Chest Diseases
Asthma


​Overview:
  • Asthma is a chronic condition that affects the bronchi carrying air to and from the lungs, leading to difficulty breathing.
  • Types of asthma vary according to severity and frequency of asthma attacks.
  • The cause of asthma remains unidentified; however, there are risk factors that increase the chance of developing it.
  • Asthma medications are divided into: preventive medications, emergency medications, and allergy medications.
  • Identifying asthma triggers, avoiding them, and following doctor’s order will help control your asthma.

Parts of the respiratory tract:
The respiratory system consists of organs responsible for the exchange (input and output) of oxygen gas and carbon dioxide to and from the body, namely: 
  • Upper respiratory system, made up of: nose, nasal cavity, sinus, larynx, trachea.
  • Lower respiratory system, made up of: bronchioles that branch out to form bronchi, alveoli, lungs.

What is allergy?
Allergies occur when the immune system reacts to a foreign substance (e.g. pollen, mites, fungi, or certain foods, etc) that doesn't normally cause a reaction in most people.

What is asthma?
It is a chronic respiratory condition, in which the airways (airways that carry it to and from the lungs) are sensitive to certain irritants, and can affect people of all ages, but it often begins from childhood.

Other names:
Bronchial asthma, chest allergy, asthma, gasp, respiratory crisis, inhalation allergies, bronchitis

Types of asthma:
There are many types of asthma resulting from various factors:
  • Adult-onset asthma: Many people don't show any asthma symptoms until they are adults.
  • Allergic asthma: There is often a link between allergies and asthma, yet not everyone who suffers from an allergy has asthma, and not everyone with asthma has an allergy. Allergens (e.g. dust and pet hair) can trigger asthma symptoms and attacks in some people.
  • Asthma-COPD overlap: Most people with asthma will not develop chronic obstructive pulmonary disease (COPD), and many people with COPD do not have asthma. It is possible, though, for someone to have both.
  • Exercise-Induced Bronchoconstriction (EIB): It causes coughing and shortness of breath during physical activity.
  • Occupational asthma: This type is common among people who work around chemical fumes, dust, or other irritants in the air.

How do asthma attacks occur?
When a person is exposed to an asthma irritant, the body treats the irritant as follows:
  • Tightness in the muscles surrounding the bronchi, causing pressure on the bronchi;
  • The lining of the airways becomes inflamed, causing swelling;
  • A mucous layer is formed which increases the airway tightness;

This sequence of changes makes the airways narrow, making it difficult for the air to pass and breathe well, thus showing the symptoms of an asthma attack.


Cause:
The cause of asthma has not been identified; however, it is likely that asthma is caused by a combination of genetic and environmental factors. How these factors work together remains largely unknown. There are risk factors that increase your chance of developing asthma.

Risk factors:
  • Having other allergies or other conditions (e.g. eczema, hay fever or food allergies);
  • Having a family history of asthma or other allergies;
  • Exposure to negative smoke in childhood;
  • ​Mother's smoking during pregnancy increases the risk of asthma;
  • Exposure to fumes, wood particles and others in the workplace.

Triggers:
Asthma attacks often occur in response to an irritant, which may include:
  • Infection (e.g. cold and flu)
  • Allergens, (e.g. pollen, dust mite, fur or feathers)
  • Smoking, incense and air pollutants (e.g. vehicle exhaust)
  •  Some medicines (e.g. Beta-blockers, which are used to treat high blood pressure, heart disease, or migraines, and aspirin).
  • Emotional changes (e.g. stress and laughter)
  • Weather fluctuations (e.g. sudden change in temperature, or sudden exposure to cold weather)
  • Mold or moisture
  • vigorous exercising
  • Reflux
People with asthma may react to allergens differently. But knowing and avoiding irritants may help control asthma attacks and symptoms.

Asthma attack symptoms:
Symptoms vary in each attack, and may never appear if a person controls asthma well. Symptoms vary from one person to the other, but the most common are:
  • Shortness of breath
  • Whistling chest (wheezing)
  • Chest tightness
  • Persistent coughing
Symptoms often appear at night, early in the morning, or after physical activity. If asthma is controlled, the onset of symptoms will be temporary, and at relatively long intervals.

When to see a doctor?
  • If symptoms begin to worsen;
  • If you feel exhausted and fatigued;
  • If painkillers don't help relieve the attack symptoms;
  • If there is severe shortness of breath making it difficult for a person to talk, eat or sleep;
  • If the patient needs to use fast-acting drugs continuously, he or she should tell the doctor, he may need to make a modification to long-acting drugs.

Complications:
Although asthma can be controlled, it is still a serious condition that can cause many problems. Therefore, it is very important to follow the treatment plan prescribed by your doctor. Do not ignore the symptoms if they start to get worse. Poor asthma control can cause the following problems:
  • Feeling tired all day;
  • Poor performance or absence from work or school;
  • Stress, anxiety or depression;
  • Delayed growth or puberty;
  • Death

Diagnosis:
Asthma is suspected when there are risk factors, also when:
  • Asthma symptoms appear continuously, or at the same time each year;
  • Symptoms worsen at night or early in the morning;
  • Symptoms appear clearly after physical activity, the presence of allergens or infection;
  • The condition quickly improves when asthma medications are used.

Following are the diagnostic methods to be considered:
  • Medical history: Asking the patient about his or her medical history, including family history of asthma, other allergies, smoking or exposure to negative smoke, and exposure to pollutants in the workplace.
  • Clinical examination: Lung function tests, such as spyrometer: a device used to measure the flow of air to and from the lungs.
  • Air flow meter: Used to measure how hard air exits (exhalation intensity).
  • Allergy tests: Asthma is highly associated with other allergies, so an allergy test may be done by blood or spot test.
There is no need for X-rays to diagnose asthma, but your doctor may do it if they want to rule out other lung problems (e.g. pneumonia). Asthma is often difficult to diagnose in children because it is difficult for them to take a breath test, so your doctor will evaluate your symptoms and history, and may prescribe asthma medications to see how they work. The doctor may also request some tests to rule out other medical conditions. They include:
  • Electrocardiogram to rule out heart failure;
  • Laryngoscopy to rule out vocal cord problems;
  • Sleep studies to rule out sleep apnea;
  • Endoscopy to rule out GERD.

Treatment:
There is currently no cure for asthma completely, but there are medications that help to control it, which helps the affected person to live normally, as it varies from person to person depending on age, symptoms and others, including:
  • Long-acting drugs (prophylactic): Generally those are taken daily to control asthma and reduce the likelihood of attacks. They have several types:
    • Inhaled corticosteroids
    • Leukotriene modifiers
    • Long-acting beta boosters
    • Mixed inhalable drugs
    • Theophylline
  • Rapid-acting drugs (rescue): It is used during the occurrence of asthma attacks for quick effect, as well as using before exercise according to the doctor's instructions, it has several types:
    • Short-acting beta boosters (such as Ventolin): It can be inhaled by inhalers or vaporizer.
    • Ipratropium (Atropent): It relaxes the airways quickly, making it easier to breathe.It is often used in emphysema and chronic bronchitis, and may be used to treat asthma attacks.
    • Oral or intravenous corticosteroids: It relieves bronchitis caused by severe seizures, but prolonged use may result in side effects.
If a person has difficulty using asthma inhalers: There are several other ways to facilitate the use of asthma medications, including:
  • Funnel (conductor)
  • Vaporizer

Funnel (coupling, connector, tube): 
A piece attached to an asthma inhaler which helps inhaling (especially for children), and may be connected to a mask if the patient cannot close his mouth well around the mouth opening.

How to clean the funnel?
  • Remove the mask and set aside (if any).
  • Wash mouth piece, lid and funnel with warm water and liquid soap, and rinse thoroughly after completion.
  • Put all parts aside to dry, and avoid drying them with napkins or towels; as the funnel may have sediments where medication particles will be stored.

Vaporizer (water sprayer):
A device used to enable the patient to inhale the drug, where the drug is placed with distilled water solution in a vaporizer connected to a mask.

Prevention:
The disease cannot be prevented, but it can be controlled by following health tips.

General guidelines:
Although there is no cure for asthma, it can be controlled in cooperation with your doctor by considering the following guidelines:
  • Make sure to carry asthma medications all the time.
  • Use medications regularly and properly.
  • Ensure that the funnel or vaporizer is properly used.
  • Stay away from irritants, and ensure not to visit the places they exist.
  • Avoid foods and medicines that cause allergic reactions.
  • Take the flu vaccine every year to avoid getting it and triggering asthma.
  • Stay away from people with influenza to avoid infection from them.
  • Get rest and take fluids when you feel the onset of flu symptoms.
  • Avoid all kinds of smoking.
  • Cover the mouth and nose with a scarf in cold weather.
  • Discuss with your doctor the appropriate sports that strengthen your lungs.
  • Avoid stress.
  • Wash bed linen to kill any mites.
  • Record the readings when using the air flow meter and display them to the doctor, as well as the number of attacks.

Guidelines for improving air quality at your workplace:
  • Identify signs of contaminated air in the work environment.
  • Eliminate the sources of air pollution in the place.
  • Improve air quality in the workplace (such as using an air purifier). 

FAQs:
  • What is the difference between asthma and COPD?
    • COPD is an acronym for chronic obstructive pulmonary disorder and emphysema. They are two diseases caused by smoking. Many COPD symptoms are similar to asthma symptoms (e.g. shortness of breath, wheezing, increased production of mucus, and coughing). COPD is more serious than asthma, because changes in the airways are difficult to treat and usually have worse outcomes. COPD can cause a long-term disability and have a greater impact on the heart and other organs than asthma.
  • Are there specific guidelines for asthmatics with weather changes?
    • If cold air triggers your asthma, ask your doctor if an increase in medication doses or additional treatment is needed. Moreover, face masks may help warm and moisturize the inhaled air. Cold air dries and irritates the mucous membranes in the bronchi, especially in people with asthma.
  • Is exercise recommended for asthma patients? If yes, then what are tips to keep in mind?
    • Yes. Although physical exercise is a common trigger of asthma symptoms, it is important for people with asthma to exercise. The best way to avoid exercise-induced asthma is to ensure that it is properly controlled. It is also essential to see your doctor before committing to an exercise routine. He may prescribe anti-inflammatory treatment, often with inhaled corticosteroids. They are taken regularly to prevent exercise-induced asthma. Starting slowly and warming up well also reduces the occurrence of exercise-induced asthma.
    • Certain types of exercise (e.g. running and jogging) are more likely to expose your airway to large amounts of dry air and cause asthma, while less severe activities (e.g. swimming and yoga) are less likely to cause these symptoms.

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Last Update : 02 November 2020 03:24 AM
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