Asthma

Asthma is a prevalent respiratory disorder that affects millions of people worldwide. It is a long-term condition that can cause significant discomfort and impact an individual's quality of life. Understanding the various aspects of asthma, including its stages and types, is crucial for effective management and treatment.

What is Asthma?

Asthma is a chronic inflammatory disorder of the airways, the tubes that carry air into and out of the lungs. In people with asthma, the airways become inflamed and narrow, making it difficult for air to move in and out. This inflammation and narrowing can cause recurring periods of wheezing, chest tightness, shortness of breath, and coughing. These episodes can range from mild to severe and can be triggered by various factors, such as allergens, irritants, exercise, or respiratory infections. While asthma cannot be cured, it can be effectively controlled with proper management and treatment.

There are several types of asthma which include:

• Allergic asthma: This is the most common type of asthma, triggered by allergens such as dust mites, pet dander, pollen, and mould spores. Symptoms may occur seasonally or year-round, depending on the allergen.

• Non-allergic asthma: This type of asthma is not triggered by allergens but by other factors such as stress, cold air, exercise, or respiratory infections.

• Seasonal asthma: Symptoms of seasonal asthma are triggered by seasonal allergens, such as tree, grass, or weed pollen, and may only occur during specific times of the year.

• Occupational asthma: This type of asthma is caused by exposure to irritants or allergens in the workplace, such as chemicals, fumes, or dust.

• Exercise-induced asthma: Also known as exercise-induced bronchoconstriction (EIB), this type of asthma is triggered by physical activity and may cause coughing, wheezing, and shortness of breath during or after exercise.

• Difficult asthma: This term refers to asthma that is challenging to control despite adherence to standard treatment plans and the elimination of potential triggers.

• Severe asthma: Severe asthma is a form of asthma that does not respond well to standard treatments and may require higher doses of medications or additional therapies.

• Eosinophilic asthma: This type of asthma is characterised by high levels of eosinophils, a type of white blood cell, in the airways and is often associated with more severe symptoms and a higher risk of asthma attacks.

• Childhood asthma: Asthma that develops during childhood, often before the age of 5, and may be triggered by allergens, respiratory infections, or other factors.

• Adult-onset asthma: Asthma that develops in adulthood, often after the age of 20, and may be triggered by hormonal changes, environmental factors, or underlying health conditions.

The early signs of asthma include:

• Increased mucus production, which can indicate the onset of an asthma episode

• Runny or stuffy nose, suggesting congestion and stuffiness

• Itchy neck or chin, often felt before the onset of more severe symptoms

• Feeling tired or weak, especially during exercise

• Wheezing or coughing after engaging in physical activity

Asthma symptoms can vary from person to person, but some of the most common signs and symptoms of asthma in adults include:

• Coughing: A persistent cough, especially at night, is a common symptom of asthma.

• Wheezing: A whistling or squeaky sound when breathing out is a characteristic symptom of asthma.

• Shortness of breath: Feeling like you can't catch your breath or feeling winded even when sitting still.

• Chest tightness: A feeling of pressure or tightness in the chest that can make breathing difficult.

• Difficulty breathing: Feeling like you're having trouble getting air in and out of your lungs.

Asthma is classified into four stages based on the frequency and severity of symptoms which include:

• Intermittent: Symptoms occur less than twice a week, with nighttime symptoms less than twice a month. Lung function tests show a forced expiratory volume (FEV1) of 80% or more of normal values. Treatment typically involves using a short-acting beta-agonist (SABA) inhaler as needed.

• Mild persistent: Symptoms occur more than twice a week but not daily, with nighttime symptoms three to four times a month. Lung function tests show an FEV1 of 80% or more of normal values. Treatment often includes a low-dose inhaled corticosteroid and a SABA inhaler for flare-ups.

• Moderate persistent: Symptoms occur daily, with nighttime symptoms more than once a week. Lung function tests show an FEV1 between 60% and 80% of normal values. Treatment typically involves a low-dose inhaled corticosteroid plus a long-acting beta-agonist (LABA) or a medium-dose inhaled corticosteroid, along with a SABA inhaler for flare-ups.

• Severe persistent: Symptoms occur daily and frequently, with common nighttime symptoms. Lung function tests show an FEV1 less than 60% of normal values. Treatment often includes high-dose inhaled corticosteroids, LABAs, and other medications, along with a SABA inhaler for flare-ups.

Asthma is caused by inflammation and constriction of the airways in the lungs. This can be triggered by various factors, such as:

• Airway inflammation: Swelling inside the airways, excess mucus production, and muscle tightening around the airways lead to asthma symptoms.

• Allergens: Exposure to allergens such as pollen, dust mites, and animal dander can trigger asthma symptoms in sensitive individuals.

• Irritants: Air pollutants, smoke, and chemical fumes can aggravate asthma and trigger attacks.

• Respiratory infections: Viral and bacterial infections of the respiratory tract can trigger asthma episodes.

• Exercise: Physical exertion can induce asthma symptoms in some individuals, a condition known as exercise-induced asthma.

While anyone can develop asthma at any age, certain factors put you at greater risk:

• Family history of asthma or allergies (eczema, allergic rhinitis)
• Having another allergic condition like atopic dermatitis or hay fever
• Being overweight or obese, which can worsen asthma symptoms
• Smoking or exposure to secondhand smoke
• Exposure to exhaust fumes or other types of pollution
• Occupational exposure to chemicals, dust or other irritants
• Respiratory infections during infancy or childhood
• Low birth weight and respiratory problems in infancy

Asthma can lead to several complications if not managed properly. Some of these complications include:

• Respiratory failure: Severe asthma attacks can cause the airways to become so inflamed that air cannot pass into the lungs, potentially leading to death if not treated immediately.
• Chronic inflammation: Ongoing inflammation in the airways can lead to airway remodelling, resulting in chronic coughing and loss of lung function.
• Medication side effects: Inhaled corticosteroids can cause oral thrush, throat irritation, and hoarseness, while oral corticosteroids can lead to weight gain, changes in eyesight, bloating, bruising, and cognitive problems.
• Infections: Asthma can increase the risk of respiratory infections such as pneumonia, complicating recovery and worsening asthma symptoms.
• Sleep difficulties and fatigue: Asthma symptoms can worsen during sleep, leading to poor sleep quality, tiredness, and fatigue. Some medications can also cause insomnia.
• Lack of physical activity: Fear of triggering asthma attacks can lead to reduced physical activity, increasing the risk of other medical conditions like osteoporosis, type 2 diabetes, obesity, and heart disease.

While asthma itself cannot be prevented, several steps can be taken to prevent asthma attacks and manage the condition effectively. Some of the key strategies include:

• Identifying and avoiding personal triggers such as allergens (pollen, dust mites, pet dander), irritants (cigarette smoke, household cleaners), and other substances that can trigger asthma symptoms.
• Using allergy-proof bedding and keeping the home clean to reduce exposure to dust mites and other allergens.
• Avoiding outdoor activities during high pollen count days or when air pollution levels are high.
• Not allowing smoking in the home or car.
• Getting vaccinated against influenza and pneumococcal disease to reduce the risk of respiratory infections that can worsen asthma.
• Taking medications as prescribed by the doctor, even when feeling well.
• Using a peak flow metre to monitor lung function and identify early signs of an asthma attack.
• Developing an asthma action plan with the doctor to know what to do in case of worsening symptoms or an asthma attack.
• Maintaining a healthy weight, as obesity can worsen asthma symptoms and make the condition harder to control.
• Exercise regularly, as it can help improve lung function and overall health. However, it's important to talk to the doctor about safe exercise options and pre-exercise treatment if needed.

Diagnosing asthma involves a combination of medical history, physical examination, and lung function tests. Some of the tests used to diagnose asthma include:

• Medical history and physical examination: The doctor will ask about symptoms, family history of asthma or allergies, and exposure to triggers. They will also perform a physical exam, listening to the lungs for wheezing or other abnormal sounds.

• Spirometry: This is the most common lung function test used to diagnose asthma. It measures how much air can be exhaled and how quickly. The test is done before and after using bronchodilator medication to see if there is an improvement in lung function.

• Peak expiratory flow (PEF): This test measures how fast air can be exhaled using a peak flow metre. It can be done at home to monitor lung function and identify early signs of an asthma attack.

• Fractional exhaled nitric oxide (FeNO) test: This test measures the amount of nitric oxide in exhaled breath, which can be a marker of airway inflammation.

• Bronchoprovocation test: This test involves inhaling a substance that can trigger asthma symptoms and then measuring lung function to see if there is a response. It is used when spirometry results are normal but asthma is still suspected.

• Allergy tests: Skin prick tests or blood tests can be done to identify allergies that may be triggering asthma symptoms.

• Imaging tests: These imaging tests (such as a chest X-ray or CT scan) can help rule out other conditions that may be causing symptoms similar to asthma.

Asthma treatment and management approaches vary based on the severity and frequency of symptoms, which are categorised into four main stages. These include:

• Intermittent asthma: For intermittent asthma, where symptoms occur 2 days a week or less with minimal impact on daily activities, treatment typically involves the use of a short-acting beta agonist (SABA) inhaler to manage symptoms on an as-needed basis. Daily steroid treatment is usually not required at this stage.

• Mild persistent asthma: Mild persistent asthma, characterised by symptoms occurring more than twice a week but not daily, may require the use of a SABA inhaler more frequently and the introduction of a daily low-dose steroid or controller medication.

• Moderate persistent asthma: In cases of moderate persistent asthma, where symptoms occur daily during flare-ups lasting several days and significantly impact daily activities, treatment involves regular use of a quick-relieving inhaler and a daily combination of steroids and a long-acting bronchodilator medication. Referral to an asthma specialist or pulmonologist may be necessary at this stage.

• Severe persistent asthma: Severe persistent asthma, with daily symptoms often occurring at night and significantly impacting daily life, requires multiple daily asthma medications, including oral steroids, to keep airways open. Frequent use of a quick-relieving inhaler is also common, and treatment is typically managed by a pulmonologist or asthma specialist.

Living with asthma can be challenging, but there are several steps you can take to manage your condition and maintain a good quality of life:

• Stick to your asthma action plan and take medications as prescribed

• Identify and avoid asthma triggers, such as allergens, irritants, and respiratory infections

• Maintain a healthy lifestyle, including regular exercise, a balanced diet, and stress management techniques

• Monitor your asthma symptoms and peak flow readings to detect changes in your condition

• Keep your home clean and well-ventilated to reduce indoor allergens

• Inform your family, friends, and colleagues about your asthma and how they can help in case of an emergency

• Attend regular check-ups with your doctor to assess your asthma control and adjust treatment as needed

It is essential to seek medical advice if you experience any signs or symptoms of asthma, such as wheezing, shortness of breath, chest tightness, or a persistent cough. If you have been diagnosed with asthma and your symptoms worsen or become more frequent despite following your treatment plan, consult your doctor. Seek immediate medical attention if you have difficulty breathing, cannot speak more than short phrases due to shortness of breath, or your lips or fingernails turn blue, as these could be signs of a severe asthma attack.

• Asthma is a chronic lung condition that causes inflammation and narrowing of the airways, leading to symptoms such as coughing, wheezing, and shortness of breath.

• There are several types of asthma, including allergic, non-allergic, exercise-induced, and occupational asthma.

• Asthma symptoms can range from mild to severe and may vary from person to person.

• Treatment for asthma depends on the severity of symptoms and may include the use of short-acting and long-acting medications, as well as lifestyle changes and environmental control measures.

• Living with asthma involves sticking to an asthma action plan, avoiding triggers, maintaining a healthy lifestyle, and attending regular check-ups with a doctor.

• Seeking early diagnosis and treatment for asthma is crucial in preventing asthma attacks and improving overall quality of life.