Bronchial Asthma or Asthma, in general, is a chronic disease which causes inflammation in the airways in the lungs. It is a long-term disease which causes symptoms which might be variable or recurring like bronchospasms which means contraction in the muscles of the bronchioles which makes breathing difficult, reversible airflow obstruction etc. Major problems include tightness in the chest, coughing, wheezing and shortness of breath. The frequency might depend from person to person, episodes might occur very frequently like multiple times in a day or a week. The episodes might be worse at night for some people or might become worse with exercise for some others.
Allergies and Asthma share a strong link. Some other diseases of the respiratory system like nasal polyps and sinusitis are linked to allergies. Individuals who suffer from asthma and allergies both are known to experience worsening of symptoms at night, are more likely to skip their routine activities and often need strong medications for getting relief from their symptoms.
Both genetic and environmental factors play a role in the occurrence of asthma. Air pollution and various allergen are responsible factors for the triggering of asthmatic episodes. Certain medications like aspirin and beta blockers can also lead to the episodes. Asthma is linked to three types of cells in the body- mast cells, eosinophils and T lymphocytes. These cells have different roles to play in the human body. Mast cells perform the function of releasing histamine which causes stuffiness of the nasal cavity and dripping while experiencing a cold or a hay fever, leads to the constriction of airways in people with asthma and lead to itchiness in skin allergies. Eosinophils which are a type of white blood cells have a close link with allergic diseases. The blood cells which are linked to inflammation and allergies are T lymphocytes which are also a type of white blood cells. The above-mentioned blood cells in conjunction with other inflammatory cells lead to the situations like hyperresponsiveness of the airways, limiting the airflow, respiratory symptoms and certain chronic diseases. In some people, inflammation in the airways might lead to a feeling of breathlessness and a tightness in the chest mainly experienced at night or early morning. Some people might only experience difficulty while or after exercising.
The rate at which asthma has been occurring in people has been rising constantly. Most of the cases are encountered in developing countries. The problem often starts during childhood and progresses later on. The problem has no cure but the symptoms can be controlled with proper medication and treatment.
An asthma episode is a situation when the symptoms associated with asthma are worse than the usual symptoms in terms of intensity. These episodes can be mild to moderate or can be severe.
During an attack, the airway is narrowed due to the tightening of the muscles surrounding it which leads to a decreased flow of air through them. There is also inflammation of the airways more than normal production of mucus which leads to even more narrowing of the airways and thus less flow of air.
Sometimes attacks might be such that the oxygen fails to reach the lungs and subsequently the blood from where it goes to all the organs in the body. These attacks might be fatal.
There are two cases which include childhood asthma and adult-onset asthma. If the person suffers from the latter, symptoms usually appear after the age of 20 years. Some types of asthma are discussed below:
Allergic Asthma: This type of asthma is triggered by allergens like dust, pollen, mould, certain foods, pet dander etc. This varies from individual to individual. This type of asthma is mostly seasonal as it often occurs with seasonal allergies.
Non-allergic asthma: This is also known as intrinsic asthma. There are certain irritants in the air which are not associated with allergies. These include perfumes, air fresheners, air pollution, cold air, burning wood, viral illnesses, cigarette smoke, cleaning products etc.
Cough variant asthma (CVA): This type of asthma does not show normal symptoms of asthma-like shortness of breath and wheezing. A persistent and dry cough is seen in this type of asthma. But it can lead to a full asthma attack which includes other commonly experienced symptoms.
Exercise-induced asthma (EIA): In this variant of asthma, the individual might experience difficulty within a few minutes after beginning exercise and last up to about 10 to around 15 minutes of exercise. Most of the people with asthma experience exercise-related asthma but it is not true the other way round.
Nocturnal asthma: In this type of asthma, the symptoms are more severe at night. This can be the case because of triggers like dust mites, heartburn, body’s sleep cycle, pet dander etc.
Occupational Asthma: This type of asthma develops because of risk factors at the workplace which include dust, fumes, dyes, rubber latex, gases, chemicals etc. These are found in industries like farming, woodwork, manufacturing, textiles etc.
Various factors play a role in increasing the risk of developing asthma. Some of these include:
Being overweight, smoking, exposing oneself to secondhand smoke, people who have immediate relatives like parents or siblings who suffer from asthma, exposure to pollution like exhaust fumes, suffering from an allergic condition like allergic rhinitis or atopic dermatitis, exposure to pollutants and triggers in the workplace like chemicals used in manufacturing, farming etc.
The symptoms of asthma differ from person to person. Some people might experience frequent asthma attacks, some people might experience them only at some times or during some activities or some people might experience symptoms at all times.
There are frequently occurring episodes of wheezing, coughing, shortness of breath and feeling a tightness in the chest. There might be the production of sputum while coughing but it might be difficult to expel it. While recovering from an attack, the sputum might appear like pus which is because of the presence of high levels of white blood cells called the eosinophils. The symptoms experienced are most of the times worse at night or during the early morning. Some individuals experience symptoms only in response to certain triggers whereas the symptoms can be persistent in others.
Some signs that show that the condition is worsening include the necessity to use a quick-relief inhaler more frequently, more frequent and troublesome signs and symptoms and increase in the difficulty to breathe.
The cause for the occurrence of asthma is not simple and straightforward. Development of asthma is the complex amalgamation of environmental and genetic factors. These play an important role in determining the severity of the condition and the responsiveness to treatment. The occurrence of asthma before the age of 12 years is linked to genetic influence but the onset of the condition after the age of 12 is mostly due to environmental factors.
Environmental factors like allergens, air pollution and other chemicals in the environment have been linked to the exacerbation of asthma. Low quality of air or high levels of ozone has been linked to the development of asthma and to the severity of the symptoms. Indoor allergens like dust mites, cockroaches, animal dander also increase the risk of developing asthma.
Genetic factors also play an important role. The genes associated with the condition include many genes that are linked to the immune system or perform the function of modulating inflammation. Some of these genes include SPINK5, GSTM1, IL4R among others. Sometimes genes cause asthma only when they are combined with some specific environmental factors.
Some medical conditions are also linked to asthma. A history of having the atopic disease is strongly linked to developing asthma. Individuals with obesity are also more likely to experience symptoms of asthma. Some medications like beta blockers can also trigger asthma.
All the signs and symptoms should be explained thoroughly to the health care practitioner for him/her to make a proper diagnosis. The incidents which trigger the symptoms should also be noted. Some tests used to diagnose asthma are:
Spirometry: It is a type of lung function test which measures the capacity of breathing and also notes how well the person is breathing. It is regarded as the best test to diagnose asthma. Spirometry should be performed once in every one or two years to follow up on how well the condition is being controlled.
Peak Expiratory Flow: Also known as PEF, this test is used to measure the force with which a person can breathe out air. A device known as the peak flow meter is used in which the patient is asked to exhale out air in the tube to measure the force of the flow of air. This can help to monitor the condition at home.
X-Ray: X-Ray of the chest can be conducted to help diagnose the condition. It can also be used for ruling out other diseases causing similar symptoms.
Doctors prescribe medications and lifestyle changes to treat asthma. A specific plan to monitor and manage symptoms is created for the patients. Changes should be made in the plan according to changes in the pattern of symptoms experienced. The treatment that works most often and is most effective is identifying the triggers and avoiding and eliminating exposure to these triggers. If avoidance to triggers is insufficient, medicine use is recommended.
Medicines are generally of two type quick-relief medications which are used in treating acute symptoms and long-term control medications which are used to prevent the worsening of symptoms. Fast acting medications include anticholinergic medications like ipratropium bromide can be used in conjunction with SABA like salbutamol for additional benefits in people with moderate to severe symptoms. SABA is also given to patients who experience exercise-induced symptoms. Long-term control medications include corticosteroids which are considered to be the most effective form of long-term treatment. LABA such as formoterol can also help in aiding asthma control.
Making changes in lifestyle also helps in controlling asthma symptoms. Limiting smoking and reducing exposure to second-hand smoke can help in curbing asthma symptoms. Measures to control dust mites like filtration of air, vacuuming can also help. Exercise is also recommended for people with stable asthma. Yoga can also be a measure to help in providing a better quality of life and improve symptoms in people with asthma.
There is no foolproof method to prevent asthma but certain steps can be taken to manage the symptoms in a better manner. Some of these include:
Asthma Action Plan: A step by step asthma action plan can be developed in consultation with the doctor to manage the symptoms which should include a detailed plan on medications and how to manage an asthma attack. The condition requires continuous monitoring and treatment.
Vaccinations: Getting oneself vaccinated against pneumonia and influenza can be helpful in avoiding possible episodes which are triggered by these conditions.
Identifying and avoiding asthma triggers: Efforts should be made to identify what causes or worsens the asthma symptoms and steps should be taken to avoid them. These may include allergens like pollens, cold air and other irritants.
Monitoring Breathing: Warning signs of an attack like wheezing, shortness of breath and coughing should be identified. Recording and measuring of peak airflow with a home peak flow meter should be done.
Identify and treat attacks early: Quick actions result in less severe attacks and less usage of medicines for controlling symptoms. If the peak flow measurements decrease, medications should be taken as directed and any activity that can trigger an attack should be stopped.
Take medicines as prescribed: No change of medication should be done without notifying and consulting your healthcare practitioner.
Quick-relief medication use: Attention should be paid to the use of quick-relief inhalers like albuterol. If there is excessive relying of the patient on the quick-relief inhalers, it indicates that the asthma symptoms are not under control. A change or adjustment in the treatment plan might be needed at this stage.
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