid reflux. Another probable factors could be the sulphites used in wines and beers.
NON-SPECIFIC TRIGGERS: This category of triggers includes everything from emotional stress to genetic predisposition.
- Emotional Stress: Extreme emotions such as anxiety, anger and fear induce stress which in turn changes heart rate and breathing patterns. Rapid, shallow breathing causes constriction of airways which consequently leads to an asthmatic attack.
- Exercise: Asthma can be triggered by intense exercise sessions or physical exertion.
- Extreme weather: Hot and humid weather or extremely cold weather causes asthma symptoms to flare-up.
- Genetic predisposition: Yes, if you have a family member with asthma or have a family history of allergies, you are more likely to be vulnerable to asthma attack triggers.
- Decreased quality of life: It signifies the decreased ability to exercise and take part in other activities, fatigue, under performance 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 functions. In acute respiratory failure, the bronchial tubes are completely blocked. Oxygen level in the blood becomes dangerously low, or carbon dioxide level becomes alarmingly high. Such patients have to be immediately shifted on ventilators to avoid fatality.
- Pregnancy issues: In pregnant women asthma complications may include early labour, hypertension, gestational diabetes and haemorrhage. Asthma also puts the babies at risk of lower birth weight and breathing disorders.
Diagnosis of Asthma
The diagnosis of asthma is based on a patient’s medical history, physical examination and laboratory test results. Your doctor will take a detailed medical history and ask you about your symptoms and allergy triggers. He may suggest one or more of the following tests to diagnose asthma, assess your breathing and monitor the effectiveness of asthma treatment:
LUNG FUNCTION TESTS
These include a battery of diagnostic tests to assess the performance of your lungs. Most commonly advised lung function tests include:
Spirometry: This is a breathing test that tells your doctor how much and how fast you blow out air. The purpose is to measure airway obstruction.
Methacholine challenge: This is a confirmatory test for asthma, in case your spirometry doesn’t show clear results.
Peak flow: It measures your capacity to push air out of your lungs. It can be performed at home with a device called peak flow meter to figure out how successful your treatment is, whether or not you need emergency, etc.
Exhaled nitric oxide test: It measures the levels of nitric oxide in your breath. An increase in the volume of this gas indicates inflammation in the airways.
This is a first level imaging test that your doctor may suggest just to have a broad overview of your lungs.
Treatment of Asthma
The aim of asthma treatment is symptom control and easing of airway inflammation. Broadly speaking, treatment of this condition rests on three pillars: Long-term asthma control medicines, quick-acting drugs and breathing workouts. Your treatment regimen has to be decided by your doctor. Do not indulge in self-medication as the consequences can be dangerous.
LONG-TERM ASTHMA CONTROL MEDICINES
They don’t provide immediate relief to your symptoms. They work to reduce the severity and instances of asthma attack.
Steroids and Other Anti-Inflammatory Drugs: These are commonly used for most people with asthma, particularly the inhaled steroids. They prevent asthma attacks by reducing swelling and mucus production in the airways. 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: They are often combined with inhaled steroids for long-term control of asthma symptoms. Long-acting bronchodilators are never used alone for long-term therapy.
These drugs are mainly used during an emergency caused by a severe flare-up. They are 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 cough, wheezing, 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. The most commonly used short-acting bronchodilator is albuterol. Here's every you need to know about drugs for asthma.
Your doctor will suggest breathing techniques to increase your lung capacity and ensure healthy inflow and outflow of air.
TACKLING SEVERE CASES OF ASTHMA
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 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. In case of a severe flare-up, 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 sulphate (induces smooth muscle relaxation of the airways) and leukotriene inhibitors. They are anti-inflammatory drugs.
Also read about home remedies for asthma.
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.
Prevention of Asthma
The best way to prevent the relapse of an asthma attack episode is to avoid the triggers. However, the triggers vary from person to person. Common triggers include air pollution, allergies, cold air, a cold or flu virus, smoke, fragrances, etc. Here, we guide you on how to tackle the culprits behind an asthma attack.
Maintain an asthma diary
Identify your triggers and make a note of them in a diary. Also, keep a tab on your symptoms and pen them down. This will help you avoid and manage them. Discuss with your physician about all of these to chalk out a fool proof plan for dealing with asthma.
Stay away from smoke
Smoke from tobacco, candles and fire aren’t good for asthma patients. Do not smoke or allow anyone to do so in your car or at home.
Maintain distance from sick people
Coming in close contact with someone suffering from cough and cold will increase your risk of asthma attack. Stay away from them. Also, wash your hands well before eating and avoid touching your face as much as possible.
Get a flu shot
Immunise yourself against the flu virus because it can trigger an asthma attack. You need to take this shot every year. Getting a vaccine for pneumonia is highly recommended for asthma patients. This vaccine needs to be administered once in every 5 to 10 years.