Also known as Obstructive airway disease, Bronchial asthma and Reactive airway disease

Overview

Asthma is a long term condition in which air passages in the lungs become narrow due to inflammation and contraction of the muscles around the small airways. This causes symptoms such as cough, wheezing, shortness of breath and chest tightness. These symptoms are intermittent and are often worse at night or during exercise.

Some of the common triggers that can make asthma symptoms worse include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, dust mites (dermatophagoides), strong soaps, and perfume. These triggers vary from person to person.

Asthma is diagnosed mainly with lung function tests but other blood tests and allergy testing also helps in making proper diagnosis. The treatment of asthma is vast but  beta-2 agonists and corticosteroids remain the mainstay of asthma treatment. 

Lifestyle and prevention measures such as avoiding triggers, avoiding foods that increase the risk of an asthma attack, and staying away from stress could be of great help when it comes to controlling asthma attacks. In severe cases, it can lead to a condition known as status asthmaticus that might require hospitalization. 

Key Facts

Usually seen in

  • Children below 15 years of age

Gender affected

  • Both men and women

Body part(s) involved

  • Lungs
  • Airways

Prevalence

Mimicking Conditions

  • Vocal cord dysfunction
  • Tracheal or bronchial obstruction due to foreign body or tumor
  • Heart failure
  • Gastroesophageal reflux disease (GERD)
  • Chronic sinusitis
  • Chronic obstructive pulmonary disease
  • Anaphylactic reaction

Necessary health tests/imaging

Treatment

Symptoms Of Asthma


You may suspect asthma, if you or your child are noticing symptoms such as coughing and wheezing (whistling sounds) while breathing. These are common asthma symptoms. The symptoms of asthma can be characterized by:

  • Breathlessness (shortness of breath) when exposed to triggering factors
  • Cyanosis (blue discolouration of face and extremities)
  • Wheezing or whistling sound during breathing
  • Chest tightness, which feels like a tightened band around the chest
  • Intense coughing or the urge to cough that may be triggered by an allergen or other environmental factors
  • Fatigue during and after an asthma attack

These symptoms usually occur during attacks, mostly at night time. This is why some of you may feel tired during the day. During an asthma attack, breathing difficulties can get worse and develop into more serious shortness of breath, if not treated. 

Most doctors identify asthma as intermittent (comes and goes) or persistent (lasting). Persistent asthma can be mild, moderate, or severe. The severity of the condition is based on the frequency of attacks.

Causes Of Asthma


The exact cause of asthma is still not known. It is also believed to be a multifactorial pathology that is affected by both genetics and environmental factors. Ideally, when your immune system comes in contact with an allergen, it triggers an immune response to fight against the allergen. But in people with asthma, this immune response is very strong which leads to inflammation. This in turn, causes the airways to swell and become narrowed causing it difficult to breathe. 

During an asthma attack, three things can happen:

Bronchospasm: The muscles around the airways constrict (tighten). When they tighten, it makes the airways narrow. Air cannot flow freely through constricted airways.

Inflammation: The airway linings become swollen. Swollen airways don’t let as much air in or out of the lungs.

Mucus production: During the attack, your body creates more mucus. This thick mucus clogs airways.


Asthma in children

According to the Global Initiative for Asthma (GINA) guidelines, around 300 million individuals worldwide including both adults and children are afflicted with asthma. As per the World Health Organization (WHO), India has around 15-20 million asthmatics. It is estimated that the prevalence of asthma in kids aged 5-11 years is between 10-15%.

Most kids with asthma may not show any signs or symptoms of the condition for a long time or until they have an asthma attack. Moreover, in most cases, the symptoms of asthma in children can be confused with other respiratory illnesses. Hence, the diagnosis of asthma in kids is quite difficult and is based merely on the symptoms.

Asthma in pregnancy

Uncontrolled asthma means that the mother is not getting enough oxygen. This naturally has adverse consequences for the mother, continuation of pregnancy and on the fetus in the mother. Well-controlled asthma leads to a normal pregnancy, normal delivery and a normal child. 

Some of the common concerns a pregnant woman might have regarding asthma are:

  • Will asthma adversely affect my pregnancy or my baby?
  • Will pregnancy adversely affect my asthma?
  • Can asthma medicines be taken safely during pregnancy?
  • Will my child also have asthma?

Well-managed and well-controlled asthma does not create problems during pregnancy and delivery; neither for the mother and nor for the baby.

Risk Factors For Asthma

Some of the common triggers/risk factors for asthma include:

  • Genetics: Evidence suggests that presence of asthma and its severity can be influenced by the genome or genetic make up of a person.
  • Air pollution: Exposure to outdoor pollutants like nitrogen dioxide and diesel particulates, is associated with increased asthma symptoms.
  • Diet: Diets low in antioxidants such as Vitamin A, Vitamin C, Vitamin D, magnesium, &  selenium and may also predispose to the development of asthma.
  • Viral infections: Respiratory tract infections that may be caused by a virus during childhood can be a cause for asthma in adulthood.
  • Allergens: Environmental allergens such as pollen dust or mites can trigger an asthma attack. 
  • Medications: Certain medicines such as aspirin & beta-blockers are also a cause of asthma attacks in certain individuals.
  • Exercise: Exercise may aggravate asthma and make breathing difficult.  
  • Chronic sinusitis: Post-nasal drip caused by sinusitis can trigger coughing and itchy throat which can aggravate asthma symptoms. 
  • Insects or plants: Some people may be allergic to certain plants or insects that may act as a trigger for asthma. 
  • Obesity: Being overweight puts you at a higher risk of asthma and its symptoms such as shortness of breath and wheezing. 
  • Stress: Emotional factors such as stress can trigger not only anxiety but also asthma symptoms like breathlessness. 
  • Smoke: Smoke or chemical irritants such as fumes can also lead to asthma symptoms like wheezing and shortness of breath.

Diagnosis Of Asthma


Asthma is usually suspected if the patient has a history of recurrent dry coughing, particularly at night and early morning, along with other symptoms such as chest tightness, shortness of breath, and wheezing sound. Following are the diagnostic tests for asthma:

1. Physical examination
During a physical examination, your doctor might look at your eyes, ears, nose or throat for swelling or drainage which may indicate allergic reaction. Also, checking your chest and lungs for wheezing or whistling sounds which may indicate inflammation and contraction of airways.

2. Blood tests: Your doctor may recommend certain blood tests to check the level of inflammation, antibodies and eosinophils (a type of immune cells). These include complete blood count (CBC), immunoglobulin E (IgE) and absolute eosinophil count (AEC).

3. Pulmonary function test: Pulmonary or lung function tests are done to find if there are any airway obstructions. In case there is clinical suspicion but the lung function test comes out to be normal, then other tests such as post-exercise test or allergen challenge test can help in determining bronchial hyperresponsiveness in adults. 

4. Chest X-ray: In severe cases, hyperinflation of lungs may be seen which can be detected with the help of chest x-ray.

5. Allergy panel/asthma/rhinitis screening test: If you are showing symptoms of asthma and an allergic trigger is suspected, then allergy diagnosis is generally recommended. The diagnosis of an allergy consists of medical history, skin prick test, and specific IgE (immunoglobuline group E) test. ​

Prevention Of Asthma


The best possible way to prevent asthma is to eliminate or reduce exposure to triggers that could lead to asthma attacks. Some of the common triggers of asthma and their prevention include:

  • Staying away from allergens such as animal dander, dust mites, mold, etc.
  • If possible, wear a mask whenever you come in contact with smoke and other irritating fumes.
  • Patients suffering from asthma should avoid exposure to viruses and other respiratory infections. 
  • It is important to wash your hands carefully. Don’t forget to get your flu and/or pneumonia vaccine every year and reduce the risks of an asthma attack.
  • Maintain an asthma diary and note specific triggers so you can inform your doctor about these and reduce flare-ups in the future.

Click here to know about some common triggers of asthma.
Read To Know!
Specific tips based on the triggers

1. Exercise-induced asthma

  • Avoid exercising in cold, dry air. 
  • Workout indoors or avoid exercising during early morning hours. 
  • If a person is very much into workouts then warm up before working out, this helps the airways to adjust and hence eases breathing. 
  • Before working out, it is beneficial to use an asthma inhaler or bronchodilator,  these asthma medications can help to prevent the airways from contracting, and help control exercise-induced asthma.

2. Drug-induced asthma

  • Stay away from foods or medications that trigger asthma attacks like aspirin or beta-blockers.
  • Oral contraceptives may produce asthma exacerbation with long term use and high doses of postmenopausal hormone replacement therapy also increase the risk of asthma.

3. Pregnancy-induced asthma

  • Avoid smoking and places where people smoke, because cigarette smoke can increase the risk of having an asthmas attack.
  • Avoid triggers that can induce asthmas attacks whenever possible, depending on the type of allergy, triggers might include animal fur, pollen, cold air or dust mites.

4. Stress-induced asthma 

  • Emotional stress can also trigger asthma attacks, therefore you can practice meditation and other relaxation techniques to keep stress at bay. 
  • Getting enough rest, eating a healthful diet, and exercising regularly are often effective ways to reduce stress levels. People may find relief from asthma symptoms by making few lifestyle changes to help manage their stress levels.

Specialist To Visit


If you have asthma or your symptoms are similar to asthmas and are looking for a doctor then these specialists can help:

  • Pulmonologist
  • Allergist or immunologist
  • Pediatrician
  • Physician

You should seek immediate medical attention if:

  • You start feeling dizzy or weak after or during an asthmas attack
  • You are unable to complete sentences in one breath
  • You note bluish discoloration of face and extremities (cyanosis)
  • You are unable to carry out a routine activity like cleaning or other daily chores
  • Your cough doesn’t improve with medication
  • You are hearing a wheezing sound while inhaling and exhaling and you are breathing differently from your usual breathing
  • Your wheezing does not get better even after taking the medicine as most fast relief asthmas medicines work within 15 – 20 minutes

Treatment Of Asthma 

The common treatment approach for people with asthmas involves use of preventive medicines (also known as controllers) and quick-relief medicines (also known as relievers)


A. Controllers

These medicines help reduce the swelling of the airways and prevent mucus formation. They are mostly used to prevent asthmas attacks and protect the lungs. These medicine classes are: 

1. Corticosteroids
These are the best and most commonly prescribed drugs for asthmas. They act by inhibiting the activity of the inflammatory compounds such as prostaglandins, leukotrienes, and histamines which are responsible for inflammation. They are broadly classified into:

a) Inhaled corticosteroids (ICSs): ICSs are amongst the most effective anti-inflammatory medications available to treat asthma. Low-dose monotherapy of inhaled corticosteroids is usually given as first-line maintenance therapy for most children and adults dealing with asthmas. Regular use of ICS have been shown to reduce symptoms and flare ups of asthma along with improvement in lung function. Example of drugs that belong to this category are:

b) Oral corticosteroids: These are generally given for the acute treatment of moderate to severe asthmas. Prolonged use of oral steroids are generally avoided as it has been associated with potentially serious side effects. Examples include:

2. Leukotriene receptor antagonists
These medicines are effective for the treatment of asthma, are well tolerated and are safe to use. As the name suggests, they work by blocking the action of an inflammation-causing chemical messenger called leukotriene. These medicines thereby reduce the inflammation in the airways, preventing asthma and relieving symptoms of allergies. Common examples of these medicines include:

3. Biological therapies
Biological therapies such as the anti-IgE monoclonal antibody, example omalizumab, can reduce the frequency of asthmas attacks. This drug is given subcutaneously once every 2–4 weeks. This medicine is specific to patients with difficult to control asthmas with an elevated serum IgE level. It is also given to people whose asthma symptoms do not improve even with ICS therapy in combination with a second controller medication.


B. Relievers (bronchodilators)

These are the preferred medications for the treatment and maintenance of acute symptoms of asthmas and are generally prescribed to all patients with asthmas. They work by dilating the bronchioles, thereby providing only temporary relief. These medicines are used to relieve the symptoms of asthma when they occur but not reverse the inflammation that has already occured. Drugs that belong to the class of bronchodilators are:

1. Short-acting beta agonists (SABA)
These medicines are used for the treatment of asthma symptoms and its exacerbations. As the name suggests, these are known to provide quick relief. For example, salbutamol which is the common drug, has an action onset of under 5 minutes & lasts for 3 to 6 hours. Some of the common examples include: 

2. Long- acting beta agonists (LABA)
This class of medicines contain low doses of controllers and relievers with a long lasting effect. These not only help you to relieve the symptoms but also protect you from asthmas attacks. These medicines are often used in conjugation with other drugs such as corticosteroids. They have an action onset of more than 5 minutes but the effect lasts for at least 12 hours. Common example include:

3. Methylxanthines
These are a new class of medicines used for the treatment of asthmas. It is known to aid in the treatment of asthma by reducing airways inflammation and airway obstruction which is seen in asthmatics. Theophylline is one of the most commonly prescribed methylxanthines.

4. Anticholinergic drugs
This class of medicines work by blocking the action of acetylcholine, a neurotransmitter which plays a key role in controlling the constriction of smooth muscles and inflammation. These are further classified into:

  • Short acting muscarinic antagonists (SAMA): Ipratropium is the common medicine that belongs to this class. It is used to treat and prevent the symptoms of asthma and COPD along with improving the breathing.
  • Long acting muscarinic antagonists (LAMA): Tiotropium is the common medicine which is mainly used for the treatment of chronic obstructive pulmonary disease (COPD) and asthma. 

C. Other therapies

Bronchial thermoplasty is a bronchoscopic treatment using thermal energy to ablate airway smooth muscle in accessible bronchi. It may reduce exacerbations in patients not responding to maximal inhaler therapy.

Home-care For Asthma

To care for your condition, you can follow these simple steps at home and manage your asthmas better:

1. Stay away from allergens
You must know what could trigger asthma such as plants, dust or certain food items and keep them away from your home. 

2. Stay hydrated
Drinking plenty of water throughout the day keeps the mucus thinner, helps in better breath control and digestion, thereby keeping asthma in control. 

3. Keep the air filters clean
It is important to keep the air around you clean and for that you need to keep the air filters cleaned or changed to avoid triggers for asthma. 

4. Avoid strong fragrances
Not only dust, but strong fragrances such as cleaning sprays, perfumes & air fresheners can also trigger asthma. Therefore, it is best to avoid these sprays. 

5. Keep yourself active
It is commonly believed that exercise can trigger asthma attacks. However, if you are taking your medication regularly and indulge only in moderate exercise then you can easily stay active and fit. 

6. Avoid exposure to dust
Keep your surroundings clean to avoid build up of dust. Always wear a mask while cleaning or vacuuming. 

7. Keep inhaler handy at all times
It is important to always keep an inhaler with you at easily accessible places in times of emergency. 

Complications Of Asthma


If asthma is left undiagnosed or untreated, it can cause an increased risk of lung scarring. Scarring is the permanent damage to your lungs and airways, where you find it hard to breathe unless provided with external aid. This is an irreversible stage of asthmas, which means it cannot be corrected with medications. Some of the permanent changes that are possible include:

  • Increased production of mucus
  • Thickening of airways
  • Irreversible narrowing of airways over time
  • Pulmonary hypertension

It is a state where there may be a risk of complete respiratory failure with severe attacks of asthmas. During a severe attack of asthma symptoms, the airways can get shut, and even the emergency medications fail to work.

Alternative Therapies For Asthma

1. Home remedies for asthma

Garlic: Garlic is known to have several health benefits, including anti-inflammatory properties, Due to the anti-inflammatory nature of garlic it may be helpful in relieving the symptoms of asthmas.

Ginger: Ginger has anti-inflammatory properties, which may be helpful in treating severe asthmas. You can take oral ginger supplements, which can help improve asthma symptoms. 


Honey: Honey is often used as a remedy for colds. It helps in soothing sore throat and reduces coughing. You can take honey with herbal tea or warm water to provide relief for your symptoms.


Omega-3 fatty acids: Foods rich in omega-3 fatty acids such as fish and flax seeds can help in decreasing airway inflammation and improving lung function in people suffering from severe asthmas.


Caffeine: Caffeine is known to be a bronchodilator, which reduces fatigue of respiratory muscle. Therefore, it is effective for people suffering from asthmas. It is also known to elevate the function of airways for a few hours after consumption.


2. Breathing techniques

Breathing exercises may be helpful in reducing your asthmas symptoms by breathing slowly and gently. Breathing techniques focus on breathing out of your nose rather than breathing out from your mouth. Breathing out of your mouth tends to dry out your airways and make them more sensitive to allergens, thereby triggering an asthma attack.


3. Yoga

Yoga comprises both stretching and breathing exercises that help in maintaining your overall fitness. Yoga is also a great stress buster, which can help in decreasing the daily stress, which may be a trigger for your asthmas.


4. Mindfulness

Mindfulness refers to a type of meditation that focuses on being in the present and can be practiced almost anywhere. All you need to do is sit in a quiet place, close your eyes, and focus your attention on either your breath, thoughts, feelings, or sensations occuring in your body.

As it is a great stress-relieving exercise, it can be quite helpful in relieving stress-related asthmas symptoms.

Living With Asthma


Who said asthmatics have to live their life under restrictions? If your asthmas is under control, you can lead a normal, active life just like others. Do not let asthmas control your life with these simple tips and tricks.

1. Stay informed and aware of your condition
It is quite common to feel anxious about your condition, if you are not aware of the condition. It is therefore advised you must be aware and well informed about the condition. This may include reading books about the condition. If researching online, then make sure you follow legitimate sources and not everything that turns up on search engines. It is also a good idea to speak to your doctor and get all your queries answered by a medical professional who knows about your condition in depth.

2. Always take your medication on time
Taking your medications on time can play an important role in the management of asthma symptoms. Remember preventive medicines for asthmas help to reduce the swelling over time. You do not become addicted to it nor do the medicine become less effective with time. Your doctor will ask you to take these medicines regularly, if you: 

  • Have frequent asthma attacks
  • Wake up in middle of the night due to asthma
  • Use quick relief medicine more often (like twice in a week) to stop asthmas attacks

Note: If you are pregnant, talk to your doctor because most of the medicines are safe during pregnancy. Moreover, keeping your asthma in control can protect your child.

3. Never miss your doctor’s appointment
It is important to schedule appointments at regular intervals, even if you feel good or have no breathing issues. This is because these check-ups will help the doctor keep track of the asthmas symptoms and make changes to the treatment plan accordingly. It also helps you to prevent complications as your doctor keeps a track of your condition on a regular basis.

You can even ask for an asthmas action plan from your doctor which will help you to know when your asthma is getting worse and how to respond to it. Talk to your doctor, if your asthmas is not yet controlled with use of medicines. Also, inform your doctor, if you have to take controllers before, during or after exercise.

4. Make some special changes for the patient
You can make some minor changes in your bedroom to prevent asthmas attacks. For example:

  • Do not allow rugs or carpets in your room as these could get dusty or moldy.
  • Say no to soaps, shampoos, incense, or lotion that smell like perfumes, if your asthma is triggered by strong smells. No smoking or strong smells in the bedroom as well.
  • Do not let animals in your bedroom. If possible, keep them out of your house and ask someone to clean the area or their litter.
  • Use dust-proof covers with zippers for pillows, mattresses, and quilt. Avoid pillows or mattresses made from straw as these can trigger an allergic reaction.
  • Wash bed sheets, pillow covers, and blankets in hot water and sun dry them.
  • Always keep your windows open, especially when you are cooking, cleaning or if there is any strong smell.
  • Do the chores like painting, vacuuming, cleaning, or dusting when the person is not around. The same rule applies when using sprays or disinfectants.
  • Have your inhaler near the bedside to avoid panic during late night symptoms. Also, always keep your inhaler with you while traveling.

5. Maintain an asthmas journal

Maintain an asthma diary, where you note down the time, severity and triggers of your asthmas attacks. Different people have different triggers so noting them down can help you to know your trigger and avoid attacks. This could even help in deciding the treatment and dealing with the condition in a better way. 

6. Get vaccinated
As people with asthmas are at a high risk of developing complications from respiratory infections such as influenza and pneumonia, it is important to get vaccinated. Ask your doctor about the recommended one.

Everyone loves to travel and see new places! Asthmatics are no different. But traveling and visiting new places poses certain risks and problems. But with proper care and attention to detail, asthmatics can safely travel and enjoy without asthma playing spoilsport!