Asthma – Symptoms, Treatment, and Risk Factors.

Definition

Asthma is the chronic condition that causes inflammation, swell, produce extra mucus and narrowing in the airway of the lungs. People who have this chronic condition for a long time or recurrent is said to be asthmatic. This causes wheezing, chest tightness, coughing and shortness of breath. A cough often occurs early morning or at night time. It cannot be cured but some treatments can reduce the symptoms and can be controlled. It affects people with all age groups and often occurs in children’s.

History

• The term asthma comes from the Greek word aazein which means to exhale through an open mouth, to pant and sharp breath.
• 460 BC- Hippocrates (460 BC) was the first to use the term Asthma as a panting and respiratory distress. Many physicians considered him that who was identified the relation between respiratory disease & the environment.
• 327 BC- smoking the herb stramonium (which is an anticholinergic agent related to ipratropium and tiotropium which are currently used in inhalers today) was used to help relax the lungs.
• 100 AD – Aretaeus of Cappadocia, a Greek physician, is credited with the first accurate description of asthma, as we know it today. He wrote symptoms include chest heaviness, difficulty in breathing and tiredness.
• A Jewish physician & scholar by the name of Maimonides (1135-1204 AD) prescribed sleep, fluids, and chicken soup. He noted that his patient’s symptoms became worse during the wet months which proceeded to the person gasping for air and coughing until phlegm was expelled.

Epidemiology

The prevalence of asthma varies widely in different regions of the world due to distinct genetic, environmental and occupational risk factors. However, this disparity appears to be closing as the prevalence in high-income countries is reaching a plateau whereas the prevalence in low and middle-income countries continues to rise.

Worldwide, it is estimated that approximately 334 million people currently suffer from asthma, and 250,000 deaths are attributed to the disease each year. The prevalence of the disease is continuing to grow, and the overall prevalence is estimated to increase by 100 million by 2025.

Types of Asthma

Child onset asthma: For some children’s the onset of asthma may begin during childhood. Due to genetic reason, the child may become sensitized to common allergens in the environment. The child is a topic- generally in the state of hypersensitivity due to environmental allergens. Allergens are the substances that act as a foreign body that triggers the immune to respond.

Adult-Onset Asthma: This term is used when a person develops asthma after reaching 20 years of age. Adult-onset asthma affects women more than men, and it is also much less common than child-onset asthma. It is also triggered by some allergic materials or an allergy. The cause of adult-onset asthma seems to be triggered by the exposure to the allergens called nonallergic adult-onset asthma. This type of non-allergic asthma is also called as intrinsic asthma. Exposure to chemicals, plastics, metals, certain medicines or wood dust can cause adult-onset asthma.

Exercise-Induced Asthma: After exercise, if you feel difficulty in breathing or wheezing, then you could be suffering from exercise-induced asthma.  Obviously, your level of fitness is also a factor – a person who is unfit and runs fast for ten minutes is going to be out of breath. However, if your coughing, wheezing or panting does not make sense, this could be an indication of exercise-induced asthma. Some exercise may cause the inflammation of airway tubes or bronchial and thus it results in asthma.

Cough-Induced Asthma: Cough-induced asthma is one of the most difficult asthmas to diagnose. The doctor has to eliminate other possibilities, such as chronic bronchitis, post nasal drip due to hay fever, or sinus disease. In this case, the coughing can occur alone, without other asthma-type symptoms being present. The coughing can happen at any time of day or night. If it happens at night it can disrupt sleep.

Nocturnal Asthma: It occurs only during night time from night to 8 am. It is due to the dust and pet dander or may be due to a sinus condition. The patient may have wheezing or short breath when lying down and may not notice these symptoms until awoken by them in the middle of the night – usually between 2 and 4 AM. Nighttime symptoms may also be a common problem in those with daytime asthma as well.

Steroid-Resistant Asthma (Severe Asthma): Some steroid therapy, the patient responds to regularly inhaled glucocorticoid (steroid) therapy, due to steroid resistance. By reducing airway inflammation and immune activation, glucocorticoids are used to treat asthma. However, patients with steroid-resistant asthma have higher levels of immune activation in their airways than do patients with steroid-sensitive (SS) asthma.

Risk factors

Some of the risk factors that may cause the risk of having it are as follows:

• Being a smoker
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing, and manufacturing
• Having a blood relative (such as a parent or sibling) with asthma
• Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
• Being overweight
• Second-hand smoking
• Exposure to exhaust fumes or other types of pollution
• Obesity is the greater risk of getting asthma

Causes of Asthma

It’s not clear why people get it, but probably due to some allergic, genetic and environmental factors. It triggers are different from person to person. Some of the causes of asthma are as follows:

• Air pollution and smoke
• Cold air
• Emotions and stress
• Tobacco smoke
• Atopy
• Gene
• Allergies such as dust, mites, fungi, and cockroaches
• Certain medication such as including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

Early warning signs

• Itchy, scratchy, or sore throat
• Waking up at night
• Dark circles under eyes
• Runny, stuffy or congested nose
• Increased tiredness
• Chest tightness, pain, or pressure
• Shortness of breath
• Coughing, especially at night
• Wheezing
• Thirst
• Itchy, glassy or watery eyes
• Rubbing nose a lot
• Sneezing
• Stomach ache
• Headache
• Fever
• Feeling restless
• Change in face color – pale or flushed
• Throat clearing

Symptoms in Children

• Nagging cough that lingers for days or weeks to sudden and scary breathing emergencies
• Trouble breathing or fast breathing that causes the skin around the ribs or neck to pull in tightly
• Frequent colds that settle in the chest

Effects of asthma

• Stress, anxiety and depression.
• pneumonia (infection of the lungs)
• Lung collapse
• Respiratory failure, where the levels of oxygen in the blood become dangerously low, or the levels of carbon dioxide become dangerously high
• Status asthmaticus which do not respond to treatment).

Diagnosis of Asthma

Physical exam and medical history:

Your doctor will investigate your symptoms and their cases. They will question you about the family history of asthma, medicines you consume, and your lifestyle. Also, ask about previous medical conditions like allergy and eczema that might increase your asthma. During such investigations by your doctor, you should inform about your work and home environment that may worsen your asthma.

Diagnostic tests

Lung function tests: The function of the lungs is tested for how much air that you breathe in and out. It also measures the rate at which you breathe out by using equipment called spirometer. Hence this test is also called a spirometry test.

• Bronchoprovocation test: It is a test to measure how much sense the airways of your nose. With the help of spirometer function of the lungs is repeatedly measured during the physical activities or after you received a dose of cold air or a special drug called bronchodilator to breathe.
• Peak air flow meter: the peak airflow flow meter is much sensitive device indicates the changes that occur in your airways. Before you notice signs and symptoms this device can help to avoid serious effects of it.

• Fractional exhaled nitric oxide (FeNO) Test: It is a test to measure the amount of nitric oxide present in your breathing air. FeNo is a non-invasive and quick test. The results of this test will help to identify the amount of inflammation in airways.

• Provocation test: It is a form of a clinical trial whereby participants are exposed to either a substance or a molecule that is claimed to provoke a response. Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.
• Imaging test: A chest X-ray and high-resolution CT scan are used to visualize the lungs and sinuses. This may reveal their structural abnormalities and inflammations.
• Sputum eosinophil test: This test is used to visualize the eosinophils that may present in the saliva and mucus discharged from the nose and mouth during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).

Treatment and Medication

Treatment doesn’t have a cure for asthma since it is a lifelong disease. There is some requirement for the treatment.

• Monitoring asthma symptoms daily is needed for rescue medication.
• Avoid agents or substance that triggers asthma.
• Consume medications daily to stop inflammation and chronic symptoms.
• Instant drugs such as albuterol can be used.

Medications

In general, there are two types of asthma medications such as anti-inflammatory and bronchodilators.

• Anti-inflammatory drugs: They reduce swelling and mucus production in the airways, making them less likely to react to triggers. Inhaled corticosteroids include beclomethasone (QVAR), budesonide (Pulmicort), fluticasone (Flovent), flunisolide (Aerobid, Aerospan), and ciclesonide (Alvesco) all of which are usually taken twice-a-day, and mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta), which may control it in some patients when taken just once-a-day.
• Bronchodilators: It relieves the symptoms of asthma by temporarily relaxing the muscle bands that tighten around the airways. As a result, breathing improves for about four hours for the short-acting bronchodilators and for about 12 hours for the long-acting inhaled bronchodilators. Short-acting inhaled bronchodilators include the highly popular rescue inhaler albuterol.

Preventive measures for Asthma

• Use allergy-proof covers on pillows and mattresses.
• Do not allow pets in bedrooms or on furniture.
• Remove carpets and stuffed toys from bedrooms. The spur from them will act as allergens.
• Avoid areas where people smoke also try to avoid smoking.
• Avoid harsh cleaning products and chemicals.
• Reduce your stress and enjoy doing the things in your daily life.
• Pay attention to air quality in your environment.
• Perform physical activity daily.
• Understand the climatic conditions around you and act accordingly to rescue from asthma.