Overview of asthma
Asthma is a chronic, inflammatory condition characterized by reversible airflow obstruction and airway hyperresponsiveness. This disease which can occur at any age, accounts for thousands of hospitalizations each year and requires long-term follow-up. Epidemiological and observational evidence had shown an increasing morbidity and mortality due to asthma despite the increased understanding of its pathogenesis, availability of effective anti-asthma medications and newer delivery devices.
The prevalence of asthma varies from region to region. Diagnosed asthma in adults is reported as 2.7–4.0% in most European countries, 7.1% in the USA and 12.0% in England.1 In general, statistics reveal a relatively lower prevalence of asthma among adults in Asian countries such as China, Singapore, Malaysia and Bangladesh as compared to their Western counterparts.2 The prevalence of asthma in India is somewhat similar to that seen in other Asian countries.
Although chronic in nature and cannot be cured, asthma is a preventable condition and can be kept under control. Appropriate management can enable people to lead a good quality of life. Treatment approach aims to reduce the severity and frequency of the attacks and assist patients in controlling future exacerbations. The strategies include the use of relief medications such as beta (β2) agonists and medications such as inhaled and oral corticosteroids to control the long-term effects of the airway inflammation. Recent evidence indicates that asthma self-management education is effective in improving outcomes of chronic asthma.3
Types, Causes and Triggers of Asthma
Previously the condition was divided into two defined types of asthma: extrinsic (allergic) and intrinsic (nonallergic) asthma. Now-a-days, the illness can be classified into a number of different types.
Symptoms of asthma (Clinical Features)
The symptoms of asthma vary from person to person and can range from mild to severe. In between episodes, asthma patients may feel normal and have no difficulty in breathing. Some asthmatics may have chronic coughing and wheezing.
As the symptoms mentioned below can be present in other respiratory and sometimes in heart conditions, diagnostic testing is vital in recognizing this disorder. A positive family history for asthma or allergic diseases supports a suspected diagnosis of asthma.
The four major recognized symptoms are:
- Shortness of breath (dyspnea)—especially with exertion or at night
- Wheezing—a whistling or hissing sound when breathing out
- Coughing—may be chronic, usually worse at night and early morning and may occur after exercise or when exposed to cold, dry air
- Chest tightness—may occur with or without the above symptoms
Characteristically asthmatics suffer in the early morning. The patient may wake up at 3 or 4 a.m. with tightness, cough and wheezing. These attacks may be confused with paroxysmal nocturnal dyspnea due to left ventricular failure. However, the symptom of nocturnal chest tightness is a diagnostic of asthma.
Emergency asthma symptoms include the following:
- Extreme difficulty in breathing
- Bluish discoloration (cyanosis) of the lips and face
- Rapid pulse
- Decreased level of alertness
Diagnosis and Tests for asthma
The first step in providing optimal care to patients with asthma is accurate diagnosis of the condition. Clinical evaluation should include a precise description of the symptoms, as in many patients, particularly children, asthma may present as chronic cough with few associated features. Similarly, it may present as isolated dyspnea in the elderly patients.
In the clinical setting, asthma is diagnosed based on the history, physical examination and physiological testing. A thorough occupational history is crucial to identify patients with work-related asthma.
Diagnosis of asthma in children is based on a compilation and review of the patient’s medical history and subsequent improvement with an inhaled bronchodilator medication.
In adults, lung function test with a peak flow meter which tests airway restriction by looking at both the diurnal variation and any reversibility following inhaled bronchodilators can help in the diagnosis.
The basic measurement is peak flow rates. The British Thoracic Society uses the following diagnostic criteria: 7
- Difference of ≥20% in peak flow on at least three days in a week for at least two weeks
- Improvement of ≥20% in peak flow following treatment
- Decrease of ≥20% in peak flow following exposure to a trigger
Use of a peak flow meter on an ongoing basis helps in self-monitoring of asthma. Subsequent to pulmonary (lung) function test, radiological studies such as chest X-ray or CT scan will help to exclude the possibility of other lung diseases.
Allergy testing is helpful in identifying allergens in patients with persistent asthma.
Management of Asthma
The most effective treatment for asthma is identifying the triggers and avoiding exposure to those agents. Desensitization to allergens has been shown to be a treatment option for certain patients. Smoking cessation and avoidance of secondhand smoke is recommended for all asthmatics.
In patients with EIA, higher levels of ventilation and cold, dry air tend to exacerbate attacks. Therefore, it is advisable to avoid activities, which results in inhalation of large amounts of cold air such as skiing and running. Activities such as swimming in an indoor, heated pool with warm, humid air is less likely to provoke a response.
Drug therapy is aimed at the reduction of bronchospasm and airway inflammation. The medical treatment depends on the severity of the illness and the frequency of the symptoms. Medications used in the treatment of asthma may be divided into two categories: long-term control medications that are taken regularly and quick-relief medications that are taken for rapid relief of bronchoconstriction.
The 1997 NAEPP report recommends a two “step care” approaches to asthma therapy.8 One approach is to start therapy at the level consistent with the severity of the patient’s disease and increase treatment in steps if control is not obtained. The second therapy is more aggressive and focuses on initiation of therapy at a higher step than the patient’s level of disease severity and to gradually step down once control is achieved.
Bronchodilators are recommended for short-term relief in all patients. These are typically provided in pocket-sized, metered-dose inhalers (MDIs). No additional medication is needed for patients with occasional attacks. For patients with mild persistent disease characterized by more than two attacks a week, low-dose inhaled corticosteroid or alternatively, an oral leukotriene modifier, a mast-cell stabilizer or theophylline may be administered. For patients with daily attacks, a higher dose of glucocorticoid along with a long-acting inhaled β2 agonist may be prescribed. Alternatively, a leukotriene modifier or theophylline may substitute for the β2 agonist. In severe asthmatics, oral glucocorticoids may be added to these treatments during severe attacks.
Once the control is achieved, regular monitoring and follow-up are essential. A step up in therapy may be needed or a step down may be initiated in order to identify the minimum medication necessary to maintain control. With the proper use of prevention drugs, asthmatics can avoid the complications that result from overuse of relief medications.
Ayurvedic medicine is used by many practitioners in India for over 5000 years for treating many chronic illnesses. The regime uses natural herbal and mineral remedies along with other modes of treatment including diet changes, breathing exercise, yoga and lifestyle changes.
Ayurvedic medicine helps to balance the over-reactive bronchi and improves the air circulation in the lungs. The greatest benefit of ayurvedic medicine is that it can be combined with the conventional prescribed medications and can gradually help to reduce the daily dosage of prescription medications.
Herbs such as garlic, chamomile and parsley help to alleviate asthma symptoms and to control the condition, thereby lessening the daily dosage of prescription medications. Others such as tea tree, eucalyptus, marshmallow and liquorice are all good oils for loosening mucus and relieving congestion.
Maintaining a good asthma diet is one of the easiest ways to control asthma symptoms. Avoid fried, fatty and processed foods, especially cheeses and meats. It is healthier to replace meats with fish. Limit the intake of sugary foods such as candy, biscuits and other kinds of snacks. Aromatic food and the foods which the patient is known to be allergic should be avoided.
Foods and supplements with antihistamines and antiinflammatory drugs help to reduce swelling or inflammation and also protect the lining of the airways from potential irritants when present in small amounts.
Self-Management of Asthma
Guided self-management of asthma is a treatment strategy in which patients are taught to act appropriately when the first signs of asthma exacerbations appear. Patient education can allow patients with asthma to begin guided self-management of the disease. Self-management of asthma prevents exacerbations, improves care and is cost-effective. Such practice will ensure a favorable clinical outcome and an enhanced quality of life.9
The responsibility for treatment is borne by the patient and the primary healthcare system, supported by specialized medical care. The treatment plans may be based on symptoms, peak expiratory flow values or both. Patients should be taught to understand their symptoms and to monitor peak expiratory flow at home.
Patients suitable for guided self- management are those with the following:
- History of emergency room visits due to asthma
- Moderate or severe asthma
- Variable disease
- Bad perception of the severity of the disease
- Good cooperation
Living with Asthma
The impact of asthma on an individual’s life can be controlled by adhering to proper asthma management plans. The following strategies can reduce inflammation, decrease the severity, frequency and duration of asthma attacks.
- Asthma education
- Understand the difficulties and solutions
- Develop management goals relating to quality of life
- Consult health professional regularly
- Follow daily asthma treatment plan
Childhood asthma has become more widespread in recent decades. A 2004 statistics had revealed that an estimated 4 million children under 18 years old have had an sthma attack in the past 12 months and many others have undiagnosed asthma.10 As the most common chronic illness in children, childhood asthma causes more missed school, accounting for an estimated 14 million lost school days.11
Childhood asthma has the same underlying cause as the adult disease. The inflammation makes the airways overly sensitive and prone to tightening and constricting when irritated. Fortunately, the condition is treatable. With the right medications and action plan, a child with asthma can enjoy normal activities with few disruptions.
You May Also Like To Read
1. Aggarwal AN, Chaudhry K, Chhabra SK, D’Souza GA, Gupta D, Jindal SK, et al. Prevalence and risk factors for bronchial asthma in indian adults: A multicentre study. Indian J Chest Dis Allied Sci. 2006; 48: 13-22.
2. Masoli M, Fabian D, Holt S, Beasley R. Global burden of asthma. Global Initiative for Asthma (GINA). Wellington, New Zealand, Medical Research Institute of New Zealand; Southampton, United Kingdom, University of Southampton. 2004.
3. National Institutes of Health, National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma. Expert panel report 3. Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute, 2007.
4. Burgess JA, Walters EH, Byrnes GB, Matheson MC, Jenkins MA, Wharton CL, et al. Childhood allergic rhinitis predicts asthma incidence and persistence to middle age: A longitudinal study. J Aller Clin Immunol. 2007; 120(4): 863–869.
5. Alati R, Al Mamun A, O'Callaghan M, Najman JM, Williams GM. In utero and postnatal maternal smoking and asthma in adolescence. Epidemiology. 2006; 17(2): 138–144.
6. Mapp CE, Boschetto P, Maestrelli P, Fabbri LM. Occupational asthma. Am J Respir Crit Care Med. 2005; 172: 280–305.
7. Pinnock H, Shah. Asthma. Br Med J. 2007; 334 (7598): 847–850.
8. National Asthma Education and Prevention Program (National Heart, Lung, and Blood Institute) Second Expert Panel on the Management of Asthma. Expert panel report 2: guidelines for the diagnosis and management of asthma. Bethesda, MD.: National Institutes of Health, 1997; Publication no. 97-4051.
9. Stoloff SW, Janson S. Providing asthma education in primary care practice. Am Fam Physician. 1997; 56: 117–126.
10. National Center for Health Statistics. Raw Data from the National Health Interview Survey, U.S., 1982–1996, 2001–2004.
11. American Academy of Allergy, Asthma and Immunology, Allergy and Advocate: Fall 2004. Available at: www.aaaai.org/patients/advocate/2004/fall/costs.stm. Accessed on 29/11/07.
Written by: healthplus24.com team
Date last updated: December 11, 2014