Asthma 

Overview:

A long-term disease of your lungs, asthma, causes inflammation of the airways that lead to the lungs. Once the airways are narrowed and inflamed, a plethora of breathing issues and difficulties will arise. If not brought under control on time, an individual might even experience trouble being active or talking. The individual might even find it impossible to do the above activities past a certain point in the disease progression.

To understand how the disease affects, let's first understand how breathing works. When one breathes, air enters the body through the nose and mouth and travels down the throat. It passes through the airways and makes its way to the lungs. Now, this oxygen is passed into the bloodstream via multiple air passages.

When an individual gets diagnosed with asthma, the linings of these airways swell up, causing the surrounding muscles to tighten up. Furthermore, the mucus accumulates in these passages, allowing very little air to pass through. As a result, an individual experiences an asthma attack.

Types of Asthma:

Asthma is no longer viewed as a single disease. Asthma is commonly classified into various types. They include the following:

• Allergic asthma

• Aspirin-induced asthma

• Cough-variant asthma

• Exercise-induced asthma 

• Nighttime asthma 

• Steroid-resistant asthma 

• Occupational asthma

Depending on the type of asthma, there are various management strategies and treatment options available.

Symptoms:

When you have asthma, you should understand what is going on in your airways as well as the most common asthma symptoms. Understanding asthma symptoms can help you identify your triggers when you require quick-relief medications and when you are experiencing a medical emergency. 

When you have asthma, your airways undergo three changes:

1. Swelling of the airways

2. Excess mucus blocks the airways. 

3. Muscles contract and squeeze around the airways.

Asthma symptoms include the following:

• shortness of breath,

• coughing

• Chest pain or tightness

• Wheeze (a whistling sound made while breathing)

• waking up at night due to asthma symptoms

• A decrease in the peak flow meter reading (if you use one)
  Asthmatic symptoms vary from person to person. You may have just one symptom, or you may have several.
   

Causes:

Many factors have been linked to an increased risk of developing asthma, but it is frequently difficult to pinpoint a single, direct cause.

• Asthma is more likely if other family members have it, particularly a close relative, such as a parent or sibling.

• People who have other allergic conditions, such as eczema or rhinitis, are more likely to develop asthma.

• Urbanization is linked to higher asthma prevalence, most likely due to a combination of lifestyle factors.

• Early life events have an impact on the developing lungs and may increase the risk of asthma. These include low birth weight, prematurity, exposure to tobacco smoke and other sources of air pollution, and viral respiratory infections.

• A variety of environmental allergens and irritants, including indoor and outdoor air pollution, house dust mites, molds, and occupational exposure to chemicals, fumes, or dust, are thought to increase the risk of developing asthma.

• Children and adults who are overweight or obese are more susceptible to asthma.

Risks:

A variety of factors are thought to increase your risk of developing asthma. They include the following:

Having a blood relative suffering from asthma, such as a parent or sibling;
Having another allergic condition, such as atopic dermatitis, which causes red, itchy skin, or hay fever, which causes runny nose, congestion, and itchy eyes;
Being overweight;
Smoking and exposure to secondhand smoke;
Exposure to pollution, including exhaust fumes and occupational triggers like chemicals used in farming, hairdressing, and manufacturing.
 

Complications:

If left untreated, asthma can cause several complications. These complications are as follows:

Sleep: Most asthma symptoms are triggered at night, disrupting quality sleep and leading to sleep deprivation. Sleep deprivation can impede daily function, making a person more lethargic and devoid of energy. 

Physical activity: Severe asthma can prevent an individual from participating in sports, which might pave the way for other health complications like weight gain, depression, diabetes and high blood pressure. 

Medical complications: Unchecked asthma can have long-term side effects on the body and might lead to medical side effects such as oral yeast infections, insomnia, rapid heartbeat and gastroesophageal reflux. 

Attack and respiratory failure: If asthma gets too severe, an individual will become prone to more asthma attacks. As a result, he/she might even experience respiratory failure, a condition where enough oxygen isn't delivered to the bloodstream. This can result in death if not curbed on time. 

Prevention:

While there is no way to prevent asthma, you and your doctor can create a step-by-step plan for dealing with the condition and avoiding attacks.

Follow your asthma treatment plan: Create a detailed plan for taking medications and dealing with an asthma attack with the help of your doctor and healthcare team. Then, stick to your plan. Asthma is a chronic condition that necessitates frequent monitoring and treatment. Taking control of your treatment can help you feel more in command of your life.

Get vaccinated against influenza and pneumonia: Keeping up with vaccinations can help prevent flu and pneumonia from causing asthma flare-ups.

Identify and avoid asthmatic triggers: Asthma attacks can be triggered by a variety of outdoor allergens and irritants, including pollen, mould, cold air, and pollution. Determine what causes or exacerbates your asthma, and take steps to avoid those triggers.

Keep track of how you're breathing: You might learn to recognize warning signs of an impending attack, such as mild coughing, wheezing, or shortness of breath. However, because your lung function may decline before you notice any signs or symptoms, you should measure and record your peak airflow on a regular basis using a home peak flow meter. A peak flow meter determines how hard you can exhale. Your doctor can teach you how to monitor your peak flow at home.

Identify and treat attacks at the earliest: Taking action early reduces the likelihood of a severe attack. You will also need less medication to manage your symptoms. When your peak flow measurements fall and alert you to an impending attack, take your medication as directed. Also, immediately cease any activity that could have triggered the attack. If your symptoms do not improve, seek medical attention as outlined in your action plan.

Take your medication exactly as prescribed: Even if your asthma appears to be getting better, don't change your medications without first consulting your doctor. It's a good idea to bring your medications with you to every doctor's appointment. Your doctor can ensure that you are using your medications correctly and at the proper dose.

Consider increasing your use of quick-relief inhalers: If you are relying on a quick-relief inhaler, such as albuterol, your asthma is not under control. Consult your doctor about changing your treatment.
 

When to Consult a Doctor?

To be able to identify the presence of asthma, an individual needs to have a proper understanding of the symptoms that the disease entails. 

If any individual experiences any of the asthma symptoms and hasn't been diagnosed with the condition before, he/she should head to the doctor for a checkup. If left unchecked, asthma can cause significant damage to the air passages and overall health.

Furthermore, here is a collection of reasons that justify visiting the doctor for asthma:

• Diagnosed with asthma: An individual needs to head to the doctor if he/she starts experiencing any of the following symptoms. Once these symptoms have lingered for a few days, he/she must get checked.

• Monitor the condition post-diagnosis: If an individual has already been diagnosed with asthma, the next logical step is to monitor and keep it under control. This can reduce the chances of experiencing a severe attack down the line.

• Review treatment: The progression of asthma might change its course over time. So, an individual must make sure that he/she meets the doctor regularly to keep the disease under control.

Severe attacks can even prove to be life-threatening. In case an individual experiences signs of the condition worsening despite treatment, it might be an emergency. As a result, the individual will need emergency treatment if he/she experiences the following scenarios:

• No improvement in the condition after puffing the inhaler 

• Minimal physical activity causes shortness of breath

• Worsening of wheezing and shortness of breath

Diagnosis:

To obtain an accurate diagnosis of the condition, a doctor will examine the patient’s medical history. This will help the doctor understand what might be causing the symptoms. Is it asthma, or is it something else? To get a better insight into the situation, the doctor might ask the individual a couple of questions, including:

• What symptoms the individual is experiencing?

• What triggered those symptoms?

• Does the individual smoke, or has he/she been exposed to tobacco smoke in some way?

• Does an individual have allergies?

• Is the individual constantly exposed to any airborne irritants?

• Does the individual have pets?

Once this is done, they will proceed to a physical examination. The physical examination entails checking your throat, nose, and upper airways. Secondly, the doctor will then use a stethoscope to understand your breathing and gauge the airways for the presence of blockages.

If there are blockages, you might wheeze a lot, which can be easily caught with the stethoscope. 
Lastly, the doctor will also examine the skin for signs of allergies (hives, eczema, etc.) to rule them out completely.

To confirm the diagnosis, the doctor might ask the patient to get the following tests done:

Lab Tests: The primary lab test employed to detect the presence of asthma is spirometry. This test is used to detect and diagnose asthma in anyone over five years of age. First, an individual has to take a deep breath and exhale into a tube connected to the spirometer. The device studies the volume of the exhaled air, and if certain measurements are below the recommended level, it might hint at the presence of asthma.

Another lab test employed by doctors to diagnose asthma is the challenge test. If the spirometer readings are unclear, doctors might ask the individual to forcefully inhale a substance that might trigger asthma symptoms if he/she has the condition. This includes substances like methacholine.

This challenge can also be done in the form of intensive physical exercise, which might also trigger the symptoms. An individual has to retake the spirometer test post-challenge completion, and conclusive results will be obtained.

Another popular lab test for asthma detection is the nitric oxide test. This test will gauge the amount of nitric oxide in the breath. The presence of higher-than-normal nitric oxide levels in the bloodstream is a sign of asthma. This happens when the airways are inflamed.

Imaging Tests: Some imaging tests used to detect the presence of asthma are chest X-rays and CT scans. In a chest X-ray, the doctor will get a clearer view of the air passages.

On the other hand, a CT scan is essentially made up of a series of X-rays, giving the doctor a clear view of the lungs and the airways. A CT scan of the sinuses and lungs can identify the cause of any breathing problems an individual is experiencing, allowing doctors to point out exactly where the issue stems from.

Advanced Tests: Another test that can be used to diagnose the presence of asthma is the Sputum Eosinophils test. This test studies the saliva for high levels of white blood cells (eosinophils) and mucus in the sputum. This will also help doctors offer a clear diagnosis of the condition.

Treatment:

Here are some of the top treatment options for dealing with asthma the right way:

Home Care: In case an individual is constantly experiencing asthma symptoms and the medications aren't of much help, he/she can opt for some home remedies to ease the discomfort. They are as follows:

• Dietary changes

• Buteyko breathing technique (system of breathing exercises that can bring down asthma symptoms)

• Papworth method (breathing and relaxation technique to relieve asthma symptoms)

• Consumption of caffeine 

• Yoga 

• Consumption of omega-3 supplement 

• Consumption of ginger, garlic, and honey

Medication: The type of medication required to manage asthma will vary based on factors like symptoms, triggers and age. These factors help doctors decide what will help keep asthma under control. As a result, these asthma medications have been split into three groups. They are as follows:

1. Long-term asthma control medications: These medications are generally used to manage and alleviate symptoms on a daily basis. These reduce the chance of an individual succumbing to an asthma attack. Various types of long-term asthma medications include inhaled corticosteroids (Budesonide, Ciclesonide, Beclomethasone, Fluticasone furoate, etc.), leukotriene modifiers (Montelukast, Zafirlukast, Zileuton, etc.), combination inhalers (Fluticasone-Salmeterol, Budesonide-Formoterol, Formoterol-Mometasone, etc.), and Methylxanthines (Theophylline). 
2. Short-term asthma control medications: These medications are used to curb the symptoms of a rapidly approaching asthma attack on short notice. This includes medicines like short-acting beta-agonists (Albuterol), anticholinergic agents (Ipratropium bromide), and oral and intravenous corticosteroids (Ciclesonide). 
3. Allergy medications: These medications help if asthma symptoms worsen due to allergies. These include allergy shots (immunotherapy) and biologics (Omalizumab, Mepolizumab, Reslizumab, Dupilumab, Benralizumab etc.)   

Surgical Treatment: If the condition deteriorates too much, an individual needs to opt for surgery. This surgery is known as Bronchial Thermoplasty, and it aids in opening up the airways. 

Bronchial Thermoplasty: If you have severe asthma that you cannot control with other therapies, Bronchial Thermoplasty may be an option. The treatment uses heat to shrink smooth muscle in the lungs. It keeps muscles from tightening and causing an asthma attack. Bronchial Thermoplasty is an asthma treatment that focuses on the smooth muscle in the lungs. The treatment uses heat to shrink the smooth muscle, preventing it from tightening and causing asthma symptoms.

The treatment consists of three sessions, with three weeks between each. Bronchial Thermoplasty is carried out by a pulmonologist (a pulmonary specialist). During each session, your pulmonologist will focus on a different area of your lungs. Bronchial Thermoplasty is only approved for adults with severe asthma. Approximately 5% to 10% of asthmatic patients have severe asthma that cannot be controlled with medications, inhalers, or other treatments.

Additional information:

Lifestyle advises

Here are some lifestyle changes you can start today to improve your breathing.

1. Use a peak flow meter: Many doctors and pharmacists recommend that asthmatics use a peak flow meter. The portable, handheld device measures how much air your lungs expel. Essentially, it will inform you or your doctor about how well your current asthma medications are working and whether your treatment plan needs to be adjusted. Consult your doctor to determine whether you or your child should use a peak flow meter. 

2. Know your triggers: Allergens such as dust, pollen, animals, mould, cigarette smoke, perfume, and infections like the common cold or flu can all cause asthma attacks. Dust, fumes, gases, and other hazardous chemicals in the workplace can all contribute to asthma. Meanwhile, some patients only experience asthma symptoms when exercising. Your doctor may prescribe a rescue inhaler if sudden triggers cause shortness of breath or wheezing.

3. Consider caffeine: Caffeine is chemically related to the drug theophylline, which is used to treat asthma. It also reduces respiratory muscle fatigue, thereby opening the airways. Caffeine improves airway function for up to four hours in people with asthma.

4. Don't forget the fruits and vegetables: Spinach, broccoli, strawberries, and tomatoes may be associated with improved asthma symptoms. Patients with asthma were randomly assigned to one of three treatment groups: a high-antioxidant diet plus an inactive placebo medication, a low-antioxidant diet plus a tomato extract, or a low-antioxidant diet plus a placebo. The study found that altered eating habits had an effect on asthma symptoms. The high-antioxidant diet consisted of five servings of vegetables and two servings of fruit per day.

5. Try an anti-inflammatory diet: People who suffer from asthma should follow an anti-inflammatory diet. Inspired by the Mediterranean diet, it claims to reduce inflammation, which is common in asthma and other serious conditions like heart disease, cancer, and Alzheimer's disease. "The goal would be for people to be conscious of their food choices, the portion sizes, perhaps lose weight and avoid fatty or fried foods".

6. Remain active: Physical activity is beneficial in all walks of life, including exercise-induced asthma. In a study, it was discovered that after 12 weeks of education and aerobic training, patients with moderate and severe asthma had fewer severe exercise reactions. It will also help you lose excess weight that may be aggravating your asthma. 

7. Calm down:

Take a deep breath. According to research, stress is strongly associated with asthma, hospitalization, and asthma medication use. Even laughing or crying too hard, becoming angry or fearful, and yelling can worsen your asthma. Deep breathing exercises or progressive muscle relaxation, which involves tightening specific muscles and then releasing the tension while paying attention to how the muscles feel after they are relaxed. Another technique for reducing physical and emotional stress is guided imagery, which involves using words or music to conjure up images of a relaxing environment.