Seen that guy in your community center who brings an inhaler with himself. Ever wondered why that inhaler is always with him? Is there a mystic potion in it which relieves him of all his troubles? Well, that inhaler is in-fact a reliever and that guy most probably is suffering from asthma. What is asthma? Asthma is a long term or chronic disease of the airways that causes chest tightness and wheezing, secondary to inflammation. Although the cause of this airway inflammation is not completely understood, many factors are thought to be responsible.
Asthma occurs with shortness of breath, wheezing, airflow limitation and cough; mostly symptoms of asthma get worse at night (Kumar, 2012). Although it is a disease of all age groups, it mostly starts in the childhood between the ages of 3-5 years; some children outgrow their asthma symptoms during adolescence or young adulthood.
The chronic implications of asthma cause airway hyper-responsiveness, which means that there is exaggerated response of inflammatory cells in the airways in response to certain triggers. This hyper-responsiveness, although reversible with medication, causes airflow limitation and chest tightness, and can predispose to diseases like COPD in the future.
Recent research has led to the belief that asthma is not an isolated disorder, rather it is a part of systemic airway disease that affects not only the bronchi but the entire respiratory tract. This is further verified by the evidence of co-existence of asthma with other atopic disorders like—allergic rhinitis. Asthma is an irreversible disease, but with proper management and therapeutic guidelines, it can be controlled.
Over the last few years, there have been significant improvements in the diagnosis and management of asthma, with more comprehensive guidelines and literature made available for the public. However, there is still persistent increase in the overall prevalence of the disease. In the US alone, more than 24 million people are affected by asthma, whereas worldwide this number is 300 million, expected to rise to 400 million by the year 2025.
In a survey in the US, suboptimal asthma control in patients was found, likely due to under-use of medication. This has proven to be of great concern to the US public health. Patients avoid the use of long-term control medications and rely instead on quick-relief medication.
What Is Asthma? Symptoms And Diagnosis
Once you are diagnosed with asthma, the disease persists throughout your life. However, with proper medication you can control your disease. Certain allergens or triggers can flare or exacerbate the disease, and these are called asthma attacks.
The symptoms of asthma include(Kumar, 2012):
- Breathing difficulty
- Wheezing—whistling sounds while breathing
- Cough, with or without sputum
- Airflow limitation—this is usually reversible with medication and occurs due to bronchoconstriction. This means that during an acute attack, the muscles surrounding the airways in the lungs (bronchi) contract suddenly, in response to a stimulus. This stimulus is usually an irritant or an allergen. Apart from the allergens, stress can also trigger bronchoconstriction.
- Inflammation of the airway—the cells of inflammation like mast cells, T-lymphocytes and eosinophils are activated and these cause narrowing of the airway, as well as increased mucus production.
- Hyper-responsiveness of the airway—this is caused by certain triggers and causes narrowness of the airway and breathing difficulty.
- Airway remodeling—this occurs in chronic persistent disease that causes remodeling of the airways over time and causes irreversible airflow limitation and mucus impaction.
- Chest tightness
- Chest pain
What Are The Risk Factors Of Asthma?
Asthma is caused by a unique interplay between genetic and environmental factors. If a person has inherited asthma genes then environmental exposure to certain triggers will make him/her more susceptible to developing asthma. This does not always mean that such carriers always go on to develop asthma, and infact many people with asthma genes never develop asthma, but their chances of developing are increased.
The Genetics of Asthma
Asthma has a strong hereditary association; if anyone is suffering from asthma then he is likely to have a parent or sibling or cousin suffering from the same condition. There is no single gene that is responsible for asthma; a number of genes control the disease. These include (Kumar, 2012):
- ADAM 33 on chromosome 20
- IL-3,4,5,9,13 control cytokine (inflammatory cell) production
- PHF 11 on chromosome 2
Environmental Factors And Asthma
An interesting hypothesis, called the Hygiene Hypothesis—first proposed by David P. Strachan, a British epidemiologist, has been suggested that explains the allergic response in children and the subsequent asthma development.
It has been proposed that if children are raised in a ‘dirtier’ environment, instead of being protectively being raised in a ‘clean’ environment, then their immune system becomes stronger and there is no consequent IgE (Immunoglobulin E—the antibody produced in allergic reactions) production on exposure to allergens.
On the other hand, living only in clean environment does not expose the immune system enough and on exposure to any mild allergen, there is a great allergic response and IgE production.
Since asthma is also a kind of allergic response of the airways to any irritant/allergen, such children are more predisposed to developing asthma. Children living in developing countries, or livestock farming communities who are exposed to the microorganisms, develop strongly tolerance to the latter and do not develop allergic reactions/asthma, later in life.
In the US, cockroach allergy (in the inner cities), and furry pets have been implicated as the triggers of asthma in children. In fact, a research conducted by scientists in California with the help of school children found that children with pets had worsening of their asthma symptoms on exposure to air pollution.
Asthma Risk Factors
Some other risk factors of asthma include:
- History of drug addiction
- History of mental illness
- History of atopy or a predisposition to allergy. Such conditions include history of eczema or dermatitis.
- Children with low birth weight
- Children born in fall: have more chance of developing asthma because their immune system is not developed to handle the allergens the baby is exposed to during the winter season.
Common Asthma Triggers
For different people, the triggers of asthma are different. These can be:
- Common allergens—dust mites, pollens, spores. Since most children have allergic asthma, breathing in these allergens can trigger an allergic response.
- Stress and emotion
- Atmospheric pollution—smoke, car exhaust, particulate matter, fumes and vapors can all worsen or trigger the symptoms of asthma. The release of soybean dust in Barcelona and the consequent asthma epidemic prove that atmospheric pollution has a major impact on asthmatics.
- Cigarette smoke
- Cockroaches and other insects
- Exercise—exercise induced asthma occurs not during exercise, but afterwards, due to the release of inflammatory mediators.
- Inhalation of cold air
- Perfumes and other strong smells
- Drugs—certain drugs can trigger asthma. These include: NSAIDs: these include aspirin and ibuprofen. About 5 percent of asthmatics experience this type of allergy, and it is particularly common in people who suffer from both asthma and nasal polyps.
- Beta blockers: these drugs, like propranolol, are used in the treatment of hypertension or angina, and it can trigger bronchoconstriction (narrowing of airway) in asthmatics. In such patients alternative drugs should be used.
- Occupational asthma: can develop in predisposed individuals when they are exposed for long time to a particular antigen. These can include: latex, animal allergens, wood dust, bleaches and dyes, isocyanates.
- Viral infections, like common cold
- Some food preservative can also trigger asthma. These preservatives can include sulfites that are mostly found in processed potatoes, wine, beer, and shrimps.
- GERD, gastro-esophageal reflux diseases, in which there is backflow of acidic contents of the stomach into the esophagus or even higher, has been known to trigger.
What Are The Causes Of Asthma?
The exact cause of asthma is still not understood, but many risk factors and triggers work about to cause the disease. Since genetics play an important role in the pathogenesis of asthma, a strong family history especially with atopy is a major cause of asthma. In a retrospective study of asthma control in the US, it was found that certain atopic conditions like rhinosinusitis, and allergic rhinitis, were linked to uncontrolled asthma.
This means that not only are such conditions a causative factor of asthma but also worsen it. Other causes include:
- Being a passive smoker
- Exposure to allergens
- Exposure to airway infections during childhood
- Use of antibiotics in early childhood (mostly during the first year of life)
- Intake of a lot of painkillers like acetaminophen
- Low Vitamin D levels
Obesity: overweight or obese people have upto three times the risk of asthma, as compared to thin people. Although the exact relation between obesity and asthma is not understood, it is thought that inflammatory mediators produced by fat-tissues worsen the disease. Moreover, excess weight prevents lungs from expanding fully and this pressure narrows the airways. If such people reduce weight, less exacerbation of asthma is seen.
Ethnicity: in 2002, U.S. National Center for Health Statistics found that of all the races, Hispanics (9%) had the lowest incidence of asthma, as compared to African Americans who had the highest incidence (13%); on the other hand, 11% of whites and 12% of Native Americans developed asthma. This fact further supports the role of genetics in disease development.
Statistics About Asthma
According to the National Health Interview Survey, the total number of asthmatics in the US is:
- 7 million adult asthmatics
- This comes to about 7.4% of adult population
- 3 million children suffer from asthma, i.e. about 8.6% of children
- 5 million people get diagnosed with asthma as primary diagnosis [National Ambulatory Medical Care Survey]
- The mortality of asthma is about 3630, with a ratio of 1.1 per 100,000 [Deaths: Final Data]
- Asthma exacerbations lead to an average stay of 3.6 days in the hospital [National Hospital Discharge Survey]
What Are The Types Of Asthma?
The two main types of asthma are:
- Extrinsic Asthma Or Allergic Asthma: This occurs most commonly in individuals who are predisposed to atopic conditions. Children—especially boys, with asthma often have eczema as well. About 90% of asthmatics are of this variety (Kumar, 2012). Children of the mothers who smoke during pregnancy are particularly vulnerable to developing this type of asthma.
- Intrinsic Asthma Or Non-Allergic Asthma: This type of asthma occurs in middle age (usually above 40 years of age), in people who are exposed to asthma inducing substances, like toluene diisocyanate, NSAIDs, perfume, cold air, fumes etc. Such individuals do not respond well to medications and must avoid allergens where possible. It can also be secondary to viral infections.
- Exercise Induced Asthma: occurs due to the release of inflammatory mediators, as well as the loss of moisture (drying and cooling during exercise) from the airways. This type of asthma is also known as Exercise-Induced Bronchospasm (EIB), depicting the narrowing of the airway as the muscles surrounding the airway contract (spasm).
It can occur in individuals belonging to any age group. 80% of asthmatics also suffer from EIB, while 11% of non-asthmatics also show these symptoms. According to Kumar(Kumar, 2012), this attack occurs in the time period following exercise and not the during it.
- Adult Onset Asthma: occur mostly after the age of twenty. It is more common in women. In many cases, it is due to allergies.
- Occupational Asthma: as mentioned before, this type of asthma occurs in adults, secondary to exposure to certain allergens in the workplace.
These can include isocyanates, latex, salts of platinum (in metal refining industry), bleaches and dyes etc (Kumar, 2012). About 15 percent of all asthmatics fall in this category.
- Mixed Asthma: show characteristics of both extrinsic and intrinsic asthma.
- Nocturnal Asthma: despite its name, this type of asthma does not occur at night, rather, it occurs during sleep at any time of the day.
However, the symptoms worsen during 12-4am. It is not clear whether this is merely an indication of poorly controlled asthma, or a separate entity in itself. In the US, it is mandatory to assess symptoms of nocturnal asthma in an asthmatic patient.
- Childhood Onset Asthma: this occurs in very young children with genetic predisposition. If exposed to viral antigens early in life, such infants have higher chances of developing asthma later on in life.
- Cough-Variant Asthma: this is the type of asthma in which cough is the predominating symptom. Such cases can be difficult to diagnose as many other diseases, like chronic bronchitis and sinus problems also present with the predominant symptom of cough.
- Seasonal Asthma: occurs seasonally, e.g. when it is pollen season.
- NSAID Induced Asthma: occurs in about 5% of children, and 20% of adults. This type of asthma is common in individuals who suffer from rhinitis and nasal polyps (Kumar, 2012).
In adults, rhinitis typically develops first, followed by nasal discharge (rhinorrhea) and nasal congestion. Sometimes nasal polyps and sinusitis are also found during examination. These stages are precursors of asthma onset.
How Is Asthma Diagnosed?
Apart from a detailed history of symptoms, family history, current and past medical history along with a complete physical examination, a few specialized investigations are also needed to establish the diagnosis of asthma.
When there are recurrent symptoms like wheezing, coughing especially at night, and chest tightness etc, especially on exposure to certain allergens, then the diagnosis of asthma should be suspected.
In young children, asthma can be particularly difficult to diagnose. The reason for this is because recurrent wheezing and cough are fairly common in this age group. Moreover, one of the investigations used in the diagnosis of asthma—spirometry—is not reliable in children younger than 6 years of age.
Therefore, in this age group, a trial of short acting steroids, is given, which causes bronchodilation (the exact opposite of bronchoconstriction ie a major symptom of asthma) and thus the diagnosis is made easier. Some other investigations for asthma are:
- Lung Function Tests: these include the spirometry and the PEFR (peak expiratory flow rate). These are simple tests to perform and also help in assessing the reversibility of disease.
They measure the narrowness or the tightness of the airways by their readings. The patient takes a deep breath in, and then forcefully breathes out into a spirometer or peak flow meter.
These tests are performed prior to, and after, administration of a bronchodilator; an improvement of 15% in the PEFR is diagnostic of asthma.
- Bronchial Provocation Test: in these tests, the severity of asthma can be estimated. Histamine or methacholine is used as an allergen and then severity of the disease judged with the help of pulse oximeter, breath sounds heard by a stethoscope, pulse and the physical examination of the subject.
This investigation is particularly useful in asthmatics, who present mainly with cough as their main symptom.
- Chest X-Ray is mostly used to exclude other lung diseases. Apart from an overinflated lung during an acute asthma attack, no other diagnostic features of asthma can be seen on a chest x-ray.
- Corticosteroid Trial: the measure of PEFR is done in patient after a trial of corticosteroids (usually prednisolone 30mg for 2 weeks). An improvement in PEFR shows that the disease is reversible and that therapy with steroids would be effective.
- Exhaled Nitric Oxide: NO is produced by the cells of the airway. Its amount increases during asthma and measuring this exhaled NO can be helpful in guiding therapy, especially in children.
- Exercise Test: is a very useful investigation in children. A child runs for 6 minutes on a treadmill and the degree of breathlessness produced is assessed. The degree of deoxygenation produced during this time can be assessed with the help of a pulse oximeter.
- Sputum Culture: patients with asthma have an increase in a particular type of cells called eosinophils.
- Skin Prick Tests: can be helpful to identify the allergen.
Asthma Emergency—Asthma Attack
During an acute attack, asthma is triggered by an allergen or irritant; the airways subsequently become narrower (bronchoconstriction), causing breathing difficulty and chest tightness. Chest tightness is worsened when there is excessive mucus production as well; this mucus can build up in the form of plugs and exacerbate the disease. Asthma exacerbations can also be seen in cases when the patient does not adhere to medication, there is concurrent respiratory infection or a drug like NSAID is taken.
It is also advisable for a patient to have written down a personalized plan in case of an emergency; this would prevent the patient or his partner from panicking and ensure that correct medication is used. In fatal asthma, the progression of the disease is rapid with worsening of the aforementioned symptoms. While the Early Asthma Response (EAR) can be treated easily by medication (usually beta-2-agonists), the Late Asthma Response (LAR) is not reversible. Rapidly progressing asthma would then cause asphyxiation of the patient if help is not given, usually within 2.5 hours.
Clinical Features Of Fatal Asthma
Symptoms that can be potentially fatal include: To characterize the clinical features of fatal asthma, we retrospectively analyzed the clinical characteristics of patients who died of an acute asthma attack in our hospital during a 15-year period from 1989 to 2003.
- White face
- Bluing of finger or lips (cyanosis)
- Inability to complete a sentence.
- Flared nose while breathing
- Fast pulse rate (>110 beats/min)
- Fast breathing rate(>25 breaths/min) that gradually slows down (slow rate is even more dangerous)
- Excessive coughing
- Silent chest
- Exhaustion or confusion
- Comatose patient
- PEFR<30% of normal
- Relief medications like inhalers don’t work
It is important for any asthma patient to learn to recognize the onset of an attack and take medication. If he has no medication available, then he should call for help.
Early treatment can help prevent worsening of the disease. The partner of the patient should also be aware of what to do in case of an emergency.
Treatments Of Asthma
The primary aim of treatment is asthma control and prevention of an acute attack or abrupt worsening. Step wise treatment is used in asthma, with staging of asthma first and then appropriate medication is prescribed.
The treatment agents of asthma fall in the category of either controllers (taken daily for prevention of an attack) or relievers (taken during an acute attack).
These are the first line drugs that are potent bronchodilators and help in rescuing the patient from acute symptoms.
The short acting beta agonists (SABA) like albuterol, can be used in mild asthma as well as during an acute attack. Formoterol is a long acting beta agonist (LABA) that can be used in poorly controlled asthmatics as well as a reliever medication.
Inhaled Corticosteroids [controller Medication]
Is for patients who have regular and persistent symptoms. The most commonly used ICS is In step wise management of asthma, the dose of ICS can be increased if there is no relief in symptoms or if the disease is worsening. The ICSs relieve the symptoms by decreasing the airway inflammation associated with asthma, and thereby when combined with bronchodilators, they are very effective in the management of asthma. Some side effects of ICS can include: oral thrush and hoarseness of voice.
Oral Corticosteroids For Asthma Treatment
Corticosteroids are used in more severe cases when inhaled corticosteroids are not enough. Usually they are given in severe or deteriorating disease, the most often used drug.
Asthma Treatment With Leukotriene Receptor Antagonist (LTRAs)
these are given as an alternate to ICS, usually in children. They act on the inflammation producing cells. It is recommended that a patient be given a 4-week trial therapy before determining the efficacy of LTRAs. Examples include: zafirlukast, or They can be used as add-on treatment in patients who are experiencing daily symptoms as well.
Treatment Of Asthma With Monoclonal Antibodies
Monoclonal Antibodies like Omalizumab, is used in the treatment of allergy associated asthma, because it works against the IgE antibody, which is the main antibody produced in an allergic reaction. It also works against the other inflammatory cells like mast cells. It is given once per 2-4 weeks, subcutaneously, usually in patients who have uncontrolled asthma.
Anti-Inflammatory Drugs For Asthma Treatment
Anti-Inflammatory drugs are used in patients with milder form of disease. E.g. Sodium Cromoglycate.
Theophylline its use is reserved in uncontrolled asthma. It acts as an anti-inflammatory drug but can cause a lot of unwanted side effects.
Asthma guidelines according to the National Heart, Lung and Blood Institute, offer a step-wise approach. This approach is meant to assist clinicians in treating patients, and can be tailored to meet the demands of an individual patient.
The step-wise approach suggests:
- Step # 1: Using Short acting Beta agonists (SABA) for intermittent asthma
For Persistent Symptoms
- Step # 2: Low dose Inhaled Corticosteroids (ICS)
- Step # 3: Low dose ICS + Long acting Beta agonists (LABA) or medium dose ICS
- Step # 4: Medium dose ICS + LABA
- Step # 5: High dose ICS + LABA and consider adding monoclonal antibody like omalizumab
- Step # 6: High dose ICS + LABA + Oral Steroids like Prednisolone +/- Omalizumab
Asthma In Children
In the US, about 6.3 million children suffer from asthma. Between the ages of 5-17 y, this disease accounts for about 10 million missed school days. Usually, children develop the symptoms of asthma before the age of 5 years. Because of their small airways, asthma is particularly serious in children.
They experience coughing, wheezing and chest tightness as well and these symptoms worsen early in the morning or at night.
In infants, the symptoms of asthma include:
-child not feeding
-labored breathing with sucking in of abdomen under the ribs
-breathless even during rest
Children with asthma usually have lesser stamina than other kids; moreover, they avoid strenuous physical activities that can leave them coughing or wheezing. They are also particularly susceptible to cold that can also trigger their asthma. In children the diagnosis of asthma can be a little difficult to make, since there are many other causes of wheezing in children, other than asthma.
Any respiratory tract infection can also cause wheezing in children because of their smaller airways. Bronchiolitis, is a condition caused by viral respiratory infection that mimics that symptoms of asthma, but does not respond to asthma treatment.
Other diseases that can be causing wheezing/distress to an infant include: congenital heart defect, foreign object in lungs, tracheoesophageal fistula (an abnormal communication between the airway and the esophagus) or even cystic fibrosis.
Asthma Diagnosis In Children
-there is family history of asthma
-there are signs of other allergies like skin allergy or eczema
-child had a low birth weight
-Easy fatigability while playing
-the child wheezes if exposed to tobacco smoke
Because the common causes of asthma in children are allergies and exposure to cold, an allergist/immunologist can be particularly helpful. He can help determine if asthma is causing the symptoms, what allergens are responsible, what should be the treatment plan.
Make a note of how often your child wheezes, what other symptoms occur and what is their severity, before going to the allergist. In children less than 6 years of age, lung function tests cannot be reliable; one of the ways their doctor makes the diagnosis of asthma is to give trial of asthma medication. An improvement in symptoms confirms the diagnosis.
Asthma Management In Children
The National Asthma Education and Prevention Program, suggests the following:
Assess And Monitor: A follow-up period of 2-6 weeks is recommended for children to assess and monitor their symptoms.
Self Management Education In Children: Emphasizes on teaching children on how to manage their disease. This teaches them to recognize their symptoms, and promptly take the appropriate medication to avoid the exacerbation of disease. Correct inhaler techniques are also taught to children. The Open Airways for Schools, is a program initiated by The American Lung Association that teaches children between the ages of 8-11 years to manage their asthma.
Control Of Comorbid Conditions And The Environmental Factors: like avoidance of allergens and other aggravating conditions can help avoid acute asthma attacks.
Medical Therapy: like inhaled corticosteroids (ICS), beta agonist (LABA), monoclonal antibody.
Step Wise Approach In Children: Just like adults, step wise approach is also used for asthma therapy in children.
How To Get Better Asthma Control?
Asthma control has a lot of perks. Although it is not the same as eating-all-the-chocolate-you-want-and-not-gaining-a-pound, but it does have the following benefits:
- No chronic and troublesome symptoms
- Normal activities of daily living can be continued without fear of relapse
- Help you achieve a good night’s sleep without cough or shortness of breath
- Less need for rescue medications
- No hospital stay or ER visits
- Participation in activities like exercise without fear of relapse
Now that we have seen what good asthma control can reap, let us see a few pointers into getting us there.
- Work With Your Healthcare Provider: to get an Asthma Action Plan. Not everybody has the same type of disease. Work with your doctor to create a personalized plan that clearly defines what your daily medication should be, and what your emergency medication should be.A sample asthma plan can be seen at the National Heart, Lung and Blood Institute’s website.
- Know Your Asthma Triggers And Avoid Them: Work with an allergist/immunologist to find out what your allergens or asthma triggers are and then avoid them. If you think that such triggers would be unavoidable in certain situations, then have your rescue medication on you or get allergy shots after consulting your doctor.
- Increase Awareness Of Asthma: If you are an asthmatic, chances are you already know a lot about your disease. Nevertheless, it never hurts to know more about it. It can help you recognize your symptoms better and treat them in time. If your child has asthma, then it can be even more helpful for your child if you know more about her/his disease. You can even ask your healthcare provider to educate you about asthma.
- Support Network To Beat Asthma: Educate your partner/spouse about your disease, so that they can help you manage it better and know what to do in case of emergency. If your child has asthma then it is good if the babysitters, teachers or people around your child are well aware of his disease.
- Understand Your Drugs: Each person can have a personalized therapeutic plan. Understand your medication and be compliant. Taking your medication even when you have no symptoms can help you keep the disease under control. Many relapses occur because people stop taking their ‘controller’ medication.
- Avoid A Stressful Lifestyle: Stress can also trigger asthma. Try to keep stress at bay, or manage it more effectively.
The Anti-Asthma Diet: Although there is on specific diet for asthmatics, having a diet rich in protein, vitamins and micronutrients can keep the immune system healthy and keep infections at bay.
- Keep An Asthma Diary: keep a record of your symptoms, what triggers them, and how many episodes occur despite medication. This information can help your healthcare provider asses you disease and adjust your medication.
- Avoid Smoking: If you smoke, then take steps to quit it because it can worsen your asthma. Also avoid being a passive smoker.
Who Is At Risk Of Asthma?
There are a number of factors that increase the risk of asthma. Some of them are:
- Age & Gender: while boys are likely to get asthma in childhood till about puberty, more girls develop asthma during teen years. The latter trend continues till about adulthood making the percentage of women with asthma about 12%, and men, 11%.
- Exposure To Air Pollution: people who are exposed to air pollution are likely to get airway diseases, especially people with Latino and African American ancestry. In asthmatics, air pollution is likely to worsen the disease. In another research, it was found that exposure to particulate matter, especially in early life, was associated with reduced lung functions in children with asthma.
- Ancestry: like everything else, genes also have a say in this. According to a research, there are about twice the number of black and Latino asthmatic patients, as compared to white individuals. Moreover, ethnicity is also related to the mortality of the disease, with about eight times the child mortality in non-Hispanic black patients, as compared to non-Hispanic white While it is difficult to pinpoint a single factor responsible, a complex interplay between social, heritable and environmental factors is involved here.
- Occupational Exposure: during middle age and even after that, asthma can develop in an individual. This can be triggered by occupational exposure to chemical irritants. while boys are likely to get asthma in childhood till about puberty, more girls develop asthma during teen years. The latter trend continues till about adulthood making the percentage of women with asthma about 12%, and men, 11%.
- Obesity: as mentioned before, obese people are three times more at risk of developing asthma.
The Effects Of Smoking With Asthma
Needless to say, asthma and smoking don’t go well together. Not only does smoking worsen asthma, it also decreases your lung function, and increase the risk of other diseases like lung cancer, bladder cancer, esophageal cancer, emphysema, heart diseases, stroke and many other diseases.
There are more than 7000 chemicals in tobacco smoke, most of which are known to cause cancers; apart from chemicals there are fine particles in smoke that settle in the lungs and trigger asthma.
In individuals who are susceptible to asthma, smoking can initiate the disease. Even passive smokers can develop symptoms of asthma and worsening of disease.
This is especially important for children who have small airways that can be damaged by smoke. According to a research, people who smoked for 3 years or more had increased risk of asthma.
Moreover, passive smokers or people even exposed to environmental tobacco smoke were at increased risk. According to the CDC, 21% of American adults smoke. If you are one of them, then you should think about quitting.
According to the Asthma Initiative of Michigan, the passing of Smoke Free Air Law (SFA), helped cause an 8% reduction in asthma hospitalization in a 12 month period. This proves that passive smoking causes much damage to people around, let alone to the one who smokes.
In 2001, a study published in the Journal of American Medical Association, found that second hand smoke starts affecting the non-smokers’ heart in as little as half hour of exposure, with the blood flow of nonsmokers dropping to the same level as people who smoked a pack of cigarettes.
If you are an asthmatic as well as a smoker, then you should quit smoking as soon as possible to protect your lungs and your life. There are a number of programs that can help in smoking cessation, like the:
-Group therapy programs
-One-on-one therapy sessions
-12 step program
Lifestyle Changes: How To Live With Asthma?
Asthma is a chronic disease and living with any chronic disease can be a daunting task. However if managed properly it can be controlled. As with any chronic disease, it is important to make lifestyles changes to manage it. Consider improving your asthma by losing weight, eating healthy, exercising more and quitting smoke.
Meditating can also be helpful in keeping disease associated depression at bay. Eating healthy with proper meals and adding herbs into your diet can boost your immune system and help beat any disease.
Avoid The Asthma Triggers
If you know what is causing your allergy/asthma, then you should avoid that trigger. Common triggers can include: pets, molds, pollens, cold air, stress etc. Avoiding them can make your asthma manageable.
Shallow breathing exercises (Buteyko Breathing Technique) can also help you deal better with your disease better by retaining carbon dioxide and causing subsequent bronchoconstriction.
Use And Air Conditioner And A Dehumidifier
Using both will reduce the chances of allergens in the air you breathe in. Air conditioners also help decrease the level of dust mites in the air. Living in a damp environment can also be a cause for disease—a dehumidifier can help you there.
Minimize Dust Collectors In Your House
Throw out everything that is just sitting in your house and collecting dust. You might have to alter your decoration a bit, but it is all for a good cause. Encasing your pillows and sheets in dustproof covers also goes a long way in preventing dust allergies.
Regular Check Up For Asthma
This can help keep the disease at bay. Regular follow-up ensures that there are no sudden changes in the disease. If your doctor assesses your condition, he can adjust your medication accordingly and ensure a flare-free time.
Take Your Asthma Medication
This point cannot be stressed enough. Many people stop taking their medication once they think that their symptoms are under control. While they may not be experiencing an attack but that effect is due to medication and cessation in therapy can itself be a trigger.
Don’t let Your Disease Control You
With the right medication, mental attitude and lifestyle changes, asthma can be conquered. Do not let your disease control you, rather, you should control it and not let it get in the way of living your life.
Involve Your Family
Family makes everything better. Involve your partner and your family in your asthma care. Talk with them about your disease, and engage them, so that they know what to do for you in case you have an attack. Talk to them about being an asthmatic and what it feels like so they can help understand your condition better. Family support is important in asthma.
Join An Asthma Support Group
Remember, you are not alone in your disease. Helping talk about your illness with someone in a similar situation can help you deal with it better and also help you answer some of your queries.
Alternative Remedies For Asthma
According to Naturopathic physicians, allergic asthma accounts for 90% cases in children, 70% in adults under 30 and 50% of those over the age of 30. The key, therefore, to control the disease in such asthmatics is to control their allergen exposure.
Because there is severe bronchoconstriction in asthma, the goal is to relieve this spasticity of airways. This goal can be achieved with the use of green tea, herbal medicine Lobelia as well as Magnesium.
Omega-3 fatty acids, found in nuts, flaxseeds and fish can also help control asthma by decreasing the inflammatory process in the lungs. Omega-3 supplements are easily available in the market, and one can add them in daily routine. Naturally, they can be consumed by eating a lot of fish and nuts and flaxseeds.
Nutrients Important For Asthma
An improved diet can go a long way in preventing disease. Just like the omega-3 oils we talked about before, vitamin B12, B6 as well as vitamin C can be effective in the treatment and prevention of asthma.
The use of minerals like Selenium and Molybdenum combined with vitamin B12 can help prevent exacerbation of asthma in people who have sulfite allergy. Enough Vitamin C also helps keep flu at bay, which is a known trigger of asthma. Moreover, it also helps boost immunity so that the body itself fights off infection and disease.
Mild to moderate asthma symptoms can be dealt with easily by reducing allergen exposure, adding micronutrients, minerals and vitamins to the diet, and intake of appropriate herbs—like choline, phycogenol and blackseed.
Fruits And Vegetables May Help Asthmatics
An apple a day keeps the doctor, and asthma, away. High consumption of green leafy veggies, along with tomatoes and carrots helps lower asthma incidence.
Caffeine For Asthma
Good news for coffee drinkers. Caffeine works by dilating the airways, similar to the drug Theophylline, and thus helps asthma patients. However, this effect has only been noted with small amounts of caffeine, which can cause bronchodilation for upto four hours.
Onions And Chili Peppers
Both are believed to work for asthma patients. The claims are not supported by any authentic study, but people have been using these remedies for a long time for symptom improvement.
Onion is widely used in Spain for treatment of asthma, while Chili pepper is believed to provide anti-inflammatory effect since it is rich in anti-oxidants and anti-inflammatory elements.
While using home remedies for the improvement of your symptoms, do not stop the use of your medication without discussing with your healthcare provider first, as it can lead to an acute emergency.
Asthma And COPD
Both Asthma and Chronic Obstructive Pulmonary Disease (COPD), are chronic diseases of the airways with obstructive pattern of disease. The disease process of both Asthma and COPD is somewhat similar—e.g. they both cause inflammation in the airways, but while it is triggered by allergens in asthma, it is caused mostly by smoking in COPD, and the latter usually occurs in fourth decade of life.
Asthma is a reversible disorder, but COPD shows progressive and irreversible changes in the airways. Moreover, hyperresponsiveness of the airways is a feature shared by both the diseases.
In some patients, especially older patients, there is an overlap in both the diseases, called Asthma Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS)which accounts for about 15-25% of airways diseases with obstructive pattern.
While the exact cause of it is not known, ACOS has been explained by the Dutch Hypothesis, which states that asthmatics are predisposed to COPD, secondary to airway hyperresponsiveness.
Moreover, according to epidemiological studies, ACOS occurs in children who have been exposed to respiratory illnesses during childhood leading to impaired adult lung function.
The Dutch Hypothesis further puts asthma, chronic bronchitis, emphysema and COPD in the same disease spectrum.
The prevalence of ACOS is generally in the older population, with >50% patients being over the age of 80 years and less than 10% under the age of 50 years. ACOS progresses in patients who had long standing asthma, and then went on to develop COPD, or it occurs in asthmatics who smoke.
This is another reason that asthmatics should quit smoking.
Due to lack of clinical trials in ACOS, there are no specific guidelines or diagnostic criteria for clinicians. However, general medical therapy that is used in both asthma and COPD is also used in ACOS patients. These medical treatments include:
-SABAs: short acting bronchodilators like albuterol can be used to provide temporary relief by dilating the airway.
-ICS: Inhaled corticosteroids act by reducing the inflammation in the airway and can be beneficial in treating the symptoms of ACOS when combined with SABAs.
-LABAs: Long acting bronchodilators can also be useful.
-Anticholinergics: these are used more commonly in COPD, than asthma, but they are as effective as Beta agonists in causing bronchodilation.
-Steroids: in oral form like Prednisolone, can be used as well, to combat inflammation.
-Antibiotics: can be used in COPD exacerbation to prevent superadded infections. Their use is not that common, however, since viral respiratory infections are more common in COPD.
In ACOS, there is increase in the number and severity of exacerbations which can be more than seen in COPD or asthma alone. While COPD or asthma patient may end up in the ER twice a year, the ACOS patients can have upto 4-5 visits annually.
Not only do exacerbations lead to loss of lung function, they also increase the morbidity and mortality associated with ACOS.
A study published by The New England Journal of Medicine found that children with persistent asthma went on to develop COPD before their 30th birthday.
These children were part of the Childhood Asthma Management Program (CAMP) which followed a number of children with asthma into adulthood.
Because of the increased risk of such children developing COPD in their adult life, it is recommended that asthmatic children should undergo special counselling sessions that should prepare them and help them deal with the consequences of their disease.
Top 10 Cities Not Good For Asthmatics:
- New Orleans
- Chattanooga, TN
- Knoxville, TN
- Augusta, GA
- Oklahoma City
- Richmond, VA
- Memphis, TN
Common Asthma Myths And Facts
Like most diseases, there are many myths and rumours and old wives’ tales surrounding asthma. Some people think that asthma is contagious. Others believe that asthma is a psychological disease and it’s just in the mind
Asthma Can Be Cured
Asthma is a chronic disease, and like other chronic illnesses, it will not go away. However, with proper medications (controllers& rescuers), asthma can be effectively managed with significant reduction in the number of exacerbations and trips to the ER.
Asthmatics Cannot Exercise
While it is true that exercise can trigger asthma in many people, this does not mean that asthmatics should avoid exercise. Exercise is not only vital for health but in obese people it can also help improve asthma. Asthmatics can exercise after appropriate management, like taking their mediation just before they exercise.
Talk with your healthcare provider if you are unsure about what effect exercise will have on your disease. Many great players like Frank Lampard (Football), Schalk Burger (rugby), Dennis Rodman (basketball) and even David Beckham (Football) are asthmatics and have managed to make a great name for themselves despite their illness.
Asthmatics Should Avoid Dairy Products
People with allergic asthma are also likely to have food allergies, but food allergies are less likely to trigger asthma or aggravate the symptoms of asthma. There can be asthma symptoms in infants who have allergy to cow’s milk,but more commonly they may have some vomiting and diarrhea.
Many naturopaths and other alternate medicine practitioners think that dairy may worsen asthma by increasing sputum and mucus production. However, studies have demonstrated that frequent consumption of dairy products in pre-school children is actually beneficial for asthma and does not worsen their condition.
Inhaled Corticosteroids Can Be Dangerous
These controller drugs are not at all dangerous for health. Infact because they are inhaled into the lungs, their absorption by the body (systemic absorption) is also minimal. They help keep the inflammation down and prevent the sudden aggravation of symptoms. Combined with SABAs or LABAs, they can offer a good asthma control. Their side effects mostly include oral thrush and hoarseness of voice.
Both these side effects can be easily managed by ensuring the use of spacer with an inhaler and rinsing your mouth after inhaler use. Spacers are devices which propel the drug in the airway and ensure that most of the drug reaches the lung instead of ending up in the mouth.
Daily Use Of Rescue Medication Is Okay
Rescue medication is usually used in an acute attack. If you or your child is using the inhaler daily, this means that your symptoms are aggravating and you have poor asthma control. In this case you need to visit your healthcare provider as this might mean that your medication or current dosage needs adjustment.