Asthma is a chronic disease affecting your airways which are tubes carrying air in and out of your lungs. In the case of asthma, the inside walls of your airways become sore and swollen. This state is known as \”Bronchial Hyper Reactivity\” (BHR) which makes them quite sensitive, and they may react vehemently to things that you are allergic to or find some allergens, tobacco smoke, or exercise irritating. When your airways start responding otherwise, they become narrower and your lungs receive less air. This can make you wheeze, cough, and brings about chest tightness and trouble breathing, particularly early in the morning or at night. Amongst asthmatics, some may have mild BHR and no symptoms at all while others may possess severe BHR and chronic symptoms. When your asthma symptoms deteriorate than usual, it\’s termed as an asthma attack. In a serious asthma attack, the airways can shrink so much that your vital organs do not receive sufficient oxygen. Severe asthma attacks bring about 250,000 deaths per year worldwide. Even though asthma affects people of all ages, it very often appears in childhood. Even though the treatment has advanced so much, asthma deaths among young people have more than doubled.
How Does Asthma Affect Breathing?
Asthma results in a narrowing of the breathing airways, which affects the normal movement of air in and out of the lungs. Asthma affects only the bronchial tubes and does involve the air sacs or the lung tissue. The narrowing of the airways is caused by 3 major factors: inflammation, bronchospasm, and hyper reactivity.
Inflammation
The first and most crucial factor influencing narrowing of the bronchial tubes is inflammation in which the bronchial tubes become red, irritated, and swollen. This inflammation makes the wall of the bronchial tubes thicker and thus causes a smaller duct for air to flow through. The inflammation occurs as a reaction to an allergen or irritant and occurs due to the influence of chemical mediators such as histamine, leukotrienes, and others. These inflamed tissues generate an excess amount of \”sticky\” mucus into the tubes.
The mucus can gather together and form \”plugs\” and consequently choke the smaller airways. Specialized allergy and inflammation cells (eosinophils and white blood cells), accumulate at the site and cause tissue damage. These damaged cells are shed into the airways, ensuring the narrowing.
Bronchospasm
The muscles surrounding the bronchial tracts stiffen during an asthma attack. This muscle constriction of the airways is termed as bronchospasm that causes the airway to shrink further. Chemical mediators and nerves in the bronchial tubes cause the muscles to constrict. All humans can experience this bronchospasm and can be brought on by inhaling cold or dry air.
Hyperreactivity (Hypersensitivity)
In patients with asthma, the chronically inflamed and contracted airways become highly sensitive, or reactive, to triggers that include allergens, irritants, and infections. Exposure to these triggers may cause increasingly more inflammation and contraction.
Causes
It is still not clearly known why some people experience asthma and others don\’t, but probably a combination of environmental and genetic (inherited) factors influence such condition.
Asthma triggers varies from person to person. Exposure to some diverse allergens and irritants can trigger signs and symptoms of asthma. Generally, the intensity of your asthma depends on how many agents activate your symptoms and how responsive your lungs are to them. Most of these triggers can also degenerate nasal or eye symptoms.
Triggers fall into two categories:Allergens (\”specific\”) and Nonallergens- mostly irritants (nonspecific)
Allergens
- \”Seasonal\” pollens
- Year-round dust mites, molds, pets, and insect parts
- Foods, such as fish, egg, peanuts, nuts, cow\’s milk, and soy
- Additives, such as sulfites
- Work-related agents, such as latex
About 80% of children and 50% of adults with asthma also get allergies.
Irritants
Respiratory infections, for instance, those caused by viral \”colds,\” bronchitis and sinusitis
Drugs, including aspirin, other NSAIDs (nonsteroidal anti-inflammatory drugs), and beta blockers (used to treat blood pressure and other heart conditions)
- Tobacco smoke
- Outdoor factors- smog, weather changes, and diesel fumes
- Indoor factors- paint, detergents, deodorants, chemicals, and perfumes
- Nighttime
- GERD (gastro esophageal reflux disorder)
- Exercise, especially under cold dry conditions
- Work-related factors, such as chemicals, dusts, gases, and metals
- Emotional factors, like laughing, crying, yelling, and distress
- Hormonal factors, for instance premenstrual syndrome
Types of Asthma
Allergic (Extrinsic)
Extrinsic, or allergic asthma, is quite common (90% of all cases) and generally occurs in childhood. Approximately 80% of children with asthma suffer from documented allergies. Usually, there is a family history of allergies. Moreover, other allergic conditions, for example nasal allergies or eczema, are often detected. But this kind of Allergic asthma often goes into reduction in early adulthood. However, in 75% of cases, the asthma recurs later.
Nonallergic (Intrinsic)
Intrinsic asthma is evident in about 10% of all cases. It usually occurs after the age of 30 and is not normally related to allergies. Women are more susceptible to this; a respiratory tract infection is detected in many cases. The condition can’t be so easy to treat and symptoms are often chronic and persist year-round.
Exercise-induced asthma-This kind of asthma occurs during exercise. In many cases exercise-induced asthma degenerates when the atmosphere is cold and dry
Occupational asthma-This asthma occurs or is deteriorated by breathing in the midst of a workplace irritant like chemical fumes, gases or dust.
Symptoms
- Asthma symptoms range from minor to severe and are different in person to person.
- Shortness of breath
- Chest tightness or pain
- Difficulty in sleeping caused by shortness of breath, coughing or wheezing
- An audible whistling or wheezing sound at the time of exhaling (wheezing is a common sign of asthma in children)
- Bouts of coughing or wheezing that are made worse by a respiratory virus such as a cold or the flu.Asthma
- Classification according to the frequency of attacks
| Asthma | Signs & Symptoms |
|---|---|
| Mild Intermittent | Attacks no more than twice a week. Night time attack no more than twice a month. Persists no more than a few hours to days. Severity of attacks varies. No symptoms between attacks. |
| Mild Persistent | More than twice a week, not everyday. Night time symptoms more than twice a month. Attacks are severe enough that interrupt regular activities. |
| Moderate Persistent | Daily attack. Night time symptoms more than once a week. Severe attacks twice a week that may last for days. Patients need quick relief medication and to change daily activities. |
| Severe persistent | Frequent severe attack. Frequent daytime and night time symptoms. Limitation on daily activities. |
Diagnostic Tests-Diagnosing asthma can be a tough job. Signs and symptoms can vary from mild to severe and are often similar to those of other conditions, such as emphysema, early congestive heart failure or vocal cord problems. Children often experience temporary breathing problem having symptoms similar to asthma.
In order to turn down other probable conditions, your doctor will carry out a physical exam and may ask you questions about your signs and symptoms and regarding any other health troubles. You may also be recommended lung (pulmonary) function tests to verify how much air moves in and out as you breathe.
Tests to assess lung function include:
Spirometry-This test makes assessment of the contraction of your bronchial tubes by checking how much air you are able to exhale after a deep breath and how fast you can breathe out.
Peak flow– A peak flow meter is a simple apparatus that helps measure how forcibly you can breathe out. Lower than usual peak flow readings signify that your lungs may not be working accurately and that your asthma may be deteriorating. Your doctor will instruct you how to track and cope with low peak flow readings.
Lung function tests are generally done before and after taking a bronchodilator (brong-koh-DIE-lay-tur) for example albuterol to expand your airways. If your lung function gets better with the use of a bronchodilator, it\’s possible you have asthma.
Other tests to diagnose asthma include:
Methacholine challenge-If you are suffering from asthma, inhaling a known asthma trigger called methacholine will result in gentle tightening of your airways. If you respond to the trigger, you probably have asthma. This test may be followed if your initial lung function test results normal.
Nitric oxide test-This test is occasionally recommended to diagnose and monitor asthma as it measures the quantity of a gas called nitric oxide that you have in your breath. If your airways get inflamed, which is a sign of asthma; you may have greater than normal nitric oxide levels. But this test isn\’t commonly available.
Blood tests provide a detailed picture of your overall health. Specific tests are helpful to measure levels of immunoglobulin E (IgE), a major antibody released during an allergic reaction. Allergy testing is necessary to detect which allergens affect you, and if there is any. Your doctor may execute an X-ray examination of you to visualize the structures inside your chest, including the heart, lungs, and bones. By observing your lungs, your doctor can make out if asthma is causing your symptoms. While a chest X-ray is not an asthma test, it may also be used to ensure that nothing else is influencing your asthma symptoms.
All of these asthma tests guide your doctor decide if asthma is really present and if there are other parallel conditions with asthma, such as allergies, GERD, or sinusitis. Once a proper asthma diagnosis is done, specific medications are suggested to help control your asthma and prevent asthma attacks.
Treatments-Prevention and long-term control is important to prevent asthma attacks. Treatment normally consists of learning to identify your triggers and taking measures to avoid them, and tracking your breathing in order to ensure your daily asthma medications are keeping symptoms under control.
Long-term control medications
Generally, these medications need to be consumed daily. Types of long-term control medications include:
Inhaled corticosteroids-These medications include fluticasone, budesonide, mometasone, flunisolide, beclomethasone and others. They are the most commonly recommended long-term asthma medication that you may need to use for several days to weeks before they give you satisfactory result. Contrary to oral corticosteroids, these corticosteroid medications have relatively lower side effects and are normally safe for prolonged use.
Leukotriene modifiers-These oral medications include montelukast, zafirlukast and zileuton which help prevent asthma symptoms for up to 24 hours. Rarely, these medications have been linked to psychological reactions including agitation, aggression, hallucinations, depression and suicidal attempt. Seek medical guidance right away for any abnormal reaction.
Long-acting beta agonists-These inhaled medications include salmeterol and formoterol. LABAs release the choked airways and lessen inflammation. However, they are used to prevent severe asthma attacks. LABAs should be taken only along with an inhaled corticosteroid.
Combination inhalers include fluticasone and salmeterol and budesonide and formoterol. These medications contain a LABA combined with a corticosteroid. Like other LABA medications, these medications may augment your danger of having a severe asthma attack.
Theophylline-This pill should be taken regularly in order to keep the airways open. Theophylline relaxes the muscles situated around the airways to ease breathing. It\’s not used as frequently now as in past years.
Quick-relief medications-Quick-relief (rescue) medications are used for quick, short-term symptom respite during an asthma attack or before exercise if your doctor prescribes it. Types of quick-relief medications are mentioned below:
Short-acting beta agonists-These inhaled, quick-relief bronchodilators including albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler) can speedily relieve symptoms during an asthma attack. These medications act within minutes, and effects remain for several hours.
Ipratropium (Atrovent)-Your doctor might recommend this inhaled medication for instant relief of your symptoms. Like other bronchodilators, ipratropium acts well in relaxing the airways, ensuring easy breathing. Ipratropium is typically used for emphysema and chronic bronchitis, but it\’s sometimes used to take care of asthma attacks.
Oral and intravenous corticosteroids-These medications alleviate airway inflammation due to severe asthma. Examples comprise prednisone and methylprednisolone, but they can cause severe side effects when used for a long time. Therefore they\’re recommended for a short-period in order to treat severe asthma symptoms.
Treatment for allergy-induced asthma-If your asthma is triggered or aggravated by allergies, allergy treatment may improve your condition as well. Allergy treatments include:
Allergy shots (immunotherapy)-Immunotherapy injections are generally given once a week for a few months. It is once again given for a period of three to five years. Eventually, they gradually reduce your immune system reaction to specific allergens.
Omalizumab (Xolair)-This medication is specific for people having allergies and serious asthma. It acts by changing the immune system. Omalizumab is injected every two to four weeks.
Allergy medications-Allergy medications include oral and nasal spray antihistamines and decongestants and corticosteroid, cromolyn and ipratropium nasal sprays.
If you have an asthma flare-up, a quick-relief inhaler can relieve your symptoms instantly. But if your long-term control medications are working appropriately, you shouldn\’t require using your quick-relief inhaler very often. Maintain a record of how many puffs you are using each week. If you feel the need of using your quick-relief inhaler more often than your doctor prescribes, consult your doctor as you may need to adjust your long-term control medication.
Bronchial thermoplasty-This treatment is beneficial for severe asthma that doesn\’t seem to improve with inhaled corticosteroids or other long-term asthma medications. It is generally carried on in three outpatient visits. Bronchial thermoplasty heats the inner portion of the airways in the lungs with an electrode and thus reduces the smooth muscle inside the airways. This limits the ability of the airways to become stiff, making breathing easier and may decrease asthma attacks. Bronchial thermoplasty isn\’t commonly available. More research is required to find out whether the benefits of this treatment prevail over the possible risks and potential side effects.
Lifestyle and home remedies-Although many people with asthma depend on medications to prevent and relieve symptoms, you can do several things on your own to maintain your health and reduce the risk of asthma attacks.
Avoid your triggers-It is important to reduce your exposure to things that trigger asthma symptoms in order to control asthma. Here are some things that may help you if followed:
Use your air conditioner- Air conditioning reduces the amount of pollen carried by air from trees, grasses and weeds that finds its way indoors. Air conditioning also reduces indoor humidity and can reduce your exposure to dust mites. If you don\’t have air conditioning, try to keep your windows shut during pollen season.
Decontaminate your decor- Reduce dust that may aggravate nighttime symptoms by replacing particular items such as encase pillows, mattresses and box springs in dust-proof covers in your bedroom. In place of carpeting install hardwood or linoleum flooring. Also try to use washable curtains and blinds.
Maintain optimal humidity- If you live in a damp ambiance, ask to your doctor about using a dehumidifier.
Keep indoor air clean- Have a utility company check your air conditioner and furnace once a year. Replace the filters in your furnace and air conditioner as the manufacturer instructs you. Also think about installing a small-particle filter in your ventilation system. If you use a humidifier, make sure you change the water daily.
Reduce pet dander- If you\’re allergic to dander it is advised to avoid pets with fur or feathers. Having pets regularly bathed or groomed also may cut down the amount of dander in your surroundings.
Clean regularly- Clean your home at least once a week. If you\’re allergic to dust, wear a mask or have someone else do the cleaning.
If it\’s cold outside, always cover your face. If your asthma is aggravated by cold and dry air, you must wear a face mask.
Stay healthy
It is beneficial to take care of yourself and treat other conditions linked to asthma which will help keep your symptoms under control. A few things you can do include:
Regular exercise- Asthma doesn\’t make you less active. Proper treatment can prevent asthma attacks and manage symptoms during activity. Regular exercise strengthens your heart and lungs that helps ease asthma symptoms. But be careful as exercising in cold weather may trigger asthma symptoms. If you still do exercise in cold temperatures, wear a face mask to warm the air you breathe.
Maintain a healthy weight- Being overweight can deteriorate the condition, and put you at higher risk of having other health problems.
Eat fruits and vegetables- Intake of plenty of fruits and vegetables may boost lung function and reduce asthma symptoms because these foods are enriched with protective nutrients (antioxidants) that improve immune system.
Control heartburn and gastroesophageal reflux disease (GERD) – Acid reflux that causes heartburn may harm lung airways and trigger asthma symptoms. If you experience recurrent or constant heartburn, consult your doctor about treatment options available. You may require treatment for GERD before your asthma symptoms get better.