Adult Asthma
Asthma is a chronic inflammatory disorder of airways, in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.
The prevalence of asthma was one percent in 1964 in the country. But, new data as per WAO (World Allergy Organization) shows that about 14 per cent people now have asthma .The way these are occurring, WAO believes, that by 2050, about 50 percent of all children will have some sort of allergies.
Symptoms
- Recurrent episodes of wheezing
- Troublesome cough at night
- Cough, wheezing, chest tightness after exposure to airborne allergens or pollutant
- Cough or wheeze after exercise
- Common cold which goes to the chest or takes more than 10 days to clear
Since these symptoms could occur due to the other causes also, your doctors would have to confirm the diagnosis
Asthma triggers
- Dust Mite
- Pollens from grasses, trees ,plants and flowers
- Indoor molds
- Smoke
- Smell
- Viral infections
- Exercise
- Weather changes
- Temperature changes
- Infection in upper airway, nose, throat
- Cockroaches
What happens to lungs during an asthma attack?
The airway mucosa (inner lining of airway) swells up and secretes thick mucus, which obstructs the airways. The muscles around the airway tighten making the airway narrower. All this makes breathing very difficult.
If the doctor suspects asthma how will he confirm the diagnosis?
- Detailed evaluation of symptoms
- Physical examination
- Routine tests for example x-ray chest, blood test etc
Lung function tests are done to:
- Determine the cause of breathing problems.
- Diagnose certain lung diseases, such as asthma or chronic obstructive pulmonary disease (COPD).
- Evaluate a person’s lung function before surgery.
- Check the lung function of a person who is regularly exposed to substances such as asbestos that can damage the lungs.
- Check the effectiveness of treatment for lung diseases The testing may take from 5 to 30 minutes, depending upon how many tests are done.
What are the medications used for treatment of asthma and how they work?
Asthma disease has constellation symptoms. The symptoms that are perceived by us are mainly coughing, wheezing, shortness of breath and night awakening, that makes the tip of the iceberg .These symptoms respond well to the short term asthma reliever medications for example bronchodilators. Other symptoms that are constantly present in asthmatic patients are difficulty in breathing out, airway hypersensitivity, excess mucus production and swollen airway. These symptoms do not alarm an asthmatic as they become use to these symptoms. For reduction of underlying airway swelling and these symptoms, it is necessary to use preventer medications regularly.
Asthma treatment consist of two basic classes of medications
- Rescuer or reliever medications
- Preventer medications
Rescuer medications dilate the tubes of the lungs and are called bronchodilators. They give immediate relief from symptoms but their effect last only for 4 to 6 hours
Preventer medication control asthma attacks and control asthma better. These medications reduces inflammation and widens the air tube that help in reduction of the symptoms
So that preventer medications should be taken regularly till the doctor advice it to be stopped.
What are inhalers?
The inhalers are devices by which the medications are delivered into the tubes of the lung. With the help of inhaler drug can be delivered directly to the larger surface area of the air tubes resulting in rapid action.
As inhaler devices directly deposit the medicine into the lung tubes, dose of medicine is reduced significantly.
The same medicines in the form of tablets, injections, syrups have side effects where as inhaler does not have any side effect.
What should i do to keep my asthma under control?
- Take the correct amount of medicine.
- Avoid coming in contact with allergen.
- Avoid asthma triggers.
- Avoid emotional stressful situations.
- Regular follow up with your physician.
Complications of asthma
Complication of asthma includes respiratory failure, death and growth retardation in children.
What are the myths and realities of the Asthma?
Myths
- Asthma is a contagious disease.
- People with asthma cannot work or exercise.
- Inhalers are addictive.
- Inhales are very strong and they should be used as last resort in asthma.
- Steroid inhalers have a lot of side effects.
Reality
- Asthma is not a contagious disease.
- Asthmatics on regular treatment can work and exercise normally.
- Inhalers are not addictive.
- Inhalers deliver a small dose of medicines and so that they are the first and safest form of treatment for asthma.
- Inhaled steroids are safe even if taken for a prolonged period.
Types of asthma
Unresponsive Asthma
Antiasthma therapy is very effective in treating and controlling asthma symptoms but few patients fail to respond, and continue experiencing troublesome asthma related symptoms even on taking asthma medications on regular basis.
The reason behind unresponsiveness is commonly due to the wrong inhaler technique, tobacco smoke, significant environmental allergen exposure and significant occupational exposure.
Beside this some drugs for example beta blockers, NSAIDS, ACE inhibitors produces asthma like symptoms.
Any concurrent disease for example gastroesophageal reflux disease, COPD, chronic sinusitis, rhinitis, systemic disease, thyrotoxicosis and vasculitis may be the cause of poor symptom control.
Your physician needs to diagnose and treat the concurrent medical condition for the better control.
Complicated Asthma
Although most asthma patients respond well to comprehensive treatment, a few with symptoms and signs of severe asthma supported by objective evidence of obstructive airway disease will have a decidedly inadequate response to treatment. Less than 5% of asthma patients are diagnosed with severe asthma. Among these, some fail to respond to even aggressive asthma management. Such patients are often treated with daily oral corticosteroids, and many become steroid dependent. However, some severe asthma patients have a poor response to even high doses of glucocorticosteroids. Many become steroid-dependent. The term steroid-resistant asthma has been applied to asthma patients who have little or no objective response (improvement in FEV1‚) to even prolonged treatment of high-dose glucocorticosteroids.
It is now clear that the category of severe unresponsive asthma is heterogenous and includes not only steroid-resistant asthma, but also other severe asthmatics that are affected by various co morbidities (e.g., GERD, chronic sinusitis, paradoxical vocal cord dysfunction, bronchopulmonaryaspergillosus, psychopathology, uncontrolled triggers {allergens and pollution} immunodeficiency, etc.).
Brittle asthma
Is a rare form of severe asthma characterized by a wide variation of Peak Expiratory Flow (PEF), in spite of heavy doses of steroids.
Brittle asthma is classified in two types: type 1 characterized by a maintained wide PEF variability (> 40% diurnal variation for > 50% of the time over a period of at least 150 days) despite maximal medical therapy.
Type 2 is characterized by acute attacks occurring within minutes that could lead to death, with a background of well controlled asthma.
Nonallergic asthma
Non allergic asthma is more likely to occur in subjects 4 years or older than 60 years of age. Episodes are triggered by ongoing inflammation, by upper respiratory infection, purulent rhinitis and exacerbation of chronic rhinitis. Most patients have no evidence of IgE antibodies. Indoor air pollution from volatile organic compounds, formaldehyde and wood burning stoves are the trigger factor.
Other Types of Asthma
- Allergic asthma
- Potentially fatal asthma
- Aspirin induced asthma
- Occupational asthma
- Exercise induced asthma
- Cough Variant asthma
- Factitious asthma
- Vocal Cord Dysfunction and Asthma
- Coexistent Asthma and Chronic Obstructive Pulmonary Disease
Treatment of asthma
Avoidance therapy You are advised to avoid the allergens diagnosed by allergy testing by your physician
Pharmacotherapy Medicines are prescribed for symptomatic relief.
Immunotherapy
Childhood asthma
Asthma is a disease that causes the airways to swell and get narrow.
Causes
Asthma is caused by swelling in the airways. During an asthma attack, the muscles surrounding the airways tighten. The lining of the air passages swells. Less air is able to pass through as a result.
Asthma is often seen in children. It is a leading cause of missed school days and hospital visits for children. An allergic reaction is a key part of asthma in children. Asthma and allergies often occur together.
Some things that can bring on asthma symptoms (triggers) include:
- Animals (hair or dander)
- Dust, mold, and pollen
- Aspirin and other medicines
- Cold air, such as changes in weather (most often cold weather)
- Chemicals in the air or in food
- Tobacco smoke
- Exercise
- Strong emotions
- Viral infections, such as the common cold
Symptoms
Breathing problems are common. They can include:
- Shortness of breath
- Exercise induced cough
- Feeling out of breath
- Gasping for air
- Trouble breathing out (exhaling)
- Breathing faster than normal
When the child is having hard time breathing, the skin of the chest and neck may suck inward. Other symptoms of asthma in children include:
- Coughing that sometimes wakes the child up at night (it may be the only symptom)
- Dark bags under the eyes
- Feeling tired
- Irritability
- Tightness in the chest
- A whistling sound made when breathing (wheezing). You may notice it more when the child breathes out. Your child’s asthma symptoms may vary. Symptoms may appear often or else develop only when triggers are present. Some children are more likely to have asthma symptoms at night.
Exams and tests
Your doctor will need to listen to the child’s chest. She will be able to hear wheezing sounds. However, lung sounds are often normal when the child is not having an asthma episode. Doctor will have the child breathe into a device called a peak flow meter. Peak flow meters can tell how well the child can blow air out of the lungs. If the airways are narrow due to asthma, peak flow values drop.You and your child will learn to measure peak flow at home.
Lung function testing for Asthma diagnosis (Test may include)
- Allergy testing
- Chest x-ray
- Eosinophil count (a type of white blood cell)
- Lung function tests
Treatment
You and your child’s doctors should work together as a team to create and carry out an asthma action plan.
This plan will tell you how to:
- Avoid asthma triggers
- Monitor symptoms
- Measure peak flow
- Take medicines
The plan should also tell you when to call the nurse or doctor. It’s important to know what questions to ask your child’s doctor. Children with asthma need a lot of support at school.
Give the school staff your asthma action plan so they know how to take care of your child’s asthma. Find out how to let your child take medicine during school hours. (You may need to sign a consent form.) Having asthma does not mean your child cannot exercise. Coaches, gym teachers, and your child should know what to do if your child has asthma symptoms caused by exercise.
Monitor your child’s asthma
Checking “peak flow” is one of the best ways to control asthma. It can help you keep your child’s asthma from getting worse. Asthma attacks do NOT usually come on without warning.
Children under age 5 may not be able to use a peak flow meter well enough for it be helpful. However, a child should start using the peak flow meter at a young age to get used to it. An adult should always watch for a child’s asthma symptoms.
Types of long-term control medicines include:
- Inhaled steroids (these are usually the first choice of treatment)
- Preventer medicationsLong-acting bronchodilators (these are almost always used with inhaled steroids)
- Leukotriene inhibitors
- Cromolyn sodium Quick relief or rescue asthma drugs work fast to control asthma symptoms.
- Children take them when they are coughing, wheezing, having trouble breathing, or having an asthma attack.
- Some of your child’s asthma medicines can be taken using an inhaler.Children who use an inhaler should use a “spacer” device. This helps them to get the medicine into the lungs properly.
- Children who use an inhaler should use a “spacer” device. This helps them to get the medicine into the lungs properly.
- If your child uses the inhaler wrong way, less medicine gets into the lungs. Have your health care provider show your child how to correctly use an inhaler.
- Younger children can use a nebulizer instead of an inhaler to take their medicine. A nebulizer turns asthma medicine into a mist.
Asthma medicines
There are two basic kinds of medicine used to treat asthma. Long-term control drugs are taken every day to prevent asthma symptoms. Your child should take these medicines even if no symptoms are present. Some children may need more than one long-term control medicine.
Getting rid of triggers
It is important to know what things make your child’s asthma worse. These are called asthma “triggers.” Avoiding them is the first step toward helping your child feeling better.
Keep pets outdoors, or at least away from the child’s bedroom.
No one should smoke in a house or around a child with asthma.
- Getting rid of tobacco smoke in the home is the single most important thing a family can do to help a child with asthma.
- Smoking outside the house is not enough. Family members and visitors who smoke carry the smoke inside on their clothes and hair. This can trigger asthma symptoms.
- Do not use indoor fireplaces. Keep the house clean. Keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches, which can trigger asthma attacks. Cleaning products in the home should be unscented.
Asthma in special situations
- Asthma in elderly
- Asthma in pregnancy
- Asthma in diabetics
- Asthma with COPD
- Asthma with IHD
- Asthma in psychiatric disorder
