Asthma is a very common condition that affects a lot of people. It is a very old disease. The term asthma is originally derived from an ancient Greek word ‘aazein’. Aazein means ‘to pant’. But, this was acknowledged as a public health issue about 4 decades ago.
It is a chronic lung disease that affects people of all ages and ethnic groups. Worldwide, an estimated 300 million people suffer from this condition worldwide.
It affects females more than males. Likewise, children suffer more than adults (male predominance in children).
What is asthma?
It’s a chronic lung disease. Inflammation of the airway induces the condition. This usually leads to bronchial hyperresponsiveness and reversible airflow obstruction. In an asthma attack, the muscles of the air passage in the lung go into spasm. This makes the airway narrower, making it difficult to breathe. The constriction of the airway causes difficulty in breathing. Additionally, the airway walls begin to swell, and cells begin to produce more mucous than usual. This further restricts airflow in the lungs.
This stimulus can activate the type 2 T-helper lymphocytes and start producing interleukins (IL-4, IL-5, IL-9, IL-13). These can lead to significant inflammation in the airways. This recruits eosinophils and promotes immunoglobulin E (IgE) production.
SYMPTOMS OF ASTHMA:
It can present with some of the below mentioned symptoms,
- Shortness of breath
- Difficulty breathing or speaking
- Tightness of the chest
- Mucus secretion
- Airflow obstruction
- A blue-grey tinge of the skin, lips, earlobes, nailbeds are common.
- Recurrent respiratory symptoms with evidence of reversible airflow obstruction.
- Dramatic response to bronchodilator therapy
People with mild asthma can have symptoms that happen twice a week
The symptoms can occur almost everyday. But, multiple flares are rare in these cases.
In the case of severe asthma, patients have attacks almost every day. They can occur several times in a single day. The symptoms might not improve even with large doses of medications. These patients might,
- Visit the hospital regularly
- Use quick-relief medications more than 2 times per year
- Renew their inhalers more than twice a year
- Need steroid pills more than 2 times a year
- Further, they have difficulty with regular everyday activities.
TYPES OF SEVERE ASTHMA:
- Allergic asthma
- Eosinophil excess type of asthma
- Neutrophils excess type of asthma
- Finally, airway smooth muscle hypertrophy.
RISK FACTORS OF ASTHMA:
As we already saw, allergy is a major risk factor. A family history of atopy increases the risk by 3 times. Studies show a strong correlation between asthma and both serum IgE and the degree of positive allergy tests. Therefore, allergen control is an essential part of management.
Firstly, obesity especially during childhood is a major risk factor of asthma. A sedentary lifestyle and decreased physical fitness level increase the risk. Therefore, maintaining a healthy weight can prove helpful. This also effectively improves lung function.
RESPIRATORY VIRAL INFECTIONS:
An attack by rhino-virus and wheezing during childhood are major risk factors. Exposure to the respiratory syncytial virus can increase risk (during infancy). Further, recurrent wheezes also increase the chance of asthma in adulthood.
Children can easily have a variety of reasons to have asthma. But, when adults get affected, especially during the later stages of their life, occupational exposure is a major reason. Further, studies show that almost 16% of adult-onset asthma is through occupation.
Moreover, there are 2 types :
- Immunological: This includes exposure to animal allergens, plants and insects. These are sensitisers. They can sensitise the human body immunologically through these allergens.
- Non-immunological: This category includes irritants like highly concentrated gases, fumes, dust etc.
Air pollution is a known trigger. Further, exacerbation of the existing condition can occur. This has become a major environmental issue in recent days. Two major studies greatly support this statement.
The first study shows that exposure to air pollution is a known risk of wheeze. Secondly, the development of asthma is greatly linked with prenatal exposure during the mid-pregnancy period. Tobacco smoke is also a major trigger of asthma.
Apart from these above-mentioned risk factors, family history, atopic background like seasonal sinusitis, eczema and allergic conjunctivitis. Further, being overweight, having a close blood relative with asthma (parent or sibling), smoking or second-hand smoking can also increase the risk of asthma.
Detecting is pretty easy in the early stages. However, a comprehensive medical history and physical examination are essential. Further, assessing lung function forms a major part in diagnosing asthma.
But, sometimes additional tests might be required to rule out other respiratory conditions.
Obtaining the personal and medical history is one of the most initial and important parts of diagnosing. It is most likely to be diagnosed during childhood or adolescence.
It is most likely to be triggered by cold air, exercise, weather changes, allergens, environmental irritants and infections. Otherwise, it is generally asymptomatic. Further, a trigger by these factors causes a flare-up of the condition.
Atopic factors like seasonal sinusitis, eczema, allergic conjunctivitis are also suggestive. Further, medical history can also rule out other conditions like allergic sinusitis, GERD, that can aggravate asthma. Failing to identify these conditions can lead to poor symptom control.
As we already saw occupational exposure plays a major role. Therefore, work history must be obtained. Occupational exposure can be broadly divided into 2 types,
- Work-exacerbated asthma(WRA): These patients have well-known pre-existing asthma. These symptoms are worsened by triggers in the workplace. Further, WRA can be the diagnosis when symptoms flare up during work hours and subside during holidays or vacations.
- Occupational: The work actually exacerbates asthma.
Meanwhile, the other classification is sensitiser-induced or irritant-induced.
The second most important step in diagnosing is through physical examination. Airflow obstruction is suggestive of expiratory wheeze in addition to prolonged exhalation.
The examination of the head, eyes, ears, nose and throat is essential. Sinus tenderness, nasal polyps and post-nasal drips should be checked. Concurrent atopic conditions like eczema and dermatitis are common in asthmatics. Physical examination forms an important part of differential diagnosis.
PULMONARY FUNCTION TESTS:
Certain pulmonary function tests include spirometry, lung volumes and diffusing capacity, peak expiratory flow monitoring, challenge tests, methacholine challenge testing, exercise challenge testing.
IMAGING IN ASTHMA:
Asthma diagnosis does not require chest radiography and chest CT. But, these help to exclude asthma mimics like congestive heart failure (CHF), bronchiectasis, vascular anomalies and lung cancer.
MODERN IMAGING TECHNOLOGIES:
Turbo-inversion recovery magnitude magnetic resonance imaging and nuclear imaging dependent on glutathione, have been recent studies to estimate airway inflammation and measure the lung oedema in asthma.
MANAGEMENT OF ASTHMA:
There is no cure for asthma. The goal is to effectively manage and control the symptoms. The main idea behind management is to assess the severity of the condition. A step-wise approach should be undertaken and the medications have to be adjusted.
Drugs have been successfully used to control and manage this condition. Also, they are broadly classified into 2 types as quick-relief drugs and long-term control drugs.
Quick-relief medications are the SABA’s (Short-acting muscarinic antagonists) and systemic steroids. These medications when inhaled directly into the lungs causes the muscle to relax and opens the airway. But, these are only short term solutions.
The long term control drugs include inhaled steroids, combination drugs, leukotriene modifiers, anti-IgE therapy (allergy or atopy), methylxanthines and oral corticosteroids.
IMMEDIATE MANAGEMENT OR FIRST AID FOR ASTHMA:
Most people who are prone to asthma attacks usually have an idea of using their inhalers. They usually carry their inhaler around with them. So, if a person has an asthma attack, seat them, make them relax and ask them to use their inhalers straight away.
- You can reassure them and help them use their inhalers. Advise them to use a spacer if they have one.
- Ask the patient to breathe deeply and slowly. This helps them to control their breathing.
- Seat them in a comfortable position, if the attack does not get better within a few minutes, it may be a severe attack.
SEVERE ATTACK OF ASTHMA:
In case of a severe attack of asthma,
- Make them use their reliever inhaler instantly. A hand-held inhaler or nebuliser can be used. A spacer can be used in an inhaler and an oxygen mask can be used along with a nebuliser.
- It is advisable to use about one or two puffs every 2 minutes.
- A maximum of about 10 puffs can be reached.
If the person is having the first attack of asthma, and if the symptoms do not get any better and the patient seems to become exhausted call medical services immediately. In case of the availability of an inhaler, it is advisable to continue to use them.
While waiting for medical services, it is essential to regularly check the breathing, pulse and level of response of the patient. If they become unresponsive at any point of time, treat a casualty who is unresponsive.
To sum up, asthma is a totally easy condition to manage. Having awareness of this condition and catching it up at an earlier stage can help in better management.