Asthma is a chronic inflammatory disease of the bronchial tubes that causes swelling and narrowing of the airways. Asthma causes difficulty in breathing, recurring periods of wheezing (whistling sound while breathing), chest tightness, shortness of breath, and coughing. It is one of the most common disease that can affect all age groups but especially during childhood that can continue into adulthood.
Factors That Contribute to Asthma
-We have less exposure to infection compared to our ancestors.
-We spend more time indoors, where we are exposed to indoor allergens such as dust and mold.
-The air we breathe is more polluted than the air most of our ancestors breathed.
-Our lifestyle has led to our getting less exercise and an epidemic of obesity.
Asthma cannot be cured and it can only be controlled. Patients can have more frequent and severe asthmatic attacks that can even lead to death. There is better chance of controlling asthma and can have only fever symptoms, if diagnosed early and treatment started early.
Causes:
There are a variety of causes for asthma and the exact cause is not known.
some people are born with the tendency to have asthma while others do not. The environment that we live partly determine the incidence of getting asthma. People differ in having their own unique set of trigger factors. Common trigger factors include.
-exposure to tobacco or wood smoke
-breathing polluted air
-inhaling other respiratory irritants such as perfumes or cleaning products
-exposure to airway irritants at the workplace
-breathing in allergy-causing substances (allergens) such as molds, dust, or animal dander
-an upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis
-exposure to cold, dry weather
-emotional excitement or stress
-physical exertion or exercise
-reflux of stomach acid known as gastroesophageal reflux disease, or GERD
-sulfites, an additive to some foods and wine
-asthma symptoms are closely tied to the menstrual cycle
Risk factors for developing asthma include hay fever (allergic rhinitis) and other allergies, eczema, and genetic predisposition.
Symptoms:
As the air passages gets irritated or infected an asthmatic trigger occurs. It may come suddenly or develop slowly over several hours or days. The important asthmatic symptoms include
-wheezing, which is the most common symptom of an asthmatic attack. Wheezing is a musical, whistling, or hissing sound with breathing. Wheezes are most often heard during exhalation, but they can also occur during breathing in (inhaling).
-breathlessness
-chest tightness
-coughing
-difficulty speaking
Symptoms may occur during the day or at night and if they do happen at night, it may disturb your sleep.
Seeking Medical Care
The time to seek medical care or an appointment to the health care provider is by watching the clues that points to asthma
-wheezing
-difficulty breathing,
-pain or tightness in your chest, and
-recurrent, spasmodic cough that is worse at night
An action plan should be worked out in advance with your health-care provider. This plan should include instructions on what to do when an asthma attack occurs, when to call the health-care provider, and when to go to a hospital emergency department.
As a general guideline in an emergency, take two puffs of an inhaled beta-agonist (a rescue medication), with one minute between puffs. If there is no relief, take an additional puff of inhaled beta-agonist every five minutes. If there is no response after eight puffs, which is 40 minutes, your health-care provider should be called. Your provider should be called if you have an asthma attack when you are already taking oral or inhaled steroids or if your inhaler treatments are not lasting four hours.
Exams and Tests for Asthma
An assessment of severity of asthma is first carried out by a health care provider in an emergency department. Attacks are usually classified as mild, moderate, or severe.
Measurements of detecting the severity of asthma includes:
Spirometer: This device measures how much air you can exhale and how forcefully you can breathe out. The test may be done before and after you take inhaled medication. Spirometry is a good way to see how much your breathing is impaired during an attack.
Peak flow meter: This is another way of measuring how forcefully you can breathe out during an attack.
Oximetry: A painless probe, called a pulse oximeter, will be placed on your fingertip to measure the amount of oxygen in your bloodstream.
Your blood may be checked for signs of an infection that might be contributing to this attack.
Treatment and Care for Asthma:
The goal of treatment is to avoid the substances that trigger your symptoms and to control airway inflammation. The treatment of asthma takes a long course and some patients may even need lifelong treatments. Follow the treatment recommendations of your health-care provider. Know what each drug does and how it is used. See your health-care provider as scheduled. Report any changes or worsening of your symptoms promptly. Report any side effects you are having with your medications.
People with mild asthma may use quick relief medication as needed, while those with persistent asthma should take control medications on a regular basis to prevent symptoms. A severe asthma attack requires a check up by a doctor and possibly a hospital stay, oxygen, and medications through a vein. There are two basic kinds of medication for the treatment of asthma, such as 1) long-acting medications to prevent attacks and 2) quick-relief medications for use during attacks.
1) The Long-term control medications are used on a regular basis to prevent attacks, not to treat them. Such medicines include:
-Long-acting beta-agonists: This class of drugs is chemically related to adrenaline. They relax the muscles of the breathing passages, dilating the passages and decreasing the resistance to exhaled airflow, making it easier to breathe. They may also help to reduce inflammation, but they have no effect on the underlying cause of the asthma attack. Side effects include rapid heartbeat and shakiness. Salmeterol (Serevent) and formoterol (Foradil) are long-acting beta-agonists.
-Inhaled corticosteroids: The inhaled corticosteroids act locally by concentrating their effects directly within the breathing passages, which prevent inflammation with very few side effects outside of the lungs. Beclomethasone (Vancenase, Beclovent) and triamcinolone (Nasacort, Atolone) Azmacort, Vanceril, AeroBid, Flovent are examples of inhaled corticosteroids.
-Leukotriene inhibitors Leukotrienes are powerful chemical substances that promote the inflammatory response seen during an acute asthma attack. By blocking these chemicals, leukotriene inhibitors reduce inflammation. The leukotriene inhibitors are considered a second line of defense against asthma and usually are used for asthma that is not severe enough to require oral corticosteroids. Zileuton (Zyflo), zafirlukast (Accolate), and montelukast (Singulair) are examples of leukotriene inhibitors.
-Methylxanthines are another group of controller medications useful in the treatment of asthma. This group of medications is chemically related to caffeine. Methylxanthines work as long-acting bronchodilators. At one time, methylxanthines were commonly used to treat asthma. Theophylline and aminophylline are examples of methylxanthine medications.
-Mast cell stabilizers such as Cromolyn sodium is another medication that can prevent the release of chemicals that cause asthma-related inflammation. This drug is especially useful for people who develop asthma attacks in response to certain types of allergic exposures. When taken regularly prior to an exposure, cromolyn sodium can prevent the development of an asthma attack.
-Omilizumab (Xolair), which blocks a pathway that the immune system uses to trigger asthma symptoms. It belongs to a newer class of agents that works with the body's immune system. In people with asthma who have an elevated level of Immunoglobulin E (Ig E), an allergy antibody, this drug given by injection may be helpful with symptoms that are more difficult to control. This agent inhibits IgE binding to cells that release chemicals that worsen asthma symptoms. This binding prevents release of these mediators, thereby helping in controlling the disease.
-Sometimes a single medication that combines steroids and bronchodilators are used (Advair, Symbicort)
2) Quick relief or rescue medications are used to relieve symptoms during an attack or after an asthma attack has already begun.
-Short-acting beta-agonists are the most commonly used rescue medications. Inhaled short-acting beta-agonists work rapidly, within minutes, to open the breathing passages, and the effects usually last four hours. These are Short-acting bronchodilators (inhalers), such as Albuterol Proventil, Ventolin, Xopenex, and others.
-Anticholinergics are another class of drugs useful as rescue medications during asthma attacks. Inhaled anticholinergic drugs open the breathing passages, similar to the action of the beta-agonists. Inhaled anticholinergics take slightly longer than beta-agonists to achieve their effect, but they last longer than the beta-agonists. An anticholinergic drug is often used together with a beta-agonist drug to produce a greater effect than either drug can achieve by itself. Ipratropium bromide (Atrovent) is the inhaled anticholinergic drug currently used as a rescue asthma medication.
-Corticosteroids, such as methylprednisolone, may be given directly into a vein (intravenously), during a severe attack, along with other inhaled medications.
Step-wise Approach:
-Intermittent asthma is treated with a rescue inhaler which is used only for symptoms.
-Persistent asthma requires the use of maintenance medication, usually an inhaled steroid, but other medications such as leukotriene inhibitors are also used. The more severe the asthmatic condition, the more maintenance medications are required. These additional medications include the long-acting beta agonists, oral steroids, and in some cases, theophyllines or omalizumab.
-As asthma improves, decreasing the amount of medication under a physician's guidance and in some cases, stopping some of the medication may be indicated. This is referred to as "stepping down" therapy.
Follow-up Steps:
If you have been treated in a hospital emergency department, you will be discharged once you respond well to the treatment. If your symptoms return, or if you begin to feel worse, you should immediately contact your health-care provider or return to the emergency department. Take your prescribed medications as directed, both controller and rescue medications. See your health-care provider regularly according to the recommended schedule.
Avoiding triggers or exacerbating factors such as
Cessation of smoking
Avoid cigarette smoke
Avoid dust mites
Avoid animal dander
Avoid cockroaches
Avoid vaccuuming - get someone else to do it
Avoid indoor mold
Avoid pollen
Avoid outdoor mold
Avoid fire smoke
Avoid animals
Avoid strong odors - such as perfumes or cleaning products.
Avoid flu - get a flu vaccination and/or avoid people with the flu.
Avoid sulfites - in certain foods such as beer, wine, seafood, etc.
Avoid cold air
Avoid cross-reaction asthma effects of other medications
