Asthma

1 What is Asthma?

Asthma is a condition characterized by narrow and inflamed airways that affect breathing. It causes symptoms like: 

Severity of symptoms range from very mild to severe form that affects daily activities. Inflammation of the airways increases the sensitivity of the region and makes it more prone to allergic reaction. 

Asthma is diagnosed based on lung function tests, medical history, and physical examination. During an asthma attack, the symptoms becomes worse. Severe attacks of asthma require medical attention. 

Short-term relief medications and long-term medications to control symptoms are used in the treatment.

2 Symptoms

Symptoms of Asthma vary from individual to individual. Most common symptoms of the condition include: 

The signs and symptoms become worse during an asthma attack. Breathing difficulty may increase and the patient may require quick-relief inhaler more often. 

Symptoms of exercise-induced asthma worsen when the environmental conditions are dry and cold. 

Occupational asthma has disease flare up with exposure to irritants like fumes and gases. Symptoms of allergy-induced asthma are caused by allergens like dander and pollen. 

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3 Causes

A combination of genetic and environmental factors are the main causes of asthma. Allergens that trigger asthma vary from person to person. It includes: 

  • Pollen, dander, mold, dust mites and other proteins that are airborne
  • Respiratory infections
  • Physical activity like exercise
  • Cold conditions
  • Irritants like smoke
  • Certain medications
  • Stress
  • Preservatives 
  • Gastroesophageal reflux disease (GERD

Some of the common risk factors for asthma include: 

  • Family history
  • Obesity
  • Smoking:
  • Passive smoking
  • Exposure to triggers
  • Allergy

4 Making a Diagnosis

Making a diagnosis of asthma is done by several tests.

Physical examination helps to differentiate other respiratory conditions that result in similar symptoms. Review of signs and symptoms, and medical history of the person also provide important clues in the diagnosis of asthma. 

Lung function test or pulmonary function test is used to measure the amount of air in transaction during inhalation and exhalation. Spirometry measures the amount of air exhaled after a deep breath. This indicates the narrowing of airways. 

Peak flow meter is a lung function test that evaluates how hard one can exhale. Low peak flow readings indicate abnormality in the function of lungs. Lung function test is usually taken by dilating the airways using a bronchodilator. 

Other tests include: 

  • Methacholine challenge – a test in which methacholine, a trigger of asthma, is used in the challenge. The test gives the reaction of the person to methacholine, which indicates asthma. 
  • Nitric oxide test – this test measures the amount of nitric oxide in breath. Higher levels of nitric oxide is a sign of asthma. 
  • Imaging tests – imaging tests like X-ray, and CT scan is helpful in identifying the structural abnormalities or infection that result in asthma. 
  • Allergy testing – allergy testing, done with skin test or blood tests, identifies allergies to common triggers like pets, pollen, or mold. 
  • Sputum eosinophils – presence of eosinophils in saliva and sputum is another indicator of asthma. 

Airway obstruction before and after a vigorous physical activity also may be an indicator of this condition. 

5 Treatment

Prevention and control of symptoms are the treatment strategies for asthma. Asthma medications are usually taken daily for long-term control of the condition. 

Some common medications used are: 

  • Corticosteroids – inhalation corticosteroids have anti-inflammatory properties with low side effects. Fluticasone, flunisolide, beclomethasone, and budesonide are commonly used inhalation corticosteroids. 
  • Leukotriene modifiers – these oral medications open up the airways. Montelukast and zafirlukast are leukotrient modifiers that help to alleviate the symptoms. 
  • Long-acting beta agonists – salmeterol and formoterol are long-acting beta agonists that help to open up the passage. 
  • Combination inhalers – it is usually a combination of long-acting beta agonist and corticosteroid. 
  • Theophylline – is a bronchodilator that relaxes the muscles of the airways. 

Some medications are used for quick relief from symptoms during an asthma attack. Short-acting beta agonists, ipratropium, and corticosteroids are prescribed for quick relief. Albuterol and levalbuterol are short-acting beta agonists used as hand-held inhaler or nebulizer. 

Ipratropium quickly relaxes the airways and aids in improving breathing. It is commonly prescribed for emphysema and chronic bronchitis. Corticosteroids are also used for severe form of airway inflammation. 

Immunotherapy or allergy shots are suggested for controlling asthma caused by allergy. Shots are given once a week for few months. 

The dose is reduced to once a month for few years. Omalizumab is a shot given for severe asthma attacks caused by allergies

6 Prevention

Asthma cannot be prevented as such, but steps can be taken to prevent asthma attacks. Following a step-wise plan for taking medications and diet, helps to prevent sudden flares and attacks. 

Identifying the triggers and avoiding it prevent inflammation of airways. Recognizing the steps of an asthma episode like coughing, and wheezing enables one to take the precautionary step immediately. 

Taking medications at the dose for the prescribed time is very important for long-term prevention of the condition.

7 Alternative and Homeopathic Remedies

Blatta orientalis, Lobelia inflate, Antimonium tartaricum, Sambucus nigra, Natrum sulphuricum, Medorrhinum, and Tuberculinum are homeopathy remedies for controlling asthma symptoms.

Anti-inflammatory diet is also recommended to prevent narrowing of airways. Herbs like ginger and turmeric have anti-inflammatory properties and including them in the diet is effective in controlling symptoms. 

Osteopathic manipulation and Rolfing, two manipulative procedures are also considered to be useful in controlling the flare up. 

Traditional Chinese medicine and Ayurvedic medicine are also considered to be useful in treating the condition.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with Asthma.

Avoid exposure to asthma triggers by: 

  • Using air conditioners to lower indoor humidity
  • Reducing dust by using dust-proof covers and removing carpets
  • Using dehumidifier
  • Clearing molds from damp areas
  • Reducing pet dander 
  • Avoiding cold weather

Regular exercise, maintaining a healthy weight, and controlling gastrointestinal reflux disease are key to improve overall health. 

9 Risks and Complications

There are several risks and complications associated with Asthma.

Asthma attacks and chronic asthma symptoms may affect day to day activities, work life, and sleep. Flare ups may result in emergency room visits. Long-term use of preventive medications may have side-effects.

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