CONDITIONS
Asthma
What is asthma?
Asthma is a common, long-term lung disease that causes difficulty breathing. It often starts in childhood, although can develop in adults also, and affects people of all ages. There is currently no cure, but treatment options are available to manage symptoms effectively.
What happens during an asthma episode?
During an asthma episode, airflow is obstructed in the small airways, leading to difficulty breathing. This happens because:
- The airway lining becomes swollen or inflamed.
- Excessive mucus is produced in the airways.
- Tightening of the muscles surrounding the airways, narrowing them.
As a result, certain asthma medications aim to relax the airways, while others focus on reducing inflammation and mucus production to alleviate symptoms.
What triggers asthma?
People with asthma experience airway constriction due to triggers that usually do not affect those without the condition. These triggers include allergens, infections, irritants, exercise (known as exercise-induced asthma), stress, anxiety, and aspirin.
- Allergens: Inhaled allergens like pollen, dust mites, body secretions from cockroaches, feathers, animal dander, and certain foods (such as shellfish and peanuts) can provoke severe attacks in sensitive individuals.
- Infections: Viral respiratory infections such as colds, bronchitis, and pneumonia are common infectious triggers.
- Irritants: Asthma attacks can be triggered by smoke (tobacco, marijuana, or cocaine), fumes (perfumes, cleaning products, air pollution), cold air, and stomach acid in the airways due to gastroesophageal reflux disease (GERD).
- Exercise: Some people with asthma experience airway narrowing during exercise, often due to breathing colder, drier air through the mouth while exerting.
- Stress and anxiety: Emotional stress and anxiety can make the body release certain hormones (chemicals) that tighten the muscles around the airways, making it harder to breathe.
- Aspirin: Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) trigger severe asthma attacks in about 30% of severe asthma cases and less than 10% of overall asthma cases.
What are common signs and symptoms of asthma?
Asthma symptoms vary among individuals and can change over time. They may include:
- Coughing: Asthma-related coughing can worsen at night or early morning, disrupting sleep. Sometimes, coughing brings up mucus or phlegm.
- Wheezing: Wheezing manifests as a whistling or squeaky sound when breathing.
- Chest tightness: This sensation may feel like pressure or something squeezing the chest.
- Shortness of breath: Some describe feeling unable to catch their breath, breathless, or not getting enough air into their lungs.
These symptoms are inconsistent for everyone and may fluctuate in frequency and intensity.
The symptoms of a severe asthmatic attack where the individual needs to get immediate medical help include:
- Rapid breathing
- Pale or bluish discoloration of the face, lips, or fingernails
- The skin around the ribs pulls inward when the individual breaths in
- Difficulty breathing, walking, or speaking
- Symptoms persist even after taking medication
How is asthma classified?
Asthma is categorized into four main types:
- Intermittent: Occasional mild symptoms, occurring up to two days a week and up to two nights a month. Do not interfere with activities of daily living.
- Mild persistent: Symptoms appear more than twice a week but not more than once in a single day. Only slightly limit activities of daily living.
- Moderate persistent: Daily symptoms and more than one night a week. Limits some activities of daily living.
- Severe persistent: Symptoms persist throughout most days and frequently during the night. Interferes excessively with activities of daily living.
The most severe form of asthma, known as status asthmaticus, is characterized by intense and prolonged airway narrowing not responding to treatment. In this condition, the lungs are not able to provide sufficient oxygen to the body and remove carbon dioxide effectively. Treatment may involve the insertion of a breathing tube through the mouth and throat into the main airway (trachea), with mechanical ventilation to aid breathing. Noninvasive ventilation, where a machine assist breathing without a breathing tube, may also be utilized. Additionally, higher doses of multiple medications are often required.
How is asthma diagnosed?
To aid in diagnosis, the doctor will examine the upper respiratory tract (nose, mouth, throat), chest, and skin. They will utilize a stethoscope to listen to breathing and observe signs of asthma or allergies, such as eczema or an allergic skin condition.
A device called a spirometer may be used to assess lung function. The patient will be instructed to inhale deeply and then exhale forcefully into a tube connected to the spirometer. This test may need to be repeated several times. The spirometer measures the volume and speed of the air that can be inhaled and exhaled.
The doctor can order chest x-ray and allergy test. Chest x-ray can help identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.
Allergy testing includes blood tests or skin tests, which can identify if an individual is allergic to certain pets, dust, mold, or pollen.
What are asthma treatment options?
Asthma treatment options include:
Medications
- Quick-relief medications: These are used during asthma to treat acute symptoms and exacerbations, open the airways, and ease symptoms. They include short-acting beta-agonists (such as albuterol and levalbuterol).
- Long-term control medications: Taken regularly on a long-term basis to achieve and maintain control of persistent asthma. These include inhaled corticosteroids, long-acting beta agonists, leukotriene modifiers, and biologics.
Inhalers and nebulizers: Devices used to deliver asthma medications directly into the lungs.
Allergy medications: Antihistamine medications may be prescribed if allergies trigger asthma symptoms.
Lifestyle changes: Avoiding triggers such as allergens, tobacco smoke, and air pollution. Maintaining a healthy weight, exercising regularly, and managing stress can also help.
Peak flow monitoring: Regularly measuring peak expiratory flow can help monitor asthma control and detect worsening symptoms.
How can asthma episodes be prevented?
People with asthma and their doctors can create an action plan to prevent asthma episodes or effectively manage them when they occur.
To prevent asthma episodes:
- Identify and minimize exposure to triggers.
- Adhere to daily medication regimens to prevent symptom development.
To manage asthma episodes:
- Take prescribed medications promptly when symptoms arise.
- Recognize when medical assistance is necessary.
In summary, asthma is a chronic disease affecting people of all ages. It is caused by inflammation and narrowing of airways in the lungs. By understanding asthma triggers, adhering to medication regimens, and having an action plan in place, individuals can better control their symptoms and prevent asthma episodes.
References
- American Thoracic Society. What is Asthma? Available from: https://www.thoracic.org/patients/patient-resources/resources/asthma.pdf Accessed on 23rd April 2024
- Asthma. Available from: https://www.msdmanuals.com/home/lung-and-airway-disorders/asthma/asthma Accessed on 23rd April 2024
- Cleveland Clinic. Asthma. Available from: https://my.clevelandclinic.org/health/diseases/6424-asthma. Accessed on 23rd April 2024
- Asthma. Available from: https://www.webmd.com/asthma/what-is-asthma. Accessed on 23rd April 2024
- Mayo Clinic. Asthma. Diagnosis and Treatment. Available from: https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-20369660 . Accessed on 23rd April 2024
