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Asthma

Overview

Asthma is a chronic condition of the respiratory system (lungs) in which a person’s air passages become inflamed, restricted, swollen, and produce a copious amount of mucus resulting in breathlessness, chest tightness, wheezing, and cough. Precisely it’s a common lung condition making airways sensitive and causing difficulty in breathing. It is also referred to as bronchial asthma. The condition worsens according to the amount of mucus produced as swelling of airways prevents oxygen from entering the lungs. As a result, oxygen doesn’t enter the bloodstream (called hypoxemia), and vital organs are deprived of oxygen.
The causes of the disease involve genetic and environmental factors. In some people, several triggers initiate an allergic inflammatory response of the airways like pollen, dust mites, air pollution, smoke, stress, etc.
The severity of the disease varies for everyone. Some people experience only minor attacks, while it can be extremely agonizing and even life-threatening for others. Several medicines are used to control the current symptoms and prevent future attacks. A person can lead a normal life by avoiding triggers and adhering strictly to the treatment regimes.

Cause

  • A combination of genetic and environmental factors is attributed to the cause of the disease. A series of inflammatory reactions are started in a genetically susceptible individual on exposure to triggers by the following proposed mechanisms; Bronchial hyperresponsiveness means hypersensitivity of air tubes to triggers causing Airway inflammation resulting in Intermittent airflow obstruction.
    The triggers of asthma could be;
  • Environmental factors; airborne pollutants, smoke, pollens, dust mites, mold spores, etc.
  • Physical and Emotional Stress
  • Respiratory infections
  • Exercise
  • Pet dander
  • Obesity
  • Pregnancy
  • Certain medications like NSAIDs or Aspirin

Epidemiology

The national data on the prevalence of asthma in the United States, as given by the CDC, is about 5-10% of the population of approximately 23.4 million persons affected by Asthma. Children are most commonly affected by asthma; however, it is also found more in older adults and middle-aged females. The disease is more severe in African Americans as compared to whites.
Asthma causes significant national burdens by limiting daily activity, school, work absences, emergency department visits, hospitalizations, and deaths.

Risk factors

The following risk factors may increase your chances of having the disease;

  • Family History: you are more prone to the disease if you have a family member affected, like a parent, sibling, etc.
  • Atopic Diseases: if you have a history of other allergic diseases like hay fever, atopic dermatitis, you may be susceptible to asthma also.
  • Occupational: some of the occupations involve the use of chemicals that can put you at high risk, for example, in farming, manufacturing, hairdressing, etc.
  • Smoking: smoking and exposure to secondhand smoke also increase the risk.
  • Obesity: your chances may also be increased If you are overweight.

Types

Common Classification includes:

  • Childhood Asthma
  • Adult-onset Asthma
  • Occupational Asthma
  • Eosinophilic Asthma
  • Seasonal Asthma
  • On the degree of severity, it has been split into 4 categories:
  • Mild Intermittent Asthma:
    In this type of asthma, the presenting symptoms are minimal, which doesn’t impair the daily routine or activities of the individual. An asthma attack is no more than twice a week or two nights a month. It includes exercise-induced asthma as well.
  • Mild Persistent Asthma:
    The asthma symptoms are milder, but the number of attacks is more than two times a week but not more than once in a day.
  • Moderate Persistent Asthma:
    In this type, a patient experiences frequent attacks, once each day or on most days, and more than one night in a week.
  • Severe Persistent Asthma:
    Symptoms occur many times in a day and recurring nights each week.

Signs And Symptoms

The following signs and symptoms characterize the attacks of asthma;

  • Tightness in chest
  • Wheezing
  • Coughing
  • Difficulty in breathing
  • congestion due to increased mucus production
  • Insomnia due to difficulty in breathing
  • Difficulty walking or talking
  • Panic 

Diagnosis

Your doctor will take a detailed history and ask you questions about your symptoms, the triggering factors, your family, and your past medical history. He would examine your chest thoroughly and look for signs of other diseases as well. You may undergo the following tests for confirmation of diagnosis;

  • Lung Function Test: In these tests, your pattern and power of breathing are observed. You may be given a bronchodilator during the test. It includes; a)Spirometry and b)Peak Airflow meter
    Imaging: Chest X-ray.
  • Nitric Oxide Test: It measures the amount of inflammation in air passages by measuring nitric oxide concentration.
  • Provocation Test: It is also known as a trigger test. It is done under controlled laboratory methods when all other tests are normal, but you are still experiencing asthma symptoms. A trigger provokes you, and the doctor observes the response.
    Diagnosis In Children:
    A breathing test is not helpful in children, especially under 5 years, so the doctor prescribes a bronchodilator. If it helps reduce the child’s symptoms, the diagnosis of asthma is made.

Differential Diagnosis

The following conditions can present like asthma;

  • GERD; gastroesophageal reflux disease
  • COPD; chronic obstructive pulmonary disease
  • Aspergillosis
  • Upper respiratory infection
  • Alpha1-Antitrypsin (AAT) Deficiency
  • sarcoidosis
  • Foreign body in the respiratory tract
  • Congestive heart failure
  • Pulmonary Embolism (PE)
  • Vocal cord dysfunction

Treatment

The key to asthma management is knowing your triggers and avoiding them, plus adhering tightly to your treatment regime and keeping track of your breathing to assess your asthma control.
The Treatment of asthma is divided into two blocks; One is long-term control medications which is the cornerstone of treatment, and the other is quick-relief medications. Asthma medications are administered through specific delivery devices like a metered-dose inhaler, nebulizer, or dry powder inhalers.

  • Long Term Control Medications :
  • Inhaled Corticosteroids are among the common medications used for long-term control of persistent asthma. They include fluticasone, beclomethasone, ciclesonide, mometasone, budesonide.
  • Leukotriene Antagonist: Montelukast,zafirlukast, zileuton
  • Combination Inhalers: Inhaled corticosteroids plus long-acting beta-agonist (LABA). This combiantion include mometasone plus formoterol ,fluticasone plus vilanterol , budesonide plus formoterol , fluticasone plus salmeterol. LABA alone is prescribed to children as it reduces the severe asthma attack.
  • Theophylline: It clears airways.
  • Quick-Relief Medications:
  • Short-Acting Beta-Agonists: Albuterol and levalbuterol are remarkable bronchodilators used to immediately relieve the symptoms.
  • Anticholinergic Agents: these include ipratropium and tiotropium.
  • Oral and intravenous corticosteroids: to treat severe asthma symptoms, these medicines can be used for a short-term duration as they have serious side effects if used for more extended periods.

Prognosis

The future course of asthma depends upon the management of the disease. With the tight control of symptoms, morbidity and mortality will be less. The severity of the symptoms and the need for treatment decreases in nearly 50% of children by late adolescence or early adulthood.
Asthma can result in some permanent, irreversible changes in the airways of patients with poorly controlled disease and cause chronic debilitating asthma.

Lifestyle Modifications

Adopting the following lifestyle changes may help you cope with asthma;

  • Avoid Your Triggers; you must identify your triggers and make arrangements for avoiding them. Use air conditioners, regularly clean the house, use dustproof covers and beddings, control humidity, keep pets without furs.
  • Keep Track Of Your Illness; identify early attacks, take your medicines regularly, follow up visits, participate in national asthma control programs, keep an eye on worsening symptoms or excessive use of quick-relief medicines.
  • Exercise regularly to stay fit, healthy, and strong.
  • Eat a balanced and controlled diet to avoid being overweight.
  • Get yourself vaccinated with influenza and pneumonia vaccines to prevent getting infections